Robert Kaul
President and Chief Executive Officer
Cloud DX Incorporated
Recently, a study by Johns Hopkins made headlines by claiming that medical errors are now the third leading cause of death in the US. While that startling statistic was later challenged as being overly broad, it’s clear that over 100,000 people die in the US every year from preventable medical errors.
The US Government reports that every single day, around 10,000 Americans turn 65 and qualify for Medicare. If current Medicare spending trends continue unchanged, according to the US Social Security Advisory Board, healthcare spending will consume the majority of the federal budget by 2030, leaving little room for any other functions of Government.
The so-called “Silver Tsunami” of retiring baby-boomers not only puts enormous economic stress on our current healthcare system, it also raises the demand for support services. A looming shortage of doctors as well as personal home healthcare workers has generated anxiety in the industry. The only obvious solution is to deploy technology to help care for older adults, whose chronic conditions consume over 33% of all healthcare dollars.
Now imagine a world where medical errors were a thing of the past, and every person has the option of growing old at home in safety and dignity... all due to the dawn of medical Artificial Intelligence (AI).
Simply put, medical AI enables computers to help interpret healthcare data by recognizing patterns, providing insights to physicians to make better treatment decisions for patients. In the past healthcare progress relied on the discovery of new medications, vaccines and surgical procedures. Since the turn of the 21st century, the pace of these advances has slowed, and the growth of digital healthcare has taken off.
Advances in electronic medical records, remote patient monitoring platforms, and big data analytics have become a driving force in improving existing healthcare workflows and providing better patient outcomes.
In the future, medical AI will automatically track and dramatically reduce preventable medical errors and increase productivity. AI platforms will deliver so-called “deep data”, in real-time, to fully integrated patient management systems. Automating the selection of treatment options and reviewing possible calculated outcomes will give professionals unprecedented new tools to deliver better health. Initially, AI will aid medical professionals to make more informed decisions but will not replace providers themselves; however within the next few years AI will be able to make simple diagnoses, prescribe medication and vector patients to the optimum treatment resources with no human supervision. This autonomy is going to be required if medical AI is going to actually “bend the cost curve” and free up human resources for more complicated cases.
Adopting predictive analytics via medical AI will allow physicians to sort through large amounts of data using statistical methods to deliver predicted outcomes for patients in a matter of minutes. Incorporating AI’s predictive analytics into the healthcare field has the power to revolutionize the way providers and patients manage diseases and outcomes. This accurate and precise process can narrow down the moment of when a patient becomes ill, a critical step in providing preventative measures and treatments.
Implementing AI into healthcare systems will grant patients access to remotely monitor non-life-threatening conditions outside of a clinician’s work space. A patient could potentially describe their symptoms via an app and be presented with information to autonomously care for themselves. This not only reduces costly and time-consuming trips to medical clinics but also allows for data sharing from patient to clinicians, should a threatening complication occur.
Leading an organization into the ever-changing transformation of healthcare requires an appreciation of global innovation and implementation opportunities. Over the next decade, society will inevitably usher in a new era of healthcare; one where clinicians and their AI partners provide a lifetime of wellness management to prevent illness rather than simply treating symptoms. Early detection of negative health conditions in near real-time will be the leading factor that will reduce the cost of care over a lifetime, as well as improve patient outcomes in the case of illness or injury.
Organizations who are early to adapt to this growing AI trend will enjoy a competitive edge over those who are less equipped to do so. Full adoption of medical AI will ultimately ensure that everyone receives the support and resources they require. As a society we must embrace our responsibility to protect the future of healthcare. The sooner this notion sinks in, the sooner we will all begin enjoying the journey to improved health and wellness.
Robert Kaul is the President & CEO of Cloud DX Inc, a digital healthcare startup based in Brooklyn, New York. Their Cloud DX Connected Health Platform is revolutionizing personal health monitoring by providing outstanding accuracy and user experience at an affordable cost. Cloud DX was won multiple awards including 2015 Startup of the Year for Innovation. Team Cloud DX is a Top-7 finalist in the Qualcomm Tricorder XPRIZE, a 4-year global innovation competition to create a futuristic “Tricorder” that autonomously diagnoses 14 separate health conditions. The winner of the $6 million top prize will be announced in January 2017.
