10 minute read 20 Mar 2023
Brain scan results reflecting in protective glasses

How innovation can unlock the power of data to deliver value-based care

By Pamela Spence

EY Global Health Sciences and Wellness Industry Leader and Life Sciences Industry Leader

Ambassador for outcomes-based performance and healthy aging. Advocate for women.

10 minute read 20 Mar 2023

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  • How you can jumpstart innovation to unlock the power of data to deliver value based care (pdf)

Organizations have the tools to deliver a better personalized health experience, but the ecosystem needs to collaborate to build this future.

Three questions to ask
  • How can placing bigger bets, and making strategic investments that go beyond pilot initiatives, achieve transformation at scale?
  • How do organizations collaborate to share risk, data and rewards and realize a better future?
  • How do we move from a slowly digitizing world to connected care and ultimately to a smart health system?

People tend to overestimate the effect of a technology in the short run and underestimate its effect in the long run. Immortalized as Amara’s Law after the scientist and futurist Roy Amara, this insight captures the challenge that faces today’s leading health sciences and wellness organizations as they seek to understand the future direction of the industry and how their companies can adapt to it. Human tendency to think in linear terms, blinds us to the radically transformative potential of technologies already around us. Our newest report, How you can jumpstart innovation to unlock the power for data to deliver value-based care (pdf) explores this. 

The expanding universe of sensors and the internet of medical things, the unprecedented explosion of health data, and the rapidly expanding power of Artificial Intelligence (AI) to turn these data into insights are realities now. If the full potential of these and many other new technologies taking shape is unlocked, we will see a model of health care unrecognizable from the system we see today. We call this the Intelligent Health Ecosystem (IHE). A hyperconnected system build on the superfluid fast data flows and data standards to support interoperability that can optimize decision-making, improve outcomes, accelerate access to new innovations, and deliver personalized and patient-centric health experiences.

Today: Analog care with pockets of digitization; the challenge is to progress beyond connected care to a truly smart health system…. an Intelligent Health Ecosystem

Digitized connected smart

Source: Frost & Sullivan, Healthcare IT News, Mordor Intelligence

  • Image description

    The graphic above describes how health care has evolved over time; moving from analog sequential care to digitized care. Ultimately digitized care becomes connected, with AI taking a larger role as the focus on the patient increases. This culminates in the smart health system of the future.

    Analog care: Moving from paper-based to electronic records and developing data policies, principles and governance. The forces driving the shift from analog to digitized care include productivity pressure, economic pressures, consumer demand, aging populations and chronic disease.

    Digitized care: Creating interoperability between systems allowing for linkage of dataset and comparing outcomes. The forces driving the shift from digitized care to connected care include technology modernization, interoperability, workforce shortages, and empowered “super consumers”.

    Connected care: Virtual models emerge with a 360-degree patient view of AI-driven insights to inform real-time clinical and operational decision making and value-based care models. The forces driving the shift from connected care to a new smart health system include technology advancements, ecosystem acceptance, risk sharing/reward, platform dominant business model.

    Smart health system:

    • Integrated: Patient at the center and controls their data
      • Targeted therapy, proven efficacy, and personalized care
      • Continuously refined with real time feedback loops (via sensors)
      • Decisions optimized across patient journey
      • Strategic sourcing: technology acquired adheres to interoperability standards to maintain data flow
    • Digitized edge: Data is pushed and pulled from the edge (vs. centralized)
      • Virtual and physical care fully integrated
      • Insights shared

Despite the enormous potential of this vision, to date the industry has made only limited progress on the journey from the legacy “analog” health system of the past, through digitized and connected care to the truly smart health system of the future, the IHE. The major hurdle we face is not technological limitations, but human limitations. While technology is moving at an exponential rate, there is little movement on aligning the different needs of industry stakeholders. The ongoing misalignment in what stakeholders value, prioritize and invest in prevents us from moving towards the more connected ecosystem that can transform care.

Interoperable models can not only survive but thrive when stakeholders can access each other’s data, connecting and combining it with their own to create added value which is then shared back into the ecosystem. Once stakeholders understand this, the need for better alignment becomes obvious. Unfortunately, this is not the basis on which the industry’s historical business models have been built: this is the crux of the challenge for companies trying to realize a different, better future model.

