'This is healthcare's Amazon moment': Dr. Stephen Klasko's 5 predictions on healthcare delivery post-COVID-19

Health systems have accelerated their digital health, telehealth and virtual care capabilities in the past 30 days forcing them to disrupt themselves, says Philadelphia-based Jefferson Health President and CEO Stephen Klasko, MD.

Care delivery will never be the same again, says Dr. Klasko, who was also recently named the first distinguished fellow of the World Economic Forum and served as co-chair of the Forum's Board of Stewards for the Future of Digital Economy and New Value Creation at its annual meeting in Davos, Switzerland.

"This is healthcare's Amazon moment," he said. "If you are a provider and think you're going to go back to your business model solely being based on hospital revenue and not relevant to people who want care at home, I think you will be out of business. If you're an insurer and think you can just be the middle man between the hospital and the patient, you'll be irrelevant. If hospitals believe that innovation can be just this cute little thing that they do in the background but the real business is just getting heads in beds, they're nuts. I think we were always wondering what the big disruption would be that got us to join the consumer revolution, and I think this is it."

Here are five key insights from Dr. Klasko about the future of healthcare delivery.

1. There will be more partnerships between health systems and payers as telehealth accelerates. The COVID-19 pandemic is accelerating the use of telehealth and remote patient monitoring among the general population across the nation. In New York, telehealth visits skyrocketed 312 percent and Renton, Wash.-based Providence reported an 20- to 30-fold increase in telehealth visits after treating their first COVID-19 patient. Jefferson has been preparing for the eventuality of widespread telehealth use, and already had the infrastructure in place when the demand spiked.

But health systems and providers aren't the only ones adjusting to the new reality of telehealth as a primary mode of care delivery; payers are adjusting reimbursement coverage and rates to ensure beneficiaries have access to virtual care. Health systems are now devoting resources to keeping patients out of the hospital when possible and allocating the rest of their resources to patients in critical condition.

"The COVID-19 crisis will accelerate a disruption in how healthcare is delivered, paid for and perceived that would have happened anyway, albeit more slowly," said Dr. Klasko. "At Jefferson, we had invested early and significantly in virtual triage, telehealth and early AI applications. That allowed us to have the bandwidth to move from 50 to 100 telehealth visits a day to almost 3,000 a day and train over 1,500 physicians and nurses to prepare for the virtual onslaught. This move from hospital centric 'sick care' to person-centric 'health assurance' will necessitate closer strategic alignment between payers and providers."

Prior to the coronavirus epidemic, some payers did not have expansive telehealth coverage and others had lower reimbursements than in-clinic visits, making it a challenge for the systems to support a comprehensive telehealth program. In the future, Dr. Klasko says health systems will need to align with payers to provide better care at a lower cost.

"Just as hotels did not understand that the Airbnb revolution was not an anomaly, it was a fundamental change in our economy, that 20th century principles of mass production and economies of scale are ceding to mass personalization and rentable scale, hospitals will need to adapt to the 'new normal' of costly 'sick care' giving way to affordable, personalized and preemptive care with genomics, sensors and AI based digital therapies," said Dr. Klasko. "For providers that do not have a payer component, there will need to be new partnerships and creative alignments with traditional payers for either to survive."

2. The combination of increased data gathering and artificial intelligence will make the society more resilient to disease spread. In the future, people will be constantly monitored with real-time feedback on their health that integrates into their patient records. For example, they may wear a watch or shirt that can measure their temperature and tell them if their temperature increases above 100 degrees, or if their respiratory rate lowers.

"I believe we will move from the 'Internet of Things' to the 'Internet of you'," said Dr. Klasko. "At Davos this year, the CEO of a banking conglomerate said to me, 'Twenty years ago the two groups that had escaped the consumer revolution were banking and healthcare. Now you are alone!' Think about how the pandemic would have been handled differently if we had continuous data coming in from patients through their wearables and other sources as it related to temperature, respiratory rate, etc. Or if 3D-printers were as ubiquitous as cell phones. Simply put, in many cases our cars get better care than we do, they are constantly sending data to the cloud. In a few years, it will seem archaic to go once a year for a static physical to an office when your T-shirt has been sending continuous data."

