4 forces reshaping health care

Ingenuity is transforming health care.

Chronicling that change is our focus at the new Future Pulse.

Our newsletter’s revamped, daily version will continue to cover the convergence of health care and technology you’ve long come to expect from us. But we’re broadening our lens.

You’ll read about trends in health, good and bad, and how caregivers are responding. We’ll examine the business of health care, the costs of treatments and medicine and the disruptors seeking new footholds.

Genius invention and novel ideas promise to improve care, but they come with risks and challenges for regulators.

Today, we present four consequential trends that will affect health care’s future and their potential benefits and downsides.

1) At-home care 

Patients have become comfortable talking with their doctors on a computer and using a bevy of digital devices to monitor, and manage, their health care. Wireless blood pressure cuffs, wearable blood glucose meters, portable ultrasounds, at-home tests and smart scales that detect diabetic foot ulcers make it possible for patients to manage their health.

That promises huge dividends for patients’ health and cost-savings, too. “Things that were done five years ago in the hospital can now be done at home,” Michael Dowling, CEO of Northwell Health, New York State’s largest health care provider, told Future Pulse.

But getting government insurance programs like Medicaid to pay for new treatments is tricky.

And while patients have increasing access to consumer health and fitness apps, data tracking presents thorny privacy issues.

2) Value-based care

Momentum is building for value-based care — a system that reimburses doctors for keeping patients healthy instead of counting the number of services they provide.

A value-based care approach should encourage patients to get routine physicals and seek preventive care.

“You want people to be screened for cancer. You want people to go see their primary care physician — these are good things because they lead to lower costs downstream,” said Myoung Cha, head of strategy at primary care provider Carbon Health.

The Centers for Medicare and Medicaid Services has expressed its desire to move toward value-based care.

But adoption is slow because of the expense to upgrade computer systems to collect patient data, shifting rules and incentives on how providers are paid and reluctance to move from a simple payment model to one that presents more financial risk.

3) Primary care

Long waits for appointments. Little follow-up from doctors. Patients are frustrated with their primary care. But disruption is coming.

Amazon has acquired One Medical, which offers 24/7 telemedicine and storefronts for in-person appointments. Walmart bought MeMD, expanding into urgent and primary care. CVS’ $8 billion acquisition of at-home care coordinator Signify Health is another example.

If all goes well, patients will benefit from the market forces at work. But the FTC is worried about the power big firms are accumulating, and expanded telehealth could create fraud risks.

4) Artificial intelligence 

Artificial intelligence hasn’t reached its potential in the health care space — yet.

But little by little, researchers and doctors are figuring out how best to use AI to help them make more accurate diagnoses and more effective treatment decisions.

Some of the most compelling algorithms have cut down the amount of paperwork and planning doctors must complete before performing medical procedures. That eases labor constraints and burnout.

“We are leveraging advances in technology to make sense of these disparate data sets and ensure they have real-world applications to improve health,” said Stephen Gillett, the president of health tech firm Verily.

But AI that’s not carefully monitored can exacerbate disparities in health care, too, a threat regulators are watching.

This is where we explore the ideas and innovators shaping health care. We’re glad you’re here and we hope you’ll come back every weekday for more.

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New York declared a polio emergency after an unvaccinated man came down with the disease this summer and wastewater samples revealed the virus’ presence in New York City and four counties.

That’s troubled the highest levels of the U.S. government because the disease is highly infectious, mostly affects children and can lead to paralysis.

But polio could be a thing of the past if the Global Polio Eradication Initiative, a joint effort of the World Health Organization, the CDC and other public and private entities, succeeds.

It hopes to raise $4.8 billion, which it believes is enough to eradicate the virus by 2026, at an event in Berlin on Oct. 18.

Why it’s important: The case in New York is vaccine-derived and not from the wild poliovirus variety. The vaccine-derived virus comes from people immunized with an oral vaccine that contains a weakened version of the virus.

The virus can reach the water supply and sometimes mutate. It can then sicken unvaccinated people. Though no longer used in the United States, the oral vaccine is used in some parts of the world because it’s easy to administer.

But truly eliminating the wild poliovirus, endemic only in Afghanistan and Pakistan, would also eliminate the need for vaccination in the long term.

We’re not there yet. New York health officials are urging unvaccinated state residents to get an injectable polio vaccine that doesn’t carry the live virus.

There’s hope: Afghanistan and Pakistan have reported only 21 cases this year, suggesting a successful vaccination campaign could end polio.

“We need to vaccinate every child” to end transmission, said John Hewko, the CEO of Rotary International, an organization involved in the fundraising. Rotary is committing $150 million over the next three years.

Fears that the world monkeypox outbreak would spread beyond the group where it’s concentrated, men who have sex with men, are receding.

The latest report from the WHO, covering the week of Sept. 12–18, found that confirmed cases are dropping fast, down 22 percent from the week before.

And that’s coming at a time when disease surveillance has increased.

More than 97 percent of the known cases are among men, with a median age of 35, according to the WHO. Nearly 91 percent of cases are among men who have sex with men. The WHO said the same percentage of cases are connected to sexual activity.

What’s happening: Cases are falling most quickly in regions that have reported the most cases during the current outbreak, the Americas (down 42 percent) and Europe (down 81 percent).

Why: It’s impossible to say for sure why the outbreak is slowing, but the downward trend coincides with a massive vaccination campaign. Experts believe changes in behavior may also be playing a role.