Our research team breaks down this week’s top healthcare news.
In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.
This month an Urban Institute study showed Black patients were significantly less likely to be admitted to hospitals with safety ratings higher than the median. On one example safety metric reported, Black patients were more than 40 percent less likely to receive care at a hospital that was effective at preventing perioperative pulmonary embolisms than white patients. Receiving lower quality care also led to worse outcomes. Nearly five Black patients per 1,000 contracted sepsis after operations, double the rate of white post-operative cases. The same study also found more than 10 percent of Black Americans report being discriminated against by clinical staff in the last 12 months during a healthcare visit, compared to less than 4 percent of white patients.
Also reported this month, from 2019 to 2020, hate crimes against Asians and Pacific Islanders in the United States doubled. While an anti-Asian bias previously existed in the U.S., the pandemic has heightened it. Organizations like the American Medical Association have stated that racism is a public health crisis because of its impacts on the health of marginalized groups. There is a long history of scapegoating specific populations during epidemics. In both San Francisco and Honolulu during previous plague outbreaks, Chinatown in those cities experienced forceful and racially segregated quarantines. During COVID-19, this harmful, inappropriate ascribing of fault to not only Chinese Americans and immigrants but also to many of Asian and Pacific Islander descent has continued even as the epicenter of the virus shifted many times, including to the U.S.
The impact on health equity has been significant, though sometimes difficult to see when data is aggregated across all Asian American and Pacific Islanders (AAPI). Aggregated COVID outcomes for the AAPI community look similar to the white community, but when examining subgroups, we see that populations like Filipino, Vietnamese, and Pacific Islanders have significantly worse outcomes. And although there are differences in disease outcomes based on subgroup, the impact of racism on health is broad and far-reaching across Asian Americans and includes rise in crimes against AAPI persons, loss of business, and the mental and physical impacts that accompany fear of attacks, including missing work or avoidance of healthcare in an attempt to protect themselves by staying at home.
Addressing disparities requires accountability, and an understanding of and willingness to work through the complex issues at play. During COVID, Tuskegee has been an oft-cited reason for Black hesitance to receive the vaccine, despite Black Americans rarely mentioning this when asked. This takes the focus off problems like inability of the Black population to access the vaccine, safety concerns based on the tested population of the vaccine, or addressing recent, lived experiences of bias in healthcare.
Patients often go to the nearest care facility, and as the Urban Institute study indicated, the highest quality facilities are often in neighborhoods with populations that are predominantly white. Many Black Americans want the vaccine but have been unable to access it even when vaccine sites were in local neighborhoods as other populations were quickly booking appointments as they became available.
A study to examine Black Americans’ interest in participation in medical research over 14 years found that while Black Americans were more cautious about involvement, they were equally likely to participate when asked. But they are not being asked. An analysis on two trial enrollments for cardiovascular disease saw more than 2,000 white people enrolled with 30 non-white participants. Wariness is difficult to address when it is falsely attributed to a lack of willingness to participate; instead, it requires effort to overcome through inclusion in clinical trials, medical education, and access to care.
Connection of a disease to a location of origin should not be misconstrued to imply people from that geography cause or spread the disease. Applying disease naming conventions that are geographically agnostic can help prevent this. Prevention also requires education to stop racial and cultural stereotypes from emerging and leading to oppression, as Asian American and Pacific Islanders have faced during COVID. Improving health disparities will take awareness of differences in outcomes between disparate groups within the AAPI population so appropriate communities can be allocated necessary resources. Roderick McGrew in his study on cholera noted, “Epidemics do not create abnormal situations, but rather sharpen existing behavior which ‘betray deeply rooted and continuing social imbalances.’” Disasters, while often thought of as unifying people, can often have the opposite effect on marginalized communities.
Microsoft announced this week it would acquire Nuance Communications (Nuance) for almost $20 billion, further advancing the company in the healthcare industry after launching its Microsoft Cloud for Healthcare product just last year. Nuance uses artificial intelligence-powered speech recognition technology and interactive voice response, allowing healthcare providers to do direct medical transcription, reducing time spent on administrative tasks and increasing time for direct patient care. Nuance claims that 77 percent of U.S. hospitals use its technology, and with this acquisition, Microsoft CEO Satya Nadella claimed on CNBC on Monday that it will double the company’s addressable market in the healthcare provider space to $500 billion.
Several big tech companies like Microsoft, including Apple, Amazon, and Alphabet (Google), have made substantial moves into healthcare in the past several years, including large investments, acquisitions, and partnerships. Each has approached healthcare from a slightly different angle, playing to its strengths. For example, Amazon’s extensive, established distribution channels led to its acquisition of PillPack in 2019, a direct-delivery prescription service. One area in which the three giants Microsoft, Amazon, and Google compete is in the cloud space. Some market analysts believe Microsoft’s acquisition of Nuance following its healthcare-specific cloud launch is in part to help grow its market share in the competitive cloud space.
Not all big tech moves into healthcare have been successful, however. As was featured in last week’s Chartis Top Reads, International Business Machines (IBM) is exploring the sale of its Watson Health business after the technology couldn’t live up to its promised ability to identify cancers and recommend treatments that would lead to better patient outcomes. Amazon’s 2018 venture with JPMorgan Chase and Berkshire Hathaway, dubbed “Haven,” aspired to lower healthcare costs — no small feat — but after three years with little tangible output or impact, as well as the loss of CEO Atul Gawande, the venture was ended in early 2021.
With big tech’s many forays into healthcare, not all will be successful. Healthcare appears to be an attractive opportunity for disruption — it “is a paper-based, manual, terrible industry riddled with inefficiency,” as one Jeffries analyst explained in a Wall Street Journal article this week. However, healthcare is also incredibly complex and a potential minefield for businesses that are not familiar with the practice of medicine, the many stakeholders involved, extensive regulation, and other dynamics at play. Many new entrants that have had success have chosen a very small and inefficient part of healthcare on which to focus, such as the time-consuming medical transcription process that Nuance sought to make efficient, suggesting that perhaps broad-reaching ventures like Haven and its vision to lower the total cost of care overall may be taking on too much to succeed.
Despite the ventures and projects that don’t pan out, big tech appears to continue to march forward into healthcare. Amazon’s closure of Haven was quickly followed by an announcement that it will offer national telehealth services and is launching Moving Health Home — a hospital-at-home service in partnership with Amwell, Intermountain Healthcare, University of Pittsburgh Medical Center, and Advocate Aurora Health, among others — likely fueled by the need to keep care at home during the pandemic, now translated into a growing consumer preference for home care.
Healthcare providers have been watching big tech’s move into healthcare warily for years, but these potential disruptors haven’t yet taken significant business away from traditional providers. In addition, given the complexity of healthcare it may be difficult for them to do so broadly. However, with deep pockets and an industry ripe for disruption, it is likely that the tech giants will continue to try.
How can healthcare providers mitigate the impact on their own businesses? Competing head-to-head will be difficult as these tech companies have deep pockets, giant distribution channels, and advanced technological expertise — and they can evidently afford to make mistakes as big as Haven. Instead, finding ways to partner with the tech giants — as is the case with Amazon’s new hospital-at-home service that is attracting healthcare provider partners — may be a more sustainable path. In addition, healthcare providers will need to differentiate themselves more than ever. The increasing number of healthcare options means legacy providers will need to focus more on consumer experience, and elements of the practice of medicine and provision of healthcare that cannot be so easily replaced with tech solutions.
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