The Next Century of Health: Predictions on the Future of Health Care | Future of Health Summit 2023

Systemic Context & Diagnosis

• The U.S. healthcare system is described as fragmented ("a string of pearls minus the string"), having undergone a "metamorphosis" from chronic care to curative care that has paradoxically left the system "broken."
• Historical progress in the 20th century (pill, penicillin, vaccinations) is currently facing reversal due to behavioral issues, including antimicrobial resistance, the rise of vaccine skepticism, and political threats to reproductive rights.
• Greg Adams identifies "human behavior" as the primary obstacle to future health system improvements, noting that while science is the answer, humans remain the problem.

Electronic Health Records (EHR) & Data Interoperability

• Judy Faulkner (Epic):
  • Corrected the founding myth of Epic: It originated from a 1979 project at the University of Wisconsin to track patient clinical information over time (continuity of care), not billing.
  • The company's billing system was an accidental add-on five years later; the initial $3,000 charge for billing was far below the $3 million development cost.
  • Future Outlook: Anticipates significant disruption from AI and external technologies, aiming to integrate data across the fragmented ecosystem.
  • Payer Integration: Currently deploying the "Pair platform" to connect providers with payers in real-time, aiming to reduce prior authorization delays and denials.
  • Impact Metric: A pilot at Mayo Clinic with a specific payer reduced claim denials by 80%.
• Hirsch Hirschlander (Palantir):
  • Philosophy: Rejects the trade-off between privacy and security; prioritizes securing data while enabling governance, auditability, and interpretability.
  • Data Strategy: Does not act as a data broker but aggregates existing siloed data into a common ontology to support decision-making.
  • National Security Link: Frames healthcare fragility as a national security risk, citing the lack of coordination during the pandemic as a vulnerability.
  • Proposed Doctrine: Calls for treating public health as a national security issue, necessitating endpoint detection (e.g., wastewater surveillance) and centralized infrastructure for bio-threat response.
  • Operational Goal: Connects data analytics directly to operational decisions (supply chain, resource allocation) rather than just visualization.

Genetics & Personalized Medicine

• Joyce Hung (23andMe):
  • Strategic Shift: Moving from early adopters to a "lifelong genetic care" model, where a genome sequence is generated once and interpreted differently across life stages (e.g., childhood, family planning, aging).
  • Product Evolution: Acquired "Lemonade" for telemedicine access; launched "Total Health" with exome sequencing and clinician interaction to reduce friction between genetic risk identification and clinical action.
  • Core Mission: Aims to prevent diseases before they occur by empowering consumers to take ownership of their health data (e.g., integrating Apple Health data to resolve medical anomalies).
  • Systemic Gap: Highlights the misalignment between population-level screening guidelines and individual risk factors.

Diabetes Care & Technology Adoption

• Jared (Abbott):
  • Innovation Focus: Prioritizes "ease of use, affordability, and accessibility" to drive behavioral change, citing the failure of products with high burden or cost.
  • Current Metrics: Over 50 billion hours of glucose monitoring data accumulated; almost half of the 5 million daily users interact via smartphones (iOS/Android).
  • Future Outlook: Describes the current era as the most promising for diabetes care due to GLP-1 agonists, closed-loop insulin systems, and advanced CGMs.
  • Systemic Warning: Identifies a fundamental conflict of interest where payers hedge diabetes costs by investing in fast-food chains, undermining prevention efforts.
  • Access Concern: Stresses that technological breakthroughs are meaningless without equitable access and affordability, a challenge exacerbated by the U.S. fragmented system.

Future Outlook & Hope

• Consumer Empowerment: Joyce Hung expresses hope in the public's ability to act in their best interest if given access to their own health data and tools for self-advocacy.
• Data Democratization: Judy Faulkner cites the growth of "Cosmos" (220 million de-identified, de-duplicated patient records) and patient-facing apps (MyChart) as key drivers for future improvement.
• Public-Private Collaboration: Hirsch Hirschlander finds hope in the accelerating integration of private sector innovation (e.g., ARPA-H, Supply Chain Control Tower) into federal decision-making.
• Technology as Catalyst: Jared (Abbott) believes that with the right technology and cost control, the industry can move forward despite systemic behavioral challenges.
• Closing Call: The panel acknowledges that while the current system is flawed, the next century of healthcare depends on solving human behavioral issues and aligning incentives to prioritize patient outcomes over population statistics.