During a gathering of healthcare professionals and industry leaders at CNBC's recent Healthy Returns Summit, which included Joaquin Duato, Johnson & Johnson CEO and Dr. Nancy Brown, Dean of Yale School of Medicine, we were given a glimpse into a future world of ubiquitous health, powered by cutting-edge technology and personalized care at scale. Duato summed it all up by declaring "there will be more innovation in health care over the next ten years than in the past century." That unrelenting pace is dictated by the urgency of an increasingly larger aging population and the frenetic rate of technology advancements.
Robust Innovation Engine
Back in March 2001, futurist Ray Kurzweil asserted that technological change is exponential. "We won't experience 100 years of progress in the 21st century; it will be more like 20,000 years of progress (at today's rate)," he asserted in the The Law of Accelerating Returns. Today we see evidence of those exponential advances in a suite of enabling technologies ranging from computing power to data storage, to the scale and performance of the Internet. These critical advances are creating multiple tipping points in the healthcare industry -- moments at which technologies such as robotics, artificial intelligence (AI), biology, nanotechnology and 3D printing have crossed an important threshold and galvanized steady and significant change in the quality of patient care and health outcomes.
"Innovation is the lifeblood of our J&J business everywhere," Duato said. "We increased our investment in innovation by 23% -- a sign of how much we believe in the power of science and technology to improve patient care." The role of external innovation at J&J through partnerships, collaborations and acquisitions has driven 50% of new ideas and products at J&J, with over 700 emerging companies incubated to date.
AI and Velocity of Data
AI and machine learning ushered in an era of quicker, cheaper and more-effective drug discovery, patient diagnosis, treatment and recovery. "We can do genomic sequencing, and at the same time with large data sets, utilize AI and machine learning to create patterns in which we can correlate diseases with genomic profiling to identify what are going to be the underpinnings of diseases that are going to be the triggers, the targets that we are going to be able to utilize in our discovery," Duato explained.
Through rapid testing powered by tools like AI and ML, new potential drug targets can be assessed for therapeutic activity and potential toxicities and accelerate the development of new medicines. "We can plan much better our clinical trials," he said. "We are able to create synthetic control groups instead of having placebo groups and we are also able to stratify and identify patients that are difficult to find in rare diseases utilizing algorithms that enable us to identify them. I’m very bullish about the potential of technology in accelerating discovery and developing new medicines."
Consumerization of Health
Many presenters pointed out that we are moving towards a radical consumerization of health and value-based care -- positioning patients as consumers as digital tools create transparency, more ubiquitous access and autonomy to choose the best health solution.
From the proliferation of health-related apps (Calm, Maven, Talkspace and ZocDoc, for example) to the accelerated adoption of telehealth, consumers are now in the driver's seat with increasing flexibility to choose who, where and how they access care. This trend towards consumer empowerment has to be analyzed in the context of the reality of inflationary pressures.
"Overall, we've seen volatility in the consumer demand," Duato said. "But we continue to see very solid consumer business coming through and we continue to try to deliver what is best for consumers and try to mitigate our cost increases by improving our own efficiency, and in some cases also having price increases. But, overall, we are bullish about the potential of our consumer health business and about our ability to navigate the inflationary pressures in a way that is optimal for consumers."
For full consumerization to come to life, the health ecosystem has to remove a number of entrenched friction points from payor breakdowns to transaction bottlenecks to systemic health inequity.
A 360° Care Model
In today's complex healthcare landscape, there's only one way to stop patients from falling through care gaps. Evidence-based telemedicine provides a valuable 360-degree view of the patient’s healthcare history and optimizes diagnosis and care coordination, cost control and patient outcomes. Telemedicine can benefit every player in healthcare, from providers to patients to caregivers.
The issue is that healthcare complexity can bring transparency on the most relevant factors in the patient’s care story, particularly with chronic disease management. There's often no central source of truth as the patient moves along the continuum of care. A patient may be treated for diabetes by one doctor, see a gastroenterologist for an irritable bowel, visit a physical therapist for a neck injury, and obtain medication for chronic migraines from another physician -- with none of those providers aware of each other's diagnoses or treatment plans.
Patients are getting lost in the gaps between their providers. The statistics paint a dismal picture for 360 degree care, with only 59% of U.S. hospitals notifying the patient's PCP upon emergency room admission and only 25% agreeing that they can usually contact colleagues for collaboration in an efficient way. What is more alarming is that 80% of serious medical errors involve miscommunication during care transitions.
Without effective collaboration, accountability and oversight, providers base their care plans on imperfect and insufficient knowledge. Primary care providers may miss evaluating key symptoms and connecting the patient observation dots -- and therefore be unable to catch a serious illness in time. Chronic diseases can become worse and turn life-threatening, leading to costlier and more time-consuming outcomes.
Vertical Integration in Healthcare
According to Deena Shakir, Partner at Lux Capital, a venture capital firm that invests in emerging science and technology, these frictions can be addressed through digitizing the entire health value chain. "There is a mandate for long-term technology adoption with digital front doors and patient-facing platforms," she asserted. She posed the important question, "Who is going to be the next Stripe, Shopify or the AWS for digital health?"
Mohamad Makhzoumi, Managing General Partner at NEA, another venture capital firm that specializes in seed to growth stage companies, highlighted a number of potential candidates to serve as the go-to ubiquitous healthcare digital destination and e-commerce engine, including Steady MD and Commure.
Perhaps the most likely company to serve as the king of healthcare is Amazon. The Amazon Care model moves towards an inclusive and comprehensive one-stop destination, promising to provide the "care you need in seconds, in all the moments that matter." Amazon Care is expanding in-person healthcare services to more than 20 new cities in 2022 as the trend continues while other retail giants like Walgreen and CVS Health look to become more vertically integrated.
According to Rosalind Brewer, CEO of Walgreens Boots Alliance, who spoke at the Summit, "inequities in delivering healthcare in certain geographies" has ignited more focus on novel care models, including VillageMD clinics which consist of primary care physicians and CareCentrix, which covers post-acute care. This is part of the vast network of 9,100 Walgreen stores nationwide, serving 75% of U.S. households, all within five miles of every household. Walgreens is currently spending another $5.2 billion on VillageMD.
Brewer also spoke to the important healthcare provider role that pharmacists can play and how their role has been elevated during the pandemic as administrator of the COVID-19 vaccine. "Pharmacists are absolutely front and center and the first touch point at many times with our customers and patients and has grown through this pandemic," she explained. By opening robot-powered micro-fulfillment centers across the U.S. to fill customers' prescriptions, Walgreens is reshaping the role of its stores and giving back time to pharmacists to develop patient relationships. Another health retailer, CVS, continues to add more physician practices as it expands its diversified strategy to grow its primary care business. The biggest retailer in the world, Walmart, has also been expanding healthcare services in certain U.S. markets.
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