FUTURE OF HEALTH CARE
Dr. S. A. Tabish
FRCP, FACP, FAMS, MD HA (AIIMS)

Challenges
• Challenges of Healthcare Tech -
Adapt to High-Tech Healthcare
• Technology is advancing and
restricting healthcare, learn how to
utilize it for safe care. A great
physician-patient relationship is
something that every patient would
love to have.

Current Practices
• Innovation is blurring traditional
health care boundaries
• The life sciences and health care
industry is on the brink of large-
scale disruption.
• In a future of health that’s defined by
radically interoperable data, open
yet secure platforms, and consumer-
driven care, what role will you play?

Fundamental Shifts
• Fundamental shifts in innovation tend to
occur in seven-year cycles.
• While it’s possible to foresee what could
happen over the next one or two cycles,
looking ahead to 2040 (three cycles from
now) will likely reveal a completely
different reality than what we can
comprehend today. What will emerge in
the next 21 years that will dramatically
reshape the life sciences and health care
industry?

Healthcare to Health
• There will be a fundamental shift from “health
care” to “health.”
• Wwhile disease will never be completely
eliminated, through science, data, and
technology, we will be able to identify it earlier,
intervene proactively, and better understand its
progression to help consumers more effectively
and actively sustain their well-being.
• The future will be focused on wellness and
managed by companies that assume new roles
to drive value in the transformed health

• More Patients
• More Technology
• More Information
• The Patient Will Be the Ultimate
Consumer
• Different Delivery Model
• Opportunity for Innovation
• Costs will Increase
• Uninsured Will Increase
• Providers will be paid less

The Coming Transformation
• The problems in our health care systems
include subpar quality and patient safety, a
misplaced focus on acute care rather than
on prevention and population health,
inadequate person centeredness, and
unsustainable cost.
• The next decade will see major shifts in the
design of health systems and health care,
propelled by digital health, growing
consumerism, mounting financial
constraints [NEJM]

Drivers of Change
• Transformation requires strong drivers. One will be
the digital health revolution. We expect digital
transformation to change health care as it has
changed banking and retailing.
• Consumerism is growing, as people become more
knowledgeable and active in their care. The health
industry will need to become more person-
centered, personalized, and more transparent
• Another driver is unsustainable cost structures
across the developed world, creating a “burning
platform” for providers, insurers, consumers, and
policy makers

Drivers of Change
• The health care workforce is facing
fundamental changes.
• New specialties will require new
health professions.
• Workforce shortages, seen in
many countries, will force adoption
of new technologies to stretch the
available workers.

Current Health System
• Modern health systems often fail to
provide care that is focused on patient and
family needs and expectations.
• Most systems can’t consistently measure
outcomes that matter to patients, and can’t
improve their health-related quality of life
and overall function.
• Current health systems often can’t
effectively involve patients and their
families in the care process or provide
empathic care

Future Health Systems
• Most systems can’t consistently measure
outcomes that matter to patients, and can’t
improve their health-related quality of life and
overall function
• Hospitals today are typically responsible for the
largest portion of spending in health care, but
we expect that within 10 years, care will move
from the hospital into the community and the
home.
• Hospital-at-home programs are growing,
because they improve outcomes at lower cost
and with higher patient satisfaction

Future Trends
• Personalized medicine will increasingly
improve our ability to predict and
prevent acute complication of chronic
disease, thus preventing many
hospitalizations.
• Advances in digital health will allow us
to deliver hospital-level care in the
home through telemedicine.
• The Covid-19 pandemic has
accelerated this trend considerably.

What is Needed?
• Consumerism is growing, as people
become more knowledgeable and
active in their care.
• The health industry will need to
become more person-centered,
personalized, and more transparent.
• If we are to sustain health and prevent
disease, we must focus on the healthy,
predicting and preventing chronic
illness

Future HC Systems
• Future health systems need to be
learning systems
• Evidence-based Medicine: “science,
informatics, incentives, and culture are
aligned for continuous improvement
and innovation, with best practices
seamlessly embedded in the delivery
process and new knowledge captured
as an integral by-product of the
delivery experience

What is needed?
• If health care systems are to evolve, they must
shift both operations and leadership out of the
hospital.
• New technologies such as augmented reality,
surgical navigation, and tele-mentoring will
enable procedures to shift to community
surgical centers, and this shift can be
accelerated by changes in reimbursement.
• Telemedicine services will enable clinicians to
deliver chronic disease management programs
not anchored to a hospital or clinic

Future Trends
• Patient safety and quality have been
a concern since the early days of
structured measurements
• The next decade will see
considerable transformation in how
health systems are designed,
propelled by opportunities such as
digital health, growing consumerism,
and mounting financial constraints.

