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Chief Growth Officer

HLTH Content Director, Jody Tropeano interviews Manisha Gulati, Chief Operating Officer, Clarify Health and Bhash Parasuraman, Vice President and BU Lead, Rare Disease Patient &amp; Health Impact, Pfizer . They both recently presented on a HLTH GoLIVE series webinar called “Rearchitecting the drug launch model.” The discussion zeroed in on the incentives of regulators, payers, providers, and patients, which are often at odds with each other when it comes to drug launches.

Rearchitecting the Drug Launch Model

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Chief Medical Officer, Image-Guided Therapy

One in 10 people undergo a surgical procedure each year [1]. That means that over the next decade it’s highly likely you – or someone close to you – will too. This may sound like a scary prospect, but it doesn’t have to be.  That’s because we’re making huge strides forward in innovation that I believe will make your operation more likely to be a medical success while having a better experience along the way.  Got five minutes? Because I’d like to show what I think the future of surgery will look like in a decade. Getting you back to living the life you love faster, safer, and with less anxiety If you need to see a doctor in 2033 for a major disease, you could be diagnosed and treated in one single room on the same day. This could include medical emergencies like a heart attack or a stroke or long-term diseases like lung cancer or disorders of the spine, for which many patients today have to wait weeks, or even months, for treatment.  In 10 years’ time, your care could be radically improved thanks to advances made by combining cutting-edge technologies into one intelligent room. This is a room that gives doctors like me almost superhuman abilities, enabling us to treat some of the most common and most life-threatening diseases in one go. I’m talking about an entire room that will be powered by a mix of photo-realistic Augmented Reality (AR), robotic automation, artificial intelligence (AI), ultra-high resolution 3D medical imaging and smart devices that all <a href="https://www.philips.com/a-w/about/news/archive/standard/news/press/2020/20200901-intuitive-integrated-and-efficient-world-premiere-of-philips-next-generation-azurion-image-guided-therapy-platform.html" target="_blank">talk to one another.</a> It will enable doctors to perform operations with less damage to your body, less time spent in the hospital, a faster treatment and recovery, and in some cases, immediate diagnosis and treatment. Today, we can already do some of these procedures thanks to a combination of technologies called Image-Guided Therapy, or IGT for short [2]. IGT is essentially modern-day surgery that uses minimally invasive techniques to allow me to do what surgery used to do (by cutting you open, which is far more dangerous and requires more time to recover). IGT procedures are carried out through incisions not much larger than a pencil point, leaving behind just a band aid.  Imagine that it’s 2033. Let’s look at four of the world’s most common diseases in four different countries and explore how your care will be radically different:  Care will be faster  The paramedics are at your home somewhere on the U.S. East Coast. They suspect a stroke, but it could also be a number of other things. Fortunately, their hand-held monitor can now connect them to the hospital and instantly to a stroke expert who reviews your monitoring data and confirms that you’re having an acute cerebral event, possibly an ischemic stroke.  The paramedics rush you to the hospital, where CT scans are taken and then reviewed by a remote neurologist, who quickly confirms your diagnosis and sends you to treatment.  So far, only 45 minutes have passed since your stroke began. Every minute that a stroke goes untreated results in the death of 2 million neurons. Every 30 minutes’ delay before treatment reduces the chance of a good outcome by 14%. And each hour of delay ages your brain by 3.6 years [5]. Time is literally brain [4].  Luckily, you get to us within <a href="https://youtu.be/K9fj2TpberE" target="_blank">the golden window</a> – the earliest hours following a stroke when we can reduce or even reverse the long-term effects. Scans confirm the diagnosis, so I make a pencil-point incision in your thigh. I touch a hologram of an artery in your neck and in seconds the device (with the aid of robotics) rapidly threads itself along your arteries to a tiny clot that is cutting off blood flow to your brain. Within just minutes, we have removed the clot.  Through my AR glasses, I can clearly see that the blood flow has been restored, reversing the stroke-in-progress and preventing any devastating long-term effects. All while an expert from Tokyo was watching your entire procedure through her AR glasses and sharing her clinical advice. You are then whisked to recovery bays in the neuro intensive care unit. You’ll be home having dinner with your family within 48 hours.  Care will be “one and done” Perhaps you live in the Netherlands, and you’re in the operating room with my colleague Jess because you’ve been referred for a suspicious spot towards the base of your left lung. Less than one hour later, Jess has diagnosed and destroyed all of a tiny tumor in one go without opening up your body.  How? It turns out you had lung cancer, a disease that kills more people than breast cancer, prostate cancer and colon cancer – combined. In the Netherlands alone it kills more than 10,000 people every year [6].  