Rahul Dubey
Senior Vice President
Innovation and Solutions
America’s Health Insurance Plans (AHIP)
Innovation Lab
Shahid N. Shah
Entrepreneur in Residence and Strategic Adviser
America’s Health Insurance Plans (AHIP)
Innovation Lab
The Affordable Care Act (ACA), Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), Merit-Based Incentive Payment System (MIPS), Alternative Payment Models (APMs), Precision Medicine Initiative (PMI), and Patient-Centered Outcomes Research through PCORI are all taking us towards a more value-driven payment system for the U.S. healthcare system. Physicians and hospitals have been, for decades, paid fees for services they perform on patients and the higher their volume the more money they made (regardless of outcomes). Given the unsustainable growth rates in national healthcare spending, all health insurers and the federal government are working to figure out how to pay providers and health systems for the value they deliver to patients and the public health system.
The question on the minds of many skeptical health systems and front line healthcare professionals, who have lived through multiple cycles of managed care that were going to “revolutionize the industry” in the past, is whether value-based payments are a long-term trend or short term fad?
To help answer that question, America’s Health Insurance Plans’ (AHIP) Innovation Lab (IL) has been facilitating and moderating many “Solution Working Groups” (SWGs) between payers (insurers), providers (health professionals and systems), retailers (pharmacies, clinics), and pharmaceutical manufacturers. An SWG is a collaborative session usually focused on an insurer’s “stated need” and centered on a specific, tough- to- solve problem which typically involves health systems and care providers.
For every SWG, AHIP IL convenes major stakeholders across multiple institutions, value-added technology, and services partners. Stakeholders could be as wide and varied as physicians, nurses, call center personnel, pharmacists, dentists, or even actuaries. Anyone willing to help eliminate innovation logjams is welcome. Once we get all the stakeholders into a single room for one or two days we’re able to speak not from siloes but from a collaborative patient team’s point of view. Instead of looking at the problem from a particular institutional viewpoint, we try to imagine what’s best for the patient’s long-term care and sustainability from a financial perspective. Too often solutions are envisioned without sustainable business models but, when multiple stakeholders work together, our solution working group participants have been able to create sustainable innovations.
1. The path to payments in VBR and FFS both remain complicated
After running dozens of SWGs at AHIP IL, we’ve come to the practical conclusion that value based reimbursement (“VBR”) initiatives are real and that insurers are serious about implementation. There is little reason to believe that VBR is a fad, especially because it’s hard to unwind later. The other major learning from AHIP IL’s SWGs is that most of the pressing problems in healthcare cannot be solved without significant reworking of agile multi-stakeholder and multi-institution workflows and information architecture.
The entire healthcare industry’s aspirations to shift from fees for services (FFS) to value-based care is now well understood. However, repeatable evidence-driven execution plans of how we’re going to go from FFS to VBR remains elusive. CMS’s new MACRA and MIPS programs along with substantial bi-partisan work being done on the yet to be passed 21st Century Cures Act indicate that the Federal Government is very serious about value-based care. However, the significant IT, data interoperability, and unparalleled cooperation among traditional competitors that will be required to make value-based care a reality are not really well understood. Will these value driven aspirations stand the test of time or will we end up falling back on old models because the industry’s structural problems of reliance on volume and state-specific licensure requirements not let the fees for services business models die?
ACA, MACRA, MIPS, APMs, PMI, PCORI, and the many other initiatives the healthcare industry has embarked upon all have an insatiable appetite for data. Through our SWGs, we’ve come to a consensus that existing workflows and data architectures built on siloes across institutions prove that the efficiencies in cost and improvements in outcomes that we need across the healthcare industry cannot be created without changing the reimbursement model to a more value-driven system. Many institutions cannot handle complex next generation value-based business models which require more collaborative and flexible multi-organizational structures. This means that the best will survive and we’ll need to figure out how to fold in the rest into centers of excellence.