Quality and Access are Key
 Vary – a lot; Not clearly related to dollars spent
 Matter – can be measured and improved
 Measurement science is evolving:
– Structure, process and outcomes
– Broad recognition that patient experience is
essential component
 Strong focus on public reporting is good
– Motivates providers to improve
– Not yet ‘consumer friendly’

Delivery As A Science
“The fundamental
problem with the
quality of American
medicine is that we’ve
failed to view delivery
of health care as a
science. … That’s a
mistake, a huge
mistake.”

Coordination of Care

Opportunities for the Field
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Future Trends in Health Care
Quality and Access
 Knowledge Creation
 Synthesis & Dissemination
 Translating Research Into
Practice
 21st Century Health Care

Objective/Aim
Improve the quality, safety,
efficiency and effectiveness of
health care for all Citizens

HC Priorities
Effective Health
Care Program
Medical Expenditure
Panel Surveys
Ambulatory
Patient Safety
Patient Safety
 Health IT
 Patient Safety
Organizations
 New Patient
Safety Grants  Comparative
Effectiveness Reviews
 Comparative Effectiveness
Research
 Clear Findings for
Multiple Audiences
 Quality & Cost-Effectiveness, e.g.
Prevention and Pharmaceutical
Outcomes
 U.S. Preventive Services
Task Force
 MRSA/HAIs
 Visit-Level Information on
Medical Expenditures
 Annual Quality &
Disparities Reports
 Safety & Quality Measures,
Drug Management and
Patient-Centered Care
 Patient Safety Improvement
Corps
Other Research &
Dissemination Activities

Usual Source of Care
 Overall, the proportion of
persons with a specific
source of ongoing care is
higher for females in all
racial and ethnic groups
 This proportion was
significantly lower for the
poor (78.1%), near poor
(81.4%) and middle
income (87.2%) groups
than for high income
groups (92.3%)
2007 National Healthcare Disparities Report
Higher costs, poorer outcomes and greater disparities
are observed among individuals without a usual source
of care

Future Trends in Health Care Quality and
Access
 Knowledge Creation
 Synthesis & Dissemination
 Translating Research Into
Practice
 21st Century Health Care

Effective Health Care Program
A. Evidence synthesis (EPC program)
– Systematically reviewing, synthesizing, comparing existing
evidence on treatment effectiveness
– Identifying relevant knowledge gaps
B. Evidence generation (DEcIDE, CERTs)
– Development of new scientific knowledge to address knowledge
gaps.
– Accelerate practical studies
C. Evidence communication/translation (Eisenberg
Center)
– Translate evidence into improvements
– Communication of scientific information in plain language to
policymakers, patients, and providers

New Priority Conditions for the
Effective Health Care Program
 Arthritis and non-
traumatic joint disorders
 Cancer
 Cardiovascular disease,
including stroke and
hypertension
 Dementia, including
Alzheimer Disease
 Depression and other
mental health disorders
 Developmental delays,
attention-deficit
hyperactivity disorder
and autism
 Diabetes Mellitus
 Functional limitations
and disability
 Infectious diseases
including HIV/AIDS
 Obesity
 Peptic ulcer disease
and dyspepsia
 Pregnancy including
pre-term birth
 Pulmonary
disease/Asthma
 Substance abuse

Advances in Genomics
 A recent DEcIDE report identified major gaps in
our ability to generate evidence on utilization
and outcomes of genomic testing
 The American Health Information Community
(AHIC) has called on AHRQ to help develop
standards to code and exchange
pharmacogenomics-relevant EHR information
 Reports:
– Genomic Testing in Ovarian Cancer, Breast Cancer, Colorectal
Cancer and Depression Patients
– Horizon Scans on Cancer and non-Cancer Genetic Tests (for CMS)
– Collection, and Use of Cancer Family History in Primary Care (CDC-
funded)
– BRCA Testing in Breast and Ovarian Cancers, and Screening for
Hereditary Hemochromatosis (USPSTF recommendations)

