Health in 2040: 10 archetypes that could define the future of health

My Take

Health in 2040: 10 archetypes that could define the future of health

By Doug Beaudoin, vice chairman, US Life Sciences & Health Care leader, Deloitte LLP

Twenty years from now, we predict that the health care system we know today will look completely different. We are already beginning to see the early stages of this transformation. Health care consumers are starting to demand greater transparency, accessibility, and personalization…and that trend is likely to continue. Consumers will want automated, actionable health insights that come from smart artificial intelligence (AI) applied to interoperable data that is seamless and integrated across all platforms and applications. Many consumers will shop for modular and personalized health coverage and will receive care (mostly) where they are.

A wide range of companies—from inside and outside of the health care sector—are making strategic investments that could be the foundation for a future of health that is defined by radically interoperable data, open and secure platforms, and consumer-driven care. These organizations illustrate early innovations that can help personalize health care, enable consumers to make more informed decisions about their health, and leverage AI and other emerging technologies to harness and share data.

Consider some of the announcements that companies have made in just the past few months:

• In late November, Amazon Web Services announced the formation of Comprehend Medical, which uses natural language processing to mine unstructured medical text from electronic medical records (EMRs) and other patient data.¹ The company says the data could eventually help consumers make more informed decisions about their own health and improve patient recruitment for clinical trials.
• During the Exponential Medicine 2018 conference last fall, executives from Human Longevity, Inc. outlined their Health Nucleus program, which maps out a participant’s entire genome. For about 15 percent of participants, the program identified actionable responses that could increase their life expectancy from one to nine years.²
• Apple, Inc.* is moving toward a device-enabled future in which consumer devices not only play a greater role in health care, but also put patients in control of their health information. The company’s Apple Watch Series 4 wearable device, for example, includes an EKG sensor that can alert the wearer to irregular heart rhythms.³ Apple’s HealthKit platform provides a central repository of each user’s health and medical data, and the CareKit framework for apps helps users understand and manage their medical conditions. Apple’s ResearchKit framework could help medical researchers gather data.
• DeepMind, an AI research firm Google acquired in 2014, recently said it is using Google’s scale and experience to create an AI-powered app that can assist nurses and doctors. This app could wind up being similar to Google Maps, but instead of helping drivers get from Point A to Point B, it could help clinicians navigate clinical pathways.
• Microsoft Healthcare says it intends to combine cloud computing, machine learning, natural language processing, omics data, and AI to tackle cancer.⁴ The company’s researchers expect the technology to help oncologists sift through mountains of biologic research data to determine effective, individualized treatment.
• During a December conference, the CEO of Bind Benefits explained the concept of “on-demand” health coverage, which his company is making available to self-insured employers. Copayments are priced on a sliding scale based on quality outcomes and the setting where care is delivered.

These examples point to a broader shift in life sciences and health care that is only beginning to form and signal a new future of health. I expect the pace of innovation in this sector is going to accelerate in 2019.

Jump ahead 20 years…How will innovation play out?

We don’t expect to have eliminated disease entirely by 2040, but by using actionable health insights driven by interoperable data and smart AI, we should be able to identify illness early and intervene much more quickly. This can pave the way for a future focused more on well-being rather than treatment.

Largely replacing the traditional industry segments we have now (health systems and clinicians, health plans, biopharmaceutical companies, and medical device manufacturers) we expect new roles, functions, and players will emerge. We expect the future of health will be made of three broad segments. Within these segments, we envision 10 sector-agnostic archetypes:

Data and platforms can generate the insights needed for personalized, always-on decision-making in the new health ecosystem. These archetypes can serve as the backbone for the health care ecosystem of tomorrow.

1. Data conveners: Data-gathering organizations will have an economic model built around1. aggregating and storing individual, population, institutional, and environmental data. These data can be used to drive the future of health.

2. Science and insights engines: Some organizations will likely have an economic model driven by their ability to derive insights and define the algorithms that power the future of health. These organizations will likely conduct research, develop analytical tools, and generate data insights that go far beyond human capabilities in care delivery.

3. Data and platform infrastructure builders: This new world of health will need infrastructure and platforms that can serve highly empowered and engaged individuals in real time (someone will need to lay the pipes).

Well-being and care delivery represent new virtual and physical communities that can provide consumer-centric delivery of products, care, wellness, and well-being.

4. Health product developers: The economic model of these organizations is driven by their ability to enable well-being and care delivery. While there will continue to be organizations that develop products, those products won’t likely be limited to pharmaceuticals and medical devices. They can also include software, applications, and wellness products.

5. Consumer-centric health (virtual home and community): Along with companies that develop health products, other organizations can provide the structure that supports virtual communities.

6. Specialty care operators: Two decades from now, we will likely still have disease, which means we will still need specialty care providers and highly specialized facilities where patients can receive care.

