Article | November 2, 2021
The fall is a time of renewals and choices. It is also a time of so called “open enrolment” for health plans. It is the one time of year we can study and learn about the options offered through employers or government sponsored plans. Individuals and small business owners alike are also are faced with a myriad of choices with confusing and often contradictory language promising lower premiums with higher out of pocket costs for covered services subject to deductibles. What does it even mean anymore when your monthly premiums exceed your pay check and you still have to pay for your colonoscopy or your insulin? Where is it all going?
Let’s imagine you twist your ankle playing basketball. You might go to an urgent care, receive an X-ray, probably be examined by a non-physician, and then referred to your primary care, who can’t see you for a few weeks but eventually sends you to an orthopaedic who takes another X-ray and treats your injury. Weeks have passed, multiple visits, time out of work, and co-pays, not to mention the out-of-pocket fees associated with imaging and perhaps a $100 ace bandage. What stops you from going straight to the ankle specialist in the first place? First, we have become conditioned to follow the directions dictated by the insurance companies, even when restrictions are not in place, patients have been convinced that stepping out of line will make all insurance promises null and void resulting in catastrophic bills and financial ruin. Second, the doctors and their office staffs have been conditioned to deny entry to any patient who does not have the proper referral, authorization, or identification. There are dire consequences for both if the insurance rules are not followed and fear keeps both sides aligned.
The past two decades have seen an explosion of healthcare costs. Health insurance has become the single biggest line item second only to payroll for most businesses. It is no coincidence that as the government increased its role as payor with state subsidies, the prices have gone up. Much like college tuitions, when loans are easy to obtain and guaranteed by federal support, there is little to deter those in charge from increasing the price. After all, everyone is doing it, it must be OK, and even if students end up in debt, it will be repaid because they have received the value of a great education. Right? But unlike higher education, healthcare is a necessity. We cannot avoid it, and there needs to be a reliable mechanism in place to guarantee access.
Ironically, as charges and prices have continued to escalate, payments to doctors have diminished. Why medicine is the only service industry where there is no transparency is truly astounding, especially since the there has been no increase in so called “reimbursements” for decades. As physicians, we have been complicit, being fully aware of the discrepancies between what is charged and what a patient’s insurance will pay. Even as patients began to have higher deductibles, and therefore higher out of pocket expenses, we continued to follow the rules, asking insurance permission to collect payment from the patient. It is not surprising that bad debt accounts for over 50% of most account receivables and why over 70% of doctors are now employed by hospital networks or private equity, who not only go after patients, but benefit from the repricing that occurs when insurers pay a negotiated amount as opposed to the charge. In other words, we pay more not just for less, but for nothing.
But what if we twisted our ankle and went directly to that specialist and paid out of pocket a transparent price? What would it take for that to happen? Not much, the cost of care is predictable, and because payments have always been decreasing, most physicians have learned to be economical. Plus, out of pocket costs are capped by federal law, so no patient is really responsible for catastrophic bills. Charges inflate to cover overhead, but if payments were guaranteed and immediate, then the cost of doing business goes down. Add technologies like telemedicine to a practice and you have increased patient access to a doctor without adding more personnel. Direct pay doctors are emerging all over the country and have consistently offered better access and more affordable care. The bar is also being set by independent surgery centers and imaging centers who offer better outcomes at lower costs. Perhaps motivated by prohibitive pricing, better options have emerged that have moved patients away from expensive operating rooms to safe, office-based procedures. Even cutting-edge cancer therapies can be delivered at home, preserving more of the healthcare dollar for medical care rather than the complex system built to manage it.
Competition and choice inevitably drive prices, but in a monolithic system the price is not negotiated, but instead it is set by only a few, in this case the big insurers. Small businesses cannot compete when bigger companies come to town. Eventually, the local hardware store gives way to a national brand, and the consumer is left with fewer choices and eventually higher prices. Amazon disrupted this equation by creating a marketplace for individual buyers and sellers. The convenience of finding a trusted brand, no longer available locally, is irresistible and the reason why we became loyal consumers. Healthcare is no different. Trust exists implicitly between a physician and patient, because it is an authentic, empathetic, and logical relationship. Trust does not exist between a patient and their insurer, on the contrary it is an unsympathetic business relationship without transparency or consistency. Few doubt the insurance company’s top priority is the premium, not the patient. Creating a direct relationship between the doctor and patient is a common-sense approach that serves both stakeholders well, and requires merely a fair and affordable price. But do doctors have the capability or the will to do it and if so, can the rest of the system follow?
