Between plagues and property bubbles, few would label the citizenry of 2020 as a generation uniquely advantaged. Yet in the face of the most disruptive outbreak of disease in modern history, the world continues to turn in a way it never could in pandemics past: we work remotely, toast birthdays through a screen, and beckon supplies to our doorsteps with a swipe and a tap (toilet paper notwithstanding). This 21st century brand of outbreak management is uniquely enabled by technology — these are not mere conveniences, but critical mechanisms for halting the spread of infection. We have a deeper toolbox of pandemic-fighting instruments than any generation before us.
Innovations in medicine and public health form the backbone of this toolbox. However, the ability of cutting-edge tools to impact lives is limited without deliberate regulatory and ethical frameworks for managing roll-out. Take smartphone-enabled contact tracing technology, deployed at scale with noteworthy success in South Korea but few other countries: two strangers, Tony and Jackie, eat lunch at opposite ends of a park bench. Tony and Jackie’s phones passively exchange signals, establishing that they were in close proximity with one another. Days later, Tony tests positive for COVID-19, flagging him in a public health database and enabling public health officials to alert — or even quarantine — not only Jackie, but also her daughter Monica and the commuters in her subway car last night, that they crossed paths with an unnamed infected individual. Invasive, even dystopian? Sure. Potentially life-saving for multitudes of people? Absolutely. The million-dollar question is how to find the golden mean.
We cornered three Endeavor Entrepreneurs on the forefront of medical innovation to share their big-picture perspectives on how the current crisis is revealing the value, limitations, and hazards of new technologies in healthcare around the world. What structural challenges to mass adoption remain? What adaptations are enduring, and what’s a flash in the pan? Most importantly, what can we do to better prepare for the next great health crisis?
From the vantage point of Endeavor’s Healthcare portfolio — spanning 55 companies across 22 markets — I have had the front-seat privilege of observing the unique, potent, and at-times unorthodox manner in which entrepreneurs bring technology to life. Like all crystal balls, ours are cloudy — but I’m willing to bet on the steady march of innovation.
Harmonizing public health and data privacy
Thomaz Srougi is the Co-founder and Chairman of dr.consulta, a primary care venture that attends to low-income uninsured families in three Brazilian states. Based in São Paulo, dr.consulta is now Brazil’s largest private primary care provider, serving more than 1.7M unique patients through 50+ clinics and dr.consulta Online, its telehealth offering.
Consumer-facing digital technologies are increasingly pervasive in mainstream healthcare: telemedicine is here to stay. Sensors and wearables are beginning to complement remote care as we bring more and more monitoring tools into our homes, accelerating the “dehospitalization” of care. Yet, absent frameworks on reconciling data privacy with public health, we as a society have not fully embraced technology as a means of saving lives.
Contact tracing technologies have shown significant promise in the immediate-term fight against COVID-19 — but people do not trust them. In some countries, governments are mandating these efforts; other countries are relying on private sector applications from which individuals opt in and opt out. Many will participate, but many more are leery of allowing an app to track where and with whom they are spending their time. Such concerns are legitimate and beg further inquiry, but response time is everything in a pandemic. Widespread skepticism of contact tracing technologies has emerged as one of the biggest constraints on our ability to contain the coronavirus outbreak swiftly and decisively.
Virtual care and remote monitoring will not only save lives right now, but also allow us to be smart about making healthcare more accessible and affordable in the long run. We can optimize caregivers’ time, minimize missed days at work, and save on patient transportation costs — extremely important in emerging markets with low-income populations like Brazil. However, next-generation models with game-changing potential, such as asynchronous care [EDITOR’S NOTE: “store-and-forward” telehealth in which patient and provider do not need to be communicating with one another in real-time], will run into the same barriers to adoption unless data sharing and privacy become central in policymakers’ agendas. This is a call not for any regulation, but smart regulation — entrenched interests such as medical associations will look to make their mark in ways that prevent, not permit, more efficient care.
Unlocking the power of digital therapeutics
Aaron Gani is the Founder and CEO of BehaVR, creating digital wellness and digital therapeutics for behavioral health through the unmatched psychological power of virtual reality. Aaron has been an innovator throughout his career in healthcare and financial services, including serving as Chief Technology Officer of Humana, a Fortune 50 managed care organization.
