Latest / CareTalk: Healthcare. Unfiltered. / 2024 Healthcare Predictions

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2024 Healthcare Predictions · CareTalk: Healthcare. Unfiltered.

• 0:00
  Thanks to all of our listeners for making 2023 care talk's best year yet.
• 0:05
  With 55 episodes, more than a thousand new followers on LinkedIn, and the introduction of health biz briefs, YouTube shorts and TikTok versions, it's been a year to remember.
• 0:14
  We really appreciate your support.
• 0:16
  Some of the year's big stories were AI in healthcare, abortion restrictions following the Dobbs decision and approval of the world's first CRISPR gene editing therapy.
• 0:24
  Well, John and I have polished off our crystal ball to see what's ahead for 2024.
• 0:29
  Let's have a look.
• 0:37
  You welcome to Care Talk, America's home for incisive debate about healthcare, business and policy.
• 0:42
  I'm David Williams, president of health Business Group.
• 0:45
  And I'm John Driscoll, president of Walgreens Health.
• 0:48
  Well, come on and join our ever growing community on LinkedIn, where you can access Caretalk content and interact with the hosts.
• 0:55
  And be sure to leave us a rating on Apple or Spotify while you're at it, let's talk about some predictions for 2024.
• 1:03
  John and I'll start us off with a provocative one.
• 1:06
  How about telehealth without doctors?
• 1:10
  What do you think of that?
• 1:11
  Suggesting that phone calls without mean I'm not quite sure.
• 1:16
  How would you pull that off, smarty pants?
• 1:18
  Well, here's the you know, telehealth is great for convenience, but it doesn't really do anything to address the physician or caregiver shortage.
• 1:27
  You still have to have a doc on the other end of the thing.
• 1:29
  Now, meanwhile, believe it or not, the FDA has a thing that has a name that only bureaucrat would love, something called the non prescription drug product with an additional condition for non prescription use or acne rule that's expected to be finalized in 2024.
• 1:45
  Would that be the ACNU?
• 1:47
  It sounds like it, but I don't think so.
• 1:50
  Basically what it means, John, it's a different category of drugs, somewhere in between prescription and OTC.
• 1:56
  And so what happens is basically for some drugs, like if a drug for a chronic condition or maybe for UTI, you don't really need a doctor in the mix.
• 2:06
  The patient can do more than read the label, which is for an OTC, but they can check off, hey, do I meet this criterion?
• 2:12
  Do I meet that criterion?
• 2:13
  And if they do, then they can get the drug.
• 2:16
  Now, they contemplate that maybe it's going to be pharmacy kiosks or questionnaires, but I see it actually being some sort of a telehealth.
• 2:22
  It's more like a customer service kind of a thing with a regular person, not a clinician, or maybe even with.
• 2:32
  Telehealth.
• 2:33
  It's not telephone or telehealth without healthcare.
• 2:36
  It really is making healthcare a little bit more consumer friendly.
• 2:40
  I think it's the natural evolution, David, of what is happening in everywhere else in the consumer world, which is self service.
• 2:49
  I am a little bit nervous, but know this does start to get the FDA down the path of solving for the inconvenient truth that healthcare is really inconvenient.
• 3:01
  And for a UTI or for a migraine, you could even imagine for certain mild pain meds that they would be questionnaire driven and then distributed.
• 3:16
  There is this interesting gray area or space between over the counter drugs, which are not terribly toxic, and for whom the FDA has decided that it is safe for consumers to basically purchase and take the directions and then hopefully get healed.
• 3:43
  Or those that are more dangerous, more complicated, or more toxic, like those that are controlled and require a physician's prescription and presumably their evaluation and their direction for those drugs in the middle that are actually healing drugs, but that are relatively easy to identify, diagnose and then take.
• 4:06
  I think it's really a great move forward.
• 4:09
  And I think the bigger interesting thing about telehealth without doctors, which I actually, in spite of giving you a hard time, I think will happen, is I think people are going to get increasingly more comfortable talking to bots.
