This interview has been edited for length and clarity.
There is so much more that goes into healthcare than what happens in the hospital room. Navigating care involves juggling various factors, like filling medications, coordinating with different specialists, and following specified care protocols.
So how does our healthcare system support patients through these complexities?
In this episode of the Memora Health Care Delivery Podcast, our guest Gaurov Dayal, MD, CEO at Axia Women's Health, discusses why U.S. healthcare falls short of putting patients first and how alternative care models — with the right digital healthcare platforms — can promote positive change.
U.S. healthcare is slow to innovate because it remains fragmented
A cardiac patient might see one specialist for a heart valve surgery. But after leaving the hospital, they often engage with providers who have no relationship with their surgeon.
Connecting the dots to navigate complex care episodes usually falls in the laps of patients. Dr. Dayal argues the disjointed nature of healthcare in the U.S. results from a fundamental flaw in how it's designed — with providers at the center, not patients.
He explains, “A lot of what ails us in this country around healthcare is fragmentation, which is driven by different reimbursement models, different payment models, different payors, and a lack of vertical integration … I would say it stems from a very basic issue that we have in this healthcare system, which is that the patient isn’t at the center of it. Everything is built around the provider’s convenience.”
Furthermore, Dr. Dayal suggests this fragmentation leads to a more complicated industry, directly affecting the healthcare system’s ability to innovate swiftly. He says, “We have this very complicated, large part of our economy which is healthcare, and we’re trying to fix it but keep it operating. Those are challenges that are very complicated … [and] for that reason, it’s very slow.”
Patient-centered care models are key for driving better outcomes
That’s not to say some organizations haven’t acknowledged the issue of fragmentation in healthcare. In fact, many providers are moving toward value-based care models and more consumer-centric approaches to begin shifting patients to the center of care.
According to Dr. Dayal, “Models that put people at the center of care delivery are more effective … There is a natural incentive to highly engage with patients through the Medicare Advantage plan … If you look at patient satisfaction scores and outcomes scores of models in fully capitated clinics, you see a significant upward improvement in all kinds of metrics. And that’s because the models drive that. You wouldn’t be able to be profitable if you weren’t able to engage with your patient.”
But reimbursement programs aren’t the only motivators of patient-centered care. Dayal argues the same high patient engagement rates can be seen in some private fee-for-service models. When it comes to certain concierge services, Dr. Dayal points out, “They have NPS scores in the 90s, which is unheard of and higher than companies like Tesla, Netflix, and Apple.”
Healthtech has the potential to further pivot the patient to the center
Regardless of the payment model, nascent technologies like intelligent care enablement can extend engagement to patients before, after, and between visits. And Dr. Dayal suggests that by laser-focusing on bridging gaps in care, forward-thinking innovations can assist patients through the complexities of a fragmented system and help providers continue pivoting toward patient-centered care.
Referring to virtual care as an example, he says, “One area that has started to show significant transformation is virtual care. I think that, during COVID, maybe the virtual story got ahead of itself. But I don’t think that means it won’t be an important player..”
What’s one fundamental thing that will power this new era of patient support? Using AI in healthcare. Dr. Dayal remarks, “I truly believe [AI] has the potential to be transformational. Not just from how we operate as care providers, but from people’s understanding of their own health … This is going to be a real doctor resource folks can use to make very important decisions and engage in their own healthcare, and, importantly, that clinicians can use in providing better care.”