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.

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.

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