The decentralization of healthcare may be a great talking point and the ultimate end with patients at the fulcrum of care delivery business practices, but first, many hurdles need to be overcome.
Health 2.0 co-chairs Indu Subaiya and Matthew Holt outlined the five factors driving the decentralization of healthcare during their keynote address at the conference this week. They posed two big questions to healthcare companies, including, "What is your job in the new healthcare ecosystem?"
Holt and Subaiya shared their vision of where they see the industry going, mapping out the five drivers for the decentralization of healthcare:
- The new interoperability: With new standard protocols like FHIR and technology like blockchain, a new health IT paradigm could emerge where the monopoly of a user enterprise system (like an EHR platform) could disappear.
- Machine learning/artificial intelligence: Through the use of these tech tools, communication will change, leading to new form factors. The market has already seen the early spoils of this with products like Amazon's Alexa and Google Home. Subaiya noted that, backed by the new interoperability, data transactions and services could become extensions of those new modalities.
- New entrants: One of the larger themes sprouting from 2017 is the looming question of, "What counts as a healthcare company now?" The short answer is all of them count. All of them are healthcare companies now. While that may be the cheeky answer, the fact, as Holt and Subaiya reminded the audience, is that many companies are looking into the digital health space. These new entrants are taking cues not from legacy healthcare companies but are bringing their own flavor, whether it's offering customized nutrition plans or blending gym and healthcare business principles. What's more, many of these companies are focused on consumer principles in an attempt to add a layer of stickiness to their core mission/product.
- Business model disruption: Early players in the space like Epic, Allscripts and Athenahealth have both seen changes in how they view their flagship products and all are prepping to adapt their offerings to a market that's changed since they came to power. Largely, both consumers and clients want more functionality and capabilities to more easily interact with the products. The aforementioned new entrants are disrupting the business models for these legacy companies as well as changing the idea of what an entrant can be. Payer companies like Bright, Oscar and Clover, for example, are putting the customer at the center of their models and using technology not as an afterthought but as a core differentiator for operations.
- New environments: Healthcare and its care delivery services are increasingly being thought of outside of the four walls of traditional healthcare spaces. The prevailing innovative idea is to think of managing and preventing adverse health events by mixing and elevating a population's environments. These new environments could express themselves in numerous ways such as rehabilitation parks. As Subaiya noted, health happens everywhere and these new environments could influence new players' abilities to influence health.
Pretty much, maybe...— Matthew Holt (@boltyboy) October 2, 2017
The drivers that the presenters outlined point to a changing demographic where the patient is at the heart of care delivery services and wellness management while using new technology, a theme for which the conference is known for.
It's a lot to take in, but Holt and Subaiya stated these new drivers require companies to ask of themselves "Who am I?"
For one, companies need to ask "What does value mean?" and, as Holt stated, not in the traditional venture capital way where a value proposition is another way to define why someone should give you money. Rather, what is the purpose and value a company is looking to add to the healthcare ecosystem, leading a company needing to answer "What is your new job in the new ecosystem?" Questions of who is the customer and what is the company's job will be critical to navigate the healthcare business landscape going forward, especially since the environment is ripe for winners and losers in many facets of the industry.
While these thoughts are provocative about where the industry is heading, the business community of Silicon Valley and the policy makers in Washington, D.C., still need to recognize that those on the front lines of healthcare have a different perspective than a pie-in-the-sky take.
An article published in the new issue of Health Affairs found "hospitals’ use for patient care of data from outside providers was low, with only 18.7% of hospitals reporting that they 'often' used these data."
"Our results reveal that hospitals’ progress toward interoperability is slow and that progress is focused on moving information between hospitals, not on ensuring usability of information in clinical decisions," wrote the authors.
Thus, there may be a disconnect of current interoperability practices and where industry wants to go. The study plays on the tensions between end-users and health IT product makers, with both trying to navigate the end results to something usable and reliable.
Legacy EHR companies are looking to change. Epic is trying to incorporate more patient-sharing with Share Everywhere, for example. At Health 2.0, Allscripts CEO Paul Black stated the company is attempting to disrupt itself, or else others will come into the market and disrupt it for them. He added that Allscripts will soon be announcing different tools/offerings that seek to reimagine how a clinician interacts with a keyboard and how a patient interacts with an EHR.
Elsewhere at the conference, National Coordinator for Health IT Dr. Donald Rucker stated that new standards like FHIR and blockchain are still in an early stage of development. Technology changes in the healthcare space will largely be driven by consumers armed with apps that blend clinical data and lifestyle data. "That's what the big drivers are and providers are sorting them out," Rucker said.
The great technology dance between end-users, developers and policymakers continues on, but all seem to point to the need to keep the consumer at the forefront. Their businesses depend on it.