Technologies of the future will be far too complex for a particular company to disrupt market alone. Therefore, building an ecosystem of interdependence for bringing a positive change and sustainable growth will become the norm
By Raelene Kambli
Disruption in healthcare is driven by changing patients/customers’ needs, digitalisation of the services and advancements of medical technologies and clinical processes. And, with changing customer/patient needs, traditional operating models of healthcare delivery have turned inside out. Today, companies focus on two ways to disrupt the Indian-market innovation of products and services as well as achieve transformational goals.
Take the example of global IT and med-tech companies like IBM, Microsoft, Apple, GE, Phillips, Medtronic, BD and more. These players have various collaboration programmes or strategic alliances in which they work with start-ups, IT companies, medtech companies, hospitals, diagnostic centres, logistics and supply chain companies, third-party payers and insurance firms to bring in technologies, products and innovations that are country-specific. These strategic partnerships focus on co-creating solutions for real-world healthcare challenges in the areas of digital applications for early detection, productivity solutions, telemedicine services, innovative payment models, and remote and connected care, among others.
Here are a few examples:
IBM and partners: Aetna, Anthem, Health Care Service Corporation, PNC Bank and IBM last year announced a new collaboration to design and create a network using blockchain technology to improve transparency and interoperability in the healthcare industry. The aim is to create an inclusive blockchain network that can benefit multiple members of the healthcare ecosystem in a highly secure and shared environment. The goal is to allow the blockchain network to enable healthcare companies to build, share and deploy solutions that drive digital transformation in the industry. The collaboration members intend to use blockchain to address a range of industry challenges, including promoting efficient claims and payment processing, to enable secure and frictionless healthcare information exchanges, and to maintain current and accurate provider directories. Aetna, Anthem, HCSC, PNC Bank and IBM are actively working to further define the initial use cases for the health utility network. The collaboration will add additional members to the network in the coming times including other health organisations, healthcare providers, startups and technology companies.
GE Healthcare: In 2018, GE Healthcare launched a collaborative programme for its Edison platform. This platform comprises applications focused on clinical, operational and financial outcomes; smart devices embedded with advanced intelligence to improve workflow, productivity and diagnostics; and the Edison platform. The platform enables GE Healthcare and its strategic partners to develop, deploy, manage, secure and distribute advanced applications, services and AI algorithms. Leveraging GE Healthcare’s expertise as a leading global medtech and diagnostics innovator, Edison aggregates the deep data from GE Healthcare devices with horizontal health information from across the healthcare ecosystem. Through this programme, GE Healthcare collaborated with startups to arrive at solutions that improve patient outcomes and experience, the efficiency of clinical practice and that of the healthcare facilities, reduce waste and inefficiencies, and eliminate costly and harmful errors.
Medtronic: Medtronic, on the other hand, is developing meaningful innovations at the therapeutic, procedural and system levels. One example of what Medtronic is doing is about Enhanced Recovery After Surgery (ERAS) or Fast-Track Surgery (FTS). It incorporates multi-modal interventions in the pre-operative period to expedite recovery. It provides Medtronic with an opportunity to broaden its relevance and increase the addressable market. Customers benefit from the strengths and offerings we bring to the table. Also, it helps deepening ties between complementary businesses and fostering collaboration. Medtronic signed the first ERAS deal in January 2019 with Manipal Hospital, Bengaluru, under the Value-Based Healthcare (VBHC) initiative in India. As part of this partnership, Medtronic will closely associate with the ERAS society and Manipal Hospital to implement the ERAS protocols in their existing practice. The primary goal of the ERAS protocol is to reduce the average length-of-stay of patients and decrease the complication rates.
Roche Diabetes: Roche Diabetes Care India focusses on collaborating with various state governments and private partners. The diabetes care giant conducted a screening programme for GDM (Gestational Diabetes mellitus) for the state of Uttar Pradesh, the most populous state of India with 75 districts, 823 blocks, 250K sq km area and 220 million population. This screening programme had to be carried out by ANM and Accredited Social Health Activists (ASHA) workers. As part of the screening programme, once a pregnant woman is found positive for diabetes, she is enrolled for regular monitoring and therapy. Roche, through an agency, formed training teams for this programme. The content of training on diabetes and testing protocol was taken from state programme managers for NCD and GDM. The content, training material and videos were created in Hindi, the language understood by ANM and Asha workers. Small brochures covering the training content were provided. The training team travelled to blocks at each district, gathered the ANM workers and offered training. Since the inception of training activities, the team has been to 18 districts, provided training at 100 blocks that were attended by 2,825 ANM and Asha workers. This training intervention would lead to better diagnosis of GDM and prevent IMR to a greater extent.
In the private sector, Roche has collaborated with Wellthy Therapeutics to offer an innovative artificial intelligence (AI)-based coaching app to people with type-II diabetes. This digital coaching solution addresses the urgent need for support in daily therapy management and provides users 24/7 support including education on appropriate regimen adjustments, nutrition and lifestyle changes. The remote coaching offers people with diabetes, together with their healthcare professionals, an affordable new way to continuously keep blood glucose levels in range in-between doctors’ visits while achieving improved adherence and outcomes.
