How will you seize the upside of disruption?

By

David Roberts

EY Global Health Leader

Leads global team working for clients in health. Passionate about how consumers change the way healthcare is designed, delivered and funded. Long distance biker – metaphorically and actually.

14 Sep 2017
Related topics Health Aging Disruption

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We are living longer now than we have at any point in the past. Early gains due to decreases in infant mortality, vaccines, improved sanitation and hygiene have given way to an increase in life expectancy for those aged 60 or older. The World Economic Forum lists aging population as one of the top five drivers of global change, alongside growing income and wealth disparity, and climate change.

Aging has the power to disrupt the status quo that is on par with the rise of digital technologies. By embracing and preparing for this change, we have the opportunity to close the gap between our life spans and “health spans”; write a story of purpose and productivity for a chapter of life that is, for many, a blank slate; and tap into a market full of savvy consumers just waiting to be courted.

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Chapter 1

Diving into disruption: engaging with aging will transform health

Aging has the power to disrupt the status quo that is on par with the rise of digital technologies.

Consumers have access to information on demand, can obtain 24/7 product support, can buy groceries online or can push a button to have something delivered right to their door. This mindset has made its way into health care, albeit more slowly. It will take cross-sector collaboration to meet the needs of today’s consumers who want a service-oriented experience that leads directly to desired outcomes and who are interested in exerting political pressure to shape health policy.

Health consumers want easy-to-use platform solutions that they can use to maintain health, manage chronic conditions and provide connection to a wider social circle. But working toward a comprehensive and lifelong wellness goal is hard. Solutions will have to integrate data from a variety of sources, all necessary to provide context that can help us understand our decisions and guide us in the moment.

Harnessing disruptive technologies

The ultimate goal is to develop technologies that will delay the breakdown of bodily function, which accompanies the aging process, and extend the health span. We would thus have the ability to age disease-free. A variety of data sources will contribute to the understanding that will make this kind of prediction possible, including:

  • Cheap, reliable whole genome sequencing
  • Traditional clinical laboratory results
  • “Multi-omics” analyses that quantify collections of biological molecules
  • Real-time data generated by wearables and mobile technologies
  • Personal, local and regional environmental sensors
  • Behavioral data gleaned from social media sites and advocacy organizations

With the unprecedented amount, variety and linkages between data rapidly expanding, smart algorithms are poised to transform the way we think about health care. As our understanding of the drivers of age-related diseases grows, the demarcation between disease management and disease prevention will blur, leading to earlier disease interception.

Investing for the longevity dividend

Seizing the upsides of aging requires jettisoning preconceived ideas about aging and developing engaging solutions that optimize individuals’ wellness — regardless of personal health status. To be most effective, these services will be technology-independent, community-driven and focused on the whole person.

Delivering medical care to optimize physical and cognitive wellness will be an important component of any overarching solution, but ultimately it is only a piece of a larger offering. What the marketplace mostly needs are platforms that simultaneously enable solutions for all aspects of health.

In the short term, these aging solutions will be more heavily weighted toward helping individuals and caregivers manage complex, chronic diseases. In the longer term, there is an opportunity to advance investments in precision medicine that will one day lead to precision health. Such offerings will promote preventive interventions long before any signs of disease manifest. This shift to precision health will spark changes to the businesses of both health delivery and life sciences companies.

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Chapter 2

Insights into value-driven care: for providers, payers and patients

Although value-driven health care is widely discussed, the importance of the human impact is often overlooked.

In recent years, payers have been wielding their reimbursement power to force a provider shift toward patient outcomes and quality — a recognition that the current transactional model of care is faltering, and that focusing on the procedures and not the results is not a sustainable business model.

According to Yele Aluko, MD, US Health Advisory Executive Director, Ernst & Young LLP, the priority should be delivering consumer value through systems efficiencies. “Effecting real change requires centering everything around truly delivering positive results for the patient,” Dr. Aluko said. “If the motive for change is reactive to the threat of reduced reimbursements or other pressures, a value-driven culture will not take root.”

A deliberate shift in strategy requires clearly and compellingly articulating the why, what and how to everyone involved in patient care. Though the path toward this culture shift is not easy, the potential upside is compelling: great patient outcomes, reasonable prices, and strong workforce satisfaction and talent retention.

