Is 2020 the year life sciences companies push past their 20th century models?

My Take

Is 2020 the year life sciences companies push past their 20th century models?

By Mike DeLone, US life sciences leader, Deloitte LLP

As a technologist, I have been talking about the idea of interoperable data and service-oriented architectures for years, maybe decades. Even just a couple of years ago, we were still framing interoperability as being the wave of the future. I think the future has arrived on our doorstep, and 2020 could be the year that we finally cross the threshold. I also expect life sciences firms will be focusing even more attention on the patient experience next year. More about that later.

In just the last year or two, I have noticed a mental shift among many of our clients in the life sciences sector, and I expect that shift will move faster in the year ahead. Rather than talking with clients about why they need to move toward interoperability, I anticipate we will be spending more time exploring cloud platforms and other natively interoperable and API-based architectures that are needed to attain interoperability.

The anticipated federal regulations around interoperability were recently delayed, giving stakeholders some breathing room to comply. We are encouraging our health care and life sciences clients to continue to push forward next year so that they are prepared once the final regulations are released. From my perspective, interoperability is synonymous with the future of health. I see it as the foundation of our vision. When we think about interoperability, we are talking about processes, architecture, standards, stakeholders, insight, and culture. We are talking about information across every organization’s employees and functions. This includes information generated by regulators, customers, patients, doctors, and caregivers. It also includes data produced by wearable devices, sensors…even smart pills.

Deloitte’s vision for 2020—and the years ahead—goes beyond interoperability. We are predicting radical interoperability based on the sheer volume of data that could become available and analyzed in the future. It’s not far-fetched to think that the world could contain 100 billion connected devices 10 years from now or sooner. That means trillions of connected sensors that could lead to the development of new therapies or preventive measures specifically tailored for each individual. Personalized health data combined with artificial intelligence (AI) could also lead to the development of personalized electronic health-coaching advocates and fundamentally change not just the patient experience, but the human experience, too.

Expect to see even more focus on the patient experience in 2020

While the drive toward improved interoperability and other advances in technology could drive more efficiency in the year and years ahead, we are urging life sciences leaders to consider ways to increase value and meaning across the board—for patients and consumers. Which treatment/preventive measure is working? For whom? And at what cost? By answering these questions—and by taking a holistic approach to measuring the human experience—life sciences companies can improve the value they offer for all stakeholders. Our upcoming 2020 global life sciences sector outlook takes an in-depth look into why life sciences companies should consider a holistic approach.¹

Why should life sciences firms focus on a holistic patient experience? It is important that we develop a better understanding about patients who are living with a specific disease or condition. By understanding, mapping, and learning from all the touchpoints a patient might experience along their journey, an empathic solution can be built to address the patient’s needs—from health to diagnosis to research to treatment and beyond.

Here are three more trends that I expect will have an impact on life sciences companies in 2020:

1. Organizations from outside of health care will continue to enter this space: In 2020, we expect that consumer and technology companies will continue to enter the health sector—possibly at an even faster pace than in prior years. In some cases, they will enter this market with limited experience in health care…but absolutely no fear. They might create new internet-connected devices that haven’t previously been connected, and they will be attacking health from a completely different perspective. Some of these companies are already doing significant work using AI and interoperable data. They are building architectures and platforms where future data will live. Case in point: Last month, Amazon Web Services announced a new cloud based “AWS Data Exchange” service to help customers securely find, procure and consume data and information across all industries, including health care and life sciences. Several large health systems have announced plans to move their clinical data to cloud platforms operated by large technology companies. Cloud storage and cloud computing—combined with artificial intelligence (AI), cognitive analytics, and machine learning—will likely continue to accelerate the pace of medical research, which could lead to more precise treatments and cures.
2. Clinical trials could become more inclusive: Also important to medical research is the advancement of clinical trials. To have statistical value, it is critical that clinical trials are representative of the patients who will eventually use a drug or therapy. A major challenge for the pharma sector is recruiting trial participants from important demographic groups that include racial and ethnic minorities, women, and the elderly.² Life sciences companies should consider changing the way they think about the clinical-trial model. Case in point: Johnson & Johnson’s pharmaceutical arm Janssen recently announced plans to launch a clinical trial that will allow 1,900 patients to participate virtually. The study intends to gather real world evidence to support a new cardiovascular indication for a new diabetes therapy.³ I believe we are at the dawn of the age of mobile health and will likely see more companies experiment with new clinical trial models in 2020. Organizations that successfully tap into this technology will reach populations that were once inaccessible. The ability to tap into larger and more diverse populations will only happen if companies reimagine the way that these trials are done.
3. Behavioral science could play a bigger role: We talk a lot about using data to improve patient engagement. While data on its own tends to have a limited effect on behavior, combining data with an element of gamification or even competition can be highly effective. Case in point: Earlier this year, about 600 Deloitte employees (from 40 states) participated in a 36-week randomized clinical trial to determine if a wearable activity-tracker—combined with gamification—would increase physical activity among overweight and obese adults. The STEP UP study was led by the Perelman School of Medicine at the University of Pennsylvania. Participants who used a fitness tracker that was paired with an element of competition took an average of 1,166 more steps per day than participants who had a fitness tracker alone. What does that mean for life sciences companies? Along with pushing people to take more steps, life sciences companies might use behavioral science to improve medication adherence, for example. Behavioral science could have just as much impact on health as medical science. The promise of precision medicine, of wellness, of radical interoperability…none of it is possible if we can’t influence decisions a patient or consumer would have otherwise made. Behavioral science can offer the clues, and I expect life sciences companies will be paying closer attention to this in the year ahead.