Never in the history of modern medicine have physicians been more dissatisfied. US healthcare used to lead the world in innovation and outcomes, now we struggle to break the top thirty. We may have the most brilliant doctors and scientists with access to the best resources, but the need to maximize profits while catering to special interests, be they commercial or political, has led us to favour certain therapies over others despite marginal proven benefits. Doctors have little autonomy and less authority; prescribed treatments are routinely denied by insurance companies without a second thought or appropriate peer review. In fact, insurers even renamed us “providers”, a term used to by Nazis when referring to Jewish doctors to devalue them professionally. Over 56% of physicians are burned out, nearly all report moral injury and as hospitals have systematically replaced doctors with non-physicians with limited training, we have watched the standard of care deteriorate. It is no wonder we have witnessed the single biggest loss in life expectancy since WWII. The prognosis is grim, but there are solutions.
We need to reinvent healthcare by removing the middleman. We don’t have to set the price, but we can make it transparent so patients can decide for themselves if it is worth the inconvenience, the delay, and the co-pay to use insurance or just pay directly. Health savings accounts are tax deferred and can cover an out-of-pocket maximum in just a couple of years. Paying for care means there are no surprise bills or out of network costs, because there are essentially no networks and therefore no need to follow restrictions. You’d be hard pressed to find a doctor or hospital unwilling to accept an immediate cash payment, especially when it costs nothing more than the service provided. There are no billing cycles, or claims to prepare, no up coding, or authorizations. Doctors free to care for patients, patients treated individually and not subject to protocols designed to maximize charges. There are literally thousands of direct pay primary care and specialists now available all over the country and they are building alliances with likeminded people providing imaging, ancillary services, surgery centers, and prescriptions all at fair market prices. More and more employers are moving toward medical cost sharing plans that not only lower the cost of care but the cost of administration. Even the biggest payor, namely the government, sees the benefit of price transparency and is piloting models of direct contracting.
We will always need coverage for those unexpected events, emergencies, or hospital-based services, but all the rest - doctor visits, screening tests, and outpatient procedures - are easily affordable. After all, do we use our car insurance to pay for an oil change? If we did, the cost would be prohibitive and few of us would drive. But health insurers have lost our trust, they no longer cover necessary services and no longer honour contracts with physicians or patients. It is time to offer another option and let the patients and doctors get back to the real business of medicine.
Article | November 1, 2021
Throughout my professional carrier, I iused to visit many companies involved in drug discoveries and had seen the challenges they go through. Some are pleasant as the investigational molecules were moving forward in value chain whereas few faced bottlenecks at the end. The association with Pharma industry over the years had taught me about many new ideas and allowed me to see that how innovative ideas are impacting our social and scientific world to a great extent. The changes we see today, are the results of ideas came from various quarters globally and I feel digital innovation had shaped today’s world differently. The impact of digital platform in today’s Pharma world is a “Game-Changer".
Innovation is a continuous process which simplifies challenges into reality and plays a very important role in our society. Centuries ago, scientists used to spend years in laboratories to understand material science. The chemical science evolved around discovering elements, synthesis of compounds or even isolating products from natural resources. Today’s world is highly indebted to those discoveries and efforts and modern science has gradually moved towards digital platform. Last few decades, innovations based on new technology platforms has made huge impact in scientific discoveries and few such ideas and action I feel has brought significant changes. Our lifestyle and social environment have witnessed deep impact due to such innovation. The chemical science is evolved not around only chemists today but have huge influence of mathematicians and technologists for faster development.
