Health Sector

Healthcare in 2017: Amid the uncertainty, these changes are certain Page 1 of 3
Healthcare in 2017: Amid the uncertainty, these

changes are certain
Written by Kristen Vennum, Americas Advisory Health Sector Leader, Ernst & Young LLP | January
26, 2017 | Print | Email
We are living through a truly transformative period in health — for both consumers and the
organizations who serve those consumers.
Unsustainable levels of spending are driving the shift to value-based care and the search for more
effective and more affordable solutions. New technologies are empowering patients, shifting control
away from health care professionals and innovating the delivery of care. In addition, across the world
people are viewing access to health care as a right, and governments are recognizing that societal
wellness is an economic asset. Finally, the past year saw organizations learning how to balance
adapting to new regulation while simultaneously sustaining quality, positive patient experience and
profitability.
The confluence of these changes – in mindset, technology, spending, and adaptation to regulation -- is
dramatically disrupting how healthcare is designed and delivered. And in the U.S., with a new
presidential administration in place and the process to repeal the Affordable Care Act underway, the
transition is presenting organizations with an uncertain future; one where a shift to a changing and
potentially less regulated healthcare policy environment is expected, but the precise nature, process
and timetable for change remain uncertain.
With change as a certainty, watch for the following five trends to accelerate in 2017. Our teams at EY
are focused on helping our clients navigate the potential effects of these trends, and prepare for
continued disruption.
1. Health care shifts to total health.

The very definition of the word “health” is changing. Health is no longer merely something of
concern when someone is sick. Now, health is viewed as a holistic pursuit — a daily, lifelong, all-
encompassing engagement with wellness. Early intervention is being recognized as essential to
preventing disease. New technologies are helping people make smarter, more proactive wellness
choices. Insurance companies, worksites and others are using data-driven, evidence-based incentives
to encourage healthy behaviors among populations. This trend is turning the health industry on its
head, transforming the industry from one that treats illness to one that promotes total health and
focuses on improving quality while reducing cost.
2. Participatory health flourishes.

Traditional care delivery models are being upended by technology, consumerism and greater access to
information. Patients are taking on greater responsibility for their health, curating and navigating their
care in partnership with their health care provider. Mobile and web tools are encouraging active, daily
patient participation. At the same time, individuals are shifting their focus from reactive “sick” care to
Health sector update 1

http://www.beckershospitalreview.com/hospital-management-administration/healthcare-in-... 7/14/2017
preventative care and wellness promotion. As a result, as detailed in Health reimagined: a new
participatory health paradigm, the successful health system of tomorrow will embrace participatory
health by being on-demand, connected and data-driven.
3. The M&A market stays hot.

Rapid shifts in delivery and payment models will continue to force health care organizations to
rethink their business models, structures and operations. In particular, new reimbursement models
based on outcomes are forcing providers to broaden their scope of care, while continuing to pursue
efficiencies. As a result, the health care industry is engaged in a record level of M&A activity as
organizations choose to merge, acquire or partner with other organizations that can help them provide
and control patient care along the entire health care continuum — from initial treatment through all
the stages of recovery. With mega deals under scrutiny, expect an increase in smaller strategic tuck-
ins; as opposed to a slowdown in deal activity.
4. Cybersecurity expands in scope.

As data becomes more useful in health care, protecting that data becomes more important. Medical
records have always been a high-value target for identity thieves because they contain a large amount
of personally identifiable information that is difficult to change. But now, the rise of consumer-
friendly digital and mobile health technology is fueling the cybersecurity threat by creating additional
access points for sensitive medical information, including medical devices themselves. Health care
organizations are scrambling to detect and prevent cyber-attacks, but many lack comprehensive,
enterprise-wide plans to identify and secure high-risk data. Look for health care entities to get even
more serious about cybersecurity. In traditional environments as well as within the growing biome of
connected devices, watch as health care entities adopt the leading practice approaches from other
high-risk industries, such as banking and utilities.
5. Big data, paired with human experts, provides better insights.

How do you make big data better? By adding people power. Artificial intelligence (AI) technologies
are growing more advanced, and health care organizations are rapidly adopting AI as a way to quickly
analyze large swaths of patient data and to glean insights about patient populations. But to really
maximize those insights, interaction is needed between data, technology and people. The true power
of AI is unleashed when computer-generated analytics is augmented by human decision-making and
when algorithms are well-informed by medical experts. Assuring the data is clean, accurate, properly
indexed, de-fragmented and interoperable is critical to produce insights that can arm leaders to make
better decisions.
Kristen Vennum is the Americas Advisory Health Sector Leader at Ernst & Young LLP. She is based
in Washington, DC, and can be reached at Kristen.Vennum@ey.com.
The views expressed herein are those of the author and do not necessarily reflect the views of Ernst &
Young LLP.
The views, opinions and positions expressed within these guest posts are those of the author alone
and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy,
completeness and validity of any statements made within this article are not guaranteed. We accept
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author and any liability with regards to infringement of intellectual property rights remains with
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Value-driven
care. Are you
ready?
Insights drawn from EY Health
Advisory Survey 2017

EY recently surveyed 700 qualified health care
professionals. Respondents included chief medical
officers, clinical quality executives and chief financial
officers at US-based health care providers, with annual
revenue of US 100 million and higher. Surveys started
on 22 February 2017 and were completed by
23 March 2017. This research sheds light on the state
of the provider industry, including some prominent
factors that are challenging organizations’ performance
and growth. Based on our industry knowledge and
interpretation of the survey findings, health care
organizations can address challenges through a total
transformation across the continuum of care that will
lead to a competitive advantage and better health
outcomes.
The graphs notated with EY Health A dv isory S urv ey
2 0 1 7 represent proprietary results and findings
from the survey.
V alue-driven care. A re you ready? | 1

A n ailing
industry
Much of the American health care system is straining
under an increasingly oppressive burden of rising
costs. In 2015, health care spending grew by 5.8%,1
reaching a total of US$ 3.2 trillion in the United
States, or US$ 9,990 per person.2 Health care
spending in the US has now risen to 17.8%3 of GDP,
a rate far above that of any other industrialized
nation. Yet, by many measures, American consumers
are not getting their money’s worth. Americans have
a lower life expectancy,4 higher incidences of chronic
conditions such as heart disease and diabetes,
and higher infant mortality rates5 than people in
other industrialized nations. Even worse, health
care disparities still exist among several vulnerable
demographics, and equitable access to health care
remains problematic.
1
http s:/ / w w w . cms. gov / research-statistics-data-and-systems/ statistics-trends-and-rep orts/ nationalhealthex p enddata/ nationalhealthaccountshistorical. html.
2
3
4
http :/ / w w w . healthsystemtrack er. org/ chart-collection/ u-s-lif e-ex p ectancy-comp are-countries/ ? _ sf _ s= lif e# item-u-s-low est-lif e-ex p ectancy-b irth-among-comp arab le-countries.
5
http s:/ / w w w . cia. gov / lib rary/ p ub lications/ the-w orld-f actb ook / rank order/ 2 0 9 1 rank . html.
2 | V alue-driven care. A re you ready?

EY Health Advisory Survey 2017
ho read for the financial future

V alue-driven care will req uire new reimbursement models; resources and the level of clinical and
financial inte ration var alon ith a ri e in ri and re ard Here here or ani ation tand in their
reimbursement priorities for 2017:
6 7% 4 7%
6 1% 3 8 %
3 2%
23 %
14 % 12%
8 % No value-based 7%
reimbursement initiatives Bundled payment models
6 2%
19 %
6 1%
17%
5 2%
11%
28 %
6 %
27%
1%
Alternative payment models Provider-sponsored health plans
Provider health care organization by revenue

US 100 million US 4 million US 500 million US million US 1 billion US 2.4 billion US 2.5 billion US 4. billion US 5 billion or more
Bundled payment models Alternative payment models (APMs)

These are designed to pay multiple service beneficiaries This offers incentive payments to provide high-quality
to coordinate all services required for an episode of and cost-efficient care. APMs can apply to a specific
care. clinical condition, a care episode or a population.
e pondent ere a ed at pecific al e a ed reim r ement initiati e i an are o plannin and nderta in in elect all t at appl or ot plannin and
undertak ing. ”
* S ource: http s:/ / q p p . cms. gov / learn/ ap ms.

The relationship between costs and outcomes is
complex. Priorities across the continuum of care
often compete with each other, putting unreasonable
pressure on all constituents of the health care
system. As a result, many organizations are under
tremendous pressure to balance delivering the highest
value and quality to their patients with managing
other expectations. Consider the following industry
challenges:
nefficienc
Inconsistent q uality of care
or force challen e
ac of tru t tran arenc and coordination
fici c
Fee-for-service (FFS) payment agreements and poor
integration across the health care system boost overall
costs by increasing the likelihood of repetitive tests and
overtreatment. This wasteful spending is amplified by
the increasing prevalence of expensive-to-treat chronic
illnesses, greater levels of administrative support
required to comply with regulations and the need to
invest in expensive new technologies. Organizations
across the care continuum are feeling pressure on
their bottom line. While cost control initiatives are
commonplace today, organizations are seeking
incremental improvement as opposed to transformative
gains.

o five co t control initiative

for 2017
Of the rofe ional urve ed thin the co t of care i con idera l im ortant or ver im ortant
n addition of re ondent are ta in co t control mea ure
U S$
Reducing medical errors and 5 8 %

increasing reliability
18 %
Decreasing unnecessary 4 1%
variation and utilization
24 %
Peer benchmarking and competitive 13 %

benchmarking
4 0%
Increasing patient access to primary and 3 4 %

specialist care
17%
Reducing hospital use and emergency 20% Undertaking

departments by high-cost patients
28 %
Planned
Respondents were asked: “What specific cost control initiatives, if any, are you planning and undertaking in 2017? Select all that apply for both planning and undertaking.

Inconsistent quality of
care
Clinical outcomes and health care quality are often
measured inconsistently by health care providers — if
they are measured at all. At the same time, a high
prevalence of medical errors is stoking the anxieties
of the public through alarming headlines and creating
concern among health care executives over potential
litigation. Despite these concerns, our survey found
that only 58% of respondents are currently undertaking
initiatives to reduce medical errors in 2017. It should
be noted, however, that 18% of respondents have
initiatives planned for 2017.
Workforce challenges
Organizations are struggling to identify talent and keep
their employees engaged. Our survey found that only
12% of respondents rated their clinical ancillary staff
as “highly engaged, and a mere 8% answered that
their administrative staff are “highly engaged. This
is especially concerning because the administrative
and frontline staff are often the first point of contact
for patients, and may help provide long-term patient
support. Our survey also showed that physicians and
nurses rank among the most engaged employees.
However, they constantly struggle to balance the
demands of patient care with administrative burdens,
leading to high rates of burnout.

The talent crisis in health care
The U S health care industry is facing unprecedented physician burnout and a severe nursing shortage.
hi i an i nored and under tated u lic health or force cri i that merit focu ed attention
Physician burnout: N ursing shortage:

industry-wide epidemic nationwide crisis
Fifty-one percent of physicians reported Inadequate nurse staffing has been a factor
experiencing frequent or constant feelings in 24% of the 1,60 cases involving patient
of burnout in 2017, up from 40% in 2013. death, injury or permanent loss of function
reported since 1 7.2
5 1% 24 %
4 0%
cases
“
2013 2017
S t r a t e g ic s o lu t io n s a d d r e s s in g d e c lin in g m o r a le o f t h e s e h e a lt h
c a re p ro v id e r s w o r k in g a t t h e f r o n t lin e o f p a t ie n t c a r e m u s t b e
“
p r io r it iz e d . O th e rw is e , a v o id a b le m e d ic a l e r r o r s w ill e x p o n e n t ia lly
p la c e p a t ie n t liv e s a t r is k , a n d t r a n s fo r m a t io n t o w a r d v a lu e - d r iv e n
h e a lt h c a r e w ill r e m a in n o t h in g b u t a t h e o r e t ic a l c o n v e r s a t io n .
- Yele Aluko, MD, MBA, FACC, Executive Director, Ernst Young LLP, EY Americas Advisory Health Care
1 . http :/ / w w w . b eck ershosp italrev iew . com/ hosp ital-management-administration/ a-b urnout-ep idemic-2 5 -notes-on-p hysician-b urnout-in-the-us. html.
2 . http s:/ / w w w . nursingsociety. org/ w hy-stti/ ab out-stti/ stti-media/ nursing-shortage-inf ormation/ f acts-on-the-nursing-shortage-in-north-america.

Lack of trust,
transparency and
coordination
Historically, the relationship between providers and
payers has been ruled by a FFS reimbursement
arrangement centered on health care visits and
procedures. However, unsustainable costs and a
demand for improved clinical outcomes are making
it increasingly difficult for payers and providers to
develop a contracting structure that works for both
entities now and in the future.
Health care
players are
reacting
Leaders in both the public and private sector have
attempted to craft a holistic response to these issues,
moving away from the traditional FFS model and
toward a system that ties cost to favorable clinical
outcomes. Critics point out that the existing health care
reimbursement model fails to encourage performance
standardization and provider accountability for
value delivery. Providers and payers have started to
react to market pressures coming from consumers
and legislation that encourage outcome-based
reimbursement, such as the Affordable Care Act
(ACA) and the bipartisan Medicare Access and CHIP
Reauthorization Act (MACRA).

Payers on the move
e i lation i di ru tin traditional S model ut leadin rivate a er are al o movin do n the
ath a to value centered reim ur ement on their o n Here are ome a rivate a er are em racin
value:
APMs
One major national payer is already making 50% of its reimbursements in
APMs and is committed to make 0% of reimbursements in a value-based
model by 2018.
Value-based contracting
The chief executive of a second major payer organization has stated value-
based contracting currently represents approximately 45% of the company’s
medical spending, and the goal is to achieve 75% by the end of the decade.
New payment structures

A third major payer organization has partnered with a data analytics and
population health vendor to move forward in value-based payment structures.
¹ https://www.cigna.com/assets/docs/about-cigna/thn-white-papers/8 2 7-0216-creating-value-through-collaboration-web.pdf.
https://www.forbes.com/sites/brucejapsen/2017/02/02/unitedhealth-aetna-anthem-near-50-value-based-care-spending/ 21 072ba1d4e.
https://healthpayerintelligence.com/news/how-3-healthcare-insurers-expand-value-based-care-payment.

Market forces are moving the industry toward a new
paradigm; one in which delivering the highest value
is an organization’s defining goal. Future market
share will be dependent on an organization’s ability to
measure and demonstrate properly the impact that
providers and payers have on the health of customers.
While some providers are taking initial steps to establish
quality, they are doing so in a piecemeal fashion that
does not recognize the need for a total transformation
across the continuum of care.
According to our survey, 49% of interviewees

have already initiated quality audits, 31% had
instituted physician performance scorecards
that include a quality measure and 38% plan to
institute facility scorecards in the future.
However, audits and scorecards alone will not move the

needle far enough.
Organizations that hope to thrive in the health care
industry of tomorrow must start aligning revenue
and costs with quality-first thinking and a culture of
accountability.
10 | Value-driven care. Are you ready?

