Delivering healthcare at the touch of a button - LEK Consulting
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Indepth The Covid pandemic has forced healthcare providers and patients into the remote world of virtual consultations and telehealth, but it has also accelerated the move to direct-to-consumer diagnostic testing, as L.E.K Consulting partners Klaus Boehncke, Guillaume Duparc and Leah Ralph explain Delivering healthcare at the touch of a button A s Covid ravaged countries consultations over a two-month period, But it is not just telehealth that has around the world, a dramatic while the number of publicly funded boomed as a result of Covid. The impact transformation of the traditional teleconsultations in Australia reached of Covid’s requirement for care-at-a-dis- healthcare system began to around 10 million in just two months of tance combined with other healthcare take place. No longer could patients get launching. Globally, 50‒80% of patients trends is heralding the fourth wave of a face-to-face consultation with their GP; and doctors tried telemedicine for the digital health. This is characterised by instead, symptoms and sickness were first time during the pandemic.1 growing, consumer-centric business discussed over the phone, via video call Face-to-face consultations have re- models, the burgeoning interest of tech and through apps. turned as Covid restrictions have eased. firms in health and the rise of user-gen- Covid did what the digital revolution However, the use of telehealth has con- erated data, where artificial intelligence has currently struggled to do – it marked tinued and remains at a level higher than and data analytics also come to the the tipping point where telehealth sud- before the pandemic. It’s not going to fore. It takes us beyond a health-system, denly became mainstream. disappear back into the woodwork either provider-centric focus on eHealth to an The accelerated use of virtual consul- because, for the most part, healthcare era where the patient sits firmly in the tations is nothing short of momentous. providers and patients have found virtual centre, where healthcare is delivered In the US, telemedicine provider Amwell consultations work well and are very remotely rather than in the traditional reported a 3,000% growth of remote convenient. healthcare setting. 30 | AUGUST/SEPTEMBER 2021 | HM UK - LaingBuisson
FIGURE ONE OUR CURRENT FOURTH WAVE OF DIGITAL HEALTH WILL BE CHARACTERISED BY REMOTE CARE, GREATER PATIENT CENTRICITY AND IS NOT LIMITED TO ‘SICK CARE’ 1st Wave 2nd Wave 3rd Wave 4th Wave Technology in Health ICT eHealth Digital Health Health distanceisisno Care at aa distance nolonger longer Industry Healthcare setting/ Health system focus confined to thep the physical hysicalc care setting are setting agnostic organisation focused Shared health records and (e.g. (e.g.hhome omet testing, telemedicine, esting, telemedicine, Pervasiveness of digital health in society Corporate Practice management information exchange remote monitoring) monitoring) functions systems Patient following but still Citizen and and consumer consumercentric centric (accounting, Clinical systems - large provider centric (choose where and (choose where andhowhowtotoengage engage payroll) integrated systems, best of HCPs, whereetos HCPs, wher to store data,who tore data, whototo Governments as key players share Mainframes breed systems share itit with, with, and and service servicemodels) models Healthcare as a process Corporate applications for New entrants (startups, big tech, Data still provider originated insurance, other industries) logistics and performance and management Industry and role convergence provider Health service provider (health service boundaries controlled centric overlapping with others) Emerging -server Origin of data outside of traditional care settings AI and data analytics play major roles and enable new capabilities (digital twin) and models of care Broader than health (lifestyle, prevention, mental health, social services, disability, aged care) c.1950–1960 c.1970–2005 c.2005–2020 c.2020 and beyond (and ongoing) (and ongoing) (and ongoing) SOURCE DAVID ROWLANDS, L.E.K. RESEARCH AND ANALYSIS In this wave, healthcare also becomes plex, the samples can be sent off to the Direct-to-consumer diagnostic testing more than just about sickness – it lab by the patients themselves or can is merely an extension of this trend that becomes about lifestyle, mental health, be collected from patients’ homes by a leverages telemedicine. Our research social situation, prevention and self-care. courier for analysis. This tends to be for and analyses show that typically in a more sophisticated tests such as saliva telemedicine consultation 50‒80% of samples, genetic tests, sexually trans- patients will be issued a prescription. In The rise of D2C testing mitted infection tests, nasal swab tests 10‒20% of these cases the medication Within this new landscape, we are now like the Covid PCR test and stool tests. will be delivered straight to the patient’s witnessing the rise of direct-to-consumer Results are then provided to the patient home, and in the remaining cases, the (D2C) diagnostic testing. This market either directly in digital format or via a medication has to be picked up from a was already growing pre-pandemic, medical professional (see Figure Two). pharmacy by the patients themselves. and this has now accelerated, driving In contrast, 40‒50% of telemedicine annual growth of c.26% CAGR to reach appointments resulted in a diagnostic more than $30bn globally in the next ten The maximisation of test requirement, and only 3‒5% of pa- years.2 convenience tients were sent a home testing kit. D2C diagnostic testing allows consum- This