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January 15, 2021

Digital Health in 2021 A.C [After Covid]

Commentary
Bernice Ma & Todd Kolm (Evolution Road) | Kate O'Reilly & Alette Brinth (HealthXL)
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Last year was a year like no other - we saw innovation at accelerating speed across the digital health spectrum. With no sign of things slowing down in 2021, here are our top 5 predictions for trends to keep an eye on in the year ahead.


• 1. Health @ Home is the future

It’s no surprise that 2020 was a breakthrough year for telemedicine as the world went into lockdown. In 2021, we predict that “Health @ Home” is set to play an increasingly important role in healthcare, and trends in home-health won’t be just virtual appointments.

Diagnostics @ Home

In 2020, home-test and remote diagnostics companies like LetsGetChecked and Everlywell experienced a surge in demand as patients avoided hospitals and healthcare settings. Notably, demand wasn’t limited to their SARS-CoV-2 PCR and rapid 15-minute serological (antibody) test kits. Matching the surge in demand, many home health and remote diagnostics companies raised new capital during the pandemic, with LetsGetChecked raising $71 million in financing. We predict that in 2021, the trend for convenient and easy-to-use home diagnostics will continue, as many patients are now used to the process of buying kits, collecting samples and sending them for analysis. 

Acute Care @ Home 

Finally, we also predict that at-home care will evolve beyond basic telemedicine to acute “Hospital@Home” care. In 2020, we saw CMS launch an “Acute Hospital Care at Home” program enabling hospitals to rapidly increase capacity by providing care to patients outside the ward. Unlike the telehealth reimbursements, this program is not designated “temporary”, indicating a new era for “Hospital@Home”. Hot on the heels of this announcement, Biofourmis launched “Biovitals Hospital@Home”, an AI-driven Remote Patient Monitoring solution sending processed patient data to clinicians with a predictive view of the disease trajectory to allow early intervention. As the pandemic continues to place pressure on hospital capacity in 2021, we predict that patient care is going to shift away from the traditional hospital setting, bringing the ward to the patient where it is safest and most convenient for them. 

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• 2. New end-to-end care models, bridging virtual and physical care

Despite telehealth’s accelerated adoption we also quickly learned that telehealth by itself isn't a magic bullet for care delivery. Telehealth alone leaves an inherent gap in its ability to deliver on healthcare needs holistically (what do patients do if they need to do a lab test?). It is becoming more and more clear that healthcare cannot be delivered within a silo. We predict 2021 will be the year that more integrated end-to-end care will emerge and the line between what is online vs. offline will start to blur. Specifically, we see three key trends:

 

Point of Care Integration

With the need for speed for telehealth adoption, many providers gravitated towards free platforms like doxy.me and zoom (and even just good old-fashioned phone calls!) This has resulted in a fragmented market where hundreds of telehealth platforms have emerged, most of them not integrated with the provider’s EMR. In 2021, as telehealth legislation and use starts to normalize, we predict there will be more deliberate integration of telehealth services directly within a providers workflow (like their EMR). We are already seeing some early signals of this with Epic making Microsoft Teams available within their App Orchard market, enabling providers to launch telehealth visits directly from the EHR and Cerner enhancing their AmWell solution to make it easier for patients to use telehealth (including the ability to receive an email or text link to start the visit). This will be critical in order to create a more seamless experience for both patients and providers.

End-to-End Care Delivery Integration

The Teladoc and Livongo merger, notably one of the largest ever in digital health (Teladoc paying $18.5 billion for Livongo) is a clear signal that patients need more end-to-end services. We predict that we will see many more such mergers in 2021, as companies start to realize that this type of consolidation will ultimately provide the best value for their customers.

Online - Offline Integration

Although online clinics like Ro and Hims started out primarily with lifestyle products, they have expanded their services during the pandemic to primary care in order to meet consumer demand. With Ro's recent acquisition of Workpath, a software platform that provides home-based care including sending providers to patients' homes, these online companies are now seeing an opportunity for vertical integration, including bringing on more offline offerings in order to truly become a one-stop shop for healthcare. With the trends towards more home-based care, look to see more such vertical integrations in 2021, potentially bringing in other services like transportation (e.g. Uber Health) to truly provide an end-to-end solution.

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• 3. Decentralised clinical trials will continue to reap the benefits with digital biomarkers leading the way in clinical decision making and remote monitoring

The rise of decentralised clinical trials

Zoning in on the clinical trial and data analytics space, 2020 witnessed a few interesting moves in the wake of the pandemic. One of the most notable moves was the transition to decentralised clinical trials (DCT). Having seen the clear benefits to DCTs it is likely that we will see this trend continue into 2021 redefining the structure of clinical trials for the long-term. 

