"You're On Mute!" A Look at the Healthcare Industry in 2021

I remember in late January (2020), my PCP and I were talking about this new virus that has been in medical news. She shared with me that they (her medical group) recently had a staff meeting to discuss its implications and how if it got bad, there is nothing anyone could do. Then a few months later, our lives resembled storylines from Contagion. Well, 2020 has, without question, schooled us on so many levels. It has impacted every industry, and none more than healthcare, exposing the very delicate interwoven fabric it is made from.

So, what's next? Where do we go from here?

What does the healthcare journey look like in 2021 and beyond?

Virtual care will continue.

As March 2020 rolled in, SARS-CoV-2 (aka, COVID-19) flipped the script and changed our lives forever. The world as we knew it went on lock-down and virtual became the reality for most. It was surreal. 

I don't recall a technology platform being adopted so quickly; WebEx and Zoom became the eponyms for how we were going to conduct business meetings, teach students and get together with family and friends. Healthcare organizations were not exempt.

They had to quickly pivot to care for their patient populations virtually. Hospitals and medical groups, both large and small, implemented telehealth solutions (not just technology, but the people and processes as well) at breakneck speeds. Digital transformation roadmaps were redrafted from 5-year plans to weeks.

No one typically likes change, however for many, having access to healthcare over one's phone, tablet or computer was not as bad as people thought — both patients and clinicians alike. Virtual care isn't new. It has been around since the late 1950s. Organizations that established telehealth programs before COVID-19, such as Mass General Brigham, were planning on about 12K encounters in 2020. By the end of October 2020, they were at over 1.4 million telehealth visits. Their two-year plan to expand their telehealth platform was condensed to weeks. 

In just about every specialty of medicine, we have seen adoption in virtual visits; behavior/mental health, primary care, pediatrics, oncology, physical therapy, urgent care, dermatology, etc. Most industry leaders won't argue that virtual care is here to stay. Frost & Sullivan recently predicted 1 in 3 patient visits will be virtual – globally. Because of the pandemic and convenience experienced by patients and clinicians with digital encounters, the expected growth in 2021 will be 20-25 percent. So now what? What's next?

Assessment and optimization

Many organizations quickly implemented their telehealth platform out of necessity. They are now going back to reevaluate the viability, scalability, functionality, interoperability and licensing cost germane to the healthcare ecosystem. They are looking for insights through data to drive automation with AI/ML.

Organizations realize that patients expect to have the digital experience they are used to in other industries. Having a patient-centric frictionless digital front door to their healthcare journey is what is demanded — patient registration and verification, scheduling, clinical data access, care team communication, reminders, wayfinding, referrals, payment, telehealth, etc., all on their preferred devices fully integrated on the other end to their healthcare facility's digital environment.

Remote patient monitoring 

From hospitalized patients, those at SNFs or home, the technology can span the entire continuum of care. Hospitalized patients are monitored for various decompensating events or compliance with quality metrics remotely. Home monitoring for acute conditions — such as vulnerable COVID-19 patients and chronic diseases patients needing proactive, continuous care rather than episodic reactive care — is happening today. With synchronous and asynchronous connectivity using IoT med-tech devices, AI/ML clinical decision support and patient interaction chatbots, and A/V interfaces, surveilling these patients to drive early recognition for early intervention will be the expected standard of care. 

Platforms that are intuitive, integrated and utilize automation and provide a frictionless experience for patients, clinicians and business operations will most likely rule the day. Teledoc (Livongo), Amwell, Omada and the even more multifaceted behemoth UnitedHealthcare/Optum/Vivify Health — who will rise to victory in the Colosseum as payers move more toward value-based models?

Let's talk about non-traditional healthcare.

We have seen record-breaking investment in the healthcare arena in 2020, mainly due to the doubling of VC deal sizes, swelling IPOs and huge M&A plays. As the new administration comes into office, it will be interesting to see how 2021 shakes out.

The Affordable Care Act will again go through its third ruling this spring by the Supreme Court. The ACA should be okay, even with hints of eliminating the individual mandate. This is good news as people will need healthcare insurance as we recover from the pandemic, and hopefully they can transition to employer-covered plans. Both payers and providers may find this to be stress-reducing as well. 

The good thing to note is the healthcare IT has typically had bipartisan support. We hear the term "disrupters" often in our industry. I, for one, am not a fan of that moniker. I prefer "innovators," as it sounds less chaotic. From Big Tech (Apple, Amazon, Google, Microsoft, etc.) to start-ups to Big Box Retail (CVS, Rite Aid, Walgreens, Walmart), there are billions of dollars at work here trying to change the healthcare lexicon, along with the narrative. 

Big Tech

It was announced at the beginning of the year that Haven Healthcare, a joint venture started three years ago with Amazon, Berkshire-Hathaway and JPMorgan Chase, will dissolve its efforts collectively. Haven formed with the premise of revolutionizing and innovating the healthcare delivery system. Rumor has it that misaligned objectives from these monoliths of tech and finance were their Achilles heel. 

However, we see Amazon providing digital health services for their employees via Amazon Care as a pilot. Wait, they bought Pillpack to pave the way for Amazon Pharmacy. Why stop there? Why not be the Amazon Prime for all your primary care digital health needs, along with your groceries and the rest of your consumer purchasing? It would be the ideal one-stop shopping consumer-centric experience.

Start-ups

Start-ups are not exempt from wandering down different paths from where they started. Case in point, Roman, Lemonaid and HIMS began their journeys in sexual health, supplements and hair restoration treatments for the most part. As I visit their websites, it seems like they retraced their steps to caravan toward the digital primary care delivery destination. This territory is relatively new, and the vast landscape is still uncertain.