Employers as power payers

Provider organizations and associations need to take the lead in ownership of the quality agenda, creating the “pull” toward value-driven care. Payers should continue to play a role in “pushing” change using reimbursement and other cost containment strategies to incentivize results. Although governments and insurance companies have a strong voice, large employers or employee groups are emerging as “power payers” in the industry.

Employers are already active in offering and encouraging healthy choices in the workplace through programs, such as on-site cafeterias, subsidized gym memberships and others, because they see the financial and productivity results. In fact, companies with exemplary safety, health and environmental programs have outperformed the S&P 500 by between 3% and 5% — and they are poised to do more. With built-in employee communication and education infrastructure, employers have the power to help change the way employees consider and think about health care costs and value.

Changing the patient conversation

It is a near global truth that people “buy” health care with no idea of its actual cost. Although many people are keenly aware of their monthly premiums and out-of-pocket fees, there are a few incentives to understand the true cost of care, differences in this cost between providers, or the cost or benefit value of any given procedure or test. In fact, many people don’t think of it in terms of a buying purchase at all.

The advent of big data and increasingly sophisticated analytics is having a profound impact on chronic disease and patient outcomes. Providers now have access to data shared within their networks of care, and in some cases, patient wearables, allowing for data sharing at a broader population level. New technologies are fueling progress in the analytics needed to consolidate these large sets of data into meaningful insights.

All these steps have the potential to give providers the information patients need to make better informed decisions about their health care and improve health organizations’ operational infrastructures. However, these insights will only become a reality if people are at the center of the equation, curating the data, managing the algorithms and finding ways to translate the insights into practical use.

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Chapter 3

Consolidation, integration and disruption

Cost containment continues to drive M&A activity, even as companies bolster capabilities to thrive in a value- and outcomes-driven environment

Health care is one of the world’s largest industries — and getting bigger. Global spending on health is expected to grow from approximately US$9 trillion in 2014 to US$24 trillion in 2040, with the fastest per capita health growth in middle-income countries moving forward. Cost containment continues to be driving M&A activity, even as companies look to bolster capabilities that will allow them to thrive in a value- and outcomes-driven environment.

In developed markets, managing costs and creating efficiencies that power the shift to outcomes-based care has meant controlling more of the continuum of care through vertical integration, joint ventures and alliances. The largest provider systems can afford better IT and data analytics necessary to track behaviors that can change outcomes, improve purchasing contracts and have greater negotiating leverage with commercial insurers. Existing physical infrastructure is extremely expensive and outdated, and consolidation has been an important part of eliminating redundancy and excess capacity in brick and mortar facilities.

Disruption, inside and out

Consolidation through mergers, acquisitions and strategic alliances within the health sector is a natural response to disruptive forces that have the potential to upend investment, growth, resource allocation and other societal priorities. The key disruptive trends include aging populations, rising chronic disease rates, changing reimbursement structures and increasing dependency ratios. New technologies enable novel responses to these trends and serve as disruptors themselves; this is most noticeable in the number of stakeholders from outside the health sector looking to apply their technologies to thorny problems in health.

The trend toward consolidation has also been good for the alignment of incentives within the sector. Health care has long been siloed — fragmentation across the system has historically created misaligned incentives. As the role of value-driven care within the sector increases, aligned incentives will be needed to determine what reimbursement mechanisms create the best incentives across the continuum of care.

Health has to continue its move toward prevention — among providers, vertical integration has allowed for controlling costs and assuming more of the risk associated with value-based care. In providers, we see an alignment of incentives that allows for a focus on population-level health and wellness. But, prevention is the ultimate goal — no one wants to be sick, and the cost of treatment once a disease state has been reached is unsustainable.

This requires changing traditional care models. Technologies, such as remote sensors, wearables, massive databases with an array of data types and deep learning algorithms, are enabling us to take the first steps toward precision medicine.

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Chapter 4

What does the participatory health system of tomorrow look like?

As health systems strive to improve outcomes and control costs, the convergence of non-traditional players into the health care space are transforming the sector.

As health systems worldwide strive to improve outcomes and control costs, the convergence of non-traditional players into the health care space is transforming the sector. This shift powers the growth of a participatory health system, a consumer-centric system where patients own their data and care is personalized.

