Conference Presentation, Panel
Driving the Digital Health Revolution
Milken InstituteIndu Subaiya, Paul Chew, Karen DeSalvo, Esther Dyson, Cindy Elkins, Donald Jones, Don Jones
- By July of the current year, the digital health sector is projected to have raised between $3.5 billion and $6.5 billion, with future convergence of health and technology expected to generate significant market opportunities.
- Heart disease, diabetes, and cancer are forecasted to remain primary causes of death, with 84 million people currently at risk for prediabetes; by 2030, the number of individuals over 65 with diabetes and chronic diseases is expected to reach 70 million, necessitating new payment models and scalable solutions.
- Intensive behavioral counseling is predicted to reduce diabetes incidence by 58%, outperforming metformin's 31% reduction rate, while a shortage of 40,000 primary care doctors by 2030 will drive reliance on digital approaches rather than personal coaches.
- Due to only 15% of primary care physicians knowing diagnostic criteria, 90% of people with prediabetes remain undiagnosed, requiring digital therapeutic companies to demonstrate clinical efficacy via peer-reviewed publications or face consolidation, as the market will retain only those proving such value.
- The healthcare system is expected to shift from a "sickness model" to a "health model" driven by payer and government leadership, with payment reforms like bundle payments and capitation anticipated to be the primary drivers of change in physician practice.
- "Connected drugs," including pills with connectivity and sensors, will become a major focus of the Internet of Medical Things, while traditional brands like Mayo and Cleveland may eventually be replaced by new digital-native trusted brands such as Omada regarding patient referrals.
- Organizations like Livongo are expected to see early digital health adoption by managing care directly for employers, as traditional physician groups and hospitals are characterized as slow movers vulnerable to disruption by vertically integrated technology services.
- Successful digital health companies are predicted to capture all available revenue in a disease area by evolving from monitoring services to therapy management and professional services, relying on convenience as the primary mechanism to build trust and customer retention.
- The "Way to Wellville" initiative, a 10-year non-profit project, aims to simulate community-level prevention funding that could eventually transition from philanthropy to sustainable market activity, with mayors potentially re-elected based on outcomes like increased housing prices and reduced incarceration.
- Amazon is forecasted to completely disrupt McKesson's business, including retail pharmacy, PBM, and DME sectors, potentially within ten years, while autonomous driving is expected to be a reality within five years, altering medication access and delivery through vehicles.
- Consumers are predicted to increasingly interact with household and automotive devices like TVs, refrigerators, and cars for health needs, integrating drug delivery into vehicles and homes, which supports a "health without healthcare" model where intermediaries other than emergency rooms step in.
- The "Rise of the Interlopers" is expected to continue exploiting low barriers to entry to build trust and expand services, with companies like Omada potentially improving patient sentiment toward insurance by 80%, while Amazon and other tech giants monetize patient data for machine learning and drug discovery.
- Social determinants of health will gain prominence through the "health without healthcare" model, which aims to make healthy choices the easy choice via the built environment, though policy changes are required to prevent the elimination of community health workers and medical legal teams in fee-for-service systems.
- A "sickness model" utilizing AI devices like Echo Dots is predicted to provide responses for minor ailments comparable to board-certified clinicians, potentially leading to doorstep package deliveries, though the speaker acknowledges uncertainty regarding the specific state of the world in 10 years.
- Data democratization carries the risk of dividing populations if issues like lack of broadband, shared device usage, and legal status fears are not managed, despite the potential for technology to reduce digital divides and address disparities in low-literacy and Spanish-speaking groups.
- Digital therapeutics companies will need to condition customers to demand ROI and medical credibility as the market matures from a lack of an organized "Office of Digital Therapeutics," with a specific focus on reducing churn in the Medicaid population where connection lasts approximately 8.5 months.
- Technological advances are expected to improve care efficiency and scope even if they have not yet reduced costs, with the potential for AI and connected devices to reinvigorate public health's role in addressing social determinants while filling gaps left by traditional healthcare system investments.
- MyWays expects to "rewire society" within five years by leveraging the human capacity to care for one another, a sentiment supported by public responses to natural disasters, while the CBO is anticipated to eventually shift focus from healthcare costs to the benefits of a healthy population.