• 4:22
  I mean, my prediction for next year is you will have more telehealth without doctors.
• 4:27
  It'll be doctor supervised, but the bots are going to be your clinical friends, because they also solve for the real challenge we have, which is a shortage of healthcare professionals, an expanding amount of compute, and just the need for a lot of quick answers to simple questions that really are healthcare related that the bot might help with.
• 4:50
  So I do think you're going to see healthcare brought to you via telehealth.
• 4:56
  That's bot assisted.
• 4:57
  So, John, we have a few things going on.
• 4:59
  So one is there's the technology enablement, because the AI and the telehealth infrastructure have gotten better.
• 5:05
  You've got a policy direction coming from FDA related to access and the Biden administration.
• 5:13
  And then you've got some financial incentive, too.
• 5:16
  Because I'll tell you one thing is that drug companies would love to be able to promote drugs directly to the patients without having to say, ask your doctor if such and such is right for you.
• 5:25
  No, rather go and ask the telehealth bot about that.
• 5:29
  And then the telehealth companies, too.
• 5:30
  They're like wait a minute.
• 5:31
  I could set up a telehealth network without having to have a network of physicians all of a sudden.
• 5:36
  It's quite interesting.
• 5:37
  So, John, I think we're actually going to see that in 2024.
• 5:40
  The deadline for the expectation for when this rule is going to be issued is in April of 2024.
• 5:45
  So I'm going to say ac new ACCU and ACCu view.
• 5:49
  We're going to see it in 2024.
• 5:51
  I agree.
• 5:53
  So, David, what do you think about the possibility of using AI to actually address the challenges of cultural competence and bias?
• 6:03
  Can we use the, we all know that there's massive amount of cultural bias in the healthcare system that is reflected in the algorithms that are causing a lot of people concern in deploying them directly to create kind of healthcare clinical protocols or give answers.
• 6:23
  Is it possible we can use the machines to solve our cultural problems?
• 6:28
  Well, John, I'll call you just Mr.
• 6:29
  Counterintuitive today, and maybe that's going to be your New Year's resolution.
• 6:35
  I think we should drive for it.
• 6:36
  Here's my thinking about that. John.
• 6:37
  So we have spoken, we've been, I think, early on where we talked about AI is great, but it could reinforce bias because you have training steps that don't represent the population.
• 6:46
  On the other hand, what I've seen in 2023 with a generative AI is that people will give a prompt for an email.
• 6:54
  So they'll say, for example, give me something with a professional tone, expressing regret about this, that or the other.
• 7:00
  Right, and then chat.
• 7:01
  GPT or another large language model can write a very nice sounding email. But why don't we use that for culturally competent care?
• 7:08
  We have some personalization, some empathy, and there, for example, there's a lot of organizations that are trying to do recruitment for clinical trials, and they may get all the data on people, but they still not overcoming the issue of empathy and talking to people in the right sort of language.
• 7:25
  So I think if you combine that type of data with the right type of a prompt, you could actually get there.
• 7:31
  That's for clinical trial recruitment, but it also could be, let's say, for medication adherence.
• 7:35
  Say, hey, somebody who had side effects or a bad experience with something else or has been told this, or lives in a place that doesn't have public transportation, figure out what information is relevant, put it in as a prompt, and use that as the basis to help with a culturally competent communication and care.
• 7:53
  I think that's true, David.
• 7:55
  The challenge I see, though, is in addition to tweaking the rules to make the protocols and the answers more culturally competent.
• 8:07
  And this is a big problem.
• 8:10
  People of color were more like, black people were three times more likely to die of COVID during the public health emergency than white people and some of that social determinants.
• 8:23
  But it turns out that far more white people were tested for Covid when they showed up at the ER than black people with exactly the same conditions.
• 8:34
  Black people are 40% less likely to be given to be prescribed pain meds post to surgery black women, black female mortality, maternal mortality is three times that of white women.
• 8:48
  So these are pretty material challenges for the healthcare system, and I'm absolutely certain we should be using AI and tweaking the rules.