If insurers and more sophisticated organizations can help health systems and providers become more agile, then value based reimbursements will move from aspirational to operationally capable and sustainable initiatives. VBR is real, it’s here, but it’s unevenly applied because the path to defining, agreeing upon and measuring outcomes along with payments attribution issues remains complicated. We still have a lot to learn, especially through our collaborative experience at the AHIP Innovation Lab, but it’s clear there’s no turning back.
The AHIP IL is an open lab – if you have payment reform, patient facing tools, payer focused solutions, or ideas around provider led care management please reach out to Rahul Dubey and see how we can run a Solution Working Group (SWG) centered on one or more of your ideas.
Rahul Dubey is currently responsible for collaborating with the C-level executives at AHIP's Health Plan Membership to develop and implement innovative, best in class, emerging solutions and approaches that accelerate utilization of these mission critical applications in order to deliver a higher quality of care, improve the wellbeing of consumers and drive down the cost of care received.
Rahul is responsible for creating the Lab's one of a kind concept, continues to fulfill its mission of delivering an invaluable resource for AHIP Membership and leads all of the Lab's collaborative and confidential Solution Working Groups that involve individual payers, providers, manufacturers, MedTech, innovative solution providers and the AHIP Innovation Lab's trusted and crucial Inaugural Partners.
Shahid N. Shah is an award-winning and influential healthcare IT thought leader who is known as “The Healthcare IT Guy” across the Internet. He is AHIP Innovation Lab’s technology strategist, business modeling specialist, and entrepreneur in residence responsible for helping insurance plans define and create solutions to major innovation challenges.
By Harold L. Paz, M.D., M.S.
Executive Vice President
Chief Medical Officer
Aetna
Compassion is a unique characteristic.
This simple truth is integral to the evolution of health care and the role of physicians in the future. No matter how sophisticated technology gets, computers and data can’t offer compassion, but they can dramatically change where, how, when and what care is provided.
This evolution is already changing the way we think about the doctors of tomorrow.
In a peer-reviewed article recently published in the journal Academic Medicine, I argued that the emerging model of health care will not only be fundamentally different from the traditional fee-for-service model, but it will require a whole new way of thinking for physicians.
What will the physicians of the future look like and how will they operate? We can expect that physicians will play an important role when patient care is more “art” than science or can’t be automated. This will increase the pressure on academic medical institutions to look for and develop the personality and skill sets necessary to fill the void left by technology.
Consumer-directed health care, where patients are more actively engaged in their own health and wellness, is accelerating this move to what I call the “third curve” of health care. The first curve is characterized by the familiar fee-for-service approach to delivering medical care, where each activity is a billable event. Ian Morrison defined the second curve as population health, where the medical community started to focus on the bigger picture of disease and condition management, including the idea that prevention and wellness efforts can make a significant difference in the progress of chronic conditions.
As we enter the third curve of health care, we acknowledge that patients, not physicians, own their health.
New resources and tools will enable each individual to take more ownership, become more likely to adhere to care plans, and feel empowered to take charge of their well-being. Doctors must embrace these new tools and resources, such as mobile apps, telemedicine, home health, urgent care centers and other technologies to improve the health of patients. By the same token, Aetna has the opportunity to play a critical role in personalizing each member’s health and wellness “ecosystem” over time, beginning in the home and extending out into the community by partnering with health care providers through the use of innovative tools and data analytics.
Collaboration will be the key to leading us into the future. If the doctor-patient relationship is to be preserved, physicians must be trained to serve as leaders of multidisciplinary teams that work to address all five determinants of health.
As a former dean of two medical schools, I know that we have a responsibility to train students to succeed in this new world order of consumer-driven health care. By 2025, we will face a physician shortage of 90,000. While shortages generally predict increased demand, I believe that in Curve III things could take a different turn, accelerating more than just the need for more doctors, but demand for a new breed of physician.
With the capabilities, strengths and challenges of all of the players in the health care system, I see a remarkable path forward. Our successful move into the next curve of health care will be predicated on putting patients first, emphasizing compassion, embracing change, and building both hard knowledge and soft skill training into the programs that are building our future medical professionals.
This article was originally published on The Health Section, Aetna’s online news magazine. For more information like this, go to https://news.aetna.com.
