Dear Reader,
This Profile in Product | Strategy | Innovation begins a 3-Part Series on a Health Ecosystem and model to describe it. Such a model can have great utility, but our focus here is to inform Strategy and Innovation. This provides opportunities to advance health plus the products and services to do so. But why consider such a model today when many dedicated groups have spent years and billions of dollars trying to fix and advance healthcare? Maybe they were focused on being better. We seek something different.
We previously discussed the 3 largest global markets. More details are covered in [U12] Update: Beyond the FAANGs, but Healthcare is one of the 3 largest markets with an estimated global market cap reaching $12 trillion by 2022. Healthcare remains fragmented with many incumbents. We need emerging disruptors to driving change to gain greater efficiencies and lower costs. We can learn from other industries to identify relevant proxies for something different? And can we model an ecosystem to determine key points for innovation to drive these changes?
The 3-Part Series will cover:
A 3-Pillar model for a Health Ecosystem,
Improving Outcomes with Connected Care, and a
Deep Dive into Connected Transactions.
This Part 1 will cover how Amazon, Square and Spotify influenced this model. One key feature of the ecosystem model is only two of three Pillars are core to healthcare delivery. The first Pillar covers consumers to expand the scope of the model with more attention to the determinants of health. Providers can share information on these determinants with their patients and make recommendations, but individual behaviors and social determinants are more impacted in the community by government, non-profit and corporate activities. What if organizations in a city like the Boston Celtics, Red Sox, Bruins and New England Patriots collaborated to promote healthy living and prevention within the Greater Boston community, but each organization also focused on a different determinant of health to expand the scope. Corporate partners could also enhance these efforts in cooperation with area Health Systems.
The recent pandemic accelerated wider access to virtual primary care out of the necessity to adapt to the situation. Telehealth visits are no substitute when a careful physical exam is required, but these virtual visits from home can help Consumers with easier access often at lower cost. Providers can also allocate time to provide virtual care outside of their primary office.
This is possible when HealthTech Services are considered as a separate Pillar with a scope beyond Provider Networks to enable access for Consumers, too. And Healthy Living and Prevention targeting Consumers can influence dynamic pricing for health and life insurance as benefits through employers. Tesla is already doing this with dynamic pricing for automobile insurance with Tesla electric vehicle owners in Texas based solely on a driver’s Tesla Safety Score.
And a health utility network is another HealthTech Service for an ecosystem model when multiple stakeholders who might even compete find ways to collaborate on efficiencies for all by developing and using common tools. Aetna, Anthem, Cleveland Clinic, HSCS, IBM, PNC Bank and Sentara are developing such infrastructure with utilities and solutions through a membership-based network provided by Avaneer Health, Inc.
Background
Disruptive innovation offers the potential to unseat incumbent leaders in global markets. It is straight forward to define market leaders and opportunities for disruptors in the 2 largest global markets covering Financial Services and Transportation / Energy, but Healthcare is so fragmented, it is difficult to even define the market and the clear roles companies play in the market to integrate services effectively.
So, a simple, but comprehensive model aimed at capturing the Healthcare market is a primary objective. However, to do so we need to consider more of a continuum. I may be a patient tomorrow treated by a physician, but today I’m a consumer focused on healthy living and prevention. Healthcare models should consider a Health Ecosystem that spans consumers, employers where cohorts of consumers work, and provider networks that treat patients downstream on the continuum.
Philips describes a Health Continuum and positions business groups in a specific stage of this continuum. This helps to understand the friction points at a particular stage of journeys through this continuum and where to position a business to define scope, but we need a model that is even more basic to define the core components of a Health Ecosystem.
Key domains of the model should expand to as many dimensions as needed to cover every detail needed to define the requirements and technical specifications to solve problems as they emerge. Such a model also helps to identify gaps and the role disruptors play. It may also help to understand the criteria to predict winners and losers.
