What The Tech Industry Takeover Of Health Care Means For Americans, Part II

The following is an article written by PrescribeWellness CTO Yesi Orihuela for the Forbes Technology Council and was first published here.

One by one, Silicon Valley heavyweights are rolling up their sleeves and making moves to reinvent American health care. On the heels of the CVS-Aetna merger, Amazon announced intentions to form its own health care company with Berkshire Hathaway and JPMorgan Chase. Apple followed suit. Now there are whispers — loud whispers — that Google will enter the fray.

My last Forbes article looked at how health care could end up in an Orwellian-esque nightmare, with a bevy of future technologies constantly and silently monitoring every lifestyle decision we make and rewarding — or penalizing — us accordingly.

In this article, we’ll take a look at the best possible outcome.

IoT Devices, Our New BFFs

Preventive care is a powerful piece of the puzzle the current U.S. health care system has miserably failed to leverage, but it is a piece that these tech giants will bring to bear to cut costs.

If the worst-case scenario is a kind of dystopia, the best-case scenario is one where privacy concerns are adequately addressed, and these same IoT devices serve as an army of allies to provide a wealth of information that we can use to make healthy choices.

The co-chair and senior adviser of the Bipartisan Policy Center Prevention Task Force recently noted in a U.S. News & World Report op-ed: “Our behaviors … are the primary determinants of health and well-being. And when it comes to health, the old trope is true: An ounce of prevention is worth a pound of cure. Prevention can reduce the risk factors that lead to chronic diseases, slow their progression, improve overall health, and reduce health care spending.”

Harnessing this information would empower Americans and would drastically reduce health care costs.

Health Care Tailored To Suit

These new IoT devices would guarantee extremely personalized care: Patients would be armed with a detailed, holistic view of their health, interpreted by artificial intelligence and delivered to health care providers so that every aspect of patients’ lives could be addressed before poor lifestyle choices led to illness.

They would also allow for faster diagnoses. Sebastian Thrun, a professor of computer science at Stanford best known for his work on self-driving cars, imagines a world where, as noted by New Yorker columnist Siddhartha Mukherjee, “Cell phones would analyze shifting speech patterns to diagnose Alzheimer’s. A steering wheel would pick up incipient Parkinson’s through small hesitations and tremors. A bathtub would perform sequential scans as you bathe to determine whether there’s a new mass in an ovary that requires investigation.”

In this world, illnesses could be treated sooner and more effectively, which would provide better outcomes for patients’ health and their checkbooks.

The Marriage Of Big Data And Live Data

Additionally (and it is already starting), patients will have their electronic health record stored in a smartphone app so every care provider has instantaneous visibility into their health history, recent diagnoses, chronic conditions and, most importantly, the medications they are taking. This information is integral in avoiding and correcting negative drug interactions, or “medication reconciliation,” and will provide a level of transparency and cohesion of care that neither patients nor health care providers have ever had before.

Last but not least, humans and IoT working together will yield massive amounts of invaluable big data that the research community can use to further understand and treat the illnesses that plague us — indeed, the National Institute of Health’s All Of Us campaign and Project Baseline are already actively recruiting people to share health data to “speed up health research breakthroughs.” When this new big data is combined with “live data” — the information collected by health care providers in face-to-face medical encounters — it will help paint a complete, holistic view of the patient.

Bye-Bye, PCP

Speaking of health care providers, America’s current health care system is essentially built around one: the primary care physician (PCP). Fever, sore throat, heart flutter? Make an appointment with your PCP. Suffer from a chronic condition like diabetes or high blood pressure? Your PCP manages your care. Need a specialist? Your PCP refers you.

The problem is that this system doesn’t work for a lot of people. There’s scheduling, logistical issues and, of course, there are the millions of uninsured Americans who don’t even have a PCP. And if all of these barriers to entry weren’t enough, the number of PCPs is on the decline.

