In this last episode of 2020, we will reflect on the year and look into the future with some of the experts and opinion leaders from the digital health industry across the world. You can hear from experts from the US, Israel, Mexico, Chile, UK, and South Korea. They shared their thoughts about the state and future of digital health globally. 

Speakers: 

Levi Shapiro, Investor, Digital Health instructor and founder of the mHealth Israel community (Israel),

Gil Bashe, managing partner of FINN Partners Global Health (USA),

Gabriel Alejandro Garza Caro, Co-founder and Managing Director of DocTour (Mexico), 

Luis Santiago, the CEO of Pegasi, a healthcare IT company based in Venezuela (Venezuela),

Ogan Gurel, Though leader, MD, Professor, Entrepreneur (South Korea),

João Bocas, The Wearable Expert (UK),

Dr. Brennan Spiegel, gastroenterologist, director of the Cedars-Sinai Center for Outcomes Research and Education and who recently published a book titled VRx (USA), 

Robert Miller, Director of Product Management and Strategy at Consensys Health (USA).

2020 was a testing year for digital health. For a long time before that innovators have dreamt about the potential of personal data tracking for individuals and population health. What 2020 showed us is that humanity is not yet ready for the society of surveillance. We also learned that even when surveillance models are accepted, their potential can reach a tipping point. What I mean by that specifically is that by summer 2020, South Korea was the world exemplar of success in pandemic containment with the track and trace approach. When the Western countries introduced contact tracing apps they failed miserably - the majority of people didn’t want to be traced. At the same time, by the end of the year, the system of tracing fell apart in South Korea as well. By Christmas, the country found itself in the position of struggling to build new capacities for much-needed ICU beds for new COVID-19 cases. 

According to Mercom Capital Group, The top-funded digital health app categories in the first three quarters of 2020 were mental health, diabetes, fertility, fitness, and meditation. We will see what final yearly reports will show. This year was one of the worse years for healthcare professionals and one of the most significant years for shaking the culture in healthcare and speeding up digitalization related changes. 

Expansion of the Affordable Care Act in the US, rise in suicides, negative health impacts of sleep disruptions during the pandemic, a huge scaling of digital therapeutics

Levi Shapiro, Investor, Digital Health instructor and founder of the mHealth Israel community (Israel), predicts five major changes: expansion of the Affordable Care Act, rise in suicides, negative health impacts of sleep disruptions during the pandemic, a huge scaling of digital therapeutics, and accepting that despite the vaccines, COVID-19 will be with us for a long time. Here is his full elaboration:

Despite the vaccines, Corona will be with us for a long time. Expect to see structural changes to public health systems and ongoing impacts like sleep disruption and deaths of despair. The biggest driver in the US Healthcare market (which accounts for 48% of global healthcare spend) will be policy changes from a new administration. These will have massive effects.

Expansion of the Affordable Care Act

The pandemic laid bare the disparities in US healthcare, which ranks LAST among developed nations on measures of healthcare quality, efficiency, access to care, equity, and longevity. A system dependent on Employers for health insurance left an enormous swath of the population, including low-skilled, part-time, gig and unemployed workers, outside of the safety net. At the same time, America’s tolerance (even preference) for monopolies means that, by international standards, hospitals, insurance companies, pharmaceutical companies, device makers and doctors are wildly overpaid. Using the Affordable Care Act, federal and state governments (which account for half of healthcare spend) will enact change. Expect to see a greatly expanded public health insurance option and meaningful checks on monopolistic practices to reduce cost. 

The most impressive reforms will occur at the State level. Even before the pandemic, states faced an unsustainable burden. Payments for Medicaid spiked from 20.5 percent of spending in 2008 to 28.9 percent in 2019. The 39 states (including DC) that adopted the Affordable Care Act will push for broader insurance coverage and lower industry margins.

“Deaths of Despair”

COVID is having extraordinary effects on mental health. In Japan, where there was not a national lockdown, suicides in October rose to their highest number since 2015. Japan is one of the few countries to publish recent suicide statistics. Other countries may see a similar pattern, including disproportionate levels (+83%) of female suicide. Male suicide rose 22%. 

In the US, the economic fallout, social isolation and uncertainty caused by COVID will account for an additional 75,000 deaths. This follows a long-standing trend, evident since the mid-1990’s, of “deaths of despair” (alcohol / drug misuse and suicide) most pronounced with middle-aged, White Americans, without a college degree. Even before the pandemic, one in five Americans had a diagnosable mental health condition, according to the Substance Abuse and Mental Health Services Administration. More than half received no treatment at all.

Expect legislation across the developed world, including the US, to ensure systemic and centralized approaches, particularly at the local level. A patchwork of programs tends to be less effective than unified coordination and policy.  

