Future of Healthcare

6 Big Themes from HLTH 2021

by Mona Schreiber | Nov 2, 2021

Our team chose HLTH 2021 as our first conference to attend since the pandemic began. It was a fantastic experience—here are 6 big takeaways.

Practicing clinicians need to be here

What’s the easiest way to get a digital health solution adopted into clinical practice? Solve a real challenge, integrate seamlessly into the clinical workflow, and enhance both patient and clinician experience (we’re taking “Do no patient harm” as a given). This might sound like a lot to strive for, but all these elements are essential. We noticed that the majority of panels and conversations at HLTH were among entrepreneurs and CXOs. While medical expertise was showcased, we didn’t hear from many practicing clinicians who see patients day in and day out about their perspectives on these trends and solutions. We at MDisrupt know that involving clinicians early and often in your healthcare solution yields better and faster adoption. So let’s stop discussing healthcare in silos and make sure all stakeholders have a seat at the table and a voice in the process of digital health development. We’re all united in addressing the same challenges.

Health equity is on everyone’s mind

New health care delivery models like telemedicine are here to stay—entrepreneurs at HLTH made that very clear. Many top payers have even announced virtual-care-specific plans to be launching soon. That’s great for those with reliable internet connection who know how to use technology. But conversations among entrepreneurs and payers revolved around how to reach those who haven’t been reached yet, to enable a more inclusive experience. This included discussions on payment models beyond self-pay and ways to reduce barriers to health literacy based on socio-economic background. From our perspective, the conversations around health equity are important—but now it’s time to move beyond conversation and into action.

Implementing available solutions into the current system is hard

Right now, consumers have access to a plethora of digital health solutions. But there’s a huge gap between what consumers can access and what actually gets used and is clinically useful in the healthcare setting. Furthermore, the consumer/patient experience becomes very disjointed once they bring digital health solutions to healthcare providers with no knowledge or experience of these solutions. Often the potential health outcomes and the ROI of the solution are not clear. The current solution for this is that the big players in healthcare like to test solutions with ‘Pilots” However the term “death by pilot” was heard a lot during HLTH. Our favorite quote came from Chrissy Farr’s interview with Alan Lotvin MD, who is EVP of CVS Health; he said, “Big companies in healthcare like to torture small companies.”

Payers, providers, health systems, and employers all agree that we need a better system of vetting evidence based digital health solutions. How do we solve this? At MDisrupt, we believe that missing from our industry is a unified standards system for digital health to assess the real-world clinical performance of these products. We intend to focus on this monumental challenge over the next few years.

Healthcare’s tech shift was super-accelerated by the pandemic

This was the first conference we’ve attended where a testing protocol was implemented at the conference. Every single person who attended had to be tested. And we have to credit HLTH, as the process was relatively fast and efficient. Deployment happened through an app, human guides helped us through the process, and an onsite testing system delivered results to us in 20 minutes via our apps. This is a demonstration of just how far we have come in digital health in just two years. It showed us that we can bring lab testing closer to the consumer at scale, we can make it more efficient and more convenient, we can take care of people where they live and where they work. Now that we know it can be done, imagine if this could be applied to all areas of healthcare!

Mental health is no longer an afterthought

The pandemic changed the way we think and talk about mental health. Treatment and services for conditions that were once stigmatized, with care available primarily for severe cases, are now becoming part of the norm. . Leaders in mental and behavioral health came together at HLTH to discuss improving delivery models, like telemedicine; integrating mental health practices into a complete healthcare plan, and, best of all,making these changes mainstream. There’s still a long way to go in reaching the masses, but it was clear that technology can make it happen.

The need for human connection is so real

As we registered for HLTH, we were asked to choose a wristband that signaled how you wanted to be greeted:

Green bands signaled that you were ok with hugs and handshakes
Yellow bands signaled that you preferred fist elbow bumps
Red bands signaled a no touch-greeting.

By the end of the first day, the basket of green bands was completely empty, with the majority of us selecting them. After two grueling pandemic years—in which many of us have been in lockdown and seen the suffering and loss of many people close to us—it was clear how much we all needed human contact. There was a lot of welcome hugging and handshaking as folks who hadn’t seen each other for over two years reconnected. The unspoken feeling between us was that we are all in this together, and that we are the changemakers for a better future.

To quote this year’s HLTH motto: ”Dear Future, we are coming for you.”

If you want to dive into more interesting topics related to healthcare, check out our blog at MDisrupt.

At MDisrupt, we believe that the most impactful health products should make it market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our experts span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

Using Digital Health Tools to Strengthen the Doctor-Patient Relationship

by MDisrupt Guest Author | Oct 15, 2021

Meet Arti Thangudu, MD, an endocrinologist pioneering a new model of patient care.

