Smart Bets on the Future of Healthcare Delivery
Four Examples of Healthcare's Digital Evolution
As we imagine the future state of healthcare delivery, we know that things like improving efficiency and controlling costs will always be beneficial, to both the patient and the provider. A survey of the care continuum reveals other ideas, what we call “Smart Bets,” that also align human needs with financial drivers. We’ve explained four of these “smart bets” below, and provided for each an example of a healthcare organization who is leading future-facing programs that bring these bets to life.
Enhance the face-to-face experience.
Use technology to better honour patients’ time by adding value to their time on-site and enhancing the provider interaction. When they’re off-site, patients are looking for convenience. When they’re on-site, patients want a sense of progress and a sense of control over their environment. Phygital experiences put the bricks-and-mortar context front and centre, augmenting it with information, guidance and the occasional sense of delight.
Example: Forward Clinic is a technology-enabled primary care clinic launched in San Francisco in early 2017. Forward has designed all aspects of the practice, including technology, the facility and the service model, to enhance the patient-provider relationship. It has identified every step of the experience — both for the patient and the provider — that leads to dissatisfaction, and then applied technology to improve it.
For example, before an exam, patients visit a custom-designed biometric kiosk to capture their vitals. Some of the off-the-shelf components include iPad registration, a mobile app, on-site lab testing, genetic testing and approved wearable devices. The exam room looks like an exam room, yet enhanced with a large screen monitor and a comfortable exam chair for a more consultative interaction. The physician is also able to present the patient’s medical history, genetic information, wearable data and lab results in real time. Forward’s proprietary Artificial Intelligence functions as a medical scribe to capture physician notes from the interaction and help the physician filter and focus on the most relevant information. It also created its own care management platform to house the medical record, ingest and present data, populate the mobile app and enable secure patient-provider communication.
Augment and extend the provider.
Patients look to their providers as experts who can filter information, identify patterns and make recommendations. Technology can help automate “the dumb stuff” and scale the influence of the provider from one to thousands of patients. Look for opportunities to create “human-technology hybrids” that honour the importance of human expertise, and scale their influence through automation, personalized content, behavioural economics and digital engagement.
Example: Digital therapeutics are great examples of this type of hybrid. Case in point: Omada Health is a behaviour change program for chronic diseases that combines human coaching with adherence monitoring, peer influence and digital interactions. The first diabetes prevention program in the United States, its platform harnesses both behavioural economics and data science to reinforce progress and intervene before poor adherence becomes a bigger problem.
Members’ tools include a wireless scale, handbook, resistance band and measuring tape, and they interact with their coach, connect with peers, and track food intake, activity levels and weight through the mobile app. The program is highly effective, lowering the risk of diabetes by 30 percent, stroke by 16 percent and heart disease by 13 percent in one year. It estimates that employers and health plans will recoup the cost of the program in two years and save $2,000 per enrollee over five years. As of January 2018, Omada is embarking on a large, randomized, controlled study to measure the effectiveness of integrating the Omada program into clinical practice.
Driven by real-time data.
Organizations that are able to derive insights generated in the course of serving customers and running their enterprise have a distinct competitive advantage. They can identify operational issues, anticipate behaviour and use a variety of interventions to redirect customer behaviour. Technology components now exist that give healthcare leaders real-time visibility into patient flow, patient experiences and panel health status, whether patients are on-site or remote.
Example: The Hospital for Sick Children (SickKids) in Toronto, in collaboration with IBM, set out to use real-time vitals monitoring to predict and anticipate nosocomial infection. Researchers have shown through retrospective data analysis that the warning signs for such infections begin 12 to 24 hours before any overt signs manifest. The challenge is that the changes in vital signs are subtle and still within normal range. Although clinical monitors take measurements many times per second, the data is summarized as point-in-tie values every 30 minutes, losing the richness of trends over time and during real-time changes. Clinicians worked with software developers to translate clinical rules into algorithms to assess the streaming vitals data in real-time. Project Artemis, the resulting analytical platform, is currently undergoing clinical research to demonstrate its effectiveness.
Maintain connections in between.
Even the sickest patients, with the most complex medical issues, consider themselves “patients” for only a small fraction of their lives. People make decisions that impact their health every day. Providers and health systems have very little visibility into these choices — and into adherence. Clinicians need digital platforms that help fill the gaps in between appointments to stay connected with their patients to keep them on track and motivated.
Example: Pregnancy calls for a well-defined care plan; for low-risk pregnancies, 12 to 14 prenatal appointments is standard. Despite this frequency, the expecting mother often has questions and concerns between visits.
The Mayo Clinic’s technology-enabled care model called OB Nest facilitates communication, enables direct support from the nursing team and meets the needs of patients outside of scheduled visits. Developed from the insights generated from 14 experiments that tested engagement models, the resulting technology-enabled model of care prioritizes convenience without sacrificing support and quality care. Four prenatal visits are replaced by virtual visits with a nurse, either by phone or online. Between visits, the expecting mother is supported through secure messaging, an OB nurse phone line, online care community, and self-monitoring. The end-to-end experience is created by a blend of in-person visits, an expanded care team and digital engagement.
Learn more about healthcare's digital evolution in the "End-to-end Experiences: How Healthcare Can Reach Its Digital Nirvana" chapter in Delta, Volume 2.