Johnson & Johnson announced on November 12 they intend to split into two different companies. One company will focus on consumers and the other core company will focus on its pharmaceutical and medical device companies. The trend is definitely to break up conglomerates with General Electric also announcing recently they intend to split into three different companies. The idea with a Health Ecosystem is not to define the scope of single company, but to understand where various companies are positioned or could be positioned for significant growth with interoperability between key stakeholders and the right products and services.
Health Ecosystem
An ecosystem defines a complex network or interconnected system. These occur in nature, but are also relevant in business. Silicon Valley is identified as an important ecosystem for entrepreneurs and startup tech ventures. This is based on a culture that supports entrepreneurs and a community with the human capital and talent to develop technology under conditions of extreme uncertainty. Venture capital also provides a key role to fund entrepreneurs and their startup tech ventures in Silicon Valley.
Boston is an ecosystem for innovation in the life sciences with leading research universities, teaching hospitals and companies covering the pharmaceutical, biotech, healthtech and medical device industries. Venture capital, shared work spaces and wet labs also continue to develop with a focus on the life sciences in the Greater Boston area.
An example of another robust and evolving ecosystem is ethereum.org to support the growing Ethereum community. The genesis of this ecosystem was the Ethereum white paper and the adoption and growth of the cryptocurrency, ETH. Open source projects almost require a robust ecosystem for viability. But they also need commercial activities linked to the ecosystem. The Ethereum community is made of entrepreneurs and developers building solutions enabled by the growing policies, standards, and capabilities driven by ethereum.org and the non-profit Ethereum Foundation. Non-fungable tokens (NFTs), smart contracts and decentralized autonomous organizations (DAOs) are just some examples of commercial activities developed recently through the Ethereum community of entrepreneurs and developers. And many companies have formed to commercialize these Ethereum-based technologies.
So the Consumer Pillar for Amazon is represented by Amazon Prime estimated to cover 76.6 million households by 2022.
A key feature of the Health Ecosystem described here is a model based on 3 Pillars to define scope. Amazon is probably the best proxy for such a model where consumers access products and services from sellers through an Amazon e-commerce storefront with orders fulfilled through Amazon, too. This forms a marketplace spanning consumers, businesses and Amazon. Once this marketplace was realized, Amazon took customer access to a new level using a membership model with Amazon Prime. What Amazon has mastered over the years is taking an expense on their income statement and turning it into revenue. An effective marketplace still has to acquire customers through advertising and other means. Amazon Prime not only acquires customers and generates membership revenue, but keeps those members coming back to spend more with Amazon versus alternatives to get the most out of their membership. So the Consumer Pillar for Amazon is represented by Amazon Prime with an estimated 76.6 million US households covered by 2022.
Consumers and Sellers transact and fulfill orders for products and services through two Pillars spanning Amazon Prime and Amazon Marketplace. The third Pillar is the result of Amazon again taking an expense and turning it into $45 billion in revenue in 2020. Those expenses covered the IT services Amazon needed to operate e-commerce and fulfill orders and were the genesis for Amazon Web Services (AWS). Scalable services provided by AWS internally to Amazon are also sold externally to other businesses. Virtual computer services operated by Amazon disrupt the need to buy on-site servers to host, process and stream data.
Square is also creating a marketplace with 70 million consumers using Cash App and 2 million businesses using its Seller Ecosystem to form two Pillars.
Amazon is not an outlier. Square organizes Consumers under its Cash App services to provide many of the routine services consumers use with a bank. So Cash App is the bank for many of its users with direct deposit of paychecks from employers and spending with a debit card linked to a Cash App account. But the founding of Square focused on small-to-medium sized businesses to help them make more sales. That started with a small, square device attached to a smart phone to swipe and mobile app to process credit cards. Then Square went a step further so entrepreneurs did not have to complete a credit application to start processing credit cards within hours of signing up for the service. Square is creating a marketplace with 70 million Consumers and growing using Cash App and 2 million businesses using its Seller Ecosystem to form two Pillars.
Spotify provides a marketplace between Consumers and Creators with a focus on streaming audio formats on-demand. Creators are primarily musicians and recording artists, but more recently include podcasters, too. Music and podcasts are streamed to Consumers through either ad-supported or paid subscriptions to compensate Spotify Creators. Spotify negotiates with recording labels for these recordings and increasingly direct with Creators using multi-year contracts that monetize how Creators earn revenue when content is consumed.
