The Future of Healthcare
Carlos Sentís, Founder and CEO of World Innovation Alliance, Dr. Brian Jackson, an Associate Professor of Pathology at the University of Utah, Malinda Elien, Senior Technical Project Manager at Fresh Consulting, Dr. Biju Mohandas, Partner and Global Co-Lead of the Healthcare Investment Team at LeapFrog Investments, Marc Kuperstein, Managing Director of Software Development at Fresh Consulting, Ben Heiser, Vice President of Operations and Business Development at Lumicera Health Services, join Jeff Dance to discuss the future of healthcare in ten to twenty years from now, the emerging technologies that will impact healthcare the most, and how to design with more intent to improve the human experience.
Welcome to The Future Of, a podcast by Fresh Consulting, where we discuss and learn about the future of different industries, markets and technology verticals. Together, we’ll chat with leaders and experts in the field and discuss how we can shape the future human experience. I’m your host. Jeff Dance.
Jeff Dance: In this episode of The Future Of, we’re taking a slightly different approach. Today’s episode is centered on the future of healthcare. And rather than limit ourselves to a couple live guests this week, we’ve expanded our reach to more experts than ever to collate as much unique industry perspective as possible. Their insights hold significant value to understanding what the future of healthcare looks like ten to 20 years from now. The emerging technologies that will impact healthcare the most, and how to design with more intent to improve the human experience given the problems we’re actually facing today. So, join me, Jeff Dance on The Future Of, to listen to serious thought leaders on the future of healthcare.
Carlos Sentis: Hello everyone. My name is Carlos Sentis. I am the founder and CEO of the World Innovation Alliance. I am a consultant, a public speaker and a lecturer in a number of universities. I have worked for more than 130 large companies and institutions from multiple sectors on innovation, social impact, communication and international relations.
The World Innovation Alliance is an initiative that I launched as an ecosystem that brings together companies, institutions and remarkable individuals from all over the world. Already we have more than 1,000 experts from 150 different countries and it’s organized in commission. So we have a healthcare commission that is focused on healthcare, innovation, health tech, and more broadly, how can we collaborate between different types of stakeholders to maximize our ability to improve and expand access to healthcare? How can we leverage the best technologies to help more people to access better healthcare?
A big element of healthcare, as everybody shall know by now, is prevention, right? And so one of the things that we are extremely bullish on is the necessity of teaching kids and adults about healthcare. How can we have better information about health? Because most people have never experienced any sort of training about health at all. And we receive some messages about the importance of having a healthy life and doing exercise and so on. But there’s a lot of information that we’re lacking.
So, one of the things that we want to do and we’re inviting experts to join us to develop this, is a very concrete and practical guide of the top 100 recommendations from the best experts of different medical fields that could address 80% of problems of each specialty. Basically what we’re doing is trying to condense, with the principle, with the 80/20 rule, what are some of the most common problems and what are the most avoidable problems in health that we could just make people aware of and could prevent a big part of those issues just because you have the information and you know what to do to prevent it, or you know what to do when something arises, both for yourself or for everybody else.
And it is important because we are not trained on the importance of health and we’re not trained on how to practically improve our health or the health of our loved ones. And it’s funny that we are taught so many things in school and yet we live in our bodies and we need our bodies to function and it is pretty much the single most important thing and yet there’s no single specific subject in school or specific program to address this thing. What we’re doing is we’re building programs to advocate for this and to educate people about the practical health that individuals that are not medical experts can use and bringing together those best recommendations to address the biggest number of problems with the minimum amount of effort and the smallest intervention possible.
I believe if we look at what AI is doing and can do, if we look at what digital twins can do, if we look at generative design and combinatorial, if we look at the opportunities with gene editing, if we look at quantum computing and what that can do, we are leaving a revolution of new technologies that are converging and creating an explosion of opportunities for healthcare development.
Sam Altman, the CEO of Open AI recently expressed his vision of how AI and generative AI can create, per year, 1000 times more scientific output than before. And what he says is that we’re not ready for it because the amount of breakthroughs that we’re going to leave every single day is going to be absolutely unbearable for our own minds and it’s going to be very difficult to even consider what to do with all of this. But it’s going to allow us these new tools to allow us to, for example, test a million possibilities of a drug for a specific problem and find the best one, find the optimal path towards a solution in no time.
