What can we expect to see in the next few decades as medicine progresses? You might think that science fiction and movies are just stories. Pie in the sky. But often, ideas for future procedures are dreamt up in the films we call entertainment. This infographic looks at this in more detail.
Harnessing the full potential of digital innovations in healthcare could have a profound impact on the quality and financial sustainability of health systems. It would also involve profound changes for care providers and healthcare professionals. To shift mind-sets, healthcare authorities will require a clear and compelling vision and ambitious action. But the benefits for both quality and economics will be well worth it.
Right now, the majority of health care is paid for by fee for service. Doctors are paid each time they order a service, such as medical tests, surgery, or medications. The danger is that this can lead to too many tests, too many procedures, too many medications. And since everything in medicine has risks and benefits, we know that doing too much can actually harm patients. Too many prescriptions can lead to harmful side effects or unanticipated interactions among drugs. Doing unnecessary screening tests lead to false positives, images or lab results that indicate there might be a problem, when there really isn’t a problem. This then leads to more and often invasive tests, which carry their own risks. The current system rewards doctors for providing more care and more services, with little regard for whether those services provide any value.
Most physicians are very concerned about antibiotic prescribing and think it’s a bad thing, but when you look at their electronic records, you see they’re doing it fairly often!
Antibiotic resistant illnesses, sometimes called superbugs, are on the rise — affecting 2 million Americans, with as many as 23,000 dying from them each year. And nearly half of the antibiotics prescribed outside the hospital aren’t appropriate or medically necessary.
A lot of people just go to their doctor and say I can’t miss work, I can’t miss school — may I have an antibiotic? Not realizing antibiotics aren’t risk free. They hand them out like M&Ms in a candy jar. We just want doctors to be really mindful when they prescribe.
Many of the problems we face in medicine are doctors’ doing. Physicians are people, too. Not all their decisions are driven by their understanding of disease — they also respond to social cues and the behavior of their peers in making decisions.
Many patients are harmed. Colonoscopies, which are used to detect colon cancer, are one example. They can be effective as a screening tool for people in their 50s and 60s. But as you get older, the lining of the colon thins. So the benefits begin to be outweighed by the risks that the colonoscopy could damage your intestines. A perforated colon requires surgery, and can result in sepsis or even death, while a small cancerous polyp might never kill an elderly person.
Mammograms can also be effective in catching breast cancer early. But they can result in false positives, biopsies, even surgery that does more harm than good. Another example is total hip or knee replacements. For the right patients, replacements can make people active again, which is terrific. But for some people, the risks of infection and other complications may outweigh any benefits. The problem is that the current fee-for-service model encourages even well-intentioned doctors to do procedures that may do more harm than good.
The profession is beginning to recognize this. For example, the American Board of Internal Medicine (ABIM) has developed an initiative called Choosing Wisely with a list of procedures and tests that are over-utilized given lack of evidence that they benefit patients. Examples include routine imaging for low back pain and use of antibiotics for upper respiratory infections.
Now there is a new approach called Accountable Care Organizations, or ACOs. The idea is simple. Instead of rewarding doctors and hospitals for the volume of services they provide, the system rewards them for keeping patients healthy—keeping them out of the hospital, for example, and for preventing illnesses and complications. ACOs are accountable both for the cost and quality of care for patients.
Hospitals or doctor groups that decide to become ACOs must agree to meet quality measurements. With all patients, the strategy is to engage them, to give them the most complete information, to support them in their treatment plan, and to prevent unnecessary hospitalizations or readmissions. It is called shared decision-making. In the case of cancer, patients should be given information about all the treatment options—chemotherapy, radiation, surgery, or watchful waiting—and then decide, in collaboration with their doctors, what’s best for them.
How do you fit that long-delayed appointment with your doctor into your jam-packed schedule? Telemedicine is your answer. Telemedicine technologies can connect you and your doctor in cyberspace. Telemedicine redefines modern health care. With the aid of wearable health monitors, computers, and video, doctors are able to evaluate, diagnose, and treat you—all without your physical presence in their office.
These technologies offer convenience and huge potential cost savings, but they are not without controversy. Some doctors are concerned about the safety of prescribing drugs without examining the patient in person. Can they really assess what the patient needs over a video link? They also worry that telemedicine could depersonalize your health care. In addition, some medical problems will always demand a physical exam.
Still, some aspects of telemedicine are likely in your future, if they aren’t already. Here’s what you need to know about this form of health care, and how to use it for your advantage.