Payers and providers
With health care expenditure accounting for nearly 18% of
America’s gross domestic product, both payers and providers
recognize the need to bend the cost curve. There’s an
opportunity to optimize value, and the payoff is huge.
U S$ 1 trillion
Estimated wasted spending each year in the
health care industry due to factors such as
inefficiencies, redundancies, fraud and abuse
¹ Harvard Business Review. https://hbr.org/2015/10/how-the-u-s-can-reduce-waste-in-health-care-spending-by-1-trillion.

A new vision of value
Historical cost management models — including disease management programs, authorizations/pre-authorizations
and benefit designs — are no longer sufficient on their own and have done little to address quality and value
in a meaningful way. Today, new value-based care models are emerging with the expectation to increase both
reliability and industrialization within health care. However, adoption has been slow and inconsistent, and results
have been mixed.
Focusing on value is essential to overcoming the current challenges in the health care industry, but executives
will need to act quickly and strategically if they want to stay ahead of competitors. The first step toward
transformation is to broaden the understanding of the narrow but frequently used term “value-based care to a
new vision of value that describes a complete transformation of care delivery: “value-driven care.
Our definition of value-driven care is delivering the best clinical outcome relative to the optimal cost of care within
an environment that fosters the right patient experience delivered by engaged and satisfied providers.

he four illar that u ort
concept of value-driven care are:
Clinical Cost Patient Talent

outcomes optimiz ation ex perience engagement
Effective care Transparency, efficiency, Access to care Engaged, satisfied
that delivers and process and high levels of employees
positive, improvements that customer committed to the
sustainable, and eliminate waste, satisfaction. organization’s
measurable redundancy, and misuse mission.
results. of resources.
Cultural transformation
=
Technology and data
analytics
V alue-driven care
These pillars must be enabled by cultural transformation and robust technology, which increase
transparency and accountability across all stakeholder organizations.
Through this new value-driven lens, organizations can start to view their disconnected initiatives as part of a
total transformation across the continuum of care that will lead to a competitive advantage and better health
outcomes.

M oving to
value-driven
care will req uire
balancing
the following
priorities:
Embrace a holistic approach

Or ani ation are ta in a iecemeal a roach to deliverin ualit and value o unloc the full otential of
value driven care an or ani ation mu t im lement all com onent of the model in a coordinated manner
of EY Health Advisory Survey respondents “strongly agree or “slightly agree
78 % that health care or ani ation need to ivot to thrive in a value-based

environment.

Elevate the patient experience
Health care is becoming a consumer-driven industry, so patient satisfaction is an integral part of the move to
value-driven care. Provide patients with appropriate access to health care, focus on customer service, measure
clinical outcomes and deliver patient-centric tools that increase transparency for the consumer.
of respondents are undertaking patient experience intiatives in 2017. However, only 26% of
9 3 % respondents selected patient access/satisfaction as one of their top three initiatives for the year.
Transform the culture

Successful organizations will exhibit the cultural behaviors that indicate “the head and the heart are operating
together to deliver on a collective purpose, collaborate effectively in teams and maintain a steady focus on
the patient.
5 1% of respondents believe that employee satisfaction in health care drives patient satisfaction.
Advance with analytic insights

Value-driven care relies on predictive, proactive and preventative analytics to deliver the best clinical outcomes.
Organizations will need to invest in robust technology that can leverage statistics and exploratory data mining
techniques to help identify the underlying drivers of cost and quality.
26 % of respondents ranked new technologies as one of their top three priorities for 2017.
Increase productivity
Costs are only part of the equation in the move to value-driven care. Monitoring costs must be counterbalanced by
monitoring productivity, and both must be measured and reported accurately.
of respondents are undertaking cost control initiatives for peer benchmarking/competitive

13 % benchcmarking. Forty percent of respondents have these intiatives planned for 2017.
Embrace the new way to pay

Payers and providers will devise a new type of partnership and redefine the current reimbursement structure.
An essential part of the process is redefining the payment model to focus on overall value rather than
transactional services.
25 % of respondents have no reimbursement initiatives planned for 2017.

Elevate the
patient ex perience
Health care is becoming a consumer-driven industry.
With patients increasingly involved in their own care,
patient satisfaction needs to be front and center. This
means providing patients with appropriate access to
health care, focusing on customer service, measuring
clinical outcomes and delivering patient-centric
tools that increase transparency for the consumer.
More importantly, involving the patient will improve
performance results. Engaged patients support quality
initiatives, reduce cost and lead to better outcomes.

Engaging the patient
Patient engagement is proven to drive measurable results.
B etter clinical Reduced M edication

outcomes cost adherence
More engaged Less engaged Text messaging

patients are more patients had can improve
likely to have readmission rates medication
biometrics such as up to adherence rates
body mass index, for chronic
blood pressure 1. 75 x disease patients by
17. 8 %
and cholesterol in ³
normal range higher .
3 0 days
than less
engaged
patients.
after discharge
than more
engaged patients.
¹ http :/ / content. healthaf f airs. org/ content/ 3 2 / 2 / 2 0 7 . f ull# ref -2 7 .

² http :/ / w w w . medscap e. com/ v iew article/ 8 1 3 4 4 3 .
³ http :/ / j amanetw ork . com/ j ournals/ j amainternalmedicine/ f ullarticle/ 2 4 8 4 9 0 5 .

Transform the culture
Transformation requires a vision and culture of shared Optimizing patient experiences across the continuum
accountability and ownership regarding the patient of care while industrializing quality requires more
experience and health outcomes. Providers must be than episodic effort. Quality measures, balanced
held responsible for their overall performance through scorecards, financial incentives and other metrics are
measures such as physician scorecards and facility important methods to clarify objectives. In addition
dashboards that allow for internal and external peer to that, however, each patient’s care experience along
benchmarking, with scores made public for consumers. the continuum must be delivered in a coordinated and
For physicians, the only way to drive change in synergistic way to avoid variation and yield the best
behavior and enforce accountability will be to tie their possible health outcomes and patient satisfaction.
compensation and incentives to the delivery of positive Successful organizations will exhibit the cultural
experiential outcomes. behaviors that indicate “the head and the heart” are
operating together to deliver on a collective purpose,
collaborate effectively in teams and maintain a steady
focus on the patient.

Shifting health care culture

toward value-driven care
ulture i the a an or ani ation doe u ine o ered an underl in et of rule value and
elief that ever one from the to to the ottom i ali ned on and a lie con i tentl
Current health care environment Leveraging purpose

According to the EY Health A dv isory S urv ey, the drives engagement
employees that ranked as the most engaged at Employees are:
provider organizations are:
1. 4 1. 7 3
times times times
8 2% 8 0%
M ore M ore M ore lik ely
engaged1 ati fied1 to stay1
Physicians N ursing
staff
75 %
Department
heads 8 4 %
of business
ex ecutives
However, these employees ranked
lower on engagement:
believe that transformation is
more successful if integrated with
purpose.2
4 5 % 3 8 %
A dministrative M aintenance
staff staff
Hi hl en a ed em lo ee create hi hl ati fied atient n a in around the

or ani ation ur o e not onl enhance the atient e erience ut al o hel
or ani ation attract and retain the e t talent
P ercentages aggregate “ q uite engaged/ committed”
and “ highly engaged/ committed” resp onses. ttp e com l en er ice ad i or e p rpo e led tran ormation enefit
and-ex amp les.
R esp ondents w ere ask ed: “ How engaged are emp loyees at your organiz ation/ comp any? 2 . http :/ / w w w . ey. com/ P ub lication/ v w LUA ssets/ EY -inf ograp hic-b ased-on-harv ard-and-
lea e e ollo in fi e point cale pro ided or eac o t e ollo in role 2 0 1 4 -ex ecutiv e-surv ey/ $ F ILE/ EY -inf ograp hic-b ased-on-harv ard-and-2 0 1 4 -ex ecutiv e-
surv ey. p df .

Advance with
analytical insights
Determining the effectiveness of value-driven care
requires an organization to collect, store and analyze
meaningful metrics. Organizations should invest in
the IT infrastructure needed to provide near real-
time data analysis for measuring performance. They
can then use predictive, proactive and preventative
analytics to drive the best clinical outcomes.
Statistical modeling and exploratory data mining
techniques will help identify the underlying drivers of
cost and quality, enabling disciplined processes for
system-wide cost containment, expense management
and quality outcomes. Our survey found that only 26%
of respondents ranked new technologies as one of
their top three priorities for 2017. In terms of patient
experience, only 8% said they are leveraging patient-
centric analytics. The competitive field is wide open
for an organization that invests in robust technology
and talent to exploit big data beyond the current focus
on actuarial risk.
Increase productivity
The EY survey shows that CEOs and CFOs are more likely
to prioritize costs. However, costs are only part of the
equation in the move to value-driven care. In the drive
to increase value, keeping the bottom line under control
should be a function of performance optimization rather
than a separate priority that competes with quality of
care. Monitoring costs should be counterbalanced by
monitoring productivity, and these metrics need to
be understood and managed by all members across
organizational leadership.

Embrace the new
way to pay
Finally, the existing payment model needs to be
redefined to focus on overall experiential value rather
than transactional services. Payers and providers will
need to devise a new type of partnership and redefine
the current reimbursement structure. Despite pressure
on the current payment model, many health care
executives today appear to be unprepared for a change
in payer contracting. Our survey found that 5% of
respondents are taking cost control measures, but
25% do not have any “value-based reimbursement
initiatives planned for 2017.
Cultural transformation
Eighty-four percent of survey respondents agree that improving

ualit co t mana ement and outcome can e a hared o ective of
health care providers and payers.
e pondent ere a ed lea e rate o r le el o a reement or di a reement it t e ollo in tatement in t e fi e point cale pro ided

V alue-driven
care is the
destination
With market forces pushing for a new care delivery The move to value-driven care will not be easy. Not
model, many organizations will undoubtedly be only does it require the industry to look at patients
dragged into the realm of value. Relying on a series as consumers, it also demands a holistic approach
of disjointed initiatives to get there is not an effective to operations, the adoption of new technologies, an
strategy. The leaders in the next iteration of American increase in transparency and a dynamic organizational
health care will be organizations who boldly embrace culture. But the payoff is huge. Organizations that act
value-driven care now. By going all in with a patient- strategically now will become more resilient in the face
centered, outcomes-driven approach, organizations of tomorrow’s challenges. They will be empowered by
will have the opportunity to build market share an engaged workforce that collaborates to deliver the
by attracting more customers based on their core best outcome possible: healthy happy patients treated
competency of delivering value. in an enabled ecosystem of affordable, accessible,
accountable care.

Value-driven care. Are you ready? | 23

Contributors
Clinical outcomes Cost Cost
Yele Aluko Brian Flynn Dana Alexander

MD, MBA, FACC, Partner/Principal Executive Director
Executive Director Ernst & Young LLP Ernst & Young LLP
Ernst & Young LLP Finance, EY Health Advisory Finance, EY Health Advisory
Finance, EY Health Advisory brian.flynn@ey.com dana.alexander@ey.com
yele.aluko@ey.com
Patient experience Talent engagement Analytics and insights
Erik Swanson Jon Powell Christer Johnson

Executive Director, Strategy Executive Director Partner/Principal
Ernst & Young LLP Ernst & Young LLP Ernst & Young LLP
EY Health Advisory People Advisory Services Enterprise Intelligence,
erik.swanson@ey.com jon.powell@ey.com EY Health Advisory
christer.johnson@ey.com

Value-driven care. Are you ready? | 25

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advisory services. The insights and quality services we
deliver help build trust and confidence in the capital markets
and in economies the world over. We develop outstanding
leaders who team to deliver on our promises to all of our
stakeholders. In so doing, we play a critical role in building a
better working world for our people, for our clients and for
our communities.
EY refers to the global organization, and may refer to one or

more, of the member firms of Ernst Young Global Limited,
each of which is a separate legal entity. Ernst Young Global
Limited, a U company limited by guarantee, does not
provide services to clients. For more information about our
organization, please visit ey.com.
2017 EYGM Limited.

All Rights Reserved.
EYG no. 04181-174GBL

1706-233728
ED None
This material has been prepared for general informational purposes only and is
not intended to be relied upon as accounting, tax or other professional advice.
Please refer to your advisors for specific advice.
ey.com

a e com cc health th edition
Health highlights
Global Capital Confidence Barometer
eal activit and local economic confidence re ilient a ain t a ac dro of
eo olitical uncertaint
A note from W. Gregg Slager, EY Global Health Transaction Advisory Services

Health executives foresee steady sector growth, with tech and health
services firms eyed most for new deals.
Health sector results from EY’s 16th Capital Confidence Barometer (CCB16) indicate
that executives remain positive in 2017, with improved economic fundamentals driving
organic growth.
Executives in the sector expect the M A pipeline to remain stable, with 36% planning to
actively pursue mergers and acquisitions in the next 12 months. Among those looking for
re Sla er new deals, technologies and services top the list of strategic interests.
EY Global Health
Transaction Advisory i e t ri include c er ecurit
Services
Concern around cybersecurity was the top reason cited as to why deals failed over the last
gregg.slager@ey.com
1 212 773 8041 12 months. As the recent WannaCry attack demonstrated, acquisitions that lack up to date
security measures can be a liability, as they may be a vulnerable entry point into an otherwise
secure environment. Executives are justifiably cautious.
Issues uncovered during due diligence was the next largest concern. The use of analytics to
derive high quality insights from structured and unstructured data sets has never been higher,
enabling companies to rapidly identify and raise issues prior to deal completion.
From a macroeconomic perspective, volatility in capital markets and uncertainty about US
government policy is slowing decision-making around investment. But caution, not pessimism,
seems to rule the day: only 10% of health executives worry that the new US administration will
implement policies that will reduce M A activity. Similarly, 70% responded that Brexit is not
influencing decision making about making investments in the U .
i e t di ru tor di ital and ne technolo ie

Digital disruption is top of mind for health executives. The impact of new technologies on the
current business model is the issue most frequently discussed in the boardroom. Disruptive
technology and potential changes in trade policies are compelling companies to be more
responsive, and more frequent, in their portfolio and operational reviews.
onfidence o timi m ith on oin deal and i eline

Uncertainty about policy and capital markets is influencing a relative pause in M A activity
compared with 2016’s record levels. Pipelines remain focused and stable with more than 75%
of respondents reporting that they expect no change in pipeline size. Optimism remains high
with ongoing deals, as 4% of executives expect deals to close at the same rate or higher than
last year.
Of those looking to achieve strategic goals through M A, more than 75% anticipate pursuing
small deals ( US 250m). Strategic growth is the focus for this group, which reports a desire to
tap into new areas of geographic and market share growth.
he outloo ro th e ectation ta hi h
Fluctuations in currency and capital markets are moderating last year’s record breaking deal
levels. Expectations for growth remain high, and interest in new geographies and cross-border
activity has moved to the forefront of the boardroom agenda.

expect no change in deal
8 8 % 72%
expect their i eline to remain look at cro order deal to
24 %
com letion in the next ta le in the next 12 months secure market access and grow
12 months their customer base
see the lo al econom

