Given the dramatic decline in R&D productivity (70% according to one analysis), and the spiraling costs of healthcare globally, the first question to ask is does medical innovation have a future ?
The simple answer is YES – global disease burden continues to grow at a dramatic pace. But the nature of disease has shifted – from infectious to lifestyle diseases, even in poor & middle-income countries. According to the WHO, non-communicable diseases, already the leading cause of death globally, are expected to account for 74% of deaths by 2030 with cardiovascular disease being the leading culprit. This change in the nature of disease is fundamentally changing the practice of medicine.
The current healthcare system arose in an era where infectious diseases were paramount & therefore was designed to be transactional – if you have a problem go to the doctor, get medicine (hopefully take medicine), solve problem and perhaps see the doctor again for a final check-up. If you have a serious problem, repeat the same process but now in a hospital setting. But this system of medicine struggles to cope with lifestyle diseases which are often chronic & require continuous care.
Drug therapy also reflects an infectious disease origin – in simple terms find the bug and kill it or improve the body’s resistance mechanism. With chronic disease however, where the root cause is often behavioral – not biological – its not a surprise that this approach fails to solve the issue. And perhaps explains why it is increasingly difficult to create drugs that offer significant benefit over the previous generation, while the burden of disease continues to grow unabated.
So given this context, how is the medicine of tomorrow going to be different from the medicine of today? In 3 important ways:
1/ The Future of Medicine is Networked
Highly specialized centers of excellence will reach out into the community to deliver care, often virtually.
2/ The Future of Medicine is Digital
Pretty soon your doctor will be prescribing a piece of software instead of a chemical or biological entity.
3/ The Future of Medicine is Frugal
The massive growth in disease burden in emerging markets combined with the growth of digital health is going to call for and result in frugal solutions.
Part 1 of this series explores the first of these predictions in greater detail.
1 / The Future of Medicine is Networked
The essential change in the healthcare system will be moving from a physical / single point of care to multiple care providers connected together, often virtually. We are already seeing significant consolidation in the American healthcare landscape – according to Accenture the number of independent primary care practices has dropped from 57% in 2000 to 39% in 2012 – driven by rising costs and increased documentation needs.
Hospital systems are also consolidating at a rapid pace. As the NYT recently pointed out, hospitals across the nation are being swept up in the biggest wave of mergers since the 1990s. The same article carries a prediction from Booz & Company, that 1,000 of the nation’s roughly 5,000 hospitals could seek out mergers in the next five to seven years. The Affordable Care Act is cited as a big cause … but also the rise in overall costs of healthcare.
Patients’ needs however haven’t changed – they still want high quality, cost-effective care that is convenient. So its not a surprise that many have rushed to fill this emerging void – from Walgreen’s Minute Clinics to Walmart’s Solo Health kiosks as well as phone based systems such as Aetna’s Teladoc. Many, if not most, of these emerging primary care options are connected to a local or regional healthcare system.
Parallel to this is the rising trend of super-specialized centers of excellence building links into the community to deliver their care. Joslin, one of the nation’s top diabetes centers with an excellent track record of research & innovation in the space, is expanding its affiliate program. Mayo Clinic, a top ranking institution, is rolling out a Mayo Clinic Care Network, and so is Cleveland Clinic in cardiovascular care. Affiliates are typically offered direct access to often world renowned researchers and physicians as well as the latest thinking on best in class care in that space.
Legacy EMR and Health IT systems will be under pressure to support this change (meaningful use provisions of the Affordable Care Act are slowly nudging them here). This change has created opportunities for targeted solutions, for example :
1/ Provider to provider connectivity : e.g. SupervisionMD which enables portable telepresence in medical situations
2/ Patient to provider connectivity : Welldoc a smartphone based technology that is targeting disease management, Glooko a seemingly simple piece of hardware that makes it easy for doctors to read data from the plethora of glucose meters in the market and Ginger.io which is using big data to help providers (& patients) gain insight.
Yet, despite these promising ideas, the current reality is that of a healthcare system changing faster than technology has been able to support – creating huge opportunity for technology that can seamlessly bring together different stakeholders (often with different sets of incentives) into one care solution that effectively addresses a patient’s needs.
Do you agree with the above 3 … what would you predict for medicine? Comment below and stay tuned for a discussion on the next 2 predictions.