Yesterday CVS Health announced that it has agreed to buy Aetna for $69 billion. If the deal goes through, it should send shock waves through the health care system. CVS is not only the largest pharmacy chain in the US, but it is also the 7th largest company in the US with approximately 9600 retail stores in 2016. But CVS Health has plans to move beyond being just a pharmacy and convenience store to become a bona fide healthcare company. The emerging 3-part strategy is potentially powerful! One part of the strategy is to expand the current offerings of CVS pharmacy’s to included more traditional healthcare services that formerly required hospital or doctor’s office visits. Given that CVS Health already provides healthcare services through its more than 1,100 MinuteClinic medical clinics as well as their Diabetes Care Centers currently located within CVS stores this transition is likely doable. The second part of the strategy appears to be aimed at driving down healthcare costs through creating a virtually wholly owned prescription drug ecosystem, not unlike the IOS ecosystem created by Apple. which is on the brink of becoming the first trillion-dollar and most successful company in the world. The third part of the strategy, which builds on the first two parts, is focused on driving value for consumers. While some may doubt their ability to accomplish this goal, the rising popularity of retail healthcare outlets, the potential for vastly enhanced consumer healthcare experience (little to no waiting lines or delays in seeing providers, easy access to medical facilities located in local communities, lower medication and care delivery costs, familiar, trusted care delivery settings combined with convenience shopping opportunities) strongly suggests that the essential elements are indeed in place. Interestingly, this vision and emerging strategy is in line with that of Aetna the 3rd largest health insurance company in America. Aetna’s CEO, Mark Bertolini took things even a step further last month while speaking at the Healthcare of tomorrow conference where he said that it will soon be possible to provide the bulk of care patients need, in the home and community. So, in the near future, “if you must go to the hospital, [the healthcare system] will have failed you”. In this new world traditional high cost, brick and mortar tertiary healthcare systems will simply not be able to compete on costs, convenience and as the evidence is beginning to indicate, not even quality. Their ability to pivot to a more sustainable care delivery model that substantially improves patient experience and value, will be limited. As such, the classic scenario for disruption, as originally articulated by Harvard Business School Professor, Clayton Christensen, and as applied to the organization and delivery of healthcare by Johns Hopkins experts Gibbons and Shaikh, is in place and could eventually significantly impact the traditional healthcare system as we know it. Rather than sticking their heads in the sand, CVS and Aetna appear to be embracing the challenges that lay ahead and seizing the opportunities these changes bring. It remains to be seen, if others will join them, or be left behind.
Diabetes
“DeepCoder” may signal the beginning of the end for IBM’s Watson.
Recently a group of researchers from Microsoft and the University of Cambridge announced the development of a program called DeepCoder. Deep Coder is a combination of an Artificial Intelligence System and machine learning system that can write its own code. Currently, the system is only able to write relatively simple programs, but the developers envision a day when anyone can simply tell DeepCoder what they want and it will then write the code to accomplish the requested task within seconds and without error!
The implications of this technology are simply profound and absolutely disruptive!
Today, much has been said about the potential of using IBM’s Watson supercomputer to solve challenging societal problems across diverse sectors such as security, finance and healthcare. However, to get the benefit of Watson, you have to be able to pay IBM to use the platform. According to recent reports, you will likely have to be able to pay a huge amount of money! (See MD Anderson benches IBM Watson…) Microsoft’s DeepCoder on the other hand, offers the potential, if placed in the hands of consumers, for almost anyone, anywhere and at anytime, to recognize a need or problem and have a working solution developed for it “On Demand”. As the authors point out, this is not meant to replace current infrastructure or personnel, but to augment and enhance current abilities.
In the health sector, the opportunities are almost endless, particularly if we think across the entire care continuum from wellness, to diagnostics and therapeutics, through recovery, chronic disease management and end of life care. Through this system, every problem essentially becomes a “Big Data” problem for which the appropriate code can be written to address the problem!
