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Healthcare tomorrow


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How the healthcare ecosystem is changing thanks to new tech entrants

Published in: Healthcare

Healthcare tomorrow

  1. 1. Healthcare Tomorrow How the speed of innovation is accelerating and how new companies are positioning themselves to win
  2. 2. About Me Nikhil Krishnan is a healthcare research analyst, writing about the intersection of healthcare, life sciences, and software. He was a senior research analyst at CB Insights, where he built out the healthcare research team, and had research that was featured in the Wall Street Journal, Economist, New York Times, and more. He also authored the weekly CB Insights Digital Health Newsletter, which grew to 100K+ subscribers. He is currently on the Strategic Partnerships team at TrialSpark, a technology company creating a distributed network of clinical trial sites to run faster and more efficient clinical trials. Writing: Contact:
  3. 3. 1. Why does this matter today? 2. The big changes in healthcare a. The changes in infrastructure b. AI-first companies c. Patient experience as a business model 3. The impact of these changes Table of contents
  4. 4. Why does this matter today?
  5. 5. The business models in healthcare today are in jeopardy
  6. 6. Drug discovery IRR is decreasing steadily Endpoints
  7. 7. Hospital margins are pressured, especially in rural areas Endpoints
  8. 8. Governments are changing business models significantly “The fight over 'Medicare for All' is only beginning” -August 30th, 2019 “Trump's War On Middlemen Might Reach Well Beyond PBM Rebates” -April 16th, 2019 “CMS clears Louisiana Medicaid 'Netflix model' for hep C drugs -June 26th, 2019
  9. 9. Tech is entering healthcare
  10. 10. Infrastructure developments have made it easier to start a tech company Open Source + Horizontal Scaling Cloud + AWS Plug-In APIs, developer tools, etc. Both sides of the table
  11. 11. Tech companies have advantages over healthcare companies Advantages 1. They are liked by customers and have high user engagement 2. They have strong software and cloud expertise 3. They don’t need to make money from their healthcare business 4. They have built-in distribution from their core business 5. Their organizational structure is designed for faster decision making
  12. 12. Bezos explains, correctly, the traditional corporate hierarchy: "Let's say a junior executive comes up with a new idea that they want to try. They have to convince their boss, their boss's boss, their boss's boss's boss and so on—any 'no' in that chain can kill the whole idea." That's why nimble startups so easily slaughter hidebound dinosaurs: Even if 19 venture capitalists say no, it just takes a 20th to say yes to get a disruptive idea into business. Forbes
  13. 13. The big changes in healthcare today How new entrants are targeting the weak spots of healthcare incumbents
  14. 14. The changes in infrastructure
  15. 15. The hardware infrastructure is improving
  16. 16. The hardware infrastructure is improving
  17. 17. New chips are enabling more computing intensive processes to happen via the phone
  18. 18. More diagnostics + data in patient’s hands embedded in tools they already have Apple patent to monitor blood composition via cameras + ambient light sensor Apple patent for non-invasive glucose monitoring
  19. 19. Passive data capture is creating massive, real-time, structured datasets HIT Consultant
  20. 20. Patient data infrastructure is becoming cleaner and more patient controlled
  21. 21. FHIR + cloud infrastructure enables faster and more powerful software deployment How to build a real-world evidence platform using AWS services
  22. 22. FHIR + cloud infrastructure enables faster and more powerful software deployment Microsoft Azure Releases Open Source FHIR Server For Health Data
  23. 23. The API infrastructure is making it easier than ever to start a healthcare business Pharmacy Fulfillment API
  24. 24. The API infrastructure is making it easier than ever to start a healthcare business Credentialing Verification
  25. 25. The API infrastructure is making it easier than ever to start a healthcare business Billing, Claims, and Eligibility
  26. 26. It’s become easier than ever to start a tech-enabled healthcare company with new tools
  27. 27. AI-first companies
  28. 28. Being AI-first means 1. Caring about how data that’s captured is being structured and annotated 2. Creating novel workflows + business models dependent on AI 3. Taking on risk to be competitive with existing incumbents
  29. 29. Machine learning packages are making it easier to start an ML company Packages like Comprehend Medical are making it easier than ever to deploy machine learning with models trained on health data
  30. 30. AI + analytics tools for patient triaging More companies are aiming to use AI to compete with existing healthcare players AI-assisted algorithmic drug discovery AI for diagnostics/monitoring AI-based biotech companies AI-differentiated payers/providers AI-first medical device/diagnostics companies
  31. 31. Playing in someone else’s sandbox has risks MD Anderson Benches IBM Watson In Setback For Artificial Intelligence In Medicine “MD Anderson changed the software it uses for managing electronic medical records, switching to a system made by Epic Systems of Madison, Wis. It has blamed this new system for a $405 million drop in its net income. According to the audit report, the Watson product doesn’t work with the new Epic system, and must be revamped in order to be re-tested. The information in the MD-Anderson/Watson product is also now out of date.” Forbes
  32. 32. Generating your own structured dataset enables leaves room for expansion Initial target: Monitoring of Neutrophils, Lymphocytes, etc. via deep learning Valuable asset: Pathology image set for future analysis Initial target: Atrial Fibrillation detection Valuable asset: Heart rate data + outcomes for monitoring other diseases Initial target: Portable ultrasounds Valuable asset: Ultrasound image dataset
  33. 33. Being AI-native allows for better labor triaging...
  34. 34. ...and create new forms of care that are more proactive than reactive
  35. 35. If you believe AI is a key differentiator going forward, these companies are setting themselves up for the future
  36. 36. Patient experience as a business model
  37. 37. Having high engagement rates from patients makes it possible to 1. Proactively reach out to them 2. Guide them to a mutually beneficial solution 3. Ask follow-up questions and get more data 4. Acquire new customers through word of mouth marketing
  38. 38. High patient engagement + trust means patients come to you and you can guide them Oscar
  39. 39. Good patient experience allows companies to ask patients for more data
  40. 40. When consumers like you, they’ll engage outside of the hospitals
  41. 41. Patients talk to each other about good experiences We find new customers through many channels. No one channel accounts for more than one-third of our new members. What's been most surprising to us is we get a lot of references from word-of-mouth. Not Twitter or Instagram word-of-mouth-- real, one-on-one human interaction.” - Zachariah Reitano, CEO of Ro Inc
  42. 42. The impact of these changes
  43. 43. New business models are becoming more prevalent 1. Platforms 2. Cash pay and direct-to-consumer 3. Completely at-risk contracting and full-stack competitors 4. Healthcare as a loss leader for some other core business
  44. 44. 3. Patient brought in if absolutely necessary Utilization is going to move from reactive to proactive care Today - Reactive Care Tomorrow - Proactive Care 1. Feel physically sick 2. Go to a physical clinic 3. Capture confirmatory data via additional testing 1. Anomaly detected - patient is reached out to 2. Telemedicine + additional testing ordered virtually
  45. 45. Healthcare is coming to patients in the regular routines vs. requiring standalone routes Where you shop In things you own With people you trust Consumers have regular interactions with their electronics, grocery stores, community centers, etc. Embedding healthcare services into regular interactions reduces the friction for patients.
  46. 46. This also means jobs will change - moving to different kinds of patient touchpoints Today: Tons of labor in data collection + administrative functions Tomorrow: More jobs in care management, with new kinds of roles Health navigators Healthcare trained community members Telemedicine triaging
  47. 47. Thought experiment: If you were to rebuild your organization around its core value proposition, what would it look like if you wanted to incorporate these 3 big changes?
  48. 48. Thank You Email: Twitter: @nikillinit