Digital twins are going to be extremely valuable for this. Also Cloud Labs, which is a concept of robotic laboratories that are there on demand so anybody can access it and request a specific experiment and it’s working 24/7. It’s obviously way cheaper than any other solution. Also, there’s very limited access to laboratories for people that are not working in a specific university or institution. And so the possibility of running digital experiments with millions of options until you find the optimal path and what seems to work can be sent to a laboratory that’s going to perform the physical experiment and it’s going to determine if it works or not. With that you’re going to be able to go and try to find the best solution or the best drug or whatever it is.
I think it is absolutely remarkable and it multiplies our ability to find solutions, it multiplies our ability to create papers, it multiplies our ability to crack the code of whatever issue we’re dealing with in a way that we’ve never seen before. Alpha fold. With 200 million elements in the database of different ways that products can fail, it’s going to unlock a huge number of breakthroughs as well.
So, this is just the beginning. I truly believe that generative design, so this idea of creating lots of different options based on combinatorial, creating the right fine tuning of the models and creating the right parameter and the right variables and the right framing of the question that we’re asking this machine, it’s going to be extraordinary.
Quantum computing is going to allow for a multiplication, again, an explosion of the things that we’re able to do with all of this. So I would say that we are at the verge of a unique moment in history. I think it’s going to be an incredible opportunity for health and innovation. I think it’s going to be a beautiful, beautiful moment also for humanity, at least from a health standpoint. But of course, there’s lots of considerations that we have to take into account.
Dr. Brian Jackson: My name is Dr. Brian Jackson. I’m an Associate Professor of pathology at the University of Utah and an adjunct associate professor of biomedical informatics. I’m currently living in London on a sort of personal sabbatical, but I’ve spent most of the past 20 years in various medical director and executive roles at ARUP Laboratories, which is a large medical testing company that’s part of the University of Utah. So that experience, having one foot in the corporate world of healthcare products and services, while having my other foot in the academic world, has given me lots of time to reflect on the intersection of healthcare corporations, medical ethics, and technology.
In my opinion, most healthcare technology companies over the past half century have been chasing after the wrong goals. So, as evidence for this, think about how healthcare technology, at least in a narrowly scientific sense, has become more and more amazing and admittedly, truly amazing. Well, at the same time, affordability and accessibility of those technologies and even older technologies has become worse and worse.
In the US, for example, low income patients with diabetes will routinely self-ration their insulin because even if they have insurance, if they purchase all the insulin they need for a given month, they might not have enough money left over to pay their rent.
Here in the UK, there may not be that insulin problem, but people are being encouraged to self ration emergency care because the hospitals in the UK, at least in the National Health Service, just don’t have enough staffed beds. And so, this reduces the throughput and efficiency of the A&E departments. Patients are stuck waiting in ambulances for hours because there’s no room for them to get in, even though they need care urgently by definition.
Insulin, ambulances, hospital beds, A&E departments––these are all really old technologies in our healthcare system. But what good is a technology if it’s not available to the person and at the time that it’s actually needed? So that’s why I find it so frustrating when I look at healthcare technology investment across high income countries, because most of that investment continues to be directed at drugs and devices explicitly designed to capture higher and higher prices, rather than trying to address these larger needs.
Over the past half century or so, patients’ expectations of autonomy have increased at the expense of paternalism and physician authority. So, as an example of this, think about the episode of The Crown where King George VI was dying of lung cancer and he had surgery, and the king thought that his surgery had cured him, even though the physician knew full well that it hadn’t, that he was still going to die pretty soon.
The reason the physician hid the truth from the king was out of concern that the bad news would negatively affect him. So this sort of thing would be unacceptable in today’s world. Patients expect to be told the full truth. And this expectation of truth is part of this larger principle of autonomy, which extends to a lot of other domains.
For example, patients want to be able to buy their own medications over the Internet, and they’d rather not have to talk a doctor into prescription in order to do that.
Here in the UK, a lot of patients purchase private insurance plans in order to give them more control and personal choice than what they can get through the NHS.
