This story is changing daily, but there are important points to be made, so we are writing about it. We’re talking about the announcement that Amazon made in January stating that it would change healthcare, at least for its employees. The specific announcement was that Amazon, JPMorgan Chase, and Berkshire Hathaway had joined forces to form an “independent healthcare company.” Their goal is to reduce costs for their combined one million employees based in the United States. The healthcare industry, stock market, and major players in healthcare reacted as though they were Chicken Little and just heard the sky was falling.
The stock market fell. Analysts gave the story wall-to-wall coverage (and still are). CVS Health Corp. and Express Scripts Holding Co, the two largest pharmacy benefit managers (PBMs) in the U.S., immediately joined forces with two of its largest insurers, Aetna Inc. and Cigna Corp.
The story changes daily. There is hopeful speculation about what the formidable group might accomplish in some corners, and in other corners, skeptical pontification about why they will fail.
Full stop. We think it’s time to say, “All hail to those who would dare to think differently about healthcare.”
Today, most of the conversation centers around whether the healthcare industry will shrink in Amazon’s shadow or rebuff this reform effort with its regulatory force field – like it has all others. That’s a distraction. It’s time to welcome innovators with the track record, experience, collaborative critical thinking, and proven capability to disrupt healthcare. We say, “Climb aboard; we could use a new captain – or two or three.”
The Amazon announcement has already brought thought leaders on artificial intelligence, machine and causal learning, and telemedicine to the fore. It’s already beginning to shake the moss off the trees. We think it has raised the following question that begs to be answered:
What happens when someone dares to attempt creating the healthcare of the future? What can be achieved when big changes happen in particular areas of healthcare? Let’s take a look.
Improving fractured communications
The first question to ask is, “What if Amazon could fix the fractured communications that currently exist between physicians, their patients, and healthcare insurers”? It’s safe to say that nearly every patient in the United States has struggled to get through to a doctor’s office or insurance company to get help or information. There is little or no coordinated communication between primary care physicians, specialists, imaging, laboratories, and affiliated care providers like physical therapists. Right now, it doesn’t matter if they are all treating the same patient at the same time. Consequently, in the current system, patients must be their advocates. That assumes they have the time, education, and intestinal fortitude to fight uphill to get any traction for their benefit.
Can Amazon use the equation they employed to become a world power distribution system to create an effective distribution of knowledge and information? Can they figure out how to eliminate this broken, fragmented system and introduce coordinated communication? Someone needs to make it easy for healthcare consumers to find out what is going on with their health. Let’s ask Amazon if they can make it easier for consumers to obtain the information necessary to treat chronic disease and make informed decisions about wellness, especially if the result could lead us to the promised land of better outcomes and improved population health.
In today’s medicine, it’s a major problem that effective communication, or lack thereof, impacts every corner of healthcare. It creates difficulties in everything from physician/patient interaction and understanding to compliance. That one factor – compliance – is, without question, one of the most significant obstacles to successful treatment and medical care faced by physicians and other providers today. If you’re going to change healthcare, you better improve compliance.
What if better communication led to better medication adherence?
Medication adherence is one element of the compliance issue, and it is a problem of global proportions. It has led some providers and pharmacists to wonder if we already have the drugs we need to treat chronic disease – we don’t know it. When patients don’t take medications appropriately, the success of the medication can’t be measured accurately. What would happen if patients with one chronic disease consistently took their medications appropriately? Would we suddenly discover that many of the drugs on the market today are more effective than we realized? Statistics show the extent of the medication adherence problem today:
- It’s estimated that 50 percent of those with heart disease and major risk factors for the disease have “poor adherence” to their medications.
- 75 percent of Americans have trouble taking their medications as directed
- Estimates are that approximately 125,000 deaths per year in the United States are due to medication nonadherence.
- 33% to 69% of medication-related hospital admissions are due to poor adherence.
- The total cost estimates for medication nonadherence range from $100 billion to $300 billion every year, when both direct and indirect costs are included.
Imagine what creating big changes in this specific area of health could do for the system at large. Imagine improving medication adherence to achieve improved outcomes, lower healthcare costs, and effectively manage chronic disease.
The Amazon/Berkshire/JPMorgan trio may have set its sights on this issue. We do know that Amazon is moving into the pharmaceutical space, specifically mail order and retail pharmacy. The giant has been approved as a wholesale prescription distributor by pharmaceutical boards in 12 states.
