In September, Michael W. Ferro, Jr., a healthcare tech entrepreneur who is founder and CEO of the Miami-based Merrick Ventures, and Robin Farmanfarmaian, a professional speaker and entrepreneur who focuses on technology in healthcare, pharmaceuticals, medical devices, and digital health areas, published a new book, entitled How Artificial Intelligence Can Democratize Healthcare. The book covers a number of issues, as indicated by chapter titles that include “Data, HIPAA & the FDA,” “Digital Therapeutics Overview,” “Who Pays for Artificial Intelligence Enabled Software in U.S. Healthcare?” “Remote Patient Monitoring,” “AI Voice Technology,” and “XR: Extended Reality in Healthcare,” Democratizing Digital Health,” and “The Shift in in Healthcare Delivery.” The authors delve into a very wide range of innovations being produced by a very wide range of organizations and individuals, concluding that there is a world of potential in AI, potential that can and should be explored over time.
In the chapter “The Shift in Healthcare Delivery,” Ferro and Farmanfarmaian write that “There are many trends happening in the U.S. shifting delivery to the patient’s home environment. While many of these trends are government, payer, and major retail pharmacy trends that are not driven by AI like the previous examples, it is important to understand what these major entities are doing in the U.S. in order to have a clear picture of the artificial intelligence component. Those who control the flow of money control the power.” Further, they note, “In healthcare, the major payers have significant influence over healthcare delivery: CMS, UnitedHealthcare/Optum, CVS/Aetna, Humana, Anthem, Cigna, Kaiser Permanente, and the VA (Veteran’s Affairs) are eight of the biggest payer influencers, though of course there are many more. All eight of these giant entities have been making a push for aspects of healthcare to shift from the hospital or clinic to the patient’s home or nearest retail pharmacy clinic. The major commercial payers are also starting to control the actual healthcare delivery by owning provider networks and companies. In April of 2021, Humana spent $5.7B to buy the remaining stake in Kindred at Home, a home healthcare company Humana had bought a 40% stake in a few years ago. Kindred at Home helps over 500,000 patients a year in-home with nurses, physical therapists, and other medical professionals when a physician determines the patient is home-bound. A couple of months after that acquisition, Humana announced they were acquiring One Homecare Solutions (onehome) for an undisclosed amount.” Later in that section, the authors note that “The great news is that with in-home care, while the (e.g.) nurse is in the patient’s home, s/he can check to make sure there is enough healthy food and identify potential pitfalls in the living environment, such as a rug or other obstacle that could result in tripping and falling. This is especially important for Humana’s enrollees, many of whom are over 65 years old and covered by Medicare Advantage. This is a win-win situation for both the patient and the payer. The patient gets better care that is more comprehensive and allows them to stay at home, which is a very big deal for people too sick, disabled, or elderly to easily be transported to a clinic. The insurance company is able to deliver less expensive care that can be more frequent, cover and investigate more things, and spend more time than the standard doctor appointment of 7-20 minutes. By meeting the patient where they are in-home, the insurer-provider may catch more medical problems at the earlier stages, when they can be easier and less expensive to treat.” And, they note, “By providing at-home care, Humana and many other companies are helping democratize healthcare to underserved communities.”
Per all this, Healthcare Innovation Editor-in-Chief Mark Hagland recently interviewed Robin Farmanfarmaian, to get her perspective on where artificial intelligence is headed, and how indeed, its adoption might help to democratize and improve healthcare delivery. Below are excerpts from that interview.
Let’s begin by having you share your connection to the world of AI innovation?
I have worked with over 20 early-stage startup companies, everything from one working on curing cancer, to others working on diabetes, asthma inhalers. I’m also a severe chronic disease patient. I was misdiagnosed with an autoimmune disease at 16, and ended up having several organs removed. Crohn’s disease. So when I finally got diagnosed correctly… I chose to pay it forward.
What has been involved in working with some of the start-ups and other companies?
Yes, I do writing, thought leadership, business development, and sales. I’m a money girl. Which is how I can jump around between AI, virtual reality, cancer work, etc.
Given everything that you and Michael Ferro have written about in your book, what’s your overall perspective on the potential of AI in healthcare?
