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An expert panel at CES 2020 discussed Deloitte's vision for health care in 2040, with the empowered consumer managing their own health, enabled by a new ecosystem of secure, open access to data and "nudges" to change behaviors. Consulting firm Deloitte foresees outside disruptors dismantling the traditional health-care system, but panelists from Johnson & Johnson and Anthem flexed their muscles.




By 2040, the health-care industry will see a major transformation, where consumers enabled by digital technologies, including wearables and "always-on" sensors, will be able to manage their own health, identify health risks early and prevent chronic disease, according to Neal Batra, a principal in Deloitte's Life Sciences and Health Care practice.

"We believe that health is going to move away from a clinician-driven industry and business to a consumer-driven industry," Batra told Medtech Insight during the January Consumer Electronics Show (CES) 2020 in Las Vegas, where he also led a panel discussion on Deloitte's vision for the future of health care with representatives from his firm, health insurer Anthem and Johnson & Johnson.




Medtech Insight


Batra expects the "empowered" consumer will soon be at the center of health care and today's leading institutions – providers, payers, pharmaceutical and medical device manufacturers – will need to rethink the way they operate in this new ecosystem and create value for consumers.

"There is a fundamental shift from health care to just plain health with data science and technology; diseases will be diagnosed earlier and there can be proactive intervention to help people stay well," Batra said.

Interoperable Data, Open Source, Secure Platforms
By 2040, Batra told panelists, we will see the "end of the general hospital, the end of health insurance as the primary financing vehicle and the end of mass-produced pharma," adding that the disruptors, however, are unlikely to come from within. While the established entities have begun shifting their focus on wellness, they are still practicing "sick care," and stand to profit from incentives that exist in today's marketplace.

Tech giants such as Google, Inc. and Apple Inc. are already disrupting the current health-care model. He believes that, in the new system, the winners will be organizations that focus in three areas  – the creation of data and platforms; the development of consumer-centric products in partnership with others that promote health and well-being; and financiers and intermediaries that offer logistics, payments and get products to consumers fast.  

Batra explained: "The explosion of granular, robust and individualized data and the ability to link disparate sources – through open source, secure platforms – allowing that data to come together, will drive this change and will create a holistic [and individualized] picture of our health through wearables and the next-generation 'always-on sensors' that are embedded in the devices around us."

Many medtech companies are already beginning to incorporate always-on biosensors and software into devices that can generate, gather and share data, he noted.

For example, in the diabetes space, Medtronic PLC, Insulet Corp. and Tandem Diabetes Care Inc. are all gearing up to introduce their next-generation hybrid closed-loop systems in the US, offering physicians and patients integrated devices to make it easier to collect and interpret data and manage disease. (Also see "Market Intel: After A Year Of Partnerships, Insulin Pump Manufacturers Will Face Fierce Competition In 2020" - Medtech Insight, 9 Dec, 2019.) Last December, Tandem became the first diabetes company to earn US Food and Drug Administration clearance for an interoperable automated insulin delivery system, which can be integrated with other hardware from other diabetes device makers to create a customized automated insulin dosing system. (Also see "Tandem Wins FDA Clearance On First Stand-Alone Glycemic Controller" - Medtech Insight, 19 Dec, 2019.)

Livongo Health Inc. is a digital-health company that offers members smart connected devices and guidance through a health coach to help them manage chronic disease. For instance, a person with type 2 diabetes will be able to manage disease with a glucose meter and a wireless scale that generate data, which is used, in turn, to generate personalized "nudges" or messages telling users to exercise more or take their medication, for instance.

The company claims its "nudges" have delivered a “40% behavior change.” Livongo's solutions bring together health-care technologies combined with machine learning that aim to address the "whole person" and is "highly personalized," all of which Batra said puts the consumer at the center of health care. The company also has various partnerships, including with Abbott Laboratories Inc. and Apple, and teamed up with MDLIVE and Doctors on Demand to bring telehealth capabilities into its platform. Livongo's solutions are subscription-based and paid by a third party. Among Livongo's competitors are Lark Technologies Inc., Glooko, Vitra Bioscience Inc. and Omada. (Also see "Connected Health Summit: VCs Discuss Digital Health Investment" - Medtech Insight, 6 Sep, 2019.)