Dr. Paz leads clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses. He is responsible for driving clinical innovation to improve member experience, quality and cost in all areas of the health care delivery system. Reporting to Aetna’s Chairman and CEO, he is a member of the company’s executive committee.
Before joining Aetna in 2014, Dr. Paz served as CEO of Penn State Hershey Medical Center and Health System, senior vice president for Health Affairs for Penn State University, Dean of its College of Medicine and Professor of Medicine and public health sciences for eight years. Prior to his appointment to Penn State, he spent 11 years as Dean of the Robert Wood Johnson Medical School and CEO of Robert Wood Johnson University Medical Group.
By Matt Patterson, M.D.
President
AirStrip
Imagine a future in which dozens of different patient-centered technology solutions compete with one another, contributing to a disastrous combination of higher costs, lower-quality care and scores of angry and confused patients. Without robust health information interoperability, this scenario is a very real possibility in the U.S.
The need for interoperability comes at a time when healthcare is under extraordinary pressure to improve overall care quality and cost efficiency. The Affordable Care Act is tightening the screws even further on the revenue side. For these reasons, it is understandable that health systems are eager to deploy a patient-centric approach to data portability and interoperability.
The good news is that in both private and public discussions with health and policy leaders, there is encouraging talk around interoperability through open and available application programming interfaces (APIs), which allow health data solutions to communicate with each other. Public comments by Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare and Medicaid Acting Administrator Andy Slavitt support this analysis.
While imperfect, a patient-centric approach is currently the best framework available. Individuals should own their data and have easy, real-time, plain-English ways of opting in and out of recording and sharing data in both identified and de-identified ways with anyone they wish, to benefit themselves and/or society at large.
However, the patient-centric approach is not a cure-all. In fact, Meaningful Use Stage 3 – and its requirements for making data available to patient-facing applications – could result in unintended consequences for clinician workflows.
The stated purpose of Meaningful Use is to leverage certified electronic health record (EHR) technology in stages to improve quality, efficiency and care coordination while maintaining the privacy and security of patient health information. The hoped-for results in Stage 3 include improved outcomes.
Yet Meaningful Use and open APIs for consumer-facing applications will not be enough to solve the interoperability challenges we face. For example, imagine an emergency department physician ordering tests for a patient who knows those tests were already recently done by another provider. Even if that patient has an application on his or her phone that can access data from various sources, it is still unlikely this could translate to a scalable, reliable, effective workflow for the physician. The more likely results are already familiar to those dealing with ineffective health information exchanges (HIEs): incorrect data, a difficult-to-navigate solution, a failure to tailor the focus to the specialty of the user, or suboptimal data provenance, to name a few.
By relying too heavily on a patient-centric approach, we risk diminishing momentum toward the real game-changer: enforcement of affordable, open, bi-directional APIs among all health information systems. This is a must-have on the road to innovative and intuitive workflow solutions for clinicians and consumers. Referring back to the scenario above, ED physicians need access to an integrated workflow that incorporates their own hospital’s data, along with relevant patient data from multiple other disparate sources. This will enable more cost-effective, efficient and clinically accurate decisions.
While this may sound idealistic, it is absolutely achievable. We can start by putting the consumer in the driver’s seat as the broker of his or her data in ways that reduce unnecessary complexity. For example, the creation of a simple consumer-facing application that simply has two buttons - ‘Record’ and ‘Share’ - would provide control over an individual’s data and interoperability in an easy, real-time way. From there, wide-open, bi-directional interoperability among the patient’s historical data sources can support nimble, innovative workflow solutions geared toward clinician use and faster, more informed decision-making.
Another benefit to giving the patients real control over their data is the potential to finally expose the overt data blocking that exists today. Data belongs to individuals. Those acting as gatekeepers should no longer be able to profit from blocking access. The gate should be unlocked to create innovative workflows and value from this data. Ultimately, business models that simply monetize the hoarding and simple transmission of data from closed, Byzantine health information systems without creating meaningful insights and workflows will crumble – as they should.
