How technology, aging populations and a global pandemic are reshaping healthcare — Insights for hospital leaders

As the American population ages, demand for healthcare services has increased, creating pressure on the entire healthcare sector. This pressure is influencing major shifts in healthcare delivery, such as value-based care, the rise of nonacute care settings and more.

Becker’s Hospital Review recently spoke with Michele Holcomb, executive vice president of strategy and corporate development at Cardinal Health. She discussed how macro trends are impacting healthcare and how companies are responding. Our discussion happened before COVID-19 had become a worldwide pandemic. We reached out to her again to see how the current situation is affecting the healthcare trends we initially discussed.

Demographic changes, technological advances and, now, the COVID-19 pandemic are reshaping the world we live in

The United States Census Bureau1 estimates there are 73 million American baby boomers. The Pew Research Center2 projects that between 2011 and 2030, each day 10,000 Boomers will reach age 65.

The aging of the baby boomer generation is significant from a healthcare delivery perspective for two reasons. First, as people age, they require more healthcare. "In most industries, when demand increases, that’s a good thing. In healthcare, however, it’s challenging because as costs go up, they eventually reach a ceiling of society’s ability to pay," Holcomb said. "This is creating reimbursement pressure at nearly every interface in healthcare." The emergence of COVID-19 has exacerbated these demographic challenges because individuals over the age of 65 are more likely to experience severe illness due to the new coronavirus. The healthcare needs of the nation’s older population will increase due to the current crisis.

Against the backdrop of the aging population and ongoing pandemic, technology is likely to continue to influence healthcare consumer expectations. Almost every aspect of life has been transformed by the emergence of digital convienences. Digital technology is transforming industries, including shopping, communications and entertainment. Healthcare is no exception. On the scientific front, the ability to map and process massive amounts of clinical and genetic data has enhanced the medical community’s understanding of where and how disease happens. This knowledge is transforming the pharmaceutical industry, thanks to new cell and gene therapies or "precision medicine."

According to EvaluatePharma3, this sector is expected to see enormous growth — up to a 70 percent compound annual growth rate. Experts believe precision medicine will represent around $3 billion this year and could reach upwards of $20 billion by 2024.

According to 2018 data from IQVIA Institute4, over the past 10 years, specialty medicines grew from about half of the products in the pharmaceutical pipeline to around 65 percent of the launches coming from this pipeline.

Overall, these trends were cascading throughout the healthcare ecosystem, from how and where care is delivered to new economic models, improved data interoperability, more robust analytics and more. With the emergence of COVID-19, we are seeing some of these trends advance more quickly.

Consumers’ desire for convenience is transforming where healthcare is delivered

Although hospitals still play a large role in America’s healthcare system, nonacute care is gaining momentum. One major driver is the lower cost of treating people in ambulatory surgery centers, clinics, outpatient settings and even at home. Another driver is the convenience factor. Many patients prefer to be treated in locations closer to where they live rather than travel to a hospital. Most health systems now offer both nonacute care sites and traditional hospitals. According to the L.E.K. Hospital Study5, about half of health systems had nonacute care sites in 2017; today, it’s closer to three quarters.

Connectivity in combination with mobile devices is making home-based services like telepharmacy and telemedicine a reality. These are great options if patients feel too sick to leave their home or they want a second opinion. It’s also possible to connect people in rural areas with academic medical centers. During the pandemic, the use of telemedicine has risen dramatically. Nonurgent physician interactions are either delayed, cancelled or conducted via telemedicine. This is introducing physicians and patients — including those over 65 years old — to using these digital approaches more frequently. It is rapidly bringing people over the hurdle of trial and adoption.

"Technology is enabling access to healthcare in many ways," Holcomb said. "You no longer need to live in certain places to get access to great care, and you no longer have to go to your physician in person, for many aspects of a visit – this is helping people get care, even as they stay at home."

While specialty medicines hold great promise, cost pressures are driving new payment models

Although cell and gene therapies represent a major advance in how diseases are treated, their economics are challenging, as cell and gene therapies can be extremely expensive. This huge expense is forcing the industry to think differently about reimbursement models for these therapeutics. Value-based reimbursement is emerging, as are new payment mechanisms such as subscriptions.

Holcomb said, "Biosimilars are an important area to watch because they may make specialty medicines more accessible to a broader set of patients. As Adam Fein of Drug Channels Institute6 noted, The U.S. had six launches of biosimilars in 2019 and we are starting to see greater market penetration, particularly among supportive drugs like Epogen and Neulasta."

