Editor's Note: The following is one healthcare CEO's reflection on some of the most memorable highlights from the 2020 Oliver Wyman Health Innovation Summit. Here, over 400 C-suite attendees convened virtually over two days to help predict the future of an industry in transformation. Here are some five takeaways in terms of what the next decade may hold for the healthcare industry and those who help lead it.
Takeaway 1: Hospitals will remain important in times of public health crisis. But they will need to adapt as overall healthcare continues to decentralize toward clinics, home care, and personalized care.
Although the COVID-19 pandemic has highlighted the efficiencies inherent in large hospitals and health centers — emergency care, labs, diagnostic imaging, isolation wards, and intensive care units (ICUs) all under one roof — when the crisis has passed, overall care is likely to resume its migration toward more decentralized venues such as community and specialty clinics, as well as home-based care.
The US is already structured for this change to some degree; it has a large network of primary care physicians, specialists, and existing clinics in small offices, versus countries such as China, where routine care is delivered largely from hospitals.
Nevertheless, care decentralization will carry obvious financial implications for US hospitals, which will need to adjust. In home care, one emphasis is likely to be on developing the role of nurses, aides, and physician assistants (PAs); more generally, personalized disease management via cell phones is likely to augment other changes. Existing care venues will necessarily adapt as the patterns and degrees of utilization associated with them evolve.
Takeaway 2: Telemedicine will find its natural place in the spectrum of care. It will be seen as useful in some situations and less so in others. And this clarity will eventually be encoded in practice guidelines and reimbursement strategies.
Telemedicine is — at least in times of crisis — a practical and viable alternative to office- and clinic-based care. Although it’s difficult to predict to what extent this trend will continue when most of the population has been vaccinated against COVID-19 and is safely able to return to clinicians’ offices, both the advantages and disadvantages of this modality are now clearer.
Advantages include convenience of access, lower cost, and the ability for physicians to screen patients for dangerous contagious conditions without risking exposure to themselves or other patients.
Disadvantages include the challenge of accurate diagnosis via video feed, which makes thorough examination more difficult, and the lack of physical proximity for imparting information and reassurance. Such concerns have slowed adoption of the technology until recently, but it seems likely that in time, telemedicine’s strengths and weaknesses will simply become part of the conversation about appropriate care.
Takeaway 3: Empathy will increasingly inform communication between physicians and patients, including a broader view of a patients’ socioeconomic circumstances and how these affect overall health. It will ideally inform and improve communication from governmental health agencies as well.
Health providers and other stakeholders increasingly emphasize the importance of empathy in the relationship between physicians and patients. This takes many forms; for example, empathy may include a fuller cognizance of the socioeconomic factors that affect a given patient’s health and treatment outcomes.
As one presenter noted, economically disadvantaged children have higher asthma rates, and poorly controlled asthma strongly predicts problems with school attendance; as a result, inhalers have a more profound effect on quality of life than simply controlling inflammation in the lungs. In the same vein, health equity is gaining increasing attention and primarily means that people who need more care than others have equitable access to it.
Finally, at governmental levels, recognizing the importance of empathy may carry profound implications for the communication strategies of those at major health agencies within the US Department of Health & Human Services, such as the National Institutes of Health, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and others.
As the COVID-19 pandemic has made clear, confusing or contradictory information from the highest levels of government undermines trust in both individuals and agencies, leads to fear and confusion, and in times of public health crisis, carries lethal consequences.
Takeaway 4: The US will continue to move toward value-based care. But it will be more difficult to achieve cost savings when inefficiencies are part of entrenched profit structures.
Although healthcare utilization in the US is roughly congruent with that in other advanced industrial democracies, costs here are much higher. The reasons include pricing variation and opacity, waste, fraud, and a paucity of generally accepted standards regarding the appropriateness of care.
Progress toward eliminating or ameliorating these variables could eventually bring US healthcare spending more in line with that of similar countries. But questions remain as to how much of the problem is structural. Nations with centralized healthcare — particularly those socioeconomically similar to ours such as Canada, Britain, Australia, New Zealand, and the Scandinavian countries — are more efficient because their systems don’t contain the array of profit-related inefficiencies that ours does.
In any case, a shift to value-based care may address some of these concerns, but it’s worth noting that institutional definitions of value and consumers’ beliefs about it are often very different.
Takeaway 5: Big data will continue to inform research, diagnostics, and therapeutics. Concerns about ownership, portability, and privacy are likely to reflect evolving societal trends toward data democratization. And legislation will eventually codify those trends.
Data will play an increasingly important role, not only in driving diagnostic and therapeutic advances but also in measuring outcomes and designing appropriate-care guidelines based on them. It will also underpin and strengthen the development of artificial intelligence (AI), with practical applications ranging from population studies to interventions such as personalized health monitoring and early disease detection. AI will also support advanced gene-editing tools such as CRISPR (aka clustered regularly interspaced short palindromic repeats), which will eventually offer patient-specific therapeutic interventions.
Although the potential exists for tension between the trend toward empathy and patient-centric care on the one hand, and the seemingly impersonal world of big data and AI on the other, presenters emphasized the ways in which they may symbiotically coexist. The knowledge to be gained is potentially tremendous, whereas the person-to-person interactions between physicians and patients will — at least ideally — bring that knowledge to its fullest and most humane fruition.
Consumers have indicated a willingness to share personal health data as long as it contributes to the quality and personalization of care they receive. And although there is also some distance between their expectations and that of health care organizations around portability — both consumers and data collectors expect to own their data — such issues will likely be clarified both by legislation and by societal trends toward data democratization and sharing.