OREANDA-NEWS. November 12, 2015.  New Jersey consistently ranks in the top third of states for the overall health of its residents—but its healthcare costs per person are among the highest in the country. In recent years, New Jersey has begun to address a fundamental challenge that the nation as a whole faces: how to drive improvements in patient care while controlling costs.

The Atlantic hosted a town hall event, convening a group of entrepreneurs, doctors, researchers, business leaders, patient advocates and health officials to discuss the partnerships and strategies that New Jersey’s healthcare sector is implementing to solve the cost and quality riddle—and if these ideas are translatable to the national arena.

Gordon Coburn, President, Cognizant, discussed the role of data in transforming health costs and health quality and reinventing the “Future of Health” with Steve Clemons, Washington Editor at Large, The Atlantic. Excerpts:

“Healthcare is now on the cusp of the beginning of a fundamental transformation. A lot of this would have to do with the patient or the consumer—how they want to interact with the providers, the payers, the government, how they view their healthcare information, their data. There are significant differences in the answers to those questions. If you start to break them down by demographic, by age or by socio-economics, you start to see some trends.

If you are a millennial, you want to be empowered, you want to have control, you want to have self-service, you want to decide when, where and how you interact with the whole eco-chain. You want to be able to get information on your own so you can be an informed consumer. That will differ a little bit by socio-economics and education. But millennials are less concerned about one-to-one relationships.

We rolled out in our company an e-health system that allows you to schedule online an appointment with your doctor. Within a 30-minute window, you can decide how much information you put in that health information record. We looked at usage. The usage among the millennials was off the charts. The usage among the 40-55-year-olds was modest. When we asked the millennials why they used it, they said they loved it and although it was a different doctor each time, they liked that they were in control. The above-40 users said they wanted that personal relationship with the doctor.

There is a mindset change that is happening in the approach to health care by millennials vis-?-vis by the earlier generations. This shift has huge ramifications for how is healthcare delivered, implications to what is the role of the payer, certainly implications to how do you educate and interact with the consumer. And, in our mind, it has created tremendous opportunities for those in that ecosystem. The challenge is, it is not going to happen overnight.

Around 150 million Americans use our administrative platforms today—that’s half the country. A quarter of all providers go through our data exchanges. We don’t necessarily control the data, but we have insight into what all those parties are thinking. We see silos of information. Payers are a bit better and further ahead in terms of better data sharing and monitoring, but when you look at the provider side, the siloes of data that exist are mind-boggling. That impacts quality of care because more mistakes are made when you don’t see the whole continuum of care for that individual. You are starting to see that with health information exchanges within provider systems.

Why data portability is so tough on the provider side has historically been because of technical issues. There weren’t common data sets. There were competitive issues where providers and doctors didn’t want to share that data outside their hospital chains. The patients themselves did not want everyone in the healthcare system to know they were taking certain medications.

We are firm believers that over time, it is going to be a patient information record controlled by that patient who is going to decide who gets access to it. If the patient doesn’t have control over his or her medical record, you are going to continue to see a lot of resistance. But I think that is starting to change. Until recently, the standards weren’t there. The governments pushed hard on that, in terms of both pushing EMRs into the doctors’ offices and getting some standards for that. So technically, it is now right on the cusp of being feasible to have interoperability across delivery channels. That wasn’t true even 3-4 years ago. I think payers are supportive of it.

Generally, a patient is not going to trust the payer to give them good advice. No matter how great the payer is, a patient is going to assume that the payer is trying to control costs. Patients will generally trust the provider more. Millennials are more open to sharing information. Over time, I think incentives are going to be put in place. Just like you are starting to see employers creating incentives, like charging less premiums if an employee doesn’t smoke or walks a certain number of steps a day. Some of that may happen with information sharing. If you can be a better patient, that is going to improve outcomes, reduce costs, and therefore you should benefit from that. People are just starting to experiment with this stuff.

If you look at health plans we work with in rural areas where they may be the only health plan in town, there you actually have a good continuum of care through a health information exchange that is proprietary to that network.

Digital technology plays a key role in health care. For example, we are doing a project with one of the big insurers where people with diabetes were given Fitbits. Over the Internet of Things (IoT), we monitored their glucose levels and all the devices they interacted with. Therefore, we were able to proactively, with nurses, call them and say, “I see you didn’t do this today. Is there something wrong?” We have seen a significant improvement in outcomes as a result. People needed that prodding. People knew they were being watched a bit. We created some financial incentives for the people to participate in the program, but it was a net win to that payer, because even after those incentives, the cost of care for that population—we are only about a year into it now—is already coming down.

We were challenged by an overseas hospital that they wanted to reduce the cost of cardiac care by 30% and improve outcomes by 40%. We went there and looked at how they were doing things, where was the inefficiency. There are numerous alarms that are going off. The nurse has to come to each one. The doctors get called on the wrong things. We turned their cardiac care completely paperless by enabling all that through an iPad. We used technology to streamline which things needed what sort of assistance. After two years of doing that, we have achieved both the cost and outcome benefits.

If you go back, a while ago, the power was with the insurer, then the power shifted to the provider. What I am absolutely convinced about is that the power is going to shift to the consumer. Value-based care has to happen.”