Health market 2.0: What care provider teams will look like in 2020


Smart care teams — a group of physician assistants, nurses, social workers, coaches and physicians — communicating in real time, 24/7, with consumers, will personalize the provider-patient relationship and shift the care model to prediction and prevention.

In just the first six months of 2014, venture capitalists poured a whopping $2 billion into health tech. It's pretty hard to miss: It seems that every day brings the announcement of another startup company touting its remote monitoring system, disease support app, patient navigation tool or e-prescribing assistant. Meanwhile, the tech giants are pouring billions of their own into health-related projects.

When tech entrepreneurs focus on an industry, they bring on a future of transformative change. Look to personal travel and Uber as one example of a business that has been turned upside down thanks to technology. But how will this play out in healthcare?

From supply to demand

In business, you succeed by meeting customer demand — that's the way things have traditionally worked. But in the age of the Internet, innovative companies have been turning that on its head. They don't respond to demand, they create it. Think of the iPod: We didn't need to carry our music collections in our pockets until we saw that we could, and then nothing else would do.

The health tech companies are doing something similar by getting people to expect that they can have information about their health 24/7 in the palm of their hands. They're getting patients with specific conditions to look to their peers for support and advice. And most importantly, they're creating a surprising level of demand for the "quantified self." One of three distinct movements driving the shift to consumer-focused care, the quantified self refers to the use of personalized apps, social networks and wearable sensors such as Fitbit, Jawbone UP and Livongo that are helping consumers better understand their health and leading people toward healthier habits.

This movement is generating real-time health data that can be used in a multitude of ways. After the recent Napa earthquake, for example, Jawbone released a graph showing exactly when the quake woke people up and how it varied by distance from the epicenter. But there are much more practical uses. Consider the ability for patients to share with care teams health and wellness information from a Fitbit or daily blood glucose values from a Livongo device to help them track patients' conditions, identify risks (or avoid an acute event), and generate suggestions and plans for bettering health. Imagine what care teams could do with daily information about their diabetic patients instead of receiving it just once or twice a year from routine check-ups.   

Tech companies have a remarkable track record of changing the way we live. It's easy to forget that the always-on, totally connected social media lifestyle of many Americans is just a few years old, so strongly has it taken root. Hospitals, on the other hand, have always provided lots of good advice and prescriptions, but traditionally, relatively few patients actually follow all the way through on their recommendations. Sharing consumer daily living values with proactive, patient-centered care teams has the power to bridge health and wellness, change consumer engagement and drastically shift the age old "react/prevent" formula. This approach is better for the consumer and much better for health system sustainability.

The emergence of smart care teams

The quantified-self movement is fuel for smart care teams — a group of physician assistants, nurses, social workers, coaches and physicians — communicating in real time, 24/7, with consumers, personalizing the provider-patient relationship and shifting the care model to prediction and prevention. Smart care teams will have specific characteristics that separate them from traditional healthcare providers, including:

  • Extensive use of information and insights: Access to big data, predictive models, evidence-based medicine protocols, real-time daily living and clinical data will infuse the work of smart care teams. At a macro-level, these capabilities enable population-based stratification, reduce practice variation (and consequently improve quality) and support complex adaptive workflow to apply the right resources to the right patients at the right times. At a micro-level, this allows the smart care team to provide highly personalized health itineraries, track progress, predict issues and conduct proactive outreach to prevent acute events.
  • Configurable resource models: The information and insights mentioned above will support an adaptive workflow with advanced scheduling capabilities, matching the patient with optimal care team resources to align with the current situation. For example, a diabetic struggling with keeping his blood sugar in control might spend an hour with a social worker and a diabetes educator — versus a physician — due to their ability to effectively address the immediate problem. This reallocation allows the physicians to spend more time with the most critical and complex patients while being able to step back and architect overall population care. Where today a physician-to-patient ratio of 1 to 2,000 is common, 1 to 6,000 will be more the norm, as teams comprise eight to 10 team members per a primary care provider in a smart care team environment. The result will bring relief to the pressure of the current physician shortage while allowing for systemic improvements across entire populations.
  • Coordinated ecosystem: A configurable resource model applies not just to the care team but the entire ecosystem. Understanding the importance of expanded access and coordinated care, smart care teams will extend their reach and flex around the patient through telehealth, kiosks and retail pharmacy clinics. With the right integration across the ecosystem, consumers should be able to have around-the-clock access to convenient care. After all, healthcare does not conveniently happen during business hours, and the emergency department is a very high-cost alternative. Cornerstone Health Care and Rite Aid, for example, formed a partnership in High Point, N.C., in which Rite Aid offers 24/7-health coaching services and medication management within the retail pharmacy. Rite Aid and Cornerstone also share an electronic health record and operate as a single, connected team. As a result, Cornerstone is able to offer its patients full access, support and a much more personalized relationship.

Embodying the smart care team model, Rushika Fernandopulle, co-founder and CEO of innovative new primary care provider Iora Health, shared firsthand that he and his teams run sophisticated metrics on their performance and get extremely consistent results: a 40-percent reduction in hospitalizations compared to the control group, roughly 50-percent reduction in emergency room use and up to 80-percent reduction in the use of specialists. And he's only getting started on integrating sensors and patient data into his model. In the long run, he is betting that he can take 40 percent out of the overall cost of healthcare.

Can he succeed? A large part of the answer rests in how people respond to the products and services the tech companies are currently bringing to market and how health plans productize alternative care models relative to traditional PPO networks. If they transform the way we feel about health, as they have transformed the way we feel about so many things, then we may be looking at a world in which the role of healthcare providers and hospitals switch radically — and a world where, thanks to greater transparency and focus on preventive care, our new health and wellness system can provide a dollar's worth of care for 70 or even 60 cents.

Tom Main is partner in the global consulting firm Oliver Wyman, founder of the Oliver Wyman Health Innovation Center and co-author of The Patient to Consumer Revolution: How High Tech, Transparent Marketplaces and Consumer Power Are Transforming U.S. Healthcare with Adrian Slywotzky, a partner emeritus at Oliver Wyman.



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