LOOKING OUT TO 2022: HOW WILL HEALTH CARE BE CHALLENGED?
- Health care and life sciences are becoming industrialized on a global scale, now that eyes are finally opening to the advantages offered by – indeed the necessity of – adopting digital techniques and factoring in AI and machine learning in the delivery of care.
- Medtechs and pharma players must either embrace these system changes or opt to focus on their own best-in-class technologies. But either way, newly empowered patients will increasingly demand modern standards of care, higher quality, and better speed and affordability.
- So what? New attitudes, new business models, new hurdles and new entrants ready to take health care to the next level: it makes for a daunting prospect for medtechs and other commercial players who want to continue shaping the direction of the health care industry. But do they really have a choice?
Much to the routine consternation of the medical technology industry, health care has been famously slow at reinventing itself and leveraging the digital technology revolution of the 21st century. A lot of health care remains rooted in the last century, as other, albeit largely privately financed industry sectors, have sailed past it in terms of embracing innovation.
But matters are now changing in health care too, which, although behind the game, is now making promises about the radically different shape of health care to come in the decade to 2030.Philips Healthcare, one of the standard-bearers of IT-assisted health care, has leveraged its Intensive Ambulatory Care (IAC) telehealth program, built upon a population management software platform, to care for patients with complex conditions at home, which reduces hospital admissions. The group believes that digitally enabled health systems will by the end of the next decade be making full use of virtual reality and AI, offering networked care and prioritizing patient experience quality. Individuals, in turn, will have adopted proactive approaches to updating their data.
At the other end of the medtech scale, UK orthopedic company Corin Orthopaedics Holdings Ltd., which has recently undergone a change of ownership, has developed its own value-based business model centered around IT-assisted personalized delivery of hips and knee implants. Recently acquired by Permira, its strategy as explained recently toIn Vivo is to meet the competition head on by focusing on information about the patient to enable personalized surgery and/or rehab, for better outcomes and decreased costs. (Also see "Wright Place, Wright Time? Ortho Specialist's Focus Is Paying Off" - In Vivo, 26 Jul, 2017.)
Philips and Corin are just two examples of how the tide is finally turning, even if the changes are largely led by industry. Nonetheless, governments and policymakers are making efforts to catch up. Last month, UK prime minister Theresa May issued several future-oriented "grand challenges" to the wider national industrial ecosystem, two of which were health and well-being-related: transforming the prevention, early diagnosis and treatment of cancer, diabetes, heart disease and dementia by 2030, using data, AI and innovation; and ensuring an extra five healthy, independent years of life by 2035, in the healthy ageing grand challenge. Cynics might say that if Brexit-beset Britain is on the case, then the health care world must finally be in motion.
But more proof of this comes from Deloitte LLP, which released a report,The Future Awakens – Life Science and Health Care Predictions to 2022, in late 2017. The messages and predictions contained in the report, outlined below, have recently been gaining air time at medtech industry fora in Europe, including, most recently, Europe Medtec (Stuttgart, Germany) and Medtech Innovation (Coventry, UK).
Global health care expenditure is expected to reach $8.7 trillion by 2020
Some statements and predictions in the report might sound overly confident, Deloitte acknowledges, but the trends will nonetheless be seen regionally at least, or maybe even down at individual hospital level. That was the rider given by Mark Steedman, a manager at Deloitte's Center for Health Solutions, as he addressed Europe Medtec attendees in Stuttgart last month.
Karen Taylor, Deloitte's Center for Health Solutions research director and the report's author, echoed the sentiment a week later. Detailing the report's six life science and health care trend predictions for MedTech Innovation delegates, Taylor issued the proviso that they represented an optimistic view and perhaps not all of the initiatives would be fully realized within the five years. "But the evidence today does inspire confidence, because things are happening, and not just in little silos," she tellsIn Vivo. "It's not too far away in the imagination," she contends.
So the direction of travel is set, and the journey speed is increasing, in spite of the fact that the cost of health care funding is still not matching the average 4.2% rise per year in global health care expenditure, which will reach $8.7 trillion by 2020. Pharma spending alone will rise by 5% per year in the five years to 2022 – twice the rate of the previous five years.
Diagnostic And Digital Tech To The Fore
As for medtech, the global market is primed to reach $529 billion in 2022, with sales ofin vitro diagnostics set to total over $67 billion by 2020. Funding for IVDs remains behind the curve, in spite of its central role in treatment decisions. In Europe's largest IVD market, Germany, spending by the sickness funds on lab services and diagnostics was 2.91% of total spending in 2016, its lowest for six years, the German Diagnostics Industry Association (VDGH) said last month. And while the sickness fund spend has increased by 71% over that period, spending on IVDs alone has risen by just 61%.
That is surely the wrong path. In fact, diagnostic medicine is one of the two principal domains for the future of health technologies (along with digital), according to Sir John Bell GBE, Regius Chair of Medicine at the University of Oxford (UK) and author of the UK's report,Life Sciences Industrial Strategy. There will be huge opportunities is that space because if a diagnostic isn't targeted and precise, the therapy won't work, he believes. The market for precision medicine is expected to reach $87 billion by 2023, says Deloitte.
