Rubin Pillay will be presenting at HFMA’s 2018 Annual Conference, taking place June 24-27 in Las Vegas. This blog post touches on the theme of his presentation, Healthcare’s Renaissance: Converging to Heal. For more information or to register, go to annual.hfma.org.
Health care in the United States and across the globe is plagued with erratic shifts in quality, unequal access, and sky-high costs. The good news is that converging technologies in medical science, software, hardware, and communications are transforming medicine, giving clinicians, patients, and key industry players the unprecedented ability to make appropriate health care more accessible, affordable, and humanistic.
Patients, physicians, pharma, and regulators would do well to face these profound changes, because their lives and their industries will not look the same after they have transpired. By preparing for the inevitable waves of change, healthcare leaders can make informed decisions about how technology will shape their organizations.
The convergence of exponential technologies is propelling three major trends that will see health care flipped on its head: the transformation from patient to “prosumer,” the move from a pipeline-based approach to sick care delivery to a platform-based approach, and a shift from an insurance-based payer approach to an “out-surance” based approach.
Patient to Prosumer
For two millennia since Hippocrates, only physicians were able to acquire and access medical data and make medical decisions. Physicians are the decision makers, and patients are merely the subjects of their work. Advancements in technology, however, are democratizing the access to knowledge as well as the ability to deliver care. The convergence of smartphone, sensor, and artificial intelligence (AI) technologies now enables patients to not only contribute to decision making about their own health care but also actively engage in the care delivery process—a move from passive recipient of care to active producer (“prosumer”) of health care.
Through an array of wearable and edible sensors (about 300 currently commercially available and several in development) patients now have thousands of data points that range from activity to emotional status to vital signs to continuous blood labs. The combination of these sensors with smartphone technology and built-in AI is resulting in a flood of point-of-care diagnostics—medical testing and monitoring devices that come to patients without the need for an office visit.
Pipeline to Platform
Health care has much to learn from disrupters outside of the industry such as Uber, Airbnb, Amazon, and Apple. These cutting-edge companies are built on platforms: two-sided markets that are revolutionizing way we do business. As digital networks become more ubiquitous, the most successful providers will be the ones that do the best job harnessing the power of the platform. This approach has significant potential to address many of the challenges that historically have been experienced in terms of the provision of safe, accessible, affordable, cost-effective, and convenient health care. The application of telemedicine and telehealth technologies are principal examples of how platforms can be used to strengthen healthcare services by overcoming many of the barriers (e.g., geography, technology, access, and cost) and provide quality diagnostics and treatment that improve patient well-being among all demographics — particularly traditionally disadvantaged groups and underserved communities.
A number of design- and patient-centric companies and organizations are driving the industry forward with innovative technologies and solutions. According to some market reports, this industry has the potential to realize a growth of 20.8 percent by 2020 with a market of $86.6 billion. Fairly new companies like American Well and Doctors on Demand are set to become the largest provider groups, and recently, giants like Apple and Amazon have entered the healthcare market.
In short order, augmented reality, virtual medicine advances, biotech, and wearables will be integrated into this landscape to provide additional methods for the provision of care, patient monitoring, diagnosis, and treatment. These further advancements will increase the level of physician-patient interaction, which, leveraged and facilitated by technology, will require new ways of thinking about health care, tech, and medicine and significant amounts of user-centric and human-oriented design thinking.
Insurance to “Outsurance”
Massive reductions in insurance costs are coming, along with a wave of disruption. Traditionally, insurance premiums are determined by actuaries who simply hope that the pool of insured individuals is big enough to account for the variation in their predictive model. But exponential technologies—namely computation/digitization, AI, machine learning, sensors, networks (especially social networks), and genomics—will change all of that.
Social networks will allow us to create true peer-to-peer insurance models. Imagine finding a group of peers, whom you trust and can vouch for, and coming together as a group to self-insure. Patients will be able to skip the centralized, expensive middleman insurance carrier in favor of a technology stack (e.g., app, database, AI-bot) that manages a decentralized network of people who pay premiums and file claims that the group approves.
This new way of insuring patients takes an enormous percentage of the cost structure of traditional insurance. Instead of paying fees and insurance company salaries, a peer group can opt to distribute the extra cash that wasn’t paid out.
When talking about insurance, it’s going to be difficult to ignore genomic data. Although the Genetic Information Nondiscrimination Act of 2008 (GINA) is intended to protect people from genetic discrimination in health insurance, there is a real possibility that DNA could have a serious impact on the future of medical insurance. Groups with favorable genomic indicators could get together to self-insure, giving them an advantage. Sensors will allow insurance policies to be based on actual data (e.g., usage and health), rather than general heuristics and rules. Sensors will have the biggest impact on health insurance, as hundreds of new health sensors are coming to market in the next five to 10 years. Sensors tracking healthy behavior such as diet and exercise will help patients obtain lower insurance costs. Several health insurance companies are already using health sensors in their policies.
Rubin Pillay, PhD, MD, MBA, MSc, BSc(Hon)Pharm, is professor of medicine, healthcare innovation, and associate dean for global innovation, School of Medicine at University of Alabama at Birmingham, Birmingham, Ala. Twitter: @PillayRubin