EDITOR’S NOTE: During a recent case study interview, Senior Vice President, Digital Health and Chief Digital Officer, BioReference Laboratories, Inc., an OPKO Health company, Richard Schwabacher said that responding to COVID-19 has accelerated trends in the digital health by 7-10 years. We asked Schwabacher, a veteran of Pfizer and Quest Diagnostics who had left diagnostics only to return due to COVID, to expand on his perspective in this guest author post. (Learn how BioReference used Auth0 to quickly scale to meet pandemic requirements.)
There has not been an event that has impacted humanity as intensely as COVID-19. It has exacted a heavy toll, and it is clear that we will be confronting the effects for years to come.
In terms of digital health, we already see COVID-19 accelerating trends that were thought to be a decade or more away. Trends like telemedicine and remote patient monitoring, to name just a few, were just starting to take hold when the pandemic hit and are now experiencing rapid adoption.
Responding to COVID-19 has created a moment when patients, physicians, and insurers are more open to new ways of thinking and working. What this means for the future of healthcare is not just exciting but potentially profound.
FinTech as a Proxy for HealthTech
Today, most of us bank from our smartphones. This is, in part, because the financial services industry has done a relatively good job balancing customer experience and data protection within their digital solutions. FinTech companies that focused on micro journeys within the space, like peer-to-peer exchanges, led to consolidation in the sector as large institutions clamored for ways to attract new customers and delight their existing customers through thoughtful digital experiences.
Take Zelle’s peer-to-peer payment technology. Zelle, now integrated into several of the traditional banking institutions, focused on simple peer-to-peer transactions. They appealed to a segment of the population increasing in value to the banks as customers and offered a treasure trove of data on consumer behavior. Although peer-to-peer can be prone to additional risk, the big banks incorporated Zelle into their user interface, knowing that customers would seek out this functionality and might leave their old bank behind. It’s a degree of personalization that is aligned with customers’ needs. The fear of a devaluating customer, or worse, one who's about to leave, is a powerful incentive for innovation. As consumers, there’s virtually nothing stopping a consumer from trying or switching banks entirely if not satisfied. We can do that with relative ease and without asking permission. We can just make the change frictionless.
Not the case when it comes to healthcare. Don’t like your insurance company? Not so easy to jump ship. If you receive your health insurance from your employer, like most Americans, you’ll have to wait for annual open enrollment to make a change. And even then, you’ll have only a handful to choose from.
Experience Will Shape Future Digital Health Solutions
We have become conditioned as consumers to expect all experiences to generally be the same, often judging an experience against those that immediately preceded it, especially a personalized experience. When it comes to healthcare, personalization is difficult. Pre-COVID, the patient experience would weave from analog (i.e., in-person experience) to digital (i.e., telehealth) and back, all the while attempting to silo data and protect privacy. The protection and safe transportation of data in healthcare is an industry in and of itself. The patient, or consumer’s, expectation is that when they show up at a healthcare institution, that experience is going to be consistent with what they get at their bank, and they are frustrated when it’s not. Healthcare accounted for 17.7% of the gross domestic product (GDP) in the U.S. in 2019, and given the amount of interaction behind that large a number, we’re seeing a high degree of general dissatisfaction within healthcare. When so many of us are interacting with a sector that’s antiquated and unable to keep pace with consumer expectations, dissatisfaction is expected.
Pre-COVID, the solution to personalizing experiences was to create healthcare institutions that are oriented horizontally so that experience would be tailored to patient circumstances. For example, if you were receiving treatment for cancer, the cancer center's physical layout would be orchestrated literally around a patient’s journey.
As digital experience continued to grow in other sectors, patient’s expectations seemed to outpace healthcare experiences. After all, there’s only so much that a building layout can accomplish when you’re still working off a clipboard every step of the way. Patients began to expect their medical records would simply travel with them. For the patient, this might mean a combination of an analog and digital experience that might not feel seamless due to the rigor required to protect sensitive data.
The shift we see from analog to primarily digital experiences is driving three main trends: the decentralization of healthcare, improving physician acceptance of telehealth, and where I think we’re headed; virtual care will become the default.
Decentralization of healthcare: One of the important and immediate impacts of COVID was an attempt to keep most patients that didn’t need to be in a healthcare setting at home for care. This change started with the most at-risk patients for COVID co-morbidities.
If you have chronic kidney disease, going into a healthcare facility puts you at a higher risk, even if you’re taking all the precautions. But assuming greater risk by having the patient physically enter a facility is not just about protecting the individual patient.