“Coronasomnia” and Sleep Disruption

Sleep deprivation, always prevalent, became a population health crisis during the pandemic, with residual impact across conditions, including Heart Disease, Hypertension, AFib Stroke, Diabetes, Obesity, Depression, Acid Reflux, Asthma, Memory Loss, Decreased Sexual Desir and Liver Problems. 

Regulators, providers and consumers have adapted. In the US, The Centers for Medicare & Medicaid Services (CMS) dramatically expanded coverage for telemedicine services and increased payment rates for virtual visits. Providers and sleep clinics transitioned 70% of treatments via telehealth. Research has confirmed that cognitive behavioral therapy sessions via telehealth are as effective as in-person treatment for people with chronic insomnia. 

After stocking up on toilet paper, consumers made a run on sleep meds. According to Express Scripts, demand increased 15% at the outset of lockdown. More recently, use of digital therapeutics and mobile applications has grown. Juniper projects the sector to grow 865% by 2025. 

Google, Amazon and Apple will drive most progress in the USA 

Gil Bashe, managing partner of FINN Partners Global Health (USA) predicts that the game changers in driving digital health will be familiar power names now flexing their muscles to enter the three-trillion-dollar health sector in the US. “ Google has both ability and credibility to smash obstacles to interoperability.  Amazon will squeeze out costly waste from an overextended drug supply chain.  Apple will demonstrate clinical value as a frontline diagnostic assessment tool.  Microsoft will change the drug-development workflow and monitoring.  These behemoths know how to integrate innovation, market to consumer expectations for personalized experience and address government cost-saving demands.” 

As further mentioned by Gil Bashe, this powerhouse global umbrella serves as the champion of innovation, and their interest alone will fuel continued investment in digital health technologies: artificial intelligence, data accessibility, decentralized clinical trial protocols, new diagnostics tools, telehealth, virtual reality platforms, wearables and much more. “Physicians of 2021 and beyond will have expansive clinical (and cost-saving) abilities if they choose to embrace the possibilities offered by these technologies. The current system of inefficiencies and disparities is built on economic realities that require a makeover. That is why companies comfortable with creating cultural change are needed to step in to void in order to guide medicine into the future. Otherwise, culture will squash innovation.”

Mexico and South America will see a democratization of healthcare information 

With the world turning to teleconsultation, remote patient monitoring, and clinical decision support fueled by artificial intelligence, Latin America was not outside this reality, says Luis Santiago, the CEO of Pegasi, a healthcare IT company based in Venezuela. “Two type of countries exist in the region, the one that had invested in digital health technologies before COVID-19 and the ones beginning their 2021 budget discussion with extraordinary investments in building networks for digital services to be adopted. Countries that had investors such as Uruguay, Chile, Brazil, Argentina, and Mexico quickly saw their output capacity insufficient, so 2021 will be a year of strengthening these services. The formula of choice, probably by partnerships, spaces of alliances between startups and SMEs with highly scalable technologies supported by large corporate groups, such as the ones in Pharma and insurance companies, deployed in public institutions or for large population sectors via government networks. It is no wonder consulting offices such as McKinsey report that digital healthcare investment in the region is going to rise by 21%. In a region where over 70% of healthcare information is still in paper, and we're more than a third of this population doesn't have access to any sort of healthcare services, digital health services can be a game-changer and a great democratizer. Public-private alliance has become a tool to grant many services traditionally unavailable to population.” 

Gabriel Alejandro Garza Caro, Co-founder and Managing Director of DocTour (Mexico) says the biggest change triggered by COVID is the democratization of patient empowerment and public awareness about health. “In Latin America and in Mexico specifically, a big healthcare challenge is that a large proportion of the population has no access to healthcare or insurance. Because of the limited mobility caused by the pandemic the problem is even worse. However, we see that a lot of healthcare innovators are addressing this issue. A population that knows about health, that knows how to access health will improve their health. A big percentage of the population here is below the poverty line. And without having access to even basic education, it's difficult to create a culture of health and wellness.I believe the number one change that will be driven forward in 2021 is access to information about health for the population. The other big challenge is interoperability. Efforts have begun already before the pandemic and will be continued in 2021.”

Digital health wallets and telemedicine in South Korea 

Despite being technologically advanced, telemedicine was not legal in South Korea before the pandemic. That is now shifting, says Dr. Ogan Gurel, though leader, doctor, professor, entrepreneur, who has been living in South Korea for the last 10 years. 

South Korea is a special example to look at during the times of COVID. In South Korea, digital health in some aspects is not legal. This changed only to a certain degree during the pandemic. “Even though people often regard South Korea as very technologically advanced, all the big mobile phone companies are here and so forth. However, telemedicine, which is a major part of digital healthcare, remote care is actually not legal in South Korea. And there are many reasons discussed more broadly in our previous discussion.  Because of the pandemic and the need for social distancing we also saw the increased need for digital health care, so the restrictive rules have been relaxed. For example, in the early days of the pandemic, telephone consultation was allowed telephone refilling of prescriptions was allowed on a kind of emergency basis. And of course, that has put some additional pressure and interest in telemedicine.  There is a lot of talking on the governmental level about relaxing those rules more permanently. There's a lot of activity among startups to do telemedicine and many European companies were interested in entering the telemedicine and digital healthcare market in Korea. I actually advised them that this is perhaps not such a good idea because of the regulatory barriers,” says Gurel. 

