The quixotic quest to unify and streamline fragmented U.S. healthcare is getting a dramatic boost in the wake of the global health crisis. Digital technology is stepping into the tangle of deductibles, premiums and medical pricing with new capabilities that pull from a wide range of data, creating better connections and experiences between patients, providers and payers.
“You look into the characteristics of the U.S. healthcare system … and why it’s so expensive … there’s such a big price variation … not just on the service level, but also on the episode level,” he said. “Very big health systems have been able to negotiate preferred rates. Independent practitioners … also drive a huge price variation without necessarily any quality improvements … parallel to those price changes and increases.”
Comparing healthcare’s conundrum to other messy markets remade in recent years by online marketplaces, Afek told Webster, “It’s very similar to any … paradigm we’ve seen before. We’ve seen digital marketplaces coming in and enabling competition on the supply side for cost and quality that drives value to the top. But we haven’t seen it [in U.S. healthcare] because of siloed systems, siloed data … and other aspects of how our healthcare system is built.”
Describing the different touchpoints of U.S. healthcare — hospitals, physicians, pharmacies and even ratings firms — as “nodes” in a network, Afek said, “Those nodes are not interconnected. If there was a way to bring those healthcare nodes together and make sure that they all see the same data … then I think there’s a chance to evolve into a true marketplace in U.S. healthcare.”
Vim is vying to be a key player in connecting these nodes into consumerized “shoppable” healthcare marketplaces typified by transparency, affordability and delivery of patient value.
“Vim is a platform in the sense that we don’t try to solve for everything,” Afek said. “We try to integrate and enable others to solve many of the different things that providers and payers need, whether it’s companies doing Big Data analysis or producing devices or providing services like risk-scoring. There are great companies out there, and all they need is access to this interaction between payers, providers and patients. What we need to do is enable third parties. I like to think about us as a browser versus … an iPhone.”
Clearly, they’re onto something, as marketplace goliath Amazon recently rolled out new features to make it easier to find and compare prescription drug costs.
Leapfrogging Single-Payer Notions With Digital Innovation
With Webster noting that private health insurance is preferred in America to the point that it’s a perennial election issue, Afek concurred that the U.S. seems unlikely to embrace single-payer — and doesn’t need to do so in order to control costs, or to improve access and experience.
Citing Israel, Canada, the U.K. and other close U.S. trading partners using single-payer, Afek said, “I think we can leapfrog those systems – not just in performance, but also in efficiency of cost. If you build an open-platform approach to healthcare where every service provider can list their services and they’re measured based on cost and quality, then you can really enable third parties and innovative players to introduce technology like at-home care and telemedicine. That allows them to really play in a meaningful way that we haven’t seen in other single-payer states, because it’s so gated and so outdated, and introducing technology is a slow process.”
He added that “people keeping their private insurance is an advantage. It’s a feature – I don’t think it’s [a defective system]. I don’t think we should move to a single-payer system [in the U.S], because … it’s going to slow down innovation and slow down the marketplace effect.”
Those marketplace effects on healthcare break out into three primary areas, as Afek sees it. “First, we need to be multi-payer. If we have an amazing value offering for our provider, she will always join us,” he said, based on “how good the solution is for a majority of patients, and the more patients we can represent. That’s why for some of our investors – including Anthem, United, Blue Cross and others – it’s about a multi-payer approach to aggregating data and incentives and representing them to providers. That’s the first thing that needs to happen.”
Next, he said, the burden of physicians managing electronic health records (EHR) requires immediate, appropriate triage. “We need to make sure that our technology is not interrupting the workflow and is obviously … not outside of the workflow. It is in the workflow. It makes their life easier. That’s easier said than done, but we need to make sure that technology is removing clicks, not increasing clicks. That’s the second thing that is really, really critical.”
Third on his list of critical provisos is that “we need to be a platform, not necessarily the only solution. If we chose [to be] the gated end-all-be-all solution and tried to do everything ourselves, blocking other innovation, we’d be talking from both sides of our mouth,” Afek said.
To illustrate, when healthcare touchpoints are mapped out, he said, “you see that clinicians and physicians – specifically primary care physicians and top specialists that see people on a high-frequency basis – are actually very important network nodes that influence a lot of downstream costs. A primary care physician in the United States on average may influence between $8 million to $10 million in downstream costs every year.”
Healthcare Marketplaces Can Drive Down Costs, Drive Up Care Quality and Value
Afek described the company’s client base as “large national health plans … United and Anthem and others … local single-state Blue Cross and Blue Shield payers that have big geo-density … [and] at-risk health systems that think about value-based care in a meaningful way. We see more and more of those health systems engaging with us … especially when you think about large integrated delivery networks [IDNs] that have contracted with so many different physicians and are not … [all] on the same system. They need our technology to connect everything into a singular, fully coordinated system. Also, retail pharmacies for the exact same reason,” he added.
As an enabler of innovation rather than the solution itself, Vim is taking on a somewhat strategic role in enabling healthcare players to build a marketplace, connecting insurance carriers and healthcare systems wishing to participate, “and allowing practitioners and patients to participate in an efficient marketplace where cost and quality surface, based on value.”