US government representatives attended the recent Health 2.0 conference in Santa Clara, California to talk about the innovative initiatives the federal authorities have set in motion so as to help more people access the medical care they need.
The health insurance system in the United States is funded mainly by the private sector. Only 18.9% of the 18-64 age group are covered by public insurance through the federal Medicaid programme (which assists people living in deprived circumstances) or the Medicare programme (for senior citizens). However, a substantial number of people have no health insurance whatsoever, either from these two public insurance programmes or from a private insurer. In 2015, 28.4 million people in the USA under the age of 65 – i.e. 10.5% of that age group – had no medical insurance at all. According to data from the US National Center for Health Statistics, in 2015, 4.5% of the population “failed to obtain needed medical care due to cost”. Increasing people’s access to medical treatment is therefore one of the priority action areas for the US health system.
Health Department drawing on the power of the community
Since the Affordable Care Act – better known as ObamaCare – came into force, bringing the cost of health cover within reach of greater numbers of citizens, 19.8 million more people now enjoy medical cover than in 2010. The US Department of Health is very proud of this progress. However, the struggle to widen access to healthcare still goes on, Dr Karen DeSalvo, Acting Assistant Secretary for Health in the US Department of Health and Human Services, told the audience at the Health2.0 conference, focusing on ‘connected health', which took place in Santa Clara in late September. “Even today, a person’s ZIP code reveals a lot more information on his/her health than his/her genetic code,” she pointed out.
Reducing geographical disparities in accessing healthcare is the goal of an initiative called Public Health 3.0, which the Department of Health and Human Services launched in 2015. Under the project, high level meetings bringing together private sector players, including e-health startups, and public sector providers and officials are held in cities across the United States. The basic aim is to encourage concrete proposals based on collaboration for modernising the public health system on a local basis. “Innovation built on collaboration between the stakeholders is the key to success,” argued Karen DeSalvo.
In addition, Public Health 3.0 promotes recognition of the importance of data collection and use. For instance, there are plans to set up a computer system programmed to highlight innovative initiatives taken by local communities. “For the last eight years we’ve been working upstream with healthcare providers to give a positive steer to the way healthcare is delivered, and at the same time reduce the overall cost of the system,” revealed Karen DeSalvo, adding: “Such efforts have an even greater impact if we make use of data.” In March, more than 40 thought leaders from all sectors and disciplines got together in Washington D.C. to discuss how to build the Public Health 3.0 informatics infrastructure.
One of the recommendations was to set up a national metrics dashboard which will display in real time indicators of the impact the measures taken by local authorities are having, with a view to optimising the way the US healthcare system works. In pursuit of this aim, participants highlighted the importance of aggregating not only healthcare data but also social data, which would involve forging partnerships with non-healthcare government agencies plus private sector firms.
VA Department getting in tune with startups
The Department of Health and Human Services is not the only US federal department involved in health-related policy. The US Department of Veterans Affairs (VA) is responsible for managing access to medical treatment for over nine million former combatants who have public insurance cover.
However, two major issues have recently cast a shadow over the management of healthcare services for US former military personnel. A scandal which erupted in 2014 highlighted the excessive waiting time before obtaining a medical appointment at a public hospital. “Veterans’ access to healthcare, especially mental health care, needs to be improved. Technology provides the best means to achieve this goal and focus our efforts on the patient,” LaVerne Council, the Assistant Secretary for Information and Technology at the VA Department told the Health 2.0 conference audience.
In fact, the Department of Veterans Affairs has always taken a close interest in innovation and today VA has an IT budget of over $4 billion. The first outline plan for a system of electronic health records was drawn up thirty years ago by members of the VA’s medical unit. VistA (Veterans Health Information Systems and Technology Architecture), as it was named at the time, has undergone quite some improvements since then. A graphical user interface for clinicians to enter data during a consultation, known as the Computerized Patient Record System (CPRS), was one VistA add-on that was released back in 1997. The latest version of VistA, called My HealtheVet, is not just about electronic health records but provides an entire toolbox for both veterans and healthcare workers.
Veterans can access My HealtheVet through an online portal or via a mobile app in order to consult their medical test results, view their health indicators in real time, and schedule medical appointments.
To keep the innovation flame burning bright, the Department of Veterans Affairs also runs hackathons. In August they held a VA Innovation Demo day, an opportunity for VA staff to develop innovative solutions for veterans services, especially in the health field, and pitch them to senior officials at the Department.