I was recently invited to participate in an interview for Stride (on twitter), a developing local Health Information Technology ecosystem that is the first of its kind in scope and vision. I’ll let you check out their site for details and spare them here, but I was excited to participate in helping to promote this project as a local member of the Health IT community in Colorado. While reading through the questions that had been prepared, I was thinking about the way in which Stride is poised (intentionally) to disrupt our current healthcare delivery model by bringing together stakeholders from startups and the institutional healthcare system. As a company that’s been around for 35 years, MINES & Associates is certainly in that latter category in many respects; however, one of the reasons that I have decided to make MINES my home is that, as a company, we have embraced technology as a tool to reach our organization mantra: to “save lives, and influence the course of human events.”
This is part I in a four part series. Links for Part II, Part III, and Part IV
A shifting landscape
The Affordable Care Act has caused a seismic shift in our healthcare landscape and some are preparing for the fault lines’ impact on what were once the prairielands of the healthcare system. The new mountain ahead of us consists of layers of changes that I will attempt to outline as I see them. These are the result of following some very bright people that I will try to mention as I go. Follow these people! They are making huge steps toward preparing for these changes.
One of the opportunities (or threats, depending on your viewpoint) of consumer-directed healthcare may be the collapsing of the system within which the decisions in healthcare are made at an administrative level. Those changes could result in significant, down-stream implications for how the future healthcare consumer engages with their health. As a fellow Health 2.0 Denver/Boulder chapter member of mine, Sumanth, mentioned while on a panel regarding open-innovation models in healthcare, ‘We have a sickcare system, we’re working toward a healthcare system, but I’m interested in a health system.’ When we begin empowering people by giving them purchasing power, we also saddle them with the responsibility of that decision and we need systems in place to make those decisions reasonable.
Institutional vs. startups
If there is one person that I’ve heard that captures this coming change the most succinctly from the institutional perspective, it’s Aetna CEO, Mark Bertolini. A keynote at HIMSS 2014, Mr. Bertolini explained how Aetna is preparing for a more engaged, consumer-like patient in the Aetna model. If you don’t believe it, simply look at their acquisition of iTriage (among other advances, led by Michael Palmer, Chief Innovation and Digital Officer) that put the power of access and empowerment in the hands of their future patient.
Aetna made the right move by acquiring iTriage. By purchasing tech, rather than trying to build it out themselves, Aetna’s model is to scout and engage experts trying to help quell the shift in the landscape by harnessing technology. This means that rather than developing that internally, at a potential loss to the organization if it’s unable to deliver, Aetna can focus on its core offering. It also highlights a bigger shift in the healthcare ecosystem – one that Stride is very interested in nurturing – coopetition. Because these lean startup organizations have the ability to make changes quickly and bring in top talent to tackle tough, smaller issues – issues that can then be used in many different arenas. In my opinion, that nature of coopetition is a critical element to the new model of healthcare delivery, as I hope to illustrate in this blog series.
This is what disruption looks like
There’s no question that telemedicine is becoming a more regular part of the healthcare industry with companies like CirrusMD, Call-a-Doc Plus, and AccessCare Technologies’ Aveo platform and many others (disclosure: MINES currently has business relationships with CADR+ and AccessCare Technology) making strides to disrupt the traditional delivery model for healthcare by enabling secure text messaging, prescriptions by phone, and HIPAA-compliant video telemedicine, respectively – this isn’t an exhaustive list of what these platforms do, but just a couple of examples. This enables asynchronous, non-geographically-specific, and convenient communication between a provider and patient. While our current model of on-site care is relatively new compared to the entire history of medicine where patients go to the provider, the bigger disruption here is in the fact that the premises is moving away entirely.
The weekly #HITsm chat had a great discussion on January 24th (transcript) regarding retail healthcare – the movement of retail organizations into the healthcare space. Companies like CVS, Walgreens, and Target are making movements to put clinics in their retail locations to decrease barriers to accessing care for routine events like physicals and non-urgent medical needs. If you want to check out a really cool aspect of this, Theranos is partnering with Walgreens to make onsite blood testing a realistic part of this system.
If you’ve not heard of wearable tech or the Internet of Things (of which wearables are only a part), you soon will. While Nike took early steps in tracking the efforts by athletes with the Nike+ system, this sub-industry has exploded with newcomers like Jawbone UP, Misfit Shine, FitBit, and even a tracker that will shock you into behavior change. While these various tracking devices are great at providing data to the person using them, efforts to make them usable in healthcare have been lacking. That said, there are efforts between Apple, the Mayo Clinic, and Epic EHR to solve this problem through Apple’s HealthKit. However, this change is only helpful to those that are on the iOS ecosystem. As you probably know, Google’s Android continues to gain ground in market share and as these devices continue to become more customizable and cheaper, iOS will either need to adapt or face staying in an ever-growing, niche market.