9 9 %
expect corporate earnings cite a broad range of
im rovin to either im rove or eo olitical or emer in
remain ta le olic concern a ociated
ith S overnment a
reate t ri to growth
8 8 %
have increased the frequency of
3 0%
plan to out ource routine cite digital innovation, the
their ortfolio revie roce o eration or ac office earch for ro th and ector
function in the next conver ence as the most
12 months prominent topics on their
boardroom agenda
o five inve tment de tination
1 2 3 4 5
United States Australia United ingdom Germany Canada
EY Assurance Tax Transactions Advisory
About EY About EY’ s Transaction Advisory Services

EY is a global leader in assurance, tax, transaction and advisory How you manage your capital agenda today will define your competitive
services. The insights and quality services we deliver help build trust and position tomorrow. We work with clients to create social and economic
confidence in the capital markets and in economies the world over. We value by helping them make better, more-informed decisions about
develop outstanding leaders who team to deliver on our promises to all strategically managing capital and transactions in fast-changing markets.
of our stakeholders. In so doing, we play a critical role in building a better Whether you’re preserving, optimizing, raising or investing capital,
working world for our people, for our clients and for our communities. EY’s Transaction Advisory Services combine a set of skills, insight and
EY refers to the global organization, and may refer to one or more, of experience to deliver focused advice. We can help you drive competitive
the member firms of Ernst Young Global Limited, each of which is a advantage and increased returns through improved decisions across all
separate legal entity. Ernst Young Global Limited, a U company limited aspects of your capital agenda.
by guarantee, does not provide services to clients. For more information This material has been prepared for general informational purposes only and is not intended to
about our organization, please visit ey.com. be relied upon as accounting, tax or other professional advice. Please refer to your advisors for
specific advice.
2017 EYGM Limited.
All Rights Reserved. ey.com/ccb
EYG no. 00000-000GBL
1701-2166 71
ED 1804

Disrupt or be
disrupted
The future of health
is digital

Digital is transforming the world of health so dramatically that even organizations not
rooted in technology know they must respond — and embrace — technology’s wide-reaching
disruptions. Today’s health care consumers are more networked, engaged and empowered
than ever before. They’re accustomed to technology making their lives easier, speedier
and more connected. They’re demanding harmonized health experiences with simple,
coordinated interactions as they receive service across the health care spectrum.
Brave new (health care) world

Inspired by consumer interactions in other industries, it is easy to imagine a brave new health care world where:
• A diabetic patient shares her personal glucose levels directly with her insurance company via a remote-care app. Her
insurer uses the data to adjust her premiums favorably to reinforce her positive behavior.
• Your primary care physician gets an email alert when you fail to pick up your prescription from the pharmacy, and a
care manager calls you to find out why you aren’t taking the prescribed medication.
• Artificial intelligence analyzes the medical history of an entire patient population and, making decisions based on
historical results from millions of patients, recommends customized disease prevention coaching for each patient,
based on their medical history.
Technology is forcing health care organizations to shift how they approach their business, who they collaborate with and
how they interact with their patients. And many traditional players are scrambling to keep up. A badly designed patient
portal or long wait times for an appointment won’t stand with a population accustomed to rides-on-demand and real-time
blood pressure data available on their wrists. The successful health care organizations of the future will be those that best
adapt to the new digital reality.
1 | Disrupt or be disrupted; the future of health is digital

The changing landscape
The digital health era is here • Electric carmaker Tesla, which produces a fraction of
vehicles compared with major US automakers, has
The digitalization of health care has been a multifaceted achieved a higher market capitalization than any —
discussion over the last decade, but it has now arrived. based on its prospects, not profits. It uses personalized
One key stumbling block is the isolated and fragmented digital marketing, as opposed to a dealer network, to
way in which many health organizations approach drive sales.
customer engagement. To win in digital health,
organizations need to rethink their business models to So the pressure is on the health sector to catch up and
align cost, quality, patient engagement and customer keep up. As other industries have learned, disruption is
experience. This requires partnerships with IT companies, full of threats — and opportunities.
payers, start-ups and even other industries. These new
partnerships and the products they create are paving the What can I do differently to avoid
way to a digital health future.
being disrupted?
Furthermore, health care’s high barrier of entry is
As Apple’s early marketing so famously posited, “Think
falling as entrants from other industries bring their
different.” The digitization of health care requires a
competencies to bear:
new business model, a new organizational structure, new
• Technology companies are using social and consumer talent and new questions. Leadersare asking:
engagement platforms, coupled with data analytics
• How can digital simultaneously improve patient safety
and mobile health solutions, to develop personalized,
and quality of care, while bringing down costs?
actionable insights on a population health-level.
• How can digital transform care management across
• Retailers are driving insights into patients’ lifestyles and
multiple care settings, such as hospital, ambulatory,
behaviors and becoming the future of health care service.
retail and home?
• Consumer product companies are introducing user-
• How do I use digital to improve patient outcomes by
friendly technologies from other industries and making
better managing handoffs within my facility and across
big bets on nutraceuticals and superfoods.
care settings?
• Start-ups are accelerating the industry’s speed to
• How do I leverage data and analytics to direct patients
market, spurring fresh thinking and forcing traditional
to lower-cost care settings or providers?
players to move fast.
• How can blockchain help me manage provider data?
Consider this: since 2000, digital disruption has
demolished 5 2% of the F ortune 5 00* • How will digital solutions impact my operating model?
What processes, technologies and organizational
To prepare for disruption, take note of other industries
changes are required?
where digital convergence is a way of life. In many cases,
established players failed by ignoring similar customer That last question is key. If your destiny is to disrupt
demands and reacting too slowly. Remember Blockbuster? rather than be disrupted, you must shift how your
It was overrun by Netflix, and today, major television organization operates. Digital will impact every facet
networks look to Netflix with envy as the streaming service of your organization, so the silos must give way
continues to transform how people view and pay for to interoperability. In the new digital environment,
television and movies. Other examples include: disconnected departments, such as supply chain, risk,
technology, finance, recruiting, accounting, scheduling
• In four years, Airbnb has completely disrupted the hotel
and care management, will all be linked and collaborating.
industry and today has more than 100 million users with
close to a million listings around the world.
• Robotics process automation helped an international

insurer cut down reporting times from 90 to 12
minutes, with 100% accuracy.
* Source: https://www.constellationr.com/disrupting-digital-business
Disrupt or be disrupted; the future of health is digital | 2

The patient-centric health ecosystem
Digitaul rE nablement
rsec ity and A
rtificial
tics, Cybe Intel
lige
ly nce
Ana Automation
Robotic Process Automation
Conversational Intelligence
Blockchain
Provider Payer
Care delivery Billing and premium
Collections Care management
Compliance Claims
Customer service Compliance
Denials or referrals Patient portals M obile Customer service
Patient access Membership management
Patient engagement Plan or product
management
Telemedicine
Self-service W earables Provider networks
Implantables Care
coordination
Social media Pricing

transparency
Sensors and monitors
O ther ecosystem partners

Telecom, retail, pharma and regulatory

Realign the model
Is your business strategy and operating model aligned to reap the benefits of the digital age? Silos
are a barrier to progress. Think of digital as an enterprise investment, not a simple solution to one
problem. A holistic view is best. Workflow and architecture need to be aligned to capitalize on the
full capabilities of the technology. Future digital investments need to expand the return of prior
initiatives.
Convergence of industries will unlock value

The convergence of industries is moving health care forward in ways never imagined. Twitter
is tracking disease outbreaks, telehealth is now a standard model of care delivery, insurers and
employers are now investing in preventative care, 3D pills allowing “downloadable medicine,”
home-based genetic testing kits, fitness trackers and wearable devices. These innovations are all
part of an industry that will reap great rewards in improving safety, decreasing costs and meeting
customer expectations.
Know your customer

Do you know when consumer demands change? How are you monitoring shifts in consumer
sentiment? Today’s super consumers want super experiences. Embrace the world of the
constituent, from consumers to providers to brokers and employers in the health care value
chain — then design and recommend new experiences for them. Obsess over helping your
customers solve their biggest problems.
Say goodbye to the digital divide

Is your operating model designed to support and enhance your digital decisions while advancing
the member and patient experiences? Digital is most powerful when your entire organization
embraces its possibilities and understands its internal and external impacts. Sharing technology
through common platforms will enable artificial intelligence, advanced decision-making and more
consumer-friendly capabilities. Align your operations to deliver on the promise of digital.
Manage your risks

Are you scanning the horizon and protecting your business from risks inherent in the digital
future? Patient chat rooms, electronic medical records and social media all require the most
advanced cybersecurity measures. But — a word of caution — don’t let cybersecurity paralyze your
digital transformation.


Be a winner in the
consumer-driven, health
marketplace of the future
Health care’s future winners will be those that can best recognize the impact of
the digital future and adapt accordingly. They will focus on core competencies
and outsource tasks others can do better. They will team up quicker, collaborate
in a more meaningful way and invest in dynamic capabilities. But most of all, they
will overcome the inertia to change, as well as the perceived risks of adapting and
diversifying their business model.
EY is equipped to help as you apply digital solutions and innovation to your

business, reinforce your cybersecurity programs, make sense of massive daily
data collection or look to tax savings to fund an acquisition. No matter where
you are on this journey, we have proven experience that can help you apply a
holistic view of your organization to take care your business, systems, talent and
communities reap the full value of today’s digital enterprise.
We can provide end-to-end services, as well as the confidence to help you
navigate the complex world of digital ecosystems. Ask us about new ways to map
the latest breakthrough, manage risk, lower costs and find new markets.
At EY, we have the knowledge, experience and talent to provide options as

the universe of digital health evolves. From back-office operations to the most
innovative strategies, we are leaders in helping businesses like yours reimagine,
comply, measure and monitor in a changing landscape.

EY contacts:
Rachel Hall
Executive Director — US Health Advisory
rachel.hall@ey.com
+1 720 931 4723
Lloyd Smith
Principal — US Health Advisory
lloyd.smith@ey.com
+1 404 817 4297
Debra Loggia
Senior Manager — Digital and Emerging Technologies
debra.loggia@ey.com
+1 215 901 6371
EY | Assurance | Tax | Transactions | Advisory
About EY
EY is a global leader in assurance, tax, transaction and advisory services. The insights
and quality services we deliver help build trust and confidence in the capital markets and
in economies the world over. We develop outstanding leaders who team to deliver on our
promises to all of our stakeholders. In so doing, we play a critical role in building a better
working world for our people, for our clients and for our communities.
EY refers to the global organization, and may refer to one or more, of the member firms
of Ernst & Young Global Limited, each of which is a separate legal entity. Ernst & Young
Global Limited, a UK company limited by guarantee, does not provide services to clients.
For more information about our organization, please visit ey.com.
About EY’s Global Health Sector

Across the world, health care systems and entities are under unprecedented pressure.
Spiraling costs, exacerbated by aging populations and emerging market growth, are
bringing newfound focus on value and outcomes. Mobile health and data analytics
promise to revamp care delivery but are also bringing in competitors from other sectors.
For governments, payers and providers, these trends create a host of challenges:
extracting insights from “big data,” partnering in new ways, boosting operating
efficiencies and more.
EY’s Global Health Sector brings together a worldwide network of more than 4,000
sector-focused assurance, tax, transaction and advisory professionals with a range of
health care and business backgrounds. Our wide-reaching network allows us to rapidly
share leading practices and solutions around the globe and deploy diverse delivery teams
to meet your needs. ey.com/health
© 2017 EYGM Limited.
EYG no: 03440-174GBL
CSG no: 1705-2292153
ED None
This material has been prepared for general informational purposes only and is not intended to be relied
upon as accounting, tax or other professional advice. Please refer to your advisors for specific advice.
ey.com/industries/health

Health care:
the cross-currents
of convergence deliver
participatory health
A second paper in the
Health Reimagined series

Home Contents < >
The EY Health Reimagined

Compendium
Health reimagined: The future of
a new participatory health insurance
health paradigm A participatory health solution
This paper explores a vision
This paper discusses six trends
of the future of an expanding
Health disrupting health insurance.
reimagined: and participatory health
a new participatory The future
of health
These trends are driven by two
ecosystem based around
health paradigm
insurance shifts: the need to tame runaway

the individual as an engaged
cost inflation, which is spawning
A road map through change
and active consumer. Health

new incentives and payment
systems will reshape into a
structures, and digital health,
digital health ecosystem — one that is globally connected
which is democratizing data and
and locally relevant. Solutions to sustainability, growth and
empowering consumers.
delivering health care to the rapidly growing population will
be driven by three key shifts around digital technologies,
1
social media 2.0 and a maturing health care consumerism.
http://www.ey.com/au/en/industries/health/ey-health- http://www.ey.com/Publication/vwLUAssets/EY-the-future-of-
reimagined-a-new-participatory-heath-paradigm health-insurance/$FILE/EY-the-future-of-health-insurance.pdf
The new innovation How will we disrupt aging

imperative before aging disrupts
Reshaping biopharma economic growth?
business models Building an engaged aging strategy
New technologies, customers Aging is a megatrend as big as
The new and competition are forcing — How will we disrupt aging
digital disruption. EY Engaged
innovation
and enabling — biopharmaceutical Aging Summit, and associated
before aging disrupts
imperative
Reshaping biopharma
economic growth?
business models Building an engaged aging strategy
January 2017
companies to find novel ways to thought leadership, explores how
create and capture value. we — industries, governments,
health consumers and non-
governmental organization
(NGO) — can seize the upside
of aging.
The new innovation imperative: reshaping biopharma business models 1
http://www.ey.com/gl/en/industries/life-sciences/ey-vital- http://www.ey.com/gl/en/industries/health/ey-health-
signs-reshaping-biopharmaceutical-business-models reimagined-how-will-we-disrupt-aging-before-aging-
disrupts-economic-growth
2 Health care: the cross-currents of convergence deliver participatory health

Home Contents < >
Contents
The EY Health Reimagined Compendium 2
Foreword 4
Health care: the cross-currents of convergence
deliver participatory health 5—8
The long run to transformation
A digital ecosystem is inevitable — emerging and
developing economies may leapfrog ahead 9—12
Revisit, redesign and reset health care:
a new default setting
Shifting health care from reactive to proactive 13—16
Discontinuity with the past:
a curation-navigation-fusion model
Capacity to scale will be the turning point 17—21
Getting to business as usual — system transformation
Breaking out of old models requires a new way of thinking 22—31
Creating a cadence for change 32—33
Our view 34
Methodology 35
Contacts 36
Endnotes 37—39

Home Contents < >
Foreword
This paper further extends our thinking on participatory health.
We examine shifts in emphasis, direction and focus necessary to
realize a new and disruptive paradigm. Based upon conversations
with a broad group of health and wellness industry executives
in the United States, Europe, Southeast Asia and Australia,
desk research and a pulse survey of professional young adults
globally, this paper outlines shifts that will move health care into
an entirely new space — that of participatory health becoming
embedded as business as usual in the health industry. How this
might be financed will be addressed in the third paper in this series.
The innovation challenge to shift health care organize transactions and interactions, as well as draw upon
toward a participatory system is quite clear. the power of the crowd, will create new pathways by which to
Breakthrough technologies, new sciences organize and deliver health care. Global alliances that blend
and integrated design-based solutions will the technical capabilities of one partner with the health care
drive fundamental change in the delivery of expertise of another could offer interesting opportunities if they
health, wellness and care. The leading edge were to get off the ground.
of the health industry is already moving at
So who will lead and who will follow? Emerging and developing
breathtaking speed toward anywhere, anytime
economies may well take the lead in this journey to participatory
care fashioning health care as continual and participatory in the
health. Advanced technologies enable these economies to
home and community. But delivering participatory health care
leapfrog the more industrialized as they seek to build, rather
and well-being at scale is immensely complex, especially in an
than retrofit, health care markets. This will not be simple — or
industry notoriously slow to change. In this paper, we propose a
easy to put into practice — but may well deliver a decidedly
model of industry transformation where key elements of curation,
disruptive change.
navigation, data fusion and an eventual global platform-based
ecosystem drive innovative solutions to some of the intractable Participatory health is not the future of health care; it is, without
problems in health care. doubt, the present.
What realm of possibilities exist as health runs headlong into
the space where industry, technology, science and social
constructs converge? This convergence brings opportunity for
those seeking to enter the health arena as well as to incumbents
willing to reinvent core business, create non-traditional alliances David Roberts
or step into adjacent areas. Platforms that build networks that EY Asia-Pacific Health Leader

Home Contents < >
Health care: the cross-currents

of convergence deliver
participatory health
Digital clones of real-life medical

experts that give personalized
advice and support on a vast
range of medical issues around
the globe — far-fetched? Not at all.
Medical avatars that look and
sound like your own doctor
are under development at the
University of Southern California.1
Virtual reality technology and
artificial intelligence come
together as an interactive and
responsive virtual physician —
one that maximizes quality time
spent with you, in partnership
with your regular physician or
health professional.

