30 May Is there a better market to invest in than healthcare?
Is there a better market to invest in than healthcare?
We shouldn’t need a pandemic to inform us that we need to bring our healthcare administration practices into modernity — or to show investors the opportunity they have to bring about much-needed change.
Recently, as I was scheduling a routine procedure, the nurse asked for my fax number so she could send me the pre-op procedures. A fax machine in today’s age? I was flabbergasted, as this was from an affiliate of one of the most sophisticated medical institutions in the United States, if not the world. I asked her to send me an email, and she indicated her systems were not equipped to do that but she might be able to scan the instructions and email them to me.
In light of the sweeping spread of Covid-19 and the increased pressure that has been and will continue to be brought to bear on the healthcare system, my experience becomes almost chilling.
And yet, we shouldn’t need a pandemic to inform us that we need to bring our healthcare administration practices into modernity — or to show investors the opportunity they have to bring about much-needed change.
My fax experience indicates that one major area to address is the antiquity of our healthcare system. In a time when our leaders and healthcare providers now face real concerns about Covid-19’s potential to overwhelm our facilities and drain our resources, we have to wonder — could the application of modern technology have improved our ability to handle a pandemic? The answer seems surely to be yes.
It is mind-boggling how healthcare practices stand in stark contrast to how advances in technology and science have dramatically improved diagnosing and treating a host of issues. In this context, profiting as an investor doesn’t require one to be steeped in science or healthcare. In fact, one might argue that it’s best to come from the outside and apply a fresh perspective, as has been the case with many recent healthcare-focused entrepreneurs.
The size, growth and dysfunction in healthcare lead me to believe there are few investment environments as fruitful as those concentrating on improving many key aspects of healthcare. There are enormous opportunities in biotechnology that are now possible due to massive leaps in computing power and cost, but I believe there are also equal opportunities to improve the actual processes associated with delivering healthcare. In the latter category, one is not required to have a deep science or medical aptitude to pursue or capitalize on.
It is these areas that I am most excited about, as they present the possibilities of applying otherwise-available technology to improving quality and reducing costs. According to Harry Glorikian in Moneyball Medicine, “There are also substantial wastes and inefficiencies in healthcare – factors that could be costing the United States $1 trillion. This includes costs related to overtreatment and unnecessary treatments, bloated administrative structures, fraud and overspending that result from an inability to effectively shop for best price.” These gaps, failings and their corresponding enormities are an entrepreneur’s and investor’s dream.
At its core, medicine is about gathering, deciphering and sharing information; information flows between patients and doctors, doctors and doctors, doctors and pharmacists, and so forth. This stream of facts, figures, and experiences ultimately results in the care of a patient.
Thanks to the transformative technologies we’ve seen in this young century, a transformation in the processing and dissemination of information has taken place, with more knowledge at our fingertips than imaginable just a few decades ago. From globe-spanning social connections to seemingly infinite encyclopedias to mobile connectivity and computing, several quantum leaps forward in technological capabilities now enable forward-thinkers to create a new world where price transparency and seamless collaboration are the norm.
Yet, despite the enormous advances in processing power and capability over the last 50 to 100 years, there remain many aspects of the actual process of practicing medicine that have barely evolved. While machines are unlikely to completely replace doctors anytime soon (or ever), the fact remains that there are a number of areas where the accurate, timely processing of information can dramatically improve patient well-being and ultimately the quality, cost and accessibility of both basic and complex healthcare.
Areas, like streamlining administrative processes, reducing redundancy or unnecessary procedures, or facilitating early and frequent interaction with medical professionals to treat conditions early or prevent them in the first place, are ripe for disruption from innovative approaches driven by technology. Investments in the following four categories are among the most obvious, lucrative and mutually advantageous areas where transformational change is possible and needed.
Medical Records: When you think about it, health records are actually incredibly inefficient. Not only do you have to fill out comprehensive medical questionnaires by hand—you have to repeat this process every time you change doctors, switch insurance companies, or alter your records in any way. Not only is this a colossal waste of time, but I shudder to think of the details that are mistaken or forgotten and how that might impact optimal care.
It’s not unreasonable to expect that, in today’s digital age, one’s health records should not only be easily accessible but also reside with the individual rather than being dispersed among the countless healthcare providers that the person is involved with. For too long, healthcare providers have been overly protective of this information — often to the detriment of the patient. While some strides have been made in this area, substantial work remains to be done to create true interoperability among providers for a specific patient.
This efficiency will improve the process of caring for a patient and in many cases will improve outcomes because doctors will always instantly have comprehensive information at their fingertips. Medical histories, treatment plans or idiosyncratic issues will no longer slip through the cracks. The scope of this issue is highlighted when considering patients dealing with multiple complex issues that might involve numerous specialists and general practitioners. Moreover, a patient’s health record shouldn’t be just for the provider, it should be user-friendly so that the patients themselves can monitor and manage their health.
