Discover the New Disruptors and Why You Need to Disrupt Your Strategy
Big changes are in store that will forcibly cause a shift in managed care, from state governments becoming more active in healthcare to online retailers making a push for space in the industry.
David Friend, MD, MBA, Chief Transformation Officer and Managing Director of The BDO Center for Healthcare Excellence & Innovation explains, “As industries continue to blur, traditional healthcare companies will need to break down silos to drive value across the industry ecosystem. To compete with disruptors, healthcare companies will need to capitalize on data, maximize profitability, and innovate patient care all while managing growing risk in the areas of patient privacy and data security.”
The Big 5 Disruptors
- Online Retailers
As mentioned, online retailers are marching into healthcare territory in significant style. This year, there have been plenty of talks between retailers and healthcare organizations as they make deals; this includes Amazon’s acquisition of PillPack, and online pharmacy; Walmart’s early stage talks to acquire Humana, and more. CVS continues to combine their stores with walk-in clinics and digital healthcare delivery platforms. Health retailers like healthwarehouse.com and FSAStore.com offer product delivery right to consumers. In addition, UnderArmour has invested heavily in wearable devices. It has also acquired MyFitnessPal and MapMyFitness, with which the company now has access to massive amounts of peoples’ health data. Finally, online retailers are partnering with pharmacies to reach more consumers to develop consumer-centric models of care and lower overall costs.
- Targeted Therapy
Immune effector cell therapy, a new treatment that allows a patient’s T cells to be harvested and re-engineered to target cancer cells, looks promising as a disruptor to the healthcare we’ve become accustomed to. The therapy is designed to target small populations with limited treatment options; however, there are challenges that must be overcome before it even becomes widely available, starting with its high upfront costs, its potential adverse side effects, and its uncertainty of effectiveness. The revolutionary therapy is intended to be a one-time treatment – but its list price set by the manufacturer is more than a quarter million dollars. Still, the potential for this disruptor to revolutionize the battle against cancer is certainly noteworthy.
- Social Health Determinants
These include education, health and healthcare, built environment, neighborhood, and economic stability, in addition to community and social context, according to Healthy People 2020. Lori Tremmel Freeman, MBA, CEO of the National Association of County and City Health Officials says, “These are the conditions in which people are born, grow, live, work, and age, as well as the circumstances that impact their health. Social determinants of health undergird many current healthcare challenges including obesity, heart disease, diabetes, and depression.” While it’s true that genetics does play a role in a person’s health, most outcomes are the result of circumstances beyond the healthcare system. Some insurers, hospitals, and states are factoring social determinants into healthcare by ensuring patients have adequate housing and access to medical programs and resources. More attention to social determinants will provide a more balanced approach to healthcare.
- Artificial Intelligence
It goes hand in hand that as electronic health data becomes more widely available, artificial intelligence also unlocks the potential for that data to improve healthcare. It’s already happening, too; the phrase “Doctor knows best” is at best a mere piece of advice reminiscent of yesteryear. Jodi Daniel, a partner in Crowell & Moring’s Healthcare Group and a member of the firm’s Digital Transformation Practice explains, “Clinicians will need to apply their training and experience along with data and sophisticated systems that can identify new information that may not have been available or transparent before. This could lead to significant improvements in diagnosis and treatment and create efficiencies for provider and patient interactions and administrative functions.” AI applications include diagnostics, population health management, and patient care, for starters.
- The Intervention of State Governments
Since 1965, states have operated the Medicaid program as a fundamental driver of healthcare policy and service delivery. It currently covers 74 million people, pays for more than 65% of nursing home bills and more than half of births in the country. Thirty-three states have expanded their programs to cover adults without children, and legislation introduced in October of 2017 would introduce a public healthcare option that is Medicaid-based into the marketplace. Since then, many more states have introduced Medicaid buy-in proposals to cover those who need insurance. States must innovate to make sure their programs are sustainable and produce results. The programs face relentless challenges to keep costs down but still provide quality services, but new flexibilities allow for payment of interventions that are far more cost effective than traditional healthcare services.
While there will undoubtedly be a continuous introduction of new, exciting disruptors for the healthcare industry, the most important take-away here is that your digital strategy must adapt and grow with these introductions if your group is to remain competitive and at the forefront of the market. Take advantage of the vast amount of health data that is newly available and use it to understand your market, your target audiences, and ultimately, the patients who rely on you to do so.
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