United States: Disruption And Innovation On Display At The 2018 CEO/Innovators Roundtable

On June 19 and 20, 2018, more than 60 innovators and thought leaders came together for the 13th annual, invitation-only CEO/Innovators Roundtable (Roundtable), hosted by Foley & Lardner LLP and BDC Advisors, LLC. The overall theme of the Roundtable was "disruption and innovation" in health care, and the discussion was divided into panels on five key topics:

  • Re-engineering Primary Care
  • Digital Therapies and Distributed Care
  • Big Data and Machine Learning
  • Consumer Engagement
  • Health Company Venture Investing

Focusing on the "Patient as a Person" Emerges as a Common Theme

There were several themes that resonated across all five panels, but most prevalent was a common frustration with our current health care system because of its disjointed nature and its focus on treating the patient with "sickness care" rather than the person with "health care." One panelist described his family's inability to coordinate care for their mother, who suffered for years with chronic liver disease she got from a tainted blood transfusion, despite the fact that the family was full of health care professionals. Another asked rhetorically, "Why should the consumer have to piece everything together?" His company sells treatment packages, including drugs, counseling, and discounted medical services (when necessary) directly to consumers. Another panelist is CEO of a company that gets people to share stories about themselves, their health, and their likes and dislikes, and then synopsizes these stories and delivers summaries to their PCPs, to give them a perspective on the whole person as more than a bundle of symptoms. Another panelist summarized the fragmentation problem succinctly: "My smartphone is awesome. My new car is awesome. Health care is not an awesome product."

Another common theme was how current payment systems get in the way of innovation. One national primary care company charges people a small fee to make patients "members," which creates loyalty and moderates somewhat the fragmentation of fee-for-service medicine. Another national primary care company relies on risk contracts with payers to resource its clinics with NPs, nurses, social workers, and pharmacists, in order to provide personalized care to patients. A leading provider of telehealth services described the slow progress being made to reimburse telehealth providers, despite ample evidence accumulated over more than 20 years that telehealth improves quality and reduces cost. Another "virtual" care provider avoids insurance payment issues altogether by focusing the company on the self-pay market, where consumers reign.

A third theme was captured by one panelist who said, "Healthcare is a team sport." Many panelists told stories about the value of having multiple providers with different skill sets working together to care for people. One progressive primary care practice shifted nursing functions – and nurses – to provide "collaborative care where they interact with people around what they need." Nurse navigators are critical for upsetting conditions like cancer care, explained one panelist who runs a large multi-system cancer network with almost 1,000 physicians. Not only do they help patients navigate a complex system with multiple specialists, but they act as concierges, making appointments for patients where and when they need them, and advocating for patients, including moving patients from one provider to another, where necessary.

Primary Care Innovation in Practice

It was impossible to listen to this panel and not be impressed with how primary care is becoming more differentiated and segmented around patient needs. One panelist described how his traditional, rural primary care practice with a very old population has evolved into a more leveraged, multi-disciplinary practice where patients are better cared for and physician burnout has been ameliorated. Another panelist described his "member-based, technology-powered" primary care company, which has grown rapidly by focusing on millennial patients and customizing the clinic experience to their needs for timely appointments and "24/7 digital access." This focus has produced net promoter scores of 90%, an extraordinary accomplishment. (As it grows, the company is acquiring a more diverse group of patients, which may change aspects of its model.) Another primary care CEO described how his company delivers comprehensive "community care" that requires different types of providers and how it has gotten payers to finance much of this change through global risk arrangements. Another panelist, the CEO of a large urgent care network, described how immediate care can complement primary care, as long as the two can communicate and work together effectively. All four of these panelists are re-engineering primary care in quite different, but potentially important ways.

Disruptions in Traditional Care Delivery with Digital Therapies and Distributed Care

Digital therapies have developed with patient needs at their core, but they are playing out differently in urban and rural areas. Rural practitioners can often readily identify individual patients with acute or chronic conditions for whom local help is not available. They can then use tele-consults to connect with distant specialists or utilize innovative technologies like remote monitoring or telephonic or internet-enabled care coordination to improve their care. Physicians in busy urban practices, on the other hand, while in theory they may have access to many specialists, can encourage their patients to utilize distributed technologies like video emergency room visits or connected urgent care centers or in-pharmacy clinics to obviate time-consuming trips to their offices or overcrowded urban Emergency Rooms.

