The Growing Role of Health and Wellbeing Ecosystems

Even before COVID-19 took hold, health and care systems around the world had their challenges. In the US we see the highest spend but decreasing outcomes around life expectancy, infant mortality and a continued upward trend in lifestyle-related health conditions. The UK and other public health systems were already suffering from supply-constrained delivery leading to long waiting lists, COVID-19 has merely amplified these issues.

Something has to change! the silver lining of COVID has been the crisis-mode innovation and adoption of technology that has forced changes to operating models, but will these changes stay or will we simply revert back to where we were?

Outside of these systemic issues we have been seeing a creeping transition in the overall health and wellbeing ecosystem. New entrants, players moving into new domains, and transitions in delivery to accommodate new technology.

Above Wellbeing

The adoption of technology that supports the broad umbrella of virtual health reinforces the role of telco providers in the ecosystem. Whether this is to perform virtual consultations (telemedicine) or to help gather body telemetry as part of an Internet of Medical Things use case, something like simple remote patient monitoring or hospital in the home, the last mile connectivity provided by telco providers is essential.

Telco moves into Healthcare

Many telco providers have already established themselves in the healthcare delivery ecosystem, BT is one such example. Others are looking to use their consumer base to provide a healthcare related business that better supports many of the virtual care scenarios we have seen emerge as part of the COVID response. With the rollout of 5G technology and some of the advantages that this brings, telcos are partnering with hospitals to provide high throughput networks that underpin the fast and wide transport of medical imaging around the hospital or health campus.

A parallel trend is retail health. Big-box retailers like Walgreens, Walmart and others providing much needed coverage in the US. As part of the current Microsoft Masters in Health I hypothesised about a retailer like Tecso entering the healthcare market to complement and augment the universal health coverage scheme run by the NHS. Their role? how they could discount or make free the data used to provide virtual health services on their mobile network, Tesco Mobile.

Overall Wellness

Long the realm of fitness and slimming businesses like Weight Watchers International, overall wellness is where them majority of the upstream prevention and proactive management of long term conditions happens. This approach to total wellness includes mental wellness and the growing food as medicine trend where people are actively looking to reduce risk factors for conditions like obesity that leads to Type 2 Diabetes and other complications.

With the popularity of applications like Zwift and the growth in wearables from the likes of Garmin, the gamification and quantification of self has allowed consortiums like Vitality to stake a place in the overall wellness domain. Increasing active participation in sport as a means to prevent or minimise risk factors from lifestyle. Banks are also moving into this domain as they try to reinvent themselves in the era of the 'super app'. Banks are trying to gain their share of your lifestyle and not just your wallet by acting as an intermediary and deploying nudge theory from behavioural economics to help you meet some of your longer term goals and thereby provide more value with the aim of retention.

Simple Long Term Conditions

Your chronic condition might be genetic, or it might be the consequence of lifestyle or some other social determinant of health. Either way you now have to deal with the changes to your daily living. Knowledge and education are key tools here to move people living with one or more long term condition towards active participation and self-management. For many public health systems, and despite best efforts, the actions of public health have mixed success. Enter the health insurers who are moving upstream into this domain. With the aim of working with members on prevention and proactive treatment to help defer or otherwise reduce the cost of care as these patients move into the formal care delivery sector. AXA has been building a digital healthcare platform as one such healthcare payor entering this part of the ecosystem.

Also active in this domain are the charities that actively work to advocate for their cohort. The British Heart Foundation is merely one example of a charity that is leading the way on education towards self-management. They are also very active in sponsoring clinical trials and observational studies that can further the understanding of the science and treatment of the people that they support in the community.

Complex Care and Episodes of Acute Care

Still the role of traditional hospitals and healthcare systems. Even here we see the changes in how and where care is delivered. Accelerated by COVID-19 the use of remote patient monitoring, virtual wards, AI assisted triage and condition checking and virtual consultations have all proven their value in the last two years. I think it is inevitable that public health systems will have to continue to invest in and adopt these responses to constraints on the supply side of healthcare. The deep wait lists and backlogs that are the direct result of the focus on COVID will take years to work through unless healthcare systems find ways to incorporate virtual care where the clinical risks and outcomes are appropriate.

If reliable internet connectivity is not already widely considered to be a social determinant of health this extended period of virtual care will solidify its place in those wider determinants. It is one of the key reasons why telcos moving into the ecosystem is important and welcomed, but it is has to be managed wisely.

In Conclusion

The role of well designed health and wellbeing ecosystem is essential to the long term health outcomes of nations in all stages of development. The very foundation of such systems has to be interoperability and informed consent. As societies continue to age, and as ecomomies continue to transition away from agriculture and heavy industry we will only see more demand for long term care. The health and wellbeing ecosystem will be a central tool to help nations manage their healthcare burden.