The Future of Health: You need to believe it to see it

By Neal Batra, principal, Deloitte Consulting LLP

Over the past several months, my colleagues and I have been detailing Deloitte’s vision for the future of health to our health and life sciences clients. In meetings and presentations, we describe a landscape that looks vastly different from what we have today. Some of our clients are understandably skeptical—especially considering some of the dramatic changes we anticipate. While it is impossible to accurately predict details when gazing 20 years ahead, we are confident that our vision is directionally accurate.

In just the past couple of years, we have witnessed a wide range of scientific breakthroughs—from stem-cell therapies to microscopic cancer-killing nanobots¹—that were likely inconceivable 20 or even 10 years ago. But science is just part of the transformational changes ahead, and we expect new innovations will soon begin to surface at an exponential pace. These breakthroughs, which will help define the future of health, will likely be less invasive, less expensive, more precise, and more convenient than what we have today. 

Five defining truths for the future of health

We are urging our clients and other stakeholders to suspend their disbelief so that they can see what we see and take appropriate actions to prepare. Below are five defining truths which, when linked together, are guiding our vision of the future of health (along with a few frequently asked questions from some of our clients)

1. Data sharing
Question: If consumers gain full ownership of their health data, will they find it useful? Will they be willing to share it with stakeholders?

Strong participation in data sharing is a key component of the future of health, and we expect that consumers will not only be willing to share it, they will be motivated to share it. According to our 2018 survey of health care consumers, people are growing more comfortable with the idea of data sharing. About 60 percent of surveyed consumers told us they are willing to share personal health data (e.g., generated from wearable devices, apps, or always-on sensors) with their doctor to improve their health. Along with helping individuals maintain or improve their own health, we know that sharing data generated by wearable devices can help improve population health, advance clinical research, and enhance the performance of the device itself. Over the next 20 years, personal health data will likely be far more robust and accessible…and it will be owned by a consumer who sees value in sharing it with appropriate stakeholders or researchers.

Consider these examples:

• Northwestern University has developed a wearable device equipped with an always-on sensor that can analyze the chemicals in a person’s perspiration and provide real-time information about the wearer’s levels of chloride, glucose, and lactate (high levels could signal cystic fibrosis, diabetes or a lack of oxygen).
• doc.AI is a mobile application that stores biologic data points (omics) and applies advanced analytics to predict health outcomes.
• Health Wizz, a Virginia-based start-up, developed a secure mobile application that helps consumers organize and aggregate health data generated by providers, labs, and wearable devices, and share it, or sell it to interested buyers, such as pharmaceutical manufacturers.
• Nebula Genomics performs full genome sequencing. Consumers can decide it they want to sell their data to researchers and pharmaceutical companies.

As the ability to easily and securely share personal health information becomes a reality, interoperable data will likely become indispensable.

2. Interoperable data
Question: Some hospitals, physician groups, and other stakeholders still have trouble sharing digital data internally. How can they be expected to gather, share, and analyze vast amounts of data flowing in and out of their systems from patients, devices, and traditional and non-traditional health care stakeholders?

The US Department of Health and Human Services (HHS) is pushing stakeholders to make data more accessible and user-friendly. In February, HHS’s Office of the National Coordinator for Health Information Technology (ONC) released proposed rules aimed at driving the US health care system toward greater interoperability of electronic health records (EHRs).

This is an important step that we expect will lead to the development of large aggregated data sets that provide a real-time and holistic view of the consumer and their environment. These data sets can enable advanced analytics to generate novel insights in real-time. Incoming data from various sources can be standardized, aggregated, stored and continuously updated.

In the future of health, radical interoperability can allow us to collect and connect all of a consumer’s data. Imagine taking an individual’s biologic data and combining it with health information from a wide range of sources—even population and environmental data—and storing it in one secure and accessible place.

Interoperable data can help to break down barriers that can hinder access.

3. Access
Question: Factors such as geography, socioeconomic conditions, and even health care literacy keep some people from receiving medical care when they need it. How can these barriers be broken?

We envision a radically transformed health system where the cost of wellness and care has plummeted thanks to interoperable data and data sharing. Technologies such as virtual health are already beginning to shatter many barriers that have kept some people from accessing care or maintaining their well-being. Such programs could also allow clinicians to stay in close contact with their patients. The Deloitte 2018 Surveys of US Health Care Consumers and Physicians found that consumers and physicians agree on the benefits of virtual care for improving access to care. Sixty-four percent of consumers and 66 percent of physicians said virtual care would improve access to care. In addition, health stakeholders are likely to have a more thorough understanding of social determinants—where people work, where they live, what they eat, and how they get around—and the impact it has on their health.

