Health ecosystems: striving towards an integrated and seamless patient experience
We have seen a shift in focus from treatment to prevention. It has come to be understood that it is much cheaper to prevent a condition from developing than to treat it.
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We have seen a proliferation of apps and digital solutions designed to promote healthy lifestyles and wellness, all of which are supposed to keep people healthier for longer. From meditation apps that promote a reduction in stress to step counters and calorie trackers to counter obesity or vital signs monitors that allow you to track dips in your health, being connected often now means people are in some way engaging with their health. Knowledge has always equated to power, and one of the major benefits of health ecosystems is that they are placing more information in everybody's hands. Poor regulation or oversight of some digital solutions means that many systematic analyses have called the efficacy of some solutions into question; apps based on pseudoscience, or actual science to which they only have the most tenuous of links, can be dangerous. They can erode patient trust in this type of solution and can also be damaging to future health.
The focus on prevention is helping us to identify early warning indicators and one early warning indicator popping up time and again is loneliness. Isolation, or loneliness, is associated with worse health outcomes for a variety of conditions. We're seeing ecosystems counter this with many solutions now including not only the patient in their networks, but also the patient's family, friends or care support. Often the same person performs a dual role, with an outsized proportion of unpaid care work still being performed by women. For carers, it can be frustrating and scary to assume responsibility for a loved one's care, only to be met with a wall of silence. Multiple authorisations for information sharing can be required, especially as patients move between practitioners.
Often, eager to avoid an error, practitioners will err on the side of caution and opt to not share information as a default. Ecosystems can solve this. Carers and friends and family can be included in networks for information purposes; it has been proven that there is a strong correlation between adherence, health outcomes and having a strong support network. Ecosystems can connect patients with people in similar situations and provide forums for support. There are potential problems to be worked around; what happens, for example, if evolving relationships means that patients no longer want certain people to have access to their care? How easy is it to remove members of the network? Misinformation is also a danger, especially in patient forums. Negative experiences can spread fear but are highly subjective. There is such a thing as too much information.
Digital solutions to wider societal problems are also on the rise. Thinking beyond the individual is a key driver of health services. One of the most successful public health solutions was increasing the frequency and thoroughness of handwashing; hygiene is an amazingly effective infection control measure.1 If digital solutions can be as effective as this very simple intervention, we may have a chance of combatting real population level problems. Alternatives to opioids for chronic pain show a trend that puts the patient first. The problem with opioids is that they are not only not effective for long term pain treatment, but they are highly addictive and can actually make perception of pain worse. Opioid addiction became an epidemic in the US and there are signs it is spreading. Glasgow has a higher mortality rate than the US, proportionate to the population.2 Companies like MyoScience3 are using cold to temporarily disrupt the transmission of pain signals, while the Sana device from Sana Health4 uses pulse light and sound to induce a deep state of relaxation and relief from pain. Both companies saw ineffective treatment causing a public health emergency and responded with digital alternatives. Vulnerable groups are benefitting from reduced access barriers.
Maternal mortality is on the rise in the US, with almost two times as many African American and Native American women dying than white women.5 Ecosystems are offering a solution; Mahmee is an electronic health system that links the electronic health records of both mother and baby, bringing all aspects of care – pedicatric, maternal, wellness services such as doulas and other professionals like midwives - together in the one platform. They have trained professionals looking for complications that are specific to new mothers; they have caught septic shock post- birth from a breastfeeding question a new mother asked offhandedly, and have prevented postpartum depression from developing into psychosis in multiple patients. They are truly impressive and have been designed to respond specifically to the needs of a vulnerable patient set.
Insurers' interests are aligned with the interests of the public; they want more people living healthier lives for longer. A reduction in negative health outcomes and premature mortality would be great news for insurers in all areas; not just for private medical insurers but for long term disability and life insurers. Historically, there have typically been few contact points for insurers and their customers – at the time of taking out a policy and at the point of claim or renewal. These points, due to the heavily fragmented style of both medical care and insurance, could be repeated often for each individual service; diagnosis tests, treatment, aftercare etc.
As an alternative that is better for insurers and the patient, the insurer is seen as an investor in the patient's health and wellbeing. They often are an intermediary offering services of value that help the patient reach and then maintain their optimal health state, using technology and digital services for targeted behavioural interventions. The patient is no longer solely responsible for the management of a messy and overcomplicated system; their next need can be pre-empted by their insurer. Whether that is finding out if treatment is covered, or buying an add-on for something that isn't, or paying for their treatment, everything the patient needs can be presented to them chronologically, placing the power in their hands.
There are obstacles to overcome before this ideal can be reached. At the moment, services are not the only aspect of healthcare that are heavily segregated. Data is held in silos and often isn't utilised effectively. There are many intermediaries springing up to help hospitals and other medical providers monetise their data. OmnyHealth is one such solution, who use distributed ledger technology to empower the health system. Providers can choose which buyers can purchase the data they own and can control what data they offer, turning profits into revenue streams. Systems often don't 'speak' to each other. Social services and the healthcare system often have users in common, yet the records for the same user, which could better inform both services, are held separately and are not accessible to the other.
Whether insurers own ecosystems or whether they 'plug in' as an additional service, big changes will have to be made to the business model to make incumbent insurers an exciting and integral partner whose input is actively sought out. They will need to match the dynamic and real time services of other ecosystem players, as well as adapt to change customer perception of the industry. They will also need to make products more accessible and work on closing the protection gap. Ecosystems are successful not just because they bundle services and increase convenience, but because they reach more customers and there are less barriers to entry.
Some of the people most in need of protection from emerging risks are those who do not have access to traditional financial products; rising incidences of non-communicable diseases in developing countries, for example, not only changes the insurance products that need to be offered but also the way we offer them.
1. W. Hall, A. Mcdonnell, J. O'Neill, Superbugs; An Arms Race Against Bacteria, Harvard University Press, 2018
2. "Trainspotting Revisited", The Economist.com, 18 July 2019, https://www.economist.com/britain/2019/07/18/scotland-overtakes-america-as-the-worlds-drug-overdose-capital
3. J. Chow, "MyoScience announces agreement to be acquired by Pacira for up to $220million", businesswire.com, 5 March 2019, https://www.businesswire.com/news/home/20190305005257/en/Myoscience-Announces-Agreement-Acquired-Pacira-220-Million
4. Sleep and pain relief on demand, from Sana Health," healtheurope.com, 30 October 2018, https://www.healtheuropa.eu/sana-health/88721/
5. R. Jones, "Women in the US are dying at an alarming rate", National Geographic, December 2018