Advancement of digital science, new algorithms to solve the problems has modified the way of drug discovery to a great extent. In the recent past, we were heavily depended on big machines, but innovation has brought the whole items in a small packet now. The technology platform is modified, speed has increased in identifying new drugs with artificial intelligence (AI) and machine learning is accelerating the drug discovery and development processes. Today’s Pharma industries for commercial supplies are now depended on automation, optimization of the manufacturing processes, as well as designing effective marketing and post-launch strategies. The process is aimed to have better control on the operation, improving safety and better predictability of quality. For conducting clinical trials, identifying patient’s profile, an eligibility criteria is crucial which has been made by the processes being faster and cost effective by introducing Artificial Intelligence (AI).
Earlier when focus was to identify the origin of life, finding new elements, compounds or building blocks, today’s world is heavily dependent on data or ‘Big Data’. The amount of information available throughout drug discovery and development process, analyzing, interpreting, and predicting right candidate require high-performance systems to analyze data properly and derive value from it. There is advancement of analytical techniques, which provides more accurate information about the clinical trial reports and the data across patient pool, zeroing down towards right candidate is a real challenge and there are several AI enabled tools available where the processing time is reduced significantly which might have taken several years. The exciting part is that innovation is not only limited to laboratory work but works in coordination of mathematical interpretations, data analysis and provide significant clues to develop new molecules and even provide approach towards therapeutic categories. Currently available advanced technologies enhance drug development process, making it less time-consuming and cost-effective process where AI can recognize hit and lead compounds, and provide a quicker validation of the drug target and optimization of the drug structure design. Data scientists play a very significant role in all these activities.
Innovation focusing personalized medicine is now a reality and companies involved in such basic research have made breakthrough to understand how the human body responds to drug. Software solution is also available for simulating effects of drugs in patient body based on individual characteristics, scientific data for real time prediction of efficacy and drug interaction on individual. These predictive models are shortening drug discovery pathways to a great extent. Small molecule drugs or even large molecules development are heavily depended today on such modelling and predictive approach. The aim to reduce cost of drug development, shortening discovery path, focus on clinical trial mechanism is more productive with a higher success rate. During the pandemic period, in a shortest possible manner, several companies started working to develop new drugs or vaccines using drug-specific exposure models for drugs under investigation for the treatment of Covid-19.
Similarly, discovery platform is also working on cutting edge technology ‘Organ-on-a-chip’ that can emulate the physiological environment and functionality of human organs on a chip for disease modeling, mimicking the impact and could be a game changer in future. I will be happy to see when technology platform can accurately predict human mind and with the help of AI, can find a probable solution to avoid any such complex conflicts. It would be interesting to see that AI is analyzing and predicting the chemical change in the bodies impacting human mind and analysisng it quickly to predict psychological behavior of the patient and guide physician for right therapy. This may lead to predicting problems one may face in old ages where the decays may be prevented at early stage. This is a challenge but understanding and predicting psychological behavior may improve patients’ life. Depression and its remedy may be based on understanding changes, patterns of physicochemical behavior and its impact during mood swing and predicting such things in advance by using the advanced AI tools could be a game changer.
Another path breaking development where technology involving both engineers and scientists to help drug design to obtain maximal therapeutic benefits for patients including designing drug delivery systems and biomedical devices is 3D-printing technology. This involves high end computer simulations making analysis faster and predictive than before. Influence of 3D printing in designing variety of dosage forms has simplified its preparation. Though further study is under progress but the technology implementation at late has reduced cost of drug development to a significant extent and will add value in future drug development. It is interesting to see how this 3D printing technology works on human brain mapping and predicting a right path for treatment for betterment of large patient pool. Today with advanced technology, we are now more dependent on machines, limited close interaction with our near and dear ones, but created more friends on social platform. Though life looks easy, but over dependent on machines is creating another complex environment and this growing complexity may change the disease pattern. It will be interesting to see that how these technology platforms improve further to ease out such complexities for a healthy future.
