How will you optimize the business of today while maximizing health outcomes?

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.

2 Oct 2018

In the 2018 edition of New horizons: Executive insights on the future of health, we explore the duality of growth, and how optimizing business will create a prevention-focused future.

Welcome to the 2018 edition of New horizons: Executive insights on the future of health, the EY annual collection of insights for executives that explores the trenchant health and wellness issues facing society today.

The theme this year is the duality of growth: we are all challenged to optimize the business of today and maximize outcomes for health consumers, while at the same time build a strategy for a wellness and prevention-focused future. This requires solid, core offerings, and bold steps that move away from the intractable to the possible.

We begin with three articles that dive into building today’s business. Two EY surveys, one in the US and one global, offer guidance on digital strategies that give consumers and their care providers what they want: more convenience and time to interact. This includes a look at differences in how people want to engage digitally with their health and clinicians.

For additional on-screen reading, please view our New horizons 2018 interactive magazine

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Chapter 1

With growing health needs, is digital the best medicine?

Digital health engagement: highlights from the EY global survey of health consumers and physicians

Digital health has now been around for quite some time. From the outset in the 1990s and ensuing global reach of the internet, the genie was undoubtedly let out of the bottle, unleashing a flurry of rapidly evolving health technologies. And ever since, clinicians, entrepreneurs and investors have all sought to capture the vast clinical and commercial promise of a digital and mobile health economy.

EY has long been vitally interested in the evolving health care ecosystem and assisting the health sector to prepare for a consumer-centric and prevention-focused future. It is clear that solutions to sustainability, growth and delivering health care to the growing (and rapidly aging) population will be driven by key shifts around digital technologies, health care consumerism and the changing model of health. In recent EY research, it is signaled that participatory health, or the empowerment of consumers (in part through disruptive digital health technologies) to make smarter choices and pursue responsible behaviors is a profoundly disruptive force for change in the health care system.

In mid-2018, EY conducted a health survey of over 6,000 consumers and over 500 physicians in Australia, England and the Netherlands to get a deeper appreciation of consumer and physician use of, and sentiment towards, digital technologies. In particular, EY was interested in understanding consumers’ and physicians’ perceptions about and willingness to engage with digital health technologies and whether these might deliver better outcomes.

We found that both consumers and physicians believe that emerging health technologies will substantially reshape the consumer experience, support improved health and enhance the patient-provider relationship. But there is a long road to travel. Technology uptake in the health industry is notoriously slow, and our study finds that physicians and consumers are taking their time to adopt and adapt.

Health systems are well regarded, but slow to introduce digital health technologies

Our survey results show that both consumers and physicians generally hold the health system of their respective countries in high regard. Combining the data from the three countries surveyed shows that overall, physicians were more favorable with 57 percent rating system performance as ‘excellent’ or ‘very good,’ compared with 45 percent of consumers.

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Overall, many believe that their health systems perform well in critical areas such as the security of personal information, access to care and being up-to-date with the latest treatments and innovations. Protection of identity and personal information was held in the highest regard, with 57 percent of physicians considering this to be ‘excellent’ or ‘very good’ and 48 percent of consumers indicating the same.

The least well-regarded aspect of health system performance was the introduction of digital health technologies. Overall, one-third of physicians considered health systems to be failing in this function. A considerable gap in perception of health system performance in this domain is evident between physicians and consumers in England — consumers view the introduction of digital health technologies in their health system far more favorably than do physicians. Similarly in Australia, opinions between consumers and physicians diverged markedly in the ‘fair’ or ‘poor’ dimension.

With intense pressure for change, also comes opportunity

Physicians and consumers both agree that the future of health care will be substantially re-shaped by digital health technologies that promise new and very different solutions to pressing health care issues. Some technologies are considered likely to deliver better care, do so more efficiently and improve engagement and the overall consumer health care experience. However, there appears to be a gap between future intent and current use.
Beyond relevance and need, what inhibits or slows adoption of new technologies may be driven by:

