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

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.”

Indeed.

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.

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.