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Dr. Thangudu is a triple board-certified physician and endocrinology, diabetes, and thyroid specialist at Complete Medicine. She takes an evidence-based approach to care, focusing on the patient and their lifestyle, and uses a membership-based model of practice.

Putting the doctor-patient relationship first

MDisrupt: Tell us how you turned from practicing physician to physician-entrepreneur.

Arti Thangudu: I completed my endocrinology fellowship at the University of Pittsburgh Medical Center. When I graduated, I landed my dream job as an attending physician at the largest endocrinology private practice in the world. I had tons of patients and was seeing more than 30 a day.

I came into medicine to take care of people, and I chose endocrinology because it’s very relationship-based. But with 30-plus patients a day, that relationship is broken down. I thought, “Is this what I see myself doing for the rest of my life?”

In this fee-for-service model, doctors get rewarded for seeing more patients. The quality of care does not get rewarded. Better-quality care takes more time. And it’s not what the healthcare system wants us to do. The incentives are for us to see more patients and order more tests because that brings more money into the system.

I just wasn’t about that. And so I started my practice, Complete Medicine, which strives to break down the barriers to healthcare that I saw in the insurance-based model.

MDisrupt: What is your clinic trying to solve?

Arti Thangudu: The breakdown of the relationship between physician and patient and the lack of pricing transparency. For example, you go to a doctor and you have no idea how much you’re going to pay or how much your insurance is going to cover. And you get a bill two weeks later, another bill two months later, another bill three months later. And they’re all way higher than you expected. My practice is membership-based. Patients have unlimited visits. They can call me, they can text me, they can email me between visits. We can do virtual visits, we can do phone visits.

And our prices are transparent. The patient knows on day one how much they’re going to pay. We have negotiated cash pricing on labs and imaging. Patients can use insurance if they want to, but our prices are usually about one-tenth of what they would be with insurance. And there are no surprise bills.

The patients have better outcomes when they’re working with a physician they can trust and lean on and reach out to when they’re having trouble. So with my diabetes patients, we’ve had stellar outcomes—lots of patients coming off insulin, reducing their need for medication, just getting overall healthier, because good care delivers good outcomes.

Lifestyle medicine: caring for the whole patient

MDisrupt: What is lifestyle medicine?

Arti Thangudu: Lifestyle medicine integrates evidence-based nutrition, exercise, management of stress, sleep hygiene, cessation of bad habits. When I was in private practice, I noticed that people weren’t getting better. As an endocrinologist, I knew that nutrition and diabetes go hand in hand. During my endocrinology fellowship, nutritional training, for me, was 30 minutes with the dietician. That is insufficient for any doctor, especially somebody trying to call themselves a diabetes expert.

I realized that if I was going to create a more patient-centered practice, nutrition had to play a big part. And so I got certified in nutrition. And I also got board-certified in lifestyle medicine. These are all such important things that are bypassed by traditional medical training. When you can teach a patient why they should make lifestyle changes, and can be there to support them, they’re much more likely to make the changes and get themselves to better health.

A life-changing digital health tool

MDisrupt: How do you incorporate digital health tools into lifestyle medicine for your patients?

Arti Thangudu: The majority of my patients have diabetes. We use continuous glucose monitoring (CGM). And it has been fantastic. With these CGM devices, we can see the patient’s blood sugar in real time. So I can see exactly what their blood sugars have been doing all day, and they can too. And they don’t have to use a fingerstick anymore.

Studies have shown the more times a patient takes a blood sugar, the better control they have, but more importantly, the better quality of life they have. And so now with these CGM systems, they can input what they ate. You can see exactly how foods, exercise, and sleep affect them and the patient gets real-time feedback.

I have informally studied my own patients. This is not a randomized controlled study. But I did a small study on patients whose intervention was continuous glucose monitoring and lifestyle coaching. And those patients dropped their hemoglobin A1c by 2% after three months. That’s like a 50% reduction in their risk of complications from diabetes. It’s also cost-effective. Every 2% somebody decreases their A1c, it saves the healthcare system at least $4,000 per year—although it could be much more than that. And in that little study, 75% of my patients who were taking insulin were off of insulin by the end.

It’s a huge improvement in quality of life, health, and cost. Can you imagine using this little tool, and then you go from four shots of insulin a day to none, just by changing your lifestyle? That’s really motivating.

Making digital health better

MDisrupt: What are some of the biggest challenges in digital health?

Arti Thangudu: One is the evidence base. There are a lot of at-home lab tests, or testing that you can order online direct-to-consumer. They say they’re evidence-based, but then when somebody who’s a physician or scientist reads that evidence, they can recognize that it’s not at all evidence-based.

