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Drive Innovation October 30, 2019

Five Hot Topics Healthcare Leaders are Talking About

Oliver Wyman Health, Editor
Key Takeaway
Overheard at #HLTH19: “I don’t remember a single word of nutrition training at Harvard Medical School.” #OWHealth

Oliver Wyman attended this year’s HLTH (pronounced “Health”) conference from October 27 to 30 in Las Vegas, where over 6,000 attendees from a wide range of healthcare sectors convened to discuss the future of health, healthcare, and wellness. Here’s a summary of trending topics we heard leaders talking about throughout the week regarding the industry's greatest current problems and how to solve them.

1. Doctors don't (yet) find wearable data that useful or actionable. YouTube and Google, however, are a different story.

There was general consensus across different panels and keynotes that siloed consumer data from things like wearables or apps or chatbots is not helping clinicians and physicians make informed, actionable decisions or helping patients better understand how they can independently improve their health over time. Electronic health record burden and documentation burden means doctors (still) spend less time healing and more time recording and processing. Although patient data can be isolated and analyzed (or as some clarified, perhaps more like twisted and turned) to reach certain health findings/vendor conclusions, in general, patient data's frankly something doctors just have way too much of. And the data the industry does typically collect on patients (when patients trust companies enough to provide, say, their social security number and medical record data) doesn't prove to be too useful in helping trend patients towards meaningful behavior change, because companies still insist on collecting independent data and keeping it to themselves.

What kind of information do doctors find useful? Said David T. Feinberg, MD, MBA, Head of Google Health, surgeons are more often turning to social media platforms like YouTube or online search engines like Google before they perform operations.

"You think, 'Wow, that's kind of a trip. My doctor's checking out YouTube?' Well, when I did my pediatrics internship, I had this little book in my pocket and when I would put in a chest tube or a lumbar puncture, or [increase a potassium level], you'd go to the book to see what happens."

"We were asking [Google] questions about Lupus," he said. "This is the most up-to-date information," he told attendees. "If you have a general surgeon in a small town, and they haven't taken out a thyroid, actually, YouTube is a great way for them to see up-to-date [information] by the Mayo Clinic specialist."

Indeed, Google is a powerful tool to instantly acquire health information. (Patients, for example, conduct hundreds of millions of health-related Google searches each day.) David says he envisions Google as being considered an authority someday on health-related searches.

2. Wearable data shouldn't be analyzed as pieces of information, but as pieces of a patient's untold story.

If you have a wearable like a smartwatch on right now, consider that the fact it may say you only got five hours of sleep last Tuesday and eleven hours last Wednesday is probably not of much interest to your physician. This information is merely a series of isolated, short-term data points shaped by many personalized factors that vary greatly depending on the user. For example, did your French bulldog climb into bed with you and start snoring, waking you up throughout the night? What was your alcohol level last weekend? Did you have to wake up early to commute to the office every day last week, ending up skipping your workouts to hit the snooze button?

In contrast, long-term trending data that shows a more holistic picture of a patient proves to be more valuable – and actionable. For instance, said Amy McDonough, Senior Vice President and General Manager of Fitbit Solutions, even when she’s wearing a Fitbit device and monitoring the information it creates for her based on her individual behaviors, this data doesn’t always help her make ideal health decisions. The reason is, life tends to get in the way.

“I tend to be a ‘weekend warrior’. I exercise a lot on the weekend. During the week when I’m commuting into the office, not as much,” Amy said. She’s noticed that her Fitbit “sleep score” tends to be better during weekends, and she's now working to better incorporate exercises more throughout the full week. This kind of data-driven realization is a small first step in behavior change, and one that physicians and clinicians can help initiate through more in-depth conversations beyond a cold data read.

As Amy told Oliver Wyman Health earlier this year, “You’re much more likely to be active and engaged in your well-being if you’re surrounded by others who do that as well. Being able to connect with others in a social way that supports your health is really important.”