We are moving closer to the promise of true precision medicine and a future of health where we learn from every radically interoperable data point in the context of every patient. When we look back 20 years from now, I expect 2020 will be seen as the year life sciences firms finally moved past their 20th century models and stepped into a new era.

Email | LinkedIn

¹ Measuring human relationships and experiences, Deloitte Insights, June 20, 2019
² Why improving inclusion and diversity in clinical trials should be a research priority, UK Centre for Health Solutions, Deloitte Services LP, September 4, 2019
³ AHA: Janssen drops clinical sites for smartphones, wearables in 100% virtual Invokana study, FierceBiotech, November 16, 2019

Back to top

In the News

House approves sweeping legislation targeting drug costs

On December 12, the House passed a bill seeking to lower prescription drug prices. The bill, which House Speaker Nancy Pelosi (D-Calif.) proposed earlier this year, empowers the federal government to negotiate the cost of drugs in Medicare and in private insurance plans and limits prices to those in other countries (see the September 24, 2019 Health Care Current). Although the House approved the measure by a 230-to-192 vote, the Senate has its own legislation to lower drug prices and might not take up the House bill, let alone pass it (see the November 26, 2019 Health Care Current).

Recent estimates from the Congressional Budget Office (CBO) and House Democrats are that the drug-pricing bill would save up to $500 billion over the next decade (see the December 10, 2019 Health Care Current). The savings could pay for additional drug research and translate to less cost sharing for Medicare beneficiaries who have prescription drugs. According to CBO, the bill could also mean fewer new drugs enter the US market than would have been the case without the legislation. The trade group Pharmaceutical Research and Manufacturers of America (PhRMA) opposes the legislation and has highlighted the point that enacting the bill could result in fewer medicines.

Back to top

White House agrees to remove biologic drug protections from final USMCA deal

The White House last week agreed to remove biologic-drug patent protections from the United States-Mexico-Canada Agreement (USMCA), which would eliminate exclusivity periods as part of the final trade deal. The original agreement included 10 years of exclusivity for biologics. The pharmaceutical industry has argued this period is necessary so that money can be re-invested in research and development for future lifesaving drugs. Several biopharma companies have spoken out against the move, which they contend fails to protect pharmaceutical intellectual property in international trade negotiations. Democrats have applauded the decision, stating that it could hold down price increases by allowing more competition from biosimilars. In addition to the removal of exclusivity periods for biologics, the final version of the USMCA also cut language around patent evergreening, which would have limited brand-name drug companies from extending a patent when they discover a new use for the patented drug.

(Source: PoliticoPro, USMCA deal ditches new protections for big pharma, December 10, 2019)

Back to top

Health care costs cause more Americans to delay medical care, Gallup finds

About one out of four Americans say the cost of treatment caused them to delay care for a serious medical condition this year, according to Gallup’s annual Health and Healthcare poll. An additional 8 percent of respondents said costs played a factor in deciding to put off care for less serious conditions. In 2018, 19 percent of Americans said treatment costs led to a delay in treatment for a serious condition.

The poll tracked a few trends within this data, including the following:

• Household income: 36 percent of adults with household income of less than $40,000 reported delaying treatment for a serious condition, a jump in 13 percentage points since last year. Rates stayed relatively flat for middle- and high-income households.
• Pre-existing conditions: Americans who reported having a pre-existing condition, or living with someone who has, were more likely to delay medical care for a serious condition this year compared to 2018. 

According to Gallup, these trends could have broad implications for both the health care system and the economy.