Big box retail 

Oh yes, they have been at this a while, staring with retail clinics over 20 years ago. CVS, for example, was one of the early players in this space. Reading the primary care tea leaves, they began offering QuickMedx in 2000 to their patrons in the Minneapolis-St. Paul area. Demand grew from the convenience, and CVS expanded this model as sizeable employers requested their health plans to include QuickMedx, which then became 'MinuteClinic." From this, CVS launched CVS Health, became the first retail clinic provider to earn Joint Commission (formerly JCAHO) accreditation, now have well over 1,100 MinuteClinic locations across the U.S. Not stopping there, CVS Health acquired Aetna in 2018 for $69B… you can see where this is going, right?  

Over the summer of 2020, Walgreens announced it has partnered with VillageMD to open doctor offices in 500 to 700 of its drugstores over the next five years. These brick-and-mortar offices are essential, as more than half of them will provide care to underserved populations and areas where healthcare professionals are sparse. Walgreens will not be alone, of course. Walmart Health also continues to move further down the road in primary care delivery to expand the Care Clinics and Telehealth services.

Don't forget a few other insights.

Value-based care or pay for performance (P4P) 

As I mentioned, this pandemic has caused hyper-speed adoption of virtual care paved by relaxed state licensing restrictions and somewhat improved reimbursements. It seems that COVID-19 has propelled value-based care further down the new normal road as well.  

Healthcare organizations dependent on fee-for-service took massive hits to their bottom lines secondary to the dive in elective surgeries. These surgeries were being canceled either by the patient on the count of fear or by the hospital because of infectious disease containment and care of COVID-19 patients. However, organizations sharing risk in value-based models were still getting paid, which hedged against some of the lost fee-for-service revenue. Additionally, CMMI (CMS Innovation Center) looks to be rolling out additional value-based care programs that are more vigorous and binding than today. I suspect we will see greater adoption of value-based care and shared risk moving forward.

Strategically building technical equity 

This pandemic poked the mildly hibernating healthcare ecosystem grizzly. Pre-COVID-19, organizations were foraging on narrow margins supported by archaic reimbursement methods, aging and costly IT infrastructures, piecemealed clinical application tools with lackluster utility for those that use them, all while being lost in a disparate data wilderness. 

Sometimes managing P/L meant reducing staff. I have seen organizations reduce cost by laying off their nursing staff to replace them with less expensive travel nurses, just as capable, however only not as familiar with the hospital's protocols or quality initiatives. As the pandemic began and raged on, this tender, soft underbelly was now exposed. As revenues dried up, more drastic measures were reluctantly invoked. Clinicians, including physicians, were being furloughed or outright laid off in a time when we needed these superheroes most.  

From March 2020 till now, we have learned a great deal from this pandemic. Now, proactive organizations realize that strategic investments need to be made sooner rather than later in paying down their technical debt. The short-term cost adjusting methods of the past are not the way forward. Proactive healthcare organizations are strategically investing in next-generation IT infrastructure, fluid interoperability, unified data models, multicloud environments, value-driven IoT, AI-supported cybersecurity, advanced analytics — all to move significantly closer to the Quadruple Aim of Healthcare.

Advanced analytics 

Again, another lesson taught by mother nature since last March is our supply chain ill-preparedness. Scrabbling and rooting for ventilators, PPE and other clinical resources exemplified where AI/ML can change the future paradigm. Now, as we are in the throes of vaccinating our population, patient tracking, proper storage, distribution and patient communication/notification will be paramount for AI/ML to drive supply chain intelligence. 

Advanced analytics plays a significant role in evolving diagnostics across different medical specialties, R/D of new products, accelerating drug development and precision medicine, clinical trial initiatives, patient-centric focused interaction (chatbots), social determinates, advanced CDS and practical clinical workflow process automation to help reduce clinician burnout. Of course, let's not forget the bottom line: revenue cycle management implications driving automation and timely opportunities to be proactive with advanced analytics is table stakes today. As bad actors become more sophisticated and ruthless in their ambition to hold healthcare organizations hostage and put patient lives at risk with ransomware, advanced analytics is critical in a modern cybersecurity strategy.

Prescription digital therapeutics (PDT) 

We are seeing PDT leap-frog into 2021 as some have now been FDA approved as well as being prescribed by physicians and reimbursed by payers. For example, Pear Therapeutics offers reSET, a 90 day PDT used for substance use disorder approved by the FDA. EndeavorRx became the first game-based digital therapeutic to help children with ADHD and got FDA permission to market its non-drug option over the summer. 

I suspect this space to continue to grow as patients expect healthcare to be just as accessible as ordering an ahi poke bowl from the Hawaiian spot across town via their favorite app. The challenge we will see is how physicians integrate these PDT into their patient's treatment plans and how payers will handle reimbursement.

Since the beginning of this pandemic, we have come a long way, and the journey is not over. However, I'm inspired and reminded of a quote from Sir Winston Churchill towards the end of WWII: "Never let a good crisis go to waste."

[i] https://www.ncbi.nlm.nih.gov/books/NBK207141/

[ii] https://www.himss.org/resources/accelerating-telemedicine

[iii] https://www.healthcareitnews.com/blog/frost-sullivans-top-10-predictions-healthcare-2021

[iv] https://abcnews.go.com/Politics/obamacare-appears-survive-supreme-court-challenge/story?id=74125898