Home Contents < >
Now is not the time to be thinking about how sty

le
| P
ersona
lized experien
ces
|
Lif
es
ife ty
health care might benefit from digital technologies —

yl le
lth c
Social
ho
He
ice
media
s
that time has long passed. In fact, the important
Lif
|
elo
Con
ng
tinu
Payers Smartphone
h eal
conversation around the future of health care is not
apps
al pers
th
onal data
|
about shifting to digital at all. It is about people.
Well-being
Consumer
|
medical Providers
|
The real force for change in health care is patient
ility
devices
We
ta b
ll n
un
es
Circle
co
s
mediated — the power of the patient or consumer
of
ac
Se
|
n
al
lf- support o
di rs
re
c Pe
ti o |
n
to engage and participate. A new health care

| Flexib nie n ce
ility | Conve
ecosystem is arising from convergence between Participatory health is reflective of a deep and profound
shift in perspective toward well-being and wellness, greater
traditional and non-traditional players that blends
convenience, flexibility, self-direction and personalized
health care expertise with network and platform experiences. It is a transformation in the patient-provider
capabilities. New pathways of health and wellness relationship where individuals work with their health
arise at the interface between the consumer and professional team as an equal and responsible partner.
Individuals become empowered as they gain the knowledge,
the system that transform the industry into one skills and confidence to engage persistently with the
that is online, networked and participatory. health system.
Participatory health —
a radically different future
A significant catalyst for change is an engaged and participating new entrants (retailers, telecommunications and technology
patient or consumer who acts as an equal partner in their care. companies, entrepreneurs and venture capital investors) create
Market dynamics are shifting rapidly to the consumer as the tools and platforms by which participatory health can be
integrative platforms form ecosystems that disrupt both supply delivered. Exponentially developing technologies through
and demand with new ways of creating and consuming health care integrative platforms delivers a suite of new offerings around
goods and services. Central to this is the deep and profound shift well-being, remote care, medical imaging at home and the
in the model of care toward participatory health. internet of things (IoT). Participation is the underlying premise
as the notion of health transitions from reactive to proactive
Integrating participatory health as a pillar of the system, as part
care systems focused on wellness, chronic care and population
of the core business of health care, takes the industry into a
health management.
radically different future. The digital revolution has changed
what is possible in health care. Low-cost, fast mobile connectivity This paper discusses a model of industry transformation and
and smart devices redefine how consumers manage their health three conditions necessary to achieve scale:
and engage with care systems. Sensor technologies and mobile
• C
 onsumer participation through curation and navigation
solutions are reinventing how the health industry can connect
technologies that are the interface between the consumer
and communicate with patients. In participatory health, it is the
and the health care system
fusion of all these tools that builds an ecosystem and capabilities
to deliver at scale. • D
 ata-fusion platforms, which are the glue that hold the
system together
The first paper in this Health reimagined series A new participatory
health paradigm discusses how demand for health care can be • Global aggregators or “orchestrators”2 that pull together a
reshaped by participation, strengthening an individual’s scalable ecosystem
capabilities to manage their health status and lifestyle choices,
We conclude with some thoughts around opportunities that
foster prevention and wellness, and support chronic conditions
emerge at the intersection of consumerism, technology and
in vastly different ways. In this second paper, we suggest that
markets for those willing to explore beyond their traditional
convergence or points of intersection between traditional players
boundaries.
(providers, payers, life sciences and devices) and non-traditional

Home Contents < >
The challenge
The awkward truth is that, for the most part, the current reach Emerging and developing economies may well take the lead,
of digital health technologies is restricted to pockets of activity being less constrained by existing infrastructure and vested
globally, directed toward a specific condition, operational interests seeking to preserve the status quo. Delivering
or administrative problem. In a fast-moving and early stage participatory health care and well-being at scale is immensely
environment, adopting an incremental approach makes sense, complex. What is not yet clear is how health care systems — either
picking the “battles to be won” by targeting outcomes that are national, regional or local — will transition to incorporate or
amenable to action. Getting across the “last mile” to the replace existing ways of doing business with participatory health.
hardest-to-reach consumers — whether they are in remote The case for change is being written today but, in an industry
underserved areas or disinclined to engage in managing their notoriously slow to change, this will be a deep-seated journey of
health and wellness is a clear focus for disruptive innovators, transformation — for the system, for the professionals and for
health professionals, technologists and payers. the consumer or patient.

Home Contents < >
Background
“More of the same” can't resolve
21st-century health care problems
F
uture adoption of advanced technologies built upon arising from aging populations and as the burden of disease shifts
networks or platforms that organize transactions and to chronic conditions such as diabetes, musculoskeletal disease
interactions is important for all economies — whether and cardiovascular disease.4 Chronic conditions and increasing
they be emerging and developing or developed. Economic, longevity extend the end-of-life cost burden. Growing middle
epidemiologic and demographic shifts mean that legacy systems classes in emerging/developing economies will bring increased
of providing health care or “more of the same” are failing to demand through rising health consumption expectations and
deal with the many difficult problems facing 21st-century health health-related outcomes of lifestyle changes.5, 6 Moreover, how
care.3 Rising costs, consumer expectations, new technologies care is organized and delivered is being reshaped by changes in
and increasing globalization place intense pressure on the the broader environment, including self-determination, social
health sector to align better with economic constraints. Long- and crowd source networks, and a cultural shift toward sharing
established systems of primary, secondary and tertiary care and participation.
are increasingly unsuited to deliver responses to challenges
Population aging and a rising middle class push health systems toward participatory health
By 2050, 1 in 5 people
globally will be aged
2015 2030 2050 Disparities in
investment
60+ years. Rapid in health
population aging
places increasing Global health
demands on health expenditure per capita (2014)
care systems and
• High-income countries US$5,251
expenditure.
• Middle-income countries US$292
• Low-income countries US$37
Source: UN World Population
Aging 2015. Source: World Bank 2014.
In some regions, around 25% of the population will be aged more than 60 years old by 2030.
Improved longevity and larger numbers of the aging put pressure on health systems.
Latin America and Northern

Africa 6% the Caribbean 17% Asia 17% Oceania 20% America 25% Europe 25%
Showing proportion of population aged 60+ years, 2030. Source: UN World Population Ageing 2015.
Overall, the middle class will grow from 1.8 billion (2009) to 4.9 billion Mobility and rapid telecommunications underpin
(2030), bringing rising consumption expectations. Growth will be in the shift to integrated, digital health care systems.
Asia-Pacific, with two in three of the growing middle class located in this
region by 2030. Adult smartphone Adult internet users
Europe owners (2015) (2015)
36% 2009
North 14% 2030
America Asia-Pacific
18% 2009 28% 2009

7% 2030 66% 2030
68% Advanced economies

(median) 87%
10% 2009 6% 2009 2% 2009
Central and
6% 2030
Middle East and
5% 2030
Sub-Saharan
2% 2030
37% Emerging and developing economies
(median) 54%
South America North Africa Africa
Source: Showing size of middle class, percentage of global share in 2009 and 2030. Kharas and Gertz 2010. Source: Pew Research Center 2016.

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The long run to transformation

A digital ecosystem is inevitable — emerging and
developing economies may leapfrog ahead

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T
he internet of everything (IoE)7 is emerging as cyber Telehealth has been around for a long time without gaining
and physical systems combine the physical, digital and traction. However, the concept is maturing and, as health care
biological worlds8 in novel and powerful ways. This so- becomes fully digitized and consumers and health professionals
called Fourth Industrial Revolution9 is profoundly altering our embrace participatory health, technological and contextual
way of life as the speed and scope of breakthroughs propel a conditions now exist that support delivering connected care
transition to a new set of social and economic systems.10 at scale. The notion of telehealth has moved beyond that of
Self-driving cars, for example, have moved from concept to care as usual, augmented by an internet connection to that
real-time tests and are expected to be on the road by 2021.11 of sensor-based teleconnected solutions embedded in lifelong
Advancements such as gene-editing technologies, additive health and wellness through the internet of health care things
manufacturing (3D printing), robotics and artificial intelligence (IoHT) ecosystem. Developments in the burgeoning digital health
(AI) are rapidly changing health care.12, 13 At the societal level, landscape in China are an interesting example of a forming
in anticipation of “technological unemployment”14 as jobs ecosystem moving toward scale. Shortages and maldistribution
disappear due to automation and AI, some countries such as of health professionals, a rapidly aging population and hospital
Finland and the Netherlands are experimenting with overcrowding are some of the many issues driving growth in
paying citizens a guaranteed and unconditional universal China’s digital health space. Digital giants from insurance, online
basic income.15 search engines, social media and e-commerce are moving into
the health care space and developing nationwide diagnostic,
For many in the health care industry, the journey to and
treatment and administrative platforms. And the numbers are
adoption of digital is inevitable. Industry executives interviewed
vast (see below). Ping An Good Doctor, for example, claims to
were confident that the future of health care includes a
have 77 million registered users16 — larger than the entire United
participatory and digital ecosystem. Many saw the need to
Kingdom population, three times the population of Australia and
move from running a supply-side agenda of imperfect resource
one-fourth that of the United States. With industrialized countries
allocation to tackling a demand-side agenda. Shaping the
facing similar drivers of demand and changing demographics
drivers of demand is a key lever in managing health care
as China, there is potential for a powerful impact from lessons
consumption — but the demand-side of the health care equation
learned across the health value chain, from service delivery
is customarily discounted. As the market moves toward the
through to structural reform and rising investment opportunities.
consumer, the tools of participation will empower consumers
and create bottom-up levers for change.
Several executives surveyed emphasized the importance of

mobile devices as the primary tool to get consumers to engage
“It’s just a matter of time before the whole
in their own care. Mobile devices are the route to “get the market shifts to ‘got to know the patient,
consumer into the digital space and take them on the journey.”
Especially so if tools could make that journey easier by freeing
got to know the consumer, got to know
up communications and removing complexity and friction points the data, got to connect the stuff.’”
to make health care simpler and navigable. In isolation, a mobile
Deborah Kilpatrick, CEO Evidation Health
device is of limited benefit. The real value arises when connected
to a suite of services through a platform.
Ping An Good Doctor Guahao.com

This is a Chinese online to offline (O2O) health care platform backed by Meaning “take a number”, Guaohao.com initially targeted resolving long
the Ping An Insurance and Financial Services Group. It provides rovides wait times for hospital services in China, introducing an online appointment
24/7 virtual health care consultations by phone, text or video online registration system. Recent intentions include expansion into a national
appointment booking, diagnostic services, health education, and online digital health platform covering diagnostic and treatment services.
retail of pharmaceuticals and medical devices. In 2016, there were 77
million registered users and up to 250,000 consultations per day.
24/7
virtual health care
consultations
77 million 250,000+ 190,000 100 million 1,600
registered users consultations per day medical specialists registered users hospital locations
Source: PRNewswire The Largest Unicorn to Date Emerges in

the Online Health care Industry, 2016. Source: SeekingAlpha, Billion-Dollar Unicorns: GuaHao Targets China’s Health care, 2016.

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Shifting the mindset —

easier with a clean slate
In the long run, many of the interviewees expect improvements centrally organized health care systems. Many executives
in quality, cost and consumer experience through participatory thought that emerging and developing economies could bypass
health. Technologies open the doors to radically different setting up traditional primary care structures in favor of a
approaches to care and will transform how we deal with ill participatory health model that can support low-cost models of
health and disease; capture, manage and share health data; care across larger populations. System transformation is highly
and how consumers engage with care systems. Opinions as to dependent upon “crossing the chasm”17 of adoption, or the
how this might likely happen varied greatly. Uptake was thought propensity to act early or wait and see. Of course, there may be
to be perhaps more likely in single payer, large integrated or little choice but to act if, as Christensen’s disruptive innovation
theory18 suggests, fast-moving challengers disrupt the market
using technologies to offer cheaper and better products, forcing
incumbents to rethink legacy systems. Some interviewees also
“... if you’re building a health care system weighed the possibility of a “big-bang” large-scale and fast-
from scratch, you would not mimic or paced disruption completely upending health care.19
replicate what we have and so I think you Facing the “double burden of disease” (the overlap between
communicable diseases and a growing prevalence of chronic
might see people who have more of a, health conditions), many emerging and developing economies
you know, clean slate. They're actually are looking to deliver services via low-cost mobile solutions and
analytic insights from digital devices data. AI has the potential
able to be much more progressive and get to lower the cost of care, mobile device ownership fosters
to that end state in a far quicker time.” communications and application program interfaces (APIs)
bridges the gaps between solutions.
Venture Investor Executive

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Emerging economies —
leading the way?
Innovations designed around mobile devices, telecommunictions • RapidSMS (www.rapidsms.org), an open-source framework
networks and AI will enable emerging economies to bypass for building customized mobile services with web-based
establishing traditional health systems and move directly dashboards, is the basis of a range of registry, performance
toward a virtual system. Initial steps may focus on discrete improvement and outreach programs:
components of the health system, such as supply chains,
• The EGPAF performance-based financing program is in
frontline services, workforce and public health measures,
Mozambique. Health workers are incentivized to complete
rather than whole of system development:
mobile-based quality surveys, resulting in improved
• For developing health systems, health navigation will quality of health services:
provide an alternative to the costly establishment of the
www.rapidsms.org/projects/episurveyor-for-pbf-verification
current model of primary care and avoid the substantial
overcapitalization of Western health systems in favor of
virtual. Navigation supports a participatory health model • The Liga Inan (Mobile Moms) Project uses mobile
that is better equipped to provide low-cost models of phones to connect expectant mothers and health
care for larger populations and underpinned by emerging providers in Timor-Leste. Maternal health and post-
supply chain advances. delivery care are delivered via SMS, and midwives create
local support networks that communicate by SMS:
• Solutions will be shaped to achieve best fit by factors such
as demand for basic health care and preventive services, www.rapidsms.org/projects/liga-inan-mobile-moms
work—arounds of the limitations of existing infrastructure,
national budget constraints, the degree to which solutions
• mSakhi is an open-source Android application developed
can be integrated rather than act in a stand-alone capacity,
specifically for frontline health workers in India. Health
affordability and opportunities for partnerships to develop
workers access up-to-date information, training and
a sustainable ecosystem. Barriers include rising anti-
supervision through their smartphone, and it also functions
globalization sentiment, evidence gaps regarding the
as an electronic medical record system, replacing multiple
effectiveness of some solutions and impact on health
paper-based tools. Workers can track and report outbreaks
system objectives, and protection of intellectual property.
or rising health issues in their communities:
• An interesting question arises of who leads and who
www.intrahealth.org/msakhi-award-winning-mobile-phone-
follows. Will established economies take on lessons app-frontline-health-care
learned from the experiences of virtual health systems
implemented in the emerging economies or not? Will
• Switchboard builds software to register health workers’
governments force the changes due to fiscal constraint
mobile numbers and connects them to colleagues and the
or will a consumer revolution be driven by a commercial
larger health system through messaging platforms and free
explosion of alternatives?
calling networks. These services, along with nationwide
phone directories of health workers, allow practitioners
Mobile phone-based systems are used in emerging and to receive information, guidance and advice, while also
developing economies in many ways for system enhancement supporting government efforts to track diseases and
(such as registries that replace paper-based systems), manage potential epidemics, and are in action in Ghana,
quality improvement, delivering frontline care, health Liberia and Tanzania:L
worker supervision, training and further education and
www.switchboard.org
establishing communications and networks between
health workers.

