Yours Digitally - Making Your Healthcare $S Work Better For You!

Gagan Bhalla, CEO, Apollo Sugar ClinicsA Healthcare industry expert, Gaurav has worked across Indian, U.S., and European Healthcare and Health Insurance markets for over two decades. He is currently the Chief Executive Officer of Apollo Sugar Clinics, the Diabetes vertical, and Chief Operating Officer of Apollo White Dental, the Dental vertical, of Apollo Hospitals.

Today, digital interactions permeate almost all aspects of our daily lives. With Facebook, WhatsApp, Instagram, Email, AI bots and others, connected technology has become an inseparable part of our daily lives at work and at home. While healthcare has been a traditional ‘touch and feel’ industry, digital can help create a more personalized digitally enhanced ‘care’ model for you the consumer. Use this ubiquity of connected technology to amplify the health benefits you get from your Healthcare expenses (e.g. visiting your doctor's clinic or neighbourhood hospital, or conducting an annual check-up paid for by your Health insurer). Can a digitally enhanced and personalized care model produce better results for you? Absolutely. While there is a lot of clinical evidence from prestigious scientific journals that prove this, in this article, I have explored this theme through two lenses ­ one, a Consumer view for a layperson, and second from an industry professional's view.

Consumer View
Majority of healthcare consumers today, be in Boston or Bangalore are ‘non-millennials’ ­ forty something or older people. They grew-up in a world without smartphones & emails, and adapted to such devices and social media. They are typically busy adults with teenage or grown kids, have busy jobs, are managing older dependent parents, and use technology to hold it all together. Think for yourself ­ these non-millennial personas are all around us ­ you yourself, an uncle, an aunt, a parent, a neighbour. Their disease profiling is most frequently on lifestyle diseases such as hypertension and diabetes ­ diseases that can be managed well with regular medication, proper diet and exercise ­ lend well to an amplified model that combines traditional healthcare (i.e. doc visit) with digital healthcare (e.g apps, connected devices).

These healthcare consumers tend to be more cost conscious than the millennials, spend less on their health, and often do not prioritize preventive care. They are also less likely to be compliant on regular maintenance medicines for BP, Diabetes, and diet restrictions. Typically, the average person is only 60 percent compliant in taking meds. Due to poor preventative health measures, they tend to go through a downward spiral of ‘small misses’ that over a long period of time cost them serious health issues down the road ­ a classic case of penny wise, pound foolish ­inefficiently spending on one's heath for a stent at a later stage, but not on preventing the need for a stent by spending preventively on Hypertension management and compliance for a decade, so a stent is not even needed! Another example ­ ironically, in a sunny country like India, Vita-min D deficiency is rampant and leads to expensive, quite painful spinal procedures, since people don't want to take Vit D tablets periodically! For such healthcare consumers, if a proper handholding that is digitally enhanced, we may be able to prevent complications and the costly hospitalizations.

Digital media can easily personalize ‘care’ for each consumer. We can start with a simple smartphone app that reminds us two-three times a day to take our medicines or to take BG or BP measurements. Even with something as simple as this, the compliance for regular medication can be increased to 90 percent or more. This difference in compliance between 60 percent normally and 90 percent through digitally enhanced care, will over a long period of time be the difference between expensive surgery, being out of work for two weeks due to hospitalization, thou-sands of dollars in insurance premiums, and being healthy & well. The key thing is, this digitally enhanced care technology has to fit the person, not the other way around. While it is easier to get millennials on board with new technology, today's non-millennials already spend an hour on their smartphone every day ­ all we need is five-seven minutes of this time on healthcare. For non-millennials that are not comfortable with apps, technology should fit them ­ use SMS and WhatsApp to communicate, rather than app alerts if they are more comfortable to these rather than apps. Have customer care call them on the phone and have them talk instead of writing messages. Non-millennials need
handholding to ease them into this model; for example, when they come for a doctor visit, help setup the app on their phones and do a test run to build their confidence on ease of use.

Taking a ‘piggy bank’ analogy, saving your own health one dime at a time everyday via this digitally enhanced care piggybank will over a long period of time mean the difference between good & inexpensive health condition, and bad, but expensive health status.

Expanding this a bit further, if you can do three things ­ take meds on time, sleep enough (at least eight hours) and walk enough (at least an hour a day), you are well on your way to add a decade or more to your life without spending any more on health insurance premiums or on doctor visits ­ all three can be easily done much better in today's day and age, thanks to the support from the omnipresent smart-phone and a range of free apps.

