The Covid-19 pandemic changed the U.S. healthcare system virtually overnight. While insurers, hospitals and patients had been dipping their toes in new technologies, virtual encounters quickly reigned supreme. Some analysts have suggested the pandemic has sped up adoption of telehealth by three to five years. “The pandemic has given us liberty to move even faster,” Anthem CEO Gail Boudreaux told the 2020 Forbes Healthcare Summit. “While many of these things were in place before, the pandemic has really allowed us to see, with everyone predominantly at home or shelter-in-place, that we have to think very differently about how healthcare is delivered.”
Boudreaux’s remarks were echoed by other top healthcare executives, even though some argued the pace still isn’t fast enough. Jonathan Bush, executive chairman of Firefly Health, argued regulators haven’t been able to keep up with technological change, resulting in a huge backlog. “We just learned this with the vaccine: if you liberalize the sclerotic rules, you can do social miracles,” he said. “We have lots of sclerotic rules that are miracle killers all the time, we just don’t have this focus on the pandemic to get us to get out of our own way.”
Here are some of the key insights about digital health that were presented at the Summit.
Doctors Aren’t Going Away
While Covid-19 has ushered in the era of the virtual visit, the robots won’t be taking over anytime soon. “We cannot think of technology in healthcare operating on its own,” said Roy Schoenberg, co-CEO of telehealth company Amwell. At the end of the day, the practice of medicine is experiential. “The reassurance that you get from a clinician is important, even though the positive predictive value of an algorithm is amazing,” said Schoenberg. There is an art, he said, to merging the two: “Part of the humility is for us to recognize the evolution of that kind of multiplex of technology and physical healthcare will only happen if we understand what actually patients want to feel good about.”
Speed Needs To Be Balanced With Safety
Silicon Valley has popularized the mantra “move fast and break things,” but healthcare technology companies don’t have this luxury. “You’re not going to get a successful company at this convergence by having only health experts, or only engineers working on this, you really need to bring those two cultures together,” said Daphne Koller, founder and CEO of insitro. Companies need to figure out how to navigate the speed of engineering innovations, while also ensuring patient safety and regulatory compliance.
But there is also a need for regulators to adapt their longstanding practices to account for changing technology. “There is a balance here that hasn’t yet been addressed, especially as it relates to things that involve measurement devices and software that touches a patient,” said Koller. She offered the example of a machine learning software, which learns and becomes better over time, instead of a typical therapeutic where the clinical trial process is structured to reach primary endpoints.
Digital Biomarkers Will Lead To Better Care
The next frontier will be incorporating more sensors into treatment decisions. Boudreaux said that Anthem had entered into a recent partnership with Apple and the University of California Irvine to use Apple Watches to “help us understand biomarkers for asthma,” a disease that affects 25 million Americans. “The success around asthma is often self-care and self-management,” said Boudreaux. The hope is to go from clunky paper-driven protocols to help patients figure out real-time triggers by monitoring things like heart rate, blood oxygen and sleep, with the end goal of being able to suggest personalized behavior changes. The study plans to enroll 900 patients.
The ability to constantly monitor patient biomarkers is also going to have huge implications for new drug development said Roche CEO Severin Schwan. “The health care status of a patient can be very different from day-to-day,” he said. But these sensors will be able to more precisely measure how patients are responding to new medicines. “You can track movements with your smartphone. That wasn’t possible 10 years ago, but today it’s possible and it’s 24/7.”
Big Datasets Will Create More Equitable Healthcare
When it comes to clinical trials for drugs, a longstanding issue has been that trial participants don’t necessarily reflect the gender and ethnic diversity of the population. But this can be overcome through technological advances and the creation of secure nationwide patient datasets. “Right now a lot of the patient databases that we deal with are people of primarily European descent with very specific socioeconomic status. And it’s really creating biases in what we learn from these data,” she said. But as more companies figure out how to securely use machine learning across large unified datasets that include more diverse patient populations, then more equitable solutions will follow. “I think that’s going to be a dramatic opportunity for biological discovery that’s also going to unlock the ability to discover new medicines,” said Koller.