For years, healthcare has been a poster child for misaligned incentives, with healthcare consumers either unaware of or unconcerned with costs of care. Patients were happy to let providers decide what was best for them. Adversarial relationships among stakeholders were not uncommon.
Faced with increased financial responsibility for healthcare, and enabled by digital health tools, the healthcare consumer reached a tipping point in 2016, according to VC firm Rock Health’s survey of consumer attitudes and behavior. One of the most significant findings of the survey was that consumers showed a threefold increase since the previous year in their willingness to pay out of pocket for healthcare. Not coincidentally, health insurance deductible limits skyrocketed during that same period.
The ongoing transfer of financial responsibility and the shift toward value-based care are driving some unusual partnerships between traditional and nontraditional players in healthcare with a common purpose — increasing choice and improving outcomes. In this blog post, I will discuss a couple of these.
The emerging doctor-patient relationship: bound by technology
Healthcare has always looked to patients to take more control of their medical decisions. However, patients have chosen to go with a doctor-knows-best approach to their care. Now, increased financial responsibility is driving consumers to seek information and take control of their healthcare. They are increasingly consulting “Dr. Google” and other sources of information for health and cost information and then showing up at their physicians’ offices with their findings, and even recommendations for treatment options.
Physicians are becoming willing participants in these discussions, driven by a shared purpose. They are motivated further by incentives launched last year by the Centers for Medicare and Medicaid Services (CMS) for shared decision-making between doctor and patients. Various studies indicate now that engaging in collaborative decision-making is turning patients into active participants in their healthcare.
How does technology feature in this new model of doctor-patient collaboration? As the wasteland of technology startup debris can attest, it’s one thing to develop a consumer-focused application or technology, and entirely another to get them or their physicians to use it.
Blame it on the system of reimbursements for healthcare. Many early startups were dogged and doomed by a payment system that discouraged physicians from recommending a mobile health application unless it qualified for insurance reimbursement.
Many digital health companies have realized that the route to profitability and sustainability lies in demonstrating ROI for the platform or service independently. Consumer willingness to pay for the technologies is likely to increase physicians’ willingness to recommend these innovative new digital health solutions, untethered from the system of reimbursements that drives healthcare choices.
Consumers are also more likely to stick with apps recommended by physicians and show more involvement in their healthcare. A 2015 study by the QuintilesIMS Institute for Healthcare Informatics on patient adoption of mobile health (m-health) applications indicated 30-day retention rates for apps prescribed by a provider are 10% higher than average.
Emerging healthcare services partnerships: bound by data
As the digitization of patient medical records over the past several years comes to a logical end, the new gold rush is about unlocking the value from electronic health records (EHR) systems, in part by combining them with emerging data sources. We are now awash in data; not just EHR data but also data from remote sensors and devices (the internet of things, or IoT), social determinants data (age, income, demographics), and other forms of structured and unstructured data.
Many of these data sources don’t work well together today. This is partly due to the absence of industrywide interoperability standards. This is also due to the fact that data that is emerging from nontraditional sources that have not been part of the healthcare ecosystem. An example of this would be genetic testing data and patient-generated health data (PGHD) from wearables that would not be considered in a clinical setting such as a hospital. (Early pilots to integrate PGHD data with EHR data and other data sources are showing promise. I discuss this in an earlier blog post on how Sutter Health is leveraging PGHD).
To serve the newly untethered healthcare consumer, healthcare services firms, technology vendors and a handful of nontraditional players are coming together to develop unique value-added offerings by combining data pools.
One company that is leading this trend is lab test leader Quest Diagnostics, which sits on over 20 billion test records and is aggressively expanding its data monetization efforts. Seeing a desire by patients to be more involved in decisions about their diagnostic laboratory testing, the company has launched Patient Initiated Testing services that allow patients to manage their health by ordering certain lab tests directly without a physician’s order in select states. Patients across the country can also access their test results through the MyQuest portal.
Quest has also signed unusual partnerships: a deal with retailer Safeway provides convenient access to testing services at approximately 50 Safeway locations; another with Ancestry.com provides genotyping test services on behalf of Ancestry’s AncestryDNA service, which identifies and quantifies an individual’s ethnic origins based on results of DNA testing.
Genetic testing data, in particular, seems to be emerging as an important data source. In addition to Ancestry, Quest has partnered with IBM Watson Health to provide a Watson-powered genomic sequencing service for cancer patients. The Watson cognitive computing platform’s advanced analytics capabilities for oncology, combined with Quest’s diagnostic testing capabilities, aims to benefit cancer treatment at the Memorial Sloan Kettering Cancer Center. (For its part, Watson Health has also signed several interesting partnerships — which I will discuss in a separate post).
Quest CIO Lidia Fonseca, who is also responsible for the IT infrastructure supporting the partnership, says that Memorial Sloan Kettering’s deep knowledge of cancer treatment, combined with Watson’s specialized cognitive capabilities for oncology and Quest’s diagnostic testing infrastructure, creates unique value for cancer treatment. She also believes that the partnership can greatly benefit rural hospitals and providers who may have limited resources and access to cancer care.
The future of healthcare is one where the healthcare consumer will be what she has always needed to be: involved. Emerging partnerships among existing and new stakeholders that are focused on the consumer are the surest signs that the baton is changing hands.