And just like Amazon serves its marketplace between consumers and sellers with Amazon Web Services, Square and Spotify use technology-based services to serve the needs of their marketplaces between consumers and businesses. Square focuses more on transactions today, but is building decentralized financial services on top of Bitcoin for the future to monetize assets like securities, tokens, currencies and intellectual property. And Spotify uses global streaming services to reach an estimated 400 million users worldwide by the end of 2021. Machine Learning also allows Spotify to recommend new artists based on user preferences. This provides value to both consumers and creators.
Determinants of Health
Determinants of Health are another key feature of a Health Ecosystem. The US Department of Health and Human Services through its Office of Disease Prevention and Healthy Promotion (ODPHP) has worked since the 1980s to advance a Healthy People program as part of its National Health Initiatives. That seems to be a model for perpetual delegation of a problem to someone else, but nested within the Healthy People program are the Determinants of Health.
Policymaking
Social factors
Health services
Individual behavior
Biology and genetics
We will not cover these in detail here because the ODPHP is the real source for this information, but social factors
and individual behavior
require some attention here because they are so linked to individuals in our Consumer Pillar and the roles local communities, non-profits, employers and governments can play to help advance Healthy People.
Social Determinants of Health
The Social Determinants of Health (SDoH) are getting a lot of attention right now because of their positive impact on outcomes. UnitedHealthcare Group announced in June 2020 it was increasing investments to $500 million to provide new affordable housing for older adults and families struggling with housing insecurity. This is the result of insurers intensifying efforts to reduce costs and improve outcomes beyond covering traditional medical treatments. The SDoH graphic above and link cover 5 domains:
Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context
These social determinants cover the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. How we deal with individuals in our communities plays a huge role in healthy living outside of the health systems where so much activity and attention is the costly result of not healthy living. Examples of SDoH include access to nutritious foods and physical activity opportunities.
Non-profits and for-profit businesses can work collectively to make sure underserved communities have access to quality groceries and prepared foods. Everytable is a new venture started in South Los Angeles to provide better quality food options in underserved communities. The idea for Everytable was inspired within work being done by the non-profit known now as Feast. These for-profit and non-profit synergies provide the scope needed to make a difference. Feast partners with other for-profits like Aetna, Anthem, Boeing, Kaiser Permanente and Kroger to address food disparity.
Individual Behavior
Another important factor for the Determinants of Health is individual behavior. Basic positive behaviors include hand washing, diet, physical activity and adequate sleep. Substance abuse is a negative behavior and includes alcohol, cigarettes and other drugs. Community and online programs can reach most individuals to promote positive behaviors and limit negative behaviors to advance Healthy Living.
Influencers like professional athletes, chefs and community leaders can promote various programs to advance Healthy Living. Businesses like professional sports teams, arenas, gyms, health systems, athletic wear brands, restaurants & grocery stores can provide incentives and rewards for individuals to participate in community-affiliated programs to improve these individual behaviors for Healthy Living.
Three Pillars define scope
The model above spans 3 Pillars based on reviewing markets outside of healthcare and building models on companies disrupting incumbents to drive change in their respective industries. A common observation is these disruptors might originate with a scope that would be classified by a single Pillar like Square’s Seller Ecosystem, but over time these disruptors expand their scope to cover more Pillars to scale their business. But the required scope is limited to avoid opportunities outside the core scope and is best described by 3 Pillars, not 10 of them. Another common observation is the 3-Pillar model is well-suited for direct to consumer models to form a “marketplace” between buyers and a network of target suppliers. That is true for Amazon, Square and Spotify. Square in particular offers customized services for Restaurants and also Retail in its Seller Ecosystem. And the third Pillar provides comprehensive technical services to the marketplace through Amazon Web Services. AWS is a great example of such services provided within Amazon that are also offered to other businesses on scalable technology and pricing plans.