A major hurdle is a misalignment in what stakeholders value

As a patient As a provider As a payer As a policy maker As a biopharma or med tech
How can I be in control and get access to the right treatment quickly so I am healthy? How can I use data and evidence-based practices to diagnose faster and provide the most effective treatment? How can I keep our members well and provide the most cost-effective health solutions? How can I align incentives as well as manage risks to improve population health? How can I get approvals faster and be paid longer at a level to sustain innovation?

Yet the different stakeholders are not in a zero-sum game. If they can recognize the interdependency in their aims and take such a collaborative approach, a major barrier to the IHE’s development will rapidly disappear. Instead of a model where large amounts of data are housed by different stakeholders, we need a model where stakeholders can make interdependent use of detailed data specific to an individual “patient journey” within a specific therapeutic area, using these data to make better decisions and achieve better outcomes for all.

Why value-based care can bring stakeholders together

The advantages of value-based care (VBC) have been widely recognized over the past decade and the principles of VBC are now readily accepted by most parties. The sticking point for VBC achieving scale is the question of “what is agreed to be valuable”. Interdependency in aim and agreement on value will give stakeholders a meaningful framework for understanding and building mutual shared value. VBC models enable this interdependency: they need to become the standard model for aligning stakeholders Without alignment via VBC the industry’s investment and innovation journey can be compared with a boat adrift without a rudder. Once VBC reaches scale, the industry can at last begin to steer the utilization of health technology towards the goal of delivering smart health in the IHE.

Today, the EY Intelligent Health Ecosystem Innovation Dashboard displays the current lack of direction in the industry’s pattern of investments into new technologies. While organizations have initiated a wide range of pilot programs with new technology in recent years, these programs have yet to mature to the scale and level of interoperability that could have game-changing implications. This lack of transformative success stories in turn deters organizations from making the big bets that can unleash the potential of these new technologies and kickstart a new wave of radical growth.

EY Intelligent Health Ecosystem Innovation Dashboard

EY Intelligent Health Ecosystem Innovation Dashboard
  • Image description

    The graphic above shows a snapshot of the EY Intelligent Health Ecosystem Innovation Dashboard, which tracks Health Sciences and Wellness companies’ investments in innovations outside the traditional core areas of expertise for the industry (for example, digital technologies rather than traditional drug development technologies).

    The dashboard groups companies’ investments according to whether they are targeting digitized, connected, or smart care models, according to the definition above. The dashboard also identifies in which area of the value chain the investment is focused:

    • Commercial
    • Drug discovery
    • Patient engagement
    • R&D
    • Regulatory
    • Supply chain and operations
    • Multiple different areas

    The dashboard also groups companies’ investments according to the level of maturity of each innovation they are investing in:

    • Pilots: innovations that are pre-market or marketed only in four or fewer different geographies
    • Deployed: innovations that have progressed further and are marketed in five or more geographies
    • Mature: innovations that have achieved deployment at scale and are now embedded in multiple care settings as standard tools.

    With most of the investments captured on the dashboard representing Digitized or Connected (not Smart) innovations and clustering in the Pilot stage, the graphic indicates that investment in innovation is taking place, but not yet at the scale or interoperability to achieve real change within the industry.

Consider three examples of new technologies that have won general acceptance and achieved some traction in the market.

  • First, smart inhalers. These products take the traditional “analog” inhaler used to control respiratory disease and build sensors into it that can capture and feed data back about how the patient is using the medicine, with the aim of improving its effectiveness.
  • Similarly, the implants that have long been used in joint replacements are now being augmented with installed sensors that can track how the patient’s progress with the new implant and communicate this data to a care team.
  • And we have also seen an increased role for virtual care teams in the increased embrace of telemedicine and tools like chatbot-driven digital triage for patients.

