Future of Health Care Crystal Ball Via Rock Health – Inspiring Stories. Much Potential. More Questions.

If you want to see the future of health care, the can’t miss conference of the year is the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I had the opportunity to view health care through the lenses of a technology entrepreneur. I thought the conference was even better than the one I attended last year. Absent was the provocative rhetoric by 2012 keynote speaker Vinod Khosla who noted that “technology will replace 80 percent of doctors”. What continued to remain was the curiosity, confidence, enthusiasm, and optimism that health care and medical care could be even better and the willingness of entrepreneurs to fix a problem and build a business around it.

Themes I found particularly interesting included the following:

• Make health care smarter by creating platforms, whether software or hardware, like wearables, to collect patient data and to analyze data, whether at the individual or population level, to gain insights and change behavior or predict outcomes.

• Make health care better by using expertise from other fields, like the wisdom of the crowds, to provide patients more accurate diagnoses particularly when it revolves around a constellation of systems more likely due to a rare diagnosis.

• Make the health care a more personalized care experience comparable to other industries with the use of information technology and mobile computing.

• The creation of the ACA will fundamentally shift how patients will access care. This provides a tremendous opportunity for entrepreneurs.

• Entrepreneurs believe that they can both do good, improve the health and medical care of individuals and the community, and make money.

Branded Consumer Health Care Services – MD Live

Keynote speaker, former president of PepsiCo and former CEO of Apple, John Scully predicted that in health care “you will see big branded consumer health care services – much like we are comfortable with the national brands Starbucks, Chipotle. It may start as large branded urgent care clinics.”

 

He expects the irrevocable changes in how people access health care as a consequence of the implementation ACA.  Higher health care costs due to its mandates and entitlements will force employers to cut costs by increasing deductibles to $5000 by 2018, move to self insurance, and create more penalties and incentives for employees to be healthier. Faced with higher future out of pocket costs, he expects the public to find cheaper means for care as well as to seek alternative methods to stay healthy.

Scully is focused on these two areas. Instead of accepting the fact that patients on average wait 20 days before getting an appointment, wait again in the lobby for another hour before getting face time with a doctor, which last only seven to eleven minutes, Scully and this group at MDLive are delivering a superior experience using technology and the business discipline of a consumer facing company.

Already MDLive provides telehealth services to Proctor and Gamble, McKinzie, and Yahoo. The 2300 doctors of MDLive are US based doctors, certified, trained, and monitored by MDLive to ensure each experience is high quality. Careful triage and protocols ensure that patients get the right care. Those with more serious issues are recommended to seek alternative care. Everything at MDLive complies with HIPAA.

Replicating the Urgent Care Market

He is focused on replicating that experience with consumers in the urgent care market. Scully found that 24 percent of the US population, roughly the same number that owned an iPad, visited an urgent care clinic twice over a year. Yet despite a fairly high national penetration of use, unlike Apple, there is no national brand or presence that people talk about. Scully noted that out of the three top urgent care issues (upper respiratory infections / flu like symptoms, flu shot, and prescription request), two can be done online more quickly and for less by connecting care.

MDLive will soon deploy a medical kiosk, which will be available at a large pharmacy chain. The kiosk is complete with full screen HD video monitor, high precision digital camera, digital stereo audio, medical grade devices. Members of MDLive will be able to access doctors on the video monitor in less than 2 minutes. Should a prescription be needed, it will be quickly available at that pharmacy. With a monthly membership fee of less than $15, a video visit with a doctor under $40, Scully believes people will prefer this method of care which is more convenient and less costly.

He might be right. If deployed across a national pharmacy chain, might this be the national health care brand he envisions?

Scully also has focused on his belief that people, faced with higher health care costs, will seek alternative methods to stay healthy. Specifically, the public will embrace wearable devices that track information, link it with big data, and adopt the actionable behaviors that was created from predictive analytics. This should improve health and outcomes.

Misfit Wearables

This is the purpose of his other company, Misfit Wearables, and its first product, Shine. With a battery life of months rather than one week, Shine collects data on sleep and exercise and synchronizes with a smartphone. Imagine if an entire nation tracked their data, which then was then subsequently analyzed, what impact might that have on the health of the nation?

With patients forced to find less costly solutions to receive care as well as incentives to stay healthy, Scully expects many exciting companies to develop to fill these needs.  The time for innovation is now.

Both collecting data and making smarter decisions and better discoveries with the data was the theme of “Turning Lemons Into Lemonade”. Inspiring stories from entrepreneurs Sean Ahrens, Jared Heyman, and Leah Sparks demonstrate how health and medical care can be better when driven by personal passion and experience.

Crohnology – Chrons Disease

Ahrens, cofounder and CEO of Crohnology, suffers from an “incurable condition” of Chrons disease.  He realized that every patient in this situation becomes an experimenter and a researcher. What treatments and remedies work? Which ones do not? He created a platform, which helps others track information, pools the data together, and connects with other patients as well as researchers so everyone benefits from shared learning and discovery. Ahrens already has about 4000 patients in 66 countries and is the subject of the documentary “In Our Own Hands”. Giving patients tools to not only track how they respond to various therapies but also the ability to share and learn from experiences from others will be powerful.