7. Localized health hubs: While there will be some specialty care, most health care will likely be delivered in localized health hubs. Localized health hubs can serve as centers for education, prevention, and treatment in a retail setting. Additionally, local hubs can connect consumers to virtual, home, and auxiliary wellness providers.

Care enablement includes the connectors and facilitators that can make the new health engine run.

8. Connectors and intermediaries: These are the logistics providers that will run the just-in-time supply chain, facilitate device and medication procurement operations, and get the product to the consumer.

9. Individualized financiers: Unlike the health insurers of today, these organizations will create the financial products that individuals can use to navigate their care. These organizations will likely offer tailored modular and catastrophic care-coverage packages. They can drive reductions in care costs by leveraging advanced risk models, consumer incentives, and market power.

10. Regulators: While we will still have regulators, we probably won’t view them as governmental traffic cops. They will set the standards for business transactions. The regulators of the future can influence policy in an effort to catalyze the future of health and drive innovation while promoting consumer and public safety.

Tomorrow’s consumers can expect the exponential changes I’ve outlined above—and they’ll vote with their feet and their wallets. Legacy stakeholders should consider whether to disrupt themselves or isolate and protect their offerings to retain some of their existing market shares. We anticipate that successful companies will identify and compete in one or a few of the new business archetypes above, taking into consideration their existing capabilities, core missions and beliefs, and expectations for the future.

PS: Feel free to bookmark our future of health webpage and subscribe to our content—over the coming weeks and months we will be rolling out additional Deloitte insights on this exciting topic! We are looking forward to the transformation.

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* Apple, Apple Watch, CareKit, HealthKit, and ResearchKit are trademarks of Apple Inc., registered in the U.S. and other countries. The Health Care Current is an independent publication and has not been authorized, sponsored, or otherwise approved by Apple, Inc.

¹ Amazon Comprehend Medical overview, https://aws.amazon.com/comprehend/medical/
² Exponential Medicine 2018, November 5 session, http://www.gregoryschmidt.ca/writing/exponential-medicine-day-2-2018
³ Apple Watch Series 4, https://www.apple.com/apple-watch-series-4/health/
⁴ How Microsoft computer scientists and researchers are working to ‘solve’ cancer, https://news.microsoft.com/stories/computingcancer/
 

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In the News

FDA announces new framework to review digital health device applications

In a prepared statement released on January 7, US Food and Drug Administration (FDA) Commissioner Scott Gottlieb announced the agency’s draft regulatory framework to test new approaches for reviewing applications for digital health devices. The statement explains how the agency will conduct its Digital Health Precertification (Pre-Cert) program, a pilot program under its Digital Health Action Plan, which FDA first launched in late 2017 (see the December 11, 2018 My Take).

According to the press release, FDA intends to streamline the review process for some digital health applications. The proposal would allow device developers to submit less content than is traditionally required by taking advantage of information that FDA already has. The agency plans to assess the new approach to see whether it results in the same degree of oversight. According to Gottlieb, “By utilizing the power of real-world performance data on software, Pre-Cert will help the FDA and developers better evaluate the real-world benefits and risks of these tools, and more quickly identify and address any issues and communicate safety information to patients.”

Related: During the annual J.P. Morgan Healthcare Conference on January 8, Gottlieb announced FDA’s plan to create a new office to improve the review process for new medicines. According to Gottlieb, a new 52-person group, called the Office of Drug Evaluation Science (ODES), will develop a standardized approach for using digital data, personalized medicine, and patients’ own data. ODES will be part of FDA’s Office of New Drugs within the agency’s Center for Drug Evaluation and Research, which oversees the approval process for new medicines.

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More nurse practitioners are providing primary care, new study suggests

The number of nurse practitioners (NPs) providing primary care is increasing, a trend that is offsetting the low number of primary care physicians (PCPs), according to a recent study, which analyzed US census data, physician workforce data from the American Medical Association (AMA), and Medicare billing records from doctors and nurses providing primary care from 2010 through 2016.

While the number of PCPs in the US outnumbers nurse practitioners, the number of PCPs is declining. The study suggests that NPs are outpacing other groups of non-physician primary care clinicians in the workforce. Nurse practitioners are increasingly providing primary care in predominantly rural and low-income US communities that face a shortage of PCPs.

According to the study, from 2010 through 2016:

• The number of NPs in low-income communities increased from an average of 19.8 to an average of 41.1 for every 100,000 people
• The number of NPs in rural communities grew from 25.2 for every 100,000 people to 41.3 
• The number of PCPs in low-income communities decreased from 52.9 to 52 for every 100,000 people
• The number of PCPs in rural communities decreased from 59.5 to 47.8 for every 100,000 people

The researchers note that rural and low-income communities have faced disparate access to PCPs for quite some time, and the growing number of NPs could begin to improve both primary care capacity and access in these communities.