According to a survey by the Deloitte Center for Health Solutions and AdvaMed, in the next two years, 80% of medtech companies will collaborate with organizations from outside the health sector to leverage new opportunities focusing on prevention and early intervention.

Batra expects that homes will be equipped with remote-monitoring biosensors that might include "hyperconnected bathrooms," where sensors are embedded in mirrors that track body temperature, blood pressure, and can detect anomalies by comparing vital signs to a person's historical biometric data, as well as toilets that might be able to spot biomarkers.

Scientific breakthroughs will happen at an exponential pace in areas including stem cells, biome sensors and nanobots, he said.

"There are lots of exciting conversations around cancer and oncology right now," Batra said.

Chicago-based start-up BiomeSense has developed biosensors that can detect certain bacteria in patients' feces, which may be useful to improve the efficacy of clinical trials. Scientists that study the microbiome can use the data – captured by patients at home via a feces sample – to investigate the impact on gut microbiomes on things like cancer progression. BiomeSense announced last October that it raised $2m in a seed round, led by the venture capital firm BioX Clan, to complete its prototype biosensor and data-modeling platform, and test their biosensors in human trials.

Batra said it's too early to predict how the future will play out and who the disruptors will be, but noted that the signals are already on the market. In most industries, innovation tends to occur in seven-year cycles and build on each other. He gave the example of robotic-assisted surgery, which was first performed in 1998, and is now standard of care. The smartphone didn't exist until 2007. By 2020, nine out of ten people, or 6.1 billion people, are expected to have smartphones. Innovation in health care is no different, he said.

Empowered Consumer
One notion that all three panelists seemed to agree on was the rising empowerment of the consumer and the need to serve them.

Rajeev Ronanki, senior VP, chief digital officer with the IT division at Anthem, said rising health-care costs and consumers' rising knowledge about pricing and quality, are compelling health insurers to innovate.

"Because the way in which the health-care economy is expanding, and the costs are increasing, it's not a sustainable future at the moment," Ronanki said.




Medtech Insight


Eric Tarnowski, VP business technology for Consumer North America and R&D at Johnson & Johnson Consumer Inc., said J&J recognizes that consumer health plays an increasingly important role across health care.

"In the consumer-health sector specifically, we especially see this trend and it's really centered on what we're doing and [we're] trying to figure out how do we get in front of it and meet consumers where they are and where they want to be," Tarnowski said.

Seema Pajula, managing partner and vice chairman and US industries and Insights Leader for Deloitte, said there are five things that health-care organizations may want to pay attention to.

"Product and price will continue to dominate, but the battle will be won or lost on convenience," she said, exemplifying the on-demand prepared food-delivery system DoorDash, which delivers food to customers ordering on a mobile app.

Secondly, companies need to pay attention to the ecosystem they're operating in – not just focus on their products and services – and partnerships will be key.

Third is the rising role of data and analytics in targeting individual consumers. She pointed to the mattress industry which has completely revamped itself as an industry focused on "health and wellness."

"They're building mattresses that are very specific to you," Pajula said. "If you think about something that was technically a very old-school, you know, not a very sexy, sector [that] has become a really technology-driven, fast-growing sector [that's the mattress industry]."

Fourth is the supply chain. "A bad shipping day doesn’t exist in the future," she said. A lot of consumer-product companies are developing strategies for "direct-to-consumer" shipping and Batra predicts that in the future we will see drones delivering personalized therapies.

Ronanki foresees that in the next 10 years a lot of care will also be delivered into the home via telemedicine. He also believes personalized medicine is well on its way: "You put all of your phenotypic, genotypic and all of your real-world evidence together, you can create therapies that are personal."

Fifth will be the future of work and how that will be changing in the consumer industry and is already changing, pointing to Walmart's recent roll-out of robots designed to scan shelves and looking for items that are out of stock.

Batra said traditional jobs will undergo change.

