Post COVID Digital Health & Chronic Disease (Part 2)

The COVID-19 pandemic and healthcare systems’ responses to it have been the biggest disruptors in digital health’s 30-year history. We hope this will be the biggest disruptor for a few decades to come! Therefore, this is a unique moment of opportunity for digital health. Especially, we hope, for digital support of chronic disease management, particularly chronic inflammatory diseases (CID), autoimmune and autoinflammatory. Part 1 looked at the rapidly changing digital health landscape accelerated by COVID and exemplified by the Teladoc/Livongo merger. Part 2 looks at future trends and challenges in the post-COVID digital health arena. Throughout we focus on chronic disease, especially chronic inflammatory (autoimmune and autoinflammatory) disease.

The Telavongo merger is the biggest digital health deal yet, with implications for more M&A and bigger deals. But M&A is not the only sign of digital chronic disease management moving into a once-in-a-lifetime zone of opportunity. The post-COVID digital health chronic disease landscape will feature other trends we’ve identified. We will discuss these from the autoimmune patient and business consultants’ angles in our upcoming State of Autoimmunity 2020 post.

Post-COVID disruption trends

The disruption of medical office visits, hospital elective procedures and the sudden plunge into telemedicine have greatly accelerated existing trends. On the other hand, is telemedicine really here to stay? Will regulators roll back some or all of the restrictions and legislators not step up to support change? Once the COVID-19 contagion threat recedes, how many patients will freely choose telehealth to replace or augment in-person healthcare visits?

Will long-COVID finally prod stakeholders to give CIDs, many triggered by viral infections, the attention and funding we have sought in vain? What other COVID disruptions will be forgotten 2-5 years from now as the inertia of the legacy systems reasserts itself?

COVID and immunology

The pandemic shone a much brighter spotlight on immunology than ever in history! Social media enabled an unprecedented, if rough-and-tumble, level of citizen participation in discussions about every aspect of the disease and public health responses. The emergence of long-COVID has illuminated the existence of post-viral chronic syndromes similar to CIDs, autoimmune and autoinflammatory. Such visibility may kick-start public awareness, funding, R&D, even clinical practice to move beyond the famous autoimmune diseases to help those with less familiar, less prevalent conditions. Post-COVID, chronic inflammatory diseases will be more visible and perhpas more digital health entrepreneurs will seize the opportunity.

Technology infrastructure for health care–not just “digital health”

“As these next-generation payers and providers (NGPPs) reimagine how to best care for their populations, one thing is clear: technology is the critical enabler of most innovative approaches. Using predictive analytics to guide patient interventions, supporting patient choice via price and outcome transparency, providing on-demand care via telemedicine, and helping care teams make the best data-driven decisions all hinge on technology investment.”

https://rockhealth.com/reports/next-generation-payers-and-providers-setting-a-strategy-for-tech-enabled-innovation/

Like telemedicine, the unprecedented move to work from home (WFH) forced by the COVID lockdowns would not have been possible without recent increases in bandwidth and Cloud/API. The lockdowns broke many old habits and resistance to virtual work. How much of that will stick only time will tell. In retrospect, since 1990, the US has slowly developed a digital health infrastructure that supports better care coordination. Key components include the internet, EMRs, big data, predictive analytics (AI/ML), Internet of Things (IoT), multiple competing CCIT platforms, etc. 

However, will this acceleration make digital care coordination the new normal? This could be good news for CID patients, whose care requires more long-term coordination than even the big target chronic conditions. And, as Rock Health points out, the end of “digital” health is nigh, because everything is digital. Healthcare is finally catching up with finance, manufacturing and retail in integrating IT into its business models and daily practice.

Maturing digital health sector with disruptions from multiple directions

The trends of increasing consolidation through M&A, bigger deals and record venture investment may be good for smaller players. But the recent entry of big box retailers (Walmart, Best Buy), bigtech (Amazon, Apple, Google) and well-capitalized healthcare players (CVS, McKesson, Walgreens) raise barriers to independent success for smaller players. The growth of self-insured employers has significant implications for disrupting the legacy insurance and benefits management sectors. Even more disruptive may be the growth of next-generation payer-provider enterprises. Digital health emerging companies may look as those in the biopharma and medical device models have since 2000. In these models, start-ups innovate and then sell themselves, their products and technology platforms to the large established companies.

More M and A

M&A is of course, typical of a maturing digital health industry. However, the pandemic’s disruption to legacy practices, impact on valuations and increased public awareness of healthcare may lead to more. As long as US healthcare remains such an over-regulated industry, companies with big size, policy clout and the means to shoulder regulatory costs will command premiums. 