FUTURE OF HEALTHCARE
Article | October 25, 2021
In today's uber-fast-paced world, the human race, in general, has gotten highly comfortable running on all cylinders in the rat race of life, especially people in India. Our country is a land where opportunities are aplenty, and competition is ever-present, which makes every day life so tedious and constant that taking a breather is something that people can rarely afford. This has led to increasing cases of anxiety, depression, high blood pressure and insomnia. These cases rose to such high numbers that it gave way to one of India’s most prominent industry sectors: The Wellness Industry.
Though the industry captured global attention between 2015 and 2017, a study conducted by McKinsey & Company found that the wellness industry is currently valued at $1.5 trillion globally. This sudden boom can be attributed to the realisation that it is more important to remain healthy than getting healthy. Furthermore, the report, produced after analysing 7500 consumers in six countries (including India), has offered keen insights into consumer behaviour. When it comes to wellness consumers, their trends can be grouped into six categories:
Health: People are now investing in many remote medical devices that can constantly monitor their state of well-being. With the increase in popularity in digital wearables, telemedicine, and remote patient monitoring services, this trend is bound to increase.
Fitness: People are exercising more. Whether it’s jogging, going to the gym, investing in a pedometer, FitBit, etc., there has been a steady increase in people exercising more.
Nutrition: Dieting has always been a significant part of being healthy. An increase in dietary food, supplements, nutrition coaches can be observed in recent years.
Aesthetics: With a major chunk of India’s youth population getting invested in their social media, notably the pictures that they post, aesthetic well-being has seen a sharp increase. This includes investments in specific Athleisure clothing apparel (Nike, Addidas, Puma), skincare products (collagen supplements, face masks), and plastic surgery.
Sleep: Burning the midnight oil is counterproductive. There has been a steady increase in consumers willing to invest in sleep medications, specialised mobile applications that track their sleep and the state of their sleep, ASMR generating devices, White noise devices, and other products that can enable a consumer to maintain a healthy sleep cycle.
Mindfulness: Introspection, understanding the body and its processes to the molecular level, and figuring out ways to implement clarity of thought and methods for improving focus have been huge draws for the wellness industry. Furthermore, with central government’s schemes like AYUSH and the introduction of International Day of Yoga by the United Nations, this particular trend has seen enormous growth.
Impact of these trends on the future of Indian wellness industry
Organic Products: According to APEDA, India has become one of the largest producers of organic products. A growing number are actively investing monthly in organically grown produce, meat that is organically processed, oil that is wood-pressed or cold-pressed, cosmetics made from organic materials, and clothes made from pure cotton instead of manufactured materials. People becoming more conscious of what they put in their bodies has led to a steady increase in organic shops across India.
Exercise, Dieting & Nutritional Supplements: From using simple Calcium supplements and energy drinks to adhering to a strict diet regimen, today’s consumers are genuinely worried about falling sick. This has led to an increase in purchasing supplements. Another trend can be observed where an increasing number of consumers have started buying vitamin, Zinc, and iron tablets, to shore up immunity. Furthermore, Indians have begun consuming gluten-free cereal, cold-pressed juices, Kale products, Avocados, and other food products recommended to be healthier alternatives. Indians have also become BMI-conscious, and an increasing number of them have started to invest in gyms, yoga/cardio classes, exercise-wear, sports wearables, and other products that can enable a person to work out more effectively.
Constant Increasing Demand for Oxygen: Even before the second wave of the COVID-19 pandemic, getting access to 99% breathable oxygen has pure oxygen was a necessity considering the rising concerns of pollution in Indian cities. As per the ‘World Air Quality Report, 2020’ prepared by Swiss organisation, IQAir, 22 of the world’s 30 most polluted cities are in India, with Delhi being ranked as the most polluted capital city globally.
Moreover, people who indulge in extreme physical workouts exercise, or suffer from high-altitude sickness, need oxygen handy to maintain their wellbeing. In India, prominent wellness companies like UCS Wellness Pvt Ltd have made significant strides to ensure that every individual has access to oxygen through their innovative specially outfitted 18-litre aluminium-bottled oxygen cans of 18 litres under their brand gO2therapy. With the pollution rate showing no signs of slowing down, and the steady increase in demand for oxygen, it would be no surprise to find every household medical kit fitted with a portable oxygen cylinder.