In 2033, Jess is able to look at your lungs on her AR screen and see <a href="https://www.philips.com/a-w/about/news/archive/standard/news/press/2021/20210519-philips-introduces-the-new-spectral-computed-tomography-7500-system-providing-spectral-information-for-every-patient-and-every-scan.html" target="_blank">every detail </a>within and around your lungs in sharp focus. She pinpoints precisely where the cancerous cells are that need destroying. She virtually sculpts a 3D model of an AI-predicted kill zone around the tumor, and she then destroys the cells using microwave energy.  When you wake up, instead of facing a six-month waiting period before follow-up scans to see if it is an early cancer that is growing, you find out immediately its all-clear.  One and done. How amazing is that? Care is closer to you  We have a saying in the medical world: Save a limb, save a life. This is something we’re doing much more easily in 2033. Even if you live far away from a city.  Take Australia for example, where almost a third of the population still lives in rural areas. Even though the country has more hospital beds per capita than the U.S. or the U.K., hospitals are desperately overcrowded, and patients face a huge increase in waiting time for elective surgeries. So instead, we come to you. In the U.S., physicians like me have been using office-based labs, or OBLs, for decades to perform routine procedures like the removal of fibroids, or even minimally invasive operations on your heart. And they’re fantastic because they enable doctors to take care outside of hospitals and bring it closer to the communities and patients that we serve.  In 2033, we put our highly-intelligent IGT rooms into mobile OBLs – creating what’s essentially <a href="https://www.youtube.com/watch?v=hS_rcRzKAEg&amp;list=PL3WBa0emAbeJCS4_zCZ4KuHz9JH-_ChTV&amp;index=21&amp;t=4s" target="_blank">a hospital on wheels</a>, with doctors inside who can carry out elective procedures on your doorstep. Procedures to treat things like peripheral artery disease (PAD), or poor blood circulation in the leg, which causes cramping and pain when you walk. Incredibly, nearly a quarter of a billion people suffer from PAD worldwide [7]. If left untreated, it can lead to amputation, which in turn raises your risk of dying. But with mobile OBLs, we’re making sure to reach our patients who find it hard to get to us.  Care is safer for you (and me) If you live in India, you almost certainly know someone with cardiovascular disease (CVD). That’s because CVDs are more common, especially among the younger population [8]. Replacing an aortic valve in your heart used to require massive surgery, splitting the chest open, lots of blood loss, lots of days in the hospital. In 2033, we can do this through a minimally invasive procedure called transcatheter aortic valve replacement (TAVR).  And in 2033, our intelligent surgical rooms will include a <a href="https://www.philips.com/a-w/research/research-programs/fors.html" target="_blank">groundbreaking technology</a> that uses light rather than X-rays to let me navigate through the body in real-time and in 3D, from any angle. So not only can I perform a TAVR through a tiny incision in your groin, but you go home the same day and there’s no radiation, making it safer for both you and me.   More accessible care for everyone  I started this story by saying that one in 10 of us will need surgery over the next decade. Now let’s end on a positive note: at Philips, our minimally-invasive solutions already help doctors worldwide to treat one patient every second of every day. Which means since you started reading this blogpost, more than 400 people have had their tumors killed, their strokes reversed, and their hearts and blood vessels mended using our technology. And because every single innovation you’ve just read about is being developed right now, I’m confident we’re well on the way to getting even more of you – and the people you care about – back to living the lives you love.  As futures go, that’s literally life-changing.  To learn more about developments in minimally invasive procedures and the future of health, follow me on LinkedIn @AtulGupta_MD Sources:[1] <a href="https://academic.oup.com/bja/article/119/2/249/4049141" target="_blank">https://academic.oup.com/bja/article/119/2/249/4049141</a>[2] <a href="https://www.youtube.com/watch?v=BAt-akrOw_o&amp;list=PL3WBa0emAbeJCS4_zCZ4KuHz9JH-_ChTV&amp;index=2" target="_blank">https://www.youtube.com/watch?v=BAt-akrOw_o&amp;amp;list=PL3WBa0emAbeJCS4_zCZ4KuHz9JH-_ChTV&amp;amp;index=2</a>[3] <a href="https://emorymedicinemagazine.emory.edu/archives/issues/2019/spring/briefs/not-too-young-for-a-stroke/index.html" target="_blank">Emory University </a>[4] <a href="https://www.semanticscholar.org/paper/Time-Is-Brain%E2%80%94Quantified-Saver/6556f7e325f1862269b855d7dcae6e43232862ed?p2df" target="_blank">[PDF] Time Is Brain—Quantified | Semantic Scholar</a>[5] <a href="https://www.ncbi.nlm.nih.gov/pubmed/16339467" target="_blank">ncbi.nlm.nih.gov/pubmed/16339467</a>[6] <a href="https://www.jto.org/article/S1556-0864(20)30821-2/fulltext" target="_blank">https://www.jto.org/article/S1556-0864(20)30821-2/fulltext</a>[7] <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113064/#:~:text=It%20is%20estimated%20that%20%3E200,symptoms%20from%20none%20to%20severe" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113064/#:~:text=It%20is%20estimated%20that%20%3E200,symptoms%20from%20none%20to%20severe.</a>[8] <a href="https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)" target="_blank">https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds),</a><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994761/" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994761/</a>

