As we live longer and healthier lives, health and life sciences organizations should keep up with our changing needs

My Take

As we live longer and healthier lives, health and life sciences organizations should keep up with our changing needs

By Sarah Thomas, managing director, Deloitte Center for Health Solutions, Deloitte Services LP

I was recently with a friend sitting on a lovely terrace on one of the most beautiful Saturdays I can remember. Looking out over the pretty harbor, we struck up a conversation with a friendly group of people. As is often the case in Washington, the conversation migrated to what we do professionally (I know there are parts of the country where this is generally not the first question someone asks a stranger, but even outside the Beltway, it is a common icebreaker).

One of the women I met that morning turned out to be a geriatric clinical social worker. My friend (an architect who is less familiar with that type of work) asked some good questions about the profession. Rather than jump in with my opinions and years of accumulated thoughts about aging, I decided to sit back and listen. Our new acquaintance said she helps people rethink what achievement looks like, especially as they retire and as success is no longer defined by professional accomplishments. She explained that she helps her clients focus on relationships, experiences, and maintaining a presence out in the world—even if that means using a wheelchair or walker.

Her comments lined up well with our recent research on the future of aging. To get insights on what the future of aging might look like, we spoke with 30 individuals who work in in aging services, policy, innovation, and technology. We discussed how aging might change in the future, what is currently happening that points to those changes, and which societal, policy, scientific, technological, and economic factors will likely change along the path to the year 2040. From our interviews, we found several themes. Here are a few of the many interesting things I learned from this paper.

1. Middle age is lasting much longer: Our health system has been so successful at treating disease that we now have more people living with (instead of dying from) chronic disease. Having a long life is a relatively new phenomenon.
2. Our health issues will likely be much different in the future: Imagine (and I so hope) that in 11 years, scientists have developed a vaccine to prevent Alzheimer’s. Maybe a few years after that, we have access to a targeted treatment, vaccine, or therapy for the 10 leading types of cancer. Imagine remote health monitoring and telehealth are the norm, rather than the exception, and that people respond to nudges to eat right and exercise, which can help lower rates of heart disease and diabetes. As we develop more precision treatments, cures, and preventive medicine techniques for existing diseases, some of the experts we interviewed predict we will need to place greater emphasis on mental and behavioral health, suicide, loneliness, social isolation. They explained that depression, loneliness, and behavioral health conditions caused by social determinants could become epidemics in the 2020s and 2030s. Supporting changing needs (physical, social, emotional, and more) as people age, and meeting them in the places where they spend most of their lives (their homes, communities, work, and retail settings) will likely be critical as the sector places greater emphasis on preventing disease and supporting well-being.
3. Relationships and experiences (will continue to) matter: Researchers have found that in a cohort of otherwise similar individuals, people who have weaker social networks were 50 percent more likely to die earlier than people who are more socially connected. An entire industry dedicated to treating social isolation and loneliness has already emerged. Element3 Health, for example, has created solutions to improve physical, social, and mental activity in individuals. The company’s platform, GroupWorks, connects individuals to group activities based on their social-recreational interests—ranging from arts and crafts to sports and outdoor adventures. The organization says these connections can bring enjoyment, fulfillment, and purpose to their lives. The company says its engagement platform is currently onboarding about 1.5 million members across more than 120 passions. Some governments are also getting involved in this issue. Following a 2017 report that determined 9 million people in Britain suffer from loneliness, the prime minister appointed a minister for loneliness.¹
4. More people will likely work past the traditional retirement age: Some of my older friends, and even some parents of my younger friends, are still working—sometimes in jobs they had when they were younger, and sometimes in new ways. As advances in health care help people stay healthy longer, many people are staying in the workforce longer. Some of them are taking advantage of the so-called gig economy.
5. More people will likely access the health system from home: I know some older people who spend hours visiting doctors, getting tests, and filling prescriptions, all of which involves transportation logistics (even for those who use ride-sharing services), waiting, and keeping track of what was said and what was meant during the visit. As we imagine the future of health, we envision this scenario could change significantly, with most care migrating away from offices and facilities. Instead, we expect to see greater emphasis on information related to health problems, advice, and treatment plans, which will likely be made available through technology.

In the future, we expect that smart homes—enabled by the internet of things (IoT) and always-on biosensors—might become a part of our daily routine. Highly attuned sensors embedded in a bathroom mirror, for example, might track body temperature and blood pressure, and detect anomalies by comparing those vitals to a person’s historical biometric data. An always-on, sensor-driven environment could generate massive amounts of data. But emerging technologies will likely also be needed so data can be continuously gathered, stored by multiple owners, and selectively made available to generate the real-time insights that are essential for personalized, always-on decision-making. This step can be critical to shifting toward a prevention-centric model.