With all this in mind, health systems seeking to innovate with patient-centric technology solutions should support open APIs and discourage data blocking practices from their incumbent vendors. And, by partnering with technology firms that offer demonstrated interoperability and workflow innovation capabilities, these health systems can create tools that improve the lives of patients and those who care for them. The results can have a powerful impact on both individual patient care, and the broader healthcare system.
Dr. Matt Patterson has built his career around the goal of delivering better quality healthcare to more people at a lower cost. Responsible for operations, he leads AirStrip's people, processes, and technology required to deliver the full value of AirStrip mobile solutions to clients. Dr. Patterson joined AirStrip from McKinsey & Company, where he was a core leader in the North American Healthcare practice's strategy and operations engagements. He focused on clinical and business model transformations of major U.S. health systems transitioning from "pay for volume" to "pay for value" environments.
Dr. Patterson also brings a wealth of clinical and operational leadership from his experience as a former U.S. Navy physician, where he served as the Medical Director of the Naval Special Warfare Center in San Diego, CA—the elite training command of the U.S. Navy SEALs.
By Reenita Das
Partner and Senior Vice President
Transformational Health
Frost & Sullivan
Frost & Sullivan’s Transformational Health program provides insight on the growth opportunities driven by innovative healthcare technology
The healthcare landscape is changing exponentially and the following technologies are expected to have far-reaching implications in terms of diagnostics, treatments and delivery of care in the future.
1. Artificial Intelligence: CAGR of 42% to reach $6.6 billion in 2021
Artificial Intelligence (AI) is defined as the intelligence demonstrated by machines or software with the ability to depict or mimic human brain functions. AI in healthcare aims to improve patient outcomes by assisting healthcare practitioners in using medical knowledge, which has been thoroughly analyzed and memorized by these systems, thereby providing excellent clinical and medical solutions. AI systems have the potential to provide physicians and researchers with clinically relevant, real-time, quality information sourced from data stored in electronic health records (EHRs) for immediate needs.
The AI market for healthcare applications is expected to achieve rapid adoption globally, with a CAGR of 42% until 2021. Excellent patient outcomes, reduced treatment costs, and elimination of unnecessary hospital procedures with easier hospital workflows and patient-centric treatment plans are the prime reasons for the wide adoption and successive growth of the AI market in the healthcare industry.
By 2020, chronic conditions, such as cancer and diabetes, are expected to be diagnosed in minutes using cognitive systems that provide real-time 3D images by identifying typical physiological characteristics in the scans. By 2025, AI systems are expected to be implemented in 90% of the U.S. and 60% of the global hospitals and insurance companies. In turn, AI systems will deliver easily accessible, cheaper and quality care to 70% of patients.
AI is consistently improving the approach and access to reliable and accurate medical image analysis with help from digital image processing, pattern recognition and machine-learning AI platforms. For example, a startup, Butterfly Network, has developed a handheld 3D-ultrasound tool that creates 3D images of the medical image in real time and sends the data to a cloud service that identifies the characteristics and automates diagnosis. Such clinical support from AI is expected to have a significant impact on the overall medical imaging diagnosis market and its growth.
Innovative, automated patient guidance and engagement solutions, such as AI-enabled medication adherence to observe patient devotion by using advanced facial recognition and motion-sensing software, have started to automate one of the major healthcare processes of directly observed therapy (DOT). New entrants with similar solutions are expected to rapidly capture this sub-segment of the market.
IBM Watson Health’s recent acquisition of Truven Health Analytics for $2.6 billion creates a new and important dimension in health data analytics, further strengthening IBM’s already strong healthcare market position.
2. Immunotherapies: Checkpoint inhibitors growing at 139% CAGR
Immunotherapy provides therapeutic benefit by focusing on the capabilities of the immune system in regards to the tumor and promises to transform cancer care. It charts new territory in both individual duration of survival and the potential for significant numbers of patients to benefit. For example, malignant melanoma is a significant unmet medical need with limited treatment options. More than 160,000 cases of melanoma are diagnosed worldwide with 40,000 deaths annually.