  • The need to convince both physicians and consumers of validity and value and secure their buy-in. This includes recognizing that adopting new ways of doing things requires letting go of the old. For physicians and health care organizations, this means openness to considering new approaches. For consumers, this means a willingness to gain the skills and confidence to manage their health and wellbeing.
  • A “last-mile” problem in the S-curve or classic new technology adoption curve. Adoption of new technologies occurs in phases. A bell-shaped curve spreads between the early adopters through to laggards, with the majority only following suit when a critical mass is reached. Ensuring that innovative technologies reach such a dispersed, siloed and complex market as exists in health care is a substantial challenge. To engage the end user, the technologies must be able to deal with complex conditions and generate usable insights.
  • Decision-making priorities regarding the use of scarce resources. A key question for health care organizations, policy makers, clinicians and consumers is whether benefits gained from new technologies outweigh the costs and deliver outcomes better than care as usual. This also includes issues around scaling across systems and sustainability over time. 
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Chapter 2

Could a new health ecosystem catch diseases before they catch us?

A dose of digital: what consumers and physicians want from new technologies

We are at a unique point in history ─ at the cusp of reinvention. Driven partly by pressures to reduce costs and improve quality of care and partly by the advent of new technologies, cheap sensors, ubiquitous connectivity and cloud storage, the opportunities to invest in transformative digital infrastructure are almost limitless. How are provider systems to choose where to invest in digital transformation?

1. The drivers of change

The ever-increasing demand for health services is fueled in the US by growth in aging populations and chronic disease prevalence. Health industry experts and executives are looking to digital solutions to address the following challenges, while meeting demands for access and convenience:

  • Aging population
    Rising life expectancies are driving the growth of aged populations, globally. By 2030, the number of elderly with multiple chronic diseases will increase by 160 percent. Digital solutions such as telemedicine, telehealth, mHealth and AI-powered applications are a perceived means to address this growing need for health services among the elderly.
  • Rise in chronic diseases
    In 2015, 59 percent of the US population was affected by one or more chronic diseases, while 30.8m people were affected by three or more. This number is set to rise to 83.4m by 2030. Chronic diseases are estimated to cost America US$2t in medical costs – and an extra US$794b annually in lost employee productivity. The success of many health interventions relies on patient behavior, which is linked to how engaged people are with their care. Digital health offers a way to make monitoring and tracking easier.
  • Increasing costs
    CMS (Centers for Medicare and Medicaid Services) projects that health care spending will on average rise 5.5 annually between 2017 and 2026, at which point it will comprise an estimated 19.7 percent of the US economy. Digital tech solutions can cut administrative costs and help organizations manage the cost of labor and goods. That tech can enable cost containment has likely been a key factor motivating recent record-breaking investments in digital health.

2. Enablers

As health industry leaders and executives look to digital solutions to meet increasing demand and cost pressures, growth in digital technology and access to it has enabled the uptake and adoption of digital health solutions for payers, providers and patients.

  • Ubiquitous mobile connectivity
    In 2018, 77 percent of Americans own smartphones – twice as many as in 2011. The ubiquity of mobile connectivity means that most people are connected to the internet wherever they are. With age-related attitudes towards digital solutions set to change over the coming years, the likelihood for mHealth solutions such as app-based chronic condition management to become mainstream is strong.
  • Inexpensive sensors and health IoE
    Advances in the fields of smart materials, sensors, low power electronics and power harvesting has inspired the application of these technologies in medical and health care domains. The introduction of wearables and smart devices have made patient-generated health data collection possible.
  • Analytics and AI
    The field of health data analytics encompasses analysis activities for data collected from claims and cost records, clinical data from EHRs, operational efficiency metrics of hospitals, and patient-generated health and wellness data. In recent times, non-health care data – such as data on consumer behaviors – have also piqued the interest of health care providers. With the availability of potentially limitless data that can be used to derive insight into the drivers of health and disease, the promise of precision medicine seems close at hand.
  • Volume, variety and velocity of data gathering
    The proliferation of mobile tracking of health indicators and smart devices with inexpensive sensors have led to an explosion in health data gathering. The use of EHR data from providers in conjunction with claims data from payers is increasingly recognized as a valuable resource in health system planning at the country level.

Digital health is transforming the way that health care is delivered, while empowering individuals to more effectively manage their health and navigate an increasingly complex health care system. With increasing number of hospitals implementing digital solutions, digital offerings have improved to more rapidly meet their needs.