Assessing a patient’s “sleep score” on, say, a Fitbit from a clinical perspective means understanding the little bits and pieces that make up people’s days are incredibly varied. “A holistic approach to medicine is really necessary attacking sleep with my patients, that has surprised me at times. The things that really play a role in ‘sleep quality’ are not always intuitive,” said Sara Seidelmann, MD, PhD, a Physician Scientist at Columbia University College of Physicians and Surgeons. For instance, alcohol consumption, she said, is a huge driver of bad sleep. Another cause of bad sleep Sara tends to notice often is when someone's partner or spouse who sleeps in the same bed as them has sleep apnea and snores all night long, thereby lowering the other person's, or both people's, "sleep score". Factors like these, she said, impact your wearable data, but are complicated to interpret off hard data results alone, without understanding a patient’s backstory and lifestyle more closely. Sara pushed for more conversations across the industry not just on wearable data itself, like how many steps someone tends to walk, but why (or why not) in terms of typical habits. This way, whatever a patient’s baseline or starting point is can improve over time, based on whatever tends to be happening in a person’s life on a given day.

The greater push for this kind of mindset to become mainstream is evident by, say, the fact that Fitbit is in the midst of clinical trials. It was echoed from other HLTH speakers as well that considering wearable data as the starting point of a connected story unique to each person's life events will be key to making this data actionable.

3. Innovation isn't about the hottest new gadget or app. It's about understanding what consumers want. (And eat.)

Another idea several physicians and leaders brought up time and time again was how they received many pitches from companies all promising the next best app, digital technology solution, or patient portal answer. And they weren't really interested in their ideas, which often failed to listen to consumers' voices and needs. There was an overarching theme that companies looking to break into healthcare or redesign healthcare must do so by focusing on what consumers want, and by understanding what specific problem they're attempting to solve.

There was lots of talk this week about what the future of healthcare looks like (HLTH's theme was, indeed, about "creating the future of health"). In short, it seems not to be about implementing the latest and greatest technology, but instead to be primarily about a change in mindsets regarding helping patients eat better. For example, there was concern that the healthcare system is still based on the idea of doctors as dispensaries. Said Sara Seidlemann from Columbia, health's future is about a focus on nutrition to prevent chronic disease. It's perhaps a great irony, for instance, that although Americans tend to eat way too much food – an estimated three in four Americans are overweight, and the average American eats 3,500 milligrams of sodium every day which is double what's recommended – there’s still widespread nutrient deficiency in what's widely considered to be the "Land of Plenty". People generally struggle to find balance in their lives, grabbling with a combination of some kind of burnout, stress, and the like – in combination with poor nutrition, she emphasized.

Another future direction of health and healthcare involves listening to what patients need. Added Ivelyse Adino, Chief Executive Officer and Founder of Radical Health, listening to patients (who may not always have lots of letters after their name, compared to the physicians who care for them) has tremendous value. It's patients who have rich experiences, who navigate through the care delivery system knowing where it falls short, and who can express their pain points. She mentioned, for instance, a patient who'd come in because of leg pain, did not receive a diagnosis, and then later found out they had cancer which had spread across their body. She said this happened because the patient wasn't being listened to carefully enough or taken seriously enough by their caregivers as a real person, as opposed to just another list of symptoms to check off on a list before being mistakenly sent home as "healthy".

In an ideal world, care delivery should give consumers what they ask for, which is mainly simplicity, access, and low prices. "Address the full healthcare needs of the individual," said Marcus Osborne, Walmart's Vice President of Health Transformation. "We engage in a system that is high in cost, inconvenient, uncaring: the one we all designed and work in."

Marcus shared how Walmart is catering to patients' three greatest concerns: cost, convenience, and care. The average patient, said Marcus, waits three or more weeks for a primary care visit. Across some clinics, Walmart is attempting to shatter healthcare's status quo by making care, for instance, very easily accessible and a "one-stop shop" experience where someone goes to the dentist, the therapist, health screenings, the primary care physician, and the like, all in one location. And, at cheap prices. Therapy is $1 a minute. A physician visit is less than $50. Want a dental crown? It can be made ready while you wait in 15 minutes, whereas the norm is a patient having to come back a couple weeks later. It's this transformation spark from Walmart Marcus hopes will help transform the greater industry and inspire others to approach care delivery in this same holistic manner.

"Over half of Americans come into our stores every week. We may be one of the most impactful entities in terms of Americans’ health,” Marcus told Oliver Wyman Health earlier this year. "We believe there have got to be providers at the local level who are high value. We should be steering our associates to use those providers. To the extent we can, we should be informing and educating our providers so we can start to up our game and have more providers be truly high value."