In Scandinavia, it plays out a little bit differently, given the egalitarian culture there. But there’s an interesting trend in Sweden, where renal failure patients who need hemodialysis are increasingly operating the dialysis machines themselves. Patients aren’t required to do this. They can still have the nurse run the dialysis machine if they prefer, but a lot of patients actually do want to do it themselves. And so they’re taught how to insert the needles into their arms, turn the dials, adjust the settings, all these highly technical tasks that have been traditionally performed by nurses.
Whether you use the word consumerism or not, I think there’s a real trend here, a real thing that has to do with patient autonomy and control and self determination.
Malinda Elien: My name is Malinda Elien. I’m a Principal Technical Project Manager at Fresh Consulting. I have over 20 years of experience in end to end product development, with a focus on product development of medical devices.
Given today’s problems, it is particularly important that we pay attention to designing products that will work for everyone, regardless of socioeconomic status, location, gender or skin tone. We need to keep in mind the full range of human condition and try to design products that will work for as many people as possible.
For many years, the target patient for many product design decisions was a man from a European or North American country, and then the product was partially adapted to meet the needs of women or people from different geographic locations.
The pandemic really demonstrated how healthcare is a global problem. As designers, we need to be intentional about making sure the effectiveness of the products we design is not limited based on who or where you are.
I’m particularly excited about augmented reality and how it has the potential to improve diagnostics and enable more advanced remote care. As you read about the challenges and access to healthcare in rural areas, technology that will enable healthcare providers to get more robust information about the patients they are seeing remotely may be a game changer for ensuring better management of care, even with fewer hospitals and clinics.
In 10 or 20 years, I would expect that the demands of an aging population in advanced countries will require a greater focus on affordability of the medical devices that are developed. As device developers, we need to be careful to develop products that can meet the needs of the majority of the population rather than the privileged few, and advocate for funding streams that encourage development of devices and solutions to help manage chronic conditions across the entire population.
Dr. Biju Mohandas: Hi, I’m Dr. Biju Mohandas. I’m a Partner and Global Co-Lead of the Healthcare Investment Team at LeapFrog Investments. We are an impact investor, managing about $2 billion in assets across Asia and Africa, investing in businesses that provide access to financial services and healthcare to emerging consumers in these markets. Prior to LeapFrog, I spent two decades as an operator and investor in the healthcare space across multiple countries in Asia and Africa, starting my journey as an officer in India’s Medical Corps.
If we are to design with intent in the healthcare sector, I think as a first step, we should zoom out and recognize some secular trends which are spanning the globe and are manifesting pretty much across every country.
One, life expectancy is increasing. Global life expectancy today is about 73. In the nineties, it hovered in the 60s. significant increase. However, the healthy average life expectancy today is about 63 years. This is the number of years an average human lives in good health. As is obvious, there is a large gap between the average life expectancy of about 73 and the healthy average life expectancy of 63.
So put a placeholder there.
Secondly, non communicable diseases as a proportion of global disease burden has risen dramatically, these diseases now account for about 70% of the mortality globally. They’re also a major reason for the growing gap between the healthy average life expectancy and the life expectancy that we discussed earlier.
Now, if you put it all together and look into the future as early as 2030, we will have one in six humans over the age of 60. By 2050, the number of people over the age of 80 would have tripled. This by itself isn’t bad at all. However, if we haven’t course-corrected, at this point, NCD-driven gap between the healthy life of the 60 year olds and 80 year olds and the length of life that they are going to live will keep increasing. And if that happens, we are looking at a world with enormous financial burden of health for families and for states, as well as a world where the scarce human resources involved in healthcare are going to be stretched to a breaking point.
This is the context in which one needs to think about designing with intent in healthcare. Thankfully, the solution, at least theoretically, is rather simple. While genomics are a factor, most non-communicable diseases are influenced by social determinants of health: sleep, diet, fitness, stress, etcetera. And most of these social determinants can be influenced by the individual to a large extent.
Hence, the important design shift in health is to shift it from what it is today and what it has been for the last several hundred years––an episodic treatment of disease, or sick care––to a regular prevention of disease and enabling of wellness.