Big players in tech are already making strides towards filling this customer service void, but the big gamechanger in this field still has yet to present itself. It’s a completely realistic expectation that within the next decade we’ll have moved onto quick, convenient, and secure medical records. There likely will be many players enabling the gathering, managing and sharing of patient information; however, the real transformational change will occur when the data contained in the health record is used to proactively diagnose and treat patients.
The Delivery of Care: Traditionally, the doctor’s office or hospitals was where medicine was almost exclusively practiced. Today, technology is enabling care for many basic issues to be delivered remotely to wherever the patient is. Telemedicine, or virtual care, utilizes technology so that doctors can seamlessly and, in some cases, instantly connect with patients to deliver care on demand.
The first iteration of this approach is traditional telemedicine, which uses video conferencing or a phone call to connect a doctor and patient. This approach is quickly and not unsurprisingly being usurped by asynchronous text on a smartphone – how the world prefers to communicate – where the doctor’s capabilities are being augmented by deep technology and AI. Providing easy and true on-demand accessibility for patients enables them to be treated early and often, which will unquestionably improve health outcomes. Pairing physicians with leading-edge technology can generate substantial efficiencies and leverage that, in turn, will reduce costs, increase quality and substantially expand those covered.
The flu offers a simple illustration of the power of technology that allows on-demand, remote care delivery: At the onset of symptoms, a patient can engage with a doctor and receive treatment. Instead of juggling their schedules or waiting to see a doctor — which averages 29 days according to a Merritt Hawkins 2017 study — the disease is treated promptly before it gets too far along. Furthermore, this remote treatment dramatically reduces contamination because there is no sitting in a waiting room or traveling — often on mass transit —to visit a doctor or urgent care center. In this scenario, everyone —patient, provider, community and employer — wins.
Similarly, technology is transforming how a patient is monitored — either following a procedure or for chronic issues. In many cases, vital statistics can be monitored remotely and transmitted instantly to a care team. This enables patients to recover at home, which is more comfortable, cheaper, and comes without the infectious risks present at a hospital. For patients with chronic diseases, the ability to easily and accurately monitor factors like blood glucose levels, heart rate or blood pressure can be transformative in terms of managing a disease or preventing problems down the road. On a related note, technology-based tools can be employed to aid and ensure prescription adherence, which currently poses a huge and unnecessary cost to the system.
Healthcare delivery is only beginning to embrace the power of technology — especially that of a smartphone — to cut costs, increase access and improve quality. As I previously wrote, I believe that the power and ubiquity of smartphones will improve the world’s health on an individual and collective basis. Virtually every other aspect of our lives have been enhanced by this technology with the exception of primary healthcare.
Clinical Decision Support: The capabilities of AI, machine learning and big data can be applied to many aspects of healthcare in order to leverage a doctor’s time, improve quality and drive much needed efficiencies. Deep technology can now review images and tests faster and often more accurately than humans. The sheer mass and dispersion of medical information and current research makes it virtually impossible for a single doctor to always be “up to speed.” Technology that can foster the analysis and sharing of vast and complicated information will give doctors instant access to the plethora of research studies and clinical trials that might be relevant to their patients. Using technology to quickly and accurately identify and process information on a client’s behalf will only improve care and drive down costs.
Precision Medicine / Personalized Diagnoses: Given the powerful computers at our disposal, it is easy to envision how we could use computers to aid decision-making, plugging in numerous permutations, conditions, and individual attributes unique to patients in order to determine the problems at hand and the optimal treatment plan. For example, for a prescription one will no longer need to rely on the catch all “adult” dosage and can instead determine the best amount for each patient based on their unique composition and metabolism.
Personalizing diagnoses is where AI is beginning to show real promise. Researchers have developed the technology for identifying heart disease, lung cancer and eye maladies with machine learning, and they’re only getting started. Even more cutting-edge is where a patient’s genome is analyzed to determine precisely the diagnosis and corresponding treatment plan. This capability is still in its infancy and only possible due to the advancements and price reductions in computing power.
Healthcare is ripe for the benefits technology affords and, as the responses and capabilities relating to Covid-19 demonstrates, desperately needs an update. Relative to other areas, I think the aforementioned categories might be “low hanging fruit” and hence represent significant investment potential. What I find particularly exciting is that the space is so large and in such desperate need that there will be a wide array of places to invest with potentially several players in each area. Fields such as Artificial Intelligence, Data Management and Cloud Computing offer much promise when applied to healthcare, especially in disrupting several areas that suffer from stagnation and lack of development. These applications will benefit doctors and patients alike while concurrently offering very attractive returns to the investors and entrepreneurs behind the companies. Lastly, and equally compelling, is that an investment that helps improve healthcare provides a greater good by enhancing lives and benefiting communities.