A lot of healthtech products are done in a silo and the physician is practicing in a silo. There’s no connection between the patient’s physician and the technology. And physicians don’t know how to interpret the data given to the patient from these tech solutions. If the physician can’t help interpret the data, it makes the patient lose trust.

If there’s a solution that wants to be really big, we need to get the patient’s physicians on board. Or the tech companies need to have a physician that they can send patients to who understands that tech. If we work together as physicians and a digital health team, we can make these products all the more robust and meaningful for patients. Digital health has so much potential—we can’t alienate doctors from it, because it’s the future. We, as physicians, have to get on board, and we have to make these digital tools usable by both patients and physicians. We can do so much together.

MDisrupt: What is your dream digital health tool for lifestyle medicine?

Arti Thangudu: If we could integrate the continuous glucose monitor plus our patients’ dietary and exercise logs, and then create an AI-sourced daily feedback model for them, supported by a health coach or nurse and into the clinical model—with the physician in that same team—that would be amazing for patients with diabetes. I know there are tools getting pretty close to that, but it seems like still there’s a bit of limitation with the physician being part of the team.

Doctors and patients as allies

MDisrupt: What will the doctor-patient relationship look like in 10 years?

Arti Thangudu: My hope is that we, as a community, recognize the value of that relationship. And we as patients and physicians fight to get it back, because doctors and patients are on the same side.

Patients feel frustrated. They’re rushed through their appointment and they blame the doctor because that’s the person in front of them. We need to take a step back and say, “Well, the system is making this doctor have to see 35 patients a day to keep their office open.”

If that same doctor could be in a situation where they saw 12 patients a day, would they be able to deliver better care? The answer, 99.9% of the time is, absolutely. I’ll tell you a story. I consult for a company that takes care of retired police and fire. I have more time to take care of these patients because it is not an insurance-based clinic.

I saw a patient for hypothyroidism and pre-diabetes. After I spent 20 minutes with her, taking a really thorough history, she said, “Doctor, I have to tell you something. You’ve seen me before.” And I was like, “Really? When?” And she said, “In your old clinic. It was really rushed—I must’ve spent three minutes with you. I never went back because the experience was so bad.” I was horrified! I said, “I hope I can make it up to you.” She said, “You already have. I recognize that you were put in a bad situation. Now I’m really excited to be on this journey with you.”

The same doctor can be put in a bad situation or a good situation, and that’s going to affect the care they provide. And so for things to improve in the future, the system really, really needs to change. We as doctors and patients need to recognize that the system isn’t necessarily helping us and maybe move outside of the system until the system decides to catch up. And really be our own advocates.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our experts span the healthcare continuum and can assist with all stages of health product development: regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

And check out our blog and services!

The Future of the Healthcare System

by MDisrupt Guest Author | Feb 12, 2021

Meet Chet Robson, DO, chief clinical officer at Walgreens.

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Beginning as a family practice physician, Robson went on to C-suite positions at health systems and one of the largest health retailers. He was an early adopter of electronic medical records (EMR), educating himself and helping colleagues understand how to use and implement them. He later earned his MBA at Dartmouth in health care delivery science with a focus on how healthcare can be delivered to different populations. At Walgreens, he delivers healthcare directly to the consumer on a national scale—in everyone’s neighborhood.

Listen to the full interview here.

MDisrupt: How do you envision healthcare delivery in the US changing?

Chet Robson: Health care is becoming more home- and consumer-driven. Examples of this include telemedicine for care delivery, oral oncology medications that can be taken at home, home testing (COVID-19 testing, cholesterol and genetic tests), mental health coaching, and health tracking through apps. Hospitals are having to become parts of a system that reach beyond the hospital walls; integrating with retail pharmacies, companies like Uber, and more.

From the pharmacy standpoint, it’s a very similar theme—meeting consumers where they live and making it easy for them to get medications and other health care services. Several retail healthcare venues now have primary care doctors’ offices inside of their pharmacies—an elegant integration of delivery models supplementing the norms of the traditional health care system.

The final piece is the payment models to help facilitate care. It’s not simply about how we pay for a particular diagnosis and treatment , but how we pay for the prevention, the treatment, and the aftercare for the best outcome.

Recently with COVID-19, there’s been a huge evolution of home delivery, medication, and medical goods.

MDisrupt: As a health retailer, how do you evaluate innovative technology for introduction into the retail pharmacy market?

Chet Robson: This is always an exciting challenge because there are so many great ideas at different stages of development. Given this, we have a very formalized approach that we go through. The first thing we evaluate when a company brings something new to us is identifying what problem the technology is trying to solve. We’ve seen things where it’s great technology and an interesting scientific venture, but it doesn’t really solve a problem. Then we dive into the fundamentals around the basic medical science, clinical efficacy, real-world evidence data, multi-population studies, outcomes, and feedback that affects patients around use, price, insurance coverage, and ordering. We really want to understand if the technology actually improves the problem that needs improving.