shows that there is considerable ers to use test kits at home that can be Direct-to-consumer diagnostic testing potential for a better overall telemedicine bought from a pharmacist, ordered on- is part of a bigger trend that we refer to experience with both prescription drug line, or delivered to the home following a as the ‘maximisation of convenience’. delivery as well as at-home-testing. As a telemedicine consultation. They can then Over the past few years there has been result, we are seeing many companies carry out the required examination by significant growth in digital home deliv- jumping on the bandwagon and incor- themselves in the comfort and conveni- ery. Think Amazon, Deliveroo, and online porating testing as part of their offering, ence of their home. Simple tests that are grocery shopping, where you shop online and a broad range of D2C testing busi- well known include those for Covid-19 from the comfort of your home then wait ness models. (lateral flow), pregnancy and urinary tract for the doorbell and your delivery. For instance, many traditional lab and infections. Results are delivered very This convenient home shopping trend diagnostic firms have, even before Covid, quickly either through the test kit itself was dramatically accelerated during set up consumer arms, while a raft of or via an accompanying smartphone app Covid, and as a result, for example, 48% D2C start-ups have entered the space. (e.g. by taking a photo of a testing strip of UK consumers purchased a product In the US, LabCorp has a consumer di- that is then analysed by the software). online during the pandemic that they had vision, Pixel, that offers home collection If the diagnostic tests are more com- never purchased online before.3 tests for colorectal cancer and Covid that laingbuissonnews.com | AUGUST/SEPTEMBER 2021 | 31
Indepth FIGURE TWO IN THE MARKET TODAY, A VARIETY OF HOME COLLECTION SAMPLING METHODS CAN BE USED TO TEST FOR A VARIETY OF CONDITIONS Blood prick Urine sample Stool sample Saliva sample Nasal swab l Diabetes l Chronic kidney l Colorectal cancer l Genetic testing l Covid-19 l Cholesterol disease l Calprotectin (IBS) l Covid-19 l Influenza monitoring l Thyroid function l Peptic ulcers l STI l Kidney health l Clostridium l PrEP monitoring difficile toxin l HIV l Iodine level l Hepatitis l Hormone l Pregnancy NOTE NON-EXHAUSTIVE SOURCE COMPANY WEBSITES; L.E.K. RESEARCH can be purchased out of pocket without introduced at home genome and blood Apple Watch, Google Fitbit and others a doctor’s visit. Competitor QuestDirect testing for its AI supported personalised broaden this to include measurements offers diabetes, colorectal cancer and nutrition service.4 such as heart rate, ECG, blood oxygen, Covid home collection tests that can be In addition, large eCommerce and sleep quality. Blood glucose is likely purchased online. platforms have started to specialise in to be the next big step in this list5 which healthcare products in recent years, of- will have a significant quality of life and fering an alternative to products bought healthcare outcome impact on many of The entrance of non- in traditional brick and mortar pharma- the 400m+ patients with diabetes in the traditional companies cies. Pharmacy2U and Zur Rose are both world. Startups are also ‘following the good examples of this. Delivery compa- money’ and entering the digital diag- In recent years, we have also wit- nies, including Uber and Deliveroo, are nostics and digital therapeutics space nessed another trend in this space – the taking advantage of the D2C trends, and which is increasingly being reimbursed entrance of non-traditional diagnostic provide same-day delivery. by payors. companies including dedicated D2C Meanwhile, telemedicine leaders For example, last year Germany testing start-ups, many of which are including HealthHero, Kry, Teladoc and became one of the first countries in the centred in the wellness space and who Babylon continue to look for opportuni- world to fund approved digital mobile offer additional products. For instance, ties to expand their business offerings healthcare apps through statutory (pub- wellness firm Lykon in Europe combines and are increasingly creating or partner- lic) health insurance. the use of blood and saliva genome ing with health platforms, governments, lab tests to offer personalised nutrition insurers and large corporates, which will and supplements. In the US, Vivoo is a further drive this trend. Finding a path forward wellness assistant that focuses on nutri- Alongside these developments, there In the future, we expect the D2C tion and lifestyle and uses patient data is also substantial growth in testing for testing marketplace to become increas- from urine tests to provide personalised digital biomarkers driven by the larger ingly complex with a larger variety of advice, while Numan describes itself as tech players. The ubiquity of smart- players and business models. How the a ‘digital health company for men’, offer- phones already allows people to meas- landscape develops will also depend on ing blood tests alongside personalised ure movement, walking balance and how companies approach the challenges supplements. In Japan in 2018, Nestle activity data, and wearables such as the presented by telehealth and D2C testing. 32 | AUGUST/SEPTEMBER 2021 | HM UK - LaingBuisson
FIGURE THREE TELEMEDICINE PROVIDERS TODAY ARE ALREADY DOING MANY CONSULTATIONS THAT EITHER REQUIRE PRESCRIPTIONS AND/OR TESTING, D2C TESTING IS EXPECTED TO GROW RAPIDLY Our current view of the market of D2C prescribing and testing Remote consultations and e-prescriptions (2020) Percent (%) Other l According to a recent report, the global
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