Freeing Up Healthcare Resources to Improve Access and Care

When the beginning of April brings to mind for most people April Fool’s Day pranks and the start of spring, at Change Healthcare it also causes us to think about new beginnings as we begin our new fiscal year and reflect on the one that just ended. In thinking back on the past 12 months, I couldn’t be more proud of the many achievements of our team in what has been a historically unprecedented and challenging year.

While we are not clinicians on the front lines of care, our team members used our existing products and services to help many stakeholders understand and fight the global pandemic, along with creating brand new solutions. We collaborated with Carnegie Mellon’s Delphi Research Group to leverage our deidentified COVID-19 claims data into its COVIDcast tool, which helps forecast the spread of COVID-19. In addition, we launched our COVID-19 Analytic Data Sets to give researchers and disease progression modelers a look into pre-existing conditions and past/ongoing care of COVID-19 patients, so they can study how the disease is spreading, which population groups are most vulnerable, and the effectiveness of proposed treatments. 

The pandemic initiated a new wave of innovation and collaboration across U.S. healthcare, including the massive growth of virtual care and telehealth services. Our team members stepped up to utilize our existing products for telehealth, for example, taking our MedRx? claims billing and consumer engagement solution for pharmacies and enhancing it to expand access to COVID-19 testing. Our InterQual? clinical decision support platform and our Intelligent Healthcare Platform? were often updated daily as diagnoses, treatment and reimbursement aspects of addressing the pandemic changed and evolved.

As COVID-19 vaccination efforts began scaling in December, we collaborated with companies like Microsoft, Apple, CVS Health, Epic and others to develop an open standard for a Vaccine Passport? solution. We now see large organizations like Wal-Mart using this open standard and we hope other organizations, including states and counties, do as well, given the Federal government has not mandated a singular approach for the country.

As we begin to see some stability in the healthcare delivery system during the spring and summer, we need to turn our attention to the long-standing inequities in access to healthcare that came into sharp relief during the pandemic and remain today. As we already spend more on healthcare per capita in the U.S. than any other country (nearly double other comparable countries), one way to address inequities is to reduce unnecessary, and in some cases actually harmful, spending and re-direct those resources to underserved communities.

The amount of money we can free up in U.S. healthcare through such efforts is astounding. In a 2019 study published in JAMA, researchers found that waste accounts for nearly $1 trillion of U.S. healthcare spending annually. This waste puts an undue strain on healthcare providers while also driving up costs for patients and payers, like health plans. The experts note that some of that waste comes from complex and sometimes contradictory incentives in clinical care, but as much as $300 billion is pure administrative inefficiencies that can be addressed by current or near-term technologies underpinning innovative approaches. At Change Healthcare, we identified $100 billion of waste in the healthcare system that we can work with stakeholders to eliminate in order to create a better, more efficient healthcare system.

Over the past 12 months, despite the pandemic, we’ve made great strides towards reducing waste in the healthcare system by focusing on three specific outcomes:

1. Superior consumer experiences
2. Efficient and accurate financial transactions
3. Optimized decision making in the transition to value-based care

Consumer Experience and Improved Financial Performance for Providers and Payers: Mutually Advantageous Goals

Improving the healthcare experience for patients and health plan members is intrinsically linked to improving transactional efficiency for providers and payers. A patient-centric approach to healthcare focused on improving their clinical and financial experience is linked to better outcomes for all. As consumers assume more responsibility for healthcare costs than ever before, price transparency becomes key to engaging patients, making sure hospitals and health systems receive appropriate reimbursement, and reducing administrative cost and friction for all stakeholders. 

To help make price transparency attainable and scalable, we launched an innovative consumer and financial engagement platform called Connected Consumer Health? suite in collaboration with Adobe and Microsoft. This included Shop Book and Pay?, an online e-commerce solution that allows patients to view healthcare services, schedule their appointment, and pay for their care digitally.

We also focused on meeting new Federal regulations as we help providers and payers improve patient experience and reduce waste. Our Clearance Estimator Patient Direct solution helps providers meet new CMS price transparency requirements by equipping patients with financial estimates for the out-of-pocket cost of visits, tests and procedures. Our Connected Consumer Health? interoperability APIs, which we made available to health plans with no fees, help payers quickly achieve compliance with the CMS Interoperability and Patient Access Final Rule. Providing these no-fee or low-cost solutions to tens of thousands of smaller entities in healthcare through open standards, API and cloud-based technology improves the regulatory compliance and operational efficiency of the whole healthcare ecosystem. 

The Journey to  Value-Based Care through Optimized Decision Making

The transition to value-based care, a healthcare model in which care delivery systems get reimbursed based on the patients’ health status or outcomes, is enabling greater flexibility in care delivery models, increased data integration, and improved results for patients.

As the many payers and providers, we work with make the shift to value-based care, we’ve committed to helping them make better decisions more quickly using unique, insights-driven technology. In November 2020, we launched our Social Determinants of Health (SDoH) Analytics, a national data resource that connects the circumstances of people’s lives to the care they receive. We also collaborated with Amazon Web Services (AWS) to launch a DSaaS offering to make SDoH data broadly available to all types and sizes of healthcare organizations. These solutions help healthcare organizations explore how geodemographic factors affect patient outcomes to provide the appropriate care upfront.

We’re also using artificial intelligence technology to help caregivers deliver higher quality care. Through our InterQual? AutoReview solution, we’re using AI models, trained by expert physicians, to extract meaningful diagnostic information from text in electronic health records (EHRs) to automatically determine the medical necessity of a specific healthcare service – a typically time-consuming task with significant administrative burdens on clinical staff. In the enterprise imaging space, we are helping radiologists tackle what JACR calls the “free-text epidemic” that impedes providers’ ability to reduce unnecessary imaging while satisfying requirements for the Protecting Access to Medicare Act (PAMA), which becomes mandatory in 2022.

Looking to the Future

As we look ahead to the future of healthcare, we feel privileged to continue to work with our innovative customers and partners to improve healthcare for all. We will continue to build upon our early investments in healthcare consumerism to broadly empower patients and caregivers to coordinate care and prevention to maintain or improve health status. And through our partnerships, joint development, and support for both industry leaders and start-ups, we will enable our innovation to be incorporated into their solutions at all sizes and segments of the healthcare industry.

To further accelerate the ability of the industry to use modern information and technology-enabled solutions, subject to Change Healthcare shareholders’ approval, regulatory approvals, and other customary closing conditions, Change Healthcare is planning to combine with OptumInsight, a division of UnitedHealth Group’s Optum division that provides data, analytics, research, consulting, technology and managed services solutions to providers, payers, governments and life sciences companies. Together, we will continue to work towards eliminating waste in the U.S. healthcare system and make healthcare work better for everyone.