Telemedicine provides opportunities to keep people healthy and outside of hospitals. For example, in certain regions and medical practices in the US:
You can send a digital image of a suspicious rash, along with your medical history, to a dermatologist, who will review it, diagnose, and prescribe medication to treat it.
You can check-in with your doctor after surgery for follow-up care in your own home.
If you have diabetes, you can monitor your blood sugar levels at home and upload the readings to your doctor’s computer, saving yourself a time-consuming visit. Irregular blood sugar levels would generate an alert to the doctor’s staff to call you in for immediate intervention to prevent complications. If you have hypertension, you can wear a monitor that tracks your blood pressure daily and transmits your results to your medical record, allowing your doctor to track your progress.
United Healthcare, announced that it has established a partnership with Doctor On Demand, along with two other telemedicine companies. United Healthcare says that 20 million of its insured patients are able to use their smartphones to consult with doctors.
Here are some of the key pros and cons to help you decide. Among the pros:
- Convenience. Need a quick consultation with your doctor? Telemedicine can save you travel time and the hassle of sitting in a waiting room with other sick people.
- Increased rural access. There’s a shortage of doctors in many rural areas of the US. Telemedicine has a unique capacity to increase medical service to rural patients.
- Cost and efficiency. Doctors often charge less for a telemedicine consultation than they do for an in-person visit. A telemedicine consult might cost $40 to $70, compared for $130 to $180 for an office visit. In addition, telemedicine allows doctors to efficiently and closely monitor patients with chronic conditions such as diabetes and high blood pressure.
- Second opinions. Telemedicine allows a far-away specialist to evaluate your MRI, X-ray, or other scans and tests. This will help patients who want a second opinion, as well as doctors who want to consult with experts on complicated cases.
Despite this wide range of potential benefits, telemedicine still has its share of downsides:
- Inadequate assessment. When consulting your doctor online you don’t get a physical examination. Certain non-verbal cues might still slip through the cracks. Your doctor must rely on your own descriptive abilities instead of his or her own expert touch. At worst, this could lead to an improper diagnosis.
- A depersonalized experience. Telemedicine may be more impersonal than a face-to-face visit with your doctor. A good doctor-patient relationship is characterized by trust and intimacy. Patients often bring up issues during a doctor’s visit that go beyond their immediate health problem.
- Electronic defaults. Technology is only as reliable as the electrical current that keeps it running. If your Internet connection is disrupted, your session will stop instantly. Technical problems could complicate your online consultation or remote monitoring.
Healthcare companies are developing new digital technologies to give consumers more control over the care they receive. That could upend the industry’s move toward greater consolidation and scale.
In the not-distant future, financially accountable, tech-enabled consumers may avail themselves of a range of discrete digital health services from a variety of providers. As a result, they would be able to create their own health-management ecosystems, acting as stewards of their care and controlling not just where they access it but also how and from whom, as well as the price they pay. The impact of these changes—the friction created between large, fully integrated healthcare systems that prioritize efficiency and scale, and newer, more distributed digital upstarts emphasizing speed and the consumer experience—could put up for grabs $270 billion of the incumbents’ current revenues and an additional $13 billion to $24 billion in new ones.
Admittedly, several significant barriers must be overcome before that shift in the sector’s dynamics can fully take root. At present, the effectiveness of many digital and mobile technologies remains to be proved. In fact, the IT platforms needed to aggregate data and to integrate the consumer experience across care venues and new modalities (e-visits, for example) remain to be built. Other hurdles include concerns about information security and about who should underwrite the cost of adopting these solutions at scale, as well as the potential need for US Food and Drug Administration (FDA) approval of some devices. But even the modest adoption of the new technologies could have enormous implications for providers and health insurers alike.
According to our research and analysis, technologies that make it possible to deliver primary care less expensively could save $175 billion to $220 billion a year if they came into widespread use. Although consumers are likely to be the primary beneficiaries of the savings, incumbents will probably capture some of the money. Increased automation and self-service could lower their overall administrative costs by an additional $24 billion to $48 billion annually through productivity gains.
Although some of the new technologies will replace more expensive services, others (personal diagnostic devices, for example) will create new classes of offerings. Furthermore, healthcare-utilization levels may rise once primary care becomes cheaper and more accessible. Combined, these factors could generate $13 billion to $24 billion in new revenues for incumbents and technology companies.
To better understand the path to this reordered landscape and its implications for participants in the sector, we interviewed technology innovators, investors, healthcare providers, and insurers. We also surveyed thousands of US consumers. Our research revealed five key findings, three of which we outline here:
Consumers are starting to replace traditional healthcare services with digital ones. Although utilization trails awareness, inroads are being made, particularly among younger Americans. Millennials, for example, are twice as likely as Baby Boomers (and three times as likely as people born before 1945) to use email or text messages to communicate with physicians.
Investment in digital and mobile health and in related technologies is robust and growing. The strongest growth has occurred among direct-to-consumer technologies that require little or no involvement by physicians (for example, wearable fitness trackers and scheduling applications) and among intermediated technologies (more complex ones, such as remote diagnostic equipment, that require a doctor’s prescription). Investors appear equally interested in both, but for different reasons: direct-to-consumer technologies for their ability to achieve scale quickly and intermediated ones for their greater cost-reduction potential.
New technologies address consumer dissatisfaction with the current healthcare system. These technologies fall into six categories, all of which could alter the economics of the healthcare system:
- self-service tools that make it easier to schedule appointments, renew prescriptions, and pay bills
- “quantified self” and wellness tools that assess a patient’s health status, monitor adherence to treatment, or enable coaching, as well as devices that can be worn, ingested, or embedded in the human body
- clinical-transparency tools that help patients use healthcare services more appropriatelyby enabling them to make more informed decisions
- financial-transparency tools that help consumers to compare prices and benefits from different health plans and providers
- virtual-access tools that enable consumers to consult with doctors online, to be monitored remotely, or to receive certain types of care at home
- IT platforms that aggregate data from different tools and enable them to work together, as well as technologies that help consumers receive information through multiple channels
While it remains unclear who will pay for the new technologies, most of the stakeholders we interviewed believe that employers, providers, and insurers will assume this responsibility.
The more engaged consumers enabled by new digital health technologies could shift the sector’s dynamics in three ways:
- The basis for competitive advantage changes. The geographic scope of competition, historically concentrated in metropolitan areas, could broaden, especially once digital access points, such as self-service tools, become more prevalent and price- and quality-transparency tools alert consumers to higher-value alternatives.
- Consumers become clinical-data integrators. Increasingly, consumers could own and manage their clinical data, which would allow them to decide for themselves who should gain access to that information (and when) in clinical, transactional, and administrative settings.
- The roles of providers and insurers evolve. Providers, especially physicians, could find themselves spending less time gathering information about their patients and more time helping them make sense of the information already gathered. Insurers may become trusted advisers, helping consumers to understand how best to manage their financial accountability and risk preferences. They’ll have competition for this role, though. Retirement and wealth advisers, for example, could include health-risk assessments and estimates of health costs in the advice they give clients.
Notwithstanding the barriers, incumbents should be prepared to make bold changes to their business and operational models to compete in a digital healthcare landscape. Their approach to the coming transformation should be comprehensive and integrated, not a series of random, disconnected initiatives. The transformation process will require frequent trade-offs between physical and digital assets, and all bets on new technologies will probably have to be reviewed every three to six months.
Incumbents shouldn’t rely on price as the sole point of competitive difference. Those that prevail will be defined by how well they know their customers—and by how customers behave in a given scenario. Physically active consumers, for example, may be price seekers when they shop for primary-care services but completely indifferent to price when they look for orthopedic surgeons.
The full impact of engaged, tech-enabled healthcare consumers may not be felt for five to ten years, but now is the time for providers and insurers to start preparing for the new reality. If they don’t, they might find it too late to remain in the game. In other sectors, many companies that didn’t prepare for the impact of digital and mobile technologies eventually lost out to more nimble new entrants.
Having an optimistic outlook on life, a general expectation that good things will happen, helps people live longer. People who are optimistic have a significantly reduced risk of dying from several major causes of death — including cancer, heart disease, stroke, respiratory disease, and infection.
While most medical and public health efforts today focus on reducing risk factors for diseases, evidence has been mounting that enhancing psychological resilience may also make a difference. We should make efforts to boost optimism, which has been shown to be associated with healthier behaviors and healthier ways of coping with life challenges.
Optimism can be altered with relatively uncomplicated and low-cost interventions — even something as simple as having people write down and think about the best possible outcomes for various areas of their lives, such as careers or friendships. Encouraging use of these interventions could be an innovative way to enhance health in the future.