The Future of Digital Health
The health technology landscape is evolving — and that’s causing a major shift in perspectives that will impact how we imagine access to services, health data collection, and the role of wellness and prevention.
Switzerland is a leader in life sciences and digital trust, and from swissnex San Francisco’s unique position, we bridge an understanding of Swiss markets with our access to future trends and tech from a US perspective.
This article examines the technology driven shifts in healthcare that could transform the landscape: from data analytics to customer experience, turning data into action (as with Blockchain), and the shift from patient to consumer-driven engagement. We’ll check in on Apple and Google as they offer roadmaps to the emergent futures of healthcare, with an eye toward how Switzerland fits in.
TWO BASELINES OF TRUST
Large Swiss organizations, such as Swiss Post, interact physically with Swiss households on a daily basis. This has led them to develop diverse product offerings that draw upon what I call “explicit trust.” This trust is a line across all of Swiss Post’s services: from delivering the mail to delivering financial services. Without trust, Swiss Post could not be responsible for assuring services such as reliable bus services, E-voting, health parcel delivery or digital health records.
This consistent and persistent interaction with Swiss households can be juxtaposed with a more common issue for a technology company: the need to establish trust on a user by user basis, in an entirely digital manner, practically every time they engage. So that even though a user may “implicitly trust” the technology and the company to provide a solution, they have not had the benefit of trust-based engagement across time.
This has a big impact on the health technology industry, which is beginning to reframe these relationships. Traditionally, people interacted with a small group of healthcare providers. The conveniences of digital healthcare move users toward interactions with multiple providers and practitioners. This asks users to shift their baseline from “trusted person” to “trusted party.”
Incumbents in the digital health market have the clear advantage here. Why? Because even in the midst of a mobile solutions and a telemedicine marketplace boom, patients still prefer digital health care when it is delivered from known medical practitioners. As healthcare providers enter the technology space, they will come to market with the benefit of patient preference and economies of scale on their side: that means a greater agility as they move from “trusted person” to “trusted party.”
For startups, being mindful of this person-to-party transformation can help steer into a radical shift in the market for patient-generated data. Currently, health outcomes and advice are formed after a brief interaction with a physician. But the data any user produces from their personal device is implicitly trusted. Connect these dots and you see the opportunity for meaningful, informed action based on device-driven data that could bolster a “new” experience with a new provider. There is a clear market for technology that bridges this trust into new spaces, not only measuring and improving health outcomes, but by linking or combining that data with access to health practitioners.
It will be interesting to see how Alphabet’s “study watch“ will impact this market, as well as the notion of “health service on demand”, that is, connecting personal health data devices via a driverless vehicle network while commuting.
AI AND DATA ANALYTICS
AI solutions are poised to revolutionize predictability, diagnosis, monitoring, and treatment protocols. Alphabet, Google’s parent, is investing heavily in this market through its subsidiaries Verily and DeepMind. Mobile service solution providers, virtual visits, and outpatient services (data heavy, but working better in aggregate) are shifting patient service delivery.
Collaboration drives adoption. Digital therapeutics options — for example, Akili, an AR/VR solution for treatment of ADHD; and Coclear, an over-the-counter hearing aid with an app driver thanks to loosened FDA approval mechanisms — are the result of this new understanding.But data cleanliness and data breach remain major concerns as users are asked for increased access to digital health records. I don’t believe society would be as passive in its response to an Equifax-like breach of our collective health records.
It’s hard to imagine an aspect of health data / systems management that couldn’t benefit from blockchain.
Health data sets are incredibly useful when pooled, which lends itself perfectly to distributed ledger technology. Governance protocols (such as clinical audits, education, training, grievances), hospital logistics and supply chain management (including traceability) — all point to blockchain solutions.
Blockchain could help to establish the identity of a patient for treatment, ensure accurate billing, or share access to medical records only with permissioned parties. Blockchain could lead to tools that put health data into action, for example, by building data marketplaces where multiple medical facilities can share access to patient records.