We will describe Pillars with key attributes or domains. Amazon Prime membership for example consists of the following core benefits:
Delivery (free 2-day, 1-day or same-day for qualifying products and ultrafast grocery delivery),
Streaming & Digital (Prime Video including Amazon Originals and thousands of popular movies & TV shows, Amazon Music for access to millions of songs and podcasts and Gaming for access to popular digital games and a free Twitch channel subscription),
Shopping (WholeFoods Prime deals, Prime Day and Rewards cards), and
Reading benefits (First Reads for early access to editor’s picks; Prime Reading for unlimited access to thousands of e-books, magazines, comics and more; and discounted Print Magazine subscriptions).
1. Consumers
We have already covered some benefits of expanding the scope for a Health Ecosystem to include consumers outside of traditional healthcare. Consumers enable more focus on Healthy Living
. This includes daily habits and individual behaviors influencing the determinants of health like a nutritious diet, physical activity, adequate sleep, hand washing and oral health. We also discussed social determinants of health above, but these are also critical to healthy living. Our communities can play a big role in addressing these social determinants.
Prevention
addresses more specific risk factors such as eliminating soft drinks to reduce the risk for dental issues and diabetes. Family history can also play a role for prevention with more attention to eliminating certain foods from our diet and scheduled physical exercise. Employers can also address prevention through cohorts of consumers as employees with Environmental, Health & Safety programs. OSHA regulates training for ergonomic risk for specific jobs to reduce the risk for repetitive strain injuries and requirements for personal protective equipment (PPE).
The National Highway Traffic Safety Administration (NHTSA) regulates reducing risky driving behaviors, seat belt safety, air bags and driver assistance technologies all to save lives and reduce injury risk. If you buckle up in the front seat of a passenger vehicle, you can reduce your risk of a fatal injury by 45% and a moderate to critical injury by 50%. Air bags are designed to work with seat belts, too. Not driving under the influence of alcohol or drugs, distractions with digital devices or drowsy driving further reduce the risk of a fatal injury.
The third domain of the Consumer Pillar covers what individuals can do when they recognize symptoms. Just as we go to Google to search information on a topic of interest, consumers can use a Symptom-Based Query
with a trusted brand to investigate a symptom. The outcome would be recommendation(s) for next steps available to consumers or to see a provider.
An example of such symptoms would be ongoing difficulty falling asleep and daytime impairment. Healthy Living would outline good sleep hygiene to improve sleep habits. Caffeine or working out at the gym late in the evening are not ideal for a typical bedtime. So recommendations to address problems sleeping would provide best practice for sleep hygiene and substituting caffeine and the gym late in the day with morning routines. Eliminating screen time on digital devices late in the evening is also recommended for difficulty falling asleep. For many individuals, more discipline around sleep habits will improve outcomes. But if symptoms persist, primary care can help determine if there is an underlying sleep disorder like chronic insomnia that may indicate the need for a Health Psychologist or Sleep Medicine physician who might prescribe medication if indicated.
K Health also offers pediatric services to families with kids.
Google is often a resource to investigate symptoms, but health-focused resources linked to trusted health brands and thought leaders are likely a better option. Google Health and Microsoft Health Vault were past attempts to connect consumers to their own health data. Both failed because the value provided was not significant enough. Trusted health brands like the Mayo Clinic, Cleveland Clinic or Mass General Brigham could work with tech companies like Google or Microsoft to build, update and maintain evidence-based chatbots to communicate directly with consumers at scale in their preferred language regarding symptoms for a family member. K Health allows consumers to check symptoms for free through a chatbot on its mobile app.
This is great when common symptoms provide routine, evidence-based solutions without the need for a provider. When needs are more time-sensitive or symptoms alone do not provide resolution, consumers can also connect online thorough K Health to a licensed provider for urgent care, mental health or help filling some prescriptions. These services are clearly marked with prices and a subscription to some services provide even lower costs for more frequent, ongoing use. K Health also offers pediatric services to families with kids.
Ro and Hims/Hers provide similar services with more of a focus on connecting consumers with common symptoms to a provider who can prescribe medications for a limited number of conditions like hair loss, erectile disfunction and smoking cessation. These services are provided online compared to services available to consumers through retail clinics. We will cover those below.
