The Future of Healthcare According to NextMed Health

Telemedicine is dead, embrace the cyberdelics, digital sleeping pills, and retail enhanced care.

If you ever want to immerse yourself in the latest innovation trends in the digital health space, the NextMed Health conference is probably the best choice to do so. In a 4 day, mostly US-centered program with only one stream, hence no FOMO on other sessions, we heard a fresh vocabulary describing futuristic ideas for healthcare improvement. Such as cyberdelics - VR therapies for pain and mental health management. If these were a futuristic idea 5 years ago, their use is on the rise in the US. The same goes for the use of VR for education purposes and faster training of the clinical workforce.

Neuroscience is going beyond implants such as Neuralink, to noninvasive deep-brain stimulation based on sound waves. Muse is developing new digital sleeping pills - meditation programs specifically designed for cancer, menopause, and cardiovascular disease. Mary Lou Jepsen, CEO and Founder of Openwater, shared findings of the use phase of waves via interference to impact glioblastoma cells without damaging the healthy tissue. New, non-invasive ways of measuring and impacting brain function are opening up a new frontier of ethical questions.

Social determinants of health

There was no shortage of topics related to the societal changes needed for health outcomes improvement. For example, food. Schools are the largest food chains in the US, and access to healthy food should be seen as the key driver of better health for future young generations. As mentioned by Nora La Torre, CEO of Eat Real, “The American dream is to have a good life. Progress is to give your kids a better life than you had. The opposite is happening. Processed food-related diseases are taking away life and healthspan,” she said. 90% of serotonin, the happiness hormone, is made in our guts. 93% of Americans are cardiometabolically sick, and at the moment, American kids eat a bathtub of sugar per individual per year, are some of the statistics she also shared.

Additionally discussed was the importance of voting access. Since people trust doctors, doctors should encourage their patients to vote, which can impact election turnout, and, consequently, policymaking.

 Read an in-depth summary of the conference program by Zayna Khayat, or tune in to the recordings. 

Shifts in care delivery and healthcare digitalization

Digitalization has been accelerated across the world in healthcare, and as mentioned by Herko Coomans, International Digital Health Coordinator at the Dutch Ministry of Health, Welfare and Sport, “There’s more money in the space than we are able to spend wisely. Countries are looking at potential structural changes which has never happened globally at this scale.” Europe has big ambitions in the health data space, with 6 regulations coming up to create the European Health Data Space and harmonize the EU EMR market, standards and data security.

But the solution is not just in more money, we need to transform, emphasized Ran Balicer, Chief Innovation Officer & Deputy-CEO at Clalit Health Services in Israel. We don’t necessarily want more data, but insights from data.

Platforms

Digital health started a massive fragmentation in healthcare said Simon Gisby, Life Sciences & Health Care Group Leader at Deloitte (DCF) and Bori Kheyn-Kyeyfets, Digital Health Specialist at Deloitte. This also had several effects:

1. the shift from sick care to health care is turning the patient into a consumer.

2. The physician became a gig worker.

3. Primary care is being unbundled because it is currently too broad and too brunt.

4. Modularity is making it possible to offer an array of primary care services separately (symptom checking, urgent care, and condition management).

Consequently, platforms will start to pull together unique solutions addressing each individual’s current issues.

How is Healthcare Re-Shaping (Towards Virtual and Retail Care) Globally, According to NextMed Health Participants?

Advocate Health, a US healthcare system with 67 hospitals, recently announced an agreement between Atrium Health (a hospital network in Charlotte, North Carolina, part of Advocate Health) and consumer electronics retailer Best Buy. The aim of the partnership is to provide 'hospital at home' care services. Best Buy will sell and install devices and educate patients about the use of devices.

As mentioned by Rasu Shrestha MD MBA, Chief Innovation & Commercialization Officer, Executive Vice President at Advocate Health at NextMed Health, "fee for service has failed the test of the pandemic. Cloud, virtual, AI has become the core of healthcare systems."

In the latest episode of Faces of digital health, we took this announcement as a starting point to ask 8 participants from across the world at NextMed Health about their thoughts related to shifting towards virtual and retail health in their country.