Six Of The Best For 2022
Moving forward to 2022, Deloitte's predictions from 2017 are having effects on health care delivery in the following ways:
Individuals are more in control of managing their own health in 2022. This is largely down to expanded knowledge generally and to genetic profiling in particular by the "genome generation," which is, by now, very involved in its own health care. People visiting physicians in 2022 are more aware of their conditions and more active in preventing and managing them, ready to spend time and money to stay healthy. They interact better with health care practitioners (HCPs), but they are also more demanding, keen to be proactive and preemptive. Monitoring alone is often not enough for the category of patients that Deloitte calls the "quantified self."
Evidence of this is seen in the proliferation of self-care and monitoring apps, like OurPath with its initial focus on weight loss and diabetes prevention. ( (Also see "Test Beds, Digital Hubs And Innovation Tariffs Top Medtech News At UK's NHS Expo" - Medtech Insight, 15 Sep, 2017.)) Providing scientific evidence to coach people through a weight loss program, including advising on sleep patterns and eating habits, is delivered over a six-week program. The app originator struck partnerships with large pharma companies and National Health Service (NHS) England based on its ability to reduce the progression from prediabetes to clinical disease. Saving money is one of its main goals.
Biosensing wearables have become fairly commonplace in 2022, and individuals are being encouraged to use the data derived to further improve prevention. Older people have become better adopters of connected devices and virtual assistants, meaning this demographic is now monitored and better cared for at home. Similarly, the growing confidence in telemedicine in 2022 has meant that patients are opting for it even for an initial consultation. People in remote areas are benefiting from programs such as SENDoc, a multinational northern European initiative to evaluate the use of wearable sensor systems to support independent living in rural, ageing communities.
Incentives are being offered for good health care behavior, via gamification and other initiatives. The system is benefiting from policymakers' more active roles in ensuring the ecosystem is ready. In May 2018, Scotland issued a new national Digital Health and Care Strategy to better seize the opportunities offered by digital and ensure that data science becomes mainstream in health and social care. This measure aims to reshape and equip services for the future, while further empowering users.
Such actions are welcomed, for although individuals have taken on a lot more responsibility to make the system work, led by go-ahead countries such as the Netherlands, there has been a disconnect in that health care systems have not helped as much as they should in terms of funding, Steedman tells In Vivo.
On a macro level, environmental planners are routinely incorporating health into all planning and development ideas leading to "smart cities."
Digital technologies are delivering patient-centric care. Digital technologies have transformed the culture in health care, and "smart health care" is delivering more patient-centric, effective care. Clinical roles are being optimized and staff are using cognitive technologies to deliver seamless integrated care designed around patient needs. The vision is for robotic process automation (RPA) and AI to coordinate internal clinical workflows, allowing nursing and other staff more time to provide care.
"That is the goal that we are hoping for 2022," says Steedman. The importance of robotics and AI was not identified so acutely in Deloitte's 2014 report,Future Awakens, which predicted the scenario in 2020. There has been a major shift there.
Back-office functions and supply chain activities are increasingly automated in 2022, and clinical decision-making is being enabled by centralized digital command centers. This is certainly happening in pockets of activity. One example is the Mercy Virtual Care Center in Missouri ( (Also see "Digital And Connected Care Are Pushing On An Open Door – But Is Medtech Ready? " - In Vivo, 28 Mar, 2018.)). It opened in 2015, covering some 40 hospitals in seven neighboring states. It has no beds, and no inpatients, but has 300 staff onsite and another 300 offsite who monitor patients virtually by telehealth. In 2017, the center was able to treat some 1,300 ICU patients in their own homes, saving $50 million. Average patient stay length in the satellite hospitals has been cut by one third.
Steedman believes that we will see a lot more telehealth and these types of monitoring technologies, proving that patient don't necessarily need to be in a hospital to be treated.
Patients are increasingly taking digital control of their data. Patients Know Best is a reference system that allows patients to control all of their data. They can see their full medical record and share it with health care professionals wherever and whenever needed. They can also add their own data, and are currently able to transfer data from over 100 wearables and devices. A number of different devices and wearables can also link into the record.
The rise of the electronic health/medical record (EHR/EMR) has fueled the notion of the paperless hospital, which has caused quite a stir but also some over-heightened expectations, including in the UK, Steedman observes. That, plus the use of smartphones and tablets by nursing staff, will make a huge difference, in time, in terms of accurate and early diagnosis of obesity and depression and other conditions with the help of customized questions and ability to make treatment decisions.
Medtech and pharma innovation processes are becoming industrialized. Automated processes have accelerated pathways for regulatory compliance, reimbursement and supply chain activities, which means a certain redeployment of staff in pre-automation manual roles. Market access is quicker and more predictable, in what Steedman calls the fourth industrial revolution, which has unfolded as advanced cognitive technologies have improved core processes.