However, when it comes to solutions, the requirements of health care organizations vary greatly. Organizations need to understand the needs of the populations they serve in order to identify and implement solutions that are simultaneously patient oriented, physician friendly, and useful to their overall organization.

3. EY study of physicians and consumer attitudes

In order to understand consumer, physician, and executives’ attitudes towards digital health, EY US worked with EY Sweeney to field a survey of health consumers and physicians. The surveys were conducted in the US across four regions and among a range of physicians at different stages of their careers, and revealed the following trends:

  • Attitudes toward digital tech
    Engagement with digital technology in the health sector is gaining momentum, driven by a desire to improve wellness and underpinned by convenience.
  • Willingness to share consumer-generated data
    Americans are open to sharing a broad range of health-related information with physicians, including their medical history, with less interest in sharing lifestyle habits.
  • Incentives for sharing
    Reduced waiting time was the most appealing incentive to motivate consumers to increase digital engagement with their physicians (61 percent), followed by cost savings (55 percent).
  • Knowing your stakeholders
    Since health care provision is a complex interplay of the requirements and the benefits it offers to different stakeholders in the industry, it is essential to understand the perspectives of physicians who play a vital role in the use of digital technology in health care.
  • Knowing your physician
    Our survey findings reveal that physicians for the most part prefer the use of technology for administrative purposes such as managing appointments, use of patient portals and gathering test results.
  • Knowing your consumer
    Consumer attitudes vary by age group and manifest themselves in a varied set of expectations, usage, and adoption rates in each age group.
  • Age influences how consumers engage with technology
    The youngest age group surveyed are the most likely to adopt health apps, use smartphone-based diagnostic kits, and engage with physicians digitally by sending photos and utilizing video consultations.
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At a time when costs are rising, physicians are under enormous time pressure, and health consumers are requiring more complex care, careful thought needs to be given to how to build services that are effective and efficient. Health businesses should think about digital investments that bring the consumer and physician closer together, building on the trust of that special bond to encourage data sharing.

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Chapter 3

How can you care for both patients and performance?

Performance: optimized by and for the people

The trends of reducing costs and improving outcomes show no sign of receding, and new models for delivering health care are only adding pressure to traditional brick and mortar facilities. “Many providers are not looking for disruption or for a huge technology solution,” Jo Smith, EY Global Performance Optimization Implementation Lead, said. “They want to know, how do we deliver health care that is effective, efficient, and better for patients?”

What is performance optimization?

Performance optimization is a systematic effort to methodically examine every process, procedure and patient interface within an organization with the goal of identifying and eliminating waste and inefficiency. The work is critically needed, as health funding will likely never meet demand – whether the health system is public or private – and demand grows ever larger due to aging populations, and, in some regions, a burgeoning middle class.
Traditional performance improvement is narrowly focused on cutting costs. A performance optimization project, on the other hand, seeks to eliminate unwarranted internal variation in financial, administrative and clinical activities; improve the efficiency of performing tasks; and maintain or improve care delivery. Optimization projects undertake a deep analysis of all activities – both in the back office and care delivery – to map and route the most optimal activity or workflow.

Who benefits from performance optimization?

A performance optimization analysis helps organizations in almost every type of health care system around the globe. In mature economies, providers are focusing on technology and motivating behavior change. In emerging markets, countries are looking to leverage best practices as they build their health care organizations from top to bottom – looking to prevent mistakes from the start, building in the processes and behaviors to achieve sustainability. In the US alone it is estimated health systems are wasting up to 25% of results – in people, supplies and equipment, real estate, and processes. The World Health Organization puts this estimate between 20 and 40% globally.

Behavioral change or reform

Standardizing any activity requires the acceptance and commitment to change from the people executing the activity. Performance optimization projects are beginning to tackle the human aspect of change in order to further improve performance. This is a profound shift from process and procedures toward a focus on change management and human resources.

In addition to adding costs, variance in behavior is likely to result in a negative or uncertain patient experience. This won’t be a surprise to any hospital striving to become a High Reliability Organization (HRO), which relies wholly on people changing their practices to achieve better results for patients. Designed for organizations operating in complex environments where there is a perpetual risk for failure, an HRO shifts focus from the process to the outcome, with the goal of eliminating error.