Speakers:

• Rasu Shrestha -  Chief Innovation & Commercialization Officer, Executive Vice President at Advocate Health (USA),

• Ali Hashemi, investor, CEO of meta[bolic] (UAE),

• Bianca Rowenhorst, CIO at the Ministry of Health, Welfare and Sports in the Netherlands (Netherlands),

• Lucien Engelen, thought leader, who operates globally at the convergence of Innovation & Strategy for executive boards, governments, corporates (Netherlands),

• Michael Friebe, HealthTEC Inventor/Investor/Entrepreneur and professor (Germany),

• Alex Zhavorkonkov, CEO of InSilico Medicine (USA, China, Canada, UAE, Belgium, UK, and Taiwan),

•  Emilian Popa, CEO of Ilara Health (Kenya),

• Zayna Khayat, VP Client Success Teladoc Health in Canada, In house health futurist at Deloitte Canada's Life Sciences & Healthcare team and Adjunct faculty with the University of Toronto Rotman School of Management in the Health Sector Strategy stream (Canada).

Why is Healthcare Reshaping

Healthcare is facing challenges on all fronts. WHO estimates a projected shortfall of 10 million health workers by 2030, mostly in low- and lower-middle-income countries. Countries at all levels of socioeconomic development face, to varying degrees, difficulties in the education, employment, deployment, retention, and performance of their workforce.

Several other factors, such as the aging population and the rising demand for healthcare services, put healthcare systems under pressure to change and adapt. To a degree, with the help of technology.

A big topic in many systems, especially in the US, is the move of retail providers such as Amazon and pharmacies Walgreens, and CVS into primary care:

• In 2021 Walgreens bought VillageMD, and plans to open at least 600 co-located Village Medical at Walgreens primary care practices in more than 30 U.S. markets by 2025 and 1,000 by 2027.  

• Last year, Amazon decided to acquire the primary care provider One Medical, and finished the deal this year.

• CVS acquired Signify Health last year, and is acquiring primary care provider Oak Street Health, to address the underserved, since the majority of Oak Street's patients have either a housing, food or isolation risk factor. 

• Walmart Health was launched in 2019 and has been opening health clinics and supercenters to provide key health center services for local customers with transparent pricing, regardless of insurance status.

Hospitals are looking at opportunities for virtual care and turning homes into hospital-like environments supported by virtual monitoring. 

Atrium Health,  which is part of Advocate Health, announced a partnership with the electronics provider Best Buy to provide services for virtual care. With this, the healthcare system wants to meet its customers where they are. “It's not just throwing digital and data and technology after a problem, but it's really helping them and meeting them in the middle. So we have paramedics, we have social workers, we have nurses, we have physicians, and then we have data and remote patient monitoring, but entering the patient's home, really improves the experience, bringing cost. This is an opportunity for us to really say, can we actually decrease the length of stay? And we're showing that we can take patients who would otherwise have prolonged stays in the hospitals, such as post-op patients who are maybe recovering from a knee arthroscopy or a hip arthroscopy or congestive heart failure patients, or patients with pneumonia and  COPD. Can we actually discharge them earlier so that we can then treat them in the comfort of their home? In addition to the cost, there actually is an increase in the quality as well as a 10-point increase in patient experience, which is amazing,” explained Rasu Shrestha in a short interview.

The United Arab Emirates is very keen on adopting technologies from the West. However, when it comes to virtual care and retail health, Ali Hashemi, Investor and Co-Founder and CEO of meta[bolic] believes the advantage in the US is the large market. “I'm not sure that there's a one-to-one comparison or copy-paste in that specific secular trend. In the UAE we don't have the scale that you need to have in order for an Amazon-like play to make sense or a CVS play to make sense.”

Regardless of that, he believes the shift toward retail doesn’t solve the key challenge of moving towards value-based healthcare.

“If you talk about retail and health within retail, that's a channel story. The more important picture is what are we actually buying? You don't just watch movies on Netflix. You actually subscribe to a number of different channels as your source of content or source of a product. And the same is likely to be true for healthcare because you're much more sensitive to having choices in some sense. The reason you're sensitive to choice is that it's very hard to determine what's good and what's not, because there's an information desert. People so far aren't accountable, aren't reporting outcomes, and they're not accountable for those outcomes. I'm thinking way beyond the channel partnerships. What I'm trying to figure out is how do we actually move everyone away from paying for products, lab tests, diagnostics, and paying for the outcome itself.”