In the worst-case future scenario, doctors are eliminated altogether. But in the best-case scenario, these companies lean further into a decentralized model where patients are treated for chronic conditions by local health care providers, like clinics and community pharmacists, and visits to the hospital are reserved for acute conditions. As noted in a recent New York Times article, people have begun seeking out this model on their own.

The Renaissance Of Patient-Centric Care

This will have several major benefits. For one, it will be more convenient. It will mean faster care closer to home. For another, it will mean a renaissance of patient-centric care: Instead of the quick visits with overbooked PCPs rushing from room to room, patients will get quality time with their health care providers, which promotes wellness in and of itself. In fact, new tech players are already offering 75-minute provider visits.

If these companies play their cards right, we may well end up with a highly effective health care system that leverages preventive care, local care and IoT technologies to keep the population healthy at a fraction of the current cost. It truly is great to see the entrance of new tech players aiming to place patients at the center of care. It only validates what independent pharmacies have known for years.

Most likely, when the dust settles and American health care has been “Uberized,” we’ll end up with neither a dystopia nor a utopia but something with elements of both. And that is a massive upgrade from what we have now. Here’s to hoping we can pull it off.

What The Tech-Industry Takeover Of Health Care Means For Americans, Part I

The following is an article written by PrescribeWellness CTO Yesi Orihuela for the Forbes Technology Council and was first published here.

Is tech’s role in healthcare a first step towards an idyllic Kurzweilian partnership between humans and machines or the beginning of an Orwellian nightmare?

As more tech companies become involved in making the American health care system more efficient, the monolith as it has existed for decades will finally be disassembled.

There are many reasons to get excited about this disruption. These new players are masters of efficiency who have looked at the costs involved with health care and understand that they can do better — much better. As Bruce Jaspen wrote in a recent Forbes article put it: “If Amazon and Buffet lift the veil on health prices, insurers are in trouble.”


However, the way they achieve these efficiencies in their warehouses and sales floors gives us a clue about how they might achieve the same effect in health care. It might just be what the doctor ordered, so to speak. Or, as American author and futurist Amy Webb predicted in her #SWX18 Tech Trends keynote, policymakers may fail to appropriately deal with the new privacy and security challenges these technologies will present, landing us in a sort of big-brother-like dystopia. In this first of two articles on the topic, I’ll explore the latter outcome.

An Introduction To The Players

Numerous shakeups in the healthcare industry have taken place in the last few months. First, CVS and Aetna announced a merger that, as Reed Abelson and Katie Thomas reported for The New York Times reported, is intended to “create a world where … getting high-quality, low-cost medical care will be as close as your corner drugstore,” which they hope to accomplish by putting their “merged data about people’s health and vast reach” to work for them. What this would look like in a nutshell is that diagnoses would increasingly be made by artificial intelligence, Internet of Things (IoT) sensors and web portals. Anything non-acute would be handled by a local health care provider, such as a clinic or community pharmacy.

Then, Amazon announced its intentions to form its own health care company with Berkshire Hathaway and JPMorgan. The details have not yet been disclosed, but we know that this company will focus on “technology solutions.” We need only to look at the technology solutions they are employing elsewhere to get an idea of their vision.

Last but not least, Apple entered the fray, announcing that it will open private medical clinics in order to offer its employees the best healthcare experience in the world. According to Christina Farr at CNBC, Apple is also looking to hire “doctors, health coaches and ‘health designers’ to create a program to promote healthy behavior.”

Variations On A Theme

All three entities will seek to achieve economies of scale by relying heavily on technology — artificial intelligence (AI), IoT sensors and telemedicine — local health care providers and preventive care. Notes Dylan Scott at Vox of the Apple plan, “Population health and preventive care will be the guiding principles, driving down costs by helping workers stay healthy rather than treating them once they get sick.”

Unfortunately, this is where things could get a little dark.

Trimming The Fat

Preventive care is wonderful, important and a critical component often omitted from the public discourse on lowering health care costs. At PrescribeWellness, we are big believers in preventive care and steadfastly encourage Americans to take control of their health by actively managing their nutrition, exercise and chronic illness.