This in turn means shifting the agency. So far, the agents of healthcare have been doctors, nurses, paramedics, and the venue of healthcare has been hospitals, clinics. This needs to shift. The agent has to be the individual himself or herself, and the venue has to be wherever that individual is their home, their office, or wherever else.
So what will the future look like? Let me give you an example.
I come from a family with a history of diabetes. I got my annual medical check done last year and found my HbA1c, the Glycated hemoglobin levels to be on the higher side, not yet pre-diabetic, but close to that. I happen to have led an investment into India’s largest digital wellness app called HealthifyMe. I mean, they have about 35 million registered users who use a combination of AI and human coaches to help individuals take charge of their own health.
I signed up for one of their programs, which meant wearing a continuous glucose monitoring patch, typing in my food intake and exercise, and being coached by a fitness and a diet coach. The CMG patch recorded my blood glucose levels real time and the effect of various external inputs such as diet and exercise on these blood glucose levels. The coaches were able to use these inputs to design a fitness and diet program tailored for me and my body and how it reacts to diet and fitness and help me monitor and stick with this program.
For about $40 or $50 a month, my HbA1c decreased drastically to well below the danger zone, and I happened to shave off some fat and add some muscle in the process. All this took about five to six weeks.
While I didn’t use them in this particular instance, I could have started the journey through genomic sequencing at one of our other portfolio companies, MedGenome, India’s largest molecular diagnostic firm, and understood how my gene causes me to have predispositions to certain diseases, diabetes or others.
I could have gotten my annual blood work done in the comfort of my home via Redcliffe, another investment of ours, which sends phlebotomists home to allow an individual to get their health checks or diagnostic checks done at the comfort of their homes at a fraction of the price and very high quality.
I could have, without leaving my house, gotten my stomach sequencing done, understood the prediction to various diseases. As a result of that, I could have gotten my annual medical checkup done, and then eventually these coaches, with the very tailored and customized program, could have helped me achieve my health goals and prevent illness as opposed to having to go to a doctor.
In this entire process, I did not use the word doctor or nurse or hospital even once.
For me, that is the future of healthcare that we are driving towards. And while use of technology will include high sciences, cheaper, better medical equipment, more targeted and customized drugs, gene-based therapy, personalized medicine, etcetera, the most massive shifts will happen by leveraging relatively simple tools like your mobile phone, but will require a massive shift in thinking and in the design of health systems.
Ironically, in my view, these shifts might happen faster in the emerging world, countries in Asia and Africa where the health system currently is still nascent and therefore better suited to leapfrogging into this new age.
Marc Kuperstein: Hi, I’m Marc Kuperstein, Managing Director of Software here at Fresh Consulting. One of my jobs here is to make sure that we are dealing with the emerging technology and building solutions for our clients. We look at best ways to solve problems with today’s modern technology, to keep all of our ideas fresh, if you will, and make sure that we are providing the best opportunity, the best consulting to our clients. In the area of health care, prior to coming to Fresh, I was one of the executive leaders at Microsoft Microsoft Health Team, helping build out our health products, including Fire, FHIR, Best health information, resource, DICOM, MedTech, things like that.
COVID taught us that people don’t want to come into the doctor’s office always, they’re happy to be at home. And one of the segments that I think things are really emerging is this whole notion of IoMT: the Internet of Medical Things, medical devices or even consumer devices that collect medical data––your blood pressure, your pulse oximeter, your temperature, whatever it happens to be, how to collect that data in a meaningful way and get it to the clinicians who can actually act on that and deal with the data as it’s happening?
One of the problems in AI is, do you have enough data? But over time, that issue will hopefully get resolved where more and more people collaborate to build these models and to share information. And I think we’re going to see a lot of breakthroughs as we think about looking for predictive analytics around data. Right? If we’re looking at data over time, can we predict what’s going to happen? Can we look at what we expect to see next? Or can we recommend treatments or missing gaps in care? We’re using models to help us. This is what we expect the normal clinicians to find, what the norm is, and then we can look at a person’s data and make determination on how to act on that data and make it meaningful.