Many countries in Europe are publishing their healthcare digitalization strategies this year.

The Netherlands will have one ready by April. In the Netherlands, hospitals are private with a certain freedom in terms of investments but are still very limited in data sharing. Bianca Rowenhorst, CIO at the Ministry of Health, Welfare and Sports in the Netherlands says the Netherlands is in the transition of trying to figure out the best approach towards the move to home hospitals. “We are just starting with this transformation and have to work at the trust and adoption of digital care when we want to provide care at home instead of different hospitals. Clinicians from different hospitals need to work together. As the government, we only make laws. My job after returning home is to talk to hospitals and help them with the transition to care at home.”

The Netherlands has a highly digitized healthcare system and a generally strong startup ecosystem. As presented by Lucien Engelen,  who operates globally at the convergence of Innovation & Strategy for executive boards, governments, corporates, and professionals via his company Transform.Health, one of the startups in the healthcare space, designed a machine that could be placed in pharmacies and provide automated phlebotomy services. He is also organizing an innovation consortium of different stakeholders in the Netherlands for further exploration of options around retail health in the country. “When patients get into their drugstore or their supermarket or their pharmacy as opposed to the clinics and the GP practices, the number of touchpoints will increase. And with that, we will be able to catch diseases earlier on and be able to refer them better. I think we are in the early days of these ideas, it probably will take a generation. I now run a program which is called Healthcare Meets Retail in the Netherlands. 35 big partners chimed into it, and as a matter of fact, on May 12th, we will open up the first exploration center in the Netherlands with those 35 partners to just explore what the opportunities are,” he said in addition.

Germany has been at the forefront globally with the reimbursement system designed for digital therapeutics (DiGA). But when it comes to the national digital healthcare infrastructure, the country is lagging behind other countries.

HealthTEC Inventor/Investor/Entrepreneur and professor Michael Friebe, sees the reason for slow progress with digitalization in Germany in the fragmentation of the country into states, the legal setup of care provision, and culture. However, he believes solutions that don’t require medical supervision could be introduced. 

“A good friend of mine has said that Germany has by far the best analog healthcare system in the world. I think the major problem is that doctors typically have all the power. Doctors are the only ones who are able to charge for health services. You are not allowed as a normal company to employ doctors. That's against their statutes. On the other hand, I believe I'm not sure that we need a doctor for kind of booth setup, this health booth or this health checkup as long as the booth doesn't give you any diagnostic information, only merely information about your status. Biometric status.”

An additional challenge for Germany to move faster in updating its digital healthcare infrastructure is the fragmentation of decision-making to state levels.

“In Germany, we have 16 states, and health is the responsibility of the states, which also means then that the federal ministry cannot really tell the states what to do. And there are a lot of people who just always see the problems rather than opportunities. And that's why nothing happens in this country. In 2012, we're supposed to have the electronic healthcare record. It's 2023 now. Nothing has happened. Now our new federal minister has promised it will introduce electronic prescription healthcare by the end of 2023. So we'll see what happens. I'm skeptical. Germany has always been on the forefront of a lot of innovations, but they have not been capable of actually making a business model out of it or do actually scale it. But at the end of the day, there are lots of entrepreneurs, lots of ideas, and lots of concepts that are then blocked in the German system and then these German entrepreneurs have to actually move outside or move somewhere else. ADA Health is basically a US company now. But they were started in Germany, Berlin. And this is really sad to see, but it's, that's what happens.”

“China is the future”

When discussing virtual care, a good market to look at is China. It’s digital economy and culture have been reshaping care delivery and healthcare access for years. Alex Zhavorkonkov, CEO of InSilico Medicine, an artificial intelligence company headquartered in Hong Kong, with R&D and management resources in the USA, China, Canada, UAE, Belgium, UK, and Taiwan, believes that China has a strong competitive advantage compared to other countries due to the preparedness of people to share their healthcare data.  

