Predictive Analytics for Personalized Healthcare

I am fascinated by the way predictive analytics has revolutionized so many industries. Be it retail (Amazon), Online Search(Google), Social Media (Twitter/Facebook). Whenever I use these companies’ products, I get a feeling that they know me very well. Based on my previous interactions they predict my future behaviour and more often than not they are spot on. They seem to know what I want which makes me feel I am not just another consumer but a unique person with particular tastes, likes and dislikes. And this truly delights me. On the other hand my experience with my physician is hardly personalized. Appointments after appointments the saga remains the same. Is it possible for healthcare industry to adopt the predictive analytics toolset to delight its consumers (patients)? Can they delight the patients the way other industries are doing?

Doctors have long been predicting outcomes based on historical information. But lack of holistic data and sophisticated tools for analysis made them rely on their judgement to deliver care. This made healthcare delivery as much art as it is science. With access to new sources of data and capabilities of analytics tools, the subjective component can be significantly reduced. What’s more – doctors can now, with the help of predictive analytics, deliver personalized care which was not possible with the traditional practices.

Simply put, personalized healthcare (PHC) is right care, at the right time, and at the right place. With the advancements in genetic sequencing and advent of big data analytics, PHC is now a reality. If predictive models based on behavioural and genetic data can tell how an individual will metabolize coffee, imagine their potential to predict the right treatment for a particular patient. Here’s a video that demonstrates how powerful predictive analytics enables personalized care-

Hippocrates once said “It is far more important to know what person the disease has than to know what disease the person has”. Cannot agree more in the context of personalized healthcare. And if personalized healthcare is the end, predictive analytics is certainly one of the means to the end.

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Ideal Patient for Patient Engagement

“If patient engagement were a drug it would be the blockbuster drug of the century”.

Leonard Kish, Healthcare IT Consultant

It has been generally accepted that healthcare is a complex business and treatment is best left in the hands of professionals. Historically a patient played a more passive role in the delivery system, letting specialists make most of the decisions for them. But latest research has proven that a more engaged patient receives better quality healthcare and also incurs lower costs. Given these benefits, some experts have touted patient engagement as the block buster drug of the century.

So where do we start to reap full benefits of patient engagement? Of course, with the patients.  While it is essential for all the stakeholders to support patient engagement efforts, much of the responsibility lies on patient’s shoulder to drive the success of such initiatives. It requires deliberate, focused and consistent efforts that entail critical cultural and behavioural changes from patients’ end.  So what qualities make a candidate ideally suited for patient engagement?Here’s what I think are the top three:

Receptive to Education: When it comes to something as serious as healthcare one cannot afford to make our decisions on wrong or partial information. Health literacy is critical for patients and having a mind-set that is receptive to learn is crucial for effective participation.

Ready to Take Control and Act: Once the patient has access to information, acting on it is crucial. Creating a personal health plan, tracking personal health information, involving other caregivers & family members are some of the measures that an engaged patient ought to take.

Open to Share: It turns out that inspiring someone else to choose an apple instead of an ice-cream, has a greater overall benefit that simply receiving a benefit yourself. A more engaged patient has the power to influence a wider audience which can lead to a healthier population in general.

In essence, an ideal patient for patient engagement transforms from “Someone should tell me what to do” to “I need to self-direct my healthcare” mentality. And only when this is achieved we can realize the true potential of THE blockbuster drug of the century.

India’s Medical Tourism Industry : What is Working and What is Not

Soaring costs, high wait times, lack of choice in treatments , comparable/better clinical outcomes in developing countries are few reasons why patients from developed nations are choosing medical tourism increasingly. In need of timely, cost effective healthcare patients around the world travel to South Asian countries such as Singapore, Thailand, Malaysia, India that not only offer competitive prices but also high quality. According to TRM, an American Market Research firm, the global medical tourism industry is currently pegged at $10 Bn and is estimated to reach $40 Bn by 2019.

India’s share of that pie is 20% with a CAGR of nearly 18%. A report by the Confederation of Indian Industry estimates the total number of medical tourists in India to hit around 300,000 in 2015.The country’s key competitive advantage is definitely low costs but the show doesn’t end there. Highly qualified surgeons and medical professionals, consistent track record of successful outcomes, sophisticated technology, state of the art private hospitals, and alternative medicine are other major attractions for the foreign healthcare seekers. Additionally, the recent government announcement to give visa on arrival for 150 countries will further give a boost to healthcare related travel.