Of course, the whole notion of AI models is growing like crazy right now. And of course, this pure technology, the things we can do now, miniaturization small components, being able to follow the patient. I saw a demo the other day of a blood pressure cuff that sort of was a very lightweight device. It clipped on your arm. It didn’t wrap around. It wasn’t a big multi blood pressure meter. It was a very non intrusive device that you could wear constantly. It would send data to your phone and bluetooth, and then that could transmit over the Internet, cell versus cell.
You have the ability to be monitored while you’re out doing things. You don’t have to stop to take your blood pressure. The system can do that for you.
Ben Heiser: Hi, thanks for having me on today. My name is Ben Heiser. I’m Vice President of Pharmacy Operations and Business Development at Lumicera Health Services. In my role, I oversee all the operational aspects that go into providing exceptional service for our patients, as well as the strategy and continually developing our business to meet the needs of our patients and clients. This includes making sure that we’re positioning ourselves to be a key player in the future state of healthcare.
I think when you’re looking at technological advancements in healthcare, I think there’s a lot of different directions you can go here. And I think there’s a lot of different things that will come into play. And that in and of itself is quite exciting. I think you can look at virtual reality and blockchain, machine learning. I think genomics, proteomics, digital therapeutics, I mean, it’s pretty crazy. We’re already at a point where there are certain things like sleep, where the digital therapeutic might be something that’s preferred over a traditional medication that has its downsides.
But a couple of things that are of highest interest for me, I think, are around continued development of preventative medicine and really the advancements in personalized medicine and a deeper understanding of how both our genomics but then also more so our proteomics and all those other -omics out there to better understand how they interact with everything that we do––from the food that we eat to our sleep, to the environmental stressors that we face––influences each of us individually and impacts our health.
The human genome took years to sequence and it was very expensive. We’re at a point now where that’s quite a bit cheaper and a lot easier to do. And it’s great that we have that information at hand on people’s genomes to be able to understand what risk factors they face for certain disease states. But those genomes are fairly static where the proteins in our body are actually quite a bit more dynamic. And I think the more that we start to understand the impacts of those, we can better understand the impacts of the things that we do, how they impact our health, and really start to dive into individualized personal care.
We need to really shift from what we currently have as a procedural reimbursement model, which is really healthcare organizations getting paid to perform procedures, dispense medications, etc. It’s really a broken system and we need to start charging for the value that’s being added from a healthcare standpoint, not for essentially marking up medications or procedures.
We can’t really prevent everything. So when things do occur, I think it will be a focus from managing with treatment throughout the rest of life to moving towards how can we cure more things through continued advancement and expansion of gene therapies.
Now obviously this comes into question is who’s going to pay for all this preventative therapy and curative therapy? And I can’t say with 100% certainty who will be investing in that. We could be looking at a situation where the government would have interest in that given the massive amount of spending in healthcare right now, but I don’t necessarily want to go down a political rabbit hole right now.
It could also be a burden of our employers looking for healthier, more productive employees so that not only do they have those productive employees, but they also lower their overall healthcare costs in the long term.
At the end of the day, again, it all comes down to value. There will be a need to identify the value provided in those preventative investments and there’ll be a need to show the value in those curative therapies for it to make sense, to be economically feasible for more patients to be able to be exposed and benefit from those. Additionally, I think there will be an enhanced visibility of the cost within healthcare and where that dollar is truly going and more and more emphasis on organizations like Navitus and Lumicera who are maximizing that value by decreasing the administrative costs that are very much bloated in the healthcare industry currently.
It’s pretty crazy that 78% of Americans have greater than an average amount of fear as to how much their health care is going to cost and will sometimes forgo taking their medications or getting treatments or procedures as a result.
That’s not going to help move us forward in the direction that we’re talking about. That’s only going to compound the issues that we currently have.
I think organizations need to make sure that they have a focus on providing value so that these preventative and curative therapies are more attainable, and we get rid of the excess that’s being taken from the system in the current landscape.
Jeff Dance: The Future Of podcast is brought to you by Fresh Consulting. To find out more about how we pair design and technology together to shape the future, visit us at freshconsulting.com. Make sure to search for the future of in Apple podcasts, Spotify, Google Podcasts, or anywhere else podcasts are found. Make sure to click subscribe so you don’t miss any of our future episodes. And on behalf of our team here at Fresh, thank you for listening.