Post COVID American Healthcare Landscape

As we turn the corner on a once in a lifetime experience the world has faced with the COVID pandemic, we have a great opportunity to capitalize on a common mission, reflect on the lessons learned and use the momentum to address our long-standing healthcare issues across the world. Some key themes that have emerged from the pandemic include Health Equity, Social Determinants of Health (SDOH), Community Care Delivery, Virtual Care as a true modality of Hybrid Care Delivery and our Future Blueprint for Healthcare Innovation & Care Delivery using the incredible success of our COVID response. Also, many healthcare experts predict that we have a great opportunity to make a final attempt at disrupting our failing healthcare system and make a permanent impact for the good of humanity. We will look at how the Healthcare landscape is shaping up post COVID and what the future might look like.

First let’s familiarize ourselves with how the current landscape looks like. We call it the 5 Ps. The 5 Ps (per John McDonough from Harvard T. H. Chan School of Public Health) that represent the healthcare industry are

1. Patients – consumers, citizens, taxpayers
2. Providers – physicians, nurses, hospitals, LTC facilities; pharma and device makers
3. Payors – insurance companies, pharmacy benefit managers, governments, large businesses, consumers (for out-of-pocket costs)
4. Purchasers – businesses/employers; consumers
5. Policy Makers – national/federal; state/province; local; quasi-governmental

What we have seen in the recent years are various Digital Health and Care Delivery Navigators that have been looking to address pain points in the first three Ps – Patients, Providers and Payors. We have found these Navigators to straddle between different stakeholders (rather than focus on a specific P) and address the friction points between these 3 Ps and in the process disrupt the status quo. While it has been very hard to keep track of the latest in terms of the full inventory of these digital health startups, here are some sources that attempts to keep track of them.

1. CB Insights
2. HLTH
3. Becker’s Hospital Review

Some of the noticeable healthcare disruptors that have emerged out of the COVID pandemic are

1. Ro – A Patient Centric Company determined to disrupt the status quo end to end and eliminate players who don’t have a role to play in the future state of healthcare and bring transparency to cost at every stage.
2. Transcarent – Disrupting care delivery by putting employers and employees back in charge giving them unbiased guidance and choices and at the same time offer fully at-risk model by paying providers upfront for surgeries.
3. Mark Cuban Cost Plus Drug Company – Disrupting the drug manufacturing and delivery model by providing full transparency on cost involved and, in the process, drastically lowering the cost of expensive generic drugs
4. GoodRx – Targeting the loopholes in the current Pharmacy drug delivery model and disrupting it by looking out for the uninsured patients and help them get discounts using coupons and forcing the PBMs to bid for lowest price they can give GoodRx
5. EQRx – Revolutionizing affordable drug discovery by breaking the status quo and disrupting the current drug discovery process that has plagued all the current pharmaceutical companies.

Other noticeable disruptors with unique business model that is worth keeping an eye on include

1. Digital Care Delivery – Firefly Health; CityBlock Health; Buoy Health; Maven Clinic; Olive/Circulo
2. At Home Care Delivery – Dispatch Health; Landmark Health; Signify Health
3. Telemedicine – Hicuity Health; eVisit; Caregility
4. Drug Delivery – TruePill; ScriptDrop; Alto  
5. Drug Discovery – Medable; Insitro; 23andme
6. Population Health Analytics – ActivateCare; Persivia
7. Medical Device – AdhereTech; AppliedVR
8. Interoperability – 1upHealth

What about all other Digital Health startups who have been crowding the healthcare space lately and getting a lot of venture capital funding?

While it is certainly a good thing to have so many startups jump into the healthcare space, especially considering the pandemic, not all of them have a clear path of existence in the long term. It does appear that some of them are solely looking to show some value and eventually get bought by larger players. Having said that, many of them have a solid story and value proposition that needs to be closely watched. Also, many of them might end up collaborating or consolidating to bring more value and efficiencies in the overall care delivery value chain.

Where are the Tech Giants in all these conversations?

1. Amazon – Amazon has made progress in disrupting Care and Drug Delivery using its AmazonCare and AmazonRx (Pill Pack acquisition) capabilities; However, some argue that they did not totally disrupt the Drug Delivery business model as they are still closely tied to Cigna/ExpressScript PBM in terms of pricing of the drugs; Having said that, we need to give them full credit for enabling Cloud implementation for many of the digital startups
2. Google – Google has certainly made a huge contribution in the AI/ML space thru its initiatives driven thru Deepmind, Verily, Calico and also drive personal health thru its Fitbit acquisition. Google has also enabled multiple Healthcare Digital Startups thru its Cloud infrastructure. Having said that, we need to closely monitor how Google adjusts its Healthcare strategy after some major reorgs in its healthcare units including dissolving of Google Health.
3. Microsoft – Microsoft has done a great job enabling healthcare stakeholders in different capabilities including Azure Cloud infrastructure, AL/ML processing and thru its acquisition of Nuance to enable NLP/NLU capabilities like Virtual Scribe. Microsoft has been collaborating with major health systems and pharmaceutical companies thru its NeXT initiative in genomics and drug discovery projects. Microsoft is also partnering with Walmart Health to disrupt the current healthcare system where possible.
4. IBM – While IBM stumbled with its IBM Watson Health implementation, it is looking to come back with full force and cement its place in the healthcare industry. IBM certainly has a lot to offer, especially in AI/ML and its use in genomics and deep learning use cases.
5. Apple – Apple has been very narrowly focused on its involvement in healthcare by looking to use its device for monitoring health and integrating with other stakeholders in the healthcare system. Knowing how selective Apple can be in its product strategy, it is not surprising that it has not gone beyond to solve the larger healthcare issues and pain points. It will be ideal to have it be seen as disrupting the system to make desperately needed changes.

Conclusion & Closing Thoughts: What do we need to watch out for in the upcoming years and look to get more clarity and drive solutions?

• Are we underestimating the value that Payors, PBMs bring to the table? US Healthcare is complex, and do we think we can have the Govt. (Medicare/Medicaid etc.) and Self-Insured Employers can fully own the responsibility of underwriting and paying for healthcare?
• Will we see the Tech Giants take a larger role than just enabling digital health startups and drive bleeding edge technologies? Can they solve the healthcare complexity thru software design?
• Will we see in healthcare the type of disruption we saw in other industries like Travel (Expedia, Travelocity), Hoteling (Airbnb, Vrbo), Tax (TurboTax, TaxAct), Taxi (Uber, Lyft)?
• Will we be able to replicate the speed of drug innovation and efficient care delivery that we saw during the pandemic? If not all of it, can we at least replicate some of them?
• Will be able to make positive impact to Health Equity and Social Determinant of Health (SDOH) thru Consumerism or we will need intervention from policy makers and legislature?
• How open minded will the current healthcare stakeholders (specifically Payors, PBMs, Pharmaceuticals and Health Systems) be to change their business model to bring transparency into the end-to-end care delivery and finances?