A vision for the future of healthcare

Since Donald Trump’s presidential election win, many are wondering whether Obamacare will survive – or whether it will disappear “on day one” of the new presidency. But future progress in healthcare doesn’t only depend on Obamacare. If we want to see a better healthcare going forward, paying for making people healthy, and making personalized and home-care a reality makes can get us far, too.

Can we realistically expect these results? In today’s world we still have to manually fill out those long checklists at every doctor’s office. We must visit hospitals based on their payer’s plan affiliations rather than on their areas of superior expertise. We have no access to own health data. And we often end up with non-differentiated treatments instead of individualized ones that make us better sooner.

Yes we can. The first step is realizing that the vision of home-health is science – not fiction.

Consider first the gathering of health care data. A whole 92% of the data currently collected in the doctor’s office, we know, can also be collected outside of it: at home, for example, or in a mini clinic, like they already exist in U.S. pharmacies like CVS, Walgreen’s or RiteAid. Expanding the use of these “mobile” health solutions could in itself generate billions of dollars in savings and improve outcomes. Indeed, visits to a doctor’s office become less needed and the data collected more widely available in the healthcare system of the future.

That doesn’t mean that the diagnosis should be outsourced to patients. Symptom checkers are different from data gatherers, and this is where people often get misguided. Recent research has shown that real doctors make a correct diagnosis more than twice as often as online symptom checkers: 72% to 34% according to a Harvard study published in the Letters section of JAMA Internal Medicine. Or to put it differently, a doctor gets your diagnosis right in three quarters of cases, online symptom checkers get it wrong almost two thirds.

Rather consider the virtual doctor’s office as the first triage step. If data can be gathered at home or in a generic mini clinic, then a diagnosis from a remote doctor’s office becomes a much more realistic alternative. And that means more patients can self-administer follow-up routine care at home, when hospital based scarce resources get spared to only be applied where acute care episodes do necessitate that.

Additionally, under the new paradigm, when routine care happens outside the four walls of hospitals, the more clinical care delivery networks can in turn specialize in the management and treatment of more severe chronic diseases. They do execute on quasi-industrialized sets of protocols and workflow, as they apply in a systematic manner evidenced based gold standards of care.

A 2015 research from the Memorial Sloan Kettering Cancer Center, published in JAMA Oncology shows for example that survival outcomes can vary widely depending on where patients receive care. A patient admitted for a same stage cancer would enjoy a 21% improvement in survival rate five years from diagnosis, when first admitted in a freestanding cancer hospital, when compared to receiving treatment in a non-teaching community hospital. A similar situation occurs for most non-communicable diseases be it diabetes, cardiovascular diseases and respiratory disorders: large, specialized institutions with a high volume of patients secure better outcomes than small, generalist institutions around the corner.

So why aren’t we seeing more virtual care? It is because the healthcare system isn’t incentivizing care institutions this way. In the current set-up, including in the U.S., hospitals are still largely so paid for treatments, not outcomes. It means that hospitals are rewarded to admit patients, produce exams and treatments, even if they aren’t best at securing healthcare improvement or cure. When the incentives get reversed, the door opens for the delivery of virtual treatments by the best hospitals as long as they contribute to better outcomes, a reduced pressure on emergency departments for non-acute care episodes, and cost containment.

Ultimately, specialized outcome driven state of the art healthcare delivery systems will be at the core of personalized medicine. Despite perhaps common belief, this isn’t a futuristic idea, but one that is scientifically possible since at least the 1980s. Science is not the issue. By gathering patient genome information, doctors can with a high statistical probability predict whether or not a patient is at risk of breast or prostate cancer, they can define the malignancy of the disease, or anticipate patient’s response to select available courses of treatment. By combining specific drug treatments with molecular diagnosis, doctors can certainly increase the chance of the right treatment protocol to be applied to you as a patient, based on data sets of thousands of similar cases.

A sure thing is that the current healthcare system is not as advanced as the science behind it is. First, the FDA and other global regulatory bodies do still approve drugs and devices based on clinical trials run on indiscriminate populations of patients, as opposed to genomics based targeted ones. Second when research brings to the world breakthrough science that can cure the incurable, societies are not equipped with the mechanisms to even put a price on them. Healthcare with at home data gathering, virtual treatment, healthcare delivery systems specialization and personalized medicine is not science fiction – it is simply robust and agile enablement of best available science.

Barack Obama might not see it happen in his days as President. But, when the societal and regulatory framework will become part of the reform agenda of his immediate successor, then this may well become a shared legacy of our generation.