Industry View
Many of us who work in healthcare, be it in biopharma, medical devices, healthcare delivery or a Government healthcare think tank, are constantly rethinking healthcare to be more patient centric and technology enabled. We are trying to move ourselves from ‘Product’ model to a ‘Solution’ model. To achieve this goal, companies are combining traditional and digital together. For example, instead of offering a glucometer, now, device companies offer glucometers that connect to the healthcare provider in real time, so that the data is reviewed by doctor and care teams. If the data is not within pre-defined ranges, the care team is automatically alerted and can contact the patient, offering timely solutions for the problems at hand.

Patient centricity is great ­ but unless it is delivered along with patient simplicity, it will not work

Patient centricity is great, but unless it is delivered along with patient simplicity, it will not work. We need to go much further in simplifying consumption of healthcare for the consumer. We need to move beyond basic apps and get into utilizing the power of machine learning and AI to deliver evidence based outcomes that are scaled across large patient populations. We can apply AI and machine learning in many settings ­ US managed care environment or India's cash paying patient environment in rural areas with limited healthcare infra or in urban areas where abundant healthcare facilities exist.

Having had the benefit of being a healthcare management professional for over two decades now, I have had a ring side seat in witnessing the significant efforts and investments it takes to go from the preclinical to phase-3 studies in pharma, the massive upfront capex investment it takes in medical device manufacturing while having little to no control on future pricing, the protocol driven care models in solid tertiary & primary care environments, and the underwriting grids and MLR reviews at insurers. Yet, after all this, we as industry professionals struggle to meet patients' needs on their own terms at their own convenience in their own setting of care. All our investments and efforts usually fail at final steps, where patient involvement and buy-in is essential.

Since we struggle to inspire patients to have active participation and control of their own unique healthcare journeys, we resort to the averages ­ average mortality rate, average premium increase, and average clinical improvement instead of customized and patient specific information that can be used to benefit the patient. The digital toolsets avail-able today now give us the means to cross the finish line in the journey of personalized care, to inspire and bring the healthcare consumer into his/her own `care team' and to include patient as an active participant and not a passive onlooker, into a healthcare ecosystem that is responsive and personalized to each person.

Under the iceberg of each health economy, significant tectonic shifts are underway. Regulations have seen pendulum swings over the last decade, but wasteful spend still climbs. Technology is fast evolving in medical devices; for example, in point of care and home settings. The potential for automation, advanced analytics, machine learning and big data in healthcare is immense. Technology can not only save money in healthcare, but more importantly, it can help deliver vastly better clinical health outcomes and patient satisfaction.

We have an amazing opportunity to create next-gen models that are bigger and better than any of our value chain driven models of today, and reduce costs, improve health and efficacy of care. We are finally in a position to create such models ­ models that combine physical foot-prints (e.g. Hospitals, clinics, pharmacy stores) with technology platforms that reside in our households and pockets (e.g. apps, devices) to deliver personalized, patient centric and responsive care. And we have the opportunity to apply this model on swathes of large populations efficiently. The winning healthcare model must be built around the patient first and help them use healthcare in a smart, personalized, less expensive way. In my view, it will include three critical aspects:

1. It will bridge multiple care platforms across a per-son's work and home life in a seamless way so that the patient has an ‘always-on-health-pal’. The care can transition from patient's household technology to his workplace computer to his smartphone. The model should self-learn from the health data collected and keep getting smarter in understanding a person's health needs using its emotive, ML, data collection aspects.

2. It will personalize health interventions for each individual. For example, a CABG Patient two weeks post procedure will have different interventions versus a hypertensive patient. Similarly, a young person will need different interventions than older one.

3. It will focus on pre-emptively & proactively delivering preventive care that is cost effective for today's non-millennials. Enable consumers to access care in close-by clinics, pharmacies, and even grocery stores to reduce costs. Such interventions will lower acuity and improve wellness, thereby reducing future costs related to complications and hospitalization.

In conclusion, the brave new world of digitally enhanced healthcare is here ­ both for the consumer to access a responsive Healthcare that saves money and improves their health, and for the industry to rethink how a combination of traditional and digital can deliver a more efficient and more responsive healthcare model where the patient experiences a much more simplified and personalized journey and is part of their own care team, not a passive onlooker.