• 8:58
  The challenge, I think, will be that all of these rule sets, massive amounts of data.
• 9:05
  It's billions of different facts and probably trillions of different rows.
• 9:10
  It's going to take some work to get them there.
• 9:12
  It's not as easy as kind of reversing a function in an equation.
• 9:17
  And a lot of these, when we talk about training data sets, the artificial intelligence or the computer's answers, if you will, depend on a base of billions of pieces of information that probably really have grooved in a biased direction.
• 9:39
  So I think it isn't just the training data sets you use, it's how you train the training tests to train the algorithm, which is going to be sounding like a children's story here.
• 9:50
  Yeah. Mr.
• 9:51
  But you need to use the training to change the training.
• 9:54
  So I think it's definitely doable, but I think it's going to take a great deal of care and people who are a lot smarter than you and I to take those training data sets, because that's really what gives the artificial intelligence, the computer, the programs, the ability to come up with a sensible answer is the mass of the data they've used and the thousands of people they've used to train it.
• 10:17
  So, John, Jeff Bezos was comparing the large language models to the telescope.
• 10:22
  So it's like you've got this new invention and now you're going to peer through it and see what's what.
• 10:28
  So I would agree that we're not going to see a wholesale change, and all of a sudden, a year from now, there's going to be culturally competent care everywhere.
• 10:35
  But I want to offer an alternative to the idea that this is such a massive undertaking to do anything.
• 10:40
  I think that the tools are already there and that the larger language models actually have these abilities if people try it.
• 10:47
  So what I would like to see, and what I expect to see is some folks making that attempt to use AI for culturally competent care the same way they're doing it for the email rewrites.
• 10:59
  That is a good place to start.
• 11:01
  Do some prompts and see where the prompts can lead us.
• 11:04
  And the prompting can be prompt. John.
• 11:07
  Doesn't have to take forever.
• 11:09
  Well, I am skeptical, but hopeful. Mr. Prompt.
• 11:13
  Great.
• 11:14
  Well, we'll have another new year's resolution to stay on time.
• 11:17
  Now, John, I mentioned clinical trials a little bit before, but I think there's an interesting direction going on in clinical trials and the potential to see more real world evidence, health economics and outcomes being done as part of the drug development process.
• 11:33
  And I actually think that this is going to benefit digital therapeutics in particular.
• 11:39
  So hear me out for a second.
• 11:40
  So most of the time, drug development is focused on safety and efficacy.
• 11:44
  Get the drug out there, you promote it, then people use it, it helps them, et cetera.
• 11:48
  Now, with more value based care, which is finally coming into play, thanks to Medicare Advantage and some others, there is an interest in total cost of care.
• 11:58
  What's the overall quality impact?
• 12:00
  And digital therapeutics have a good opportunity to prove their cost effectiveness.
• 12:05
  They're inherently less expensive.
• 12:07
  They don't have the know, just cost or development and manufacture.
• 12:10
  So you already see that happening.
• 12:13
  But what is a digital therapeutic?
• 12:15
  Well, John, it's not something you put in your mouth unless you're a child.
• 12:20
  But a digital therapeutic is basically, in most cases, using cognitive behavioral therapy that's embedded in an app to achieve a clinical effect.
• 12:30
  And so these can be used for things like depression, anxiety, post traumatic stress disorder, and the product is developed and approved, and then it can be sold.
• 12:42
  And some of them know intentionally meant to be a first line therapy, and some of them are supportive therapy, but it's a therapy that's not in a pill, John, it's on the smartphone.
• 12:55
  Well, let me try to unpack all of the complicated mumbo jumbo you just laid out there.
• 13:01
  Clinical trials are developed for largely medical devices and drugs to make sure that the devices work, and they work at a level that is nontoxic and scalable and really delivers the impact.
• 13:17
  And they've historically been done through randomized trials which require blinding large enough groups of people to actually do the placebo, the non active ingredient, or the non active, or the non intervention group, and the intervention group.