Product launch preparations have been standardized and predicative analytics is being used for market research, to improve the consistency and impact of product launches. Standardization and consolidation are the core of the first of three phases in the industrialization of health care, says Deloitte. The next stage is automation, leading to high-frequency output based on quality and structured data, and the third is utilizing machine learning and AI to increase the pace and productivity of these processes further.
Companies are operating more like software organizations, focused on managing and analyzing data to create value. The industrialization process also factors in with new technologies such as blockchain, to enable safe data linkages. Steedman comments that the goal of embedding privacy and security in technologies is solution agnostic, so whether blockchain is the answer is still up for debate. But the expectations around security of data have risen exponentially, in the wake of high-profile stories about the wrongful use of personally identifiable information. National blockchain contracts are emerging (Dubai and Estonia), but it may be in this instance a case of waiting to see the evidence of outcomes before it takes off.
A key benefit of industrialization is the reduced time needed to set up contracts, with improved transparency, simplified processes and enhanced stakeholder collaboration cutting the time needed from up to eight weeks to between one and 10 days, making the "contract in a day" an attainable goal.
AI and RWE are really unlocking the value of data. Data are set to "be the new health care currency." In the past, systems generated a lot of data without necessarily capturing the information well. The next challenge is to utilize the captured data, and that is what Deloitte wants to see happen in the coming years to 2022.
The pace and adoption of technology has increased markedly during the past three years alone, as witness the deluge of health apps (260,000 were made available by publishers in 2016) and pharma moving toward a patient-centric approach.
Turning real-world evidence into real-world data and using that data to make impactful changes to the health care and life science industries will be really transformative. As the cost of health care is rising, the challenge is to utilize data and the IoT to reduce cost – deploy automation more, speed up processes and use data in ways that haven't been instituted before. The Google subsidiary DeepMind is trying to create ways to make patient data safe. It has conducted much work on AI and is trialing NHS projects. It is now aiming to develop world-leading standards on encryption.
Another example given by Steedman is the Broad Institute of Massachusetts Institute of Technology and Harvard University, which is utilizing data to understand individuals' genetic makeup, and using the knowledge to target specific diseases, understand individual susceptibilities and be able to address them both in the future.
Evidence of future possibilities is already emerging. Exponential advances in life-extending and precision therapies are already improving outcomes. The past year has seen the launch of CAR-T cell therapies. They are in their infancy, but will be transformative, with CAR-T technologies likely to play in a market of $10 billion in the next 10 to 15 years. Whether this technology can be extended to solid tumors or other types of cancer is another matter, but in terms of where we were a year ago, it's pretty exciting, says Steedman.
The US, again, has proved that it is ready to put programs around these developing technologies. The 21st Century Cures Act set aside funding for cancer, brain, precision and regenerative medicine, and provided for regulatory change too. The aim of such programs is to address conditions like dementia, which affects 50 million people globally, but which has been without a drug breakthrough in 15 years – that was when the US FDA last approved one. "That's going to be a big push. Whether pharma can create a dementia drug will be the proof of whether the future of health care comes true or not," Steedman contends.
New entrants in health care. These are disrupting health care and the blurring the boundaries between the different stakeholders in the health care and life sciences industries. This is already happening. In 2017, the Amazon-JP Morgan-Berkshire Hathaway combination was one of the year's biggest talking points, and yet few people still know what this combination is going to do. "But they have the potential, the power and the expertise to apply what they do in their own industries and apply them to health to really disrupt what's going on now," says Steedman.
We are seeing all the big tech giants getting involved in health, whether conservatively or broader scale, but Amazon's Alexa and Apple's Siri, and the like, are laying the ground for a revolution in health care by 2022. Health-centric devices such as theApple Watch, and that group's ResearchKit, which is already producing medical insights and discoveries; and its personal care service (CareKit) are proof that the disruptors are putting a lot of investment into what they think will take health care to the next level.
Across all the six predictions, Deloitte sees three key enablers that will make the vision of 2022 become a reality. Firstly, the adoption of new technologies – AI, the use of real-world evidence, innovative medical devices – will change how the life sciences sector functions.
Secondly, there is a need for new talent and the appropriate skills to maximize the value of the new technologies and ensure nurses and other professionals are trained to use them; and thirdly, there needs to be a slight rethink in how regulators work with industry.
'Medtech is quite critical in delivering value-based care, but there will be winners and losers' – Karen Taylor, Deloitte
The risk-averse attitudes that are the foundation stone of regulation will need to be reappraised selectively to ensure that initiatives like the FDA's Digital Innovation Plan can become less the exception and more the norm.
Taylor concludes that the role of medtech in this heath ecosystem is changing, influenced by connectivity and improvements in the way data are exchanged. Medtechs need to take a look at themselves and be prepared to take risks. "Medtech is quite critical in delivering value-based care, but there will be winners and losers."