By Trish Conheeney
As an Executive Recruiter in the digital health space, I wanted to better understand and uncover how COVID-19 is affecting digital health companies as well as the new challenges and opportunities the sector is embracing. The consensus among many in the health community is that COVID-19 will surge to even higher numbers some time later this year. While 15.5 million people have been infected globally with over 4.3 million in the US, many of us have been deeply concerned about the lack of staffing, PPE and respirators, but the spotlight is also glaring brightly on other deficits. Most nursing homes and elderly care facilities for example have not been using modern IT, don’t use connected devices, nor do they analyze the data they have. There are rarely CIOs or anyone in charge of IT strategy, let alone a Chief Innovation Officer. Since COVID, they’ve been forced to make big changes primarily because of regulations, and are now being awarded state-funded grants so that they can get equipped before they are overwhelmed — mainly for telehealth services to enable communication for the elderly and family members.
“The window is over the next 6 months to get everything back to the new normal”, says Eran Ofir, CEO of Somatix, a provider of wearable-enabled remote patient monitoring solutions for healthcare providers. “Post-COVID-19 will be very different because processes that took years will take months. Hospitals are now required to meet higher standards and they face challenges they never had like severe understaffing, which means that they now have to look at people in their homes–and they see the tools they have are not working.”
Arguably no societal need is more pressing than the growth of the unmet needs of certain populations, which are outpacing the availability of trained resources. This shortage can only be met by technology that augments what people can do, while doing what they can’t (simulating outcomes in a second) and don’t have to (certain repetitive tasks that are easy to program a computer to do), especially for the aging population that our healthcare system hasn’t found equitable or effective ways to reach and support yet. For now, health care providers are focused on short term patients and running their businesses. Not a lot of intervention is going on as doctors are supporting all patients but seeing fewer patients who are being monitored and diagnosed. Arthur Bertolero, Chief Business Officer and CEO of PeerBridge, a mobile health IT company seeking to bring independence and precision with remote monitoring capabilities for medical, wellness and performance-based medicine sees COVID’s impact in a few ways. “Long-term results of this for cardiac conditions are unknown but short term it will present more opportunity. How people visit their doctors will change for sure and the impact will be felt all of 2020 and could end up being all of 2021. How can we do this without being face to face is the big question.”
What has happened in telemedicine over the last 5-7 years has been a slow evolution where there was no reimbursement mainly because the practice wasn’t widely adopted, and efficacy had to be proven. However, the COVID-19 pandemic is forcing the use of telemedicine. “We recently set up a patient monitoring device for a 92-year-old lady on her iPad, and it went really well. They’re doing it better because our experts are face to face with them on a Zoom meeting and of course we’re HIPAA compliant. Yes it takes a little longer than in the office, but it’s done right,” added Bertolero.
A lot of medicine doesn’t even touch on personal goals or develop protocols unique to each person. This happens in pockets only, using proven care models that have been around for decades. But these haven’t been scalable. At least not until now. With unique AI/machine learning technology we may be getting closer to filling gaps we couldn’t before–and perhaps fill brand new gaps that COVID has created. For years, it’s been clear that one of these gaps involves our elderly. A lot of the population is getting older and lacks trained resources to help them. Now access to trained resources affects everyone, it seems. Good news is, AI technology appears to be beginning to close at least some of these gaps while supporting the trained resources we do have.
When I asked Chad Chadwick, CEO and Founder of LiveCircle, a company that uses proprietary algorithms to predict the anxiety levels of various speakers during a live conversation to comment on the new normal he said, “It’s too late to be an early adopter. The question everyone is asking now isn’t ‘how can I see the doctor in the office?’ It’s ‘how can I see the doctor in my living room, now, this minute?’ But what new capabilities are needed for this remote care to really work at home? The healthcare community now needs to assess virtually what people used to assess with an eyeball, and even in person, it’s hard to really know what is going on. Fortunately, AI may help with assessments and fill in some of the backstory, just by using spoken words as biomarkers –no matter where people happen to be talking, or with whom.”
All of this new technology sounds promising, but what about the insurers? I wondered if they were paying for these services. “More has happened in tech in 3 months than over the past 10 years”, says Bunny Ellerin, Director Healthcare Management, Columbia Business School and President and Co-Founder of NYC Health Business Leaders. “The dire need for payment came on very quickly, and payment really drives a lot of adoption, and as long as payment stays we will see a lot more telehealth mixed in.”
Soon enough, individual prediction models will be used to model risk more effectively than any insurance company can possibly model today. “Today’s insurance claims tend to deal only with what is claimed and not with what isn’t, and the vast majority of life is spent where claims aren’t filed, which is outside a medical facility. 80% of the elderly live in their own homes. So there are huge data holes in insurance data. We believe we will be able to fill these data holes and get health insurance back into its rightful role as an exception-based financial product. It hasn’t always been a routine payment method. More importantly, we believe that our approach has the potential eventually to eliminate insurance as the gating factor to scalable, personalized care”, added Chadwick.
RxAnte, a population health management business focused on prescription drug use and improving pharmacy services care on behalf of health plans, is building the right service at the right time as they are serving 12.5 million people, nearly all Medicare Advantage patients, which is subsidized by Medicare and growing by double-digit percentages year over year. Through COVID, Medicare Advantage is the fastest growth across any insurers of the business. Medicare Advantage customers are the same population that are at a high risk and told to stay home and who are not seeing doctors as regularly as they used to. These people need a telepharmacy service to cater to their needs. On the topic of payers Joshua Benner, CEO, says this. “Payers are looking for proven outcomes. And now there are a lot of digital healthcare companies out there that can’t show outcomes or value for the money. For RxAnte, we can show that, and we offer not only the technology but also the services that enable that technology to create value for our payer customers”.
Just to close with a few of the short observations from leaders I spoke to on the ripening of the market conditions necessary for scalable personalized care. We know that payers and the acceleration of technology are the key drivers of change, but there are other market drivers we haven’t discussed. Clinicians for example have found it hard to compete against big health providers like hospitals, so have opted for the security of a job with one. But the cost to these clinicians now includes 15%-30% of their time on covering their backsides, administrative tasks and/or other functions to protect themselves and their employer. All of this means bigger bills for patients and makes doctors less available than what’s actually required. But the reality is, hospitals and insurance companies remain in a titanic struggle to define care options and the administration around those options, which is exactly why we need to adopt high tech services that mitigate risk and time-sucking paperwork. And while the tug of war between insurers and hospitals rages, one of the fastest-growing groups of clinicians are direct primary care physicians. These include independent physicians (i.e., non-hospital employees), who are increasingly swearing off insurance altogether, forging transactional relationships directly with patients instead, and developing unique plans for them. In other words, a paradigm shift threatening the hospital-insurance duopoly is well underway. COVID is clearly accelerating this and accentuating the unmet needs of clinicians. And maybe that’s the silver lining here—innovation around affordable healthcare that will save and prolong the quality of life. How long will that take? I asked. Not as long as it would have before COVID, I was told. But we shall see.