"Health will be monitored continuously so that risks can be identified early," he said. "Rather than assessing patients and treating them, the primary focus will be on sustaining well-being by providing consumers ongoing support and advice."

Not all the panelists, however, agreed with Batra in that disruption will come from outside the health-care industry.

J&J's Tarnowski, for one, said while he welcomes "more participants disrupting the establishment," he said that J&J has the scientific knowledge, innovative prowess and regulatory know-how to step up to the plate.

While the future of health will require that data be collected from multiple sources, Tarnowski noted that bringing together data from different places with different partners is "hard work," "really complex," and "really messy." He noted that J&J is currently focusing on creating an internal database to ensure they have a comprehensive view on their customers and customer products.

"Even doing that internally, where we know all the pieces, takes a lot of work and is really, really hard," he said. "And when you think about the skill complexity and exponential complexity that comes from trying to do that across super diverse datasets that bring all kinds of different pieces together – it's a really complex and massive challenge."

The other big issues are data privacy and security.

"We talked about data … and if you think about the sensitivity around privacy and ownership of data in a commercial context, it's ten thousand times more complex and more significant in the health-care context," he said.

An expert panel at the AdvaMed Digital Medtech Conference held in San Francisco earlier this year discussed the implications of new privacy rights and data protection, in particular, the California Consumer Privacy Act (CCPA), which became effective this year, and mimics the EU's General Data Protection Regulation (GDPR) on the medtech industry. (Also see "Expert Panel Discusses Impact Of Stricter US, EU Data Privacy Laws On Medtech Industry" - Medtech Insight, 29 May, 2019.) And several panelists agreed that tighter restrictions will force them to rethink how they are using and collecting data.

Batra, however, said that the transformation he's suggesting doesn't necessarily honor the regulatory body that has traditionally been in place.

"They [disruptors] tend to be consumer-centric in nature and honor a consumer view of privacy and security and not necessarily 'HIPAA [Health Insurance Portability and Accountability Act] land' or a legacy industry," he said

Tarnowski stressed that in the health-care ecosystem, the stakes are high and one can't afford missteps.

"There's a reason why those frameworks exist – to protect consumers and to make sure that their health is put first and foremost, and that the science is there. And the controls are in place to do that," he said.

When it comes to data collection and sharing, winning over consumers' trust is another major issue.

Pajula said that a Deloitte consumer study has found that consumers trust hospitals and physicians, but they don't trust credit card companies and retailers.

In another panel at CES 2020 discussing the "Healthcare Value Chain in Medical Device Consumerization," panelists also underscored the importance of health-care providers and clinicians being able to trust the data they're looking at.

Panelist Bakul Patel, director of digital health at the FDA's Center for Devices and Radiological Health (CDRH), who has been a key architect of the FDA's Digital Health Software Pre-Certification Program, said with more consumer technologies moving into the medical space, the FDA is grappling with the issue of how to make these products available.  (Also see "CDRH Will Experiment With Pre-Cert Pilot Participants To Figure Out Right Metrics, Processes" - Medtech Insight, 7 Feb, 2019.) The precertification program seeks to reduce certification hurdles for developers of low-risk-software-based medical devices.

"At [the] FDA, we start thinking about 'How do we make these things available?'" – but with high trust, with high confidence and the guards on safety and effectiveness," Patel said, adding that the FDA has been working on establishing guidelines for interoperability and cybersecurity.

He also said that "the FDA recognizes that a 40-year-old-paradigm is not suitable for current technologies and the speed at which technology is evolving" and is trying to come up with a new way of regulating these new technologies. (Also see "Exec Chat: CES 2020: For FDA's Amy Abernethy, It's About Data, But Also Community Engagement" - Medtech Insight, 14 Jan, 2020.)

Batra said while 2040 seems far off, it is incumbent that organizations that want to stay viable need to transform their business models and also prepare for incidences of major chronic diseases such as type 2 diabetes and hypertension to decline, given that consumers will be able to identify risk factors and intervene much earlier. He added that it was important for companies to forge new partnerships with technology giants and start-ups and other disruptors that are new to health care, and appeal to the newly empowered consumer by developing strategies to effectively engage with consumers.

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