Payers want integrated solutions

Chronic disease management digital health companies are moving in general from DTC to selling to payers. Since payers want more integrated solutions, we see an inevitable roll-up of the smaller single disease-focused companies into platforms that include a wider variety of diseases. We expect to see this first in higher-prevalence diseases. But soon, we hope to see larger platforms that can help practices more effectively help patients with rare diseases to manage their conditions.

Demographics

This trend is so big, it’s easy to overlook. As the Boomer bulge ages, we are already seeing more Americans with healthcare paid through Medicare and Medicare Advantage programs, increasing demand for aging in place (poignantly illuminated by the high COVID death rate in nursing homes), and growing chronic disease prevalence in the aging cohort. 

Growth of chronic disease

But it’s not just age. Growing chronic disease prevalence in the young, especially CIDs in working-age people, is a daunting challenge to practice FFS models. These patients need access to scarce specialists, often more than one. Even more important they need guided care, where nurses, coaches and physician assistants can contribute much value. Care teams and coordination are the wave of the future. 

Social determinants of health (SDoH)

Finally, the importance of social determinants of health (geographic, financial, psychographic, education, class/ethnicity/race) has been highlighted by the pandemic and the (otherwise pernicious) critical race theory movement, accelerating bringing SDoH into analytics and clinical practice. 

What about alternative/functional/integrative medicine? 

Over the past decades, functional medicine has moved to fill gaps many CID patients experience in conventional care. There are likely more functional practices focused on autoimmune patients than there are conventional ones, although that may be changing. Digital health now includes new players, like big box retailers and bigtech, plus new primary care models and next-generation payer/provider enterprises. We wonder if the divide between conventional and functional medicine will start to disappear for autoimmune/CID patients. 

If conventional practices and centers of excellence can integrate the best non-pharmacological methods, they can gain market share from concierge functional practices. Such methods include lifestyle and behavior modification, food triggers, exercise and life-long PT (not the limited number of sessions that payers currently support), even acupuncture and meditation. But as long as evidence-based medicine and medical education continues to be a slow road to innovation, there will be room for more agile practices that can serve patients’ needs now, not after the next professional association guidelines are updated. This will be true until payers pay for alternatives to the pharmaceutical-focused models of current conventional care.

What’s the future look like?

Post-COVID vision of patient-centered care digital chronic care connecting a team of healthcare providers: specialists, coaches, exercise therapist, nutritionist and others.
DrBonnie360 2019 vision of future care for autoimmune (chronic inflammatory) disease patients.

See a somewhat different analysis of trends from Rock Health. A key takeaway for us is that we share a similar view of the future of healthcare. We both see technology enabling a completely different landscape that puts the patient in the center. Not just patients with common diseases, but those with rare, complex and chronic conditions that currently fall through the cracks in delivery systems. See our 2019 vision illustrated below.

In conclusion

We think COVID-accelerated trends, especially technology ones, are finally speeding up the slow push to build the infrastructure necessary, if not sufficient, to improve care of chronic inflammatory and autoimmune patients. Nevertheless, we still need more payer and provider attention, public awareness, funding, R&D, and changes to clinical practice if CID patients are to get a healthcare system that better fits their long-term needs. In any case, the post-COVID digital health chronic disease landscape will be different. How depends on how players can seize the opportunity to advance towards a patinet-centric, digitally enabled care delivery approach. Maybe long-COVID and its bright spotlight on post-viral chronic syndromes will be the next impetus raising awareness of the Invisible Epidemic!

Look for our upcoming State of Autoimmunity 2020, a follow on to our State of Autoimmunity 2016.

Contact DrBonnie360

We approach these posts from two different multi-lens perspectives

  • DrBonnie360: clinical dentist, Wall Street analyst, patient advocate, and digital health consultant. 
  • Ellen M Martin: evolutionary life science, finance & investor relations, marketing, communications and writing/editing.

DrBonnie360 Strategic Consulting & Professional Services 

We provide professional consulting and services to companies working to bring the best of digital, conventional and functional medicine to patients with chronic inflammatory diseases. 

  • We are thought leaders in helping our clients apply digital health innovations to chronic inflammatory, autoinflammatory & autoimmune disorders. 
  • Our subject matter expertise includes oral health and microbiome, autoimmune patient advocacy, digital health, self-hacking and more.
  • We have decades of experience in biopharma, finance, marketing and communications for healthcare and life sciences.
  • Our backgrounds include clinical dentistry, osteology, biotech investor and public relations, marketing communications, content creation, strategic consulting, autoimmune advocacy and much more.

Contact us for help defining and articulating your marketing position and strategy, including conducting virtual facilitated brainstorming and planning sessions. We excel at creating content, including articles, blog posts, collateral materials, web site copy and white papers. Our Your Autoimmunity Connection website showcases our own content.

Disclosure–we have done paid consulting work for IQuity, Mymee and Oshi.

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