Patients want greater engagement and for their care to be more convenient. They also want to see the same innovation and value in the healthcare system that they experience in every other aspect of their lives. How are modern market forces changing the state of healthcare delivery? And what role will Google play?
At an event held under the auspices of the American Hospital Association on March 20, 2019, a panel of healthcare specialists gathered to explore how current market forces are changing healthcare and the delivery system. Rick Pollack, President and CEO, American Hospital Association, introduced three leaders to address these questions and others: Sam Glick, Partner in Oliver Wyman’s Health & Life Sciences division and Director of the Oliver Wyman Health Innovation Center Leaders Alliance; Dr. Michael Howell, Chief Clinical Strategist at Google Health; and Brian Gragnolati, Atlantic Health System’s president and CEO, who moderated. What follows are key insights from the panel, “Forces Changing Healthcare Delivery,” which was held in Washington.
Healthcare Consumerism’s Steady Rise
In his introductory remarks, Pollack noted that innovation and the need to provide greater value and more affordable comprehensive care are propelling change. New entrants (such as Google, Amazon, and Apple) and well-capitalized traditional entrants (such as Optum and Aetna) are all competing with hospitals, Pollack said. Thus, hospitals – which will remain the safety net that communities lean on – need to evolve to remain competitive. That blue "H" sign should represent much more than just a hospital building, he said.
At the core of this innovation is the consumer. Healthcare consumerism, as an idea and a goal, is steadily rising. But the concept is not a new one: It has been "trending" for quite some time now, Glick pointed out, with the idea of the patient as the "consumer" of healthcare services having been talked about for the past 40 years.
This discussion around healthcare consumerism is shaping what hospitals focus on next, Glick said. And a redefined definition of consumerism is impacting how hospitals consider care delivery, especially as consumer choice, consumer advocacy, and value-based care evolves, said Glick. The idea of patient as consumer has taken on a new meaning over the past decade, as healthcare costs (which consumers mostly pay for themselves) have risen between 50 and 60 percent, with out-of-pocket costs spiking by 200 percent. Numbers like these mean consumers are forgoing care and are reducing care indiscriminately. “It’s dramatically changed how people behave,” Glick said. “That’s how ‘real’ consumerism is.”
Just how expensive has healthcare become? The average deductible in the US, said Glick, is $1,600. Numbers like this, he added, are sparking a shift in consumer behavior and mean some people must decide whether to pay their deductible or their rent.
Google’s Consumer Strategy
One possible solution? Google is getting into the healthcare business, seeing both a tremendous market and a societal need. And consumerism is a key driver of Google’s healthcare strategy.
Consumers already turn to Google first when it comes to their health, conducting hundreds of millions of health-related Google searches every day.
“I’ve had many patients coming in, knowing what they had before speaking with me,” Howell said.
- What is endometriosis?
- Why am I always tired?
- What causes high blood pressure?
- What does heartburn feel like?
- What is the keto diet?
But while Google offers an online option for consumers to search for medical information reviewed by physicians and organizations like the Centers for Disease Control and Prevention, World Health Organization, United States Surgeon General, Harvard Medical School, and many others, it is not intended as a substitute for a medical opinion or diagnosis, as the site itself emphasizes: “Medical information on Google doesn't apply to everyone, and it isn’t medical advice.”
Google’s Potential to Impact Care Delivery
Instead, Google is working to leverage technology to improve healthcare delivery. Google has developed algorithms that, for certain diseases, are better able to diagnose a patient than a physician is, thanks to biomarkers that didn't exist until now, Howell said. As the technology behind medical algorithms is applied to more diseases, more biomarkers will emerge, leading to fundamental discoveries the healthcare industry has yet to realize.
An example of this is diabetic retinopathy, a preventable complication of diabetes that can rapidly lead to blindness. It is a condition that is difficult to screen patients for in-person. However, when a machine photographs patients' retinas and predicts their five-year health outcomes, there was 97 percent accuracy, regardless of patients’ gender. Humans simply can't achieve this level of accuracy on their own, Howell said.
