How Can Healthcare Survive? The Technological Customer and Patient Revolution
A Piece on Blockchain By Konrad Dobschuetz on ALTCOIN MAGAZINE
A look into how a systemic change using technology such as Blockchain and AI can help to keep healthcare sustainable.
The healthcare sector is experiencing a see-change and giants like Amazon are starting to enter the market, with new offerings and a much faster turn-around in innovation. Pressures to modernise have changed. Innovation cycles have accelerated from years and decades of cycles to a more demanding, fast paced approach. Players in the market, predominately around new tech are popping-up as fast as they disappear again. These pressures to innovate are caused by a growing and ageing population, cost demands of the healthcare system as a whole, increased patient and payer demands for transparency as well as the need for an cross touch point 24/7 IT structure for everyone. Last but not least, climate change is playing a major role in how disease patterns have moved according to a new study of 7,000 Canadians published in the Lancet.
Patients are leaving no stone unturned to find what they are looking for with information that is freely accessible and that importantly can be challenged in real time. Thus their demands on the system have completely shifted. They moved towards an information-inclusive and 360 service model, whereby insurers, governments and Healthcare Professionals (HCPs) are under pressure to deliver a sustainable or better service. As a result, there is just not enough time to react quickly and decisively when the environment changes. Granted, the sector has its unique challenges but so have others too. I am going to be addressing the opportunities the sector has from my personal point of view. I will also be providing thoughts of how AI and Blockchain technology can be of help beyond the hype to enable these opportunities. Done right, there is potential in both but more about that later.
So, what to do?
To be able to withstand the aforementioned pressures the whole sector needs to be at the forefront of nothing less than the re-invention of how we understand the model currently between pharma, issuers/payers, governments, patients and HCPs. The concept evolves around two ideas — introducing an amended value exchange model between the parties based on a variety of factors and the ability of opening different revenue streams for pharmaceutical companies and partners. There are three core elements: One model based on patient Adherence and one around Outcome based value exchange, both enabled by Machine Learning and Blockchain technology and lastly, Digital Services, enabled through well-established subscription engines that we know of from the software industry and the likes of Netflix.
Let’s start with Adherence. To simplify hugely, when it comes to this complicated subject, there is one weak block in the chain — the patient. Currently there is no way to make patients take their medications as prescribed since we don’t live in a police state, may it continue to be like that. So, what if we could raise the stakes and have patients participating in the value exchange? What if they get remunerated for their willingness to stay on their medicine? Would it not be feasible to look at a model like that? One could look at voucher systems for example or even go as far as Blockchain currency. This could benefit the overall healthcare system since face to face visits to the doctor might not be as frequent as before and patients can be better managed with their conditions through the use of technology and devices. For the latter, there are solutions being looked at or already launched, some of them with the governmental support in Spain (Mabu), others privately funded (Pillo, pictured).
The second piece is an Outcome based value exchange, where the overall model between all parties involved in Healthcare shifts. The flow of money would change and all would be based on patient Outcomes. Examples for an Outcome based value exchange could be diseases prevented, patients cured, lives prolonged or hospital stays shortened. One could also think further and look at societal impact achieved, such as saving to the healthcare system overall. Following through with this approach, it could go to a point whereby a person who has stopped drinking vast amounts of alcohol has a value to the healthcare system since they are less likely to suffer from the aftereffects of the addiction. Thus whoever helped the person to quit from a systemic point of view would benefit financially from this Outcome in a greater manner than others. An interesting case study around length of hospital stay shortened and more details can be found here. The article also talks in more detail around the challenges, namely the data exchange and monitoring the Outcomes, something that can also be addressed with the use of Blockchain technology.
The last element in this is digital services, whereby the provisioning of value-add services outside of the required support and beyond the pill could be payable via subscription or one off fees by payers, never patients, through new digital channels. This could off-set some of the new weighting of burden in the system. Examples here could be the entertaining of a smart TV channel stream and generating ad revenue as well as in-game activity to further enhance patient experience.
Why Blockchain?
When we look at healthcare data we need to consider trust in data, its security and independent validation as the three key elements. Simply put, a Blockchain is a type of distributed ledger or decentralised database that keeps continuously updated digital records of who owns what, what has been done and when. Every transaction has a timestamp and cannot be altered retroactively. This provides the exchanging network the first level security that data integrity has been kept. In the future world of exchange in the healthcare industry this is ever more important since not all parties involved have relationships and the amounts of data which would otherwise be personally validated is rapidly increasing. Rather than having a central administrator like a traditional database, (think banks, governments, accountants and insurances), a distributed ledger has a network of replicated databases, synchronised via the internet and visible to anyone within the network. Blockchain networks can be private with restricted membership similar to an intranet, or public, accessible to any person in the world. Each party in the chain is being incentivised to validate and cross check the integrity of the data. The validated block of transactions is then timestamped and added to a chain in a linear, chronological order. New blocks of validated transactions are linked to older blocks, making a chain of blocks that show every transaction made in the history of that Blockchain. The entire chain is continually updated so that every ledger in the network is the same, giving each member the ability to prove who owns what at any given time.[1]Ultimately, Blockchain can act as an enabler of change. The addition of stakeholders within the chain without the high levels of trust that have been required previously makes for a fast(er) turn-around of new innovative approaches and ideas.
Where do Machine Learning and AI come in?
For the purpose of the article I will keep this brief. In the shortest ways possible to describe this, Machine Learning could be employed to optimise processes and also spot fraudulent behaviour patterns when it comes to the models which involve remuneration. Furthermore, since every patient has their very individual needs, it requires an individual response. All of the models work with reducing the human impact and touch points to be fit for scale. The benefit of Machine Leaning and ultimately Artificial Intelligence and Augmented Intelligence is to be able to tailor responses based on needs — something that an overstretched healthcare system will be struggling to cater for. The question remains — what is the critical mass or breaking point of system failure for people to start pro-actively engaging with technology that replaces the human interaction?
In Conclusion
To enable all three elements, Adherence and Outcome value exchanges as well as Digital Services, more medicine needs to be made accessible to an ever increasing amount of people. With an increased accessibility the narratives changes and, ultimately the value exchange shifts to a differently weighted share of the burden throughout the system, all based on patient Outcomes. One could call this the democratisation of health. To be sustainable, this requires funding and broad support, also outside of governmental structures. Thus all big actors in the sector will need to play a crucial role; all with the aim to survive the technological patient and customer revolution and be able to deliver healthcare to the many and not the few in future. We all need to be keeping our eyes open and being sensitive to change as this can make the difference in who determines what we are, you or somebody else. The changes in the sector are real and they are happening right now. How we cater for them and how all parties involved are able to manage that change remains to be seen. Of course there are a million things I haven’t touched on, such as wearables, digital pills and so much more. Having been exposed to a variety of sectors in the past 20 years, from Fashion Retail, e-commerce in FMCG and Healthcare to Finance and now Pharma, I’d classify myself as a conscious observer and dot-connector. Something I hope I did bring across in this article. Once again, the views expressed here are my own and only my own.
[1] Section also with material from “How does the Blockchain Work?” by Collin Thompson, Accessed, 11/2018, http://bit.ly/2wR4Sx4
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