One panelist's company is disrupting care by focusing on a specific health condition and building a full service "virtual" platform that delivers comprehensive care for a low price to patients anywhere in the world. Innovations like this meet patients' expectations for getting care "better, faster, and cheaper" than the health system currently provides. Despite differences in scale and technologies, all these approaches represent disruptions to traditional care delivery aimed at better meeting patient needs.

Big Data and Machine Learning/Artificial Intelligence Will Not Replace Relationships

Machine learning (or "artificial intelligence") working with "big data" represents a potentially dramatic health care innovation, although it is still early in its development cycle. Panelists described a number of applications of predictive analytics, including EKG interpretation, medical imaging of solid tumors, management of hospital operations, and population health management, some of which require new methods of structuring unstructured data sets (e.g., images), and all of which involve analysis of complex data. Some of these applications use feedback loops to "learn," and others are still developing and validating data structures that will be used in future machine learning applications.

One important theme which all the panelists addressed is the relationship these new systems are likely to have with professional experts (e.g., cardiologists, radiologists). In general, panelists believe that machine learning will be used to augment, not replace, professional expertise. One reason for this is practical: Convincing radiologists to adopt technologies that enhance their readings will be much easier than convincing them to replace themselves with expert systems. Beyond this, the acceptability of expert systems to patients is debatable: Patients are likely to insist on human intervention to accept the results of even the most sophisticated expert systems. Finally, machine learning is a technology where the "sizzle" is considerably greater than the "steak," as exemplified by the well-publicized issues IBM Watson Health has had sustaining relationships with some of its early adopters.

Consumer Engagement Means Understanding the Whole Person

The Consumer Engagement panel discussed many different ways health systems can connect with people / patients to influence their behavior. One panelist from a major health system described her system's commitment to marketing highly specialized ("precision") services. Key to this system's success has been developing marketing tools that capture a wide variety of variables and use them to understand referral behavior. This understanding has enabled the health system to make connections with patients in between episodes of care, broadening their understanding of patient needs and helping them engage the patient more fully in their encounters. Another panelist described his company's methodology for understanding the whole patient and communicating this to providers. Two other panelists described their company's team-based approach to managing social as well as medical conditions for their patients. Two overarching themes emerged from the discussion:

  1. The importance of understanding where patients are, exemplified by one patient's comment: "It would be great if you could join me in what I want to do, rather than 'engage me' in what you want me to do."
  2. The need for health systems to demonstrate empathy and connect with the whole person, not just their conditions. One panelist described this as "restoring humanity to health care."

Health Systems Tie Investments to Company Strategies

The final panel dealt with a meta-issue: Should health systems play a role in financing disruption and innovation, and if so, how? Many health systems are in fact investing considerable time and capital in this endeavor for a variety of reasons – giving them a window on technology, enhancing their operations, diversifying their asset base, etc. Panelists described a variety of investment approaches health systems are taking, from commercializing inventions that originate in their companies to investing in promising ventures originated by others. Two panelists that manage mature venture funds typically invest in later round ventures and syndicate these investments with others. One panelist manages a fund that invests in A and B round ventures. Another experienced investor panelist is broadening its investment strategy beyond commercializing its own inventions to invest in outside ventures.

All four panelists emphasized strategic investing – picking investments that their parent companies actually use and where they believe they can contribute strategically to the venture's success. One panelist emphasized the amount of effort the venture group expends finding "burning needs" for their company. They combine this with a "curated view of external opportunities" to identify promising investments.

* * * * *

Driving Future Health Care Innovation

Across the board, panelists and attendees at the 2018 CEO/Innovators Roundtable discussed how new companies and initiatives are disrupting our current health system and the kinds of innovations that are likely to drive the industry over the next decade. But each panel discussion was unique and rich and contributed different insights. Over the next few months, we will be publishing more detailed summaries of each panel in an effort to ensure that the learnings participants had can be diffused to all.

About the CEO/Innovators Roundtable

The CEO/Innovators Roundtable is an annual, invitation-only event that features thought-provoking discussions, peer insights, and actionable plans from a diverse group of healthcare industry leaders.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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