Conference Coverage

The time is now for physicians to ride the digital disruption wave



– “The health care milieu is ripe for digital disruption,” said Anton Decker, MD. Speaking at the American Gastroenterological Association Partners in Value meeting, which was developed in partnership with the Digestive Health Physicians Association, he said that physicians need to become part of the disruption before it’s too late.

There’s no sign of improvement in worrisome trends in reimbursement, said Dr. Decker, president, international, at the Mayo Clinic, Rochester, Minn. The megamerger trend that is bringing together ever-larger payers, pharmacy benefit managers, and hospital groups is just one manifestation of the trend toward consolidation that’s also seen in the airline industry, in financial services, and in telecommunications, he said.

“The math is not good on the payer and health systems side,” but for physicians, “There are ways to survive trends like this if we can move ourselves higher in the food chain.”

Other players in the health care space are figuring it out, he said. For example, the state of Ohio has five Medicaid plans; in 2018, aggregate profits for these plans were approximately 400 million dollars. Laying this profit figure against the backdrop of Medicare reimbursement rates for physician services makes it clear that “we have to figure out ways to survive this game,” he said.

“Health systems keep their lights on because of the hospital reimbursements – that pays for everything else,” said Dr. Decker, adding that payments from commercial insurers fill the coffers that, in turn, pay physicians who are employed by health systems. However, there’s a sea change underway in the sites in which care is delivered: “There’s enormous pressure to get people out of the hospital and out of the emergency rooms,” said Dr. Decker, “And that’s not always better for patients.”

That shift to delivering care outside of the four walls of the hospital represents an opportunity for digitally savvy companies, many of whom may actually have little experience with health care delivery.

“Digital disruption is a sleeping giant that is easy to ignore, but you do that at your own peril. It’s happening in front of your eyes. My message today is: Figure out how you can move yourself further down the line.”

Chronic diseases, said Dr. Decker, “represent an opportunity for providers and health systems to leverage digital disruption.”

Overall, health care services contribute only to 10% of a patient’s health, said Dr. Decker, and are far overshadowed by individual health behaviors and social determinants of health. Is there a role for physicians to move beyond the clinic and hospital as partners in the digital disruption of health care? Yes, said Dr. Decker: “We’re not part of that aspect of a person’s life, and we need to be. ... I believe that providers have the right to be involved in other aspects of peoples’ lives to make them better, and yes, also to survive financially.”

Chronic disease management represents an enormous opportunity to better patient well-being and keep physicians involved as the health care digital revolution unfolds, said Dr. Decker. “Sixty percent of this country has a chronic disease. We as health care providers need to think differently about that.”

Changes are already well underway, with score upon score of startup companies developing apps that utilize smartphones and wearable devices to offer coaching, health education, and remote monitoring to consumers. “The barrier to entry is really low,” said Dr. Decker, with Silicon Valley already partnering with patients and payers to achieve digital monitoring and care delivery. But relatively few of these partnerships have actually involved physicians in building and executing the solutions they offer. “And that’s our fault, for not making sure we are part of this disruption,” he said.

Further, the evidence base for much of this monitoring and intervention is low. “There are some scathing articles on the level of evidence that these apps have – or don’t have,” said Dr. Becker. Physicians who get on board at the early stages of technology development could make a real difference, he said. “We could help them build the real evidence.”

Looping back to the current payer model, Dr. Decker asked, “Which pool of money is this coming from?” From the same pool of money that pays physicians, he said: “It’s coming off our backs.”

This isn’t a time when physicians can afford to wait and see how the digital health care landscape evolves, stressed Dr. Decker, making the subtle but important point that it’s hard to discern when you’re in the middle of disruptive change. Though the curve may appear relatively flat at the moment, he assured attendees that exponential growth in digital health care is already well underway.

Here is where early entry and user adoption are key: “Why do you think Facebook bought WhatsApp?” he asked. Though the messaging app, which has more than a billion users worldwide, is free now, eventual plans to charge WhatsApp users a dollar – or even less – per year will net Facebook staggering sums in the end, he said. Companies like Facebook “have figured out...the strength of exponential growth in a digital world,” he said.

All the building blocks are in place for physicians to begin contributing to health care’s digital disruption, said Dr. Decker. The Centers for Medicare and Medicaid already have reimbursement codes for remote patient monitoring, for example. “Providers are being left out, and I think it’s our own fault.”

Dr. Decker reported that he had no relevant conflicts of interest.

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