By Neal Batra, principal and Kulleni Gebreyes, M.D., principal, Deloitte Consulting LLP
Last month, we led a discussion about the future of health at TEDMED 2020 in Boston (turns out this was the last in-person meeting any of us will attend for a while). We explained that we believe over the next 20 years, consumers—rather than clinicians or hospitals—will be at the heart of the US health system. These health consumers will likely be armed with data, tools, and guidance that allows them to make informed decisions about their health.
We were just a few minutes into our talk when a physician in the audience began shaking her head in disagreement. She explained that she works with vulnerable populations and hasn’t seen any evidence of empowerment or consumer choice among her patients. Twenty years from now, she reasoned, they will still be making health decisions based on information from their doctors, family members, and friends.
We weren’t surprised by the reaction. There is a long-held belief that increasing someone’s knowledge does not change their behavior. We see it a bit differently. The idea that the physician knows what is best for the patient may be an outdated concept. We believe that all people—regardless of economic status—will make the right health choices if barriers are removed and they are given the proper tools and guidance. Access to information through channels they trust could allow consumers to diagnose themselves with great accuracy and choose the most appropriate treatment options.
Can early intervention prevent disease?
Over the next 20 years, we expect early intervention will become a core component in maintaining health and wellness. We expect illnesses will be treated in the earliest stages, which can reduce overall spending on care. Maybe we can keep some people from developing a disease or reduce the amount of care needed. We often hear pushback on this idea. What about a diabetic patient? At some point, someone with Type 2 diabetes will need to meet with a doctor or visit a hospital, right? Not necessarily. We believe that early intervention could help encourage people to make lifestyle changes maybe years before they are diagnosed as pre-diabetic. Maybe through behavioral nudging, gamification, coaching, early interventions, and even financial incentives, a person on the path to diabetes avoids the disease altogether. We’re not saying no one will get type 2 diabetes in the future, but we do expect that intervention will take much earlier.
We’ve all been hearing about the big changes on the health horizon for years. So why are things different now? We see four driving factors:
- An explosion of data: From connected medical devices to at-home genetic tests to the fitness tracker on your wrist, we are generating mountains of health data.
- Granularity of data: The health data we are generating goes beyond traditional health data (e.g., blood pressure, weight, cholesterol levels). We are beginning to gather more granular data such as cell-hydration levels, and we are getting closer to having access to these data in real-time.
- Interoperability: The value of data can be limited if we can’t connect it in a way that allows us to create insights into health and wellbeing. Our session participants agreed that we have a long way to go to solve interoperability, but no one seemed to think it was a challenge that couldn’t be solved. We believe we will reach a point where the myriad data streams we produce converge into a highly personalized picture of an individual’s health.
- Consumerism: Not long ago, most people showed up at the doctor’s office because they didn’t feel good and they wanted to know what was wrong. That line of sight may be changing as consumers gain access to deep and actionable information about their health.
Sensors and real-time feedback could promote better health
Many of the stories we heard at TEDMED helped amplify our vision for a future of health that is shaped by consumers. One panelist described a future where ingestible sensors push the idea of behavioral-nudging to the next level. For example, diseases such as cirrhosis grow slowly, and it could take years for symptoms to develop. Now imagine something akin to a Fitbit for the liver—smaller than a grain of rice—that can detect the earliest stages of the disease. Real-time data from an ingestible sensor like this could nudge a person to avoid fatty foods, or to drink more water and less alcohol. Maybe early detection means the disease never develops.
Will consumers disrupt the hospital business model?
Some of the people in our session were skeptical that the health sector was on the cusp of a monumental shift. After all, we’ve been talking about value-based care for years, but many hospitals and health systems remain mired in the fee-for-service world. The percentage of revenue from value-based care is still in the single digits for many hospitals, according to our recent survey of health plan and health system CEOs.
In any industry, incumbents are rarely able to predict or respond quickly to disruption. And when the business model is working fine as it is, there is little incentive to change. The organizations that are able to disrupt industries tend to be those that discover new ways of doing business—rather than finding success within an existing framework. We expect that 20 years from now, companies in the health sector will operate under a consumer-focused business model. They can do well financially by helping consumers maintain their wellbeing (doing good).
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