Fit for Duty podcast: Episode 1.

[00.00] Because we know that organisations — large and small — recognise that their future growth and success depend on their people, Fit for Duty brings you insights on some of the biggest health and well-being challenges and forces shaping the corporate health landscape today. We’re here to help you build a healthy, happy, productive workforce.

I’m Lorien Norden, global content marketing lead for Aetna International. I’ve spent years having conversations with some of the most fascinating and well-informed clinical, well-being and health care experts out there. And now, in this new podcast, we’re bringing the latest thought leading market insights directly to you, along with strategies you can put into place today to help your employees flourish. Because when your people thrive, your business does too. 

We hope you find our discussions not only interesting but valuable. Make sure you subscribe to the podcast. And don’t forget you can follow Aetna International on LinkedIn for all the latest news and articles.

[1.11] Hi and welcome to the first Fit for Duty podcast episode. Today, I’ll be speaking to our own Dr Anushka Patchava to look back at our health care predictions for 2019 and to see what came to pass. We’re also looking at those emerging throughout the rest of 2020 and the impact of COVID-19. I’ll also be asking Nush about digital health care tech, the dimensions of well-being, consumer demands, physical and mental health parity and the impact these have on organisations and their people. If you have any thoughts on today’s topic, you can always get in touch with us via LinkedIn. We’re always keen to hear your feedback and we hope to answer any questions you might have in future podcasts. I hope you enjoy the episode.

[1.56] Hi Nush, thank you so much for joining us. Could you please introduce yourself for the benefit of our listeners?

Hi Lorien. It’s great to be here and thank you for inviting me to take part in this podcast. My name’s Dr Anushka Patchava. I work at Aetna International, a payer environment, in the vHealth team, leading on proposition and strategy. Previously, prior to my role at Aetna, I was a physician, I worked in and still do work in policy at the United Nations, advising on blockchain in particular but also emerging technology in health care. And I’ve also had the opportunity to work in the pharmaceutical sector. Safe to say, Lorien, I’ve done four “Ps”. I’m not going to be a politician any time soon.

[2.37:] A very busy, talented lady. So we’re very lucky to have you with us. Thank you so much. So, first of all, I wanted to cast our minds back to an article we had written last year. I mean so much has changed in the world in the last month, let alone the last year, but I’m going to go back to an article that we published and shamelessly pick out elements from it. Just to get your feel on what is still relevant and how those have really come to pass and how you see those moving forward as well. So we particularly were looking at the rise in social determinants or, as we refer to them in the Aetna CVS world, as the six dimensions of well-being. We also looked very much at the rise in mental health conditions, that we had been seeing globally, and the article goes on to talk about, let me have a look here, really that P4 health care model so that whole expanding role of predictive, precision medicine. And so I think that is something that I’d really like to talk through today. So just going back to the top then, um, in terms of those six dimensions of well-being, how did you see that develop in 2019 and how do you see that carrying forward?

So I think the six dimensions of well-being and holistic health care is still the model of I guess the panacea we’re all trying to achieve. It’s becoming increasingly important to consider health being as being physical and mental health not only for health systems but also for employers with their employees. And what we’ve seen, you know, more and more growing is this shift of health systems and health care from sick care — so just looking after those that need it, when they need it —  to more around the lines of health care, and using data and analytics, risk stratification, and segmentation at a population level to be able to predict how to interact and intervene with people’s well-being and health.

[4.59:] So in terms of how that is influencing consumer behaviour as well, what is it that health care consumers are demanding and requiring of health care systems with those six dimensions of health care in mind? So looking at things like socio-economic influences. Looking at it from a holistic health care perspective?

So I think that’s an interesting question. So I think consumers right now in health care want convenience and want access. I think those are the two key areas that we see consumers expecting and wanting. And that resonates well in that we have seen it in other sectors. We’ve seen it in retail where the retail industry has gone really from bricks and mortar into an online digital world. The rise of Amazon, you know, for example where there’s a one-stop-shop for everything has become ever-more prominent in the landscape. And I think, similarly, with health care, consumers are now looking for technologies that make access to health care easier. Be that telemedicine or be that digital health apps or be that, you know, using in-house voice assistance like Alexa to answer their questions about health and provide the latest evidence or the latest research in that space.  With relation to the question around holistic, it’s hard to really understand as I don’t think that health care practitioners have a role in advising someone around their financial well-being so to speak. I don’t see that in what I read or what I know about the landscape. But it is ever more changing and I think as practitioners we look to assess people holistically and we look now to provide those targeted, personalised intervention strategies which before we weren’t able to because we didn’t have the data and the analytics or the insights that sat behind it.

[7.07:] So, I suppose rather than a physician talking to you about your financial well-being, I suppose it’s more about the fall-out of your financial well-being on your mental health, your emotional health. And that’s really where the holistic element comes in, I suppose. It’s that age-old question of ‘how are you within yourself?’ and whether your stressors are financially, um, whether they have financial origins, or whether they come from the environment in which you live, that’s something that is an area that health care assist with and support, and provide a road map into relevant support mechanisms or treatment. So from that perspective then, looking at the rise in health, in mental health conditions, that obviously is something that has been increasing in the last few years. We talked about it in our article last year, and again, is not going to go away anytime soon. I mean we are seeing the erosion of stigma in so many countries around the world. How do you see that views of emotional health and mental health have changed in the last 12 months?

So I think it’s become ever more prominent. I think it’s become more prominent because we’re starting to realise that mental health and well-being plays a part not only in affects our personal lives but also our professional lives and has an effect on our professional lives. And also that the environments that we live in now even with the COVID-19 pandemic and this new founding principle of working from home, social isolation, social distancing, has a significant impact on areas in our health that we wouldn’t have previously had, you know, when we were going about our day-to-day routines as in the world that we knew before. So I think the role of mental health is now more dispersed. In that I don’t think it’s just the health care practitioner that is looking out and evaluating a person holistically and not just on their independent symptoms. It’s not even insurers who are looking to put in place mental health and well-being propositions to help their members. It’s now the responsibility of employers to look to making sure their employees are safe, secure, have treatment options available, have services like medical evacuation, have counselling available — particularly for employees that travel the world, be it through global mobility or secondments or engagements in different geographies, and then it’s also, I think, a role in society in that there’s a rise in mental health charities and awareness. You know, it only takes an individual to go on Instagram and see that celebrities and influencers, as well call them, are promoting how do you stay mentally well, and how do you stay in that positive psychology space. And I think that’s what’s changed for me the most is that mental health has become more prominent, we’re starting to realise that it affects everyone and can affect anyone at any time. We’ve got conditions that are coming into play that have never affected society before like COVID-19 and then on top of that you’ve got this dispersed responsibility where it’s not just a health care practitioner, or a psychologist or a psychiatrist, it’s actually everyone that has to look a person, a whole person, not just independent symptoms and build solutions to help them across the continuum of their life.

 [10.45:] So looking at that environment you were just speaking about the holistic angle, I mentioned Amazon earlier as an example of the way in which we could have a connected care environment where people can log in and get hold of their, all their health data, they can have a look at their historical health records, they can be triaged and transferred into various recommendations for treatment pathways, whether that is to ward off a potential condition or to manage an existing condition. And so how do you see digital health care tech moving forward in that way, particularly bearing in mind that we are seeing a real increase in demand and a need for online and digital health care services at this point in time?

Yeah, that’s an interesting question. So, I think for me, I think one of the most positive things is — if I can say it like this — to come out of the COVID-19 pandemic, is that it has acted as a catalyst for health systems including the NHS and those across the globe to adopt technology. And several regulatory environments have shifted in recent weeks, whereby previously they would say no videos calls and we don’t really advocate telemedicine to telemedicine for all. Really promoting it, pushing it and encouraging providers to and the private entities to build telemedicine solutions. So we’ve definitely seen a catalyst in digital health technology and adoption in the last few weeks and I think that’s ever going to increase. What I think was happening prior to COVID-19, if we can look at both environments, prior and now, was two-fold. I think health systems were shifting away from high-touch, high-care, which is our traditional bricks and mortar clinics, to a more high-tech, high-care and what I call the phy-digital model, whereby with some consumers where it was appropriate and where consumers wanted and could accept it, you would take away that high-touch and you would deliver services either virtually, through the phone, through video consultation, or Skype, you know, etcetera. And it doesn’t work for everyone that solution because there are certain demographics that high-tech doesn’t work, the infrastructure in certain countries doesn’t necessarily support a digital telemedicine solution and there are certain user groups that don’t feel that, you know, a digital solution is necessarily inclusive. Although several are built on diversity and inclusive, inclusion principles. So then we had this model where we trailed at Aetna, which was around vHealth at Home, whereby we didn’t take away the touch element but we kept the high tech. So it was a high-touch, high-tech solution and we were delivering doctor and physiotherapy appointments to the consumer at home, and that really played on that convenience and access principle whereby, you know, members did not have to go, take time of work, go to waiting rooms, risk getting infections from other people in waiting rooms. They had a service at home or in their office delivered to them. It meant that they could access health care quicker — particularly around physiotherapy — they weren’t sitting on musculoskeletal health conditions for a lot longer. It was more an immediate “I’ve got backpain, let me get a physio right now” rather than let’s wait 12 weeks or 15 weeks and you know, let the problem get worse. So trialed that solution, going from a high-touch, low-tech to a high-touch, high-tech but also offering our low-touch, high-tech solution which was vHealth. And it was interesting to see what user groups were acting with which solution and to see the need for all three solutions in the market. I think now with the emersion of Google Health and Amazon in the health care space and other very large tech players, we do have the challenge of who’s responsibility and who is the guardian of health care services. And with that it’s you know, can Amazon be the panacea, whereby as you said, Lorien, the voice assistant is your access to everything. It’s your triage, it’s your information source, it’s your reassurance when you’re unwell and you know, it’s your companion in the house. Particularly, you know, in the elderly and vulnerable population. Or is it that you still need the individual players, because no one single technology is going to suffice for every single person in the population. And that, I think, is still the landscape that will evolve and we’re looking to see. But what I do think is clear is that technology is needed in health care, and health systems globally are burdened. They are at breaking point. And technology is needed particularly to help with those that are low risk and don’t need the inpatient, in-person care. And also to help with the round-the-clock care and post-discharge care and helping people not only when they are in that clinical environment in a hospital but before they get into hospital. How can you prepare someone for their operation through digital technology? How can you coach someone post-operatively to recover quicker in their home? And it’s all that, that I think we’re looking to see in the coming months and years.

[16.20:] Yeah, I mean you just touched on something really interesting there again, which brings it back to that emotional and mental health and outlook, I suppose, if you are recovering from surgery or a particular trauma in your life, having the ability to have some coaching whether it’s in the form of talk therapy, whether it’s in the form of cognitive behavioural therapy, whether it’s in the form of breathwork, to really change your mindset can have a massive impact on how quickly you recover. And so I think that’s really really interesting and again, as you pointed out, there is no one-size-fits-all. I think there is room for all of this digital innovation and there is demand for it certainly. You know, people’s behaviours and attitudes to health and health care, to those online to offline delivery mechanisms are already changing. And this has been expedited by the COVID-19 pandemic. So what, in terms of consumer, health care consumer attitudes and behaviours, what new habits and behaviours do you think will stick for people?

So I think it’s hard because we’re so early in the pandemic, a couple of weeks in, to really determine what will become a habit or not. But I was having this exact debate with a colleague the other day, in that, if your GP or primary care physician is only delivering or seeing you through a telephone, how long does it take for that to become appropriate and for you then to not want to leave the house and go see your GP? And we couldn’t really land on an actual answer there. But it’s interesting that traditional providers are now embracing, procuring and executing and launching services in the digital health space where they weren’t before. And I want to go back to that point you made about mental health, and I think you’re exactly right in that the mental health space is one that could benefit hugely from digital solutions. You remove a bit of that stigma, you provide easy access and convenience. You provide some level of anonymisation and you have support where, you know, you’re not judged. And you can access it from your desk, from your house, you can access it when no one else needs to know you’re accessing it. And that is really that personalised intervention space where we could see huge differences. You mentioned it being around the level of I’ve had care, or an operation or a procedure and I need support but actually, day to day, each one of us — you, me, anyone of us — needs guided support at any one time. And I think it’s really interesting to see some of the solutions in market right now that steer away from that clinical move into more of that consumer, you know, gamified, you can call it, space. And previously, one of the examples is that previously therapy used to be delivered in person talking to a therapist on a sofa. And now there’s so many types of therapy. There’s image therapy, which is delivered through social networks and an app called ‘Hello Tomo’, which is quite interesting. It takes Instagram to a different place, so to speak. It’s filled with positive habit forming, by sharing photos of activities you’ve done everyday with a group of people who may be feeling in low mood and struggling as well in the mental health space. You lift your own spirits. And you form great daily habits because you almost encourage each other to get into a cadence of where it’s a more healthier way of living. You’ve also got an app called Wysa, a fantastic app whereby they’ve actually said we’re going to take talking out of the therapy. It’s a text-based therapy app, and you can either interact with an AI chat bot which is hugely therapeutic because like you say, you remove that human element, you remove human touch, you don’t get judged. Or you can interact with, you know, a therapist just by texting and interestingly, it takes out that video dimension, it takes out seeing and it takes out listening. So you’re actually removing the senses but it’s been proven to be hugely effective. In that, I think one of their most powerful statistics that I’ve heard is that through just that text-based therapy and the chat bot service, I think it’s around 60 people, maybe slightly more, have written to the co-founders to say “you’ve saved my life”. Which is incredible. So I do think that the mental health space is one that can benefit from technology but also we should encourage ourselves in health care to think about not just the latest, newest, shiniest type of tech. You know, it doesn’t necessarily need to always have to be video. You can have a huge amount of impact just through voice. People listen to podcasts day in, day out. Hopefully like this one. It doesn’t necessarily have to be necessarily a health care practitioner. Who else can we use to influence and build that health care system, so to speak?

[21.37:] That’s really interesting, absolutely, and I was just thinking about, as you said, there is very much a need from somebody who is already struggling with depression or chronic anxiety and I think it’s so powerful that those people wrote to the founders of the programme and the creators of the app and I was thinking just in terms of how we’re all coping on a day-to-day basis whether you have a condition or not. You’re working from home, potentially for the first time. You are experiencing this degree of social isolation or social distancing. You know, we’re balancing our work, we’re looking after our children, and we’re then all trying to also have some form of downtime and weekends and switch-off time from home. You know, we have people who are on a day-to-day basis who are impacted, the self-employed impacted, small businesses, people we would have looked at and thought were pretty robust, are massively impacted by this situation. So it’s understandable that anxiety, stress, depression will be on the rise so I think it’s so important to have these kind of innovations in this space and it’s incredibly powerful. So how do you think that all of this will impact businesses in the next 12 months, in the way that they look after their people? What sort of offerings will come to the fore from a occupational health and wellness perspective, from a human resources perspective, to support the well-being of populations?

Yeah, I think you’re right, it will impact businesses. Firstly, I think businesses needs to take more responsibility. So, we talked about earlier how the responsibility of health care and health and well-being is being dispersed. And employers, you know, come up quite high on that list of people who take responsibility and that is from an employees’ perspective. You know, we at Aetna International have done our own research. We know that employees expect a lot more from their employers. You know, it’s not just ‘provide me with a role’ and ‘pay my salary’. It’s ‘look after me when I’m at work’, allow me that ‘flexible working, working from home’. Although I think after this stint, most people won’t want to work from home ever again. But it’s also around, you know, it’s not just a pension as a benefit. We’ve seen several employers take on board this new responsibility and action this by, you know, allow employees a personal development grant that is not restricted to academic qualifications. So I know several companies are saying here’s your personal development grant, go and pursue a passion. And that could be a language, that could be photography, that could be cooking – whatever you want to build that employee in a holistic way and allow them that, I guess, that decompression time away from the workspace. And I know that several organisations have adopted you know, running clubs, and yoga sessions in the workspace. One of the organisations I worked for had, you know, massage angels come in that would literally work on your back and neck while you were on your laptop, allowing you to de-stress and relax while delivering your work. A very interesting phenomenon. And then you’ve got wellness benefits and health plans that go one step beyond. And particularly for me, what I’m also seeing is incentivisation programs. You know we’ve got our own one with Apple and Aetna. Vitality do a similar scheme where you can track your behaviours not just in the workplace but out of the workplace and then you get a level of you know, reward, when you succeed in doing that 10,000 steps or going to the gym every day. That’s a very powerful tool that employers are using to connect with the employee, not just during worktime but also outside, influencing their behaviours out of work time, which is an interesting boundary. And then, the fourth thing is then traditionally EAP programs have been for the few. They’ve targeted those that need it, when they need it most. But it’s not been widely promoted, it’s not been encouraged to use it. And now you see the shift in EAP programs and several new providers actually seeing why not have a regular coaching session once a month with a therapist or a counsellor? And it’s not just those instances when you need it. It’s actually more of a regular habit forming, “come chat to someone because we know this is going to make a significant difference to the way you feel about your work, and your professional life and your personal life, and all aspects of your life.” And we’ve seen that shift whereby, I guess, employers are now considering their portfolio that they offer employees and ensuring that not only does it have to meet employees needs, but that it touches all those aspects. It evolves as the industry evolves.

[26.53:] Absolutely and that really helps people to form those healthy habits on a daily basis because I think that one of the biggest challenges is that individuals probably have is that you need to make time and space in your daily life, particularly if you are employed and you’re trying to navigate through a very hectic schedule. Trying to make sure have, that you prioritise your health when you might actually prefer to and spend time with your children or your family, your spouse, which is perfectly natural. So I think that having that support from the workplace to really dedicate some space and time to nurturing your sense of purpose in life, your passions, nurturing your sense of well-being, nurturing your career, really looking at that supporting individuals and helping them make healthier choices as well on a daily basis and giving them permission to do that is, I think, incredibly powerful.

[27.55] Absolutely and, sorry to jump in there, Lorien, but I also think it’s in the environment that employers create and businesses create. So you asked me the question, how will it impact businesses? It impacts businesses because they now need to think not only about their benefits packages, but also about how do I attract and keep the best talent? Is it through building a meditation studio in the office? Is it through offering sleep pods so that people who do want to nap during the day, are given that flexibility to do so knowing that and trusting them — trust is a big issue here — for them to be most productive and to know what’s best for them.  And also adapting their businesses environments. Traditionally, I think, firstly offices started off as little cabins, then it became this open plan office and now it’s, you know, questions like, is a desk actually necessary? Can I give someone a walking desk? I know at Aetna International, we’ve, in our Hartford offices, we’ve replaced a floor of desks with treadmills that allow you to work on your laptop while walking.  An interesting phenomenon. It has a massive impact on real estate space but I guess the benefit you get from your employees and their wellness and their physical health is significant to justify that. Other places have done little pedals under your desk, standing desks, of course, desks that allow you lie and sit at various angles to help with posture. It’s not just about the benefits package. It’s also about the physical environment. And then it’s, you know, how HR allows you to work flexibly that suits your needs? Because, unfortunately, the situation is such that if companies don’t mould to the individual now, the individual will find somewhere else that allows them to function at their best and moulds to their requirements. And that’s the challenge, you know, we talk about personalisation in health care but there’s also personalisation of the workspace that needs to happen as we move forward into the future.

[29.58:] So when, Nush, when we think about technology and the benefits for the consumer and helping them to really get the value out of their health care data, what are some of the biggest challenges facing the industry regarding the collection and targeted application of big data?

That’s an interesting question. I think for me, the challenges fall into three key buckets. I think the first bucket is consumers being amenable to their data — health care data — being shared, collected and utilized by the health care industry. We’re very good at giving away our data without knowing it, be it in the social media space, online, filling in forms etcetera. Somehow, though, that doesn’t necessarily always translate into health care. I think people hold health care data much more personally and in a deeper compartment than other forms of data. And what I mean by that is that you will happily accept cookies while you surf the internet because it’s a box you click and it allows you to then do what you want, look up what you want, search for what you want, post photos on Instagram, etcetera, without realising necessarily that all that data is collected, and stored, and looked at. Whereas another example of that is that you’ll quite happily have conversations at home with a little Alexa in the room as I have right now without necessarily caring whether she’s listening or not listening, or taking on board all that data. When it comes to health care data though, consumers are less amenable to allowing that data to be shared and offering that permission. One of the biggest challenges facing the health care industry is how do you collect consumer data or patient data and how to you help the patient understand the value of that data and the use cases where that data will be applied and used. So that they’re comfortable with allowing that process to occur. And there’s an area of consent in there and there’s an area of future use of that data that I think proves challenging. It’s not helped by certain, you know, breaches we’ve heard about in the press such as the Google breach. I think the second biggest challenge is on data fluidity within the health care industry on its own. And that comes from not necessarily all health systems are connected. Your GP doesn’t necessarily interact and connect fully with the hospital you visit. Your hospital doesn’t necessarily interact or connect fully with the social care that you need after your treatment. And this is where consumers start to get or feel tension or get irritated necessarily because the consumer journey becomes quite fragmented. And so health systems and the health care industry need to solve for that. People always throw about, you know, open APIs and, you know, let the data flow through systems interoperating with each other. But technologically, that’s quite difficult given that all environments operate on different types of systems and have different infrastructure. One of the new solutions that people have talked about in this space and is something that I’m hugely passionate about and is probably for entirely another podcast is blockchain or distributed ledger technology. How can that allow for that immutable trust but also the data fluidity across health systems so everywhere in the health care ecosystem has access to that patient data. And then the third challenge, I think is, who holds the responsibility of that data. If technology companies like Amazon Alexa or Google Home or your wearable devices like Apple are collecting the data, is it Apple that holds and owns and is the governor of that data, or is it health systems that then, you know, or are allowed to or should be able to access that data freely in order to make or impact health decisions. So there’s different levels there. When you’re collecting my data, day to day on my Apple watch, I’m just a consumer. But if I end up in hospital, do I want my doctor while I’m a patient — note the change from consumer, where I’m well, to patient, where I’m unwell — to have access to all that consumer data? And those are blurred lines that we haven’t really fully solved for yet. Do the technology companies own our data, and then can decide who looks at that data or is it the health care systems that should be the guardian of all the data that is collected on a holistic level? Because they’re the ones making decisions on behalf of the consumer slash patient.

[34.46:] Well it comes down to the individual who needs to be able to make an informed decision about who has access and who owns that data, and who has permission to review it and use it in which circumstances. But without that permission, without that framework, without those regulations, how can we as consumers or patients expect to have a truly personalised health care experience? I mean, um, what are your thoughts on that?

Absolutely. Without that data, you can’t really personalise that experience. You know, when you’re online and you’re on Google and you’re making purchasing decisions, you know, you see ‘Here are other products that we recommend for you.’ And 9 times out of 10, those are products that you actually want to look at. And that personalisation comes from all the back-end data they’ve collected on your use journey thus far, and your preferences. Now without having access to your health data, like I said, in your holistic sense, can we really personalise health journeys or health care treatment plans. Um, no you can’t. So you’re right. I think consumers need to be more open to their health data being shared. I think regulation needs to be stricter. I know there a lot of people who will be surprised when I say that. And what I mean by stricter is not that less data needs to be shared — Stricter understanding and definitions of who owns and who is governor and guardian of that data. And I think there’s a huge piece around education that needs to occur. Because as a patient, I’m happy to share my data if I know the impact that data could have. But what we haven’t done is educate the consumers or the patients around the real impact of that data. And what that could mean for health systems and treatments and cancer patients and the medicines that are created. That’s the critical piece to the puzzle that’s missing, that education piece. You know, you get asked that data question normally. Let me go back to one of my experiences. I recently signed up for a GP service as I moved home. Walked down to my local GP. Couldn’t do this online. Walked down, got given this form by the receptionist. Noone talked me through the form. I went through the entire form, filled it all in and at the bottom it said, ‘Are you happy for your data to be shared?’ Noone talked me through the implications of that decision. So I said, ‘Nope’, handed it in and now my data’s not going to get shared. If you spent the time to educate consumers on the impact of that decision, I suspect more people would tick ‘Yes’. And that’s the puzzle piece that’s missing. So I think you’re right. You can’t personalise without the data. It’s a Catch 22. You can’t get the data without explaining to the individual why you need the data and then you have to have the right legislation and regulatory definitions in place so that users feel comfortable knowing how that data is used, but also who owns that data. I personally think it’s the consumer at the end of the day that should retain ownership. Again, blockchain can help these type of questions. In that you know, you can consent for data sharing on blockchain and DLT — distributed ledger technology — which underpins blockchain can be easily used to set permissions, allow the transfer of data and still the consumer retains control. 

[38.10] Yeah, a lot of work still to be done in this area and thinking about the application as well from a home, self-care perspective. If you’re managing a condition for example, there’s a lot of technology that will enable you to check your blood sugar levels at home, but also a lot more in the space that is even more sophisticated than that. I mean how are you seeing transformation taking place in home health care devices?  

So you’re right. There are, the ecosystem of connected care of connected homes is growing. I recently had the opportunity to visit South Korea and I visited the Samsung Innovation Lab, while I was there, flagship store where they showed you exactly what a connected home could look like. What I mean by connected care is that it allows elderly or vulnerable individuals to care for themselves. At high level, you’ve got, you know, a mirror that can detect your retina and look if you’ve got early stages of retinal disease for example. A mirror that can detect the pallor of your cheeks, make sure you’re well perfused. Look at you in terms of body temperature and how well you are and how you look. You’ve got devices like your Amazon Alexa that can connect and give you reminders to take your medications. Can interact with your TV so it can actually dial in a doctor or a physician or a health care practitioner through your TV. And you know you then have your telemedicine consultation, not on your phone but through your TV. You’ve got sensors on the sofa, so that if two elderly people were sat on the sofa and they fell off the sofa, it would trigger a falls reaction. You’ve got wireless scales weighing scales, to your point, you know, you take your blood sugar wirelessly. That goes into a data bank. You stand on the weighing scales and that tells you if you’re a little bit overweight. If your diabetes, if you’re affected by that condition, is out of control. Um, all sorts and all of this is connected through wireless — be it 5G or 4G or maybe 7, 8G wherever we get to, um, solution. And that’s fantastic because like I say, you collect all that holistic data and you know about the individual in their day-to-day functioning and not just when they’re very unwell in your clinic. The challenge there again is who owns that data? If all those technology pieces and devices are owned by or created and developed by a different company. So your TV might be, I don’t know, Sony, your Amazon Alexa and then you’ve got Google Home for your sensors. And you’ve got the mirror by Samsung, for example. Just examples here. Who owns and collates and looks at and draws insights from all that data? Because right now, all those different data banks sit in different companies. And how do you get that data fluidity to really deliver that holistic home care experience? And those are challenges that haven’t been solved for yet. You have partnerships being put in place. Interesting partnerships. Ones that you probably wouldn’t have imagined, coming to fruition, but those partnerships aren’t strong enough yet. And I think we need to take a hold of, you know, if we are going to build these personalised ecosystems, in health care that look at a person when they’re unwell, when they’re well, throughout their life, and use all of that data to make health care decisions, then that data all needs to sit in one place. And the end-user or the practitioner at the end, needs to have access to that data. And not only access to volumes and volumes and volumes of data, but someone needs to analyse that data and add a level of insight that is applicable and relevant and appropriate to you know, the health care practitioner at the end, as we touched on.  Data solutions and analytics are fantastic, but if they don’t have meaningful insight and that meaningful insight isn’t provided to the health care practitioner, in a way that is insightful and but also understandable and doesn’t impede their daily workflow, you then have challenges of adoption on using that insight. So it’s a very complex, complicated system but huge amounts of opportunity in that connected care ecosystem to grab loads of data and it’s just how you then allow that data to flow, and be utilised.

[42.00:] Looking at the technology piece and really having conversations around — again — the opportunities in the future in terms of um, let’s say artificial intelligence. We’ve talked in the past you and I Nush, about the health care pyramid. You know from a population health perspective, which is one of your areas of expertise, So looking at how you keep people in the lowest part of the pyramid in that low cost bucket versus people with very chronic conditions at the top of the pyramid. So, really looking at the role of technology in health care, how do you see this pyramid starting to shift? How do we look at empowering people to maintain their health and keep them out of the risk categories of that pyramid?

You’re right, Lorien, we have talked about that. So, for those that are listening, the pyramid is such that at the bottom of the pyramid are those that are really fit, well and healthy and probably access health care services, you know, once in a year, um maybe just do their annual health check. They constitute around 50% of the population. The middle section of the population is those that have chronic conditions, either minor or major. And they are people who maybe have more instances of where they interact with health care. They might interact with broader than just their primary care physician. Um, you know, they might interact with specialist services, be it endocrinology, neurology. And then the top part of the pyramid, if we ignore the actual tip, which is about the one percent that are terminal, and the top part of the pyramid are people who major chronic disease sufferers, who might though poor management or other reasons end up in a hospital-based acute care environment once or several times in a year. So they’re the ones that need, you know, much more intensity of care. And you asked me how we manage them. So I think technology has a role to play across the entire pyramid. And I think more and more we are seeing that view of elderly people don’t use technology hugely challenged, and indeed elderly people being ever increasing in their adoption of new technology — be it, you know, Alexas in the home or Google Homes, to digital health apps and video consultation. So I think technology has a role to play across the entire pyramid and I say that for three reasons. We know that individuals want and seek providers that offer digital. More now than ever. That was in a recent Accenture report. It is for that booking, that scheduling, understanding of and accessing their own health records, medicines delivery services are ever more increasing, where people want to preorder or order medicines. Kind of like the Uber Eats for pharmacy. And people just want that connectivity and that convenience that technology brings. Rather than sit on a phone line and hold on and listen to a voice recorded message. If I can just log on to an app, and book or reschedule my appointment, how much more easier and convenient is it, you know, for me as an individual. So technology can play that role across the entire spectrum, offering digital capabilities so that people feel more involved in their health care. That it’s not an appointment sent to you, it’s an appointment you have chosen at a time that works for you, so to speak. I also think there’s a bigger role for technology at the bottom of the pyramid, in empowering people, using your words, Lorien, to look after their health, be it wearables or a digital health app, that encourages steps, or reminders, email reminders, whatever it is. The phenomenon of nudge behaviour to encourage positive healthy habit forming is huge. And what we can do in that healthy group to keep them healthy is encourage them to do their annual health checks, so they know proactively about conditions and their risk factors. Encourage them to do their 10,000 steps so they can reduce their cardiovascular risk. You know, encourage them to eat healthier foods so they lower their BMI and don’t necessarily render themselves susceptible to developing type 2 diabetes, for example. And that’s where you can help the lowest group. Through nudge behaviour, with that nudging coming from wearable technology, or a ring’s encouraging sleep or voice assistance in the house, digital health apps, prompts etc. You’ve got the middle group, which is slightly more challenging. Technology can help them, as well, in terms of behaviour change. It can also help them in terms of feeling that they have round-the-clock support. So there’s several type 2 diabetes apps, that provide a coach, and videos and webinars, and sessions that you can do in your home that then have a positive impact on your health outcome. And means that when you do go to see your specialist, they have access to all your results and your charts and they can see that you’ve made improvement because you’ve had a coach encouraging you to eat healthy outside of the clinic, so to speak. So I think technology can help them. And then you asked me about artificial intelligence. I think artificial intelligence critically or as I like to call it, augmented intelligence, because I think in health care, we’re at the place where we still need the human involved. It’s not fully machine driven and therefore not fully artificial. But that phenomenon of robotic process automation and augmented intelligence can really help the entire pyramid. And it helps the entire pyramid in terms of their access to health care. For example, if we can radiology scans read quicker so that those that are normal are filtered out at a quicker rate, and only those that flag on an AI solution will be looked at and deciphered by a human. Then think about the turnaround times in terms of you’re A&E visit, your imaging, your CT scans that you require either for a head injury or for query cancer. That’s a huge significant change to everyone on that pyramid for when they access health care. You’ve also got pathology services. Again, there’s a huge shortage of pathologists nearly globally, I think. Governments want to reach and achieve the 18-week cancer wait times but if you have a specimen taken from you and it’s not analysed for 16 weeks, you’re right up at the end of it, so to speak. So how can we automate pathology so that the slides are read by a machine, the machine detects abnormalities. Certain abnormalities the machine learns how to deal with it and produce a report but you know, the ones that are exceptions — as there always will be in health care — a human then goes and checks and reads. And the human overseas the entire process as well and the design of the machine-learning algorithms and the technology. Massive, massive impact to again everyone in that population health pyramid. And if you think about screening quicker, shorter waiting times, more convenience, better access, a better user journey. All of that fundamentally will affect the consumer of health care services, and provide a better experience that in the end improves their health outcomes. And not just again, from the objective, you got your health results quicker and you can get treatment quicker, but also psychologically. We’ve talked a lot about mental health on this podcast. Psychologically, if I’m waiting shorter times and my experience is less stressful and it’s less time away from work, away from my family, to get the decisions I need in health has a massive impact you know, not only on my mental health but also thinking about the six phases of well-being, or dimensions of well-being, you know my financial health. Because if I’m taking half the time off work to get my results and get to a better health care decision. That’s great for my income. And that’s great for my physical, mental and financial health. So I think that’s where the opportunity really is. Across the pyramid you have technology like AI that can really improve the experience for all. And then at each level you have solutions that can interject on that health care continuum and help to keep them in the bucket that they’re in, so they don’t, as you say, go up the pyramid.

[51.41] I mean you’ve mentioned so many interesting things that I wanted to pick out in your talk just now, in your response. Particularly, can we come back to how you use the health care workforce effectively. Because as you’ve said, the rise of technology, the capabilities that we have, how do you retain the importance of those health care practitioners? What role do they play in a future scenario? We started to touch on that, but how do you also ensure that health care workers are operating at the top of their skill set? And what does that future look like? Could you talk me through that from your understanding and expertise?         

Yeah, sure. So I think the first thing with technology is that there’s lots of it and no one ever wants to use it until they’re made to use it. I think the challenge with using technology in health care is two fold. One: you need to have the right culture, the right environment, the right infrastructure for that technology to work. Trust is a huge part in health care. And you know, if you adopt a new technology and you force all your physicians and your health care staff to use it, and it goes down, you almost lose that adoption. So you have to have the right infrastructure, culture and environment. And how you build that is through firstly investment in the infrastructure but also through appropriate integration in the solutions at the right point in a workflow. They always say if you don’t embed something into a physician’s workflow, they’ll never come to it and that is true. And I think one of the critical things is user-centric design. It’s not good enough anymore for software developers or designers, or UX people to sit in isolation and build solutions for health care. Solutions for health care need to be built with the end user in mind. And the environment in mind. And you almost have to sit, side by side, with who that is be that a health care physician or practitioner. And work out what works for them. And build the solutions collaboratively. Several organisations have adopted this and succeeded in getting their technology embedded in health systems. I think that’s the first thing. You know, that environment, culture, space, is critical and the second thing around technology is that it needs to be shown to create a positive impact. And to your point, it’s not about replacing physicians or health care practitioners. It is about allowing them to operate at that top of the licence space.  And it’s not good enough anymore to say, well we do this in this sector and therefore it works in health care. For me, it’s about finding out what’s important to those health care practitioners. You can’t given them a 15-page data analytics report because they firstly may not have the skill set to interpret that. That’s not something I was taught at medical school. So firstly, how do you build workflows that allow them to operate at the top of their licence but they still feel they have the support beneath them — be it in technology, or otherwise. And that’s the challenge I think a lot of businesses in this space are facing. There’s great technology, but how do you drive that adoption of that technology? I think for me it’s about impact. So if you were working in one of my clinics and you gave me an insights report that said, well, here’s your 100 people that you’re seeing in your clinic today. And these 10 people we have analysed with multi-dimensional analysis, and we know that you can these 10 people are low risk and therefore you can afford to spend 5 minutes with them. These 20 people we’ve put in the middle of your clinic are medium risk, and you need to spend 20 minutes with them and here are the tools you can use to facilitate that process. Be it point of care decision tools or analysis tools or information tools whatever they can be. And then here’s the 10 people at the end of your clinic that you need to spend 30 minutes with. That’s hugely impactful to a physician. And what I’m getting at is that model of risk stratification and segmentation that you can allow and use to adopt how you then flex your physician versus technology time. And those low risk have been proven to utilise and be effective for digital solutions. But also those high risk, you can reduce their risk by implementing digital, round-the-clock solutions. So it’s how you balance that risk algorithm with when and how you use technology.

[56.18:] Well that future scenario is probably going be closer to today or feel closer because of the current pandemic crisis and the amount of innovation. They say necessity is the mother of innovation, don’t they. So I should imagine we’ll see a lot of these scenarios really coming to fruition much more quickly than perhaps we might have originally anticipated.

Absolutely, and I’m sorry to interject there, Lorien. I also don’t think the technology is only useful in a patient-facing angle. The example I gave was around patient-facing, and you know risk-stratifying patients in order to then allocate resource effectively and use technology where resource is scarce or not required necessarily is fascinating. But technology is also useful in the back end of a health system. And you’ve raised that point, how are we using technology to know whether we have enough ventilators in the supply chain, or know whether we have enough personal protection equipment in the supply chain. How do we use technology to get those pieces of information dispersed across the health system so they can collaborate and reallocate supplies as necessary? How do we use technology to schedule appointments effectively? Does everyone need an appointment the next day? Not really. How do we have triage tools that say ‘you don’t seem that unwell to me, so I’m going to give you an appointment in five days to free up the urgent appointments for those that are most in need and most at risk. And if anything changes we have the safety net of ‘you call us back’. And the critical thing with technology is that you’ve got to still ensure that you have the right safety netting. And you’re still delivering the right high quality, you know, high safety care that people need. And it’s very different to environments like retail where you don’t necessarily mind so much about quality and you don’t need safety. In health care, the challenge is that you do still have a person at the end of it, and you don’t want to jeopardise that life of that person. But I think technology, to my point, has a great use in the front end, but what we’re seeing right now is actually the technological solutions that are coming to market and, as you say, accelerating, given the current pandemic. Several of those are actually in the back-end and facilitating quicker turnaround times and better supply, better working environments for those health care practitioners.

[58.59:] And you’ve mentioned obviously from a health care worker perspective and a back-end perspective, but also from a health care consumer perspective. Looking at technological advances in science as well and genetics, and the rise in genetic testing that can be done on all sorts of levels. But putting a report in the hands of an individual. You know, if I were to take myself as an example, if I were to have a report that I could download that would talk to me about my sleep, the optimal levels of exercise, and the best nutrition for me, unless that was interpreted and unless I was given a clear pathway as to actions I could take, that’s not necessarily going to resonate with me. So again, looking at how technology can be used to support the consumer in that way, and, again, coming back to augmented intelligence, do you need to have a human being supporting you through that pathway or again, can we rely on technology to support that next step in your journey towards better health?

I think we can rely on technology. And, you know, certain industries flipped from that front-facing customer service model to humans just relying on dashboards on their phone. The one that comes to mind, most prominently, is the rise of the challenger banks. Traditional banks have just become, let me sign up for a bank account on my phone, whereas it used to take hours and I would have to go in person, sign a form and personal ID. Now I can sign up for a new bank account, be it Monzo, Starling or Revolut in three minutes I think, is the record. You get your card shipped to you, you don’t have to interact with a human at all, in setting up that bank account. But also you don’t have to interact with a human at all to utilise that bank account. I look at my bank account, my challenger bank, being Revolut, Starling or Monzo, and it tells me where I’m spending my money, how I’m spending, how much money I have. It has a tool that predicts how much money I’ll need in my bank account for next month. It informs me or prompts me if I’ll have an extra 20 quid this month. Do I want to invest it, do I want to give it to charity, do you want to save it? It also says this month, you’re running a little bit low so that you can consider putting a bar on your account so you’re not spending 500 quid when you go out, you’re only spending 50. Or consider, you know, sometimes what I do is I move it bank to bank. So when I go out, I only use my Monzo. I put £50 in it. I know I’ll only spend £50 that night. And I don’t take my bank cards. And none of these processes involve a human. I can move my money between my accounts without talking or texting or visiting a bank and speaking to a human. Could health care get to that level? I think we’d struggle, but I think there are certain apps out there for example a fantastic company ‘Thriva’ or ‘Thriva’.  You can do your annual health check, you get a dashboard of results on your phone and if you want to speak to a human about your results, you can. But if not, they make some personal recommendations for you, they signpost you to the right services to make those health care decisions on your own. And they actually prompt you then six months later to say do you want to have another repeat blood test? And through this entire process again, you’re not necessarily interacting with a human because you get sent the kit, you do the blood test, you post the kit back, you download the app, you get your results on your app. People do make health care decisions based on, like you mentioned, your genetic data, your DNA, tests you do once a year — or sorry, once in a lifetime I should say — but a blood test that looks at your cholesterol levels, your thyroid function, your blood sugar you probably want to do more regularly. So you have your first layer, which is your DNA data, and then you have these regular health checks that you do you yourself. And this all empowers you on your health care journey. So we’re not at the space where we’re fully digital because for catastrophic events and acute events you probably want to see a doctor and need to see a doctor or a health care practitioner. But there are several areas of health, going back to the six dimensions of well-being, like financial health, like emotional health, like physical health where you can track it and potentially own your own journey without needing human touch.

[1.03:] Yeah, and again, I think that’s an incredibly powerful way to take this forward. So we’ve got time for one last question I think, but rather than me asking you a specific question. I was just wondering if you wanted to reflect back on anything, everything that we’ve talked about today. And is there anything that you would like to mention in a closing remark in terms of you know, how or what the future looks like?

That’s a big challenge, Lorien. So I think, let me start by saying, I think the future’s very bright for health care. If you’d asked me three or four weeks ago, it’s would have said it’s bright. But the recent health care pandemic has shown that consumers, health care practitioners, regulators, and governments are able, willing and hopefully will continue to change alongside that digital landscape that we’ve spoken about. And that can only mean one thing. Better health outcomes, more precision interventions and a better consumer experience for all — or a better experience for all — patients and physicians alike. So I think that my reflections that out of every bad, you have a little bit of good. And the little bit of good that’s come out of COVID-19 is that community in the health care ecosystem has formed. And because they’re all working to one goal, it’s accelerated, you know, the adoption of digital health. I think there are certain areas that will benefit more than others. I think it’s hard right now to see them accelerating pharmaceuticals to a level when it’s you know, the next day. But I think that historically it would have taken a decade to develop a vaccine. And we’re hoping to get this within a year. That has definitely changed. And I think, for me, that regulatory aspect of health care needs to still be robust, so I’m okay and confident that although we’ve accelerated areas right now, to bring devices to market, that we might not stay at that speed or that level once we return to normal or return to life as normal as we know it. And that regulatory decision making or that process might go down to half of what it was rather than 10 percent of what it was. And I’m okay and comfortable with that, but what I want to say is despite everything being in an accelerator right now, the consumer is still at the heart of everything that health care is doing and the direction of travel. And that holistic well-being is such an important factor.

[1.06:] Well, for such an open-ended question, you handled that absolutely beautifully. And so for anybody who’s listening if you have any thoughts or comments or questions on today’s podcast, you can absolutely get in touch with us via LinkedIn and we cover those off in future sessions. So all it remains for me to say is, Dr Anushka Patchava, thank you ever so much for your time today. It’s been an absolute pleasure. Take care.

Great speaking to you, Lorien, bye-bye.

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