These are only the first step in a long development cycle of devices (and even things that don’t look like devices) that will someday be a part of our daily lives. In fact, watch the sequence a few minutes after Ewan McGregor’s character wakes up in the movie The Island, and you’ll get a sense for how this might play out in our daily lives. Actually, while trying to find that toilet scene where the character’s urine is tested while he is excreting, I found this article on a real-life example! Which now has my mind wandering on sample integrity…
Other major tech innovations
In fact, there are A LOT of people – very smart people – working on a number of innovations related to healthcare. Look no further than the IBM 5-in-5 if you’re ever wondering what some of those things might be. But we are quickly moving into a world where the things that are imagined in movies and TV are becoming reality – or are being worked on now to become reality. If you want a great example, check out the Tricorder X-prize. If you’re not familiar with what a tricorder is, here ya go!
A word on purchasers
The purchasers of the past are slowly slipping into the fog of a system going the way of dinosaurs. While our current healthcare system relies on someone purchasing insurance on behalf of a group of people, the new model of consumer-directed healthcare would include patients insuring themselves in a similar way to most other insurances – life insurance, car insurance, etc. In this model, the purchaser is correctly aligned with the responsibilities for maintenance. During deliberation of the Affordable Care Act, the Supreme Court actually highlighted how insurance could be mandated because cars can be mandated to be insured by the state. To ensure protection for all others in the pool of “drivers,” in much the same way that maintenance of one’s health and insurance for that health is a responsible act for the pool of citizens.
Consumers make this sort of decision regularly. When purchasing electronics, for example, there are often options for insuring the item from damage and even loss. When confronted with this decision there is, in the mind of the consumer, a cost:benefit decision to be made. When making a decision regarding level of coverage to insure one’s vehicle, a similar cost:benefit decision must be made for the consumer regarding their risk tolerance related to the value and potential loss in value of the vehicle. But in these situations, consumers are aware of their role as a consumer; that same level of awareness needs to be at the core of a consumer-directed healthcare system if we expect those decisions to be more straight-forward and realistic.
Millenials are fast becoming the largest part of the consumer segment of the economy; and they do things a little differently than their predecessors. As the CTO of Connect for Health Colorado (the health insurance exchange in Colorado), Proteus Duxbury, mentioned in a Prime Health Collaborative event that Millenials are soon to make up as much as 50% of the purchasers through the exchange in Colorado and they are preparing for this group which prefers peer-reviews to authoritarian ones. When I asked him about this posting, he shared this report from the White House on Millenials that you might find interesting for more details. Keeping an eye on the factors that make up this group is going to be important for their continued planning and development and healthcare organizations from insurance to consumer-facing wearables should take heed to the particulars of this shifting landscape. Community-focused, socially-aware, technology-forward, and averse to traditional signals of “growing” up like marriage and purchasing a home are all key differentiating factors. As those factors become more pronounced, healthcare will need to be aware of, and respond to, the way that these individuals view themselves and the world. Further, the section on a personal profile below will become even more pronounced and necessary to keep these individuals engaged and aware.
Is 4PHealth going away?
If you’re not familiar with my concept of 4PHealth, check out my earlier blog post for details (secretly hoping I can stop linking to this post at some point!) but the long and short of it is that there are four P’s in the healthcare system: payer, patient, provider, and the patient’s peers. Truthfully, there’s actually a fifth P that was not originally contemplated in that post but comes to light when you consider a consumer-directed healthcare model: purchaser. For most people in the US, the purchaser is an employer, or in the case of labor organizations, a trust into which employers contribute along with the dues from the members. But now that is shifting as smaller organizations are actually sending their employees to the health insurance exchange. Increasingly, I expect this to grow; and that’s a good thing. When the purchaser and the patient are the same, there is a shift in the financial onus for having a particular benefit plan; which means we need more informed consumers (patient-purchasers). But it also creates an opportunity for further collapsing of our very tiered silo. If the consumer could then also become the payer (see more in shared-economy model, below), we could very well see a one-to-one relationship between the provider and the consumer (patient-purchaser-payer). Hold on to your seats, kiddos. It could happen.