As a practicing doctor, I found Heyman’s story of clinching the right diagnosis, particularly when it is a rare diagnosis, very compelling. Is it possible to harness the wisdom of the crowd, often observed to be more precise and accurate than an expert, if a process was created to leverage group knowledge? His personal journey began with his 18 year old sister who changed from a joyful and energetic freshman into a women afflicted with profound fatigue, hot flashes, and suicidal thoughts. Until her diagnosis of fragile X-associated primary ovarian insufficiency (FXAPOI) at the NIH, his sister had seen numerous doctors over many years. She recovered within three weeks of the right diagnosis and proper treatment.

CrowdMed

With CrowdMed, Heyman has created such a process. Using a “marketplace” where doctor and non-doctors place “bets” that a certain set of symptoms are due to a specific illness, in a trial of 20 test cases, the crowd also had one of the top five potential diagnosis as the correct one. Each of the test cases had a rare diagnosis. The first test case was his sister’s. The crowd got in right.

Wildflower Health

Sparks’ personal journey began after suffering not just one miscarriage, which affect one in five women, but four. Though she understood the complexity of both female and male factors in fertility and recurrent fetal loss, she wanted to know why. She sent off the tissue from her most recent miscarriage and had it analyzed. A chromosomal abnormality caused the miscarriage. Further analysis of her other 15 unfertilized eggs showed that only 3 were completely normal. With this reality, Sparks miscarriage rate was not the oft quoted rate of 1 in 5, but in fact 4 in 5.

This insight compelled her to improve maternity and prenatal care, which are the leading costs of hospitals and health care, the largest contributor being pregnancy related complications. There is not much data currently available that can predict future complications prior to the event. So with Wildflower Health, Sparks has created a platform to make health care smarter by acquiring real data, analyzing it, and then based on the results provide feedback to individuals and health payers to change or nudge behavior. Repeat cycle. Would it be possible to get better outcomes?

Sparks story has a happy ending with the delivery of a healthy baby.

All inspired stories. All very promising technology. All raising important unanswered questions.

Health care has trailed other industries with not only acquiring data but also analysis to nudge behavior. Big data ready drives consumer purchasing behavior with frightening accuracy and efficiency as noted in the New York Times profile of retailer Target and its use of analytics as well as its other article about how the food industry successfully attempts to cater to our most basic evolutionary urges of salt, sugar, and fat. Won’t others who will “lose” as consumers consume less to become healthier simply find other ways to circumvent these new initiatives and technologies?

Will knowledge of what to do really nudge people into healthy behavior? Evidence in behavioral economics demonstrates that knowing, at least in the area of retirement planning, does not equate to doing. It is more than just the individual, but the environment a person finds herself in. If there is some optimism, it is that the food industry beginning to cater to the public desire of healthier choices with fewer calories. This is no different than employers, who with 401k plans had a hands-off approach, have now increasingly have shaped the desired behavior with target date mutual fund plans, auto-enrollment, and auto-escalation in contribution percentage.

Will the sacred doctor-patient relationship simply become a transactional commodity? Will it be more about a brand that cares for us rather than an individual person? With an increasing number of doctors seeking employee status with large hospitals and health care systems and patients switching both insurers and doctors due to costs, job changes, or lack of choice, perhaps that day has already arrived. Yet health care and especially medical care, it isn’t just about the treatments but the relationships and human connections that matter.

Finally, who owns all of this data collected by wearables, technological platforms, and others? When doctors collected epidemiological data in research studies like the Women’s Health Initiative as well as the Framingham Heart Study, both which have provided significant information on the use of hormone replacement therapy as well as our understanding of coronary artery disease, the public benefited. Will private companies, which spent the time, money, and energy to collect and analyze this information simply make it available to the public or other providers? Might they act like Target use the information to gain a competitive advantage over others or sell the information for others to use (think the need to opt out of various marketing campaigns from other trusted partner companies)? Already the public is becoming skittish with privacy, tracking, security, and targeting whether via social media (Facebook), search engine (Google), or via other large financial services, retailers, or consumer technology companies.

Nothing is more personal or private than one’s health.

Do people want their medical information in the cloud and mined the same way companies currently mine one’s purchasing habits, demographics, and extrapolate to provide what they think I want or what I really need? In medical care, are want and need the same as consumer purchases?

Despite these personal observations, it is clear that in health care the status quo is not acceptable. As doctors and future patients, we all should feel confident that health care can be better. It will, however, be accessed, engaged, and delivered in a very different way. The individuals I highlight here are just a small sampling of the many speakers and participants at the conference. While not all will succeed, each contribution will make health care more personal and convenient.

Though it isn’t clear whether the public will accept wearables, forgoing a long-term relationship with a primary care doctor for a virtual visit in a kiosk, track individual data to nudge healthier behaviors, or use the wisdom of the crowd to clinch the right rare diagnosis, one thing is clear.

Health care is already marching toward a path where it never be the same again.