It’s 2033 and You Need Surgery: Here’s How it Will Be Radically Different

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Healthcare Industry Consulting Director

Healthcare Industry Consulting Director/ Chief Strategist, Data Driven Health

The COVID emergency, which no one anticipated, may be over, with surges of infections no longer interfering with the delivery of other medical services. But the next “surprise” is approaching. Fewer appointment slots, inflationary pressures, loss of Medicaid coverage, and high deductibles amount to interference of another kind. Delayed care will result in the arrival of more patients with higher acuity.  Sicker patients are on the way. The question is, what can you do? In this article we’ll review those underlying causes for delayed care, consider the consequences, and offer a few suggestions on how to mitigate the impact of this next shock to your system. Reasons for Delayed Care Patients are delaying care for several reasons. First, there is the shortage of doctors and nurses, which was unfolding before COVID and has only widened since then. Shortages lead to fewer appointment slots, which translate into reduced access to care. For many patients, that means having to wait longer to see a doctor, if not giving up. These constraints especially bear upon the 100 million Americans who live in <a href="https://data.hrsa.gov/topics/health-workforce/shortage-areas" target="_blank">Health Professional Shortage Areas (HPSAs</a>), where there is a current need for more than 17,000 primary care practitioners.   Inflation and changes in Medicaid are two other factors. The percentage of Americans who reported postponing medical treatment in 2022 due to costs rose 12 points year-over-year, to 38 percent, according to <a href="https://news.gallup.com/poll/468053/record-high-put-off-medical-care-due-cost-2022.aspx" target="_blank">Gallup’s Health and Healthcare annual poll</a>. This was the sharpest annual increase to date and the highest percentage in the poll’s 22-year trend. In addition, pandemic-related emergency provisions that paused the yearly reapplication process for Medicaid have ended. As a result, <a href="https://time.com/6267870/millions-lose-medicaid-pandemic/" target="_blank">millions of Americans</a> who failed to reapply or are no longer eligible are likely to lack coverage.  A final driver of delays – or avoidance – is the disincentive posed by high-deductible health plans (HDHPs). According to a <a href="https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/" target="_blank">Kaiser Family Foundation (KFF) survey </a>from 2022, 44 percent of insured Americans worry about affording their deductible before health insurance kicks in. The trend is clear. Drawing from KFF and other data, <a href="https://www.valuepenguin.com/high-deductible-health-plan-study" target="_blank">Value Penguin researchers</a> reported that 55.7% of American private-sector workers were enrolled in HDHPs in 2021, the highest percentage on record and eighth straight yearly increase.   Greater Delay = Higher Acuity (higher costs) and Mortality The negative impact of postponed care is no mystery. Failing to identify a disease in an early stage means any subsequent medical engagement must play catch up. Without intervention, disease develops on a predictable course, typically becoming more severe and harder to treat. In either case – failing to screen or intervene – the consequences can be deadly, as studies have shown.  <a href="https://www.sciencedirect.com/science/article/pii/S0025619620306042#fig1" target="_blank">A Mayo Clinic report in 2020</a> stated that a delay in colon cancer surgery of more than four months could lead to 10,000 excess deaths in the U.S. over five years. <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771035" target="_blank">Physicians at the Icahn School of Medicine at Mount Sinai </a>reported that three months after elective procedures were halted due to COVID, more than 30 percent of aortic stenosis patients who deferred care required emergency surgery or died. An <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2022/covid-increasing-cancer-screening" target="_blank">NIH report</a> noted that the estimated 9.4 million screenings for cancer that did not occur in 2020 could lead to more advanced-stage diagnoses and, ultimately, to higher mortalities.  How to Mitigate the Crisis  Reversing this downward spiral requires both analysis and a proactive stance. It is crucial to understand key indicators and see how they look from the perspective of patient, clinician, clinical executive and CFO. But you also need to act. For starters, consider just one of the drivers mentioned above: the end of Medicaid emergency provisions. To take the initiative, you could have identified at-risk patients, supported their Medicaid renewals if possible, and maximized the chances for positive outcomes, while minimizing bad debt and leakage.  To mitigate the impact of sicker patients across the board going forward, focus on these three areas:  <ol><li>Monitoring and analysis. Do you have enough visibility into patient behavior? Are patients continuing to defer care or are they migrating to simpler alternatives? Stratify your at-risk patients and populations, taking into account not only their current risk but also their changing circumstances, such as financial stability. Data analytics is the primary antidote to the new crisis of delayed care-driven morbidity.</li><li>Patient engagement. Service delivery models changed during the COVID-era, but it is not enough to maintain the digital front door to your office and facilities. You also need to build genuine connections with patients through remote monitoring and management. Patient participation is critical to bending this curve. New technologies, such as digital augmentation of the home setting and patient engagement through conversational AI capabilities, also can help you navigate these challenges. </li><li>Automation. Data and process automation can help put patients on optimum care pathways and reduce the time it takes to connect with specialists and undergo procedures. Automation can also lighten the heavy (and burnout-inducing) load of routine care and enable medical teams to focus on tougher and more complex cases. Of course, little of this can happen with siloed data. A good place to start is to examine your own organization’s data interoperability capabilities. </li></ol> Bad News, Good News The unexpected pandemic led to deferred care, which increased patient acuity, as the <a href="https://www.aha.org/guidesreports/2022-08-15-pandemic-driven-deferred-care-has-led-increased-patient-acuity-americas" target="_blank">American Hospital Association</a> has well documented. Unfortunately, while the pandemic has abated, other factors are in play, promising similar results. The good news is that the drivers of this follow-on wave of sickness are hiding in plain sight. With strategic applications of monitoring and analysis, patient engagement, and automation, you can begin preempting the next, new “surprise” today.