One of the amazing things is being able to do the predictive analytics. Epic already has a sepsis AI engine in their software. Alacrity Care does remote patient monitoring for cancer patients. They can diagnosis and predict sepsis, cytokine storm, and neutropenia, long before a hospital readmission. For example, VitalConnect has developed an EKG patch, and with AI algorithms, can predict a readmission for a cardiac patient, 6.5 days in advance. It’s mind-blowing. And even Walmart took 20 years of employee data and were able to predict prediabetes and diabetes. It turns out when you change your laundry detergent once a year… one of the first signs of diabetes is laundry detergent sensitivity. And right there, Walmart understands that that employee is 50 times more likely to have diabetes or prediabetes. Marcus Osborne, the SVP of Health for many years.
How do you see healthcare speeding up into AI—compared to other industries?
I’m seeing it speeding up substantially now. Three or four reasons for massive growth over the next five years. One is that we’ll have much better data collection, including in the home, such as through continuous BP monitoring. We’ll have data on people when they’re sick and when they’re well. Think about it: most readings are when people are in hospitals and clinics, and at home when they’re sickest. But we can unlock new secrets. JanuaryAI is taking three days of back data from a continuous glucose monitor and heart monitor, and is able to predict glucose response. A patient can be eating an apple and JanuaryAI can predict how that food will be responded to. You and I have wildly different glucose responses to stimuli, based on individual demographics but also based on fluctuating patterns in our lives.
How will the data be ingested?
Clinical-grade data from Apple Watch… Life365 manages the data for you, has number of codes under remote patient monitoring, and as of January, under remote therapeutic monitoring, for musculoskeletal and respiratory issues. And as clinicians, you get paid different rates. And there are software companies that manage that data for you, so the only time the doctor or nurse looks at the data is when the data goes outside parameters. And the parameters will vary by patient, will be individual. And a lot of these companies already exist to do. And they’re trying to work with the giant EMR companies. But the startup companies are already doing the heavy lifting on the AI algorithms. Thinking about Biointellisense, they have a heart monitor, and get millions of reading a day, because it does continuous EKG, blood pressure, heart rate variability and respiratory rate. And they’ve just started partnering with Medtronic. And they’ll do the heavy lifting, so the doctor is not going to be inundated with the data. Only a few companies do continuous blood pressure monitoring. Holy cow, that’s so exciting to me.
What would you say to healthcare IT leaders about how they should understand what’s happening right now?
I would say, start looking at what the big guys are doing. You can download Apple HealthRecords. I can look at my LabCor test results over time, graphed. I live in Silicon Valley… I can go into my app on Apple and can see a trending analysis going back five, ten years. And that’s ten times better than what my doctor is doing at Sutter Health. I can’t upload files or send links or anything, and they send me uploaded faxed information. OneMedical. And the fact that Amazon just bought OneMedical, and OneMedical went from rich, walking healthy, to servicing the senior population as well. It’s huge what they’re doing, and the fact that they have OneMedicalEMR, that’s competing against Microsoft. And Oracle buying Cerner, holds potential.
Meanwhile, My GI doctor spent ten minutes transcribing my three previous lab results. I couldn’t send him the trending analysis graphs from my ApplePhone. I couldn’t get it to my GI doctor. Sutter Health, one of the giant health systems, and I cannot upload a graph to my GI doctor.
And Epic is so ensconced, I don’t see that ever changing. So a lot of the activity will have to happen outside the EHR, but we patients will be involved in this activity. My first book is Patient as CEO. We no longer need to be a paternalistic medical society. In 1980, you went to the doctor, and your doctor told you what you do, and your doctor was your only point of access to health information apart from basic wellness information. Things have turned around. The patient will be the CEO. Patients won’t be doctors themselves, they’re not clinicians. They’ll just be the team leaders.
What will happen in the next few years?
We’re going to see a massive upswing into remote patient and therapeutic monitoring, which are already reimbursed. CVT-based digital therapeutics, Medicare is reimbursing. And I expect that there will be investment in continuous monitoring on the part of CMS. Next thing is biomarkers. And Aetna CVS launched Symphony, allows the senior to interact by voice and tracks the senior 24/7, and people can start talking with Symphony. And CVS is a pharmacy benefit manager, and as an insurance company, they’re starting to put smart sensors in patient homes already. And Amazon is going to start acquiring companies like Sonde, which has identified 4,000 unique features of the human voice. So you can tell if someone is in early stage dementia just from their talking on the phone. Japan just did a study a year ago on that. That capability is here, it just needs to be evenly distributed.