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Revisit, redesign and reset health

care: a new default setting
Shifting health care from reactive to proactive

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A
vision of the future emerged over the course of our
conversations with industry leaders. As Andrew Thompson,
CEO and co-founder of Proteus Digital Health observed,
“I would go one step further than patient
the health care system will be built: “Using the best technologies centric and say it is patient mediated.
that we now have in the 21st century, not to replace sick care
but to extend it, magnify it and make it better … you have to
Patient centric means just designing
shift from sick care into health care, and the current and future around the patient or consumer — 30%
generations of mobile devices in every consumer’s pocket will
become the most significant platform for health care service
of the way there. Patient mediated means
delivery the world has ever seen.” Technologies vital to sustained patients are actively controlling and
engagement are embedded in everyday items, pervasive, always
connected and discreetly in action behind the scenes. These draw
influencing the process … patients have
upon economic, behavioral and cognitive insights to shape an access to a data set they've never had
individual’s behavior and decisions. Payers may well be influential
in pushing general adoption of monitoring devices through
access to before — access to their data.”
incentive-based health and wellness improvement programs. Deborah Kilpatrick, CEO Evidation Health
Digital is a defining trend

Wearables and monitoring devices:
Digital is considered by our interviewees to be a central pillar a clear consumer appetite
that shapes an intelligent health care system. Technology, in all
its various forms, will ultimately embed as a common platform The global market for connected wearable medical
in all aspects of health care. This will be as an interconnected devices and remote patient monitoring systems
environment around an individual, across the continuum of is expected grow from US$123 billion in 2015 to
care and the lifespan. Most of those interviewed considered US$612 billion by 2024, driven by the adoption of
that uptake would vary. Some early adopters are in this space mHealth devices, wearable technologies and the IoT.
already, to be closely followed by the “early majority”17 in the In 2016, around 259,000 mHealth apps were available
next three to five years. Most in the industry will wait and see through major app stores, and worldwide shipments
and, as the network effect kicks in, move when comfortable of wearable devices such as watches, wristbands and
with technology. This is thought likely to occur in the short to clothing are expected to grow by a compound annual
medium term in advanced economies. The executives’ views growth rate (CAGR) of around 20% by 2020. The
on the adoption cycle of digital health technologies were based industry is beginning to consolidate, and emerging
upon three qualifications: players are focusing upon improved accuracy and
lower costs for consumer-focused medical devices.
• The early stage maturity levels of emerging technologies Some devices are targeting achieving clinical-grade
• The profound cultural shift within health care (of consumers, quality. Universal adoption becomes possible as
health professionals, administrators, policy-makers and sensors and monitoring systems become embedded in
governments) necessary to achieve this vision everyday objects and industries (telcos, life sciences,
manufacturers and health care players) converge.
• A recognition that it is early days and many iterations are
Mack, Heather, Report: Global market for connected wearables,
required to learn the lessons to deliver the evidence and health devices expected to reach $612B by 2024 Mobihealthnews,
attractiveness to persuade others (including fundamental August 11, 2016, http://www.mobihealthnews.com/content/report-
global-market-connected-wearables-health-devices-expected-reach-
shifts around payments, transparency of costs, and system
612b-2024.
incentives away from the prevailing transactional and Grand View Research, Connected Health And Wellness Devices
institutional focus)20 Market Report, 2024 August 2016 http://www.grandviewresearch.
com/industry-analysis/connected-health-wellness-devices-market.
Several interviewees stressed that digital solutions coming to Research2guidance, mHealth App Developer Economics 2016,
market need to be very clear about the problem to be solved, October, 6th edition. https://research2guidance.com/product/
mhealth-app-developer-economics-2016/.
be of demonstrable efficacy and clinically relevant, and avoid
IDC IDC Forecasts Wearables Shipments to Reach 213.6 Million
creating inequities. Units Worldwide in 2020 with Watches and Wristbands Driving
Volume While Clothing and Eyewear Gain Traction
http://www.idc.com/getdoc.jsp?containerId=prUS41530816.

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As industry, technology,
science and social converge
As digital uptake within the health care system moves from Health is running headlong into the industry, technology, science
where it is today to digitization of transactions, tasks and and social convergence space. The resulting new technologies
processes (translational) and then to more fully integrated and demystify health care and simplify wellness by solving translational
personalized solutions (transformative), expectations are also and transformative problems, and open the door to a raft of
changing around what can be delivered by technology. commercial opportunities previously considered the exclusive
preserve of the health care industry.
We seek to know more from the digital space and to do a lot
more with the information. Strong capabilities exist to capture, In the early stages of disruption, the system is chaotic. There is
analyze and predict from data arising from the“digital crumbs”21 a lot of noise, and a vast range of innovations are emerging and
of an individual’s life. Intelligent machines and devices that under trial. Not all will add value, remove pain points or give
sense, recognize and learn from signals in the environment better utility to health professionals and consumers. These will
enable disparate data about drugs, biophysical attributes, be ultimately abandoned or rethought as learnings emerge.
mood and behaviors to be combined. We want to understand, What is new, innovative and demonstrably impactful will eventually
at a deep level, who does what, who responds and, importantly, become incorporated into the core business of health care.
how can we learn from the data to deliver better care and to
engage individuals.
The digital uptake equation
+ + =
Capture, analyze and understand Tools of connection Connectivity Digital uptake
• Sensory • Locational • Mobile • Social • Enhanced 4G • IoT and IoE
• Perceptual • Devices • Sensors • 5G • E-home
Increasingly sophisticated capabilities to capture and understand

sensory, perceptual and locational information. Even entry-level
phones and tablets will soon have biometric technologies, such as
Mobile devices ultrasonic fingerprint authentication capabilities,22 that strengthen
personal data security and facilitate a vast range of actions from
service delivery through to payment.
Wearables such as Bioflux ECG monitor23 and the Phillips biosensor24

Medical-grade wearables that require approval as medical devices25, 26 are emerging. Once approved
they will be able to provide clinically relevant and reliable data.
Cognitive technologies such as machine learning on mobile devices,

Cognitive technologies even when offline,27 suggest untold possibilities for cognitive behavioral
therapies that target psychosocial issues.28-30
Enhanced 4G and forthcoming 5G networks31 will enable universality

and responsiveness of applications with faster mobility, lower latency
Connectivity and better connectivity. These will support IoT/IoE and health programs
that draw upon complex functions such as virtual reality, gamification,
robotics, video coaching and the e-Home.

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Could health care be

“Uberized”?
The question on everyone’s lips is, “could health care be
‘Uberized’ or ‘AirBNB’d’”? Some say yes, and are pursuing
their ambitions seeking to develop platforms around
transaction and interaction-based networks.2 Others believe
not, that diverse parts of the world, health systems and
industry segments, payers and providers will advance quite
differently. The disconnected and highly fragmented nature
of the health industry points to opportunities to incorporate
the power of platform-based transactional and interactive
networks and drive industry transformation. Lack of price
transparency in health care is an issue that distinguishes it
from other industries in which a massive shift has occurred.
Tackling this may well open the doors to change, setting up
conditions for an information-driven disruptor to emerge
unexpectedly and upend health care.

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Discontinuity with the past:

a curation-navigation-fusion model
Capacity to scale will be the turning point
E
nabling technologies form a data-driven foundation for the Overall systematization behind the scenes
health industry. The capacity to scale up new care models
• Order is imposed on chaotic data through:
and settings through integrated pathways will deliver the
quantum leap necessary to break with the past. In this section, • Cloud-based services, natural language processing, APIs,
we discuss a model comprised of several building blocks that deep learning intelligence and data aggregation platforms
structure the ecosystem and may deliver a clear route to achieve
• Integration of social determinants of health and behavioral,
scale (Figure 1). We then address three key elements that we
environmental and social network data
consider important in the transition toward an ecosystem.
• Insights based upon meaningful patterns for individuals
We envisage an integrated system of interconnected attributes,
and populations
all needed to operate and exist within an environment as a
complex sum of its parts. Participatory health becomes
possible through:
Unstructured and structured data feeds
• From personal devices as well as industry-generated information

(such as clinical records and payer data) interfacing with curation
and navigation technologies

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Figure 1: Building blocks of a participatory health care ecosystem
Global aggregators
• Are formed where there are strong
Y et to emerge digital underpinnings Supra- bonds between global players.
of ecosystem and engagement
system • Create a demand-driven
marketplace based upon digital
platforms delivering network
effects, value and benefit.
Data fusion platforms — the glue

that holds the system together
• Data fusion platforms are
the glue that hold the system
Emerging behind the scenes together. The point at which
Sensor
integration, synthesis, knowledge AI Robotics IoT/IoE
fusion the curation and navigation
and predictive data and insights interface in a
structured way with the system
as AI and analytics turn complex
information into usable insights
and new solutions.
Personal health cloud (PHC)

Data fusion z one • Captures and curates a digital
bio-portrait of deep personal data,
including biometrics, and a lifelong
narrative of health and wellness,
and behavioral traits, including
moods, emotions and propensity
A vailable now and rapidly evolving PHC to act.
Curation and navigation technologies
PHC PHC
• Technologies that steer through
through system complexity,
connecting a patient through to
diagnosis or treatment via a vast
array of channels.
ergence z one
Conv
PHC PHC
anytime care
health care
Traditional
A nywhere,
I S P H E
I G R Ingestibles/
D
Telcos/retailers
E
implantables
Knowledge
Sensors and Electronic Wearables

monitoring health record
Analytics Social
media
Artificial
intelligence
Funders
Specialty
hospital Life Sciences
/devices
I choose
to live well
ha
rs
ou
C
ng
i n g b e h a vi
Care teams Care teams
GP
Curation and navigation technologies

Patient participation z one

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At the health system-level, building blocks

are those of:
• Curation and navigation connecting and
steering a patient through the delivery
system (real and virtual) from diagnosis
through to treatment and lifelong learning
• Data fusion platforms are the glue that
hold the system together. This is where
the curation and navigation of data and
insights interface in a structured way
with the system as AI and analytics turn
complex information into usable insights
and new solutions
• Supra-system or ecosystem that is made
up of strong bonds emerging between
global players, with potential for alliances
and benefits that trickle down through
the system
Building blocks
For individuals, the base is a personal health and wellness cloud. • Inputs flow from environmental and social sources, including
Highly sophisticated, this: unstructured data feeds from wearables, IoT/IoE, remote
monitoring, environmental sensors and structured data from
• Captures and curates a digital bio-portrait of deep personal
clinical information systems and payer portals
data, including biometrics, a lifelong narrative of health and
wellness, and behavioral traits, including moods, emotions • Utilises multiple channels including mobile devices (phones
and the propensity to act and tablets), social media and wearables that link the individual
to their PHC and to the broader health system
Curation and navigation:

the interface between the consumer
and the health care system
Functions as a care high-risk patients who typically have multiple chronic conditions
navigator or broker with and multiple health care providers in a number of settings.
tools that connect and
Examples of curation and navigation models include:
capture, direct and deliver
I S P H E
I G R Ingestibles/
D
Telcos/retailers
E
implantables
Knowledge
Sensors and Electronic Wearables

monitoring health record
Analytics Social
media
Artificial
intelligence
Funders
Specialty
hospital Life Sciences
/devices
I choose
to live well
to assist consumers to
!
• Solera Health (www.soleranetwork.com), which connects

ha
rs
ou
C
ng
in g b e h a vi
Care teams Care teams
GP
make choices regarding fragmented disease management programs into an integrated

the services they need and the experiences they prefer. A vital network to better coordinate care for chronic conditions and
part of the participatory care team, curation and navigation manage costs
technologies follow clear pathways and coordinated resources to
• CommunityRx, a population health improvement program
help people make the right decisions regarding their care and to
that combines ePrescribing and community engagement,
answer the burning questions of “where do I go for help?” and
and links patients with local resources and community-based
“what do I do next?”
services in a high-poverty urban area in Chicago for health
These interfaces can automate many routine tasks and enhance and wellness management32
the work of health professionals, freeing them to focus on more
• Next IT Health care (www.nextithealthcare.com), which
complex tasks and interpersonal relationships. Navigation is
uses cognitive-based digital health coaching technologies to
critical to improved communication and coordination of
support behavior change

