How Did We Get Here?

The Affordable Care Act’s primary objectives are to transform the current U.S. healthcare ecosystem into one that is:

  1. good for patients, who can enjoy better health, share in their health decisions, and manage their expense effectively
  2. good for the industry, leading to overall cost-effective healthcare
  3. good for physicians and other healthcare professionals, enabling them to focus on delivery of optimal medical care
  4. good for healthcare practices, aligning practitioners, fostering collaboration, and working toward a single goal of delivery of optimal care

If we were to rate the current progress of ACA, the healthcare sectors would have a lot going for them, but looking ahead, it may be a bumpy ride over the next few years with a lot more work required. As we benchmark the financial outlook for the first quarter of 2018, the positive indicators show healthcare companies’ balance sheets are strong, overall cost structures continue to improve, and stocks have good dividend yields. Continued demand appears to be on the rise for healthcare products and services, partly as a result of the growth of our aging population. Unfortunately, these positive factors are being countered by several negative indicators, including political volatility and uncertainty facing ACA and growing national deficit that could change some of the funding sources currently earmarked for the healthcare sector.

Prior to the implementation of ACA, it was well recognized by both the public and private sector that our healthcare system was not sustainable and we were on the road toward the “perfect storm.” The growing swell was influenced by 18% of GNP directly attributed to healthcare and expected to rise to 30% of GNP by 2050; care demand on the rise with over 25% of the population having multiple chronic disease and growth of chronic disease predicted to grow 1% per year until 2030; and consumer-centric care driving health and wellness to avoid higher out of pocket financial subsidies and chronic conditions. Even more alarming were statistics such as these:

  • National average for readmissions to hospitals within 30 days following heart failure episodes: 20%
  • Patients 65 and older cost over $26 billion annually
  • $17 billion spent annually on return hospital trips that wouldn’t need to happen if patients received proper care the first time 

Adding to this trend is the fact that there will be a shortage of over 100,000 physicians by 2030.

GAME ON

Despite these mounting challenges, in today’s healthcare system, providers are expected and incented to perform at a higher level. As a key healthcare supply chain stakeholder and the routine “point of touch” with the consumer, pharmacy also plays a critical role in patient engagement, stepping up and delivering long-term expected outcomes given the headwinds of continued pressures of lower reimbursement, more governmental oversight, and expanded scope of responsibilities relating to access and coverage, emphasizing quality and coordinated accountable care, and expanding emphasis on addressing chronic care conditions.

Emerging Technology Connects with Consumers

The key to achieving successful outcomes is developing a comprehensive consumer engagement strategy by optimizing bi-directional communication: When, where, and how you reach consumers matters. The key areas of opportunities include a platform for greater access, medication adherence, predictive analytics that would share insight from patient data for continuous and sustainable insight, and solutions that personalize management and optimize patient care.

By increasing the involvement of patients in their own healthcare, enabling them to manage their wallet spend and proactively avoid health problems and better manage their conditions, we create a changing patient-centered technology ecosystem. Emerging technology helps improve access, efficiency, and quality of care by putting the patient in the center of the digital experience to drive patient empowerment and engagement. 

Based on feedback from the pharmacy community, here several key enabling technology initiatives that are being successfully integrated into business models:

Data, Data, Data! Including data analytics, artificial intelligence interoperability, and collaboration

  • Intelligence and predictive analytics can drive patient behavior change
  • Data is located in a number of databases, and previously it has been cost-prohibitive and difficult to manage
  • With the power of technology, healthcare practitioners can begin collecting consolidated views of patients by connecting, cleansing, and joining all relevant data (clinical, insurance, demographics, and more regardless of systems or format) to improve the quality of care and outcomes, thus personalizing the consumer experience to drive the right treatment plan and behavior
  • Emerging application of artificial intelligence or machine learning for more uses can be a game changer for clinical decision support: The benefits of AI could potentially increase 20% productivity gains
  • AI-based enhanced EHR technology will aid clinicians, interpret data quickly, make medical and medication predictions, and help in decision making
  • Additionally, pharmacy is exploring the use of AI enabling removal of redundancy steps to provide for a more efficient and seamless workflow between healthcare providers

Growth of Telehealth Greater access, medication adherence, quality of care

  • Telehealth continues to grow in 2018 with the rise of new telehealth solutions
  • Telehealth creates better patient access, engagement, experience, and virtual house call by pharmacy and other healthcare services
  • Telehealth meets the consumer access demand by encouraging preventative care and medication adherence; offers a lower-cost, immediately accessible care option, especially in rural regions or for those who are time-pressed. It also enables the elderly and physically-challenged to obtain regular healthcare services without leaving their homes
  • Additionally, data collected in these services will enable better cost- efficient coordinated care
  • According to many pharmacy executives and other healthcare professionals, telehealth is a high priority, and 76% will offer consumer health services in this area

Smart Devices and Digital Medicine Mobile platforms encourage better patient engagement resulting in better outcome

  • Besides the growth of telehealth and telemedicine services, there are a number of mobile software initiatives encouraging better patient engagement resulting in better outcomes
  • We are seeing emerging smart technology integrated within commonly used medication/disease devices to improve patient engagement: Applications using Blue Tooth and /or Wi-Fi are becoming more prevalent to monitor, alert, and predict behavior and sharing patients’ information with their circle of friends, caregivers and family
  • Recently, digital medicine announced the debut of a "chip in a pill," which provides the ability to monitor the physiology and behavior of patients receiving care for specific medical conditions, although there is a lot more evaluation needed on the impact of this technology

As digital health technology continues to focus on patient empowerment and engagement, 2018 is likely to be a game-changer year for the healthcare sector, driving improved access and coverage and increased coordination and quality of care, ultimately leading to better management of the spend in our current healthcare system.

David J. Fong, PharmD, is president of Dave Fong Rx Consulting, Inc. A former senior retail pharmacy executive for Fortune 100 and Fortune 500 companies, he is recognized as one of the U.S. and Canada’s business and professional healthcare leaders, leveraging his knowledge and experience working with pharmaceutical manufacturers, distributors, retailers, payers, and healthcare technology companies to bring value to the industry and the consumer.