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28 POPULATION HEALTH 28 CEO / STRATEGY 'This is healthcare's Amazon moment': Dr. Stephen Klasko's 5 predictions on healthcare delivery post-COVID-19 By Laura Dyrda H ealth systems have accelerated their digital health, telehealth and virtual care capabilities since the pandemic started, forc- ing them to disrupt themselves, Jefferson Health President and CEO Stephen Klasko, MD, said. Care delivery will never be the same again, said Dr. Klasko, who was also recently named the first distinguished fellow of the World Econom- ic Forum and served as co-chair of the forum's Board of Stewards for the Future of Digital Economy and New Value Creation at its annual meeting in Davos, Switzerland. "is is healthcare's Amazon moment," he said. "If you are a provider and think you're going to go back to your business model solely being based on hospital revenue and not relevant to people who want care at home, I think you will be out of business. If you're an insurer and think you can just be the middle man between the hospital and the patient, you'll be irrelevant. If hospitals believe that innovation can be just this cute little thing that they do in the background but the real business is just getting heads in beds, they're nuts. I think we were always wonder- ing what the big disruption would be that got us to join the consumer revolution, and I think this is it." Here are five key insights from Dr. Klasko about the future of healthcare delivery: 1. ere will be more partnerships between health systems and pay- ers as telehealth accelerates.e COVID-19 pandemic is accelerating the use of telehealth and remote patient monitoring among the general population across the nation. In New York, telehealth visits skyrocketed 312 percent and Renton, Wash.-based Providence reported an 20- to 30-fold increase in telehealth visits aer treating their first COVID-19 patient. Philadelphia-based Jefferson has been preparing for the even- tuality of widespread telehealth use, and already had the infrastructure in place when the demand spiked. But health systems and providers aren't the only ones adjusting to the reality of telehealth as a primary mode of care delivery; payers are ad- justing reimbursement coverage and rates to ensure beneficiaries have access to virtual care. Health systems are now devoting resources to keeping patients out of the hospital when possible and allocating the rest of their resources to patients in critical condition. "e COVID-19 crisis will accelerate a disruption in how healthcare is delivered, paid for and perceived that would have happened anyway, albeit more slowly," said Dr. Klasko. "At Jefferson, we had invested early and significantly in virtual triage, telehealth and early AI applications. at allowed us to have the bandwidth to move from 50 to 100 tele- health visits a day to almost 3,000 a day and train over 1,500 physicians and nurses to prepare for the virtual onslaught. is move from hospi- tal centric 'sick care' to person-centric 'health assurance' will necessitate closer strategic alignment between payers and providers." Prior to the coronavirus epidemic, some payers did not have expansive telehealth coverage and others had lower reimbursements than in-clinic visits, making it a challenge for the systems to support a comprehensive telehealth program. In the future, Dr. Klasko said health systems will need to align with payers to provide better care at a lower cost. "Just as hotels did not understand that the Airbnb revolution was not an anomaly, it was a fundamental change in our economy, that 20th centu- ry principles of mass production and economies of scale are ceding to mass personalization and rentable scale, hospitals will need to adapt to the 'new normal' of costly 'sick care' giving way to affordable, personal- ized and preemptive care with genomics, sensors and AI-based digital therapies," said Dr. Klasko. 2. e combination of increased data gathering and AI will make the society more resilient to disease spread. In the future, people will be constantly monitored with real-time feedback on their health that in- tegrates into their patient records. For example, they may wear a watch or shirt that can measure their temperature and tell them if their tem- perature increases above 100 degrees, or if their respiratory rate lowers. "I believe we will move from the 'internet of things' to the 'internet of you'," said Dr. Klasko. "At Davos this year, the CEO of a banking con- glomerate said to me, 'Twenty years ago the two groups that had es- caped the consumer revolution were banking and healthcare. Now you are alone!' ink about how the pandemic would have been handled differently if we had continuous data coming in from patients through their wearables and other sources as it related to temperature, respira- tory rate, etc. Or if 3D printers were as ubiquitous as cellphones. Simply put, in many cases our cars get better care than we do, they are constant- ly sending data to the cloud. In a few years, it will seem archaic to go once a year for a static physical to an office when your T-shirt has been sending continuous data." For example, Jefferson is teaming up with soware developers to devel- op a wearable app that will monitor heart patients for atrial fibrillation. If results are abnormal, the device will immediately notify the patient and call an ambulance. 3. How hospitals handle data today will make or break patient trust in the future. With the HHS interoperability rules making it easier for patients to own their own data, the most trusted health systems with integrated IT that allows easy and secure information transfer will have an advantage over others. Patients will also seek out organizations that ensure their health data won't be used against them. Consumer data has shown that patients trust their local hospitals and providers more than insurers, big tech or big pharma. Dr. Klasko be- lieves that big tech's place in the healthcare system will look more like the Microso model of entry, where the companies create a space for data storage but patients will control who sees their information. "We must put ethicists at the start of the conversation as we begin to amass and analyze an individual's data or genomics, we must reduce all barriers to interoperability among electronic records and most im- portantly, a patient's data should be owned by her — not the insurer, the provider or the hospital," said Dr. Klasko. "In the future if a patient wants to switch physicians, she will merely change her password." 4. Technology can close the gap between the "haves" and "have nots" but it must be applied strategically. Technology can only improve community health if everyone has access to it. "e digital revolution cannot simply make the wealthy healthier," said Dr. Klasko. "Digital medicine gives us an unparalleled opportunity to address the social de- terminants of health and provide access to everyone in their own neigh- borhoods. e pandemic telehealth team at Jefferson calls themselves the Night's Watch from 'Game of rones,' they are the 'invisible' defense to