To increase the value and efficacy of healthcare, clinicians need to connect data, not just collect it

Improved connectivity means that healthcare practitioners can shift from point-in-time measurements to longitudinal patient data gathered from multiple sources. For instance, patients with Bluetooth-enabled respiratory inhalers can share data with their providers. With that information, physicians can determine whether patients have been adherent. If a patient’s symptoms are not being controlled with an inhaler, the physician can now assess if it is because the medicine is not working as expected, or because the patient has not been using it. The physician can then make the right decision about whether to change the dosage.

"There is a massive amount of data that can now be collected from patients," Holcomb said. "The challenge is to go from collecting data to connecting it. The real breakthrough will be when we can go from data to analytics to insights to behavior change. Data alone won’t get us to that goal."

Connecting data across pharmacies, physician offices, hospitals and telemedicine providers is essential for identifying patterns across patient groups that a single physician would be unable to see on his or her own. Analytics also have the potential to shed light on the interaction of different social determinants of health, as well as environmental, clinical and genetic factors, and these analyses also help identify trends in the spread of infectious disease.

Companies are responding to consumer healthcare expectations and connected care

Companies like Cardinal Health are responding to these emerging trends in a variety of ways, with an eye toward providing high-quality, cost-effective services to consumers and health systems alike.

In the home and in nonacute settings, clinical protocols and the practical aspects of care delivery must be addressed. Home-based care in particular presents challenges. Companies are spending a lot of time on practical considerations, such as getting care providers and supplies to the bedside. If a home healthcare nurse visits multiple patients during the day, for example, he or she must have the right supplies for each individual.

"Data and digital technologies have the potential to connect nurses with suppliers to ensure that supplies are at the patient’s home at the right time on the right day," Holcomb said. "Cardinal Health has a business that supports patients in the home, but we are also evolving, so that people can receive the full range of care and products in the home setting."

Administering specialty medicines is also more complex than traditional pill-based pharmaceuticals. Additional services must be brought to bear. "Being a good drug alone isn’t enough — companies must enable providers and patients to use the drug effectively. Cardinal Health is helping customers handle the logistics of the so-called ‘vein-to-vein’ delivery of cell and gene therapy. We want to ensure that patients have a high quality of care," Holcomb said.

Optimizing the hospital value chain represents another major opportunity to improve the efficiency of healthcare. In the healthcare supply chain, data has always played a significant role in optimizing logistics. Data is critical for transportation, as well as for tracking and ensuring the safety and security of the global healthcare supply chain. Similar types of information are also useful for optimizing the supply chains within hospitals. The criticality of data, and its linkage to supply and logistics, is magnified during the current pandemic. Assuring the safety and security of the supply chain, verifying that the products are not counterfeit has been a critical role of distributors during the pandemic. Connecting the dots for hospitals throughout their supply chain is an important role for data and analytics approaches in healthcare.

"Data is the key to ensuring that the right devices and products are used on the right patients. Cardinal Health’s WaveMark solution, for example, helps hospital cath labs track and properly use the supplies used in patient treatments," explained Holcomb. WaveMark uses RFID-enabled cabinets to store and track products, and a web-based solution provides real-time visibility into inventory levels, as well as tracking of expiration dates of these products.

The future of consumer healthcare depends on improved transparency, access and affordability

Consumer healthcare is about meeting patient expectations — that means providing safe, affordable, state-of-the-art care. Physicians, health systems, manufacturers, payers and companies like Cardinal Health are all thinking about how to provide consumers the care they want, in the setting they prefer. This desire to provide for consumers has reached a new level of need, as we collectively battle to defeat COVID-19. Healthcare providers are doing all they can to treat patients, and companies like Cardinal Health are working closely with other healthcare players and the government to find solutions.

Before COVID-19, this meant delivering leading-edge precision medicine to patients in need, perfecting the details of care delivery in the home and connecting data — whether that’s health records across health systems, supply chain information or data that patients can use to compare drug costs, care costs or quality ratings for physicians or hospitals. Today, this means using data to focus efforts to fight the pandemic.

"Cardinal Health sits in the middle of the healthcare system and we\ see how trends are playing out in hospitals, pharmacies, clinicians’ offices, payers and directly with patients," Holcomb said. "We’re excited about the future and are striving to provide customers with new business models. Our goal is to help customers address the challenges associated with the changing world of healthcare delivery. And this begins now with helping our customers and their patients battle this virus." 




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