Revolution in Health – Roundtable Discussion at the SAP Alumni Network meeting
Healthcare is one of the most important factors in how we perceive quality of life, impacting everyone, everywhere: in most countries, alongside the economy, healthcare is the major political issue.
Robert Mathiowetz (SAP alumnus and healthcare expert) and I were very honored to host a discussion with SAP Alumni and SAP colleagues at the above-mentioned March 24th event.
The stage was set by some thought provoking statements: by 2050, experts agree, advances in telemedicine, robotics, nanotechnology, biomedicine, 3D printing, and deep-learning will result in highly personalized and efficient care. Most types of cancers will be turned into chronic diseases, or even eradicated permanently. Driven by big data, patients will consent to make their entire medical history and genomic information available in data clouds, mined by researchers to continuously optimize treatment. Personal early warning systems will boost prevention: the health status of consumers and patients will be monitored through real-time analysis of blood components, movement, behavior, voice. No need for a hospital: in the rare case that remote treatment by a team of MDs doesn’t work, we might have to visit a local clinic that looks like a Star Trek sickbay.
Cost as a driver
The roundtable participants immediately honed in on the top-of-mind issues that need to be considered for healthcare of the future. Due to better care, we may live longer, which could lead to an increase in the number of years at the end of our lives that we suffer from chronic disease. At the same time, there will be fewer younger people, and they will thus need to pay proportionally more into the health system. Furthermore patients are now better informed and more demanding due to comprehensive online information. Keeping people healthy will thus become more critical from a cost perspective. Societies must move away from the current “sickcare” and truly invest in “healthcare”. In short: prevention. The technology to support this is already available, but this goal can only be achieved by efficient use of the data from both the patient, and the healthy consumer. 98% of all sick patients readily make their medical information available for research, but healthy individuals are more hesitant to do so. One example mentioned was the data from flight attendants at a major airline: a wealth of information could be collected and mined, leading to exciting insights, and benefits for all. Yet, regulation and a clear definition of the benefits – in short: TRUST – is needed to make this work. Also the reimbursement model for the healthcare providers need to be adjusted as currently only sick patients are compensated
Technology to support the physician
Society is still looking at the challenges from today’s perspective. The costs of sequencing a human genome is expected to drop from 1B$ 15 years ago to about 200$ (an amazing factor of 5 million). Predictive and cognitive capabilities will improve dramatically, and as a result, healthcare will become much more data centric. In many industries, the worker/person has already been removed from the process, e.g. in banking the cashier has been replaced by the cash machine. MDs will always be needed, but in the future, they will most likely own the compassion, the intuition and the entire patient picture. They will also guide the patient through the data jungle.
Shift to prevention
At the same time, there is already now a tremendous lack of specialists. Oncologists can’t be trained fast enough, so the new technologies must be applied. Prevention and proactive, personalized medicine will become more important. Healthcare is the most expensive during the last 2 years of a person’s life. The aim, also in our own interest, will be to help us reach our nineties, but without suffering from chronic diseases, followed by an ‘undramatic’ death. Insurances will play a pivotal role in this. Currently, patients are only billed if they are sick. This will shift from a pay-for-service to a pay-for-outcome, pay-for-value or accountable care mode. Insurances will try to keep consumers healthy, and self-monitoring will play an ever-bigger role.
But how about data privacy?
Data privacy was top of mind and a reoccurring topic in the discussion. Individuals will want to know where their data ends up. The technology to keep data private and secure is available today. Novel technologies, such as blockchain, may be even better at tracking data leakage. But, in the end, the patient or consumer information should be freely available for research, in an anonymized manner, to benefit us all.
Thank you, Robert and Clemens, for the moderation of the roundtable and the summary of our discussion at this great event. The livid roundtable discussion spanned multiple areas, even though we haven’t had time to talk about the dramatic, significant technological breakthroughs that are yet to come, e.g. nanotechnology, brain interfaces (Elon Musk’s Neuralink), or – even though Thomas brought it up briefly – 3D-printing and artificial organs.
In addition to the summary I want to add some more thoughts and background to the following three important drivers of the coming revolution of health: the accountable patient, value-based care, and technology:
The accountable patient and consumerism
We have started the discussion about noting the difference between patient and consumer. This primarily from the perspective of being ill or healthy, which most certainly has an impact on a decision concerning the willingness to share data for research (among others). But there is also the perspective of how the provider approaches the individual and the resulting patient-provider relationship.
There are many movements driven primarily by patient advocates (e.g. patient engagement, participatory medicine like “the walking gallery”, quantified self) to achieve access to their own health data, better involvement in care processes, and empowerment to making an informed decision. These efforts resonance well with ongoing research that an engaged and activated patient has better health outcomes. It has even been called the “blockbuster drug of the century.”
On the other side, the trend of consumerism has been further driven by the healthcare industry through giving patients a choice in their healthcare options and therefore allowing them to act like a consumer. Regrettably, this sometimes only results in additional costs (e.g. copays) without the possibility to take greater personal responsibility.