(Source: Gallup, More Americans Delaying Medical Treatment Due to Cost, December 9, 2019)

Back to top

MA plans face some challenges in offering supplemental benefits, despite policy changes

Medicare Advantage (MA) plans would like more information about the types of benefits that are allowed under new supplemental benefits rules and more clarity around defining subpopulations that can get those benefits, according to a report published by the Duke-Margolis Center for Health Policy and the Robert Wood Johnson Foundation. Researchers interviewed leaders from MA plans to understand the barriers they face in taking advantage of the increased flexibility created by the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (for more on the CHRONIC Act, see our paper on addressing the social determinants of health).

In 2020, Medicare enrollees who have a serious illness will see more plans offering adult daycare/adult day health services, palliative care (including home-based palliative care), non-opioid pain management, and in-home support services. However, the number of plans offering caregiver support declined from 389 in 2019 to 82 in 2020. This change is primarily due to one major health plan operator that stopped providing this benefit in all of its offerings. The researchers also found that markets with higher MA penetration tend to have more plans that offer supplemental benefits to individuals who have a serious illness.

Health plan leaders noted several challenges in adopting these new benefits. For one, it can take years to develop and price a new benefit. Some programs have limited evidence and require additional piloting to understand the impact they could have on enrollees. Second, the added flexibility does not come with additional funding, though MA plans can use Star Ratings bonuses or rebates to cover the cost. Lastly, health plan executives said that community-based organizations, which typically provide the services, often lack the ability (e.g., liability insurance requirements, technical capabilities to receive, store, and transmit health information) to contract with health plans or to scale services to all of their members.

(Source: Duke-Margolis Center for Health Policy and Robert Wood Johnson Foundation, “Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits,” December 2019)

Back to top

Breaking Boundaries

Here’s a look at five innovations that could change health care in 2020

It’s the time of the year when leaders from the health care sector and other stakeholders ponder the year ahead and make their predictions about some of the trends and innovations we might see. Here are a few that The Medical Futurist is expecting to hear more about in 2020 and beyond:

• Quantum computing: Most computers work by manipulating bits that exist in one of two states, a 0 or a 1. Quantum computers aren’t limited to these two states. They encode information as quantum bits, or qubits. Qubits represent atoms, ions, photons or electrons, and their respective control devices work together to act as computer memory and a processor. Because a quantum computer can contain these multiple states simultaneously, it has the potential to be millions of times more powerful than today's most advanced supercomputers. The applications of quantum computing to health care range from faster drug design, to quicker and cheaper DNA sequencing and analysis, to more secure medical data. While the technology does hold such promises, we have to overcome some challenges to make this innovation practical and widespread in health care.
  
• Exoskeletons: There has been considerable progress in exoskeletons. For example, a man with tetraplegia (a paralysis that results in the total or partial loss of all four limbs) was able to control an exoskeleton with his brain. And in Europe this year, the first exoskeleton-aided surgery was conducted. Surgeons performed a 12-hour urological surgery wearing exoskeletons that supported their lower limbs and pelvic region, which helped stave off fatigue from standing. Stakeholders expect more exoskeleton use-cases to hit the market in the coming years as the technology becomes more affordable and lighter.
• Voice-to-text solutions: The time needed to enter data into electronic health records has contributed to physician burnout as doctors spend more time with computers and less time caring for patients. Voice-to-text technology could become more mainstream in the years ahead, and more physicians could take advantage of voice dictation solutions to more effectively capture patient encounters. If this translates to less administrative work, physicians will likely have more time to spend with patients.
  
• At-home analysis of bodily fluids: Saliva, blood, urine, and feces all hold valuable clues to our health. By analyzing these fluids, some startups and tech companies are developing tests that let consumers send samples from home for analysis. Deloitte’s 2018 survey of US health care consumers found that 45 percent of consumers are comfortable using an at-home genetic test to identify existing or future health risks, and 44 percent are comfortable using an at-home blood test (finger prick) that connects to an app to track overall health trends.
  
• Mixed reality: Medical education has not changed much over the past several decades. Mixed reality (a technology that superimposes virtual, interactive images onto the real world via devices) could change that. Future physicians are getting detailed lessons on the human anatomy using mixed-reality devices. Mixed reality can also be used to train surgeons and expose them to rare medical conditions they might not otherwise encounter.
  

As we look back at the last year, it is clear that talented entrepreneurs and innovators remain passionate about making positive changes in health care and that health care start-ups are alive and well. For more on what innovations in health care we could see in 2020, see Mike DeLone’s 2020 life sciences outlook above, and Steve Burrill’s outlook for hospitals and health plans. Also, watch for our annual Tech Trends report next month.

(Source: The Medical Futurist, Top 10 technologies we are excited about, December 3, 2019)

Back to top