*Per Raimundo Nonato
Unsurprisingly, the health sector is going through a period of marked transformation in many ways. One of them, however, needs to be carefully observed – the remuneration model for the entire care ecosystem, with a direct influence on patient satisfaction. There is an increasing need for the qualitative work of patient care with a real measure of how the treatment works and paying for merit. That is, according to what the patient actually needs and focused on bringing the best diagnosis and the best treatments for the cure. We are talking here about the concept of Fee for Performance or payment for performance or value. This is the counterpoint to the current remuneration system based on services rendered (Fee for Service).
The healthcare ecosystem is about to exceed the limits of its ability to support the exponential growth in costs, which were exacerbated more than a year ago by the Covid-19 pandemic. Starting with the patient, passing through the government, manufacturers, payers, researchers, hospitals, analysis laboratories, imaging, clinics and outpatient clinics, all face conflicts of costs versus profit versus benefits.
The proper treatment to improve this scenario also depends on the implementation of methods and technologies established in the sector, such as artificial intelligence (AI) to support diagnosis, telemedicine and compliance with the rules of the General Data Protection Law (LGPD), in addition to pay for performance. There is a common thread for the convergence of all these changes. It is an environment capable of handling and operating different types of data standards generated in all information systems of the members of the healthcare service and care chain. This environment is configured on a data platform and other robust tools that combine attributes such as interoperability, high performance and scalability.
Choosing the most appropriate technological solutions for these innovations is currently one of the most important strategic decisions for the future of hospitals, laboratories, healthcare plan operators and other companies in the sector. Interoperability between the systems is also the way to better manage the electronic health and patient health record. The data platform, together with electronic clinical records sharing software and a unified information system, are the ideal tools for the ecosystem to promote the transition of the remuneration model, which will be vital to the sustainability of the business.
In a short time, the transition of the remuneration model will be much more necessary to solve problems such as quality of patient care and profit margins. After all, the collapse of the system as a result of Covid-19 was not enough, there are forecasts of a large increase in accidents due to the aging of the population. The issue of costs currently has a great ally to reduce them, which is primary care via telemedicine in both public and private health systems. In addition, patient displacement is avoided by efficiently filtering the referral of patients to hospitals. This is the first step for artificial intelligence to support clinical decisions, leading us to the concept of the digital hospital.
Telemedicine is a resource that has proved to be efficient in this period of pandemic that we are going through and provided consultations to populations in regions lacking close assistance. We are convinced that the implementation of the fifth generation of mobile telephony, 5G, will greatly increase the speed of data transmission and will give great impetus to remote health monitoring and the adoption of new artificial intelligence tools. Once again, a data platform capable of performing all the integration with the main AI tools available on the market is needed.
As for the privacy of patients' data and obtaining their consent to transmit them, this is an issue governed by specific legislation which is now reinforced by the General Data Protection Law in force. It is another challenge that requires care in choosing the data platform and systems used by health providers. They must provide the consent and approval condition whereby the patient authorizes access to their data to whomever they want.
* Raimundo Nonato, director of the Health area of InterSystems in Brazil
Notice: The opinion presented in this article is the responsibility of its author and not of ABES - Brazilian Association of Software Companies
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