• 13:37
  And we're increasingly getting complicated, really interesting drugs that you don't have the ability to actually even do that.
• 13:44
  And so there's been a movement over time to include the impact of real world evidence.
• 13:51
  So, for example, there are cancer drugs that have not been approved, or one can't really do the randomized controlled trial, but they are actually in market for things like cardiovascular care or Alzheimer's.
• 14:04
  And so obviously, if they're used and they're not toxic in the same chemical, the same substance, if you will, then why not try it?
• 14:16
  And what's extraordinary is that how long it has taken for the FDA to actually include and get comfortable with real world evidence.
• 14:27
  But the dirty little secret is that historically, clinical trials were not comprehensive in terms of age, sex, background, male, female, and culturally competence.
• 14:38
  It's the CARES act that's really required that at even a 20, I think, or 30% percentage yet, we've got an enormous amount of data around what the impact are drug drug interaction, whether drugs are working in people, in the trillions of bytes of EMR data.
• 14:58
  So I'm really excited about the fact that the FDA is more willing to look at real world evidence.
• 15:03
  I just wish we could get there faster.
• 15:06
  And I think that the value based care or health care on a budget when you're capitated, certainly changes the incentive set.
• 15:14
  But we still have a really hard time getting at that evidence and stacking and racking it in a way that you could evaluate and make sure that you're using the right evidence to drive the right outcome.
• 15:25
  But I'm excited about it.
• 15:26
  But I think the FDA is late.
• 15:28
  But so is the system slow in actually creating the information test that would allow the thing that you'd like David to happen, which is, let's use the evidence we've got to help the people we need.
• 15:39
  It makes good sense, John.
• 15:40
  What I'm suggesting is that we'll see.
• 15:42
  So you've got, all these big things are like, what's your prediction for the next 50 years?
• 15:46
  I'm saying next twelve months, what might we see?
• 15:49
  And I do see the digital therapeutics as a good way to start with this health economics and outcomes research, especially because the biggest company in the field, the one that had pioneered it, para Therapeutics, went bankrupt in 2023.
• 16:02
  So there's a need for kind of a restart and a new approach.
• 16:05
  So keep your eyes on that.
• 16:07
  John, I have another prediction that is really just a prediction of something that's going to continue, and it's kind of boring in that sense.
• 16:14
  However, it is so big that it may be the most significant prediction that we talk about here.
• 16:19
  And really, that prediction is that the abortion debate is going to continue to play out favorably for Democrats.
• 16:25
  And I dare say, john, that it might be the key to the Democrats keeping the White House, keeping the Senate, or maybe solidifying their control over it and taking the House, John?
• 16:35
  That's my prediction.
• 16:36
  Well, I'm glad you dare to say, because I agree with you.
• 16:41
  That's one where I think it's hard to argue that you've got states that were Trump plus ten, more than 10% of the people voted for Trump in those states turning around and supporting abortion rights and access to that care.
• 17:00
  I think it's pretty remarkable, and it's been very consistent in all of the red states where it's been tried down the ballot box.
• 17:06
  So I'm cautiously optimistic that you're right.
• 17:10
  I'll give you this one.
• 17:11
  I think what could happen, some people might predict is that sort of the abortion opponents, republican party writ large, trying to find kind of a little bit of a different message, a little better positioning.
• 17:24
  The problem is, if you think that abortion is wrong under any circumstance, where's the compromise?
• 17:30
  You can't really just adjust your position to make it a little bit more palatable.
• 17:33
  And even if somebody does that now, it's pretty easy to counter that and say, they may say that now, but look what they said before and look what's actually happened.
• 17:44
  For example, in the recent case in Texas where the person was allowed to have an abortion and then they weren't, and guess what?
• 17:52
  They went out of state.
• 17:54
  I think this is really powerful.
• 17:56
  What's fascinating is to watch how the republican leaders have handled, know, initially after the Dobbs decision, the Dobbs decision that reversed the settled law of Roe v.