Consumers can also access over-the-counter medications and some medical devices without a prescription online or in local pharmacies like CVS and Walgreens. Examples are medications like acetaminophen (Tylenol), acetylsalicylic acid (Aspirin) and ibuprofen (Advil) for mild to moderate pain and inflammation. Thermometers, blood pressure monitors and weight scales are also available as Class I medical devices without a prescription. These are only regulated by the FDA with registration to comply with any requirements and serial control to enable recall procedures if needed.
These medical use cases will likely evolve over time to include other FDA-cleared apps to extend the capabilities of a consumer wearable device.
Consumer electronics and wearable technologies are growing in popularity for consumers access to services with connected mobile apps. We will discuss these further regarding Connected Care and Digital Health. The Apple Watch, FitBit and Whoop devices are examples of wearables used in Digital Health today. These help monitor physical activity by counting steps, pulse rate and elapsed time of the activity. Newer models may also estimate depth of sleep and elapsed sleep time.
Apple has also worked with the FDA to leverage Software as a Medical Device (SaMD) regulations to offer consumers the option to download an app with the capability to use the Apple Watch as a Class II medical device for a very specific use case. These medical use cases will likely evolve over time to include other FDA-cleared apps to extend the capabilities of a consumer wearable device.
2. Provider Networks
When we usually think of health care, physicians, surgeons, nurse practitioners, optometrists, podiatrists, psychologists and other licensed providers come to mind. These providers can operate as a solo practice with supporting staff, but most organize into a provider network so many comprehensive services can be provided either directly or through a referral by another provider. These networks can consist of a health system with multiple hospitals and clinics or a physician corporation that contracts with various hospitals and/or clinics to provide needed services. An example of a physician corporation would be a large practice of specialists in a city who see patients in a centralized clinic, perform procedures or even day surgery in their own co-located facility and contract with various hospitals to provide more extensive surgical procedures and patient consults in those external facilities.
Primary Care
can also organize into Clinics to cover adults (geriatrics for senior adults and internal medicine for the majority of adults), kids (pediatrics), and families (family medicine). Routine annual exams and chronic care for diabetes, asthma, mental health, obesity, and problems sleeping. Non-life threatening acute issues like fever, vomiting, etc. can also be addressed by primary care within normal business hours. Urgent Care is an option outside of normal business hours or when walk-in visits to a primary care clinic are not practical. One of the side effects of physician training through medical schools in the US is the ever increasing student debt required to pay for such an education. Medical students who might start medical school with an interest in primary care often specialize in something like surgery or ophthalmology to focus their training in a specific discipline. These specialties also pay more and enable student debt to be paid off faster. For this reason, in the US where about 75% of care would be more cost effective if delivered through primary care, only about 25% of physicians and surgeons are primary care providers. This dramatically underserves the need and drives up cost for routine chronic care.
Retail clinics through companies like CVS with Minute Clinics or Walmart with their own Health clinics are emerging to provide easier access to primary care and combat rising costs. Virtual Care is also scaling for follow-up visits and even initial consults to connect individuals to licensed providers with secure online communication. But virtual care potentially achieves even more when Digital Health is considered to determine if even more added value is possible. We will discuss this more under Connected Care, but retail clinics and virtual care offer opportunities to deliver more primary care cost-effectively. Retail clinics through Walmart Health also offer a wide scope of services. This scope varies from site-to-site, but the most comprehensive sites include physicians and nurse practitioners for routine primary medical care, optometrists and opticians for eye care, audiologists for hearing tests and hearing aids, behavioral psychologists for mental health and dentists for oral health. Walmart Health clinics are also located next to or in close proximity to Walmart stores for both convenience and access to products and pharmacy services.