Leverage the leaders

One added change management challenge in health care is overcoming the almost ingrained perception and role of the physician being at the center. One way to overcome this challenge is to leverage it. “Using the ‘champions’ model is key in health care,” Sarah Chang, Senior Consultant, People Advisory Services, Ernst & Young LLP, said. “Leaders in the true sense of the word are people who set the tone even if these individuals are not technically in organizational leadership positions. Identify them, engage in a meaningful way, and tap into their social capital. People will follow individuals they trust.”

Walk the walk – and measure success

Aligning every action with the principles and values of the organization – such as patient centricity – is critical to success. “Harp on this and really carry it out,” Chang said. “Every change must be tangible and directly tied to the goal. People will rapidly disconnect if words do not support actions or vice versa.”

It also pays to identify the measures of success in advance of any change or performance optimization initiative. With successful performance optimization projects, health organizations are establishing tangible measures over a specific period of time, and are tying compensation to results. The trend toward a variable compensation package – base pay plus bonus dependent on a specific set of performance metrics – is becoming the norm for leaders, physicians and other health professionals.

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Chapter 4

When data + sharing = insights, what value are you getting from the equation?

What’s after EMR? A move outside of the hospital

The advent of electronic medical records (EMR) and electronic health records (EHR) a mere three decades ago promised to revolutionize the health sector. Instead of relying on handwritten, paper records – which could be easy to lose and difficult to share – records would be kept in a secure digital format. This would result in improved accuracy, security, efficiencies, and a convenient way to track patient activity.

However, EMRs and EHRs – designed to make billing and record-keeping easier – have not delivered on the promise that digitizing health data would also make it easier to mine the data for ways to improve health outcomes. To date, while routinely collected patient health care data now approaches 2,300 exobytes, most of this information is not yet used in predictive statistical models to improve care delivery. Further, the EMH/EHR systems struggle to cover both the continuum of care since acute episodes are not the full story and the continuum of cost.

In the meantime, costs continue to rise. Aging populations and the growing prevalence of chronic diseases are adding more pressure to create fast, efficient, effective and affordable health care solutions. The demand for better outcomes and more convenient, patient-centric health systems is growing too. These forces are reshaping the health ecosystem, and are attracting data-savvy, tech-centric stakeholders from outside the sector who are responding to consumer demand for experiences in health similar to what they are used to having in other sectors.

These data can be used to change the health trajectory of entire populations. Moreover, they can provide a deep understanding, at a personal level, of what motivates people. That insight will enable an individual’s health journey to be tailored to them. They become, in essence, a market of one.

With new opportunities come new challenges regarding how data is captured and stored, and ensuring data is valid, trustworthy and useful:

Challenge 1: Getting health records to the patient

In the current environment the hospital essentially ‘owns’ the patient data, and the move toward people taking control and ownership of their own health history is likely to put providers in a tough place.

Health care organizations may benefit from looking to other industries for guidance. For example, consumers have very strong relationships with financial services institutions, which house but do not ‘own’ customers’ financial data and are able to nimbly share the information with those customers digitally, securely and globally. To succeed, health organizations need to figure out how to make the transition of data more seamless and similarly improve the consumer experience.

Challenge 2: Integrating and synthesizing the data

Integrating and synthesizing new and old data will be a challenge, especially as the depth and volume of data grows significantly.  When applied to health, the “internet of everything” will generate even more data, at incredibly rapid rates. Without use of open application programming interfaces (APIs) or clear interoperability standards, these data will be fragmented and hard to merge in a way that supports analysis.

Moreover, careful thought will need to be given to guardrails on the system: identifying which applications require edge computing, ensuring the transparency of the artificial intelligence (AI) governing those algorithms, and understanding how it will all be regulated. Health can look to industries such as civil and military aviation, which long ago created intelligent, human-centric dashboards that summarize reams of complex data (in real time).

Challenge 3: Trusting the data and determining whether it helps

The health industry's unique information exchange and compliance make interoperability an ongoing challenge and a strategic imperative. This imperative is accelerated and compounded by the expanding scope of the health ecosystem, requiring information to flow smoothly and frequently between providers, payers, patients and consumers – often between disparate, heterogeneous systems and across organizational boundaries.

