The next frontier of care delivery in healthcare

June 12, 2024

Healthcaretoday, APHM, Association of Private Hospitals Malaysia, IQVIA, Healthcare innovation, patient care, healthcare trends, care at home, remote medicine, elderly care, digital health, AI in Healthcare, wellness revolution, health tech, healthcare challenges, patient centric, healthcare future, medical advancements, preventive care, healthspan,

Nikhil Khicha, Managing Principal of IQVIA APAC, highlights five key trends set to gain momentum at the Association of Private Hospitals, Malaysia (APHM)’s 30th International Healthcare Conference and Exhibition.

Today, hospitals and clinics are overflowing with patients, a problem that extends beyond our region to the West as well. In countries like Australia, the average waiting time for out patient departments (OPD)s has reached up to 8 hours, presenting a significant challenge for the healthcare industry.

Private healthcare faces a myriad of persistent challenges that demand constant innovation. While earnings in the healthcare sector have lagged behind other industries, there is promise for improvement as we move into 2024. These ongoing challenges include manpower shortages, resource wastage, financial balancing, disinformation, and varying spending power.

“We are never short of evolutions and revolutions in healthcare, especially in pharma and med-tech, healthcare delivery, and support operations—3D printing, precision medicine, capacity optimization, patient centricity, remote medicine, data digitalization and blockchain, and contactless everything. However, there are 5 things that will truly gain momentum: care moves from disease to age, Doctor GPT replaces Doctor Google, general AI alleviates the health care personnel (HCP) shortage, care-at-home enters a new era—not a novel idea, but one where innovation is finally giving results—and wellness complements medical care, which we have observed in the last few months,” says Nikhil Khicha, Managing Principal, IQVIA APAC, during his presentation at the Association of Private Hospitals, Malaysia (APHM)’s 30th International Healthcare Conference and Exhibition—Shaping the Future of Healthcare: Trends and Insights for Tomorrow.

Addressing the age-based divide in hospital admissions
Medical advancements have reduced overall admission rates, but the age-based divide still exists. A 50-year study on myocardial infarction (MI) admissions in England shows that while average admission rates have declined, admission rates for individuals over 75 have increased by 20% to 35%. Older people are still admitted far more frequently than younger people, highlighting a persistent societal issue.

Our elderly population now constitutes a significant group with unique needs. When comparing elderly and non-elderly populations, the elderly have a hospital admission rate three times higher—300 admissions per 1000 people versus 80 for the non-elderly. Additionally, the elderly population requires 40% more time per visit, with an average of 2.0 to 2.1 hours compared to 1.5 to 1.6 hours for non-elderly patients. This additional time is needed for awareness and diagnosis, treatment, and post-treatment care.

“We need to start thinking about the elderly as a specific patient group around which we need to build our care to improve operational efficiency. The first issue is the higher admission rate. This is not just a problem in the UK; data from multiple countries show higher admission rates for elderly patients. These patients stay 40% longer per visit than younger patients. This is primarily due to the extended time needed for awareness and diagnosis, as elderly patients typically have multiple comorbidities,” explains Nikhil Khicha.

"You need to look at what the person is saying and assess them more thoroughly to determine whether it’s just the problem they are talking about or if there is something else. Then, there is the treatment or post-treatment process, which also takes longer to follow through. This group is significant enough for us to consider as a specific segment within our population that we care for.

In an aging society, it is important to create a special space or solution for this group. For example, the Cleveland Clinic created a specific wing for geriatrics, customizing every step of the vision, diagnosis, triaging, treatment, and discharge processes. They are improving the efficiency of the resources deployed across the entire hospital. There is specialized care being provided for how to deal with this customer segment.

Other examples include the use of geriatrics assessments in tertiary care settings or primary specialty settings in an OPD, such as pre-admission processes, which reduce triage times.

Adding pragmatic innovations has led to real and significant impact. Future hospitals are adopting differentiated interventions such as:

Patient priority care with a potential increase in patient satisfaction by 15 percent through minimized interventions.
Elderly-centric care innovation with less than 30 percent time spent per patient through location monitoring, guidance robots, and telecommunication.
Specialized geriatric emergency departments with less than 20 percent resource turnover through dedicated teams and departments.
Senior-focused interdisciplinary care teams with an 18 percent reduction in average medication/procedure costs per patient.
Comprehensive geriatric assessments (CGA) with a reduction of over 20 percent in 30-day readmission rates through age-specific non-interventional diagnostics.
Elderly-centric enrollment schemes with a 13 percent reduction in visitation due to preventive and adherence services.

The role of digital technologies in modern patient care
Digitally-sourced information has become integral to the patient journey today, spanning awareness, diagnosis, treatment, and post-treatment phases. Statistics reveal that 55 percent utilize mobile appointment scheduling apps, 45 percent consult the internet or AI for second opinions, 43 percent search for medical treatments based on their symptoms, 46 percent trust AI for pharmacy coordination, and 24 percent monitor their treatment using technology.