While a lot looks positive some roadblocks may hinder the industry from reaching its full potential. One major concern that medical tourists voice is poor post treatment follow-ups and care. Also, few hospitals educate or address travel related complications that may arise from operations. Malpractice protection laws and legal framework in healthcare in the country do not meet international standards. Moreover, lack of health insurance portability may restrict patients from seeking care outside of their own country. Language barriers, cultural differences, insufficient information, travel barriers make adoption of medical tourism difficult.

By virtue of having multiple stakeholders, medical tourism is a complex industry. There are multiple cogs in the wheel that need to work in tandem for it to run smoothly. For India to emerge as a global leader it should focus on bringing these stakeholders on one page. All the players in the field from travel facilitators, tour operators, hospitals, healthcare professionals, insurance companies to government should co-ordinate and collaborate in order to bring seamless experience to the patients. Like the rest of healthcare, medical tourism is a team sport and bringing the team together is just step 1 towards success.

Quotable Quotes

I am a quotes person, have always been one. As a 10-year old I covered the wall of my room with quotes. Even today I maintain a diary of quotes that I refer to every now and then. Quotes inspire, guide and motivate me.

I am constantly looking for words of wisdom in the business arena as well.In this post I tried to curate a list of some healthcare quotes that resonated with me and have made me think.

Here are some of my favourites:

“Betterment is perpetual labour. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.”
― Atul GawandeBetter: A Surgeon’s Notes on Performance

“But now I also understand, firsthand, the meaning of what the caregivers who work in that system do every day. They do achieve amazing things, and when it’s your life or your child’s life or your mother’s life on the receiving end of those amazing things, there is no such thing as a runaway cost. You’ll pay anything, and if you don’t have the money, you’ll borrow at any mortgage rate or from any payday lender to come up with the cash. Which is why 60 percent of the nearly one million personal bankruptcies filed in the United States last year resulted from medical bills.”
— Steven Brill (America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System)

“The Universal Laws of Health Care Systems:

1. “No matter how good the health care in a particular country, people will complain about it”
2. “No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough”
3. “The last reform always failed”
— T.R. Reid (The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care)

“A recent Economist article on dialysis perfectly illustrates the inflationary impact of cost-plus pricing. Since U.S. clinics are paid on a cost-plus basis, they prefer to use expensive drugs rather than cheaper ones. In fact, many appear to order drugs in units that exceed what a standard dosage requires because they can charge the government for the wastage. Quoting a stock research firm, the article noted that many clinics preferred an injected drug with a price of $4,100 a year over the identical drug in oral form, priced at only $450 a year. Not surprisingly, the manufacturer of the oral drug responded by increasing its price above that of the injected version to make it more competitive!”
― David GoldhillCatastrophic Care: How American Health Care Killed My Father–and How We Can Fix It

“Japan has the oldest population in the world, and the Japanese go to the doctor more than anybody—about fourteen office visits per year, compared with five for the average American. And yet Japan spends about $3,400 per person on health care each year; we burn through $7,400 per person.”
— T.R. Reid (The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care)

“The concept of multivitamins was sold to Americans by an eager nutraceutical industry to generate profits. There was never any scientific data supporting their usage.”
― Paul A. OffitDo You Believe in Magic?: The Sense and Nonsense of Alternative Medicine

“What is needed, however, isn’t just that people working together be nice to each other. It is discipline. Discipline is hard–harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.”
― Atul GawandeThe Checklist Manifesto: How to Get Things Right

“We’re paying a lot more for everything because we have this naive assumption that healthcare can be a marketplace when everyone of us sitting here knows that when we’re sick, we’re not a savvy consumer of healthcare.” Steven Brill, America’s Toxic Pill

“It drove home to me the reality that in addition to being a tough political issue because of all the money involved, health care is a toxic political issue because of all the fear and the emotion involved.” Steven Brill, America’s Toxic Pill

“Billions of dollars are spent on technology and IT in healthcare, but most of that is for legacy enterprise systems. Very antiquated systems and procedures are in place in healthcare. Technology can change that. This tells me that healthcare is ripe with disruptive potential.”
Aaron Levie, CEO of Box

“Today, however, anti-vaccine activists go out of their way to claim that they are not anti-vaccine; they’re pro-vaccine. They just want vaccines to be safer. This is a much softer, less radical, more tolerable message, allowing them greater access to the media. However, because anti-vaccine activists today define safe as free from side effects such as autism, learning disabilities, attention deficit disorder, multiple sclerosis, diabetes, strokes, heart attacks, and blood clots—conditions that aren’t caused by vaccines—safer vaccines, using their definition, can never be made.”
― Paul A. OffitDeadly Choices: How the Anti-Vaccine Movement Threatens Us All

“A patient in the American health care system has very little leverage, has very little knowledge, has very little power.” Steven Brill, America’s Toxic Pill

Theranos – A Case of Disruptive Innovation in Healthcare

“My own life’s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.”