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Data fusion platforms: the glue

that holds the system together
The integration of vast • Babylon Health (www.babylonhealth.com), a subscription
flows of data fused with AI remote care provider, is tackling the issue of misdiagnosis in
Sensor
AI Robotics IoT/IoE
fusion
form the backbone of the the face of accelerating volumes of health information, testing
system where curation/ an app that employs AI speech recognition to check symptoms
navigation materials meet against a database of diseases and provide advice to physicians.
the health delivery system. Data fusion aggregates volumes of
Currently at a very early stage of development, “complex AI” is
patient data from multiple sources (clinical, financial, social,
taking steps toward building intelligent systems that transform
environmental and operational) delivering insights into care
massive data sets into action. Personal data, real-world evidence
management, risk stratification, performance and care gaps
and growing capabilities in perception, sensing, object recognition
with respect to populations.
and language learning through iterative, dynamic modeling
Through data mining, learning and predictions from captured are hoped to deliver personalized solutions for individuals and
data,33 “simple AI” delivers an ability to organize, monitor and populations eventually. Accuracy will improve over time as
support a user, generate risk alerts from the data and deliver systems self-learn, validate and fine-tune. For example:
services. For example:
• Saffron (www.saffrontech.com) is a hybrid of machine learning,
• Sentrian (www.sentrian.com) is a remote patient intelligence AI and advanced analytics. Associative memory technology
big data predictive analytics platform. It captures and mimics the way a human brain makes connections and
analyzes a patient’s physiological data from a raft of sensors associations. Through organizing structured and unstructured
to build personalized disease deterioration models that detect data, Saffron learns, recalls and finds meaningful patterns in
subtle changes or warning signs in an individual’s condition the connections between people, places and things.34
and support clinical decision-making, especially for those at
risk for hospital admission.
• HealthReveal (www.healthreveal.com) analyzes incoming data
from medical records, claims, wearables/implantables, and
directly from patients, to monitor continually high-risk clinical
signals and sends diagnostic/treatment information directly to
the patient and care team via mobile alerts.
Supra-system: strong bonds

between global players
Digital technologies global audience to build upon existing platform know-how
are borderless. As the and forge partnerships with leading health industry players.
Supra- inflection point is reached Partnerships are likely to emerge that blend the technical
system and the reduction of capabilities of one partner with the service and health care
fragmentation becomes expertise of another. In so doing, global alliances could offer
possible, an overarching interesting opportunities if they were to get off the ground.
supra-system or ecosystem will likely appear. The catalyst to shift New business models will prompt a rethink of talent, culture
to scale will be rising interest from players who see opportunity and organizational forms. To illustrate:
in a global ecosystem of peer value creation, such as large
• Finnish multinational communications and information
retailers, venture investors, large integrated networks and global
technology company Nokia (www.nokia.com) acquired Withings
technology companies. Network orchestrators, or “digital platform
digital health start-up in 2016. From this base, it intends to
organizations that leverage a growing and virtual network of
build out beyond consumer wearables and devices to advanced
suppliers and customers,” will seek to build and manage global
sensors, AI and insights arising from large-scale data.36
networked platforms.35 A supra-system will draw together
dynamic groups of players (traditional and non-traditional) into • Qualcomm, a multinational semiconductor and
communities that evolve and change over time, and new models telecommunications equipment company through Qualcomm Life
of collaboration and competition will ultimately create value. (www.qualcommlife.com) medical-grade connectivity network
For example, consider the potential for the “Fab Five”35 trusted in partnership with Phillips HealthSuite, aims to develop a
brands of consumer, tech and electronics companies with a scalable ecosystem.37

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It is early days
The curation/navigation marketplace is beginning to emerge health technology through the Digital Hospital program.42
through start-ups and new organizations that are driving change. Japan is pursuing a portable personal health information
Governments, particularly in the United States through the Office system via cloud computing,43, 44 and Portugal is implementing a
of the National Coordinator for Health Information Technology nationwide telemedicine and telemonitoring program across the
(ONC), the United Kingdom through the National Health Service national health system.45
(NHS) and Australia through the Digital Health Agency, are
setting ambitious digital Health Information Technology (HIT)
and consumer-empowerment agendas. Improving access to "Creating a connected health ecosystem
quality health care is a priority in emerging health care markets
and in economies facing extreme pressures through population
will establish structure, priorities and
aging and rising chronic health problems. Some countries are collaboration to truly advance the market,
moving to digital platforms as a model for affordable, universal
and patient-centric care. For example, when Estonia transitioned leading to a more cohesive and successful
to a digital economy after leaving the Soviet bloc,38 a national endeavor, eliminating the ‘noise' and
e-health system was launched in 2008 that covers electronic
health systems, patient portals and e-prescriptions. Telemedicine
focusing on winning ideas and services."
is under trial in remote areas of South Korea39 and nationally oseph Kvedar, MD Vice President,
J
in Indonesia.40 Finland is positioning as a leader in digital and Connected Health, Partners Health care
personalized health, actively promoting a start-up and venture
investment culture with the Vertical Accelerator41 and exporting
The courage to lead: Mercy Virtual,

a virtual care center first
The US$54 million Mercy Virtual Care Center, the world’s
first virtual care center, opened in October 2015 in “We have shown the transformative
Chesterfield, MO. With no beds and no on-site patients, it’s a
virtual facility connecting patients to the care they need 24/7, power of virtual care.”
365 days a year. A team of medical and health professionals, Randy Moore, MD, MBA
along with leading-edge telemedicine technologies, is housed
in the four-story, 125,000m2 building. Dr. Randy Moore,
president of Mercy Virtual, spoke with EY about the
admissions and emergency room use. Besides a 98%
innovative and forward-leaning medical care.
satisfaction by patients, staff too have experienced lower
The facility is bed-free and technology-rich, with clinicians stress levels. Clinical teams have accurate data and the right
treating patients remotely, monitoring vital signs and health decision-support tools at their fingertips. “We are reaching
status and providing expert advice to patients and health more patients in more places, providing care when and where
professionals alike. Currently keeping an eye on care to they need it most,” said Dr. Moore. “In the past year alone,
patients at 34 hospitals in six states, Mercy Virtual supports Mercy Virtual has served more than half a million people.”
and cares for people in their local communities. While virtual
The result of 10 years of hard work and a US$300 million
care reduces travel costs and inconveniences for patients,
investment is paying off with reduced costs and healthier
Mercy Virtual is focused on identifying a person’s medical
patients. Insights gained inform future care and financial
needs earlier, reducing hospitalizations and keeping
models to develop and extend the reach of the virtual care
people healthier.
platform. Mercy Virtual is keen to partner with others,
Mercy Virtual is improving quality of life and delivering a sharing what they know with a firm belief that transforming
better care experience for the patient, which is paramount. the entire health care process lies at the core of their strategy
As Moore notes, “We're treating the sickest patients with to optimize health seamlessly.
the highest needs. They’re engaged, they’re getting care
and their quality of life is much better.”
And the concept is working. For Mercy Virtual’s Engagement Mercy Virtual Care Centre can be found at
@Home patients, it has meant a 50% reduction in hospital https://www.mercyvirtual.net/.

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Getting to business as usual —

system transformation
Breaking out of old models requires a new way of thinking

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T
o change course, many things need to be in place, and
where the stimulus for health system transformation
will arise — whether through consumers, government,
Emerging technologies will not
private sector or public-private partnerships — is not yet
necessarily arise from within health
evident. Moore (2014),17 discussing new technology adoption care: blockchain
in mainstream markets, suggests that the key to system
transformation is leadership commitment and intention as a Initially developed as a way of validating and relaying
matter of political and economic will. As Andrew Thompson financial transactions, blockchain offers considerable
from Proteus Digital Health explained, “Someone has to decide potential for use in health care.
it’s a priority and it’s what they’re going to get done. At some Blockchain is a distributed framework that could
point, they decide we're going to enable consumers to access support the integration of health care information
health care using mobile devices and … to create legal and at scale, across organizations and across time.
regulatory and other policy structures to make that happen. Pseudonymous accounts would allow individuals to
The Japanese Government (for example), has said they're going control their own data and privacy settings while
to build a secure foundation and they want the entire industry providing de-identified rich standardized data sets
to run off it. It appears that there is going to be an emerging for research and population health. Analytical tools
set of policy, regulatory and economic factors in that country and AI capabilities could deliver solutions for
that mean they coalesce around digital services and health care personal health management, patient engagement
reasonably quickly.” programs and virtual health systems beyond
The health industry is often noted as slow to adopt technological organizational boundaries.
change.46 Consumers are more agile, and many already take While not a perfect solution and not a substitute for
advantage of changes in information flows as the internet and an enterprise system, blockchain may offer promising
social networks become trusted sources of information and solutions to address medical records interoperability,
personal support. Conditions exist to benefit from the best of identity verification, data standardization, protection
what technology can offer — a mass market enabled by mobility, and scalability.
enhanced 4G/forthcoming 5G telecommunications and cloud
Sources: EY, Blockchain Technology as a Platform for Digitization,
storage underpinned by integrative platforms. http://www.ey.com/Publication/vwLUAssets/EY-blockchain-
technology-as-a-platform-for-digitization/$FILE/EY-blockchain-
technology-as-a-platform-for-digitization.pdf.
Vian, Voto and Haynes-Sanstead, A Blockchain Profile for Medicaid
Applicants and Recipients, 2016.
ONC, Use of Blockchain in Health IT and Health-related Research
Challenge, https://www.cccinnovationcenter.com/challenges/block-
chain-challenge/.
Three key elements that we consider important to system transition are:

Capitalizing on the advantages Empowering platforms that Cultural shifts that enable the
1 of technologies 2 combine technologies, 3 system to transition toward
people and processes an ecosystem

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Shift 1: Putting technology

to work
The right infrastructure
Core infrastructure needs include: Global locations will have some various combinations of these,
and several indices track the overlay between infrastructure
• Access (broadband, cloud service technologies and security)
and health system readiness10, 47-49 (Figure 2). For example,
• Affordability, mobility and connectivity (device ownership and the United Kingdom intends to be paperless by 2020 and to
subscriptions; 4G/5G connectivity) develop local area digital health road maps that improve digital
technology strategy.50 In the United States, the Connect2health51
• Consumer skills and readiness
project maps broadband connectivity, deployment and
• Enabling regulatory and innovation environments subscribership to metrics of health status, physician access and
prevalence of chronic conditions in urban and rural areas.
Figure 2. State of readiness: 12 countries' capabilities to benefit from information technology

Information technology state of readiness: selected countries
1st pillar
Political and regulatory environment
7
10th pillar 6 2nd pillar

Social impacts Business and innovation environment
5
3
9th pillar 3rd pillar
Economic impacts 2 Infrastructure
8th pillar 4th pillar

Government usage Affordability
7th pillar 5th pillar

Business usage Skills
6th pillar
Individual usage
Australia* Brazil^ * = High-income group Source: Baller, S., Doutta, S., and Lanvin, B. (eds),
Japan* Malaysia^ ^ = Upper-middle income group The Global Information Technology Report 2016,
+ = Lower-middle income group World Economic Forum.
Canada* China^
Singapore *
United Arab Emirates*
Showing an economy's performance on the 10 p illars of the Networked Readiness
Indonesia +
India+ Index — 53 indicators assessing capabilities to benefit from information communication
United Kingdom* United States* technologies (ICTs). Score from 1to 7 scale, with 7 being best possible outcome.

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The right environment

Participatory health of the future may well occur across national • Integration of other data, including the social determinants of
boundaries and clinical interest areas. Safeguards arise from health, environmental and social networks
regulatory, financial and policy environments that define and set
• Enterprise systems that alter the supply-side cost structure
the future course of creating a technologically rich environment.
through automation, virtual systems, disintermediation and
Regulations can and do change, particularly when driven by
predictive accuracy
public benefit and consumer demand — Uber, for example, has
rewritten the transport industry regulatory handbook.
Scaling and sustaining participatory health models that deliver
optimal health and health care for individuals and communities Regulations can and do change, particularly
will require attention to: when driven by public benefit and consumer
• User-centered design demand — Uber, for example, has rewritten
• Supporting mission-critical activities, including safe/secure the transport industry regulatory handbook.
capture and sense-making of unstructured patient-generated
data and structured system data (providers, payers) for
shared decision-making, clinician use and patient information
The right information

Mobile devices are key tools with capabilities to capture data, health and medical information leads to improved outcomes as
interface and connect via platforms, are cloud based and individuals gain skills and confidence in managing their health
require no specialized knowledge or skills. They represent a key and care.52 Solutions include health-literate organizations that
first step in personal sensors that sit alongside everyday life. support people to navigate, understand and use information and
They become the invisible hand guiding an individual, removing services,53 improved accessibility and platform design,54, 55 and
complexity from participation and self-management, and early intervention. Vivo (www.vivoclass.com.au), for example, has
bring functions to capture and understand sensory, perceptual embraced this through creating a learning platform, targeting
and locational information. Health literacy, or the ability to children at school. It has built the fundamentals of health
understand health and medical information sufficiently well knowledge and learning into the digital future for wellness in youth.
enough to make informed decisions, is foundational to engaging Incentives are used to influence and reward behavior shifts.
individuals. Evidence suggests that better understanding
The five Cs of information are:
Capabilities
Capacity Underlying technological and
Coherence
To improve outcomes, connectivity infrastructure Fit with health care
reduce costs and and clinically acceptable system – alignment,
variations, and enhance user capabilities that complementarity and
experience and convenience form the backbone coexistence with
of the system existing system
Commercial
Clinical Meet macro-environment
demand for customizable,
Achieve clinical, scalable disruptive
operational, consumer, business systems and
investor and policy new models, and predictive
outcomes and prospective analytics
and AI that deliver value
for money

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Shift 2: Platforms: the

architecture of transformation
Platforms create new pathways by which to organize and deliver platforms can fulfil functions where exchange becomes the
health care. The idea of a platform is a familiar one — something basis of value to the participants: whether that be trade of
that can capture, organize, scale and automate. A platform goods and services (such as online marketplaces), exchange of
is a layer of infrastructure upon which other applications and information and interactions (such as crowdsourcing solutions to
technologies can be built. As a vehicle that brings parties together complex diagnostic problems) or resources brokerage (such as
for exchange through sharing, collaboration and competition, accommodation rentals).
Network effects
One of the strengths of platforms lies in generating a network individuals who have shared interests and enables care teams
effect or demand-side economies of scale — the more people to manage a patient’s care across multiple locations. Consumers
who join and use them, the greater the benefit. This is a can actively source comparative information, support and
shift from a linear arrangement of inputs and outputs to an navigation. Aggregation platforms or comparison sites such
ecosystem that creates value exchange between members. as Why Not The Best (www.whynotthebest.com) and Castlight
This is evident in peer-to-peer systems such as social Health (www.castlighthealth.com) enable consumers to compare
networking sites and in shared resources networks for patients prices, products and performance of insurers and hospitals.
such as PatientsLikeMe (www.patientslikeme.com) and Health& (www.healthand.com.au) consolidates an individual’s
SmartPatients (www.smartpatients.com) and Patientory health records in the one place, providing evidence-based clinical
(www.patientory.com), an app that store and manage personal information and a personalized risk-driven dashboard.
medical information and, through a platform, connects
Platforms
Bring diverse players together to exchange,

organize, scale and automate
Activity is based upon sharing, collaboration

and competition
Connectivity is key: facilitating relationships,

new products, services and business models
Diverse outcomes are possible through transactions,

information exchange, interactions and social sharing
Network effects drive mutual value: the more users,

the greater the benefits
A health care ecosystem that provides a seamless

participatory consumer experience

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Systematize and organize

Other strengths of platforms lie in the capacity to systematize Validic (www.validic.com), for example, provides a “one-to-many”
and organize around (or to create) an ecosystem. In addition to connection between patient-recorded data from health
platform technologies, success to reach scale depends upon key applications, clinical and remote-monitoring devices, fitness
attributes of: equipment, sensors and wearables to key health care companies.
The consolidated data supports better patient engagement,
• Good governance
population health management and efficient care coordination.
• Valued partnerships And Fitbit (www.fitbit.com), the consumer fitness device maker,
has signaled its ambition to become a digital health platform
• Codes of conduct
across the health system.56
• A facilitatory regulatory landscape
For many, competitive advantage will arise in developing
Disruptions become possible due to reduced barriers to entry innovative solutions and services, as well as growing consumer
for new entrants and low investment costs as those entering relationships, preferences and brand loyalty. As health care
build upon what has gone before. New business opportunities platforms continue to evolve and mature, they deliver the
arise through the capture and monetization of vast amounts foundations to re-envision entirely how health care is delivered.
of data. Health care organizations and entrepreneurs recognize Issues around privacy, enterprise risk, cybersecurity, regulatory
value in consolidating and controlling ensuing data sets and challenges, resolving resistance to data sharing and achieving
in deep analytics that optimize information sharing and coordination across platforms will all impact the evolution
system-wide coordination, and help deliver cost benefits. of platforms.