Throughout this journey, patients and consumers spend significant time online seeking information, advice, and data, often to mitigate costs, minimize wait times, and reduce travel. This shift towards reliance on digital tools is already underway, marking a transition towards device recognition.

Key applications include:

Awareness: Digital solutions like Google and ChatGPT function akin to virtual assistants such as K Health for information gathering.
Diagnosis: Tools like WebMD's symptom checker provide comprehensive diagnoses, while scheduling applications from Teladoc and Gyant automate and optimize triage processes.
Treatment: From Oracle's EMR digital record sharing to JVion's predictive therapy outcomes, and clinical decision support tools from Elsevier and Tempus enhance and tailor treatment plans.
Post-treatment: Applications like Apple's medication reminder and AdhereTech for forecasting adherence challenges contribute to post-treatment care management.

This integration of digital technologies promises to revolutionize healthcare delivery, potentially phasing out traditional methods in favor of more efficient, patient-centric approaches.

"Many people start their healthcare journey by consulting a surgeon to understand their problem and determine their next steps. Across the board, various digital solutions exist for this purpose. However, the digitalization of healthcare is still in its early stages. For instance, when it comes to diagnosis, individuals typically begin with a Google search, then consult websites like WebMD, which can take several hours to navigate.

So, what can be done to streamline this process? K-Health, for example, serves as an initial point of contact for answering questions. Users engage in online conversations with a bot to articulate their health concerns, and if needed, are connected with a healthcare professional. Cedars-Sinai, a large chain of hospitals in the United States, has already implemented such systems. This approach effectively supplements the capacity of healthcare professionals by facilitating basic triage and follow-up processes online."

The impact of 'desktop medicine' on healthcare professionals
Today’s healthcare professionals divide their time between direct patient care and 'desktop medicine'. Direct patient interactions include medical examinations, procedures, exchanges, and direct communication. Conversely, 'desktop medicine' involves tasks such as EMR data entry, clinical documentation, prescription refills, ordering, and logistical coordination with hospital staff.

However, our current systems and governance demands impose excessive costs on the industry. Healthcare professionals spend less than half of their time on direct patient care, amounting to a staggering $20 billion in Southeast Asia alone attributed to 'desktop medicine'.

“Our clinicians and hospitals invest significant time in diagnosing rare cases or exploring new evidence and treatments beyond standard protocols. This often involves analyzing multiple data points and consulting with medical peers across different hospitals in the United States, Europe, and Japan.

Every healthcare professional's role comprises two critical components: protocol-based treatment, operation, and advising, and desktop tasks such as documentation and paperwork. While essential for managing care comprehensively, these activities detract from direct patient care delivery.”

This is not just a local issue but a global problem. To address this, innovation must focus on finding effective solutions.

From a hospital’s perspective, AI solutions are being targeted to alleviate this burden. Healthcare AI deal flow has seen significant investments in 2024, including:

February 2024: Abridge raised $150 million for AI in clinical documentation.
March 2024: Zephyr AI secured $111 million for AI in clinical decision support.
April 2024: Noah Medical obtained $150 million for AI in enhancing surgical precision.
May 2024: Rad AI received $33 million for AI in supporting radiologist workflow.

Driving innovation for efficiency is a collective focus for the industry. Emerging healthcare AI players such as Accolade, Heartflow, PathAI, Artera, Notable, Innovaccer, Insitro, BioGraph 55, and Peptilogics are leading the charge. In the longer term, AI will play a key role in diagnosis and planning, enhancing the capabilities of healthcare professionals. AI innovation will also make significant inroads into areas with major existing cost burdens in pharmaceuticals and hospitals.

The future of AI investment and partnerships in healthcare
Nikhil Khicha elaborated that healthcare AI is attracting significant investment, outpacing other directions. The amounts invested are substantial. So, where exactly are these investments going? AI’s distribution spans across various stakeholders such as patients, doctors, hospitals, pharma companies, and device companies, with the largest portion directed toward drug discovery platforms, followed by providers.

“We believe that AI will democratize everything. If applied to healthcare, we should expect investments in patient-focused and operational-based solutions, but that's not what we're seeing. Regulations, legal challenges, and a vast AI portfolio will take time to navigate.

One major change for healthcare providers will be in our partnerships. Today, some of our largest partners are equipment and device manufacturers like GE, Philips, BD, 3M, United Healthcare, Epic, Oracle Cerner, Cardinal Health, Athena Health, Stryker, Intuitive, McKesson, and Medtronic.

In the future, we'll see a new set of partners such as Microsoft, Google, Amazon, IBM, Samsung, and Nvidia. While traditional healthcare players like BD and GE may still hold significant market share, tech companies are poised to become some of the biggest vendors in the next five years, indicating a shift in the industry landscape.