Elizabeth Holmes, CEO, Theranos

Disruptive innovation by definition is an innovation that helps create a new market and value network, eventually disrupts an existing market and value network, displacing an earlier technology. Generally these innovations are cheaper, faster and more convenient compared to incumbents. Medical Diagnostics is an area where a lot of such opportunities exist and one company (valued at around $9 Billion) that has made big news in 2014 in this arena is Theranos.

According to Clayton Christensen, three things characterize disruptive innovations – simplifying technology, business model innovation, and a disruptive value network. Let’s examine how this maps to Theranos’ offering:

Simplifying Technology

Until now blood was drawn out of veins, stored in vials and transported to labs for testing.  Theranos has completely transformed the process with its patented technology. The technology utilizes microfluidic chips to conduct minimally-invasive tests with a drop of blood to deliver results within a few hours. Moreover, by automating most of the processes the company claims their results are more accurate and specific than traditional tests.

Business Model Innovation

By being able to provide personalized lab test data anytime, anywhere at a fraction of cost Theranos enables patients to be more engaged and participative in their own health. While higher prices, drawing blood out of veins dissuaded patients from getting tests done, Theranos’ innovative business model allows them to overcome these pitfalls.

Comparison of Theranos with Traditional Lab Tests

  Traditional Lab Tests Theranos
Average Costs $100 <$50
Time Days – Weeks Few hours
Quantity of Blood Required 3 oz. Single Drop
 

Value Network

Traditional blood-tests require patients to visit labs. They are essentially centralized systems. To address the problem of accessibility Theranos has adopted a retail framework to decentralize blood-testing process. It has partnered with Walgreens and a few hospital groups to administer its tests. Further, the company aims at building a pathologist-centred model and is therefore focusing on establishing relationships with pathologist groups.

In most aspects, things look very promising for the healthcare start-up. But there are a few caveats. In his article A Disruptive Solution for Healthcare, Christensen points out that disruptive innovation rarely happens in a piecemeal fashion. The new value network needs to be merged with the existing reimbursement, regulatory, insurance and provider systems. It requires disruption and remodelling from these players in the market as well. From the standpoint of Theranos, integration with payers, hospitals poses a huge challenge. If it decides to go purely via patient self-ordered tests route, educating the patient community would be crucial to its success. Whatever route it chooses, it’s certain that Theranos is here to stay and as the CEO of the company puts it, it’s here to “redefine the paradigm of diagnosis”.

Mobile Healthcare Technology: A Crucial Lever for Patient Engagement

While there are many cases illustrating how an engaged patient is a great asset to the healthcare ecosystem, one of the most compelling is that of Eric Dishman’s. In his TED talk, Eric shares his personal experience with the inefficient healthcare system. Through his own example he demonstrates how mobile technological tools can help fill in the gaps of the current flawed system. More importantly, he champions the role of a more engaged patient as a way to improve healthcare outcomes.

Patient Engagement is a Focus Across all Stakeholders

Healthcare has long been a paternalistic, hierarchical, doctor-knows-it-all industry. With the advent of the internet, social networks and smartphones this is no longer so. Patients today are much more informed, connected and ready to take an active role in their fitness and well-being. Moreover, in the wake of Affordable Care Act, patients are paying higher deductibles and out-of-pocket payments that further require them to take stock of their own health and wellness. As healthcare transitions from pay-for-service to pay-for-outcomes, providers have to ensure their services are effective and efficient, which necessitates a highly engaged patient. For payers as well patient engagement is pivotal to achieve shared savings under new delivery structures such as the Affordable Care Organizations (ACO) and Patient Centred Medical Homes (PCMH). Given that poor adherence costs US healthcare nearly $290 billion a year, patient engagement has been rightly deemed as the ‘blockbuster drug of the century’.

mHealth to Drive Patient Engagement

Mobile Health (mHealth) has enormous potential (as highlighted in Eric’s example above) to revolutionize healthcare through patient engagement. And as the focus of the healthcare system moves to Meaningful Use Stage 3, the strategic importance of mHealth is all the more pronounced.

mobile-solutions-chillmark

Source: Chilmark Research

As highlighted in the figure above, mHealth started with simple data storing and sharing systems moving to sophisticated preventive engagement. The applications include SMS medication reminders, remote medical advice and remote monitoring. A few recent innovations in the patient  mHealth space are as follows:

Education and Wellness

  • Kurbo Health: Mobile subscription service focused on fighting childhood obesity
  • HealthTap: Access to doctors anytime, anywhere to get personalized answers
  • Prana: Wearable tracking breath and posture

Remote Monitoring

  • Medtep: Targeting disease prevention through monitoring life habits
  • Nephosity : Collaborative medical imaging services
  • Sano: API for bloodstream (not yet launched)
  • ViSi Mobile System: Platform for vital signs monitoring designed to keep clinicians connected to their patients

Diagnostic and Treatment Support

  • Cellscope: Smartphone enabled home otoscope
  • Lantern: Offers online and mobile coaching programs to support mental health
  • Helius: Clinicians, patients and families can use the real-time information about medication-taking, rest and activity to make informed treatment decisions

The use and popularity of above applications attests that mobile technology enables patients to be more informed, collaborative and committed. But integration of IT systems, complex healthcare environment, quantifying the benefits, measuring the ROI, patient stickiness and privacy concerns pose serious barriers to adoption. Given an opportunity to save $290 billion and a case as compelling as Eric’s, can we afford to ignore it?

Pharma & Social Media : A Strengthening Relationship

As one of the most heavily regulated industries, it has not been easy for pharma to incorporate social media into their business. Recently, the FDA delivered the The Social Media Draft Guidance Webinar clarifying the rules pharma companies need to adhere to while engaging on social channels. Although not exhaustive, the initiative has provided the much needed buoyancy to the lukewarm efforts of pharma on various social platforms.

Johnson & Johnson is a leading example of how a pharma brand has successfully used social channels not only to improve its brand presence but also to start dialogues on some of the pressing issues in healthcare. The firm has been active on traditional social media sites such as Facebook, Twitter and Youtube where it essentially shares content to increase awareness of diseases, promote understanding of various research studies and recommend health related articles. In addition, the company was also quick to utilize the non-traditional social channels such as Pinterest to further support its campaign for nursing. Here are some ways in which phrama can further enrich its partnership with social media–

Monitor

  • Patient and HCP Activity: It is observed that most online health communities are centred around patients, care givers and health care professionals. While patients and care givers use online forums to search information and seek support, HCPs use them for social networking, gather patient info, share views on current research and concerns over treatments. Drug companies can dig this data to learn about patient and physician behaviour. This would help them identify and increase the relevance of their communication. For instance if multiple patients are reporting certain side effects of a drug that couldn’t be identified during the drug discovery process, pharma companies can take note of it and incorporate this information on their labels. In addition, pharma can use these channels to collaborate with key opinion leaders to effectively position and target its drugs.

Respond

  • Crises management: Among other things patients use social platforms to discuss side effects of the drugs they are using. Of these side effects, there are some that would require further investigation for possible adverse event reporting. Pharma companies can put analytics to use to identify such events and report to FDA which mandates adverse event reporting.

Amplify

  • Education: In light of lack of trust in between patients and pharma companies it has become crucial to improve this image. One way of doing so is through education. For instance firms can create interactive social media content that would explain the public about overall costs needed to develop a drug. Additionally through Facebook, Twitter, Youtube firms can share insights on disease condition that aims at making people more aware of them and hence better tackle them.

Lead

  • Crowdsourcing: The wisdom of crowds to solve problems has become very popular in other industries but not as much in pharma. Social media allows for a much wider audience’s (patients, GPs, nurses, scientists) collective expertise to find solutions to issues that cannot be solved by individual specialist groups. For example a translational science institute utilized crowdsourcing technique to reduce inefficiencies in the drug discovery process which in turn decreased the cost of drugs and also helped in a speedier drug adoption. Another glowing example is the website PatientsLikeMe that basically crowd sources patient outcomes.
  • Clinical Trial Improvement: By listening to what patients are talking about on social media, pharma companies can get insights on clinical trial program planning. These insights would help them make faster trial enrolment and trials more accessible to patients that need them.

The use of social media in pharma is essentially to develop and nurture stakeholder (patients,HCPs) relationships. Being heavily regulated, pharma needs to be very vigilant about how it does that.  Probably the ‘Listen more than you speak’ approach seems like the most viable option for now.