From a business standpoint, we evaluate if there is a sustainable business model and synergistic fit with our current strategy. There are many times we’ll see products that are really very good, interesting, but it might not really be the exact right fit for what our current strategy is or what we’re trying to achieve.

MDisrupt: Adverse drug reactions are the fourth leading cause of death in the US, but pharmacogenomics is still not a standard of care. How do we reconcile that and where is it going?

Chet Robson: I share that frustration with you because I’m a big believer in pharmacogenomics. It could really become a valuable tool, but we are still along the pathway to integrating it into the standard model of care. First, it’s “newer” science to the general public, regulatory bodies, and legal organizations so there are hurdles around education and defining how to use the information in patient care. Second, we have to become very specific about the benefits, impact, and use cases for pharmacogenomics. Third, there are operational challenges around getting the information into a prescriber’s workflow so that the health care provider, at the point of writing the prescription, has access to drug interaction information. It has to be simple and straightforward. Lastly, the information has to be available to anyone who’s going to interact with it. This includes the healthcare provider and the pharmacist, so they can support each other to ensure that drug interactions are identified and acted on appropriately.

MDisrupt: Do you have an example of a country or health system that’s been successful in implementing a PGx program?

Chet Robson: We’ve implemented a very successful program through Walgreens Boots Alliance and our independent pharmacies in the Netherlands. The health system in the Netherlands is a single payer system, so both the physician and the pharmacists have access to a common EMR. This is critical because the physician or pharmacist can look up a patient’s drug interaction information. The physician can request a pharmacogenomics test, the patient’s results get added to the system, the pharmacist sees the results, and then walks the patient through the information. If there’s an actionable medication, the pharmacist can then connect with the physician to request a change of medication. It’s worked extremely well and we’ve had really good uptake. Even throughout the pandemic we’ve seen the number of pharmacogenomics tests going up greatly because there is a good deal of interest from the patients. The other interesting piece is that the physicians look at the pharmacies now as part of the whole ecosystem. It’s still early and we’ve not even completed a year, but the initial results have been strong.

MDisrupt: What’s the future for pharmacogenomics?

Chet Robson: PGx is beginning to be a part of a bigger picture of understanding a robust genetic overview of an individual. Currently we have an understanding of phenotype through biometric testing, lab testing, and imaging, but we tend not to have a very good genetic view. To be able to fully manage a patient’s health, you have to understand that entire equation including the social determinants of health.

The FDA a year or so ago really pulled back on the pharmacogenomics information that could be released to patients. Currently, they’ve begun to make major strides moving forward by looking much more deeply at the research and working with the Clinical Pharmacogenetics Implementation Consortium (CPIC) and other organizations. A major hurdle to overcome is the FDA becoming more comfortable with what PGx offers. Payors are also doing a lot of different testing in various different forms with pharmacy benefit managers (PBMs), sometimes with their insured populations, and sometimes with particular disease states.

As you begin to make PGx an actionable, value-based test, we’re going to need to become much more refined in our risk stratification of how we use the test. It’s an important piece of the total comprehensive view of the patient.

MDisrupt: What does the pharmacy of the future look like?

Chet Robson: There’s only about four ways to manage health and disease. First, maintain health by exercise and good nutrition. The second is to prevent illness through immunizations, routine testing, continuous health monitoring. Third is medication delivery and education. And fourth are interventions like surgery and radiation. Pharmacists can play an integral role in the first three ways by providing medication and treatment expertise.

Part of the pharmacy of the future is helping pharmacists become integrated in delivering health services rather than simply delivering prescriptions. This can include mail or home delivery, telemedicine, followup care, and clinical services. Pharmacies are already in everybody’s neighborhood and it creates a network of places where people can easily access the health resources they need. Lastly, in the virtual world of health apps tied to medication and health management, digital pharmacy services can play an important part in medication management, providing immunization information, or answering questions around the clock via Ask A Pharmacist chat. Having that virtual, always-ready connection is definitely going to play a critical role in the pharmacy of the future.

The pharmacy of the future is really an expansion of what we do now. It’s about allowing the pharmacist to use their full skills rather than just operational ones, thus allowing people to connect virtually and in-person to their local pharmacy. It’s about an interconnected healthcare ecosystem that meets people where they live and experience health care. A health care system that operates in the continuum of people’s lives—living, working, and virtually.

At MDisrupt we believe the most impactful health products should make it to market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

If you are building a pharmacogenomics or other health product, MDisrupt can help. Talk to us.