There is tremendous innovation in cancer research these days, which was recognized just last week with the Nobel Prize in Medicine awarded to two pioneers of immunotherapy.
This inevitably begs the question, what’s next? It’s a good time to take a step back from the day-to-day changes in cancer care and take stock of the disruptive trends pushing the broader healthcare system — and therefore cancer care — forward over the next five years.
Before we examine the future though, let’s start with the reality of today. Today, we have precision medicine without a precision care delivery system. The advance in molecular understanding of disease and immunology, the ubiquitous availability of DNA sequencing, and unheralded investment into scientific research have led to an explosion in scientific innovation and new treatment paradigms such as immunotherapy, CAR-T, and gene therapy. Yet the day-to-day delivery of patient care remains largely unchanged and even somewhat medieval. When I was at the White House Frontiers Conference in 2016, Pfizer’s Chief Medical Officer Freda Lewis-Hall memorably put it best: “We have Star Wars medicine in a Flintstones healthcare system.”
From manufacturing to transportation, technology-enabled solutions have helped countless industries deliver higher quality at lower costs. In healthcare, this is called “value-based care.” Healthcare delivery, however, has not had labor productivity gains and is more often technology-disabled than technology-enabled. For a three trillion dollar industry and with millions of patient lives at stake, this is a major problem both to our economy and our health.
Everyone knows that we have a problem — fragmented information systems, scattered care teams, variations in care, complicated insurance policies, and clunky point-of-care software, all distract from the fundamental pursuit of higher-quality care at a lower cost. The slow march toward value-based care has been stymied primarily by three obstacles:
- Data and care delivery infrastructure that wasn’t developed to target and meaningfully engage specific groups of patients
- Lack of transparency and choice in the cost, access, and goals of care
- Business models that can’t sustainably scale
Over the next five years, we can expect to see the confluence of two trends that will address these obstacles and turn today’s upside down value equation on its head: precision care and the consumerization of healthcare. Specifically, this means precisely identifying patients (e.g. data analytics) and engaging each patient in a way that is best suited for him or her (e.g. telemedicine, asynchronous care, home-based care) to achieve patient-centric outcomes at the lowest cost (e.g. system efficiency, price transparency).
Traditionally, patient and provider business models have been challenging, leading to underinvestment and incremental innovation in these areas. This has been compounded by the “foot in two canoes” problem of fee-for-service and value-based care. Meanwhile, payer, life science and consumer tech businesses have all thrived. We are at a unique point in time, however, where the lines are beginning to blur. Payers are becoming providers (UnitedHealth/Davita, Aetna/CVS, Anthem/Aspire), life science companies are doubling-down on data capabilities (Roche/Flatiron Health, GSK/23andMe), and consumer tech companies are charging into healthcare delivery (Amazon, Apple, Google).
In essence, healthcare is going full-stack. This ecosystem will sustainably drive higher quality care at lower cost with the precision care and the consumerization of healthcare for which patients and providers have been waiting. In business and soon healthcare, value wins.
Photo: Flatiron Health