But what happens when the entity in charge of your healthcare has the ability to not only monitor your every lifestyle decision but also reward or penalize you accordingly? Imagine if your guilty–pleasure fast food or social cigarette carried a fine that got tacked onto your health care costs. What if your Apple watch reported when you ordered that second glass of wine? What if your employer confiscated your candy?

Every Step You Take, Every Move You Make

Amazon recently caught some heat for patenting wristbands that track warehouse employees’ hands in real time to calculate their efficiency. It doesn’t take a Black Mirror episode to imagine how similar technology could track people’s health habits to keep health care costs down. Moreover, what will it mean when nine companies control the future of AI?

There is little doubt that focusing on preventive care combined with a bevy of future technologies that constantly and silently collect data on our diets, sleep patterns, alcohol consumption, stress levels and medication adherence will succeed in driving down costs and raising the quality of care. This trade-off could plunge us into a world that is uncomfortably Orwellian. In fact, it seems to already have happened with our social data.

A Surplus Of Big Data, A Lack Of ‘Live Data’

Another way this could play out badly is by landing us in a situation where devices do the lion’s share of diagnoses and treatment, with human practitioners doing very little. While devices’ abilities to quantitatively measure, interpret and store data about our health will continue to improve, devices will never be as good as humans when it comes to qualitatively measuring that data.

If humans are removed from the healthcare equation, we’ll inevitably end up with a ton of big data on the population as a whole — and on individuals — but with a dearth of what I like to call “live data” — all the information healthcare providers can gather in a face-to-face medical encounter. This information is crucial because it paints a broader portrait of a patient’s health and allows providers to administer more holistic treatment, resulting in better patient care. Indeed, an increasing body of research shows how important human interactions with health care providers are to the healing process and to a patient’s general well-being.

Orwell’s 1984 Or Kurzweil’s 2029?

Luckily, the future is not yet written.

We aren’t necessarily facing a nightmarish 1984-esque world. It may turn out to be quite the opposite: a future where preventive care, local care, IoT technologies and interoperability are fully leveraged to keep the population healthy at a fraction of the current cost, while making security of data, privacy and protection paramount.

Healthcare In 2030: A.I. And The Shifting Role Of Your Pharmacist

The following is an article written by PrescribeWellness CTO Yesi Orihuela for the Forbes Technology Council and was first published here.

Imagine this: You wake up one morning with a sore throat and a fever. It feels pretty serious, so you decide you need some medical intervention. You open an app on your smartphone, access your electronic health record (EHR) and answer a series of questions. Based on your symptoms and visual evidence, the app determines that you likely have strep throat. It issues an order for a diagnostic test and sends you to the local pharmacy for a swab and treatment.

Or maybe it isn’t a sore throat. Maybe it’s a flu bug, or your child has a rash or an ear infection — you could still take the same steps as above. You don’t have to drive to the hospital and wait to be seen in urgent care. You don’t need to get your family doctor on the line. In fact, you may not even have a family doctor anymore — at least not in the way you do now. In this world, your local pharmacists are your frontline healthcare providers, and you see them often.

How and why could this happen?

Health care Costs Are Through The Roof

Compared to other high-income nations, health care in the United States is consistently ranked worst and most expensive by The Commonwealth Fund, particularly on measures of affordability, access, health outcomes and wealth equality. The average American spends more than $10,000 per year on healthcare — nine times what Americans spent on healthcare in 1960, adjusted for inflation. Out-of-pocket costs for individuals exceed $338 billion, and in spite of the fact that Americans don’t have universal healthcare, the U.S. government spends almost twice what the U.K. spends to run the National Health Service — the consistently top-ranking healthcare system.

