It’s that time of year — when our inboxes and social media feeds populate with words from the wise on the coming year’s trends.
This is a different Top 10 List. It’s not about trends, predictions or market dynamics. Put aside for a moment gadgets, gizmos and got-to-have smart stuff. This is about the changes afoot that we need to make happen now by moving minds, systems and behaviors. These are life-sustaining and life-saving approaches to patient care that will tip the scale toward health and wellness.
1. Artificial Intelligence (AI) — A future of engagement and collaboration:
AI has been around since the Gutenberg Bible! In 1899, medicine made a giant leap into AI by publishing the Merck Manual — a handbook that collected all known medical advice and gave physicians a compendium of diagnoses and treatments. No expert can remember the vast canon of medical information within their specialty, and books became a source of “augmented knowledge.”
But too many health systems and physicians view AI as “novel.” They think about the obstacles to implementation in their health systems rather than the enhanced decision-making benefits offered by AI. The reason for implementing artificial intelligence is not about embracing technology — it’s about adding to our wisdom.
Human intelligence can be augmented by uniting data, patient files and other health professionals’ patient-care experiences, channeled through this technology platform. We must now rally to address questions about data quality, emotional resistance to change and cybersecurity. As innovation theorist, John Nosta writes about the emerging importance of aligning IQ and EQ with TQ (technology quotient).
2. Behavioral Health — America does not lack a supply chain to manufacture chronically ill citizens:
We are killing ourselves slowly…with poor nutrition. The COVID-19 era added 19 pounds to too many waistlines. With the added weight, we also increase risks for heart disease, diabetes, cancer, mental health stressors, and more. Who pays those sickness bills? Employers foot a large percentage of the nation’s workforce health insurance. It’s time to look beyond providing an expected workplace benefit. Employers must enter the healthy workforce fray! Engaged employees need personalized health support. The only other option the C-Suite will be left with is to shell out more dollars to payers and still reap sickness.
The health that corporate America pays for today is backward. The focus on footing the bill for sick care for employees (or members) — instead of offering primary lifestyle prevention to keep our people healthy — costs individuals, businesses, and society a fortune and is completely unsustainable. It’s the equivalent of working to restore loyalty to an unhappy customer instead of focusing on delivering a world-class experience from the first touchpoint and keeping customers happy and loyal along the entire customer lifecycle.
3. Decentralized Clinical Trials — Democratize drug development:
Since COVID-19 appeared, traditional clinical trial recruitment models hit the brakes. After drug development was almost sidelined, clinical research organizations (CROs) recognized that they needed to reinvent patient recruitment. Operation Warp Speed showed how to put the pedal to the metal for COVID-19 vaccines; systems developed now can be applied to other high-priority, clinical urgencies such as treatments for rare diseases and often-fatal cancers.
Collaboration to advance the process is working. Science and research pioneers such as Amir Kalali, MD, and Craig Lipset, who co-lead the industry-wide DTRA.org group, are showing the sector’s readiness to collectively change direction. Innovators like Michelle Longmire, MD, CEO of Medable, demonstrate that a sector known to advance new medications from bench to bedside can innovate how and where patients are invited to participate in urgently needed therapeutic discoveries.
4. Digital Health — Physicians and patients need coverage clarity:
Food and Drug Administration approval for life-sustaining innovations does not necessarily sway payer access decisions. “Claim denied” is the all-to-often refrain when physicians and their patients seek access to a 510 K-approved medical device or digital therapeutic.
Payers may have sufficient justification to deny coverage. But what are the criteria for those “dead-on-arrival” reimbursement decisions? What are the guidelines to secure formulary approval? If more data are needed to secure access for patients — insurance customers — payers need to become partners in the sector’s and patient-care success. Adding bricks to the walls patients must circumvent to secure care for themselves and their families does little to improve care or customer relationships.
Digital health analyst and author Artur Olesch outlines a challenge for the coming year in a question many more should be asking:
5. Ecohealth — We need a healthy planet or else:
Where you live impacts how long and how well you live. Thousands of U.S. communities are ticking time bombs. The harsh reality is that 26% of Black Americans and 29% of Hispanic Americans live within three miles of a toxic landfill site, exposing these communities of color to dangerous levels of lead and other heavy metals and chemicals. We must face the harsh reality that while planet earth can do just fine without humanity; humanity needs a healthy planet. This was the striking call-to-action by Meharry Medical College President and CEO Dr. James E.K. Hildreth.
The longer we wait, the harder it will be to course-correct. The shift to a healthier world requires other innovative superpowers — courage and collaboration. According to Rachel Hodgdon, International WELL Building Institute (IWBI), President and CEO:
“This needs to happen quickly for the sake of every aspect of our health. Supporting our environment is a good investment with a significant return. And, although paying the price tag may seem a big pill to swallow, funding the bipartisan package won’t be achieved through higher taxes, but rather by repurposing already allocated funds, including unused COVID-19 aid. The government will not have to work alone. Industry is ready and eager to roll-up-its sleeves to help.”
