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Although the internet bubble burst nearly two decades ago, looking back at the dotcom era reveals lessons already learned that can be applied to shape the future of health care. A future that has potential to change quickly amid the ongoing coronavirus pandemic.  

“Industry was turned upside down by the dot com era and all the technology and change it forced on incumbents,” said Constance Sjoquist, CEO, Sjoquist LLC.And it feels like in health care we’re in this similar major, transformative shift because of digital health.” 

Sjoquist hosted a discussion with HealthEdge CEO Steve Krupa during the Health Evolution virtual gathering, Building Agile Operations: Adapting to an Uncertain Future of Care. The tech veterans discussed how innovators in the dotcom era asked industry-shaking questions, put new infrastructure in place and weighed in on what today’s health care organizations leaders need to execute on to digitize the system for better consumer engagement. 

Asking the right questions 
The dotcom revolution was really about what can be done with an online platform to change the way people conduct business, Krupa said.  

“Entrepreneurs in the early aughts, if you will, asked the question ‘why does the business have to work like this? Why can’t we change the way it works?’” Krupa added.  

Citing PayPal as an example, with its current market cap at about $196 billion, Krupa said that its innovators asked questions such as: Why is it so hard for me to get my money?  Why is it so hard for me to send somebody money? What’s the value in all of that and why are the fees so high? What are the costs? And what and how can we make this seamless? 

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“Today, those questions should be how do I make health care better? And how do I take a lot of the cost out and bring it back into the industry so it can be more creative and add value for its constituents?” Krupa said.  

Sjoquist added that health care executives are starting to ask those questions, while the manner of real-time, intelligent, digital transactions underpinning so many of the enterprises that emerged from the dotcom era is not yet rooted in the industry.  

Establishing infrastructure to engage consumers 
The technological infrastructure necessary to make this shift requires at least three layers: data, insights and engagement.  

A data layer needs to enable fluidity. The insights layer is where algorithms are run to glean information valuable to the business and constituents, such as providers and health plan members. The transactional layer is where highly-complex transactions occur without human touch — and to the extent it’s not technically real time it should appear to users as if it’s actually transacting in real time.  

In order to be able to get all the way to delivering valuable engagement tools to the people that you want to engage, you’ve got to be able to create data that matters. Data that’s coming in real-time so that the machines can operate on thatAnd that goes back to the transaction engine itself,” Krupa said. “It’s really looking at the transaction engine, and saying, How can we be more Amazonlike, in the way our transactions operate, particularly at the health insurance and provider level, in terms of submission of those transactions? Is this going to be able to drive the benefits you can get from that modernized dotcom experience?’” 

That said, very few health care transactions take place in real time. As two examples Krupa cited certain pharmacy transactions do or inquiries around benefit enablement, but by and large today’s infrastructure inhibits such transactions.   

The COVID-19 impact and value-based care 
The health industry has been working toward digital transformation, data liquidity and information exchange for years. Krupa says it will be very interesting to see what happens with COVID-19 because it has the potential to essentially rewrite the rules about how clinicians transact with patients and how providers transact with payers. 

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Krupa noted that health plans and providers want to drive engagement with constituents. Plans also want to create a better environment for both members and providers. Provides, in turn, want to deliver a better patient experience.  

For that change to happen, however, many provider organizations will need to develop a set of capabilities that they don’t currently have, including how to understand and manage risk in the transition to value-based care and payment models.  

“It’s inherent that health plans and providers partner so that providers can have confidence in letting go of fee-for-service,” Krupa added. “Events like COVID open people’s eyes to the fact that getting a check from capitation is not the worst thing in the world.”  

While the dotcom era is not an exact roadmap to health care digital transformation, there are lessons still to be learned from the transformation that happened so rapidly in those years and ultimately reshaped entire industries.  

Watch the on demand recording of the Building Agile Operations, Adapting to an Uncertain Future of Care Industry Solution webcast here:

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Tom Sullivan

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.