Enabling technology should not stop when people step out of their homes. In the future, communities and services should be set up to support people of all ages and needs. Communities of the future might allow residents to naturally incorporate health and well-being into their everyday lives. Medical and health facilities won’t exist in just once place—they will likely be everywhere as traditionally brick-and-mortar locations shift to mobile-enabled platforms. Community could go beyond the physical structure to focus on virtual communities that support health and well-being. Moreover, many accessibility challenges could be solved as partially, or fully autonomous vehicles become increasingly mainstream. As an added benefit, we could see fewer traffic accidents as a result, which would mean less demand for trauma care.

What does this mean for today’s health care and life science businesses?

Even though I enjoyed thinking about what this future will mean for my own older age and future generations, I think it holds a call to action for our life sciences, health systems, and health plan clients.

A system built on sustaining well-being rather than treating disease could lead to changes in the solutions that companies bring to the market. Business models built around the assumption that costs will rise as people age might not survive this transition. Leading companies should have a strategy for devising new solutions to meet these changing needs. As companies consider the roles they want to play in the future of health and aging, they should decide which solutions are likely to have the greatest impacts on health and well-being.

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¹ U.K. Appoints a Minister for Loneliness, New York Times, January 17, 2018 (https://www.nytimes.com/2018/01/17/world/europe/uk-britain-loneliness.html)

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In the News

New HRA rule could boost enrollment in individual health plans

On June 14, the US Departments of Labor (DOL), Health and Human Services (HHS), and Treasury finalized a regulation that allows employees to purchase individual coverage using employer-funded health reimbursement arrangements (HRAs). The rule lets employers fund an “excepted benefit” HRA with up to $1,800 in 2020 that employees can use to pay for premiums and qualified medical expenses (see the October 30, 2018 Health Care Current). While the final rule allows employees to use HRAs to pay for individual coverage on or off the public insurance exchanges, the funds cannot be used to purchase association health plans (AHPs) or short-term, limited-duration (STLD) plans. According to the administration, the HRA rule could help small and mid-sized companies make health insurance more affordable to employees. It is estimated that this rule could help 11.4 million employees—800,000 of whom are uninsured—obtain coverage. The final rule includes provisions to keep employers from excluding certain groups of employees, such as gravely ill workers or part-time and seasonal workers, from accessing the HRAs.

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Physicians ask Congress for pay raises, APM bonus extension

In a letter to Congress this month, more than 100 physician and provider groups urged lawmakers to change physician payment policies mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA created two tracks for physician participation—alternative payment models (APMs) and the Merit-based Incentive Payment System (MIPS). Physicians who participate in APMs receive a 5 percent pay bump. Under MACRA, however, physicians who participate in APMs are also subject to a pay freeze between 2020 and 2025. According to the provider groups, which includes the American Medical Association (AMA), replacing the upcoming pay freeze with an extended revenue stream could help physicians “invest in the practice improvements needed to transition to more efficient models of care delivery and better serve Medicare patients."

The letter also urges Congress to extend APM incentive payments for six more years. During MACRA’s first six performance years, physicians participating in APMs have received a 5 percent payment as incentive to invest in new technology and workflow systems. According to the groups, the limited number of qualified APMs available during the first three years of MACRA restricted physicians’ abilities to take advantage of this incentive. Additional requested changes in the letter include:

• Allowing physicians to focus their APM participation around a specific episode of care or health priority.
• Giving the US Centers for Medicare and Medicaid Services (CMS) greater flexibility to set the MIPS performance threshold—and to develop multiple performance thresholds.
• Updating the Promoting Interoperability performance category under MIPS to allow physicians greater flexibility to use health information technology for data reporting.

During a Senate Finance Committee hearing last month, witnesses representing several physician groups called for Congress to replace the upcoming freeze on physician payment rates (see the May 14, 2019 Health Care Current).

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FDA seeks to expand participation criteria for clinical trials

In draft guidance issued this month, the US Food and Drug Administration (FDA) outlined recommendations for drug and biologic companies to increase diversity in clinical trials. According to the agency, “broadening eligibility criteria, when appropriate, maximizes the generalizability of trial results and the ability to understand the therapy’s benefit-risk profile across the patient population likely to use the drug in clinical practice, without jeopardizing patient safety.”

FDA notes that several populations are unnecessarily excluded from clinical trials. These include patients who are at the extremes of the age and weight ranges, patients who have physical conditions such as organ dysfunction or who are HIV-positive, pregnant women, and patients who have multiple illnesses and use prescription drugs to treat those conditions. While these patients might be excluded for health or safety reasons, their omission from clinical trials could prevent the discovery of important safety information about investigational drugs, according to FDA. The draft guidance includes the following recommendations:

• Urge clinical-trial sponsors to use enrichment studies, which can allow for the targeted inclusion of certain populations. Sponsors can also use predictive-enrichment designs. Under enrichment studies, treatments are targeted at patient groups based on clinical laboratory tests or genomic factors. Enrichment strategies rely on patient selection based on one or more characteristics that can demonstrate safety or effectiveness for the specified patient population.
• Identify opportunities to reduce participant burden, which can include transportation costs and missed work days. FDA asks sponsors to tell participants about financial reimbursement opportunities for these types of patient costs and allays any questions about undue influence by saying, “FDA does not consider reimbursement for reasonable travel expenses to and from the clinical trial site and associated costs such as airfare, parking, and lodging to raise issues regarding undue influence.”
• Encourage clinical-trial sponsors to work directly with communities to address participant needs, ensure that trial sites are in locations that have diverse populations, incorporate strategies for education and public outreach, and schedule recruitment events during weekend hours.