A.I. Is Just As Good At Diagnosis As Human Doctors

While it’s safe to say that the future of medicine will likely never exclude doctors, their role in the future healthcare system may change dramatically. Earlier this year, Sebastian Thrun and colleagues published research in Nature, demonstrating that a deep learning neural network system was able to diagnose early-stage melanoma with comparable accuracy to that of human dermatologists. In terms of A.I. in health care, this is merely the tip of the iceberg.

Indeed, Thrun — a professor of computer science at Stanford perhaps best known for his work on self-driving cars — imagines a world, according to the New Yorker, in which humans are under near-constant diagnostic surveillance: “Our cell phones would analyze shifting speech patterns to diagnose Alzheimer’s. A steering wheel would pick up incipient Parkinson’s through small hesitations and tremors. A bathtub would perform sequential scans as you bathe, via harmless ultrasound or magnetic resonance, to determine whether there’s a new mass in an ovary that requires investigation.”

Some organizations, like the Human Diagnosis Project, are already using A.I. to get economically disadvantaged or otherwise underserved Americans virtual access to specialist medical care.

Community Pharmacies Are Already Important Healthcare Providers For Many Americans

About 30 million Americans — around 10% of the population under the age of 65 — lack health insurance according to CNN, and tens of millions more have inadequate coverage. Yet what all of these people do have is access to a local pharmacy. Indeed, community pharmacies already serve as the primary health care provider in many small towns across the U.S. This means that pharmacists are in an excellent position to not only play a more primary role in treating illness, but also in preventive care. The information, or “Live Data,” that pharmacists gather while having routine human-to-human interactions will work as a perfect complement to the technological monitoring processes outlined above.

Pharmacists consistently rank high in terms of patient trust according to Gallup (second only to nurses), and there are 36,000 independent and small-chain pharmacies across the nation (disclosure: map.healthcare is an app powered by karmadata.com, a startup I co-founded prior to joining PrescribeWellness) that already have the technology in place to deliver important preventive care services, such as: Diabetes prevention and maintenance, blood pressure monitoring and maintenance and immunizations and medication adherence (which is all by itself a $300 billion problem annually).

What’s more, a recent survey of more than 1,000 Americans over the age of 40 revealed that nearly half (46%) would prefer to pay cash for services at their pharmacy instead of a co-pay at a doctor’s office, and a full half would transfer their prescriptions to a pharmacy that provided preventive care services.

Obviously, some of the dots still need to be connected, as many Americans — and pharmacists themselves — still think of pharmacies as places where medications are dispensed and little else, and the technological infrastructure for how pharmacists can be reimbursed for important assessment, advice and other preventive care services is a work in progress.

The CVS Aetna Merger Is A Sign Of Changing Times

If anything signals the inevitable shifting role of the pharmacist from prescription filler to trusted healthcare provider, it’s the $69 billion acquisition of Aetna by CVS, which, as the New York Times reports, “would establish a new way of delivering care, with nurses, pharmacists and others available to counsel people about their diabetes or do the lab work necessary to diagnose a condition.” This is not CVS’s first move towards expanding its role and services to become a healthcare company — that happened back in 2007 when it purchased Caremark, a third-party pharmacy benefit manager program.

CVS has around 10,000 locations nationwide — just a fraction of the number of independent and small-chain pharmacies around the country. Imagine the impact of all of them continuing to expand their preventive care services and offerings. Imagine how convenient it will be when most non-acute medical problems you and your family face each year are treated right around the corner at the local pharmacy instead of at the hospital. Imagine a future health care system where you see your local pharmacist more than your primary care physician.

It’s right around the corner.


Why Community Pharmacies Are Not Susceptible To An Amazon Takeover

The following is an article written by PrescribeWellness CTO Yesi Orihuela for the Forbes Technology Council and was first published here.

In the 1990s, indie bookstores reeled as big-box booksellers like Barnes & Noble and Borders moved into towns from coast to coast. The David-and-Goliath struggle was even dramatized in the hit romantic comedy You’ve Got Mail starring Meg Ryan and Tom Hanks. In the movie, Hanks’ character suffers serious developer’s remorse when he simultaneously falls for Ryan’s character and — oops! — puts her family-owned bookstore out of business by opening one of his mega-chain bookstores around the corner.