Consider for a moment the capabilities of Amazon’s virtual assistant Alexa and apply it to healthcare. It could engage patients at home, remind them to take their medications, and even call in refills for medications. It could remind patients when it is time to pick up their refills at the pharmacy – or deliver them – and answer questions about their medications. Amazon might use its distribution power to disrupt the current system of pharmaceutical distribution. Who knows? At the very least, Alexa might improve medication adherence through convenience, patient engagement, and behavior reinforcement. CNBC has reported that Amazon has partnered with Merck for a “challenge” to inspire Alexa developers to create “skills” to help people with diabetes manage their condition.”
That’s the kind of innovation that can create big change in particular areas of healthcare.
In a letter to shareholders7, JPMorgan Chase CEO Jamie Dimon made an oblique reference to pharmaceuticals. He said the Amazon/Berkshire Hathaway/JPMorgan Chase trio would hire a team to address healthcare problems, including “over and under-utilization of specialized medicines.” While they may mean infiltrating Big Pharma, compliance remains the core issue.
Can anyone remove the frustration?
Here is one of the major reasons we need a healthcare change: the U.S. healthcare system is needlessly frustrating. The important questions to be asked of those who attempt change are, “Can the future of healthcare be simplified? Can it be made more logical?” Frustrations come from the fact that it can take weeks or months to get a doctor’s appointment. It can take hours and payment of a fee to get one’s medical records. It is impossible to get an answer to a simple question like “Is this rash dangerous?” without running a gauntlet of doctor’s appointments, wait times, and co-pays. It seems like the list of frustrations to get simple; everyday care goes on and on. Healthcare executives8 are implementing telemedicine and express willingness to embrace Artificial Intelligence(AI) to improve systems. However, except in specific locales, AI implementation has yet to address these issues in a meaningful manner.
- 84 percent of healthcare executives believe AI will revolutionize the way they will gain information from and interact with customers
- 81 percent of healthcare executives say it is essential to offer their products/services through centralized platforms/assistants or messaging bots.
- 72 percent of health organizations are already using intelligent virtual assistants to create better customer interactions.
What if a force came along that refused to accept the status quo of frustration? What if a team of innovators decided there had to be a better way and were willing to create a new model rather than waste time trying to fix the existing one? Oh wait, they did – Amazon, Berkshire Hathaway, and JPMorgan Chase want to do that for their employees. In 2015, The Health Transformation Alliance9, formed by American Express, Macy’s, Verizon, and Caterpillar, announced the same goal. More companies have joined the Alliance in the past three years, including JPMorgan Chase and Berkshire’s subsidiary BNSF Railway. Are they willing to extract the seemingly endless points of frustration in the current U.S. healthcare system?
Consumers are fed up with the frustration – something Amazon knows well. First of all, healthcare consumers know that making a doctor’s appointment should be as easy as making a hair appointment or scheduling an oil change. Secondly, they know they should be able to conduct healthcare transactions on a mobile device. Increasingly they are gravitating toward those providers who make that possible. A few providers and practices offer robust digital services, but it is far from standard practice across the U.S.
Other frustrations that should be addressed include:
- The ability to easily and quickly find a doctor near one’s home or location; the best doctor in the right specialty at the right time.
- The inability to have a conversation with a doctor to answer everyday questions about one’s health.
- The difficulty in finding help to navigate one’s healthcare journey from diagnosis to treatment and all the details in between.
- Support for healthy living for those who are motivated to take care of their health.
Consumers aren’t the only ones experiencing frustration with the healthcare system. Doctors are frustrated as well. They are spending at least one day a week on administrative tasks that are increasing every year. Many physicians feel they spend more time meeting federal and state regulations than taking care of patients.
Physician frustration includes electronic medical records(EMR) systems that have failed to meet the promise of the technology. It’s reflected that doctors report10 spending 50 percent of their time each day on EMR. They must cope with multiple keystrokes and documentation requirements that take time away from face-to-face patient care to use the system. As a result, it is reported to be one of the largest contributing factors to physician burnout and considerations to leave the profession.
Physicians are also frustrated with the lack of predictive analytics that could fill in the gaps in understanding patient behavior outside the physician’s office.
That brings us to virtual care – it’s time.
The future of healthcare requires that it be delivered differently – and that means seamlessly, on-demand, virtually anywhere, any time. Mobile apps, virtual care through holographic booths, remote monitoring devices, and other types of telemedicine are being developed rapidly to meet this demand.
