Accessibility and Affordability and Accountability… Oh My!

March 5, 2019

By Gillie McCreath

Investors pumped over $8BN into digital health companies in 2018 to improve the current healthcare system1 but are we really making healthcare better for the user/consumer/ patient/family advocate? In spite of the amount of investment in the sector, there are still significant gaps in clinical and consumer utilization of enhanced healthcare technologies that allow consumers to:

  1. Find immediate and appropriate care
  2. Identify the most cost-efficient service
  3. Comprehend exactly why the clinician is following a certain protocol


Online scheduling has become easier, but as much as consumers want/need a primary care physician involved in treatments, communications, and population health management:

  • It takes an average of 24 days to schedule a first-time appointment with a physician — a 30% increase since 2014, when the average wait time was 18.5 days, according to The 2017 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.
  • For those with minor conditions, immediate treatment options such as MinuteClinics and other walk-in facilities supersede any relationship that one may have with providers. Driving consumers to these entities is actually causing more electronic disconnects in capturing medical history, pharmacy disbursements, and treatment protocols, as they are not linked up with the medical records of primary care.
  • Seeing a specialist takes even more time, and with the growing need for mental health visits, this epidemic could be catastrophic for those needing immediate care. Accessibility is the highest priority according to the Kaiser Family Foundation Survey.

Yes, you can argue that there is a lack of providers, which is causing some of these delays, but with the growth of telehealth, times for visits should be reducing not increasing.


Premiums continue to rise, as are higher deductible plans. Even those with HMO’s are seeing 2-3x higher co-pays. Seniors are also feeling the burden of paying for higher per diems and other benefits, which is exacerbated by a 2.8 Cost of Living Adjustment (COLA) for these Senior Citizens,.

One would think that paying more for a service would entitle the healthcare consumer to greater benefits. However, even with hospitals required by CMS to post standard charge-masters online, it still does not solve for the lack of pre-adjudication to understand what this actual procedure will cost the consumer out of pocket.

Cost transparency is vital to empowering the consumer, aligning personal options for medical costs, and reducing stress. Families may one day understand the true total cost of care from initial procedures to discharge, to rehabilitation, and home care. Future technologies will have to focus on this as part of solving the affordability issue.


Consumers want assurance that their clinical interactions are non-biased, follow leading practices, and are acting in the best interest of the patients. Many clinicians at health systems are enjoying a newly installed 25-50 million electronic health record system, but it will be years until the Department of Defense teams enjoy their $10 billion (estimated) new EHR system.

These EHRs should provide more efficient clinical interactions with updated clinical workflows, drug interaction alerts, and e-forms delivered to patient phones. This should provide confidence to healthcare consumers that the care they receive is the appropriate care. However, according to a recent article by the Institute for Healthcare Improvement, by 2020, health expenditures will account for over 20% of the gross domestic product of the US, and an estimated 20% of those current health expenditures can be attributed to waste.

Other areas of digital accountability are centered on provider/patient communication applications. Texting, auto-dialers, and care management emails from clinical teams are hitting the mainstream. Millennial’s will continue to drive these mediums and demand more information, along with other populations. However, all consumers will have to continue to do their research and take time to ask the right questions, understand the treatment protocols, and utilize these apps in order to meet the clinical teams in the middle.


As complex as this all is, technology can, and will, drive the necessary changes to help consumers and clinicians along on this journey. The digital disruptors flooding the healthcare marketplace today are focusing more on answering the riddles of the triple A’s – Accessibility, Affordability, and Accountability.


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