The world is increasingly lonely, stressed, and in pain, a phenomenon that some experts suggest constitutes a modern-day “mental health epidemic.” This is a statement as true today as it was last year. Even before the pandemic, we did not have enough human therapists — today, as illness and economic insecurity spike, we are likely to see our overburdened system struggle to cope with an explosion of the anxious and mentally unwell.
We know that digital technology, such as social media, can negatively impact our health. Why wouldn’t we believe that it can shape our lives positively? Dozens of highly-credible, clinically-proven, and massively scalable digital wellness programs, as well as a few digital therapeutics — medical treatments delivered by software programs — exist on the market today. While far from replicating the emotional adaptiveness of a human therapist, digital therapies are a perfect adjunct to a telehealth consult: your doctor can engage with you, prescribe you a program, then monitor your progress from a digital dashboard. However, unlike telehealth, digital therapeutics are not transitioning existing person-to-person interaction onto a digital platform. Instead, it is novel person-to-digital education, skill-building, and / or treatment.
In a moment in which telehealth has become a critical agent of public health, the ability of digital therapeutics to contribute is handicapped. Until there is legislative action that recognizes the value of digital therapeutics and enables insurers to reimburse creators for these evidence-based therapies — the same way insurers reimburse for prescription drugs — we will continue to impose an unnecessary ceiling on the reach of potentially life-changing treatments. Clinicians and patients share the common goal of seeking treatments that are safe and effective. If digital therapeutics are both of these things, we need to provide the incentive for companies to bring innovative solutions to market and for providers to take them seriously as a clinical solution.
Managing doctors’ anxiety about telehealth
Amir Barsoum is the Founder and CEO of Vezeeta, a Dubai-based digital healthcare platform that serves its 4M+ patients across the Middle East and Africa through appointment bookings, telehealth, medication delivery, and more. Amir is a member of Endeavor Egypt’s Board of Directors, and was formerly a management consultant at McKinsey & Co. and Head of Strategy at AstraZeneca. He holds an Executive MBA from MIT’s Sloan School of Management.
Telehealth is already helping doctors extend quality care to more people. It removes long waiting periods, no-shows, and travel times, all while reducing the burden on overwhelmed local systems. Still, many providers continue to express uncertainty about a telehealth-driven future. How can we guarantee the same outcomes for patients? Will smart technology reduce my income or even endanger my existence as a provider? Their apprehension is not unfounded — what drives this anxiety?
Firstly, the expectation that revenue will fall if patients expect a “telehealth discount.” Patients and providers both have a strong expectation that the revenue and cost structure for telehealth is different than traditional care, and that providers will receive a smaller piece of the pie for delivering the same outcomes and quality of care.
Secondly, the unresolved question of whether the telehealth tool itself is a physician’s friend, or their competition. As AI-based diagnostics tools become increasingly intelligent and predictive, doctors are right to ask whether the future face of primary care will be man or machine.
Lastly, the loss of location control and the dramatically reduced switching costs that it brings. As a patient, I can grab my phone, open an app, and be on the phone with a new doctor within minutes. A provider in Johannesburg must theoretically compete for patients with a physician in New York, given proper payments infrastructure and training with virtual tools. We have recently seen the dissolution of state borders within the US, allowing doctors to serve patients in states outside their own. This flexibility is essential in a pandemic but conceals long-term reverberations. Not unlike the impact of cheap labor on factories and manufacturing plants across the globe, telehealth represents a powerful commoditization of the primary care provider’s role today.
Public and private healthcare entities, as well as medical schools, must transform curricula to teach aspiring doctors to make diagnoses efficiently, while maintaining empathy from a distance. Caregivers must be adaptable and incorporate digital tools into their practices. Telehealth platforms must acknowledge anxiety of change to position ourselves as an ally, not a threat, to better outcomes for patients and providers alike. We have seen first-hand the convenience, efficiency, and value that telehealth brings to providers. As our primary caregivers’ future roles evolve, we are committed to future-proofing their abilities in a way that makes them winners.
You can reach Marc Cho on LinkedIn here.