Each of these three examples has enabled some improvements in care. Yet they have not caused any major revolution in respiratory care, joint replacement, or patient access to care. To understand why the impact has been incremental rather than radical, consider a pattern we see repeatedly in nature and in business alike: the S-curve. New products and innovations often deliver rapid growth as they achieve widespread adoption – then comes a period of stabilization and growth plateaus. At this point eventual decline and extinction lie ahead for the product. Organizations will often try to delay this fate, by refining the product, digitizing existing operating structures to enhance efficiencies and extend a product’s performance curve. The digitization of products and services in the Health Sciences and Wellness industry at present looks like an attempt to prolong the market life of these goods.

Almost all life (and business models) follow a predictable pattern: The classic S-curve

The classic S-curve
  • Image description

    The graphic above describes how the “S-curve” pattern of progress/growth over time recurs frequently in nature and in business models. Within this pattern, an innovative product (or any new entity) will undergo an initial phase of growth before accelerating uptake sees the product reach its maximum speed of growth.

    After this maximum point, growth will typically stabilize. Subsequently growth will decelerate and decline, as the product approaches extinction. In business, companies may seek to delay product extinction by “stretching the curve”. They may achieve this by digitizing or otherwise optimizing the business model around the product.

    The graphic shows that a more ambitious goal is possible: avoiding extinction altogether and jumping to the next wave of S-curve growth. Companies may achieve this with the assistance of technology to unlock the potential of innovation and to transform their operations.

The real goal, however, should be not to delay but to avoid extinction. This needs organizations to be more ambitious and think beyond simply optimizing the existing product. They need to unlock innovation in a way that enables them to jump ahead to the next ascending s-curve of growth. This is challenging – what has contributed to success to date is unlikely to be the same in the future and investors both private and public (including governments as custodians for the public purse) demand returns.  In healthcare, such leap requires an ecosystem approach and alignment, enabled by VBC as described above. If the industry and its stakeholders can achieve this alignment, they can unlock positive feedback loops of innovation and adoption rising through successive waves of s-curve growth.

Bridging the misalignment on “value” and sharing risk, reward, data and insights can enable Health stakeholders to “jump the curve”

Bridging the misalignment on ‘value’ and sharing risk, reward, data and insights can enable Health stakeholders to “jump the curve"
  • Image description

    The above graphic describes how the industry might progress from its position today (a legacy analog system with digitized areas) to become a more connected and ultimately smart system, by moving through an ascending series of growth S-curves.

    In each case the decline of each S-curve towards extinction can be avoided by better alignment between stakeholders. As an ecosystem model develops, increasing alignment is seen between the industry and its stakeholders: ultimately this will include providers, payers, patients, policymakers as well as the industry itself.

    As these stakeholders align they will share data at increasing scale and ambition:

    • Connecting data streams
    • Combining data sets
    • Sharing access and insights

    This sharing of data, and the analysis of these data by the interdependent stakeholders, will provide the driver for the industry to continue “jumping the curve,” ascending in stages to become:

    • A digitized system which can understand data to offer diagnostic insights
    • A connected system which can use data to deliver predictive insights
    • A smart system which can provide value from data with prescriptive power

    Alongside increasing stakeholder engagement, the graphic shows that the evolution from today’s system to a smart system will also be supported and driven by data and technology continually learning and becoming more intelligent.

In this ecosystem approach, digital innovations will become more than stand-alone point solutions, connecting to a broader and more powerful system of data-driven, technology-delivered care. The smart inhaler and its data streams will become just part of a network of interlinked sensors providing better real-time care to the patient; for example, sensors in the home will analyze air quality and weather data, identifying respiratory risks and signalling the need for the patient to use the inhaler. In the further future, as the IHE becomes reality, detection, prediction, and intervention will happen still sooner, perhaps without needing any action from the patient: bio-electronic implants could detect neurological inflammatory triggers and disarm them before they become symptomatic.

Today we treat respiratory symptoms; how can we build a smart system that can prevent them?