A medical consult is the key feature of a provider/patient relationship when there is a medical need. Consults provide the patient an opportunity to describe their primary complaint and the provider the opportunity to ask clarifying questions to construct a medical history and examine the patient for any physical traits. These consults also allow the physician to make a diagnosis that may require a diagnostic test to make a definitive diagnosis. These diagnostic tests provide a Measurement
to establish a baseline like your blood sugar from a routine blood test. Hemoblobin A1C is a test score representing average blood sugar level over the last 2-3 months and doesn’t require fasting before the blood test. The American Heart Association reports a hemoglobin A1C level between 5.7% and 6.4% represents pre-diabetes with a high risk of developing diabetes and diabetes is diagnosed with a hemoglobin A1C level of 6.5% or higher as shown in Fig. E9.1-5. The higher the hemoglobin A1C level the more urgent the need to reduce the blood sugar with intervention. Insulin administration is the typical intervention for diabetes when blood sugar is high.
Other examples of Measurement include bone density to diagnosis osteoporosis, body mass index (BMI) to diagnose obesity, and systolic / diastolic blood pressure to diagnose high blood pressure. A physician may diagnosis obesity during a routine annual exam by measuring height and weight to calculate the BMI. A BMI over 25 kg/m^2 represents overweight, but a BMI over 30 kg/m^2 represents obesity according to the World Health Organization.
Gene sequencing will continue to play a greater role in Measurement for many diseases like cancer. These tests can identify genes to inform treatment decisions. SEngine Precision Medicine in Seattle takes gene sequencing even further with precision medicine using a tumor sample from a patient to culture their cells. SEngine then uses panels of cancer drugs to determine which drug or combination of drugs optimize killing cancer cells in the cultured cells from a patient while minimizing potential side effects. The result is a personalized cancer treatment recommendation with Measurement using a patient’s cancer cells.
Family history and other medical conditions impact treatment decisions, but Intervention
usually follows a diagnosis to lower risk factors and improve health outcomes. Obesity left untreated leads to high blood pressure, stroke, sleep disorders and other medical conditions. Interventions may include life style changes around diet and exercise, but may also include medications to treat associated conditions or even obesity itself under the supervision of a physician. Regulated medical devices may also be prescribed by a physician like continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA) that is often diagnosed with a sleep study in patients with obesity or even overweight.
Intervention may also require a surgical procedure like reconstructing a hip or knee due to wear and tear over many years of use with joint replacement surgery followed by physical therapy to rehabilitate the joint to gain function with the artificial hip or knee. Orthopedic Surgery has evolved significantly over the years and now includes robotics to improve the precision of the procedure and implant fit for reconstructing the joint. Physician extenders such a licensed physician assistants are also improving access to surgeons by providing routine services under supervision to allow the surgeon to focus more on where their direct attention is critical.
A clear feature of the Provider Network Pillar is the services provided require a license to practice and provide the specified services. This allows the drugs and medical devices used to be regulated for use only by these licensed providers under cleared labels and indications for use. Consumers may access care in this Pillar, but when they do they become a patient under the supervision of the licensed provider. But this also means privacy is maintained between the patient and provider for the care delivered. And health insurance will reimburse for all or a portion of approved care. However, one of the biggest benefits for care delivered by a licensed provider are the standards and guidelines developed and continually updated for Board certification in that field like Internal Medicine or Orthopedic Surgery. That helps to standardize care regardless of where the care is delivered.
3. HealthTech Services
If the first two Pillars represent a “marketplace” between Consumers and Providers, then the third Pillar covers HealthTech Services needed to deliver care, store and securely exchange private data and transact business. Another key feature of this third Pillar is to identify a key need with a symptom query by a Consumer that indicates a need for a Primary Care with a Provider. That process can be started and automated by a chatbot and then escalated to a Provider for a fee with full context of the discussion already characterized by AI with a risk profile already developed so the Provider can take over with additional questions by chat or on the phone. So these 2 Points of Care between the first two Pillars allow innovation to occur through the third Pillar. Adding more dimensions for a point of innovation in Fig. 9.1-4 also allows better definition of requirements and technical specifications for connected HealthTech Services.
The three primary domains for this Pillar are:
Connected Care,
Connected Data, and
Connected Transactions.
All three enable meaningful innovation across all three Pillars.