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Chapter 5

Can healthy collaboration help your organization expand in the new digital landscape?

Data fusion: bringing the health consumer back into focus

The intersection of rising costs and technological enablement is moving care back to where people live, work, shop and recreate. Mobile connectivity, inexpensive cloud storage, wearable sensors and durable environmental sensors, and portable medical devices are making new varieties of data available at astonishing rates. These data, when combined with clinical information, offer the promise of a more holistic view of health and disease, and can give physicians and consumers more insight into each person’s risks and strengths.

The participatory health ecosystem will be built on frictionless data fusion that will drive precision engagement with lifelong health that is personalized and outcomes-driven. The future of health will require businesses to rethink how they define and deliver value; at its core, this is a question of how to shape your strategy around data and the newly empowered consumer.

Diving into data fusion

The three v’s (volume, variety and velocity) of data are rapidly increasing. The amount and variety of data available aren’t suited for legacy electronic record systems. As many thought leaders have pointed out, medical care accounts for only a small part of how long we live and how healthy we are. Data from the other determinants of health, generated largely outside the medical system, do not need to be crammed into existing electronic health records.

Today, these data are incompletely captured and, where they exist, are siloed. A holistic picture of health requires frictionless, but permission-guided, data sharing. This democratized vision of data enables the data fusion required to fully manage disease and discover heretofore unknown drivers of health and disease.

Bring it home: responding to consumer demand for convenient care

As the retail model evolves to incorporate ongoing relationships and chronic condition management, consumer data capture and sharing will become important for health management and outcomes. Today these services exist mostly as a one-off, and consumers don’t have a way to capture and share the data they are generating. Moving to levels of care and integration beyond the occasional vaccination or sore throat to primary and preventive care, pediatrics and wellness, health screening and testing, chronic disease monitoring and management of data will be an important part of individuals’ health journey and an important contributor to managing population health.

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Becoming the digital wizard for consumers’ health quest

There is a big role to play for the “what comes next” in health care. Today, everyone acts as their own health manager, trying to take the information about a diagnosis and treatment plan from their doctor, figure out how to get and pay for medications, and implement lifestyle changes. This can be overwhelming, particularly when care is complex due to comorbidities or personal circumstances make any of these steps hard to do.

Lifestyle and disease managers offer a chance to integrate information from multiple sources to create a clear picture to the ‘next steps.’ And this is where technology plays a key role in offering low cost, high touch care. “Teleconferencing will be a great way to help people with the ‘what do I do next?’ part of the care journey. Right now it isn’t particularly useful because it isn’t part of an integrated diagnostic and therapeutic solution,” said Don Jones, Chief Digital Officer at Scripps Research Translational Institute. “Once customer-savvy companies dive in, we’ll see telemedicine combined with a host of other services that will really create value. You’ll be able to have a consult and have your prescriptions, diagnostics or devices show up at your door two hours later with appropriate follow-up.”

Value-driven health care

Greater numbers of us are reaching 80 years of age and beyond. At the same time, chronic disease rates are rising, and the number of people with multiple conditions is increasing. This means there are parts of many countries’ population that are living longer, are sicker earlier, and require more complex care. Our situation requires more than a fine-tuning of how we think about health and pay for care.

At EY, value-driven care means delivering the best clinical outcomes with optimized costs, while delivering a satisfying experience for patients and providers (see EY’s survey on Value-driven care for more information). This requires the right partnerships to connect, combine and share the data that will deliver a more holistic picture of risk, outcomes, and stakeholder value.

Most of what determines how long we live and how healthy we are happens outside of a care center. That means the data that payers, providers and pharma most need are the data that they currently have little access to. Moreover, in order to adequately address the health disparities that exist in many countries, a more holistic view of vulnerable populations is needed. Data on the social determinants of health are a crucial and currently missing part of addressing this gap.

 

For additional on-screen reading, please view our New horizons 2018 interactive magazine

 

Summary

We are all challenged to optimize the business of today and maximize outcomes for health consumers, while at the same time build a strategy for a wellness and prevention-focused future. This requires solid, core offerings, and bold steps that move away from the intractable to the possible.

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.