“China as we know is the future, right? So if you go there and spend some time there, you'll feel like on a different planet. Chinese are very accepting of new technologies. The payment system is all digital, there is pretty much no paper money, and people pay with their phones. So they're so used to interacting with the phone for all their basic needs. That it very rapidly propagated to healthcare. So now we have massive systems like We doctor and many other private apps and Alibaba systems that allow people to procure drugs, make medical booking appointments, make appointments in a hospital, communicate with a doctor interact with their digital files. So all the patient records, everything can be digitized and exposed to the patient in real-time via one of the apps. Healthcare integration is seamless, so you basically naturally plug healthcare into this digital world. So I think the world needs to be a little more interconnected and trusting towards technology. In the West I see that people are much less willing to share their healthcare data and are very afraid of their healthcare data being accessed by others. Employers are heavily regulated so I think it's a cultural issue.”

What about Africa?

On the opposite side of the spectrum is Africa, where healthcare delivery is often provided by nurses in the community. The quality of care is generally low, and the market lacks the buying power for digital tools. Emilian Popa is the CEO of Ilara Health, which distributes low-cost, modern-tech-powered diagnostic devices directly to primary care doctors in peri-urban and rural clinics. As he says, the environment and challenges in Africa are very different to Western countries.

“When I look at what's happening on the other side of the world and specifically in Africa and Kenya, where I am, it's very different. But I actually don't think it's that different from what can happen in the US outside of large cities. You live in downtown Boston or you live 10 miles outside. That can mean a 20 or 30 years drop in life expectancy. So what I wanna say is that we live in two different worlds and the way the car is delivered using technology or everything else is very different.”

Challenges in Africa relate to the small buying power and lack of infrastructure to provide care.

“I firmly believe that there needs to be a fundamental shift from the typical treatment to prevention and detection. This is the common point. When I look at the food crisis and the health crisis because of food in the US and Kenya it's not different. People eat the same hydrogenated oils and sugar and massive quantities of sugar, and then milk and bad carbs. I think the big difference is that here there is money to solve this issue if there was a better willing and some kind of awareness. There's money to create awareness. On the other side of the world, there's no money and there's no awareness.”

Money is just one issue. The rest falls to the broken infrastructure and the buying power.

“We often think that technology is a universal solution for everything. Not always, other things we need to come first: awareness, and pricing. Kenyans spend $70 a year on the whole healthcare delivery and this is out of pocket. And Americans spend 10,000, a European will spend between two and 5,000, right? So $70… what can you really do with $70? A lot of things can be delivered by technology, but the delivery of a better healthcare system is much more complex than just technology.”

A fact unknown to many though, is that care in Africa is already very decentralized and close to patients. The problem is its poor quality.

“There are plenty of small, decentralized care facilities, but they're all completely broken. The level of education of those medical practitioners is very low. There's no technology. So the challenge is how do you bring technology in this decentralized care, how do we upgrade tech to make it work? And that's much more complex than just virtual care because virtual care works in a place where you have a proper home. A Kenyan in an outskirt of Nairobi would not have a home in the way we understand it here. Maybe she lives in a shack. And there are maybe five clinics in the street. There're like maybe 40, 50 pharmacies in one street, as much as there are hundreds of people selling fruits and vegetables because there's no supermarket. It's very difficult to do virtual care but actually, there's no need for it. Care is already there. The challenge is that people pay out of pocket and they will not be able to afford a specialist. So you can put 'em in front of a phone and a camera with a specialist somewhere, but who's gonna pay for that? The bigger question in this context is how do you upgrade clinicians, nurses, care delivery using clinical decision systems diagnostics, or automated diagnostics, point of care, diagnostics, et cetera.”

In conclusion…

Healthcare systems are too different to be comparable. But in the context of NextMed Health, one word that wasn’t used once was telemedicine. “15 minute visits with a highly trained physicians are just so… the end of healthcare. Virtual care is now where you're untethering care from place, from visits, from time. And you're able to get a much more continuous set of engagement and data,” says Zayna Khayat, who is based in Canada, and works as VP Client Success Teladoc Health in Canada, she is also the in-house health futurist at Deloitte Canada's Life Sciences & Healthcare team and Adjunct faculty with the University of Toronto Rotman School of Management.

“For a number of years when we started to talk about e-health and my mantra was that we need to get this digital and virtual and e-health out of the world. This is just healthcare. Now, this is really starting to kick in reimbursement systems, protocols, and standardization. In Europe, we now are at the brink of this European Health Data Space. Still a lot of work, tons of work to do, to be honest, but this also will bring a bigger market for players to address Europe,” says Lucien Engelen.

Tune in to the full episode.