The US healthcare sector is no less vulnerable to digital transformation than any other and at last week’s Dreamforce conference two prime examples were on show - one a pioneering start-up, the other perhaps the most ‘establishment’ healthcare provider in the country.
The former is 23andMe, a genetics testing company, founded in 2006, that offers consumer priced services to allow users to be more proactive in their healthcare management; the latter is Kaiser Permanente, founded back in 1945 and which, as of the end of last year, boasts 10.2 million health plan members, 186,497 employees, 18,652 physicians, 51,010 nurses, 38 medical centers, and 622 medical offices across the US.
Anne Wojcicki, CEO 23andMe, makes the point that the healthcare industry needs to become more customer-centric, focusing on the patient as consumer and empowering him or her to take more responsibility for their own health.
She suggests that the healthcare industry today in the US is akin to a communist era state, where the government knows best and tells everyone what to do:
We are trying to get people to think about what they do every day…The individual should be the decision-maker. We are a company dedicated to letting people get access to genetic information. You don’t always have to go to a physician to get information.
The assumption that’s made here is that going to a physician is always going to be the gold standard for service. But a core element of our belief that is that the average consumer can make decisions on his or her own. Having a one-to-one with a physician is not always going to be the gold standard.
In fact, she argues, there are studies that suggest that such one-on-ones lead to lack of engagement by the patient with their own health management, effectively ‘outsourcing’ it without due thought:
Around 50% of individuals go along to a medical intervention and don’t actually know why they were there. If the customer takes more ownership themselves, then they will ask more questions and have better outcomes.
23andMe works from the premise that individuals are perfectly capable of learning about genetics and dealing with that knowledge without the help of the ‘communists’ in charge of the healthcare industry.
Consumers can go online, get the kit, spit in a tube and post it back and they get genetic information sent. We do things like cystic fibrosis testing and care status testing before people get pregnant. We are putting information back into the hands of consumers.
This approach is also generating massive data assets that can be exploited, she adds, explaining that in a previous life she worked on Wall Street tracking Big Pharma. In this role she noted that pharmaceutical firms would embark upon large one-off clinical trials with huge infrastructure implications. At the end of these trials, they’d end up wishing they’d done something different or asked another line of questions. As these were one-off trials, there was no ability to track patterns or trends.
Contrast that with the retail sector, argues Wojcicki, citing the example of Target using ongoing monitoring of a teen girl’s shopping patterns to conclude that she was pregnant and then marketing to her accordingly, in this case before her irate father knew about her condition. That was a prediction that might have been better timed and managed, but the implications if applied to healthcare are clear:
We want to be able to predict that, ‘Hey, you’re three years away from being diabetic’. To do that, we need to collect information from you in the same way as other industries. You can’t understand healthcare unless you have massive amounts of information. So we ask you to contribute information. I don’t have the same problem that Big Pharma has because I keep my customers engaged. People like to participate in giving feedback which gives us more information.
For example, it’s been found that there are a number of genetic variants that contribute to depression. We have more than a million customers and 400 million data points on them. It’s unheard to have a clinical study with hundreds of thousands of data points. It’s almost like doing a Google search.
That’s the bigger picture, but underpinning 23andMe, there’s one underlying thesis:
We are not taught to think. I am a Kaiser Permanente baby. My Kaiser physician taught me how to take care of myself.
The Kaiser chief
That’s music to the ears of Kaiser Permanente CEO Bernard Tyson, who supports Wojcicki’s argument about the need to empower the healthcare consumer. This is something that has always been true of his firm, he states:
Kaiser Permanente’s mantra is to have the patient at the center of everything it does and this is reflected in the impact digital is having on its operating model.
Tyson argues that there are some basic flaws in the US healthcare system that digital transformation is helping to address:
We’ve built a whole healthcare system on a couple of things. Firstly, people started to live longer, but healthcare was a ‘fix me’ system. Secondly, because we were all-knowing, we built healthcare systems where you had to come to us, wherever we want to practice medicine.
Now we’re blowing up those concepts. We have been maximizing the healthy life of the user so that we can all live as long as possible. And we’re reversing the theory that you have to come to us for everything.
That latter point is why Kaiser has invested billions of dollars in its Care Anywhere strategy, which last year passed an important milestone, says Tyson:
Last year we had over 110 million interactions between physicians and our members and 52% of them were virtual - through phones, kiosks, the web etc. We surpassed the physical visits. We seeing much more interaction with our members, who want to be better informed and who are behaving more like a consumer. Medical information becomes a critical part of how they make choices.
The economic model of healthcare thinking is skewed, he argues:
When you consider the social determinants of health, 40% of that determination of how healthy you are is based on how you eat, how stressed you are etc. Then there’s 30% on genetics. Twenty percent is about place - not race, but where you live. And 10% is about the healthcare you receive. It’s on that 10% that we spend $3 trillion and most of that is spent in the two years before you die.
Despite being CEO of an integrated healthcare provider owning significant hospital and medical real estate, Tyson looks ahead to a time when patients don’t come into such places, but are wired up to predict healthcare issues that they can self-manage.
He cites the example of Hillary Clinton’s recent 9/11 memorial dizzy spell as a case in point. With the right sort of AI technology on hand, she should have been able to predict how long she could stand in the sun or what her medical signs were and been able to take proactive action to cope with the situation. He says:
Eventually I can see hospitals being in homes. The future is technology that people can use in the home, medical wearable devices.
As it is, the healthcare providers need to break away from the management and information heirarchies they’ve been built around, mirroring the arguments made by Wojcicki. It’s no longer the case that companies need to be divided into doers and thinkers, he insists:
With technology’s ability to let information go everywhere, everyone’s a thinker. We want front line nurses to be thinking about what else can happen to make interaction between the healthcare provider and the consumer better. We want to share that kind of data across organisations, where people are thinking and doing. Improvement is a continuous effort. We don’t work from a Big Bang Theory - every day is a new day to more forward.
As a Brit living under a free-at-the-point-of-contact National Health Service, I instinctively flinch at the use of the term 'consumer' when it comes to healthcare provision, but the idea of empowering individuals to take more personal ownership of their health is one that I can get absolutely behind. What's key is ensuring that such self-service and self-management is genuinely about enabling patients to take greater control and not just a cost-cutting exercise to discourage contact between them and their physicians. That's not something the UK NHS has a particularly great track record on as yet. There are positive lessons to be learned from the US system - as well as warning lights.
Endnote: Den has used 23andMe and says that the service is very simple to use and produces interesting if incomplete information about a person's health. He says it is a useful step in the right direction when thinking about preventative healthcare but at $199 a pop, it's not going to be available to the many people in the US who struggle with health issues.