The collaboration agreement and the joint offering supports the company’s ambition to create an open ecosystem with its own and third-party solutions, across the continuum of care in diabetes. The generated data collected will be part of its Intelligent Patient Platform (IPP), which is a digital health platform that will allow Roche to collect and store all patient-related health data and enable them to create insights based on data to offer more meaningful solutions to patients, healthcare professionals and payers in the future.
L&T Technology Services: In the medical devices and healthcare segment, LTTS partnered with a leading medical equipment manufacturer to rectify multiple critical issues with their slidemaker strainer equipment to increase its efficiency and decrease service cost. LTTS, as part of the government’s ‘Make in India’ initiative, partnered with Agappe Diagnostics, an in-vitro diagnostics company, to launch an automated blood cell counter in the Indian subcontinent which would result in lower diagnostic costs. LTTS also developed the world’s first cost-effective robotic endo-training kit, a futuristic surgical training robot, in association with Global Innovation & Technology Alliance (GITA) and Department of Science and Technology (DST).
Then, there are those who are starting up by partnering with major healthcare players within the country in order to bring different models of disruption. Here are a few more examples:
Plexus: Plexus has a value-based cardiac care system that involves different stakeholders to provide a network that ensures comprehensive care to all. The model is said to be very disruptive as its impact on patient outcomes is huge.
Plexus platform for value-based healthcare is divided into parts A, B and C. Let us explore into how value can be created for Part A, B and C– especially in cardiovascular medicine – as cardiac costs and cardiac mortality are among the highest of all disease and comorbid conditions.
Part A :-
Ideally, the value can be created by preventing hospitalisations, but inadvertently, there will be some hospitalisations even with the best services.
Once a patient is in the hospital, physicians should avoid doing a battery of tests or obvious conditions. A simple phone call to the primary care provider can give a great insight into a patient’s current condition and the inter-communicability of electronic medical records will reduce unnecessary repeat testing.
Clinical skills are dying – a confident and clinically competent physician can save a ton of unnecessary imaging and blood tests and focus on the relevant ones.
Having standardised protocols for common conditions like MI, pulmonary embolism, STEMI and atrial fibrillation can reduce errors and improve quality of care.
Plexus Cardiac Care has invested in having a swift, reliable and accountable communication infrastructure platform to ensure quick communication between physicians, specialists, nurses and patients.
Part B :-
Healthcare, in general, is shifting towards outpatient settings. This shift is a good trend since preventative, high-quality and one-on-one services can be better provided in an outpatient setting. It is important to nurture the patient-physician relationship by increasing the physician-patient direct interaction time.
Trust is also important in this setting. An outpatient cardiologist should be proactive and able to identify high-risk patients, as well as follow up on them frequently. Understanding the background psychosocial structure is also crucial as it is often the key driver of many somatic illnesses. Physicians should empower patients and their family members. They should be encouraged to understand and know more about their cardiac condition.
Another important aspect of cardiovascular Part B cost is a referral to subspecialists like interventional cardiology and electrophysiology.
Plexus has a well-coordinated referral system that has saved unnecessary repeat testing and trips to other clinics for the patient. An outpatient general cardiologist should have a strong network and a Preferred Provider List, so that he can get timely updates about his referrals and care coordination is at its best.
Part C:-
The cost of cardiovascular drugs is sky-rocketing, but there are equally effective generic options available in most cases.
In recent years, direct-acting oral anticoagulants (DOACS) have been rapidly expanding market share and indications. A significant portion of cardiovascular Part C costs can be attributed to DOACs. There is real-world data to show that DOACS are cost-effective, but there is no large randomised trial to prove its cost-effectiveness.
There is no head-to-head comparison trial between DOACs. So, in most cases, it boils down to physician preference. Most other cardiovascular drugs are generic, along with most secondary prevention drugs for myocardial infarction, heart failure and atrial fibrillation. PCSK9 inhibitors are relatively newer and more expensive cardiac drugs. They are highly effective and should be used selectively in patients who are truly indicated. Again, the cost-effectiveness data is out there but on small sample size. It is important to follow up on the real-world data for these newer expensive medications.
IT & supply chain start-ups: Leveraging the digital ecosystem, companies such as Practo and MedikaBazaar are creating value for customers/healthcare providers and patients in many ways. MedikaBazaar has created a supply chain AI module that collaborates with hospitals, consumables and pharma suppliers to predict the right inventory for any hospital based on its patient load, and helps provide the best quality supplies at the lowest rate and least amount of working capital. Likewise, some of the online pharmacy platforms are collaborating with insurance companies to offer OPD insurance and provide cashless OPD medical facility to its subscribers through a closed-loop model which constitutes doctors and labs who are on the pharmacy network.
Several other examples show how companies are initiating collaborative models to disrupt market competitiveness and achieve transformational goals.
However, the question that arises is whether these collaborations are truly making a difference, and whether this phenomenon is creating the desired impact on patient outcomes, affordability, system improvement and business viability?
Say tuned to know more on how collaboration impacts providers, patients and the insurance sector, and what disruptions we will be witnessing in the coming times.