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Shift 3: The transformation

journey
Pressure from patients or consumers who want a “voice” and wellness management options at the population level, remains
“choice” will likely drive industry change toward a participatory elusive. Broad adoption is only likely when these products
health system. This comes about as people expect in health transition into cheap and readily available tools that are integrated
care what they have in other areas of their lives — autonomy, into daily life. As Associate Professor Alain Labrique, founding
connectivity, immediacy and tools for self-direction. Director of the Johns Hopkins University Global mHealth Initiative,
Consumerism trumps culture. It will be a critical lever of change told us, the need for improvements in functionality and accuracy,
in an industry resistant to technological transformation. along with a lower price point, will be necessary to shift the
market to mass adoption.
New entrants emerge as the industry transitions to an
environment that is online, networked, participatory and This shift challenges long-held assumptions and routines requiring
integrative. But this shift also breathes life into incumbents changes across organizational and professional boundaries.
willing to redevelop their core business or move into adjacent To achieve scale means:
areas. Critical to the move toward care in the home and
• Meeting consumer expectations for technologically enabled
community (such as health care homes) will be the degree to
care that is mobile and connected and as new generations of
which stakeholders (professionals, consumers, policy-makers,
clinicians turn to mobile devices, decision support, cognitive
payers and the public) and organizations embrace a participatory
assistants and diagnostic support (see below and see young
health system. This will require a deep understanding of the
professional pulse survey results)
benefits that participatory health brings along with shifts in the
economic, behavioral and motivational factors that determine • Dealing with service design, payment and performance
and shape how performance is recognized and rewarded. management issues that encourage and support the delivery
Highly fragmented and with many vested interests,57, 56 the of participatory health care
industry needs to quicken its pace to keep abreast with the
• Attending to clinical, regulatory, safety, risk and privacy
changes occurring outside of traditional legacy structures as
concerns, and organizational and cultural transformation
what was once disruptive becomes the norm.
• Understanding and addressing the dynamics of complex change
Reaching an adoption threshold capable of achieving and
and innovation adoption (for example, persuading health
sustaining a growing segment is vital. Sensors such as
professionals to change the long-held ways of interacting with
accelerometers are a good case in point. The technology is
consumers, and the ownership and sharing of information and
increasingly sophisticated and cheaper. Consumer adoption
expert knowledge)57, 59, 60
of wearables is rising (although recent studies suggest
abandonment rates of around 30%)58 and some health • User-centered design should form the basis for creation of
professionals incorporate them into treatment plans. But the integrated service models based on consumer engagement to
shift to scale to effect positive behavior change, and health and drive an individual’s health
Health care open to change
72%
of health professionals surveyed believe that
health apps will encourage patients to take
more responsibility for their health.
59% of health professionals surveyed use smartphone

technology to access medical research.
46%
of health care professionals surveyed say
that they will introduce mobile apps to their
practice in the next five years.
62%
66% Source: Research Now. 2015.
64%
57%
of United States consumers interested
in virtual care as alternative to in office Age
46% 20%
doctor visit for non-urgent care. 0 18—34 35—54 55+ of consumers who search online of consumers would switch to a
for health information act directly Primary Care Provider (PCP) who
>74% greater convenience upon the information they find. offered video visits.
Source: Rock Health Digital Health Source: American Well Telehealth Index:
Source: Salesforce State of the Connected Patient. 2016. Consumer Adoption. 2015. 2017 Consumer Survey.

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Participatory health:
taking the pulse of young
professionals’ survey
Engaged, empowered and digitally active
In early 2017, EY took a snapshot of young
professionals' views of participatory health
Young professionals clearly see for themselves an active and the future of health care. A convenience
role in managing their own health and wellness in sample of 267 respondents in nine countries,
partnership with their health professional. Engagement, respondents were male (47%) and female (53%)
and aged between 21 and 35 years. More
self-management and accepting personal responsibility for information about the survey can be found in
their own health is important to them. the "Methodology" section later in this report.
Inevitably online
Use of virtual resources is high. In the past year: Digital tools and technologies would help an individual
better manage and coordinate their health care. The most
73% 49% 24% helpful tools are (all data reflects ratings of extremely helpful or helpful)
81% 77% 73%
turned online for sought information used internet research

general research for diagnostic purposes to develop questions to
Access to Digital tools Secure phone apps
and information on for themselves ask during their most
test results in (e.g., reminders and to store personal
health issues. or another. recent appointment with
understandable self-management records and data
a health professional.
formats programs)
Changing models of health care

Open to non-traditional care models, young professionals are highly receptive to non-urgent care in alternative locations, such
as pharmacies or department stores, and by health professionals other than physicians. However, for urgent and emergency
care, preferences are evenly divided between new emerging care models and preference for physician-provided care.
Strongly To what extent do the following statements accurately reflect your views? Disagree/
agree/ (Five-point rating scale) strongly
agree I am willing to … disagree
Be treated by a health professional (e.g., registered nurse, physician assistant or

81% pharmacist) instead of a doctor for minor/non-urgent health problems, vaccinations and
basic health screenings (e.g., blood pressure, blood sugar or weight)
5%
Have non-urgent treatment, vaccinations and health screenings (blood pressure, blood
72% sugar or weight) by a health professional (e.g., registered nurse or pharmacist) at a retail
pharmacy or in a facility located in a department store
7%
39% Be treated by a health professional (e.g., registered nurse, physician assistant or
ambulance officer) instead of a doctor at an emergency department in a hospital 34%
38% Be treated by a health professional (e.g., registered nurse, physician assistant or pharmacist)
instead of a doctor for urgent or complex health problems or screening procedures 39%

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The next five years will bring big changes. The future of the health industry lies in digital
and mobile solutions, consumer influence and engagement, and non-traditional players
and locations. Health broadens to wellness, as well as dealing with chronic conditions and
population health.
Very likely/likely To what extent do you believe the following will likely occur in the health
Unlikely/very unlikely industry in your country in the next five years? (Five-point rating scale)
71% 5%
Digital, mobile and social solutions give patients the knowledge, skills and confidence to engage
persistently with the health system.
68% 10%
Individuals will use apps and social media for health-related information and support in preference
to the formal health care system.
64% 9%
The location of care will shift beyond the four walls of the clinic to care anywhere and anytime in the
home and community.
64% 6% Non-traditional players – entrepreneurs, retailers, telecommunications and technology companies —

will develop consumer-orientated services that compete with existing systems.
62% 13%
The concept of health will transition from sick care systems to wellness, chronic care and population
health management.
62% 11% Consumer opinion through crowd-sharing of experiences, ratings and reviews will become an
important influence on improving system performance.
59% 14%
Connected health will become the norm as clinical telemedicine and consumer-oriented personal
health technologies combine and create new ways to deliver care.
58% 17%
Individuals will manage their own PHC of personal data feeds, e.g., from wearables, IoT or
remote monitoring.
57% 14%
Primary care as we know it will change fundamentally as integrated care teams form around a
patient-centered medical home supporting chronic and complex health conditions.
51% 12%
Consumer demands for a “voice’ and ‘choice” will ultimately force the health system to refocus
around consumers.
Could health care be “Uberized”?

More than half consider health care in their country likely to shift to on-demand
56%
Very likely/likely
27%
Neutral
16%
Unlikely/very unlikely

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Primary care transitions

to chronic care and
population health
The primary care model is transitioning toward chronic N
 avigation will help primary care providers manage larger
disease and population health management, drawing upon populations with lower-cost models of care centered on
curation, navigation and integration technologies and the home. This will drive more cost-effective solutions for
team-based care.61-65 Personal data fusion in the individual’s treating low-acuity illness, support patients to participate
cloud will supplant electronic health records that have actively in their own health management, aid early
failed to deliver utility. identification of major illness and navigate the patient to
the right care provider. Providers will routinely have access
Two possible scenarios emerge:
to a vast array of relevant information, including research,
• “Cradle to grave” care66 within an integrated system with environmental, social and personal, to tailor individual care
the generalist physician67, 68 as navigator, guiding patients but also to focus upon broader issues of population health.
through understanding complex information and deciding Payers will draw upon population data to support and
upon a course of action encourage cost-effective self-management solutions, as well
as early identification of disease and connections with the
• Availability of multiple service options as determined by
right care provider.
the market, with integration occurring behind the scenes
through personal data fusion in the cloud
Advanced communications and virtual care models support care at a distance and reduce the need for in-person visits.
Population health and value-based care models are supported with AI and data analytics that predict risk and support
highly personalized care. Analytics platforms that can continually examine and analyze multimillions of items of sensor
data and clinical and medical history information will underpin remote patient monitoring and, ultimately, population health.
• Medalogix assists home health clinicians by analyzing

home health and clinical data with predictive analytics to
identify patient risk, predict and resolve issues that may
lead to unnecessary hospitalizations, and provide value-
based care. Three main types of predictive services target
patients at high risk of readmission; provide prospective
identification of patients who will likely benefit from
hospice care and assists clinicians with managing home
health care; and finally, predict which patients will need
post-discharge care and assistance and customized
care management plans, including monitoring tools,
calling prompts and schedule.
• Forward is a primary care service membership model
(US$149 per month) based in San Francisco that www.medalogix.com
provides members with access to physicians, data-driven
technology, AI, wearable sensors and 24/7 mobile access • The IoHT is changing the face of primary care through
via an app. Initial in-person baseline is captured through such things as home monitoring (for example, the Withings
a body scanner, blood tests and genetic testing, which wireless blood pressure monitor), medication management
are used to develop a blueprint for future health and (for example, the AdhereTech wireless pill bottle) and early
wellness. AI analytics of baseline data and real-time data intervention (for example, Omada Health chronic diseases
from phone and devices sensors is used by the medical programs).
care team to reach out to the individual via the mobile
app with alerts or monitoring progress. www.withings.com
www.adheretech.com
www.goforward.com
www.omadahealth.com

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Creating a cadence for change

“What is the burning platform event where people
will say, ‘OMG, we have to change health care?’”
oseph Kvedar, MD Vice President,
J
Connected Health, Partners Health care
T
he digital revolution in health care described by Concerns around purpose and payment were voiced, especially
Eric Topol69, 70 offers untold opportunities to deliver care how to benefit from the opportunities afforded by participatory
and connect with consumers in unique ways. In this care and, at the same time, avoid increasing health inequities.
paper, we have sought to understand the changes necessary Data fusion ecosystems that capture and make sense of massive
to embed a participatory ecosystem within the core business data flows and platforms that glue the multipiece jigsaw that is a
of health care — something that we believe is inevitable as health care system together are vital. As are shifts in industry
technologies mature, disruptive solutions succeed and health culture and in how we conceive and think about health and
systems become participatory. wellness in a globalizing and interconnected environment.
Geopolitical differences and the absence of expensive infrastructure
This paper has canvassed an early stage transformation. The
may well see emerging and developing economies take advantage
pathway to a participatory health system is under construction
of advanced technologies and promising platforms to leapfrog
as we move past the digitization of everyday practices and
into a participatory health care model.
tasks toward a future of health care that is personalized,
predictive and better value for money. Solutions are emerging In our first paper, we concluded that opportunities emerge at
that address the many governance, regulatory, social and the intersection of consumerism, technology and markets for
ethical questions that arise. Gaining public and clinician trust, those willing to explore beyond their traditional boundaries.
particularly around the safety, validity and integrity of devices, Our views have not changed — the convergence dynamic
AI and continual and unobtrusive monitoring is of the utmost continues apace. Health care will need to reconfigure to reach its
importance. Also critical is gaining and sustaining consumer digital potential. (Figure 3) There will be growing pains, and the
engagement. As one executive noted, “Most people don't big issue will be that of the “last mile” — persuading consumers,
actually want to think about their health care on a routine basis, health professionals and those charged with governance and
and that's one of the fundamental barriers to truly engaging the stewardship to adjust business, clinical, and regulatory processes
consumers”. With information comes power and responsibility — around the new technologies and participatory care models.
for consumers, a transition to a participatory health system will How a shift to participatory health might be financed will be
bring both. addressed in the third paper in this series.
Listening to the leading industry executives speak about To avoid being on the wrong side of an emerging and disruptive
the future of the health care industry has been illuminating. trend, health industry players need to recognize that preserving
Industry transformation will be built upon innovations that truly the status quo is no longer an option. It is timely to be bold.
make health care simpler and seamless – especially innovations Even highly conservative estimates suggest that considerable
developed around the devices of daily life and mobile phones. health expenditures may be wasted and potentially available
Disruptive technology-based responses that drive patient for redirection. We ask: what if even a small proportion of
engagement through participation and curation of their health this money was directed toward creating a participatory health
and wellness experience, deliver population health outcomes care system?
and deal with the burning issue of costs are paramount.