Today we treat respiratory symptoms; how can we build a smart system that can prevent them?
  • Image description

    The above graphic describes how companies can build a smart system that can better help treat respiratory symptoms. This can be achieved through:

    Digitized care: integrated sensors in device monitors that can “report”

    Connected care: home sensors that analyze air quality and weather data to signal inhaler usage to “prevent” an asthma attack

    Smart health system: bio-electronic implants that detect neurological triggers in cell responses and prevent the inflammation and thus, the asthma attack

Similarly, the “smart implants” of today will become just one node in a digital ecosystem delivering post-operative care. While today’s patients are discharged home to manage their own recovery and self-care with limited guidance or contact, the patient in the near future will access home coaching via digital personal assistants. Linked to the data from their smart implant, which will help optimize the coaching program, the patient will experience a guided and accelerated path through rehabilitation. Further on, the post-operative patient in the IHE will receive still more personalized and effective management. A simulated digital twin built from rich data from the implant and the smart home environment will enable personalized, interactive physio sessions modelled around the patient’s individual needs.

Instead of care being dispensed at brick-and-mortar sites the patient visits only sporadically, we can envisage at the end of the journey through digitized and connected care to the IHE a world where health management has effectively become ambient, technology surrounding the patient in a moving cloud of care that constantly optimizes itself for better outcomes. Where today we have some digital telehealth additions to our legacy systems, the future will see the increased presence of virtual hospitals offering comprehensive specialist support, remote yet highly personalized and even predictive. As the IHE evolves, we will go further yet, and see the emergence of large-scale specialized remote care, where medical engineers effectively manage huge numbers of patients at a distance through data and technology.

This new approach to care will deliver the outcomes each stakeholder seeks. Providers will have the information and the tools to deliver care far more effectively than can be achieved today. Payers and policymakers will be investing their resources in care that genuinely works. Smarter care will save patients the need for long and costly hospital visits, maintain the wellbeing and productivity of the population and enable policymakers to see health care (which today could more accurately be described as “sick care”) not simply as a financial burden but as a public asset to society. The organizations that enable these more effective new care approaches will also be appropriately valued for the benefits they have delivered. Differential reimbursement within the VBC system will reward and sustain innovation.

The better personalized health experience the IHE will deliver is not a luxury but a necessity

VBC will streamline operating models and introduce both efficiency and efficacy through the ability to personalize treatments. At present much health spending is mis-directed and wasted because we have too little data to predict what interventions will help which patients. Most of all, this progress towards the IHE will transform for the better the individual patient’s experience and outcomes. Personalization of care is not a luxury but an essential step in widening access and health equity.

The industry and its stakeholders have for too long underestimated how important the quality of health experience is for patients. In other industries, market leaders have shown the importance of convenience, choice, seamless transactions, transparency, and personalization in delivering a better user experience. Health care has been slow to learn these lessons; but as our care systems become more digitized, connected, and smart, improving health experience will become a key concern. In the past the individual’s subjective experience has been seen as a marginal concern, with clinical results the focus. Yet experience is central to delivering better outcomes: engaged, empowered patients are not simply happier, but also healthier.

The IHE offers a health care future that can meet the needs of the industry, its stakeholders and the patients they collectively serve. The technologies to realize that vision are here now. The organizations that can realize the long-term effects of these technologies to exponentially change the way we deliver health care will be the leaders in this new era. They will secure their position at the heart of the emerging ecosystem that will deliver health care fit for the future.

  • Show article references#Hide article references

    1. Digitized: areas of digitization, mostly in traditional operating models and diagnostic in nature
    2. Connected care: Integrated operation of discrete devices – emerging personalization and predictive in nature
    3. Smart: Intelligent intervention, highly personalized and interdependent on collaboration between organizations and prescriptive in nature 

Summary

The urgent message is that the industry has these powerful tools now. Companies need to become far more forward-thinking about how they use these tools, moving beyond pilots and experiments to invest in making the jump towards the vision of better future health care, better reimbursed through industry-wide alignment on value-based contracts (VBCs). For the industry’s current incumbents this is a positive call to action: companies can reap the benefits of exponential growth if they step up and adapt to deliver a health care model fit for the future, which delivers and realizes value for all parties.

About this article

By Pamela Spence

EY Global Health Sciences and Wellness Industry Leader and Life Sciences Industry Leader

Ambassador for outcomes-based performance and healthy aging. Advocate for women.