Healthcare transformation and the 3 digital truths
Technology is shifting the global landscape from being paper dependent to embracing digital. The rapid growth of digital information allows greater connectivity between sectors (health and social care, for example) and organisations previously in silos, which can benefit consumers and organisations by creating greater opportunities to collaborate and more data to drive insights. Digital approaches also open avenues for new types of interaction.
Momentum has been gathering, and today every aspect of our lives is moving away from simple digitisation to digital transformation, where larger and more disruptive change is affecting society as a whole (think Facebook), industries (think Airbnb) and creating big winners and losers (think Kodak).
Retail, banking, insurance and transport have undergone major digital transformation already. Healthcare is just on the cusp. Here we will explore the lessons from digitally mature sectors to see how they will apply to healthcare.
The three great truths
At DXC Technology, we talk about the three truths of digital transformation:
The consumer is already digital and will define the next move.
Platforms disrupt value chains.
Winners exploit platform effects.
In what ways do these apply in healthcare, and where does the industry diverge from others?
Truth #1: The customer is already digital and will define the next move.
The one proviso worth raising here is the use of the term “customer” in this context. Given the global mix of socialised and customer-based healthcare and the increasing importance of the wellness sector, the term “citizen” might be more appropriate. That said, it is largely true that citizens are digital. We know that the proportion of the world who use digital connectivity is high and growing. We also know that particular cohorts vary in this regard, from very high use in young people with chronic disease to lower penetration in the elderly. But even this is changing and most of the children supporting their elderly parents are connected.
The first sub-phrase in Truth #1 is valid, but do citizens define the next move? Not yet, and the rate of evolution here is likely to be context-specific, with key determinants including payment models (socialised, insured, pay-as-you-go) and digital trust. Organisations such as KRY and HealthTap are providing new services to citizens. There is also promise that new products such as Babylon Health, which uses next-generation cognitive approaches to give you a doctor in your pocket, will truly empower citizens to define the next move. Assuming these organisations can earn and maintain trust, they will provide convenience and will disrupt healthcare providers who do not make these citizen-facing digital approaches part of a 360o digitally optimised portfolio of products and services, a critical element within the 21st century organisation, as described in the Leading Edge Forum (LEF).
Truth #2: Platforms disrupt value chains. But what does value chain mean in healthcare?
Harvard Business School Professor Michael Porter describes the value chain as a “collection of processes, inputs and outputs that take place to produce a product or service”. In healthcare, the value chain may include governments, regulatory agencies, primary care, secondary care, social care, professionals, insurance, other payers, life sciences, academia, and of course the patients and those who take care of them. This is a very complex value chain indeed, made more so because of the challenge in defining value in healthcare. The complexity of resolving the politics and governance of a move towards accountable care is high compared with the challenges involved in digitisation.
In his six-point strategy, Porter elaborates on what value means in healthcare, emphasising the need for a digital platform along with organising care around the patient, measuring outcomes and cost for every patient, paying for care differently, integrating care delivery across separate facilities and breaking down the local nature of care delivery.
Of course, inherent here is that the current value chain is inefficient and clinical effectiveness is not optimal, and the digital approach can support better care that can be further driven by new payment models. These will need to be developed by analyses of existing integrated data using modern product life-cycle management approaches. No one has really implemented effective value-based payment at scale, in our view, and so the rules need to be written, which will require innovation and inevitably be disruptive.
An interesting angle on the digital platform in the healthcare value chain concerns the place for direct citizen engagement. For example, we have been involved in the development of a platform and medical app market place to bring together products that help citizens better manage their diabetes and associated risk factors while also helping all stakeholders to visualise key information (with consent) to support outcome improvements. The project is led by clinicians, which is key to embedding the digital trust that is essential to get patient engagement. Exactly how such approaches fit into health and wellness care is yet to be determined, but they will surely have a place.
The politics in all of this is clearly complex, and whilst the technology is not easy, at least we understand what is needed to build a future healthcare platform, including data integration, consent management, embedded analytics, clinical decision support, role-based access and security, resilience, optimised user experience for all players, scalability and the agility to benefit from future unexpected developments. And we also need all of this delivered at optimised cost. In this environment, data will flow securely between previously stove-piped systems, with artificial intelligence (AI) “bots” continually monitoring the stream of data looking for abnormal events (such as increasing blood glucose levels of a diabetic) and automatically alerting patients and the relevant care provider to transform outcomes, as well as supporting multiple new forms of interaction between all players.
The good news is we have most of the basic ingredients to make this vision possible, such as hybrid cloud techniques, mobile applications, interoperability standards, machine learning algorithms and the internet of things. However, like any great chef, the magic is in how you combine these raw ingredients into a great meal. It is one thing to describe a strategy in PowerPoint and another to implement a successful plan. Organisations need to become Michelin-starred digital healthcare “chefs”, adept at harnessing deep healthcare and technology expertise and taking an idea from concept to reality in months.
Truth #3: Winners exploit platform effects. What are winners in healthcare?
The third truth is that winners exploit platform effects. To understand whether this applies, we need to consider from whose perspective we consider “winners and losers”. If we link back to the first truth (and the Hippocratic Oath), all discussions should be framed around the citizen winning, but you can view things from the perspective of providers, payors, medical professionals, life sciences or wider overall economic benefits to society. The sweet spot here must surely be accountable care systems exploiting platform effects for the benefit of the citizen.
Digital platforms enable exponential interactions, collaboration and, as a consequence, more value. Most of the top 32 brands globally, according to Interbrand’s Best Global Brands’ rankings for 2016, are already platform businesses or well on the way to becoming that, and each platform has a different focus, depending on the industry sector.
There are digital healthcare platforms emerging that give value through sharing data for direct care, better platforms and substrate for analytics and innovation, utilising care co-ordination to drive efficiency and clinical effectiveness across complex landscapes and, possibly of most importance, segmenting the population to drive citizen-intimate care for key cohorts. And these platforms also can drive actions directly into the work flow of those delivering care, thereby improving outcomes and mitigating the real risks of information overload in digitised health and care ecosystems.
And the losers? Well, radiology is ripe for disruption from machine learning and collaborative platforms. How much of dermatology needs direct face-to-face consultation in an era of effective telemedicine? How will a hospital’s business case stack up when everything that can be done outside its walls is done in the community, unless hospitals reconfigure to maintain a slice of the pie? There will be other winners and losers as we start to target medications towards precision-based care rather than the implementation of crude guidelines. The list goes on and on, but no one knows how it will play out right now.
In summary, the three digital truths apply to healthcare, maybe not entirely and with some contextual subtlety, but it certainly seems a decent place to start considering how to enable digital transformation of healthcare at scale. The next stage in understanding digital transformation includes mapping the digital truths to four dimensions: digital customer experience, business model innovation, digital organisation and process transformation/digital core. We will pick this up in a future blog.