Assuming this new paradigm is built correctly, clinical data will take a back seat to the consumer-generated data collected across the life span. Although the health care sector has arguably been slow to embrace digital, with the confluence of pressures, the environment is right to implement e-health solutions.

Benefits

Participatory health will reduce the administrative burden on health care professionals, make time-critical information immediately available to providers and create patient-led health services. It will also generate big data on health trends, which providers can use to predict future demand and allocate resources accordingly. The advantage of such a system is that it can prospectively calculate personalized risk levels and then tailor a health care program for the patient’s life.

Imagine a new baby born and given a personal health cloud that can capture their genetic information; this becomes their “haven” for through-life data and helps plan their care into a predictive model rather than a reactive one.
Kenny O’Neill
Advisory, Participatory Health Lead, EY

So, what are the building blocks upon which a participatory health system is constructed? We propose a model composed of several building blocks that structure the ecosystem and could deliver a clear route to achieve scale. There are three key elements that we consider important in the transition toward this ecosystem:

1. Curation and navigation: the interface between the consumer and health system

Being a vital part of the participatory care team, curation and navigation technologies follow clear pathways and coordinate resources to help people make the right decisions around their care. These interfaces can automate many routine tasks and enhance the work of health professionals, freeing them to focus on more complex tasks and patient relationships. Importantly, navigation can improve coordination of high-risk patients, who typically have multiple chronic conditions and multiple health care providers.

2. Data fusion platforms: the glue that holds the system together

Vast flows of data — organized through curation and fused with artificial intelligence (AI) — form the backbone of an integrated health delivery system. Data fusion describes the aggregation of patient data from multiple sources, which prepares this data for analyses that will deliver insights into care management, risk stratification, performance and care gaps. Through data mining, learning and predictions from captured data, “simple AI” delivers the ability to organize, monitor and support a user.

3. Supra-system: strong bonds between global players

The catalyst needed to generate scalable solutions will be the rising interest from players who see opportunity in a global ecosystem of peer value creation, such as large retailers, venture investors, large integrated networks and global technology companies. Network orchestrators will seek to build and manage global networked platforms. A supra-system will draw together dynamic groups of players into communities that evolve and change over time. These new models of collaboration and competition will ultimately create value.

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Chapter 5

Robotic process automation: insights for the health industry

Although in its infancy, robotic process automation (RPA) has the potential to unleash a torrent of change — and benefits — for the industry.

RPA is neither a physical robot, nor an artificial intelligence software. Rather, it is a software that mimics human interactions and sits on top of existing applications. RPA software is programmed to move from one application to the next, just as a human would. RPA is easier and more user-friendly than a macro, and it better addresses security, performance and audit concerns.

Consider the steps needed to process a claim: read it, identify the provider, interpret the medical codes, key in and validate the information, and make a decision about whether to pay or forward for review. Although the flow is more or less sequential, there are varying decision points along the way, and the results are not always identical. RPA is designed exactly for this: repetitive tasks requiring multiple and variable steps to complete.

The value of RPA is clear: once the algorithm has been optimized, RPA will greatly increase the speed and reduce the variability and error rate of such tasks. The possibilities are enticing to industries worldwide, and the RPA market overall is experiencing explosive growth. Globally, the UK and parts of Asia are emerging as early adopters, partly because of their proximity to leading-edge providers of RPA technology and partly in response to cost-cutting pressures in these markets.

“The reality for many businesses today is that the drudgery and low pay associated with repetitive manual processes often create staff retention problems,” Martin Weis, EY EMEIA Robotics Leader said. “People don’t really stick with these jobs for more than two years,” Weis said. “RPA could help to reduce this churn and make work more interesting for many people.”

And don’t forget: you still need people in the process. Automating a process to occur at 25 times the speed of a human means that any errors are multiplied exponentially, and human intervention is critical. “There will always be errors, and somebody needs to take care of these,” Weis said. “So, we will still need human judgment and analytical interpretation. This is where our efforts should be refocused.”

Summary

Managing diseases as they arise is no longer affordable. By developing technologies that delay the aging process and extend the health span, we have the ability to age disease-free.

About this article

By

David Roberts

EY Global Health Leader

Leads global team working for clients in health. Passionate about how consumers change the way healthcare is designed, delivered and funded. Long distance biker – metaphorically and actually.

Related topics Health Aging Disruption