Evidence-Based Guidelines
 NGC is a comprehensive
database of evidence-based
clinical practice guidelines and
related documents
 NQMC is a database and Web
site for information on specific
evidence-based health care
quality measures and measure
sets
 The goal of both is to promote
the dissemination,
implementation and use in order
to inform health care decisions

Future Trends in Health Care Quality and
Access
 Knowledge Creation
 Synthesis & Dissemination
 Translating Research
Into Practice
 21st Century Health Care

New Clinical Recommendations
– Screening for Prostate Cancer
– Screening for Hearing Loss in all Newborns
– Screening for Bacterial Vaginosis in
Pregnancy
– Screening for Illicit Drug Use
– Screening for Chronic Obstructive
Pulmonary Disease
– Screening for Phenylketonuria
– Screening for Congenital Hypothyroidism

Emerging Methods in Comparative
Effectiveness & Safety
 Variation in methods among
systematic reviews
undercuts transparency
 Methods reduce the
likelihood of scientific
impartiality
 Methods help minimize
misclassification of data
 Methods must continue to
evolve and not remain
stagnant
 AHRQ has and will continue
to make investments in
improving methods

Future Trends in Health Care Quality and
Access
 Knowledge Creation
 Synthesis & Dissemination
 Translating Research Into
Practice
 21st Century Health Care

Health Care in 2060
 What will it look like?
– There is no way to tell. In the
meantime, goals to be
addressed include:
 Determining what can be done
to improve the system right
now
 A continuing sense of urgency
for long-term solutions
involving innovation, enhanced
risk taking and new delivery
system approaches

Quality Standards
Design systems to collect quality
of care information and define
what constitutes quality health care
Incentives
Reward those who provide and
purchase high-quality and
competitively priced health care
Price Standards
Aggregate claims information to
enable cost comparisons between
specific doctors and hospitals
Interoperability
Set common technical standards
for quick and secure
communication and data exchange
Cornerstones of
Value-Driven Health Care

21st Century Health Care
Improving quality by promoting a culture of safety
through Value-Driven Health Care
21st Century
Health Care
Information-rich, patient-
focused enterprises
Information and
evidence transform
interactions from
reactive to
proactive (benefits
and harms)
Evidence is
continually refined
as a by-product of
care delivery
Actionable information available – to
clinicians AND patients – “just in time”

Scope of the Opportunity in Health Care
 A major challenge in 21st
Century health care is
evaluating all innovations
and determining which:
– Represent added value
– Offer minimal
enhancements over
existing choices
– Fail to reach their potential
– Work for some patients
and not for others

How Do We Enhance Our Efforts?
Key T1 activity to test
what care works
Clinical efficacy research
Key T2 activities to test
who benefits from
promising care
Outcomes research
Comparative effectiveness
Research
Health services research
Key T3 activities to test
how to deliver high-quality
care reliably and in
all settings
Measurement and
accountability of health
care quality and cost
Implementation of
Interventions and health
care system redesign
Scaling and spread of
effective interventions
Research in above domains
T1 T2 T3
Basic biomedical
science
Clinical efficacy
knowledge
Clinical effectiveness
knowledge
Improved health
care quality and
value and
population health
Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 2319-2321. The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.”
The “3T’s” Road Map to Transforming Health Care

Connecting ‘Achievability’ and Reliability
 A robust health care
system must include
capacity for:
– Rapid translation of
beneficial advances or
breakthroughs
– Connectivity with the
biomedical enterprise
Achievability: What can work under
ideal circumstances for some people
Reliability: Getting it right for all
patients every time – the first time

Future Trends in Health Care Quality & Access
 Knowledge Creation
 Synthesis & Dissemination
 Translating Research Into
Practice
 21st Century Health Care

Effective Transformation
• Health systems represent complex dynamic systems,
and implementation strategies need to adapt based on
the change at hand as well as system characteristics
• We can let the market drive health system change in a
fragmented, uncoordinated, and reactive way, or
manage the change in a coordinated and deliberate
way to optimize the impact on patient outcomes and
organization performance. We will need to take a
proactive approach if we are to see these changes
take shape earlier. All stakeholders — policy makers,
payers, care recipients, and caregivers — must be at
the table to enable and deliver effective transformation