 

Digital biomarkers and endpoints: the new norm

In line with this theme, 2020 also saw accelerated adoption of digital biomarkers, particularly leveraged for identification of high-risk patients and hospitalisation predictions in response to the global emergency. We predict that in 2021 we will see greater use of existing clinical endpoints measured digitally, and new digital endpoints being trialled and tested. Investor activity also suggests that as the dust begins to settle on COVID we expect to see a pivoting back towards the neurosciences and cardiovascular space, with sporadic/breakthrough activity in rare diseases. 

 

Precision health in oncology: the next gen treatment

When we think about what precision health will look like in 2021, it is likely that we will see it spearheading the development of oncology treatment regimens and predict that common cancer types i.e. lung, colorectal and prostate cancer may begin to trial next generation sequencing and integrate it into the next-generation treatment pathways.

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• 4. Pharmacies will position themselves as community digital care hubs bridging networks of digital health offerings

In the US, more than 90% of the population lives within 5 miles of a pharmacy. Medicare beneficiaries see the pharmacist twice as often as their primary care physician. In more rural counties with primary care shortages, it can be more than 7x.


Digital calls on pharmacists to assume a more dynamic and versatile role 

COVID has only accelerated the growth of pharmacies as they remained one of the few essential businesses that remained open during lockdowns globally. Furthermore, pharmacies are expected to play a critical role in the broad rollout of the COVID-19 vaccine. Pharmacies like Walgreens, CVS have also been contracted by the government in the U.S. to support the rollout of the COVID-19 vaccinations, including delivering vaccinations to long-term care facilities. 


Furthermore, with continuing automation (e.g. telepharmacy kiosks) and shortage of PCPs, we expect that pharmacists will become more engaged in delivering all-round patient-centered care. With updates to regulation enabling pharmacists to prescribe more products, pharmacists will play a greater role in actually diagnosing and treating patients. 


As a result, in 2021, we predict that pharmacists will have the opportunity to establish more meaningful, potentially long-term relationships with patients in their community, some for the very first time. Their ability to build relationships will also enable them to deliver behavior health support as well as become a trusted partner in the management of patient’s health.


Pharmacies expanding service offerings becoming the “one-stop shop” for consumers


Given their access to consumers, pharmacies are quickly enhancing their services in order to become consumer’s healthhub. Pharmacies have started to expand into primary care to offer a broader suite of healthcare services (e.g. Walgreen + VilllageMD, Walmart + Oak Street Health), while ensuring that pharmacists become a more integral part of the patient care team.


In addition to more clinical services, pharmacies have also started to add digital health offerings and partnerships in order to deliver more holistic and integrated care. Walmart acquired CareZone in 2020 in order to more effectively manage medication adherence while CVS partnered with Vida Health to offer more holistic weight-loss coaching to their members. In order to compete with Amazon Pharmacy, some pharmacies even started offering Rx delivery by partnering DoorDash and Uber Health. 


Given the growing importance of pharmacies, especially in 2021, we predict that they will continue to be competitive with digital-first companies like Amazon by leveraging their relationships with consumers and delivering on the needs of their community with partnerships.

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• 5. Disruptive new PDT distribution models will surface reinventing our synergy with digital care

Increased end-to-end virtual patient engagement

Prescription Digital Therapeutics (PDTs) are breaking out as an exciting new therapeutic modality where the active ingredient is software. 2020 saw physicians prescribe video games for the first time with FDA-approval of Akili’s PDT for ADHD. Shaking up the PDT distribution chains, we saw Pear Therapeutics launch Pear Connect - the industry’s first patient service-portal for connecting patients suffering from chronic insomnia with prescribers from their home. We predict that 2021 will very likely see similar types of virtual end-to-end experiences take flight, especially in the area of psychiatry and mental health which support end-to-end engagement remotely.

 

PDTs: expanding formularies and reimbursement

Recent years have witnessed significant traction in the digital health reimbursement and distribution space setting the scene for 2021 to be one of the most exciting years for PDTs. We predict 2021 will be the year we see the unravelling of novel and alluring distribution models.

In late 2019 we saw the introduction of Germany's new Digital Care Act, allowing doctors to prescribe apps, which can be reimbursed by German statutory health insurance. Last year we predicted that other European countries would follow Germany’s example and at the end of 2020, we saw France following suit with Haute Autorité de Santé granting Moovcare reimbursement. We predict that 2021 will see the likes of Belgium or the Netherlands edging closer to this paradigm.

 

Across the pond we saw U.S. digital health formularies Express Scripts and CVS Caremark expand their lists throughout the year, while PDTs grabbed the spotlight in the Senate, contending their right to Medicare reimbursement. CVS Caremark also expanded access to 5 digital health platforms including Hello Heart and Livongo, while Kaiser Permanente added a new feature allowing physicians to prescribe mental health apps such as SilverCloud using EHRs. We predict that in 2021, we will see expanded access to digital health programmes and endeavours to integrate digital health prescription by way of health plans and EHRs, particularly across the states. One big question remains; will Europe xerox their highway in 2021?

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