Could a robust API marketplace create the same result? Possibly. But blockchain solutions provide the interoperability, scale, and security that an API strategy falls short of in the long game. To be actionable, health data first must be satisfactorily anonymized. We might be understandably spooked in the light of the recent Cambridge Analytica scandal and Facebook’s pullback from its own anonymized data testing (even though this initiative was led by a Stanford Cardiologist).
The current climate of the market suggests that patient centricity is “in” and doctor centricity is “out.” As we move toward patient-generated data sets that interface with multiple service providers, there is certainly room for patients and doctors to share the benefits. However, this amplifies the need to link patient compliance, engagement, communication, satisfaction and grievance within an interoperable framework.
When it comes to anonymity and trust, Switzerland is uniquely positioned in the market. The Swiss have a clear understanding of both private-cloud and on-premise data solutions, all within the deep regulatory framework a global health marketplace demands.
CONSUMER-DRIVEN (NOT PATIENT-DRIVEN)
The Insurance reimbursement process has been reimagined. Today we see a shift from fees for services to fees for outcomes. This has led to a significant uptake in remote patient monitoring and engagement.
Fundamentally, consumers are paying more for healthcare, not the insurance company. With the announcement of the Amazon/Berkshire Hathaway/JP Morgan partnership, it is impossible to think that Amazon won’t take aim at the cost of access, with the consumer as the real target. Moreover, Apple recently announced it would launch its own primary care health clinics called AC Wellness.
A second recent development is the Aetna/CVS health merger, where the second largest US health insurer was acquired by pharmacy chain CVS. CVS stated the goal of the merger was to remake the consumer health care experience. CEO Larry Merlo said, “with the analytics of Aetna and CVS Health’s human touch, we will create a health care platform built around individuals.”
Moving from a health care system focused on illness toward a culture of health could be a byproduct of technology marketplace advances and patient-centric data aggregation. Anthem explored a retail health partnership with Lucky supermarkets in 2010/11 by setting up wellness centers through in-store Pharmacies in Northern California. They might have been early to market, but that offering fell short of expectations. Indeed, Anthem had recently inked their own deal with CVS to start its own pharmacy benefit management platform(InginioRx), a deal which could now be off of the table.
Are these activities driven by a desire to own patient data under the guise of patient engagement? Perhaps we’ll see from the outcomes.
Wellness is core to Apple’s growth strategy. Activity, mindfulness, nutrition, and sleep are essential to their new business model. Hardware (wearables) + Software (app store) + Secure storage (iCloud) provide a scalable framework. With cash on hand and 40% global mobile device penetration (86m iPhones) Apple has clear advantages in the health technology market, even when compared to market veterans such as United Healthcare’s 48m or Anthem’s 34m customers.
Offering control of your personal health records, merging personal data and actionable aggregate data, and pairing all that with consumer based products and services, is the baseline for a technology marketplace that reimagines health care. This is made even more powerful with the loosening of FDA regulations on consumer devices, and Apple’s patents on EKG, glucose and heart monitoring, etc.
Apple’s massive, active customer base can deliver sets of qualified registrants for research. A recent call for participation in a Stanford health study on care coordination for chronic disease delivered 11k sign ups in one day — a feat that otherwise requires a year of coordination from dozens of medical centers to provide qualified candidates.
Can we speculate on a future for health technology? Consumer technology advances will drive down healthcare costs, and triggers will emerge with the consumer at the center of their own health outcomes. How we access health practitioners will be facilitated by voice interfaces, including vocal analysis for symptoms like pain and stress. Japan will lead the way in aging care, and whoever cracks the code to reduce these costs in the global market wins a massive prize. AI will revolutionize diagnostics, prevention, monitoring and treatment protocols. And finally, look out for the doctor robot coming to a pharmacy near you.
Steven Reading was Head of Corporate Innovation & Startup Development at swissnex San Francisco.