Still, there is such a great potential in promoting the accountable patient. A comprehensive approach to engagement needs to be focused on the consumers’ individual problems and should support them to achieve their health goals. Digital health solutions need to address usability and data fluidity so that personal health data can be shared throughout the community and provide the necessary foundation for innovative care models. Engaging the complete care team in this manner will lead to increased adoption, and eventually to better outcomes, and reduced costs.
Due to new regulations, cultural changes, and the advances in technology the accountable patient does have an enormous potential for starting the revolution in healthcare. Empowered consumers will have a greater influence on health systems and may even decide which new business model will be successful and which will not – think about disruptors like Uber or Airbnb in healthcare.
Reimbursement and prevention
Regarding a different but related topic, I want to elaborate on to the statement above, that the healthcare system does only compensate patients that are sick. In this context, the costs are indeed a major driver. It is especially apparent when comparing the costs of healthcare from various countries: per capita healthcare costs in the US are more than twice the average of other developed countries. Even though there is a myriad of reasons for this, these staggering costs are in my opinion a major driver to find new innovative care payment models in the US.
The usual “fee-for-service” payment model incentivizes volume over value (i.e. visit and procedures rather than outcome). It also does not sufficiently encourage prevention, care coordination or care integration. Since some time, Medicare’s Innovation Center focuses on the transition to value-based reimbursement and has started to develop innovate models focused on quality or value.These initiatives include shared savings (the ACO-model that we have discussed), bundled payments (i.e. paying a fixed fee for dedicated episodes of care, regardless of the number of treatments and visits), and risk-sharing models. There are usually elements included to promote wellness & prevention, telehealth (in rural areas), and chronic care management, which recognizes the massive financial and human costs associated with chronic conditions.
The shift in reimbursement models is also apparent in Germany, although still on a smaller scale. There are initiatives like network medicine driven by either health systems or regional initiatives (e.g. Gesundes Kinzingtal), integrated care contracts (IV), and general practitioner-centered models.
In any case, healthcare reimbursement and the underlying care models are a major political topic with many stakeholders. The shift toward linking payments to patient outcomes will most certainly continue and will be crucial. Interestingly, the planned efforts to repeal and replace the ACA (“Obamacare”) would have had no direct impact on most of the innovation models. With the MACRA Act, there is even a dedicated schedule on a much broader scale.
Impact of technology
As a technologist, it is of course always favorable to think about how technology can be utilized to solve problems or improve processes. It is important therefore to recognize that changes also affect people’s behavior and might introduce new problems. One example: Enhancing the patient health record with an additional source, patient-generated health data, requires not only new toolings but also adjusted workflows. Today providers, who are usually working with EHR-systems that are not yet equipped for this kind or amount of data, may be hesitant to utilize this data for several reasons. Therefore, I would agree that the future of healthcare will be more data centric. Eventually, this may even lead to new professions or roles.
In our discussion, we outlined the enormous potential of connected healthcare (IoT or Internet of Health Things). There is the potential of diagnosing chronic conditions like diabetes years earlier than today. By breaking open silos between health data retrieved by sensors and wearables, it will be possible to find correlations and to create entirely new ways to derive value from this data. Machine learning and artificial intelligence will play a major role in this process. In my opinion prevention and wellness will benefit tremendously from applying data science.
Even Smart Cities will potentially play a role. One example for this is noise, which also affects health. Especially in urban areas the high amount of noise caused by road traffic and building sites can disturb sleep, cause hypertension, or high-stress levels. Think about – automatically – augmenting your sleep pattern tracked by your FitBit with the noise data of your neighborhood. Now include the air pollution and further environmental data (in- or outdoor) and you can create an even bigger picture. Providing open data will play a huge role in these scenarios.
But even today IoT can improve the quality of life: Enabling telehealth for virtual visits, remote monitoring to support follow-up care, or improving elder care (aka Ambient Assisted Living) by monitoring medication adherence or using fall risk sensors. It is important, however, to always reflect the importance of the human factor in healthcare: empathy, compassion, and intuition. Applying these traits is important during the initial assessment or while explaining different treatment options. An essential element of care management for patients with chronic conditions is based on social and behavioral factors. Even though technology might be able to evaluate these factors in the future, it might never be able to influence patients in the same positive way that a human practitioner can.
I am confident that drivers like the empowered patient – aka consumer – and the progress in technology will have a positive impact on policy, health systems, and eventually health. I am looking forward to some further comments and thoughts in this discussion thread!
Dear Thorsten, many thanks for your comments and the deep insights, which are spot-on. Also many thanks for highlighting the Kinzigtal project (here the link to the English information), “one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications”. An intriguing and exemplary project.
Personally, I had a chance to deep dive in some of these topics in a radioshow a few days ago, which turned into an equally interesting panel discussion.