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.