The Future is Now!
The COVID-19 pandemic has changed healthcare forever. The pandemic unexpectedly pushed us all out of the nest, and there is no going back. Before the pandemic, healthcare organizations were struggling with the pressure to evolve from volume to value. When the lockdown occurred, there was no choice but to change, almost literally overnight. Now that the fog is clearing somewhat, every stakeholder, including patients, doctors, hospitals, health systems, health plans, and purchasers, must evaluate their next moves in the new normal. These choices will have to be made at a rapid pace that healthcare is not used to. For many healthcare organizations, it will be “fly or hit the ground.” What was transient and what will be permanent? What strategies are still relevant? How is the competitive landscape different and the chessboard repositioned? The predicted future that was expected to take 5–10 years, is here now, like it or not. Staying on an incremental track during this transition to the new normal would put any healthcare organization at risk. The pandemic has revealed and accelerated key aspects of the US healthcare industry.
What is clear is that the pandemic has revealed long-standing weaknesses and fault lines in our healthcare system. Vulnerable populations and African-American, Latinx, and Native Americans have suffered disproportionately in just about every way. Gaps in the Social Determinants of Health (SDoH) and negative lifestyle factors went from a chronic concern to an acute issue. It is also clear that issues of social justice and systemic racism have played a part in creating this vulnerability. This is a crisis inside of a crisis that has left previously weak communities and families, now devastated. Healthcare organizations that take care of these populations have to design strategies to address the acute crises as well as build a bridge to long-term solutions. What has been revealed requires the emergency tourniquet but ultimately will still require fundamental change. Why it is so important to do so has been clearly revealed. The response of all stakeholders will be a defining moment for health systems around the world but probably none more significantly than the fragile American system. Who will step into the leadership void? Who will defend the vulnerable populations? Who will catalyze the fundamental health system change necessary?
Despite the horrific nature of this pandemic, the remarkable silver lining is that the move to digital health has accelerated by years. The slow dial-up of telehealth was suddenly turned up to the max. It is now clear that the primary barriers to telehealth utilization were regulatory and reimbursement related. It was not technology nor consumer acceptance. The technology is now fully mature and ready, which was not the case even 5–10 years ago. Also, after being forced to try it, most consumers like it. Several studies show that consumer and provider attitudes have shifted favorably towards the use of telehealth. Most providers have seen a telehealth pattern of roughly 2–5% utilization pre-pandemic, to 80–95% utilization during the pandemic, to 20–30% utilization as there is a return to the new normal. The new normal will likely mean telehealth utilization of at least 5–10x prior utilization. When you put this in the context of several converging technology and industry trends, there is an opportunity for tremendous disruption. With increased computing power, leveraging of big data tools, Artificial Intelligence, and Machine Learning, the ability to process and analyze data has grown exponentially. With the direction of healthcare industry trends, driven by cost pressures, the shift to value-based reimbursement, increased quality focus, maturation of interoperability standards, and near-universal use of EHRs, the vision for what is possible is dramatically changed. There is the opportunity for change to occur much more rapidly than just about anything we have previously experienced in healthcare. Organizations that were well-positioned prior to the pandemic now have the opportunity to dominate the new normal. However, because everyone has been forced to accelerate their telehealth strategies in unison, there is an industry-wide reset. Who will take the initiative now and truly transform? I expect in the next 2–3 years, the landscape will be redefined and disrupted by organizations that choose and are able to lead. This will include start-ups as well as smart established players. It is time to rethink and reconsider everything.
The unmet need in the US is for health maintenance and care at an affordable cost. Obviously, keeping people healthy will lead to decreased costs due to reduced demand. The most effective approach to keeping people healthy would be continuous attention, from birth to death, to community health, lifestyle choices, healthy habits, prevention, and detecting rising risk in real-time while supporting self-management. Until recently, this was not feasible. Due to the convergence of technologies mentioned above, digital health is now possible and will likely become the best practice. Digital health is the umbrella term for all of the connected health strategies and technologies, including telehealth, telemedicine, telepresence, wearables, remote patient monitoring, and digital therapeutics. Covid-19 pushed the healthcare industry to the tipping point in terms of deploying digital health tools due to increased safety. The benefit is that continuous, connected care in health and illness is now possible. Importantly, a level of intelligence, never before possible, is available behind the scenes as we are able to generate insights to guide and nudge patients and clinicians in real-time. Whole-person, comprehensive care is possible. No need to treat by disease, focusing on diabetes or asthma, or heart failure. Connect with the patient electronically and leverage a continuous stream of data, including patient-reported data. This enables the ability to respond to the whole person with comprehensive care based on the physiologic impact of whatever conditions the patient has. You can detect rising risk in real-time. You can integrate physical and behavioral health with continuous information flow to track, monitor, and intervene proactively to keep the patient healthy. You can also close the feedback loop with this flow of data to continuously improve and refine interventions and learn from every patient. True population health management is now possible with a PHM command center, monitoring all, detecting risking risk at scale, intervening in real-time, and managing by exception. Patient self-management and shared decision-making can be robustly implemented with the care team electronically looking over the patient’s shoulder for support while anticipating needs. With interoperability, public health data is generated and leveraged while the portability of a longitudinal health record is enabled. These are no longer far-fetched or theoretical use cases. There are patients experiencing this new model of care while revenue-generating business models in place today.
This vision is now possible. Well-funded digital health startups are gaining traction and having an impact, partially due to being unencumbered by legacy IT systems and outdated business models. The mega-merger of Livongo and Teladoc reflects the increasing market power and high expectations of digital health vendors. In fact, there has been a record-setting $9.4 billion of digital health venture funding by the third quarter of 2020. Former executives of Livongo are starting a special purpose acquisition company (SPAC) that will invest in “health assurance” companies. There are companies that provide “consumer-centric, data-driven, cloud-based healthcare designed to help people stay healthy and avoid today’s ‘sick care’ paradigm.” These digital health companies will provide continuous, proactive, personalized care that is available anytime and anywhere. This paradigm could be disruptive for incumbents. The best model for health is probably based on continuous technology-enabled connectivity, not episodic care and more brick-and-mortar. What is clear is that certain things have changed that will not completely revert back to their prior state. Digital health is the future and covid-19 has made the timing, now.