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Figure 3. The patient journey in different health care ecosystems: opportunities exist to address
the wellness gap and resources deployment
Time
Patient journey Aging population and rising chronic illness
Misused
Healthcare
resources
1
Traditional health
lth
Well-being
ea
yh
tor
pa
2
tici
Par
Self-care
Wellness
gap
Preventive
well-being and health Self-monitoring Assisted monitoring Primary Secondary Specialist and
management at home at home care care acute care
Legend
1 Misused healthcare resources
Participatory health
Traditional health 2 Wellness gap
Wellness gap / misused resources

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Our view
Some will lead and others follow but, in a forward-leaning
world, three things to consider are:
1 Consumerism and technological 3 When system-ready, health care

change are the twin dynamics of will deliver affordable, accessible
disruption in health care total health
Maturing health care consumerism and changing technologies Future success depends on the system-readiness of the
are a powerful combination. Leveraging the power of the health industry. In the future state, individuals will access
crowd through technology (such as crowdsourcing and care regardless of geography through teleconnected
social networks) will likely be an effective force for change. services, and the core business of health care will be
Changes in consumer expectations and new patterns in anchored around virtual delivery, consumer engagement,
consumer behavior will arise from and be shaped by such and an integrative and long-term orientation. Platforms are
networks and platforms, and will ultimately be a key lever key to new pathways by which organizing and delivering
pushing the health system to adapt. This will require a clear health care and a broad ecosystem of many players becomes
appreciation of the market and where disruption is most possible, including virtual care centers, smart homes,
likely — whether this is upcoming generations caring for smart hospitals, smart technologies on and in-person the
aging family members, baby boomers vigorously redefining person and smart insurers. Payment models, performance
their future or a newly formed health care system in an incentives, industry structure and staffing systems require
emerging/developing economy. redesign to account for new models of care and changing
roles and responsibilities. New approaches in future services
demand different talents, including data scientists, creative
2 Convergence between science, designers and behavioral economists.
social, technology and
industry demands a rethink
of business models 64
32
Convergence opens the doors to new opportunities. A shift
in mindset requires core capabilities in partnering to operate
and thrive in the new environment of partnerships, alliances,
new locations and consumerist orientation, and identifying
innovative ways to capture value. A new ecosystem brings a
new set of players with opportunity to leverage expertise in
adjacent spaces such as financial services, manufacturing
and insurance.
$
¥
28 €
£ 55

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Methodology
This paper draws upon conversations
held with health industry leaders in the
United States, Europe, Southeast Asia
and Australia.
Executives from government and regulatory bodies, academic
institutions, providers, payers, entrepreneurs and consumer
groups were interviewed between September 2016 and
January 2017. Views around participatory health and the shift
to a digital health care system were discussed, including likely
time horizons and anticipated impact upon the health care
industry. We also spoke with our global health care industry
professionals, and reviewed relevant academic and industry
literature, and conducted an exploratory survey that took the
pulse of professional young adults views on virtual health.
Participatory health:
taking the pulse of young
professionals’ survey
An online pulse survey was conducted in February 2017 of Gender
a convenience sample of young professionals located in nine
countries. The 267 respondents were aged between 21 to 25
41%
27% 31%
(27%), 26 to 30 (41%) and 31 to 35 (31%) years. Respondents
were male (47%) and female (53%). Countries of residence
included Australia (10%), Canada (16%), Indonesia (10%), Japan
(12%), Malaysia (12%), New Zealand (7%), Singapore (14%), the
Age
United Kingdom (11%) and the United States (9%). The majority 0 21—25 26—30 31-35 50
of respondents report that they are in excellent or good health.
Around half use the health care system on an occasional basis Geographic location
for minor illnesses such as colds/flu, 17% are regular users of
the health care system for a chronic condition or long-term
injury and illness and 24% say they have no real need to use the
health care system at this stage in their life.
Ten questions were asked exploring respondents' views on

CA
SG
participatory health, use of online digital tools for health JP MY UK
AU ID US
care purposes for themselves or another, views on privacy
NZ
and security of personal information, interest in new service
delivery models and views about the future of health care in
their country. 10% 16% 10% 12% 12% 7% 14% 11% 9%
AU Australia JP Japan SG Singapore
CA Canada MY Malaysia UK United States
ID Indonesia NZ New Zealand UK United Kingdom

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Contacts Jacq ues M ulder

US Health Sector Leader
David Roberts
Asia-Pacific Health Leader
A loha M cB ride
USA Federal Government
jacques.mulder@ey.com david.roberts@au.ey.com Health Leader
The EY teams +1 917 331 8396 +61 2 8295 6661 aloha.mcbride@ey.com
+1 703 747 0547
For any questions on
the paper, please reach F inn Holm Richard L ewis A ndrea L onghi
out to our teams — we'd Nordics Health Leader UKI Health Leader MENA Health Leader
finn.holm@no.ey.com rlewis1@uk.ey.com andrea.longhi@ae.ey.com
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A uthors David Roberts

Asia-Pacific Health Leader
A ssoc. Prof. Sheryl
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+61 2 8295 6661 and Melbourne School Global Health
of Population and
Global Health
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Contributors Dr Joe K vedar M D, Vice President of Connected Health,

Partners Health care
L eadership and team members from the U nited States
Health and Human Service Office of the National
Dr A lain L abriq ue, Director, Johns Hopkins Universtiy Coordinator for Health Information Technology
Global mHealth Initiative M cK esson V entures
Dr Deborah K ilpatrick , CEO, Evidation Health Professor Jane Gunn, Professor and Foundation Chair
Damon Davis, formerly US Department of Health and Primary Care Research, Head of the Department of
Human Services (HHS) CTO's Office, Special Assistant to the General Practice, Melbourne Medical School, the University
Deputy Secretary, Director of the Health Data Initiative, U.S. of Melbourne
Department of Health and Human Services Dr Randall M oore, President, Mercy Virtual Care Center
Dr Cathy Chang, CMO, Greenville Health System Dr Daniel K raft, Founding Director & Chair,
A ndrew Thompson, CEO, Proteus Digital Health Exponential Health
L eanne W ells, CEO, Consumer Health Forum, Australia
Connect F or further information, visit our dedicated website
with us ey. com/ HealthReimagined or follow our Health reimagined B log.
Thank you
to the industry executives who shared their thoughts and insights with EY
in the interviews for this study.
Disclaimer
The examples included in this report are not endorsements of any organization, service or product, but are illustrations that suggest that
the shift toward a digital health ecosystem is already well underway.

Home Contents < >
Endnotes
1. Clay, J. USC’s Virtual Care Clinic is a step in the future of 14. Diamandis, P. If Robots and AI Steal Our Jobs, a Universal Basic
technology-driven health care, USC News, 2017, (Cited 2017 Income Could Help, SingularityHub, 2016, (Cited 2017 February)
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virtual-care-clinic-is-a-step-in-the-future-of-health-care/. steal-our-jobs-a-universal-basic-income-could-help/.
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Alibaba have in common, Harvard Business Review, 2014, (Cited world watches, 2017, (Cited 2017 January) Available from:
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airbnb-uber-and-alibaba-have-in-common. universal-basic-income-trial-as-the-world-watches/news-story/7ae9
1901c856ca697ed6b30e18cbba00.
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health-care.

Home Contents < >
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Smarter, Information Week, 2016, (Cited 2017 February) Available from: http://www.vertical.vc/.
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28. Robinson, E., N. Titov, G. Andrews, et al., Internet Treatment for 43. American Chamber of Commerce Japan Lengthening Healthy
Generalized Anxiety Disorder: A Randomized Controlled Trial Lifespans to Boost Economic Growth Utilizing Telemedicine to
Comparing Clinician vs. Technician Assistance, PLoS ONE 2010, Deliver More Efficient and Effective Health care in Japan 2015,
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29. Ebert, D.D., A.-C. Zarski, H. Christensen, et al., Internet and
Computer-Based Cognitive Behavioral Therapy for Anxiety and 44. U.S. Department of Commerce International Trade Administration
Depression in Youth: A Meta-Analysis of Randomized Controlled (ITA) 2016 Top Markets Report Health IT, A Market Assessment
Outcome Trials, PLoS ONE, 2015, 10(3): p. e0119895. Tool for U.S. Exporters, 2016, (Cited 2017 February) Available
from: http://www.trade.gov/topmarkets/pdf/Health_IT_Top_
30. Pillai, V., J.R. Anderson, P. Cheng, et al., The Anxiolytic Effects of Markets_Report.pdf.
Cognitive Behavior Therapy for Insomnia: Preliminary Results from
a Web-delivered Protocol, J Sleep Med Disord 2015, 2(2): p. 1017. 45. Castelo-Branco, M., F. Gomes da Costa, C. Ribeiro, et al.
Implementing Telemonitoring in the Portuguese National Health
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advancements in mobile, 2014, (Cited 2017 January) Available spms.min-saude.pt/wp-content/uploads/2015/08/Implementing-
from: https://www.gsmaintelligence.com/research/?file=141208- Telemonitoring-in-the-Portuguese-NHS-Med-e-tel-2015.pdf
5g.pdf&download.
46. HIPAA Journal The Slow Pace of Technology Adoption in Health
32. Lindau, S.T., J. Makelarski, E. Abramsohn, et al., CommunityRx: care Explained, 2016, (Cited 2017 February) Available from:
A Population Health Improvement Innovation That Connects Clinics http://www.hipaajournal.com/the-slow-pace-of-technology-
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33. Stone, P., R. Brooks, E. Brynjolfsson, et al. Artificial Intelligence 47. Chakravorti, B., C. Tunnard, and R.S. Chaturvedi Digital Planet:
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CA: Stanford University, 2016 September, (cited 2017 February) tufts.edu/~/media/Fletcher/Microsites/Planet%20eBiz/EBIZ_
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com/2014/06/24/building-better-brain-saffron-cognitive- 49. GSMA Connected Society, Mobile Connectivity Index Launch
computing-platform-replicates-associate-facts/. Report, 2016, (Cited 2017 January) Available from: http://www.
gsma.com/mobilefordevelopment/programme/connected-society/
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2016, (Cited 2017 January) Available from: https://www.
36. McGoogan, C. Nokia steps into digital health sector with smart kingsfund.org.uk/publications/digital-nhs.
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plan: Big ambition, risk, ZDNet, 2016, (Cited 2017 February) of primary care: New models and digital requirements, 2015,
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healthcare-transformation-plan-big-ambition-risk/. org.uk/research/digital-requirements-for-new-primary-care-models.
57. Garrety, K. and A. Dalley. Why is it so hard to set up systems for 63. Osborn, R., D. Moulds, E.C. Schneider, et al., Primary Care
sharing electronic health records? A framework for investigating Physicians In Ten Countries Report Challenges Caring For Patients
complex sociotechnical change in Proceedings of the Australian With Complex Health Needs, Health Affairs, 2015, 34(12):
and New Zealand Academy of Management Conference, 2009, p. 2104-2112.
Adelaide, Australia: Australian and New Zealand Academy of
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ro.uow.edu.au/commpapers/2394/. Quality in the Comprehensive Primary Care Initiative, New England
Journal of Medicine, 2016, 374(24): p. 2345-2356.
58. Gartner Press Release Gartner Survey Shows Wearable Devices
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59. Salloch, S., Same same but different: why we should care about
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Revolution Will Create Better Health Care, 2012, New York: Basic
Books, 303.

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Guest commentary: Why healthcare needs to hire more robots - Modern Healthcare Mode... Page 1 of 3
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Guest commentary: Why healthcare needs to hire more robots

Jon Powell, left, is the Health People Advisory Leader
at Ernst & Young and Chris Massouras is the Robotic
Process Automation Health Advisory Leader at Ernst &
Young, both based in Chicago.
By Jon Powell and Chris Massouras
In the transition to value-based care, talent
management is critical. It is equally as important as
cost, quality and patient experience. But one of the
biggest challenges facing health organizations is
employee disengagement or burnout while trying to satisfy all the demands that
come with population health, value-based reimbursement, patient centricity and
changing compensation models.
However, technology gives us a solution. Many of the most glaring pain points in
healthcare talent management can be solved by taking robotic tasks out of human
job responsibilities. This is done through the support and automation of activities that
capture and move data.
Robotics process automation (RPA) is about to transform the way people work in
healthcare. RPA is a software solution that mimics work done by humans, but
operates in the background, completely invisible to patients. For example, RPA can
replicate the work that a claims agent performs by moving from one application to
the next, gathering and making decisions based on the data accumulated. It can
also perform clinical-related tasks, such as using outputs from health monitoring
devices to update electronic health records. Essentially, RPA allows any type of
routine, rule-based work to be performed by a robot and allows that robot to mimic
the interaction with systems, applications and data (and sometimes even people) in
the same manner as a human employee.
Think of the possibilities across the revenue cycle—connecting with insurance

companies, addressing updates to provider information, and clearing a patient

http://www.modernhealthcare.com/article/20170630/NEWS/170639993?template=print 7/14/2017
financially for a procedure. In this last example, the robot would look up a procedure
code, compare it to the procedure code for the patient's insurance policy, and make
a rules-based "judgment" about whether there is a match. This is a routine and time-
consuming task that is currently performed by people but could easily be performed
by a robot.
A robot could read though thousands of medical records, look for missing
information, then obtain the missing data from another system without getting bored,
tired or making any mistakes. Furthermore, a robot can work 24/7, perform the work
faster, and complete this mind-numbing work for less than the human cost of payroll.
But the movement to automation isn't solely about managing costs, as some critics
argue. Most importantly, it is about redeploying human resources to higher-value
activities. Robots allow clinical staff to avoid mindless data entry tasks, spend more
time with patients, and work at the top of their licensing. Consider the effect on
morale and talent retention. Employees across your organization will be more
effective and more engaged when frustrating, mundane tasks are no longer part of
their job descriptions. They can then focus on high-value-added tasks that require
thinking, creativity, human touch and sophisticated judgment.
Another benefit is a reduction in basic medical errors, and the potential for avoiding
patient harm. Pretend, for example, a patient is transferring from one health system
to another. The systems' computers don't talk to each other, so information such as
medical records, chart information and medication history must be manually entered
into the receiving facility's computer system. Each time this is done, it creates an
opportunity for errors. It's easy to see where a drug interaction could be missed, or
the wrong dosage could be applied to an order. But when a computer robot handles
data entry between disparate systems, errors are avoided, the information is entered
faster, and a human worker is freed up to perform other duties. Machines certainly
aren't infallible, but when designed right and programmed correctly, they're highly
reliable.
Of course, cost savings are part of the equation. In addition to the staffing
efficiencies that are created, savings are achieved by avoiding errors, corrections
and rework. Recruiting, onboarding and attrition costs are saved as well. Quality
increases when mistakes are avoided, and the patient experience improves when
the "routine" parts of the health system operate efficiently, smoothly and mistake-
free.
In the new era of value driven care, the most successful organizations will be those
that can attract and retain the best employees by helping them work at the top of
their capabilities. This will be best achieved when the robotic tasks in healthcare are
left to the robots.
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Healthcare in 2017: Amid the uncertainty, these changes are certain Page 1 of 3

Healthcare in 2017: Amid the uncertainty, these

1. Health care shifts to total health.

2. Participatory health flourishes.

Health sector update 1

3. The M&A market stays hot.

4. Cybersecurity expands in scope.

5. Big data, paired with human experts, provides better insights.

Health sector update 2

© Copyright ASC COMMUNICATIONS 2017. Interested in LINKING to or REPRINTING this

Health sector update 3

Health sector update 4

V alue-driven care. A re you ready? | 1

Health sector update 6

2 | V alue-driven care. A re you ready?

Health sector update 7

ho read for the financial future

Provider health care organization by revenue

Bundled payment models Alternative payment models (APMs)

V alue-driven care. A re you ready? | 3

Health sector update 8

Inconsistent q uality of care

ac of tru t tran arenc and coordination

4 | V alue-driven care. A re you ready?

Health sector update 9

o five co t control initiative

Reducing medical errors and 5 8 %

Peer benchmarking and competitive 13 %

Increasing patient access to primary and 3 4 %

Reducing hospital use and emergency 20% Undertaking

V alue-driven care. A re you ready? | 5

Health sector update 10

6 | V alue-driven care. A re you ready?

Health sector update 11

Physician burnout: N ursing shortage:

V alue-driven care. A re you ready? | 7

Health sector update 12

8 | V alue-driven care. A re you ready?

Health sector update 13

New payment structures

V alue-driven care. A re you ready? | 9

Health sector update 14

According to our survey, 49% of interviewees

However, audits and scorecards alone will not move the

10 | Value-driven care. Are you ready?

¹ Harvard Business Review. https://hbr.org/2015/10/how-the-u-s-can-reduce-waste-in-health-care-spending-by-1-trillion.

V alue-driven care. A re you ready? | 11

Health sector update 16

12 | V alue-driven care. A re you ready?

Health sector update 17

Clinical Cost Patient Talent

V alue-driven care. A re you ready? | 13

Health sector update 18

Embrace a holistic approach

of EY Health Advisory Survey respondents “strongly agree or “slightly agree

78 % that health care or ani ation need to ivot to thrive in a value-based

14 | V alue-driven care. A re you ready?

Health sector update 19

Transform the culture

Advance with analytic insights

of respondents are undertaking cost control initiatives for peer benchmarking/competitive

Embrace the new way to pay

25 % of respondents have no reimbursement initiatives planned for 2017.

V alue-driven care. A re you ready? | 15