Connected Care
is best represented with both access to care through multiple channels and a hierarchy of Digital Health augmenting the care provided. The basic concept is to use technology to help provide the right care at the right price through the right channel or means of access. We will cover this in more in the 2nd Part of the Series.
Connected Transactions
envisions new technologies standardizing and automating routine transactions to reduce burden, delays and cost for all involved. Over time the technology will be able to accommodate more complex use cases, but the initial use should focus on high-volume, routine procedures that meet conditions to simplify automation. Identity is the first use case and enables providers to expedite interactions throughout provider networks and health benefit plans to communicate current credentials and licenses through a trusted verifier on a health utility network. This will also be covered in greater detail in the 3rd Part of the Series.
Connected Data
is another important domain for HealthTech Services and will be covered in more detail here. There are some critical requirements for data that include interactions within and between Provider Networks. The data span storage and communications and must provide privacy, interoperability and security from cyber attacks, loss and other unauthorized access. Digital Health applications through Connected Care operate on Connected Data across all three Pillars.
Health Systems are spending billions of dollars to deploy proprietary and antiquated Electronic Health Record (EHR) systems by Epic, Cerner and other companies. These systems improve interoperability within and between Provider Networks on the same deployments for private communications and sharing secure records. But these legacy EHRs are similar to proprietary Microsoft Windows versus an open-source Unix operating system that is the foundation for Apple OS X. Apple can hire engineers who are already proficient with Unix to work da 1 on OS X. Microsoft has to hire and train engineers to advance the Windows operating system. That is also what you get spending $1 billion on an Epic deployment.
Health utility networks can play a significant role to advance open-source communication, transaction and health record standards and technologies. Commercial entities like Red Hat provide paid services to deploy and support these open-source tools. I think this might actually be job #1 for healthcare to build an open-source EHR to deploy at the leading institutions. The Mayo Clinic, Cleveland Clinic and Mass General Brigham could collaborate to realize such an initiative. But health utility networks today are focused more on the transaction side of healthcare.
Conclusion
The Health Ecosystem presented provides a model and scope to capture key aspects to advance Health. Three Pillars and three domains per Pillar provide 9 unique points of innovation. I’m focused in my own work on Prevention with large cohorts of frontline workers through their employers and Connected Care with regulated Digital Medicine and prescribed Digital Therapeutics through providers. I will cover Connected Care in the 2nd Part of this Series.
Although prevention is possible with individuals, large cohorts of frontline workers provide an opportunity to drive change at scale to improve health outcomes. Wearables sensors, exoskeletons, edge computing, behavior change, machine learning and mobile apps will prevent workplace injuries and musculoskeletal disorders. Large manufacturers also have providers on-site. These facilities are somewhat of a hybrid spanning Consumers and a targeted Provider Network where physicians play a role to help standardize training and the solutions used on-site.
Primary Care also provides a significant opportunity to improve outcomes by expanding access with many more options including retail clinics, virtual visits and even consumer chatbots that can activate a virtual primary care consult. Connected Care can also enhance Primary Care with digital medicine and prescribed digital therapeutics. Diabetes, obesity and mental health Intervention will continue to advance with regulated digital platforms playing multiple roles to optimize continuous care with a provider acting as the quarterback to coordinate the digital care.
Success activates communities to do more of the work to advance Healthy Living and Prevention with consumers so Provider Networks can focus more on delivering care to informed patients. Consumers should also be able to investigate symptoms with a trusted health brand(s). This process should build and rank an ongoing list of risk factors. These risk factors would help consumers make informed decisions on next steps, but could also be used as a digital assistant to populate a provider dashboard with ranked risk factors and probabilities for candidate diagnoses if the consumer seeks help from a provider. This would then allow these providers to focus their attention on evaluating specifics with the patient to make a diagnosis and/or recommendation for an evidence-based intervention using these pre-identified, ranked risk factors from a digital assistant.
Best,
Stephen
I’m long AMZN, IBM, JNJ, SPOT, SQ and TSLA mentioned in this update. Nothing in this post is intended to serve as financial advice. Do your own research.