Consider these examples:

• Tele-stroke and tele-ICU programs are already being used to ensure coverage at rural and critical access hospitals that do not have enough specialists on staff. 
• Beyond Verbal, a voice-analytics company uses a smartphone app to extract various acoustic features from the speaker’s voice, in real time, and provides insight into personal health conditions. Research has already been done to identify vocal biomarkers for coronary artery disease, Autism Spectrum Disorder, and Parkinson’s Disease.
• CareCoach uses a personalized care avatar and clinical algorithms to deliver enhanced 24/7 personalized psychosocial support, health coaching, scheduled reminders and automated alerts to care team. The goal is to reduce risk, enable aging at home and better manage care.

Access in the future will likely stretch far beyond virtual care and will incorporate always-on and often-on sensors that can immediately identify potential health issues well before they become a problem. As health care becomes more accessible to more people, consumers will likely begin to feel more empowered.

4. Empowered consumers
Question: The idea that the consumer will move to the center of the health care universe is not a new concept. Patient-centered care and consumer-driven health are terms that stretch back decades. What is different now?

Consumers have historically been passive participants in their health—they have followed doctor’s orders. An empowered consumer, however, is motivated to take control of their health destiny. As people become aware of the health data they are generating, they will likely want to control it. In response, markets, clinicians, vendors, and other stakeholders should adjust their business models to cater to (and enable) empowerment. As a result, more efficient digital tools can be created that allow consumers to dig into their personal health data to create an even greater sense of empowerment. People who don’t feel empowered are likely to be motivated by others, which creates a movement and a broad population shift.

Digital tools, apps, and transparency can help to enable the empowered consumer. Consider this: The number of consumers who track their own health metrics has more than doubled over the past three years, according to our survey of health care consumers. At-home self-diagnostic and genetic tests are becoming more prevalent and could be used to identify potential future health issues. 

Consider these examples:

• 23andMe: In 2017, the FDA gave the genomics and biotechnology permission to market its at-home genetic health-risk test for 10 diseases or conditions.
• Amazon Web Services recently launched software that uses artificial intelligence to mine patient information from multiple sources, including electronic health records (EHRs) and unstructured medical text, such as hospital admission notes of patient medical histories.²
• UnitedHealth Group intends to give 50 million members access to a “fully integrated and fully portable” electronic health record (EHR). Along with medical information, members will receive the “next best action detail” for maintaining or improving their health.³

Empowered consumers will be more likely to take ownership of their wellbeing and change unhealthy behaviors.

5. Behavior change
Many chronic diseases can be prevented if identified early or modified by behavior. However, patients sometimes don’t feel empowered, or they lack the tools needed to take charge of their health. By 2040, people who help us maintain our well-being may use behavioral economics to nudge us toward healthy behavior without us realizing it. They will understand what motivates us and what discourages us. As AI and machine learning become more sophisticated, the scalability of these tactics can grow. The introduction of artificial intelligence, virtual and augmented reality, remote care, and always-on sensors will help us tailor prevention and care to the needs and interests of the consumer. Consider the following:

• By including behavior change along with treatment, some diabetes and hypertension clinics have been able to reduce HbA1c levels by as much as 400 percent. The goal is to use data to identify effective nudges that eliminate barriers and motivate patients to exercise more, eat better and take drugs that are prescribed.

• Zipongo, a digital nutrition platform, says it delivers real-time support for all the places a person makes food decisions. Pointing users to the healthiest option reduces the likelihood of making poor food choices based on convenience, cost and other factors. According to the company, people with diet-related chronic conditions cost health plans an average of $1,429 more than other patients.

• Care.coach, a California-based start-up, uses avatars (often in the form of cartoon animals), to provide around-the-clock personalized health coaching, disease management, and psychosocial support. Behind the animated character is a team of health advocates who use the avatar to engage with patients to help them or their caregivers manage their health.

When I was growing up, the year 2000 seemed almost inconceivable, and the innovations that we take for granted today would have seemed like science fiction to my younger self. It is difficult to imagine where health will be in 2040, but if you believe that these changes are real—and that they will only become more pervasive as time goes on—then you will more clearly see the large-scale disruption we’re predicting for the health care and life sciences ecosystem. This disruption will force organizations to play across multiple archetypes, and winning organizations can differentiate themselves to create a unique business model that meets the needs of the empowered consumer. To see this future, you first need to believe it.

^{Endnotes
1. Nature Biotechnoloyg, “A DNA nanorobot functions as a cancer therapeutic in response to a molecular trigger in vivo,” https://www.nature.com/articles/nbt.4071
2. Amazon press release, November 27 (https://press.aboutamazon.com/news-releases/news-release-details/amazon-web-services-announces-13-new-machine-learning-services)
3. UnitedHealth Group October 16, 2018 third-quarter earnings call transcript (https://seekingalpha.com/article/4212003-unitedhealth-group-inc-unh-ceo-david-wichmann-q3-2018-results-earnings-call-transcript?part=single)}

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