The early to mid-2000s brought with them an even bigger Goliath: the internet and, more specifically, Amazon. One by one, the big booksellers went bankrupt, as e-reader and online book sales soared. But despite many doomsday predictions, the little guys stood. They’re still standing. In fact, they’re growing.

How is this possible?

Indie bookstores offer their customers something that neither the big bookstores nor Amazon will ever be able to offer: a personal connection with their customers. As a Publisher’s Weekly article put it, “Indie bookstores offer community, discovery and beauty; readers feel good about keeping their hard-earned money recirculating in their local communities.”

Likewise, many people are now predicting that brick-and-mortar pharmacies will go the way of the dodo as more and more Americans manage their prescriptions online and Amazon continues to eye the prescription drug and pharmaceuticals market. Chain pharmacies may pass, but, like indie bookstores, community pharmacies will stand. Here’s why.

Community Pharmacies Have Deep Relationships With Patients — And Amazon Never Will

Community pharmacies have what a drone can never deliver: face-to-face care.

Human interaction pays meaningful and irreplaceable dividends in improving a patient’s spirits and therefore their health. Whether that interaction comes in something as simple as a hug or handshake, there is no denying that injecting human touch into the health equation just makes patients feel better. Think of it as chicken soup for the soul … over the counter.

Interacting with a live person also uniquely positions community pharmacies to capture something I like to call “in vivo” or live data.

Live data is all of the information that pharmacists can gather in a face-to-face interaction that provides them with a broader portrait of the patient’s health. Instead of just remotely and facelessly filling prescriptions (like Amazon does), real-life pharmacists are in a position to ask whether or not a medication is resolving a patient’s problem, whether a patient is suffering any side effects (suggest ways to mitigate those effects), ask whether a patient is up to date on their vaccinations, and then even administer the ones they need.

An engaged pharmacist can also tell whether a patient is adhering to their prescribed medications and getting all of their refills on time (medication adherence is, incidentally, a $300 billion problem annually), and they can tell if a patient who sees multiple providers has been prescribed too many painkillers or prescriptions with potential drug interactions. More importantly, they can intervene.

Community pharmacists are on the ground, and therefore, they are able to help their patients manage chronic conditions — diabetes, obesity, smoking cessation and a host of other illnesses — as well as provide other critical preventive care measures that will keep Americans out of emergency rooms and out of debt. The importance of this cannot be understated, especially as the fate of the national health care system continues to remain in a state of uncertainty.

In short, community pharmacists, like indie bookstores, offer their customers a personal connection — they are more than just a means to fulfill a prescription.

Community Pharmacies Must Keep Going Beyond The Fill

This does represent a paradigm shift for many pharmacies.

Being local or family-owned is not enough to weather the storm. Pharmacies that will outlast the chains, mail order, shrinking profit margins and the Goliath in the wings (Amazon) must employ a business model that centers on its customer relationships and community contribution — not just on refilling prescriptions. In other words, community pharmacies must go “beyond the fill.”

The industry is shifting from a fee-for-service model (transactional refilling prescriptions and selling cough syrup) to a value-based one (i.e., How are your patients doing? Are your adherence levels going up?).

Despite the fact that many community pharmacies already offer direct delivery to patients, trying to compete with Amazon on strictly convenience (online ordering, for example) will not be enough. Amazon has an entire infrastructure in place to be the best at that sort of thing. Live data — that wealth of information that happens as the result of a human interaction and all of the opportunities to better serve the patient that arise as a result — is the thing community pharmacies have that Amazon never will.

Many community pharmacies already have deep roots in their communities and go beyond the fill every day as valued healthcare providers: those who don’t will want to consider how best to expand their role and shift to a patient-centric approach. As long as community pharmacies keep using human relationships to their advantage, there will always be a place for them — as there is for indie bookstores — even when Amazon comes knocking.