Changes in healthcare happen through incremental improvements and gradual evolution rather than through revolution and disruption. Hospital systems are going to adapt and evolve rather than undergo huge transformations and radical changes, says Mark Coticchia, Innovation, Technology Commercialization, and Venture Development Leader at Baptist Health Innovations.

At the last mHealth Israel conference in Tel Aviv, he shared his prediction about healthcare systems and healthcare delivery in the US in 2033.

Mark Coticchia is the Innovation, Technology Commercialization, and Venture Development Leader at Baptist Health Innovations.

In the past, Mark established Henry Ford Health Systems Innovations and during his career has closed thousands of transactions with industry, government, academia, and philanthropy, created and led nationally recognized technology-based ecosystems in Pittsburgh, Cleveland, and Detroit, among other things.

Here is the transcript of Mark’s talk at mHealth Israel conference 2022: 

People from Pittsburgh, where i grew up, are huge hockey fans, and I love the words of the great Wayne Gretzky. He once said, “I skate to where the puck is going.”  

That’s been my approach to technology commercialization and new ventures and my style in leading the efforts at a number of institutions. I have been asked to talk to you about the opportunities that represent where the puck is going. 

Sah-mi, a serial healthcare entrepreneur, said it well when he said:

“if you want to disrupt an industry like healthcare, you have to do it in a non-disruptive way.”

Here are the trends that i believe will define the roughly 650, mostly non-profit U.S. health systems.  

The health system of 2033: digital health will be in the throes of mass adoption. 

At Baptist Health, our CEO has been quoted as saying that we want to be the Amazon Prime of healthcare. So, we are driving a shift in care from in-person to digital delivery. I take a cue about digital health from remote patient monitoring. Many doctors now access data from their patients’ wearables to detect and monitor certain conditions. These technologies are being coupled with advances in machine learning.  

For example:

1. AI algorithms can detect diseases like cancer better in some cases than radiologists can.

2. One-in-three women with apparent breast cancer detected by a mammogram is treated unnecessarily. 

AI and machine learning is improving this dramatically: 

1. Vastly reducing the need for biopsies and treatments, 

2. The cost of hospital resources, and 

3. Emotional and physical trauma.

Empowered by these digital advances, health systems will finally be able to operate as coordinated, integrated systems. Right?  

Well, not quite.  

More than 85% of customer interactions outside healthcare are handled without a human, but only about 20% of patients trust AI-generated healthcare advice. The fact is that people want to entrust their lives to people! To get these realities in sync, we need to think of it not as digital health care but rather as digitally-enhanced health care. 

1. By 33, interactions will be enabled by digital technologies but still mediated, guided, and led by humans. 

2. In the system of 33: Personalized medicine will be commonplace.  

Compared to ten years ago, health systems are already doing a much better job in this area. 

Today, top physicians are detecting diseases using these tools. A couple of examples: 

1. Before prescribing drugs, physicians who take a personalized medicine approach consult reports that highlight variations within their patients’ genes, such as those involved in metabolizing drugs.  They can then prescribe drugs with more confidence and clarity, which in turn gains better patient adherence. 

2. Some physicians are using sequencing technology to determine their patients’ pre-disposition to diseases and then apply treatments and lifestyle changes for prevention. By providing care through personalized medicine approaches, systems will offer: 

• more specific and effective treatments, 

• prevent disease, and 

• reduce ineffective medicine.

3. In the system of 33: Patients will be engaged and will demand customized experiences. Patients will finally have control over their health information. 

Just look at the partnership apple created with many health systems, including Stanford, Massachusetts General, Johns Hopkins, as well as EHR companies. The partnership uses a new standard for exchanging data to integrate all patient information across providers into a single, unified smartphone app. 

As new data standards take root, patients will be able to control their health data in one place. With the standardization of personal data, patients will be able to access and see prices of different providers. Just walk into any minute clinic today or go online and search for the menu of prices. they clearly state them: 

• burn treatment is $99, 

• COPD screening $45, 

Just as we access online price menus for food and concert tickets, patients will shop for prices and ratings of care and wellness services. 

Telemedicine will have a starring role in patient engagement. 

It’s a prime example of “what’s old is new again.” Remember the days of the doctor’s house call?  It’ll be back. In fact, CVS recently bet 8 billion dollars on the return of the house call by purchasing Signify Health, which runs a network of doctors that make house calls. This greater engagement will profoundly affect American systems. 