• 18:06
  Wade, there were a lot of bill signings that were very public about more and more restrictive restrictions in red states.
• 18:14
  Well, that's no longer happening.
• 18:16
  David, you're fine.
• 18:17
  If those laws are being passed, they're being passed behind locked doors and signed in the middle of the night.
• 18:24
  And then you had a brief burst where the republican policy wonks were saying, well, maybe we'll say we're going to be in favor of contraception, we'll protect contraception.
• 18:36
  But that annoyed some of their own party members who said, well, I'm not quite sure.
• 18:40
  I mean, you've just elected a House speaker, and I don't even know that anyone's really pinned him on how he feels about these policies.
• 18:50
  But we know he's a big fan of covenant marriage and many more extraordinarily conservative christian right perspectives.
• 18:58
  So I think the Republicans have a problem that's not going away because it's embedded in the leadership and policy of their base and their leadership.
• 19:05
  John, I want to end with an optimistic prediction, which I also predict that you will contradict.
• 19:11
  And my prediction is that lifespan and health span are going to lengthen in 2024.
• 19:19
  There's been the pandemic deaths of despair and so on.
• 19:23
  But I think things are starting to look up, John, and that with all these different medical improvements that are going to happen and things looking brighter, that lifespan is going to increase in 2024.
• 19:35
  David, David, David.
• 19:38
  I mean, we know that with all of the money we spent and all the king's money and all the king's men, that all we're helping is kings.
• 19:46
  When you look at our health care system, the difference between the rich, the poor and the middle only gets more and more extreme every year.
• 19:54
  Not only are things more costly, but access is more dear.
• 19:58
  There's a reason why during COVID white America, I think, lost a year or two based on all of the deaths of COVID but I think alaskan Indians lost about four years.
• 20:11
  The African Americans three years, latino men two and a half years.
• 20:17
  It was a very classically predictable, painful result of the fact that we have a health care system, in addition to costing too much and doing too little, has real access problems that are only getting worse, I think, for the middle class, what that's going to translate into, I think, is that rich white people are going to be fine and their lifespan will continue to improve along the lines of getting closer to asian american life outcomes, which are actually three or four years longer currently, based on the statistics, than white America and the rest of the middle class and the poor are going to continue to go down.
• 20:56
  What's most troublesome for me are those deaths of despair.
• 21:02
  The deaths by overdose in the United States continues to increase year over year.
• 21:10
  And that masks the fact that blocks out a little bit of the increase of deaths by suicide, the long term problems of substance use disorder that are also growing.
• 21:21
  I think this is a case of the haves and the have nots.
• 21:25
  And while some people's lifespan will be increasing, I think the numbers will show, David, that your prediction's wrong.
• 21:33
  Well, John, we can't leave it on such a negative note, so I'm going to say that even if it's a little hard to disagree with your points there, so I won't do that.
• 21:40
  However, I think if we pledge that during 2024, both in our work and on our podcast, we try to do things that actually highlight social determinants of health and life and actually try to highlight those things that actually may move toward lengthening lifespan and health span, and I think we could agree that that would be a good idea.
• 22:00
  So let's wrap up things John here.
• 22:02
  That's it for another episode of Care Talk.
• 22:04
  And that's it for another year of Care Talk.
• 22:07
  It's been quite a 2023 I've enjoyed, as usual, John, co hosting with you.
• 22:12
  We've had some wonderful guests, some heated arguments, a few areas where we, in a boring way, disagreed with one another.
• 22:19
  But the listeners are voting with their feet and their ears and their eyes and continuing to join us.
• 22:27
  And so that gives me at least the interest to continue going forward and producing just the very best content we can in 2024.
• 22:35
  John, I hope you have a happy holiday season.
• 22:37
  And I'll say, signing off.
• 22:39
  I'm David Williams, president of health Business Group.
• 22:42
  And I'm John Driscoll, the president of Walgreens Health.
• 22:45
  I want everyone to have a happy holiday season and consider subscribing on your favorite service.
• 22:52
  Thanks, everyone, for listening.