I’m gonna put my name on the record as to say the next 10 years will be the most exciting in the history of the healthcare industry. The stars of the system are aligning in a way where everything important is about to change in the industry:
1. How and why we pay for healthcare is changing.
2. The role of technology in healthcare is changing.
3. The roles of healthcare professionals are changing.
4. How we experience healthcare is changing.
No other time in the history of medicine have we seen so much change all at once. Once these changes happen healthcare will never be the same. If we can get this right, healthcare will reach a new level of quality and access that our experience of healthcare in the last 100 years will seem primitive in nature. It is truly exciting to be at this undeniable inflexion point. These are my humble thoughts on how these changes will manifest. I may be completely wrong, I may be missing some important perspectives from above, but these thoughts seem right to me…
1. How and why we pay for healthcare is changing
In three words this means — value-based care! Care will be paid for based on the outcomes it provides. That’s it. What is value?
Value = The set of outcomes that matter for a condition / The total costs of delivering these outcomes over the full care cycle
That is to say value is about providing the best set of outcomes for an individual’s condition, at as low a cost as possible! That is value. We don’t do this in healthcare today. In the majority of healthcare systems across the world we simply pay for what the doctor thinks needs to be done. That’s it. In healthcare speak, its called fee-for-service. Pay for what is serviced. That’s it.
In the next 10 years, I see the momentum of ever-increasing costs and stagnating outcomes (in some regards deteriorating outcomes) force the gears of the system to become value-based. It will be painful, it will be challenging. But the expertise, knowledge and ideas to make this happen exist. In the UK it’s in organisations like Outcomes-based healthcare (OBH) — who are world experts at delivering value-based care. Everything I know about this is from them. This is the single biggest and most important change for the industry. Why? Because this change will finally help align incentives to provide the best possible care for the patient at the lowest possible price. The system today is not aligned to do so. The NHS you could argue is shining light on a system that is designed to maximise outcomes per total cost. But we still have wide holes in our payment incentives. The USA will feel the most visceral pain from this change because it has the furthest to go to make this change. Arguably though they also have the most to gain.
So who will make this change? Policy. Policy, policy-makers and all the influencers of policy will make the change here. The tide of evidence around this is too large and significant to ignore. We are seeing this with the grouping of primary care practices in the UK into Primary care networks (PCNs) and the adoption of Next-generation Accountable care organisation (ACO) models in the USA. Both encourage providers and suppliers of care to work together to provide the best outcomes for patients at a lower cost of care. The savings made will allow the system to reinvest those savings and continue to improve outcomes rather than hinder it.
2. The role of technology in healthcare is changing
As policy aligns to provide the best outcomes for patients at the absolute best price, technology by nature will need to be considered as part of enabling better ‘value’. Not because technology, is ‘cool’ or ‘innovative’ or ‘new’, but because it is the most powerful tool known to man. Technology has allowed us to be so much more as humans, but also in some regards be so much less. Channelled in the right way, I am confident though, technology will help us achieve the value we all desire in healthcare. In fact, I would go as far as to say it is an essential component. Without it, we only work within the constraints of our human ability alone. The augmentation of technology and humans in healthcare is only just beginning — this joint point almost has no constraints.
This is not to recognise that technology today used in healthcare has not been hugely fruitful for patients and healthcare professionals. But I argue, the technology of the past was designed in a system with the wrong incentives. With this, I am largely referring to the electronic health records (EHRs) that currently plague the industry.
Think of everything in your life where you utilise technology today. Now think about it before technology played a role. That’s the change I’m talking about in a healthcare system with the right incentives. I could honestly write an entire book about the ways in which technology will have a massively positive impact on healthcare. But the broad areas are these:
- providing easier access,
- delivering faster quality insights,
- personalising care.
Together all these advancements by technology will reduce the overall cost of care. Mainly because — easy access means we can act quicker, quality insights means that we miss fewer things and personalising care means that we treat better. A healthcare system that acts quicker, make fewer mistakes and treats better is undoubtedly a healthcare system we all would love to be cared by. But a change in technology alone is not enough. This technology needs to be built alongside healthcare professionals, integrated into the system and aligned to value-based incentives. The augmentation of human ability by technology in care is where the change we desire will occur. Tech alone will not do it.
So who will make this change? Startups. The healthcare system cannot and should not build all the technology and changes in workflows it will need to make the change. It needs partners, allies in the development of the changing role of technology in healthcare. Big tech (Google, Amazon, Apple) will be involved but they won’t lead the way in my opinion. They have been trying for the last 10 years with no huge success, and they’re not exactly limited by resource or talent. But the organisations that will make this change are being created as we speak. These are companies with a DNA for healthcare. Built from the very ground up to serve as collaborative change-makers in healthcare. These are the organisations that the healthcare system and more importantly, patients will trust. Because ultimately that’s what it comes down to, trust. The reason why a patient takes the medication you give them is trust. The reason why a stranger you met yesterday has permission to remove your organs is trust. Trust is the most important ingredient in healthcare. Without it nothing works, nothing functions, no care is delivered. Big tech has struggled because of a lack of trust. Startups with trust baked into the fabric of everything they do will lead the way with this change.