Patients will vote with their feet and checkbooks. 

Learning to self-manage their care, patients will opt-out of receiving care at the centerpiece hospital in favor of receiving care from retail entities that offer menu-based options. In many cases, they’ll receive primary or concierge care, through a membership model, flat-fee model, or some other business model. However, when people need surgery or have cancer, they will demand skill over everything else, which gets to a key point.

4. In the system of 33: The hub will be the super specialty center. 

They’ll focus on cancer, ortho, neuro, cardio and multi-disciplinary, complex procedures. To do so, systems will need to partner with external providers on non-specialty care. The center will partner with convenient retail clinics and other providers to position itself as the center point of an integrated care system. 

Through this whole-system / whole-patient / whole lifetime strategy, the health system will be able to treat complex matters that other providers lack. Top systems will better address their patient’s full health journeys — from birth to death, procedure to rehab, drugs to wellness activities, and more. They’ll have expanded from today’s patient-by-patient approach to treat at the societal level. Population health, aided by a better understanding of social determinants, will address things like ‘food as medicine,’ housing assistance, post-discharge care, community engagement, and education. 

Naturally, the system of 33 will feature standalone centers: 

• Ambulatory surgery centers will do most simple outpatient procedures.

• There’ll be focused - senior housing facilities - specializing in memory care.

All of this consolidation and integration has to be financed. Merging, acquiring, and partnering for people, technology, and capital require tremendous resources. Several systems have already launched incubators and venture funds and expanded their business development and m&a capabilities, all in order to build out their whole patient-whole lifetime strategy. Why would today’s systems spend money on such a change? Because system leaders know that currently, up to 80 billion dollars per year are wasted on poor care coordination. The care of a patient itself is a commodity, but the coordination of patient care, the patient experience, is the covenant. 

In 33, integrated care ecosystems will better uphold the covenant with their patients.

5. In the system of 33: The culture will be more empathetic. 

For the first time, I see a pipeline of leaders who have the combination of management skills and medical training that their systems need. Skilled and experienced leaders who understand both complex organizations and human health will help implement cultural change at systems. 

A point of light in the culture of the system of 33 will be empathy ― a normal, human feeling that has proven time and again to improve patient outcomes. Patients who are shown empathy are satisfied. 

And satisfied patients: 

• trust their providers, 

• adhere to treatment protocols, 

• enjoy better emotional health, 

• heal faster, and 

• suffer less pain.

Can entrepreneurs build empathy into their products and services? I hope so, because i think it is a huge opportunity.

6. In the system of 33: We’ll see advances stemming from (1) automation, (2) better deployment of nurses, and (3) better use of i.t. professionals. 

The pandemic accelerated burnout and great resignation. Plus, the health systems are crossing the chasm on digitally-enhanced health. This combination of change, resignation, and culture has ensured that systems have insufficient skills and not the right people in the right places. That’s a huge problem! This is not new. For over a decade, physicians and nurses have felt unheard and unappreciated. They are worn out. and now, post-pandemic, most clinicians say their offices are not fully staffed. So, health systems will beef up human resources and upgrade staff pay and benefits. This is a major undertaking, but they won’t carry the burden of retail and primary care staffing; 

1. That will move to Walmarts, minute clinics, and stand-alone.  

2. They’ll basically have the specialists either employed or, more likely contracted.

3. And they will have more nurses with advanced training and education.

Recognizing the current shortage of nurses, many systems, including Baptist Health, have started their own, in-house nursing schools. 

Systems also will staff themselves with thousands of people who specialize in the field of health system navigation ― concierges and advocates who help patients and providers navigate the entire health system. 

This speaks again to the coordination of care, the patient experience, and the covenant between the system and the patient that will be more actively managed and honored.

7. In the system of 33: We’ll see positive results when it comes to preventive medicine and wellness. Systems will keep more patients healthy and out of the hospital.

They’ll use data more effectively.

They’ll have better info about reward systems so that patients move towards wellness. And with enhanced transparency and trust, more patients will better adopt preventive measures. 

I hope that one or more of these seven major trends that I feel will define the system of 33 inspires you in some way. I want to end with an  example that illustrates the complexity here:

These days, in addition to learning basic and clinical science, many med school students are also required to learn “health systems science.” In this emerging field, med school students have to show proficiency in the impact of medicine beyond the patient - to the care system and the population. I think that this new and growing med school requirement sums up where the puck is going…in the system of ’33.