HEALTHCARE

We can expect healthcare to continue changing with digitalization, patient needs, provider and drugs regulations and AI stepping into the healthcare landscape.

TRENDS AND CHALLENGES

The Affordable Care Act had a strong impact on the healthcare industry. In short, it suddenly increased demand on the health system by allowing uninsured patients access to care, which was before somewhat limited.

Overall, the system has to take care of more patients with the same allowance. It triggered in many states a large decrease in provider reimbursement triggering a change in insurance network organization. Insurance rules became somehow more complicated putting more workload on medical office staff. This increase in the number of patients needed to be seen created the need for more providers.

Given the time and cost to train physicians, the US system relies heavily on mid-level providers. Over the years, out of needs, they were given more responsibilities and clinical privileges. Despite that effort, there is still a large need for primary care providers in the US.

This problem is of course very variable depending on the region, big cities tend to have an over saturation. In that regards telemedicine is promising.

The need for medical providers is set to increase. This is a multifactorial problem: populations are increasing, access to healthcare is facilitated due to government intervention in health insurance, lastly some chronic diseases are more prevalent, this is particularly the case for diabetes.

Invariably, in each region of the world , density of provider does not always meet demand very well. Telemedicine offers a technical solution to allow patients living in remote areas with low medical density to have instant access to health care providers.

Telemedicine is not without challenges. Depending on the setting, physician might not have access to clinical data necessary to achieve standard of care. This is particularly the case for telemedicine phone app where the clinician decision making is mostly guided by the patient symptoms. In that setting, clinical exam is almost impossible to achieve. While this may offer patient reassurance for non urgent situation, it brings the question of quality of care and outcomes. Furthermore, more than likely, this initial telemedicine consultation will lead to a secondary visit in a physical location, increasing the cost of care.

To respond to the market demand for a better access to providers, scientists are looking into automation of processes in medicine.

An example of that includes digital kiosks in the doctors office.

We can easily imagine an electronic attendant that checks in the patient, verifies insurance benefits, charges copayments and proceeds with taking vitals such as weight, blood pressure and saturation.

This will reduce work load on the physician staff member allowing more time for direct patient care.

Another aspect of automation is machine enabled diagnosis. In the ophthalmic arena, major companies are working on automated analysis of retinal pictures to screen and grade diabetic retinopathy without human intervention.

A more recent study shows machines are also able to diagnose glaucoma based of optic nerve OCT analysis. Machine learning should soon allow for all imaging reading and analysis. We can also easily imagine blood work analysis.

Automation may not replace physicians or work autonomously but it can be part of the solution to ease processes and make the physician office more efficient.

Another seismic shift in healthcare are the major mergers and acquisitions taking place in the industry.

Two remarkable mergers are showing us a glimpse in the future: the planned merger between CVS and Aetna, as well as the merger between DaVita Medical Group and Optum (UHC Group). We can realistically expect to see more of those mergers at a time where insurers try to control costs of medical care.

The government has made the opioid crisis a priority. We can expect it to have consequences across the healthcare landscape: pharmaceutical companies will be impacted both for those who produce opioids and those who may come up with drugs to curb the addiction. We can also speculate that there is a market need for a pain management compound that is not an opioid in nature and that has little or no addiction potential.

The US health care system also views its patients as consumers and intent to meet their expectations. For instance, emergency room have never been the place for small medical urgencies. Meanwhile patients might not be able to see their primary care doctor readily. As a result to that market demand, urgent care centers are flourishing on every block in US cities. Pharmacies also intend to play a role, both due to their strategic locations, hours availibility and pharmacists increased scope of practice.