This marriage of technology and physician-based treatment is leading to improved care. Technology platforms are making pre-screenings for diabetic retinopathy cheaper and easier to have done, said Howell. Whereas previously two out of three physicians might have completely missed the diagnosis of diabetic retinopathy, they were now able to detect the markers for the condition, with the assistance of the technology. This means patients are more likely to be referred to a specialist, thus potentially saving their eyesight.
Findings like these from Google of a machine trumping human accuracy fundamentally changes healthcare’s status quo. But while telemedicine is a hot topic, it’s a technology that should be considered more of a frontline intervention rather than a back-burner resort for consumers with limited care access, said Glick.
“We still live in a world where your zip code determines your life span,” said Glick. "Nearly 60 percent of counties don't have licensed mental health. When you look at claims’ data spend, 4 percent of dollars on behavioral health could save 23 percent of spend if addressed."
Artificial Intelligence Advancements Surpass Administrative Advancements
The potential of doctor-technology interactions like Google algorithms is enormous, Glick remarked, especially in rural areas where behavioral health access is limited. More innovation is needed around telemedicine, artificial intelligence, and texting. For example, cognitive behavioral health gets 30 percent better compliance when a screen is involved, since consumers are more willing to share information virtually and conveniently, he said.
“We’ve seen with veterans, the screening can detect 20 percent more cases of post-traumatic stress disorder than a face-to-face discharge session,” Glick said. “We have an opportunity to not just innovate around science, but around the experience.”
Hospitals are still learning how to harness technology’s potential to keep patients out of hospitals in the first place. The innovations happening in the operating room or in imaging are lightyears ahead of administrative innovations, said Glick. “We have incredible tech in an exam room,” he said. “On the other end, we left our innovative brains at the door for the administration around it.”
It's a disheartening phenomenon, Glick added, that education and healthcare have been the only two industries to see a decline in outcomes, as compared to retail, finance, or insurance. Healthcare lags behind other industries in the pace of disruption, prohibitively high prices, dissatisfied consumers, and a need for more merger and acquisition activity. The goal of technology in every other industry is to deploy assets more efficiently and reduce headcount, said Glick — except healthcare. For instance, the commercially insured, he emphasized, make up one-third of volume, but pay for two-thirds of all consumers. Subsidization of other segments, like Medicare and Medicaid, need to address concerns such as this, given the nation's increasingly aging society. Consumers only spend 9 percent of money on hospitals, with their majority of spend on out-of-pocket drugs, deductibles, and copays. This is an area where the most focus is needed, he said.
Predictions on What’s Next for Healthcare
Looking ahead, Glick pinpointed key changes he expects to see. Firstly, he cautioned attendees to curb their expectations: only 1 in 20 innovators will end up having an impact on the healthcare industry. Why? The absence of communication. “It’s not about finding money, talent, or the science,” Glick said. “The problem of scaling is about why it takes so long to reach the right person you want to talk to at a health system. Having one point of contact at a health system is really important.” Streamlining conversations means hospitals need to decide the “where” and “what” of their partnerships.
The typical commercial member is paying 100 percent of their costs out-of-pocket, said Glick. And while consumers want to use telemedicine, few have actually tried it, according to Oliver Wyman’s 2018 Consumer of US Healthcare. “There are lots of barriers, but lots of latent demand. It’s not disintermediating. It’s consumers demanding it,” Glick said.
The industry is historically at a point where the system can be redesigned to leverage technology – but it may take between 10 and 15 years to get there, said Google’s Howell.
The status quo in healthcare delivery is unsustainable, in Glick’s view, and he’s hopeful that change is imminent. He’s also convinced that healthcare systems and innovators will one day learn how to collaboratively drive healthcare’s transformation. While certainty as to what the future holds isn’t something consumers – or anyone else for that matter – can simply Google, it is clear that healthcare’s future will be filled with disruption, driven by external and internal forces.