The promise of immunotherapy rests largely in its aptitude for broad application in various patient populations. Once the algorithm for its effective use in the oncology setting is properly realized, the growth potential is humongous. While checkpoint inhibitors dominate the current headlines in the clinical care communities, other promising approaches include novel molecular constructs such as chimeric antigen receptors (CARs), therapeutic combinations with old and new drugs, dosing regimen modifications and vaccines. The market for check point inhibitors was valued at $3 billion in 2015 and is expected to reach $21.1 billion by 2020, growing at CAGR of 139%.
3. Liquid Biopsy: Potential to monitor tumors non-invasively
Liquid biopsy extracts cancer cells from a simple blood sample and has the potential to revolutionize cancer treatment by non-invasively monitoring cancer cells. Today, repeated biopsies are needed to study the changing tumor and present a huge challenge to the patient. Liquid biopsy provides attractive investment opportunities for diagnostic companies. The focus on blood biomarkers, such as ctDNA and CTCs, has unleashed the potential to now track and monitor tumors in a non-invasive manner. It is expected in about two years, liquid biopsy will become an adjunct to tissue biopsy. This technology has proven to be much more effective and detects worsening of a disease condition even before a CT scan. There are key benefits to this technology where “go to the source” is not a concern, unlike tissue biopsy.
4. CRISPR/Cas9 (RT): Disrupting the way R&D is conducted and products are developed
CRISPR/Cas9, a gene editing technique, can make targeted modifications to DNA accurately, cost effectively and reliably. In short, it holds the promise of transforming the way R&D is conducted and products are developed across major sectors of the global life science economy. This technique catapulted onto the research scene in 2014, and companies are flocking to provide research tools and develop therapeutics using the technology. Sangamo Biosciences is the most prolific company to have applied one of these technologies—Zinc Finger Nucleases—to the development of clinical-stage human therapeutics. Other companies, such as the start-ups CRISPR Therapeutics and Editas Medicine, have focused on CRISPR, having received millions in VC funding.
However, while human therapeutic applications of gene editing steals the limelight, there are other sectors, including agriculture and specialty chemicals, in which the technology has advanced beyond research onto the market. Gene editing offers the ability to do the following:
- Modify critical traits in crops and animals
- Boost food crop yields and nutrient quotients
- Create crops capable of withstanding blights, pests or climatic extremes
- Breed hardier, disease-resistant farm animals with improved nutritional profiles
An analysis of NIH-funded projects mentioning CRISPR/Cas9 from 2013 to 2015 finds astronomical growth of this promising gene editing technology. From 2013 to 2014, funding grew seven times, and from 2014 to 2015, funding more than tripled. Academic researchers are not the only end users adopting CRISPR/Cas9 as the technique is having a major impact in therapeutics as well. The technology overcomes many of the challenges with RNAi, TALENs and ZFN genome editing tools, promising to be a market worth hundreds of millions over the next few years.
5. 3D Printing: Game changer for organ or tissue repair
3D printing technology has enormous potential in healthcare due to its ability to be customized. Customization can dramatically reduce surgery times and medical expenses. Currently, the largest applications are 3D-printed scaffolds or prosthetics (orthopedic implants) and medical devices, such as dental implants and hearing aids. The game changer for 3D printing will be in human tissue printing: printed livers, hearts, ears, hands and eyes, or building the smallest functional units of tissues, which can lead to the fabrication of large tissues and organs. This can be used as surgical grafts to repair or replace the damaged tissues and organs.
It is estimated more than a million people need kidney transplantation worldwide. However, only a little more than 5,000 people receive a transplant, as there is an insufficient number of donor organs. Scarcity of legally donated organs has led to a dramatic increase in a worldwide illegal organ trade. The 3D printing business for healthcare is expected to be worth approximately $6 billion by 2025. Some prominent companies in this field are Stratasys Ltd., Arcam AB, Organovo Holdings Inc., Johnson & Johnson Services Inc. and Stryker.
These five technologies have enormous potential to transform the healthcare industry.
This article was written with contributions from Nitin Naik, Global Vice President of Life Sciences; Christi Bird, Senior Industry Analyst; Divyaa Ravishankar, Senior Industry Analyst; and Venkat Rajan, Global Director of Visionary Healthcare with Frost & Sullivan’s Transformational Health Program.