With the pressures of COVID, hospitals are trying to manage available ICU beds. For a small hospital operating at a typical capacity, two to four additional ICU patients mean they go from having an ICU, that’s at 40- to 50%-full to 90%-full pretty quickly. By keeping high-risk patients at home, they not only protect those more vulnerable to COVID they also can focus limited resources on those who need it most.
Adoption typically follows payment structures and incentives. In November, the U.S. government released new reimbursement schedules for asthma patients, another at-risk group, to receive in-home treatment. That probably would have happened at some point. The trend line was there, but pre-COVID, it certainly wasn’t at the degree that it is now.
Physician’s more receptive to telehealth: Having a human in front of you is very different from observing them via a computer screen. In person, physicians notice things and investigate and interrogate them in a way that can lead to a diagnosis. There’s nothing that will ever replace that level of care, which is one of the reasons many physicians were reluctant to shift to a primarily virtual model.
Most physicians tend to follow the practices learned during medical school. We have a large physician population that didn’t learn how to diagnose via an electronic tablet. For them, this may feel like a hindrance. However, doctors who came through medical school more recently were more likely to use electronic tablets during their much more receptive. Again, the trend lines for telehealth there, but COVID has forced acceleration.
Virtual care will become the default: Patients typically aren’t willing to pay for care that isn’t covered by insurance, and many virtual care services weren’t reimbursable. These virtual services are now seeing insurance coverage. Alongside payment, we are also seeing massive investment in the telehealth model.
In the first three quarters of 2020, $1.6 billion was invested in telemedicine—more than twice what was invested in all of 2019.
Based on this investment and the behavioral changes amongst patients, physicians, and insurers, I think we’ll see virtual care increasingly become able to perform primary care visits. Hopefully, this will increase both the access to care and the frequency in which it occurs.
Now that people are more comfortable with a secure video conferencing experience, we may start to see connected devices like an Apple Watch or other bracelets feeding data to the physician’s computer or tablet. This allows the patient and the physician to have more of a shared experience while providing the opportunity for the data to aggregate because it’s being collected for a specific reason within the bounds of privacy regulations.
These accelerating trends also underscore the need to address the Digital Divide, the noted difference between those that have access to and can afford Wi-Fi, computers, and smartphones, and those that don’t. Data has a tremendous opportunity to increase understanding, but only if we are able to provide access.
Connecting the Dots Is Key
A major concern among patients and physicians is how to secure all this new information, and data is collected and aggregated for patient care. There’s never enough that you can do to protect personal health data, but there are important tools that can be put in place — like identity verification — that can help.
The truly transformative unlock will occur when data transportability connects important behavioral and clinical dots to form a horizontal view. Think if all of the actors in any particular set of clinical settings could actively manage and engage with patient data.
The CDC and other health organizations formally recognize that “how we live, work and play affects a wide range of risks and outcomes.” The ability to connect disparate data is an incredibly powerful tool to understand the progression of social determinants of health. This is why there are entire healthcare verticals spending so much time trying to figure out how to connect the dots. If you can connect the dots, outcomes should become more positive.
The global pandemic has made it easier for policymakers to see the clear connections between things like housing, food insecurity, and COVID outcomes. Many are hopeful that this will continue to drive social determinant conversations that could have substantial impacts. The key to this will be the successful protection of health data and patient identity.
What This Acceleration Means for Diagnostics
It doesn’t matter where you are in this world; you’ve been impacted in some way, shape, or form by COVID-19. Directly or indirectly, diagnostic testing is at the core of being able to manage what’s happening in the world and understand it. Healthcare diagnostics is like the zeros and the ones that create the binary code of healthcare.
"Humanity’s collective understanding of the value of diagnostics has never been higher than it is right now."
When you consider the number of people that have been tested for COVID-19 around the globe, it is incredible. And for every person that’s been tested in the United States, they probably created a patient portal account with whoever performed their COVID analysis. This means that not only these patients see their COVID-19 test results, but likely every other test that that institution performed for them previously is now in front of the patient. That’s millions and millions of patients interacting with their diagnostics data directly.
The conversations that are happening with healthcare providers, municipality leaders, and companies offer the possibility of lasting change because they’re not stopping at COVID-19 testing. They’re asking questions that go beyond it. I came back to this industry because I do believe in all of the trends that we’re talking about are going to lead to a significant shift.
I’m fortunate to have the opportunity to work with a team of like-minded individuals who are approaching these problems, knowing that technology, digital in particular, is going to help us solve them. And, for my colleagues and me, this is exciting, but it also comes with responsibility because we understand the opportunity that we have, and we want to make sure to make the most of it.