For busy clinicians trying to understand the potential implications of a new drug for a patient in the office, rather than scheduling a second visit with the patient, prior to which he/she would review a number of textbooks and other digital/print resources in order to make an evidence based opinion, DeepCoder could, write a program that searches the over 26 million research studies available in the National Library of Medicine’s PubMed database, determine which studies apply most closely to the current patient, synthesize the findings from the most relevant studies and print a one page synopsis and recommendations for the patient regarding the best initial dose, on the desktop printer sitting next to the doctor, for his review, faster than the patient can get undressed.
For the aging senior who is diabetic, hypertensive and lives alone, her adult son, who lives in another state, could tell DeepCoder to find the highest quality senior care day program, that offers door to door transportation, meals and is willing to dispense medications, that has an immediate opening and fits within his budget. Since both he and his mother have an Amazon Echo, he could simply tell Alexa what he needs and she then tells DeeepCoder. A few seconds later, once the program is written, Alexa could then use it as a new personalized “skill”, execute the task, complete the online application after her son’s approval, schedule the in-person interview and send the required down payment to the Senior Care center in advance of the meeting.
While these examples are exciting, they are not yet possible. However it is also true, that is likely only a matter of time before these or something even better become reality in healthcare!
This Diabetic Patient hacked a medical device to make an Artificial Pancreas
Digital Health Technologies are becoming more and more popular every day. The IMS Institute for Healthcare Informatics reports that there are now over 165,000 mobile health apps on the market. Most, over two thirds, are focused on general wellness, lifestyle, stress and diet. Perhaps even more surprisingly though, is the fact that while the number of health apps is rapidly growing, the percentage of apps that allow users to access and securely share their information has remained flat.
For years when patients, caregivers or consumers wanted, or worse needed, health information about themselves or their loved ones, the only choice was to make an appointment, see a medical professional and wait, sometimes weeks to get information that was often cryptic and difficult to understand. Today health consumers are demanding more access, information, convenience and lower costs. The healthcare system is struggling to respond effectively.
However, unlike patients and caregivers of yesterday who had no choice, today’s consumers, innovators and entrepreneurs are increasingly taking matters into their own hands when an opportunity arises. In many ways, this spirit of refusing to accept an unacceptable status quo is what threatens the traditional paradigm in healthcare more than anything else. It is the main reason “Dr. Google” is so popular! Studies suggest that people value what their doctors say, but for a variety of reasons, they are often not able to get the information or support they need, when they need it, from the current healthcare system. With advances in health technologies and digital health like 3D printing, the Internet of Things (IoT) and Google, people can now find much of the information they need, at any time day or night. Increasingly, they can also act on that information. That is exactly what Dana Lewis did by hacking into her medical device to create the The Open Artificial Pancreas System. As she puts it, the Open Artificial Pancreas System project (#OpenAPS) is an open and transparent effort to make safe and effective basic Artificial Pancreas System (APS) technology widely available to more quickly improve and save as many lives as possible and reduce the burden of Type 1 diabetes. Risky? Perhaps, but certainly inspiring. Safe? Time will tell. One thing is clear however, traditional methods of science, manufacturing, medicine and healthcare are rapidly changing. Those who embrace the times and lead the change with effective solutions could help enhance the health of people across the globe. Those who work to protect, their market dominance and the status quo, will eventually become irrelevant. Remember Woolworth and Woolco? A once dominant department store chain, is now defunct. Many other examples exist in almost every sector except healthcare. Given current and emerging trends, the question is not if it will happen in healthcare but rather when and to whom? Which of the current leaders in healthcare and medicine will become essentially irrelevant in the next decade, because they failed to respond effectively and rapidly to changing societal realities. Just like Dana Lewis’s Artificial Pancreas System, the answer to this question will become clear and may even be surprising. Stay tuned, the answer may come sooner than you think!
Greystone Health IT 
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