(Source: Thomson Reuters, More nurses providing primary care where MDs in short supply, January 8, 2019)

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CMS gives flexibility to ACOs to apply for a skilled nursing care waiver

On January 7, the US Centers for Medicare and Medicaid Services (CMS) published guidance outlining requirements for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) to apply for a waiver for the three-hospital day stay rule. This rule only allows for skilled nursing facility (SNF) coverage after a beneficiary has had a three-day inpatient stay. Only ACOs participating in, or applying to, specific MSSP performance-based tracks that accept downside-financial risk are eligible for the waivers.

ACOs must provide CMS with a list of partner SNFs (and affiliate agreements for each facility). These SNFs must have overall CMS quality ratings of three stars or higher. For the first time, critical-access and small, rural hospitals operating under swing-bed arrangements are eligible to be SNF affiliates. The waivers will take effect July 1.

In December 2018, CMS released “Pathways to Success,” a final rule to overhaul the MSSP for ACO participation—and encourage greater ACO acceptance of downside-financial risk (see the January 8, 2019 Health Care Current).

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Nonprofit generic drugmaker increases membership, continues to fight shortages

On January 7, Civica Rx, a nonprofit generic drug company founded by a group of hospital systems in 2018, announced it has added twelve more health systems to its board. These new members will join the seven health systems and three philanthropies that founded the company in response to shortages of some commonly used generic drugs (see the September 11, 2018 Health Care Current). The members developed Civica Rx to encourage price transparency and to help create a reliable steady supply of generic drugs for use in hospitals. In recent years, hospitals have reported shortages—and price spikes—of common, generic drugs. A March 2018 Deloitte blog discussed the idea of hospital-produced generic drugs.

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State and local health care roundup

• On January 7, California Governor Gavin Newsom (D) proposed expanding the state’s Medi-Cal program to undocumented immigrants under the age of 26. Following the proposal, Louisiana Senator Bill Cassidy (R) announced plans to introduce federal legislation that would halt this effort.
• On January 8, New York City Mayor Bill de Blasio (D) announced NYC Care, an initiative that would direct uninsured individuals to subsidized health care services. The $100M effort aims to guarantee access to health services and reduce costly emergency room visits among undocumented immigrants and others who are ineligible for health coverage.
• Washington state Governor Jay Inslee (D) and Democratic lawmakers proposed new legislation for a public health care plan under the Washington Health Benefit Exchange. The proposed Cascade Care aims to strengthen competition among premiums, provider networks, and care quality. The proposal would direct the Washington Health Care Authority to contract with insurance carriers to offer plans through the state’s exchange. Subsidies would be provided for those who need financial assistance to allow consumers to pay no more than ten percent of their income in premium payments. Physicians would be reimbursed at Medicare rates.

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Breaking Boundaries

Drones are flying high when it comes to overcoming global health care challenges, but barriers remain in the US

During the busy holiday travel season, you might have heard about disruptions at London’s Gatwick Airport where unauthorized drones reported near the runway led to delayed or canceled flights. Drones have been gaining popularity in recent years for both recreational use and for the potential for commercial package delivery. In countries that lack infrastructure, drones are helping to connect patients in remote, hard-to-reach areas to lifesaving medicines and diagnostic tools.

In Rwanda, for example, only a quarter of the country’s 3,000 miles of road are paved. Many dirt roads get washed away during rainy seasons. Hospitals in Rwanda struggle to maintain blood supplies, vaccines, and emergency equipment. For the last two years, the Rwandan government has been working with Zipline—a US-based drone start-up—to make health care deliveries. Remote clinics order supplies via text, and drones are dispatched from fulfillment centers. So far, more than 10,000 flights have delivered thousands of units of blood. The company expanded to Tanzania in 2017.

The government of Vanuatu, a small island nation in the South Pacific, is also contracting with a commercial drone company to deliver medical supplies. In December 2018, a test flight carried out by the island’s Ministry of Health delivered vaccines to 13 children and five pregnant women. Vanuatu plans to integrate drone-enabled vaccine delivery into its national immunization program and wants to use drones more widely to distribute other health supplies.

The data from pilots like these will also be used to show how drones can be used commercially in similar settings around the world.

Despite such success stories, widespread use of drones in the US and around the world faces a number of technological and regulatory barriers. Nearly 80,000 registered commercial drones are operational in the US. That number is projected to climb to 1.6 million by 2021. With more drones in the sky come more opportunities for dangerous crashes with other drones and aircraft. Some stakeholders say that aviation technology is typically ahead of regulatory framework. Regulators around the globe are seeking to develop and update guidelines for use of drones.

Last month, the Federal Aviation Administration released details of a new program that could help verify technologies and provide real-world data to speed the pace of broader regulatory steps to expand commercial drone use. Stakeholders are hoping this program will help the government find more reliable ways to remotely identify and track drones. A proposed rule is expected to be released in coming months, but it could take a year or two to implement it. In the meantime, many US health care companies and retailers are trying to prepare for regulations and are envisioning a day when they can deliver medications, medical supplies, and other health care products via drone.

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