Public comment for the draft guidance will be accepted through August 6, 2019.

(Source: FDA, Enhancing the Diversity of Clinical Trial Populations — Eligibility Criteria, Enrollment Practices, and Trial Designs Guidance for Industry, June 2019)

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Florida is the latest state to allow drug importation from Canada

Florida is the latest of three states to enact a law allowing prescription drug importation from Canada. Governor Ron DeSantis (R) signed bill HB 19 on June 11, which introduces multiple pathways for importing cheaper drugs from other countries. One pathway allows the state to establish a drug-importation program for use by state agencies, such as the Agency for Health Care Administration, which administers Florida’s Medicaid program. Colorado and Vermont have passed similar laws allowing the importation of prescription drugs from Canada in May 2019 and May 2018, respectively. However, each drug-importation program requires federal approval from HHS before it can take effect. So far, no state has been granted approval. Colorado is required to submit its importation plan by September 2020, and Florida is expected to submit its plan next year. Several other states plan to pursue legislation modeled after these bills, which face strong opposition from US pharmaceutical companies.

The administration has expressed support in allowing prescription drug importation from other countries as long as the drugs are available at a lower price than in the US.

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DoD, VA announce new office for EHR projects

During a June 12 House Committee on Veterans’ Affairs Technology Subcommittee hearing, witnesses from the US Departments of Defense (DoD) and Veterans Affairs (VA) announced plans to jointly develop an office to hold decision-making authority for their collaborative electronic health record (EHR) system. The Federal EHR Modernization Program Management Office will report to both agencies and serve as sole authority for their EHR projects, according to Lauren Thompson, Ph.D., director of the DoD-VA Interagency Program Office. To streamline and simplify record-keeping, VA plans to implement the same EHR version as DoD. According to witness John Windom, executive director of VA's Office of EHR Modernization, VA intends to start implementing the EHR next March. The first installations will be in locations that use the DoD’s EHR to “immediately demonstrate interoperability.”

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Breaking Boundaries

5G will make our phones faster…could it also transform health care?

Fifth-generation cellular wireless, or 5G, is the next iteration of mobile internet technology. While the change from 3G to 4G nearly a decade ago was incremental, the shift from 4G to 5G is viewed as significant because it could make mobile speed 10-to-100 times faster than today. Beyond speed, 5G will likely enable the transmission of more data with less of a lag.

For consumers, 5G might make it possible to download a large file like a movie much faster. For health care, this could make it much easier and quicker to download data—such as information from MRIs. Other health care uses include supporting remote patient monitoring by connecting devices at hospitals and off-site, which can create more reliable virtual-visit experiences, advance robot-assisted surgery, and enable better training through augmented reality. During robotic-assisted surgery, for example, any lag between a physician’s motion and a network’s reaction could be dangerous. 5G is expected to reduce this lag time, or latency. The first 5G-powered robot-assisted telesurgery was successfully tested in China earlier this year on a laboratory animal. The widespread rollout of robotic-assisted surgery will take time to ensure safety and quality standards.

An academic medical center in Chicago is partnering with AT&T to become the first health system in the US to broadly adopt 5G. A trial agreement will allow the health system to set up small cells in strategic places around its flagship hospital. The hospital will also integrate services from AT&T that will allow it to route specific application traffic to different cloud servers, which will help manage traffic across the 5G network. The goal of the trial agreement is to determine how 5G can improve various hospital processes.

If 5G were to be broadly adopted in hospitals, some stakeholders suggest it could support enhanced machine learning and artificial intelligence (AI) to improve patient care. Moreover, 5G also might support augmented and virtual reality to support health-care professional training. While developing smarter hospitals is one goal, improving virtual care and remote monitoring could help more patients avoid the hospital entirely.

For many stakeholders, 5G offers potential to advance health care. However, security concerns and digital equity (ensuring access to digital technologies) likely still need to be addressed. The federal government estimates that more than 20 million Americans don’t have access to the internet, and the problem is worse in rural areas. A 5G network could support internet-connected health care services in rural areas if counties and states invest in the infrastructure.

(Sources: Jessica Kim Cohen, Why 5G matters for healthcare, Modern Healthcare, May 11, 2019)

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