Many healthcare systems use remote monitoring devices for patients. However, compliance can be spotty. The success of remote monitoring depends entirely on the patient using it correctly. What if Amazon or another powerful innovator entered this space and made the remote monitoring truly interactive? The healthcare provider and the patient could have two-way conversations. Real-time coaching could be provided through virtual interfaces, and telemedicine providers could engage with the patient daily. Building that system provides holistic virtual care to patients who need it delivered remotely and changes healthcare at the street level. Most of all, it begins to break down barriers to access created by socio-economic factors, geographic location, mobility issues, and other obstacles to care. It would also greatly reduce the costs of the delivery of healthcare.
Another challenge to the broad-based success of virtual care is that the implementation of remote monitoring devices is spotty too despite healthcare executives’ expressed belief that they can reduce healthcare delivery costs and improve outcomes.
Currently, remote monitoring has limited applications. A survey11 on the Internet of Health Things (IoHT) discovered that most remote monitoring investments are focused on cardiac conditions:
- 76 percent of providers are focused on cardiac conditions
- 77 percent of payers are focused on cardiac conditions
We know that Amazon is already in the business of selling medical supplies and durable medical equipment. Furthermore, we know that Amazon had licenses in 43 states to distribute its medical supplies to providers. The first steps are already in place for them to make a concrete foray into the business of remote monitoring and partner it with their cloud services.
Providers are ok with that. A recent Reaction Data Survey12 showed that 62% of 152 CEOs, materials managers, operations directors, and other executives “support Amazon’s growing presence in the medical supply sector” and believe they can deliver those supplies faster and at a lower price than is currently available.
Amazon dominates the industry in cloud services; it could easily store and analyze patient-generated health data. With each consumer’s permission, data could be collected by their mobile apps, fitness devices, smartphones, watches, and tablets. It would be uploaded to the cloud and shared with their physicians. Compared to what physicians have to work with now, which is incomplete patient-reported data, the data from smart devices would be like a Magic 8-Ball for physicians. Perhaps most importantly, the data would facilitate predictive analytics and open a wide window of understanding how patient lifestyle habits impact physician treatment plans.
Virtual care also supports the collection of data for predictive analytics. Remote monitoring devices can collect massive amounts of data analyzed by artificial intelligence and machine learning. That can result in powerful diagnostics and preventive care.
The future could be bright.
If you tie all these ends together, you get a glimpse of what the future of healthcare could look like. It could be one in which providers are all working in the same direction. They would work with the same information to effect positive outcomes in each patient’s care. In this futuristic scenario, information would flow seamlessly from one care team member to another, with the patient at the hub. Therefore, patients would have increased access to care when and where they need it. As a result, they would receive appropriate care on time without jumping through multiple hoops and a myriad of delays.
Many parts of the U.S. healthcare system are irretrievably broken. They can be ignored, repaired piecemeal, or eradicated through a wholesale redesign of healthcare today. It’s obvious to many that we hold the tools to conduct the repairs in the palms of our collective hands – literally. The power that lies in our phones, which allows us to organize every minute of our days, is the same power that can be used to redesign how we deliver healthcare. We may consider them as many individual digital pieces now, but together our smart devices represent the future. It can be the future of healthcare as well.
When mobile apps and digital devices are connected with artificial intelligence, machine, and causal learning, we will lift our system to a level of excellence that does not exist today. We will override the broken promises of fractured technologies and create a future that delivers healthcare to the right people at the right time in the right way.
It’s going to take one powerful body of innovators to eradicate what’s broken and power through the detritus to change healthcare. This is not something to be afraid of. It’s something to embrace. We can afford to add fuel to the fire of change.
It’s a big task that requires big thinking.
When the powerful three announced they were going to change healthcare and improve it for their employees, they made no bones about the enormity of the task. Amazon’s founder and chief executive Jeff Bezos said, “The health care system is complex, and we enter into this challenge open-eyed about the degree of difficulty. Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort.”
Berkshire Hathaway chairman and CEO Warren Buffett said, “The ballooning costs of health care act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable.”
The magnitude of the change required and the reactions to the Amazon announcement remind us of two quotes. The first is a classic from Margaret Mead; “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”
The second is from Elon Musk. Regardless of your personal opinion of him, his quote is absolutely applicable to healthcare today, “Some people don’t like change, but you need to embrace change if the alternative is a disaster.”
As we said at the beginning, “All hail those who would dare to think differently about healthcare. Climb aboard; we could use a new captain – or two or three.”
William Payne