One of the biggest challenges in Korea is that it more difficult to engage with outside groups. “Hence globally based digital healthcare companies may still find it difficult to enter into the Korean market. So the telemedicine initiatives in Korea are very much related to domestic companies,” mentions Gurel. 

One of the more important consequences of COVID-19 on digital health is the recognized need for things like a digital health wallet or digital portable digital information, documenting vaccine status, testing status, and so forth. “We saw that on a United Airlines Flight where a patient got on, they checked that they had no symptoms that they were negative, but in fact, they were not and they died on the flight. And that was a big thing in the news. Portable health records will be very important. I'm actually working with a company that has developed a very robust solution around the digital health wallet. It's been implemented in some countries and seeking to globalize. So if people are interested in that, certainly they can contact me (ogangurel@gmail.com).”

Listen to the full discussion with Ogan Gurel from the series about digital health in Asia.

The rise of FemTech and FashionTech in wearables

João Bocas (Spain), known as The Wearable Expert, says 2021 will be the year where virtual and augmented realities will become increasingly important tools for fostering human connections. The second expectation from his side is the rise of FashionTech. “Wearable technologies have traditionally been on our wrists, and that will probably disappear in the future. We are seeing a lot of different innovators innovating and augmenting the technologies creating products such as rings,” says Bocao pointing to the Finnish company OuraRing, which predicts your sleep activities, your heart variability, and more. “We will see a lot of these different sensing technologies integrated into our belts, our shoes, smart shoes and clothing,” says Bocas. His third prediction is the rise of FemTech. ”We are seeing a lot of wearables predicting menstrual cycles for the ladies, the best moment in the month to conceive a baby. These insights will be extremely valuable in terms of personalized-self. In 2021 these things will be more mainstream since the pandemic highlighted that our biggest asset is our health. This is making consumers more prone to adopt these technologies for personalized-self.”

VR will go mainstream if insurance companies will pay for it

Dr. Brennan Spiegel a gastroenterologist who directs the Cedars-Sinai Center for Outcomes Research and Education and who recently published a book titled VRx points to a few signs that show VR could become more widespread in the upcoming years. “The FDA(Food and Drug Administration) in the United States, has now acknowledged VR as a new field of medicine. They call it a medical extended reality, or mXR for short.That's a very good sign when the regulators recognize this as real science. FDA provided a special designation for virtual reality as a breakthrough device for managing pain. That's another very important and formal designation that that acknowledges the science and the evidence. These are good signs that insurance companies may begin to take VR seriously and start paying for it. The payments will determine the future of virtual reality. If it gets paid for people will start to use it. My fear it would not fall in the reimbursement schemes. In that case, it would stay where it is today, and that is with researchers, interested physicians, and clinicians occasionally using it. We have thousands and thousands of studies about the efficacy of the therapy. But insurance companies need to pay for this for the use to explode, and it will explode. I believe that if it starts getting paid for, you'll start to see virtual reality clinics, you might see virtualists who become specialists in using VR, this may become a new specialty within medicine, or maybe each individual specialty will have people that decide to use VR and adopt it within their practice and get paid for it.”

Read about or listen to the full discussion with Dr. Spiegel here.

Blockchain is getting real 

Remember 2017 and 2018 when ideas about how blockchain could heal healthcare were booming? It seems that in 2019 and 2020, the hype boiled down and projects can focus more on execution and development. Robert Miller, Director of Product Management and Strategy at Consensys Health, predicts that a lot of the ideas from 2017 and 2018 are going to become viable in the upcoming years with new types of infrastructure resulting from years of investment and development. Blockchain and healthcare will continue to be driven by enterprises. Further, major developments will come mostly from existing business networks adding new members and use cases rather than new business networks being created. Robert Miller: “I think many of the things that people thought would happen earlier in 2017 will happen, but maybe not in the way that we expect. I'm very excited about federated learning, its potentials for more collaborative algorithms, and scaling solutions to many different parties. We will see federated learning algorithms embedded into more consumer-facing health applications. This may in some ways realize some of the promises of blockchain. For example, I have an Oura ring, which gives me metrics on my sleep in my heart rate today. And this is analyzed in a silo. I have no easy way of scaling this up to the community around me. You could quickly see how, by layering on federated learning or other similar technologies, you could quickly build something that was new and valuable of doing collective community-based analytics on top of health information that is valuable to a community. This brings a shift from quantified self to quantified community. I fully expect that to happen within the next two to five years, if not sooner.”

Read about or listen to the full discussion with Rober Miller here.

Tune in for the full predictions episode: