Think “ecosystem” over “enterprise” – healthcare in the age of patient centricity

Health sciences organizations need to recognize key opportunities and areas of synergy to thrive in a more collaborative and value-based health sciences ecosystem.

The health sciences industry is still largely viewed as segmented markets: healthcare (payers and providers) and life sciences (biopharmaceutical organizations and medical technology businesses, or medtech). Increasingly, however, these traditionally disconnected market segments are blurring, and a more synergistic health sciences ecosystem is emerging.

Several pressures have converged to drive this change, including rising economic burden, an increasing number of regulatory mandates, evolving patient expectations and emerging technologies. All of these factors are combining to form a new competitive landscape—one based on achieving better health outcomes, optimizing costs and creating new models of delivering care.

But competing in this landscape requires new levels of collaboration. Payers are buying providers, while providers are launching health plans. Pharmaceutical companies are seeking to create technology products and platforms to support their clinical development pipelines. Other health systems are even branching out into manufacturing to better support and vertically integrate device and drug research, development and commercial care offerings.

In short, healthcare and life sciences companies are shifting their focus away from siloed industry specializations. They’re recognizing a need to consolidate and remove friction from not only their own enterprise but also the larger care ecosystem. No longer content to provide patient care in a vacuum, they’re instead seeking new ways to improve overall patient outcomes and experiences while optimizing costs.

By controlling more of the patient experience, the thinking goes, you can provide better outcomes and capture more of the revenue opportunity that exists in the broader healthcare marketplace. In practice, this requires cross-industry collaboration and greater data sharing to remove the bottlenecks that could impede a more unified, cost-effective care solution that meets growing patient demands.

The question now is how. It’s one thing to decide to move to a patient-centered care model that has clear value to unlock. It’s another to move to that model when it has no gold standard and remains largely open to interpretation.

What health sciences organizations can do, however, is get started on recognizing where the opportunities lie and how they can turn those opportunities into a more synergistic and collaborative way of delivering healthcare.

Areas of opportunity for the new health sciences ecosystem

A fundamental shift in this new environment is data exchange. Though the current practice of exchanging data is to maintain many-to-many relationships, leaders will need to refocus their energy into more of a one-to-many data exchange. Doing so will allow for new process efficiencies and further business opportunities.

Here are three areas of opportunity that health sciences organizations can build on:

1. Identify how data and money flows across the patient journey
   
   There are several touchpoints between patients, healthcare payers, providers and life sciences organizations across the patient journey. By evaluating the data and money flows across these entities, organizations can discover new ways to optimize patient outcomes.
   
   For instance, while pharmaceutical companies, providers and payers all track patients’ drug adherence and treatment plans, the data for each stakeholder is segmented and siloed. At least three sets of duplicated information move through separate processes that all share a similar desired outcome. Imagine how much more dynamic the patient experience could be if everyone had access to and understood where the data and money was flowing.
   
   
2. Be alert to market signals and trends
   
   Healthcare organizations are adapting their strategies and business processes to simplify the patient experience. You can use market signals from these changes to identify successful business models of the future and learn how to prepare for change.
   
   For example, life sciences organizations are looking for opportunities to integrate into hospitals’ electronic medical records systems (EMRs) to obtain relevant patient data to accelerate the development of new therapies. Watching successful moves in the market can indicate where your company should—and shouldn’t—research opportunities for further partnerships and collaborations.
   
   
3. Get familiar with emerging technologies
   
   When used ethically, AI can provide opportunities for more collaboration between healthcare entities, driving change more quickly. AI and generative AI, for example, can predict the binding affinity and potential side effects of drug candidates with their intended targets.
   
   By accessing patient data and forging new collaborations, pharma companies and providers could predict drug-target interactions to accelerate new drug development and enhance patient outcomes. If the future is in value-based care, what better way to provide value than to more quickly find treatments that will help those who need it most?

Turn opportunity into synergy in a converged health sciences ecosystem

With greater collaboration and data sharing, health sciences will be better equipped to cross-sell and upsell current solutions, as well as to develop and commercialize new offers tailored to market needs.

Optum provides a good illustration of this. The US-based health services company has acquired at least 20 health providers in the last 2 years, which gives it access to additional data to fine-tune its care services and provide care and pharmacy services to patients.

In addition, Optum is a subsidiary of health insurer UnitedHealth Group, which means it can also act as a payer for its own providers. Being involved in all aspects of the care process, in theory, empowers the organization to deliver a patient-centric experience.

Additional examples of this kind of synergy abound. Here are three areas that stand out in the marketplace:

1. Care management: Anytime, anywhere care

Care management is a patient-centric approach to providing coordinated care. When combined with digital approaches like remote patient monitoring and digital therapeutics, health organizations can increase convenience and accessibility throughout the patient journey.

With more collaboration and data exchange, health organizations can work together to:

• Remotely monitor patient health
• Ensure medication adherence
• Develop a platform for digital therapeutics, consulting and administration
• Facilitate health and wellness through education and lifestyle management
• Leverage a 360-degree patient view to transform patient services via a virtual platform

2. Personalized care: Accelerating therapy and drug discovery

Accelerating the development and delivery of drug therapies requires collaboration between payers, providers and manufacturers, as well as advanced technology and real-world data for trial operations. This work allows therapy research and development to be more inclusive of patient needs and experiences.

Health sciences organizations can work together to:

• Transform the experience for clinical trial participants and research
• Facilitate decentralized trials
• Utilize analytics to optimize patient recruitment and trial site geo-selection

3. Value-based outcomes: A new business model

Value-based models incentivize stakeholders through measurable, real-world patient outcomes. Moving to a value-based model allows for more personalized care and provider accountability, which in turn, creates an improved patient experience.

With ecosystem collaboration, organizations can:

• Derive insights from population health and social determinants of health (SDOH) data
• Create analytics solutions for health economics and outcomes research, real-world evidence and real-world data
• Simplify patient access and reimbursement
• Streamline revenue cycle management processes
• Develop formulary and contracting strategies

Creating a new health sciences ecosystem for healthcare and life sciences

Convergence between healthcare and life sciences businesses is happening now. We recently worked with a medical technology company that offers a heart failure device to improve patient outcomes via remote monitoring and proactive adjustment of care. We developed a provider portal to encourage further engagement between providers and the care team. By automating patient engagement processes and enabling access to real-time data, the medtech firm can offer better patient care and more meaningful engagement.

The medtech firm now also offers an app that connects to wearables and EMRs via the cloud. Patients no longer need to relay data to their provider, and providers can use real-time data to optimize care for their patients.

Health sciences organizations can use these opportunities and areas of synergy to plan and guide their strategies, business models, expansion and scaling opportunities to successfully compete in the health sciences ecosystem of the future.