6. Formulary Non-Medical Switching — Stop inflicting patients with adherence challenges:
CVS operates a major pharmacy chain where COVID-19 testing and vaccination are readily accessible to millions. It seeks to do good, and is even seeking to ban cigarettes from its stores. But in this case, CVS-Caremark is excluding all FDA-approved direct oral anticoagulants, known as DOACs, except one from its preferred drug list. By doing so, CVS- Caremark is creating an immediate patient safety issue, as this and other non-medical switch business decisions place hundreds of thousands of people well-controlled on a life-sustaining medication at risk. The Alliance for Patient Access reports that 39% of people who underwent non-medical switching discontinued their medication. For anticoagulation patients this is critical, as it places them in increased risk for clots and stroke.
When people are diagnosed with a serious medical condition, we need to ensure that the patient-physician relationship guides care and the medical ecosystem prioritizes medication adherence. The National Health Institute reports that 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. We don’t need to invent or create new care challenges. Let physicians already seeking to do good oversee clinical-care decisions.
The American Heart Association and the American College of Cardiology oppose therapeutic substitution, believing that “only the prescribing doctor is equipped to determine the best drug or combination of drugs” and that therapeutic substitution “may result in the patient receiving a drug that doesn’t work well enough, produces life-threatening toxicity, or interacts dangerously with other drugs the patient is taking.”
7. Health disparities — The most vulnerable need access to care now:
Decades of racism place people of color in harm’s way from COVID-19 more than any other community. Blacks are dying at a rate of 50.3 per 100,000 people, compared with 20.7 for whites. In New York City, the most densely populated place in America, 19% of residents, many people of color, live in poverty, while 17% live in overcrowded conditions. We seem unable to come to grips with the reality that health disparities cause multiple public health disasters and cost lives and dollars.
America is among the few developed nations that denies good healthcare services to those most in need. Neglect and racism are morally counter to the health mission of medical leaders. Policymakers, corporate leaders and citizens must raise their voices to enact change. A cultural shift is needed to rally communities for awareness and education. According to Yele Aluko, MD, MBA, chief medical officer at EY:
The current conversation going on nationally about societal justice, about health equity, drives a moral imperative. This conversation is going on across health systems, big business, government, and philanthropic organizations. Everybody’s talking about how we need to fix this wrong, so the time is now. We have a convergence of goodwill that drives my optimism. But we must seize the moment and translate it into actionable solutions.
8. Metaverse — Smart technologies channel our imagination toward curative possibilities:
Do you have an imagination? Put it to work to heal. After all, medical engineering is a pioneering effort that connects people’s ideas with human biology to overcome sickness. We entered the “Matrix” the first time we imaged a therapeutic stent, LVAD and 3D-printed artificial limb; complex operations became possible when expert hands drew upon technology to realize new concepts.
Rafael Grossman, MD, FACS, has been tapping technology to improve patient-centered medical care. Always ready to explore the disruptive power of technology in medicine, Dr. Grossman has been at the forefront of using smart glasses, augmented, virtual and mixed reality to change the way we practice and teach medicine.
Grossman and medical compatriots such as Daniel Kraft, MD, don’t see the metaverse as sci-fi. Artificial reality, virtual reality and wearables are used by leading-edge practitioners to advance patient outcomes.
9. Remote Patient Monitoring and Telehealth — Remote care after COVID-19:
Digital systems are built into beds, furniture and watches. Medical wearables make hospital stays more customer-friendly by delivering patient information straight to providers’ smartphones and central monitoring stations. At the height of the pandemic, there was a dramatic uptick in telehealth and remote care. Now, as reimbursement rates shift, patients worry that they will lose the benefits of remote care.
The Centers for Medicare and Medicaid Services and private payers are pumping the brakes on continued remote access. We need to change the culture of conservatism when it comes to remote advancements.
Medicine is a culture where patients are not yet seen as customers. Cancer survivor, caregiver and health professional Stacy Hurt, a HIMSS Digital Health Influencer and recent participant in a VyTrac-sponsored webinar on remote patient monitoring writes:
Patients ultimately want two things: hope and options. We’re finally to a point where telemedicine is an option. It for sure shouldn’t replace the in-person encounter and relationship between the healthcare provider and patient, but it is an option we need to preserve.
10. Self-Care — Our health system keeps us alive — it doesn’t keep us well:
Our health system is not currently built around sustaining “health.” We have invested mightily in a national illness-management structure that offers diminishing return-on-investments. Preventive care will keep the costs of illness down is a big win-win-win for households, companies and governments that now foot much of the nation’s health insurance bill. Employers and payers will find that encouraging self-care and illness prevention is a smarter business model.
The biggest myth has been that (cancer) is primarily caused by genetics or just bad luck and there is nothing that you can do about it. The reality is only about 30% of cancer is caused by what we would say are inherited mutations or family history. The rest is primarily influenced by lifestyle. I know, although nothing is 100% preventable, we have learned through science that you can reduce your risk by deciding what you eat, how much you exercise, your level of stress, the quality of your sleep. These are all things you have control over.
If this list tells us anything, it’s that it is time we put health-system mindset change front-and-center. There are plenty of great reasons to say, “this won’t work” or “let’s not do it; it adds to costs.” It is understandable that new products, services and approaches take time to implement and cost money. But when we look at patient wellbeing, adding complexity to people’s lives that separate them from access to the best quality of care has never been medicine’s intended mission.
Health providers are at the forefront of confronting our great societal challenges. They have risen to the task heroically. Health disparities between the haves and have nots and developed and developing nations have opened our eyes and hearts. Now, in 2022, the innovations we already have combined with our determination must open the door to fundamental system change.