Sicker Patients: The Next Healthcare Surprise

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Managing Director

Chief Medical Officer

The healthcare experience and health outcomes for people who identify as LGBTQIA+, people living in poverty, veterans, racially and ethnically diverse people, people with disabilities and other groups historically marginalized by society and the healthcare system is markedly different than it should be. The impact of health inequity has been irrefutably quantified – inequities in the U.S. health system cost approximately $320 billion per year today, and that <a href="https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html" target="_blank">cost is expected to rise in the coming years</a>. The Covid-19 pandemic put a magnifying glass on the inequities experienced by historically vulnerable groups while also ushering in new expectations of employers whose healthcare and workplace benefits became a safety net for employees. Employers can continue to make a huge impact by removing barriers to health equity as they provide <a href="https://www.kff.org/report-section/ehbs-2022-section-2-health-benefits-offer-rates/" target="_blank">health insurance coverage for 51% of working-age Americans</a>. They can also make an impact through salary and workplace benefits such as paid time off and benefits that help employees overcome social barriers to health. Business Group on Health reports in “2023 Trends to Watch” from their <a href="https://www.businessgrouphealth.org/%20resources/2023-large-employers-health-care-strategy-survey-intro" target="_blank">Large Employer Survey</a> that 75% of large employers are concerned about health equity within their health and well-being initiatives. Many have planned this year to offer or expand benefits to support transgender and neurodiverse populations as well as inclusive family-forming benefits.   At the HLTH conference in Las Vegas last November, we presented some opportunities for employers to help remove barriers to health equity in 2023: <ul><li>Optimize current benefits and health plan offerings</li></ul>The new calendar year often means the launch of new employee benefits and health plans and is a prime time to evaluate your current plan offering through an equity lens. Does your plan provide comprehensive coverage that meets the unique requirements of your business’ different populations, such as those with chronic illnesses, special healthcare concerns or across salary bands?   <ul><li>Address Social Drivers of Health (SDOH) within your employee population and employ reporting for transparency</li></ul>Life and social factors affect people differently, and addressing the specific, non-medical barriers of your workforce is a key opportunity to support their overall health and wellbeing. To help address SDOH issues such as food insecurity and housing instability, <a href="https://news.delta.com/emergency-savings-program-fuels-employees-financial-security-and-well-being#:~:text=Beginning%20this%20month%2C%20eligible%20employees%20can%20earn%20up,program%20and%20contribute%20to%20an%20emergency%20savings%20account." target="_blank">Delta Air Lines has implemented a program</a> that lets employees earn up to $1,000 to establish a rainy day fund that can help address sudden financial needs. Your organization can explore the needs of your employees and then prioritize a manageable number of factors that could be addressable in the next twelve months.  <ul><li>Expand access to primary care and mental health support through virtual and community-based care options</li></ul>An <a href="https://www2.deloitte.com/us/en/insights/industry/health-care/alternative-sites-of-care.html" target="_blank">October 2022 national survey by Deloitte </a>of 4,545 representative consumers found that community- based health centers and retail clinics, combined with access to virtual healthcare, could bridge care delivery gaps for populations that have been historically underserved, and in many populations would be preferred.   The survey also found that 55% of racially and ethnically diverse people who were surveyed are interested in virtual care for mental health and preventive primary care. As many employers move to adopt “virtual first” models of healthcare and are evaluating solution providers, employers can apply a health equity lens to that procurement process.  Virtual care still includes humans. There are always people – doctors, nurses, therapists, clinical practitioners – on the other side of the screen. Employers should evaluate solution providers’ ability to offer care that is socially concordant (delivered by providers who share a social identity with the employee) and culturally informed.  <ul><li>Make benefits and healthcare easy to navigate</li></ul>In addition to adding a navigation service to your health and benefits plan if you don’t have one already, employers can leverage many tactics around health literacy, including how they utilize internal communication to equitably enable employees to find, understand and use benefits to make the best healthcare decisions. This can be as straightforward as using inclusive language and imagery or more programmatic, such as training managers to identify people with unmet needs and refer them to a specific benefit program with cultural humility.   Employers can also look at adding benefits beyond health and wellness to advance health equity, such as financial literacy, commuter benefits and tuition assistance. Accolade is working with an employer on a pilot to provide onsite clinical resources for employees including health education sessions and one-on-one health coaching. These are just a few examples of ways to help employees overcome barriers and make informed decisions for their health. <ul><li>Make commitments to address health equity issues alongside others</li></ul>We believe that addressing health equity is both a moral and business imperative, and each organization has an important role to play in driving health equity as an outcome. That’s why Deloitte and Accolade recently joined 37 other organizations in <a href="https://initiatives.weforum.org/global-health-equity-network/pledge" target="_blank">signing the Global Health Equity Network Zero Health Gaps Pledge</a>, a commitment to take concerted action to advance health equity globally. The pledge includes 10 key commitments all signatories have made to embed health equity principles throughout their operations, workforce and guiding philosophies. In the first century B.C., Hillel the Elder asked “If not us, then who? If not now, then when?” This question remains relevant today. Achieving health equity in the U.S. is an attainable goal and employers hold a coveted position of influence through the valuable contributions they can make when they begin removing barriers to health equity for all their employees. Please see <a href="https://protect-us.mimecast.com/s/C_mfC73yBxhn0KqXs8QZUL?domain=deloitte.com" target="_blank">www.deloitte.com/about</a> to learn more about our global network of member firms.

The Power Employers Have in Helping to Remove Barriers to Health Equity: 5 Opportunities in 2023

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