Transitioning to Digital Platforms: With the increase in popularity of Telemedicine and Remote-patient monitoring, healthcare and the wellness industry are gaining an aggressive online presence. There are many online exercises/online videos, fitness apps, meditation apps, motivational apps, power coaches, and so much more. Indians find it easier to use these online tools combined with a digital wearable to keep their well-being in the best of conditions.
Investing in Social Media Influencers: With the increase in online dependence, the voice of social media influencers is soon to be gospel when it comes to maintaining a fit body and healthy mind. Much like how mainstream celebrities endorse various products, the wellness industry has seen great rewards in deploying online influencers to support their products. Typical examples can include a famous workout specialist advertises particular apparel, gadget, energy drink, or brand of Whey Protein distributors as part of their video.
Alternatives to Allopathy: In the Indian market, the wellness industry has seen a shift in paradigm where an increasing number of consumers opt for Siddha, or Ayurveda substitutes, instead of conventional medicine. This is seen more in the age group of 40+. This particular age group has patients with a long history of high BP, high cholesterol, and other ailments that require continuous monitoring and medication. They feel that the healthier choice is in traditional medicine or treatments like Panchakarma, Ayurveda, or Siddha. Conventional medication provides them with little to no side effects, which is the primary reason for its increasing popularity.
India is expected to become a wellness hub in the global community following a 12% growth per annum. The Make in India initiative is expected to bring in more investments and opportunities in this sector. The Ministry of AYUSH, with a separate department for Yoga, has been exempted from service tax. A budget of around ?3,400 crores has also been earmarked to be spent over the next five years to help set up and strengthen Ayush Wellness Centers under the National Ayush Mission. This has sparked an increase in startups and businesses focusing on the wellness sector.
Meanwhile, the global pandemic is also giving rise to a new consumer behaviour called wellness rebound where they are becoming more health-conscious and striving towards regaining their health soon after recovering from an illness. Considering the aftermath of the pandemic, the aggressive implementation of technology, and the constant consumer market in India, it can be inferred that the wellness industry will evolve and expand further with little to no backslide.
Article | August 27, 2021
Do you know a friend or loved one who suffers from fear, anxiety, and depression and do not know what to do to help them?
It can be frustrating to watch someone you know struggle with their mental health and not be able to do anything to relieve their suffering.
With this in mind, here are seven ways to help the person cope in these kinds of situations.
1. Learn as much as you can in managing anxiety and depression: There are many books and information that will educate you on how to successfully overcome fear and anxiety. Share this information with the individual who is struggling with their fears. The key is to get your friend to understand how important it is to seek some guidance when it comes to their mental health.
2. Be understanding and patient with the person struggling with their fears: Maintaining depression and anxiety can be difficult for the individual so do not add more problems than what is already there. Do not get into arguments with your friend who may be having a difficult time with their anxieties. Make an effort to listen to the person rather than making judgements.
3. Talk to the person instead of talking at them: It is important not to lecture the individual who’s having a hard time with anxiety and depression. Talk to the person about their issues without being rude. Most people will listen if you approach them in a proper manner. Remember to treat others the way you would want to be treated if you were the one who was struggling.
4. Ask for some ideas: Seek advice from a professional who can assist the person you know with their mental health issues. A counsellor can give you some ideas on how to overcome anxiety, fear, and depression. Getting help from a therapist is the number one priority in getting the individual to do something about their problems.
5. Find out why the person won’t get assistance: Address the issues on why he or she will not seek treatment. Many people who are struggling are fearful and frustrated. Try to find out the reasons why your friend won’t get the help they need and then try to find the ways that will overcome their resistance of seeking some guidance.
6. Remind the person on the consequences of not getting help: Another way to convince the individual who is struggling with fear and depression is to tell them what may happen if they don’t get some counselling. Anxiety and depression can make things worse and usually won’t go away by themselves.
7. You can’t manage your mental health all by yourself: A person’s fears and anxieties can be difficult to manage and more than likely he or she will need some help. Many people think that they can overcome their mental health problems on their own. This is a mistake. The individual should admit they have a problem and then seek treatment to get their life back on track.