3. The roles of healthcare professionals are changing
If technology is designed with the mindset of augmentation and integration into the system to provide the best value of healthcare. It is inevitable that the roles of healthcare professionals will change. I have less of a sense about how exactly this change will manifest but I have one significant perspective- Healthcare professionals will be more consultants of care rather than decision-makers. What do I mean by this? I mean, healthcare professionals’ role will be as advisors of care, rather than the decision-makers of care. As technology and access become more available to patients and their families, healthcare professionals will need to be less of the gatekeepers to care but more the advisors and supporters of patient care decisions.
Healthcare professionals will always need to care. Being caring and delivering care will always be apart of a healthcare professionals role. It’s in the name — a ‘care’ professional. But this change to becoming an advisor rather than decision-maker will happen. And frankly is already happening. At medical school, we are trained to advise the patient, not tell them what to do. To make suggestions and be as impartial as possible. This is a far cry from the doctors many of us are used to and to some extent comfortable with — doctors that are seemingly all-knowing and are apparently capable of making ‘the best’ decision for patients. No wonder why we trusted doctors (as a system) to pay for whatever they asked for (ie fee-for-service). This is changing and will continue to change as the patient and their loved ones become the decision-makers of care.
So who will make this change? Patients. Patients will and have been making this change because largely technology today and into the future will empower them to understand more and feel empowered to make their own healthcare decisions. Healthcare professionals, therefore, will be required more to be supporters and advisors for care. Whilst also importantly being there to be caring and deliver care, if and when it comes down to it — this will never change.
4. How we experience healthcare is changing.
With changes in the payment incentives, professionals and patients empowered by technology. How we experience healthcare will change massively. The №1 change in this experience is that healthcare will be proactive and not reactive (as it is today).
The alignment of all the changes above will mean that healthcare will no longer be an afterthought but a forward thought. Empowered by technology, supported by healthcare professionals, patients and their loved ones for the first time in healthcare will own the greater control of their care more than anyone else in the system. Over the next 10 years, we will experience healthcare how we decide and hope for. Proactively being cared for before the worst happens. Prevention over cure. It’s the healthcare we all desire.
So who will make this change? Everyone. We are all part of enabling this change. The choices we make, the policy we influence, the companies we support, all of this will fuel this change. And I can’t wait to play my small part in bringing this about with Suvera.
A very happy 2020 all!
For further context, below is my makeshift timeline of the last 100 years of change in healthcare and potential thoughts for change over the next 10 years that I’ve had in mind
ps — I recognise I have missed a lot of system change below — getting dates for these are trickier. Also please do let me know if I’ve missed anything else, or anything here is incorrect
- 1924 — EEG device invented
- 1928 — The Iron Lung was first used
- 1931 — First minimally invasive surgery
- 1943 — Dr. Kolff credited with the first working dialyse
- 1944 — David Sheridan invented the modern disposable catheter
- 1953 — The heart-lung bypass machine was used successfully for the first time
- 1957 — First cochlear prosthesis implantation
- 1958 — Fetal heartbeat from ultrasound detected
- 1962 — First full total hip replacement
- 1965 — First portable defibrillator installed by Frank Pantridge
- 1971 — First CT scan in London
- 1972 — The first electronic medical record system was developed by the Regenstrief Institute
- 1973 — Dean Kamen invented the first wearable infusion pump
- 1977 — First MRI scan took place on patient
- 1982 — First successful implantation of an artificial heart
- 1991 — World’s fist robotic surgery by a team in Imperial College London — PROBOT
- 1993 — Patient received the first bionic limb
- 2004 — Invention of the microprocessor controlled knee
- 2013–3D printed body parts becomes available for patients
- 2013 — World’s first bionic hand
- AI augmenting most clinical decision and results-driven by healthcare data in the cloud
- Virtual medicine as the first and most prominent interaction for primary care
- New better designed EHRs that means pen and paper is the thing of the past
- Large parts of administration and documentation augmented if not automated by technology
- Genomics a part of the clinical decision making and drug discovery
- Better streamlined and coordinated clinical trials
- Focused coaching and treatment services for every long-term condition
- Medication delivery as the standard with new pharma supply chains
- Digital therapeutics as common prescriptions
- Social prescribing as common practice
- New types of insurance companies incentivised to maximise outcomes and minimise costs
- Cheaper, smarter versions of our current medical devices