Gone are the days when the delivery of healthcare was confined to the four walls of a hospital. Mayo Clinic is launching its own “hospital at home” model and has autonomous vehicles delivering Covid-19 tests. Maccabi Healthcare Services in Israel plans to deploy an AI system that can identify people at risk of developing Covid-19 complications. Simply put, the “hospital of tomorrow” will look quite different than the one to which we’re all accustomed.
Until now, the transition has been somewhat gradual — a shift to value-based payment, a renewed focus on patient outcomes rather than volume — but the Covid-19 pandemic has both amplified the gaps in hospital-delivered care and sped up innovation to find better, more efficient, mechanisms to deliver quality care.
The virtually overnight pivot to telemedicine in response to the pandemic has shown us that much of our healthcare can be managed remotely. For many patients, it’s not only more convenient, it’s safer to avoid physically going to a hospital environment for general checkups. Even before Covid-19, the Centers for Disease Control and Prevention (CDC) estimate there are 1.7 million hospital-acquired infections annually, which lead to 99,000 deaths. There’s little data currently available about hospital-acquired COVID infections here in the U.S., but one estimate from the U.K. cited as much as 20% of cases were hospital-acquired.
There will always be a need for in-hospital care as we think of it today. No one’s going to receive ED-level or trauma care via video call. But to understand where we’re headed and why, it’s important to first consider the factors driving changes in how healthcare is delivered. How we think about healthcare will need to evolve in order to deliver better care at a much lower cost.
What’s driving the change?
The skyrocketing cost of healthcare is perhaps the single biggest driver. In 2018, the United States spent about $3.6 trillion on healthcare, 17.7% of GDP. The Centers for Medicare and Medicaid Services (CMS) project that by 2028, costs will climb to $6.2 trillion — about $18,000 for every person living in the U.S. – and these are pre-pandemic estimates, which don’t account for the unknown costs yet to be attributed to COVID-19. Additionally, these higher costs are not resulting in better patient outcomes: despite higher spending, there are many studies showing the quality of U.S. healthcare lags behind other industrialized nations. Consumers, payers, providers and regulators will all need to reimagine how care is delivered and leverage technology to reduce cost and improve quality.
Consider our healthcare infrastructure. Delivering healthcare in a hospital is the absolute most expensive setting by far — 33% of total healthcare costs ($1.2 trillion) are spent on hospital care. More than $8 billion a year is spent in emergency department (ED) visits that could have been first treated elsewhere. Treating the ED like your primary care provider is like calling the fire department to change the battery in your smoke detector.
How we pay for healthcare also needs to change. The Covid-19 pandemic highlighted the deficiency of our current system. In order to keep people safe, we needed to keep people at home and avoid hospitals. Non-emergency forms of care were stopped which cut off large sources of revenue. Hospitals are facing huge budget shortfalls and primary care practices are expected to suffer a $15 billion loss due to COVID at times when we need to be investing.
If the primary driver is cost — why isn’t healthcare reaping the benefits of information technology as other industries have? Consider the way banking and financial services have embraced technology to their benefit. We hardly use checks any more let alone go to the local branch to make a deposit. Another driver will be individuals taking a more direct role in managing their own care and associated costs. We saw a sea change in our own retirement systems — the transition from traditional pensions to individuals taking ownership of their retirement planning — and we’ll likely see a similar shift in healthcare.
The healthcare industry has historically been slow to benefit from the efficiencies of technology. Healthcare economics is defined by a unique complexity: the combination of private and public payers. Government programs, including Medicare and Medicaid, account for $1.2 trillion each year; private insurance is about the same. Healthcare is also highly emotional. What parent is going to question costs when considering care for their child? It’s not like comparison shopping for a new TV.
The only way to stop or reduce escalating costs is to develop a new model of care delivery — tech companies will continue to take the lead and will prove that healthcare delivery can be more efficient, more effective and offered at a lower cost.
The doctor will see you now — please turn on your camera
Hospitals as a physical entity will change — they’ll look different. Sure, there will be more care delivery in a patient’s home. But there will also be care outside the home: the corner pharmacy taking on a bigger role or assisted living (another segment of healthcare ripe for transformation). Another avenue is self-service point of care — think of Amazon delivering at-home Covid-19 test kits directly to consumers.
We also need to embrace new ways to consume healthcare and payers need to incentivize and compensate healthcare providers to leverage technology. As Covid-19 reduced or eliminated elective procedures, routine visits and other bread-and-butter revenue streams have been slashed. Healthcare systems aiming to keep people out of hospitals, clinics and physicians’ offices, opened the doors for telehealth like never before. A friend of mine who is a physician went from seeing 10 to 15 patients a day in the office to 100% remote virtually overnight.
It took all three stakeholders to change: Patients, providers and payers to all had to adapt quickly to leverage existing technology, change workflows, and adopt new billing procedures. So far, it seems to work.
We will continue to see new practice models emerge and we can expect routine visits via telehealth to continue. And this is good news for entrepreneurs and investors. The government kick-started the digital health trend when it invested billions of dollars in the necessary infrastructure to fuel digital health during a push for electronic medical record adoption across the country. Now, the digital backbone is falling into place for connected medical devices and healthcare IT to connect everything together. Devices and services that enable remote monitoring, remote control, data analytics — technology that enables the delivery of care in diverse settings — will drive the next wave of innovation beyond the needs of the current pandemic.
If the injury and situation is serious enough, people will continue to go to the hospital. But if you just need blood drawn, do you really need to go to a hospital or your local lab? Wouldn’t it be easier on you (and less costly to everyone) if you could just prick your finger at your kitchen table and send in your blood sample? Do you really need to physically see your physician for a routine question you could ask via a secure messaging system or video chat?
Providing affordable and effective care is imperative to help solve healthcare’s trillion-dollar problem. Technology has improved our lives in countless ways — it’s time healthcare reaps the reward. Lives, and our economy, depend on it.
Photo: Getty Images, xrisca30