The Future of Connected Health, Chapter 2

I was recently asked to predict what our Center would be like 10 years hence. Stated another way, the question was: “What is your ten year vision for your Center?” My initial reaction was, “Of course I should be able to articulate that.” After all, our very capable team does all of the work here, so the most effective way for me to add value is to articulate a clear vision. However 10 years is a long time and lots of intervening forces can influence the world.

In August 2000, the ‘smartest’ phone was a Kyocera model – the handspring Treo had not been released yet. The fastest mobile network was GPRS and about 50 kbps. Apple had not released the iPod yet. Videoconferencing was still predominantly done over dedicated ISDN telephone lines. On the healthcare delivery side, capitation had swept through the country and been largely declared a failure. In fact care was even less managed than in the 90s. At that time our Center was called Partners Telemedicine and we were thinking that the web browser could be a place where one accomplished transactions rather than simply gathered information. We were creating a website where we could do second opinions online. Our goal, as a group, was to extend access to Partners specialists around the planet. While we had dabbled in some remote monitoring projects, the concept of connected health was not formed yet.

You know the story today. mHealth is hot. 4G ubiquitous broadband is on the horizon. Sensors are embedded in so many products we touch and feel each day – they are small, accurate and affordable. People are monitoring their health in a plethora of interesting ways and using the Internet to share that information strategically with a number of parties, making the data more meaningful and actionable.

So what will the connected health space look like in 10 years?

Some things we can be reasonably certain of: Electronic health records will be adopted. Mobile computing will become commonplace and wireless networks both fast and robust. Pressure on health care costs will remain. The population will continue to have an increasing percentage of older individuals who are higher utilzers of health care services. Technologies of all types will get smaller and cheaper. Ten years from now, today’s teenagers (who constantly text and view voice calls as quaint) will be graduating medical school and today’s graduates (the first generation to grow up in an always connected world) will be assuming leadership positions.

It’s hard to imagine a scenario where connected health will not flourish. Both the provider community and the patients will be comfortable with an always connected, high speed, texting, social networked world. Monitoring and location awareness technologies will be ever-present.

You may be thinking two things….”Tell me something I don’t already know.” and “You still haven’t said where your Center will be in 10 years.“ And that is because I haven’t fully digested all of the potential wild cards yet.

  • For instance, how much will The Centers for Medicare and Medicaid Services (CMS) push true payment reform, and which models will predominate? It is clear that any model that preserves ‘fee for visit’-based revenue as part of the package will be a connected health deterrent. The Health Reform Bill has many passages in it directing CMS or another government agency to study new care models and new payment models. With only experiments to hang our hat on, this part of the future is quite uncertain. Likewise, a change in partisan leadership in Washington might result in a significant slowing of the experimentation around new models of care.
  • Will a truly disruptive care concept (such as retail clinics) gain enough traction to displace mainstream health care as the predominant provider of care? Yes, there are relative provider shortages and the mismatch between provider supply and care demand will undoubtedly grow. Yet, unless something really compelling comes along and begins to threaten the dominance of the traditional ‘physician is king’ model, everyone in healthcare will still be asking doctors’ permission before doing anything meaningful to the care process and that will slow care model innovation.
  • Just how much will the coalition of employers and health plans be able to ‘bend the cost curve?’ Right now, we providers feel like we’re being pressured, but the pressure is pretty light, really. Plans need us to provide care, so they have to tip toe around pushing the envelope too much. Will there be any way to loosen the financial relationship and interdependency that providers and plans have?

By now you’ve probably figured out that this post is meant to be a teaser. As I try to rise to the occasion of positioning our group for the next 10 years, I’m grappling with these uncertainties. In large part, our collective work will help drive the market for connected health. So, I would be most interested in your thoughs on the future of technology-enabled healthcare delivery. Which trends do you think will be the most important? Which are both certain and of high impact? Which are of potential impact but highly uncertain?