Blog | 2/27/2020

Reflecting on the 17th Annual HBS Healthcare Conference

On a frigid February morning, academics and professionals convened at the Harvard Business School for the 17th annual student-run Healthcare Conference to discuss the industry’s pressing issues. Health Advances was proud to once again sponsor this event. This year’s conference highlighted the challenges associated with redefining healthcare to encompass all aspects of care (termed “whole-person care”) as opposed to only addressing individual components of health (i.e., disease). The CEO-studded panels addressed myriad topics, but discussions converged on three key questions:

1. How can various stakeholders address whole-person care?
Most Americans expect to receive world-class healthcare. However, as health outcomes fail to improve with rising expenditures, the industry must adopt a multifaceted approach in order to create the healthcare system patients expect. Historically, a patient’s immediate needs (i.e., disease and subsequent treatment) have been the cornerstone of healthcare. But to adequately address whole-person care, the speakers suggested that the industry must expand preventative and educational efforts and also adopt a broader perspective of health that considers social contributors to wellness.

There are differing opinions with regards to who needs to bear the responsibility to create and implement the innovative systems necessary to adopt whole-person care. Some believe that the government is the only stakeholder large enough to lead and execute such industry-shifting changes. To this end, many public criticisms have focused on ineffective use of federal resources (e.g., overspending by CMS) or inadequate funding for valuable programs (e.g., primary school health education). Others complain that insurance providers have been slow to identify more effective prevention strategies and are ignoring underlying issues (e.g., low comparative spend on mental health issues). Some blame the physicians, who may be poorly trained but are more likely overscheduled, either of which makes it very challenging to drive change at the “grassroots” level through direct patient involvement. Although patients are the ultimate consumer and ought to be the primary stakeholder in their own care, many feel powerless when seeking help for non-traditional issues (e.g., unable to access or afford mental health care or nutritional guidance).

To date, no single stakeholder has undertaken decision-making responsibility in order to drive change. Furthermore, the problems persist in part due to the disjointed leadership and mismatched incentives. Javier Rodriguez (CEO, DaVita) pointed out how it is often easier for entrepreneurs to focus on a narrow aspect of a broader issue. Their piece-wise solutions, while individually beneficial, fail to provide an effective, integrated tool to address complete patient care. Moreover, these are often only implemented locally and may not translate into large-scale opportunities to drive change in the overall healthcare landscape.

Although our legacy system resists change in many ways, we are nonetheless already in the midst of evolution (for example, hospitals already receive an increasing share of payments through DRG bundles). The industry is ripe for change, evidenced by ongoing debates for data privacy and interoperability or the potentially significant implications of political elections this year. Regardless of these differing viewpoints, entrepreneurs and healthcare professionals are in an excellent position to at least begin to address whole-person care.

2. How should the role of the healthcare provider evolve in the future care landscape?
Physicians are increasingly burdened with administrative tasks and many struggle to spend more time in front of patients. As Dr. Neil Wagle (CMO, Devoted Health) pointed out, even the best-intentioned and most well-trained physician may not always be able to deliver the best care. Patients may be unable to get to the office, may not understand the importance of their medication or even how to properly administer it, or may be uncomfortable receiving care through specific means. Additional HCP (healthcare professional) stakeholders (e.g., behavioral health specialists, social workers, nutritional assistants) and more efficient delivery systems can help alleviate such pressures.

Non-clinical HCPs should look to address ancillary patient needs, thereby empowering physicians to deliver better care. These boots-on-the-ground stakeholders can help address social factors of a patient’s health that are often overlooked (e.g., transportation challenges, technology illiteracy or a disabled family member at home). Kyle Armbrester (CEO, Signify Health) recognizes the diversity of patient types, and his organization emphasizes identifying “social comorbidities” by establishing relationships and conducting in-home wellness assessments. By recognizing physical or emotional barriers or financial limitations, HCPs can address individual patients’ needs and more effectively help guide patients towards better clinical outcomes. However, the greater demand for hands-on personnel will continue to push entrepreneurs to design creative operational approaches.

Efficient task-shifting towards non-clinical staff will provide physicians more time with patients, but doctors must still be aware of key cost drivers in order to reduce the overall healthcare burden. Although payers are increasingly employing value-based payment strategies, physicians are in a position to further drive the effective utilization of resources. Tom X Lee (CEO, Galileo Health) argued that medical schools must begin to include these topics in core curriculums in order to train a more conscientious physician. Well-designed practices will expand the reach of non-clinical staff and give more clinical time to physicians, allowing them to connect with patients and most effectively use their resources.

With better practices in place, the next challenge is scalability. We expect to face a shortage of healthcare professionals in the next decade, particularly mental health specialists. Digital solutions could not only amplify organizations’ clinical reach and impact but also provide a customized approach for individual patients that considers their unique circumstances.

3. How can digital innovations address critical issues and promote whole-person care?
Although the conference drew attention to many current healthcare challenges, a source of encouragement was innovations that are already transforming care delivery and the promise of more to come.

As our population grows and chronic disease prevalence increases, our healthcare system has become overburdened and overspent. The necessity to improve the effectiveness and efficiency of delivering care is paramount. Novel primary care delivery systems are reducing systemic burden by emphasizing preventative care, patient education, and informed utilization of available resources. As Geoff Price (COO, Oak Street Health) points out, one can achieve 100x cost reduction by addressing a problem in a primary care visit rather than an ER visit. Entrepreneurs should continue to implement innovative design models to seamlessly guide patients. As a result, there continues to be a need for creativity in operational management.

The expansion of telemedicine has enabled physicians to reach remote areas, and telemetry has empowered them with timely and accurate data to support actionable recommendations. Digital portals provide patients with instant access to a physician, re-creating a frictionless personal network similar to what people more often rely on (i.e., asking friends or family for health advice). These online platforms allow patients to receive trustworthy advice from their provider and maintain constant communication, as it relates to current medications or symptoms. Increased time with physicians and strengthened relationships have already been positively correlated with greater compliance and outcomes. Established relationships will encourage patients to reach out for more general advice, not limited to illnesses.

Moreover, health tracking can improve patient awareness and engagement in their health as well as help provide a more clear path towards improvement. Patient support programs facilitate easy data collection and provide actionable feedback, such as Sanofi/Verily’s Onduo program where diabetic patients photograph their food in order to better track and understand spikes in blood sugar. Digital therapeutics are poised to address mental health issues and provide faster access to programs and helpful feedback to clinicians, such as Akili’s AKL-T01 meant to address ADHD (currently under review by the FDA).

References
(1) https://jamanetwork.com/journals/jama/article-abstract/2674671
(2) https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
(3) https://www.urban.org/sites/default/files/04_diagnosis_related_groups-based_payment_to_hospitals_for_inpatient_stays.pdf
(4) https://www.beckershospitalreview.com/ehrs/epic-ceo-judy-faulkner-asks-hospitals-to-oppose-hhs-interoperability-rule.html
(5) https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf
(6) https://www.mobihealthnews.com/news/akili-interactive-digital-pediatric-adhd-therapeutic-performs-well-or-without-accompanying
(7) https://www.connectedmed.com/blog/content/how-verily-is-using-technology-to-help-patients-with-diabetes