Evolution of healthcare delivery models
The big metro areas are reaching a point of saturation, not just in our region but around the world in emerging markets. So, the question is, if patients in big metros are staying home or returning home, how do we deliver care?

We have applied various models over time, resulting in a shift in healthcare delivery:

1980s: Geographical expansion with 200-million to 300-million-scale hospitals
1990s - 2000s: Hub and spoke with the building of 20-million to 50-million micro hospitals
2000s - 2010s: Ambulatory care with 5-million to 10-million ambulatory surgical centers
2020s: Care at home with investments lower than 5 million by implementing home health programs

The biggest difference across this evolution is the shift beyond the big tertiary care model, which required substantial capital to establish full centers. The real question is, are we addressing just the capital requirements, or are we also addressing the cost of care provision?

“Singapore is proof that the care-at-home model can deliver savings and increase capacity. Singapore’s national care-at-home program, launched a few years ago specifically for chronically ill cardiac patients, offers mobile inpatient care at home. Partnered with Changi General Hospital, KK Women’s and Children’s Hospital, Khoo Teck Puat Hospital, National University Health System, Singapore General Hospital, Sengkang General Hospital, Tan Tock Seng Hospital, and Woodlands Health, it features daily virtual ‘ward rounds’ via teleconsultation, self-measured vital signs reported three times a day, remote care team monitoring around the clock, home visits for in-person medical treatment, transport to and from the hospital for scans and procedures, and a 24/7 dedicated telephone line. The pilot program included 2,000 patients and recorded 9,000 bed days by the end of 2023, with 53 percent of total admissions eligible for care at home in Singapore and a 52 percent reduction in acute readmissions at Singapore General Hospital from the transitional home care program.

The efficiency and innovation of at-home care
Evidence shows that care at home can efficiently reduce not only the capital costs but also the overall cost of care.

Innovation in remote care is progressing rapidly, but the responsibility for implementing it lies with care providers. In the future, more services will move into a community setting with a focus on:

Diagnostic solutions: At-home genetic testing, at-home blood tests, portable ultrasound devices, smartphone-based urinalysis kits, AI skin cancer screening applications, spirometry lung function tests, and digital biomarkers.
Patient engagement
Monitoring: Virtual wards, continuous vitals monitoring, continuous glucose and oxygen monitoring, caregiver smart glasses, remote cardiac monitoring, and wearable health trackers.
Interventions: Virtual reality rehabilitation, home-based dialysis, digital behavioral interventions, chemotherapy at home, home-based palliative care, remote wound care, and at-home respiratory therapy.
Advanced emergency care, complex surgeries, ICUs, and highly specialized diagnoses will remain in hospitals.

The focus of healthcare today is centered around increasing life expectancy and controlling medical conditions. However, the future will shift towards enhancing overall wellness and closing the healthspan gap.

Innovation is happening across the board in all elements required to deliver effective care. The evolution of at-home care has been on the periphery, but with the societal constraints on affordability in our region, this is a viable solution that is ready for the economy.

Expanding the spectrum of 'whole person care'
The spectrum of 'whole person care' continues to grow, encompassing various aspects of health and wellness:

Lifestyle - mind and emotions: Enabling an active lifestyle combined with social, emotional, and psychological support.
Rest - energy and sleep: Promoting sleep hygiene and intraday relaxation/rejuvenation practices.
Nutrition - weight and digestion: Promoting a balanced diet.
Therapies - genomics and physical body: Integrating contemporary and traditional therapies (such as acupuncture and herbal treatments) for comprehensive care.

The emergence of “care-centre” chains
A chain of "care-centres" is not far away, offering services that bring science and prevention together:

Personalized therapies: Pharmacogenomics, integrative medicine (both contemporary and traditional), stem cell therapy, platelet-rich plasma (PRP) injections, cryotherapy, and IV Vitamin therapy.
Mind-body practices: Mindfulness and meditation, biofeedback, art and music therapy, community workshops, social group programs, and social connection strategies.
Diagnostic and assessment: Biomarker analysis, telomere length measurement, microbiome analysis, advanced imaging (body and brain), metabolomics, genomic sequencing, and mental, emotional, and health assessments.
Lifestyle modifications: Health coaching (nutrition, exercise, and sleep), addiction cessation programs, weight loss clinics, and medical gyms.

The future of wellness
Globally, the wellness industry is nearly four times bigger than the pharma industry, highlighting the importance of a comprehensive approach to health. This spectrum looks at four pillars: lifestyle, rest, nutrition, and therapies, to best define wellness.

By the end of this decade, there will be more payers in the wellness sector. However, the key question remains: to what extent are healthcare institutions adopting this holistic approach?

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