4. The mind, body, and spirit are one. And many people are still confused by what "wellness" really is.

There was also widespread conversation around how people are generally confused by the word "wellness", which doesn't simply imply short-term "fixes" to connect to our inner selves through things like bubble baths, guided meditations, and spa treatments. And there was a motion to update our definition for what we "think" the concept actually means. For instance, Mindy Grossman, Chief Executive Officer of WW (formerly known as Weight Watchers), pushed attendees and the greater industry for scientific-based, clearly defined intersection of mental health and physical health. Wellness, she emphasized, is a lifelong journey, not something to be addressed within a series of health appointments. And this concept, she said, is one many think is being addressed by leaders, while it's actually being glossed over. She mentioned that WW clients, for example, view “wellness” as being about control of their health decisions, and about networking and socializing with others going through similar health struggles and educational experiences. Consumers really want to define what “healthy” means to them, and they find incredible value in things like community support, she said. Health habits patients implement into their lives must be ones designed for their real lives, she emphasized, not tools designed from a concept of what people might like in a hypothetical world.

Or, consider the words “mental health”. There was echoing agreement over HLTH’s four days that mental health and physical health are still considered separate, and that this must be, "corrected" (a phrase that was mentioned during the week) during the new century. As was the idea of reconnecting the head back to the body when considering care delivery. The vocabulary used across the healthcare industry regarding terms like this ("mental health", "wellness", "holistic") tends to trigger incorrect or inaccurate meanings, and stereotype-laden stigmas that hinder progress in these areas of health delivery.

One of many reasons for this mindset disconnect is that physicians don’t receive much training on things like nutrition, weight loss, or holistic health. Said Ezekiel J. Emanuel on a panel about wellness, “I don’t remember a single word of nutrition training at Harvard Medical School.”

Similarly, a push for a healthcare system not divided by terminology interpretations, or by political parties when possible was also mentioned numerous times. Everyone, Republican, Democrat, and all views in between, should know, for instance, how much their bill is going to be. This isn't something that should divide people.

"One of the greatest lies ever told to the American people is that insurance is a proxy for wellness," Mark Cuban, Entrepreneur of Mark Cuban Companies and a judge on Shark Tank, said on the main stage.

"Healthcare is so politically charged, people aren't trying to solve problems. They're not even trying to identify problems. They're trying to sell what's most politically expedient for them," he explained. "'Medicare for All' sounds great, but it deals with paying. It doesn't deal with health. It doesn't ask the question, 'How do we make people the healthiest and then pay for that?'"

5. Gender parity issues across healthcare's leadership ranks are often invisible. We must raise awareness to help organizations thrive.

Helen Leis, Partner in Oliver Wyman's Health & Life Sciences practice, presented our new research on gender parity in healthcare's C-suite ranks on HLTH's mainstage. (Read our full interactive report, Women As The Heartbeat Of Healthcare.)

“We don’t have a problem with women in healthcare. We have a problem getting women into leadership roles in healthcare," Helen told attendees.

Indeed, most of healthcare's workforce is female. But when you get to healthcare's top ranks, only 30 percent of C-suite teams and 13 percent of chief executive officers are female. 

Women are the drivers of consumerism in healthcare, she said. They are, for instance, 76 percent more likely than men are to have visited a doctor in the past year. Women also pick up three in four prescriptions.

"Eighty percent of spending decisions are made by women, and they are more proactive than men on their health. We need a broader range of views," she urged leaders.

According to our research, junior-level women in healthcare aren’t benefitting from mentorship and sponsorship opportunities. Senior women, although well-intended, tend to think these efforts are more successful than they actually are. Most men, we found, believe initiatives to advance women in the workplace are effective. Although people are generally personally committed to advancing gender parity, few people think their company is, too – a disconnect driven by women. Women also feel less support driving female leadership initiatives. (Men, in contrast, feel more pressure doing so.)

Proclaimed Parie Garg, Partner in Oliver Wyman's Health & Life Sciences practice, who also presented our research at HLTH, "Support one another. You can either lift one another up or tear each other down. Lift each other up!"

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