For example, Jefferson is teaming up with software developers to develop a wearable app that will monitor heart patients for atrial fibrillation. If results are abnormal, the device will immediately notify the patient and call an ambulance.

3. How hospitals handle data today will make or break patient trust in the future. With the new HHS interoperability rules making it easier for patients to own their own data, the most trusted health systems with integrated IT that allows easy and secure information transfer will have an advantage over others. Patients will also seek out organizations that ensure their health data won't be used against them.

Consumer data has shown that patients trust their local hospitals and providers more than insurers, big tech or big pharma. Dr. Klasko believes that big tech's place in the healthcare system will look more like the Microsoft model of entry, where the companies create a space for data storage but patients will control who sees their information.

"We must put ethicists at the start of the conversation as we begin to amass and analyze an individual's data or genomics, we must reduce all barriers to interoperability among electronic records and most importantly, a patient's data should be owned by her — not the insurer, the provider or the hospital," said Dr. Klasko. "In the future if a patient wants to switch physicians, she will merely change her password."

4. Technology can close the gap between the "haves" and "have nots" but it must be applied strategically. Technology can only improve community health if everyone has access to it. "The digital revolution cannot simply make the wealthy healthier," said Dr. Klasko. "Digital medicine gives us an unparalleled opportunity to address the social determinants of health and provide access to everyone in their own neighborhoods. The pandemic telehealth team at Jefferson calls themselves the 'Night's Watch' from Game of thrones, they are the 'invisible' defense to this viral foe."

Digital medicine will allow healthcare providers to address social determinants of health and democratize access to the best healthcare in the nation if it's applied appropriately. Currently many underserved patients are not taking advantage of available resources, like clinic visits because they can't take time off from work, need childcare, etc.

"The technology exists, but the key is to make sure everyone on Medicaid has access to it at scale," said Dr. Klasko. "If all Medicaid patients received the right wearables or a digital scale they could step on every day, we could monitor whether their condition is worsening. One cool thing Google is doing is developing kiosks where people can look at a green light on the screen and they can tell with near certainty whether they should be screened for retinal changes due to diabetes, which they are at a higher risk for than the general population."

In another example, Jefferson is deploying technology for women to monitor their health during pregnancy. During pandemics, this technology could alert people in real time about their symptoms and ensure they aren't leaving the home.

"It will be unthinkable a few years from now that a pregnant patient that needs to be monitored a few times a week will have to come into a hospital full of sick people to do it," said Dr. Klasko. "We know that the underserved population has a higher maternal and perinatal mortality partly because they cannot afford to take off from work, park the car, etc. Bringing pregnancy care into the home can be a game changer."

5. The most prized skills in physicians will be empathy, communication and self-awareness in the digital age. Medical schools traditionally emphasized the best technical skills and ability to memorize information and make quick decisions on diagnosis and treatments. Robotic technology and artificial intelligence now can assist physicians with those skills. But they can't make caregivers more empathetic or better communicators with their patients.

"There will be a disruption in how we choose doctors, nurses and other health professionals as the fourth industrial revolution, which includes AI, internet of things, 5G, 3D printing and robotics, takes hold," said Dr. Klasko. "Knowing the answers will be the least important parameter. Knowing the right questions to ask and how to listen to, talk to and empathize with a diverse group of patients will be the 'new gold' for applicants. We will not need robotic physicians or nurses that can memorize complex formulas because they will never do that better than the robots, just as we don't expect people to run faster than cars."

Jefferson is creating a College of Emerging Health Professions that will include some of the new models of care that promote self-awareness, empathy and cultural competence among healthcare professionals. The system also has the Jefferson Scale of Empathy, which is used to measure compassionate care in the context of medical education and patient care.

"Through that scale we have learned that empathy can be measured, can be taught and can be improved," said Dr. Klasko. "That has led us to change our selection process to be more holistic and diverse and to inject humanities and creativity into the curriculum. As one of the oldest health professions universities we merged with a nationally recognized 'design' university in order to 'weave' design thinking and creativity into our scientific curriculums."



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