Introduction

For the past several months, the team at Chilmark Research has been diligently working on creating our first Future of Health IT Map. It will provide a comprehensive, graphical representation of the following:

  • Top drivers (financial, technological, socio-political) shaping the market for health IT
  • Trends across the various verticals, from ambulatory care, to the life sciences, to payers and government
  •  “Big Stories” and “Wildcards” with the potential to disrupt segments of the market

We began this project in order to provide a way to offer our extensive research expertise across these market segments in an easy to access manner that does not require reading through a stack of white papers. This visualization of trends, drivers, impact areas and major hot button issues can be used as a tool for companies to build strategies across market segments, to drive innovation programs, and to think through policy impacts on different stakeholders.

A companion tool to the map will also include a guide on personas, which are frequently used in industry to understand customer journeys and experiences with a particular service or product. They can be used to facilitate thinking about how a product or service is framed, and to search for alternative framings that may be more valuable to a prospective customer segment.

We hear a great deal about “patients” in healthcare, but all too frequently this subjectivity is presented in a coherent, idealized way that may be “experience-far” for many patients compared to their actual experiences (“experience-near persona.”)  It is time to unpack the patient persona, as it limits strategic thinking. The industry also needs to go far beyond the patient vs. consumer binary that dominates healthcare debates. As Susan Sontag once noted, we sometimes inhabit the “kingdom of the sick” and much of the time inhabit the “kingdom of the well”. To highlight the multiple roles we inhabit, we add the personas of the citizen and caregiver, culminating in four personas that provide a larger palette of frames to understand the changing healthcare landscape.

Drivers of Change in Health IT

Our map first organizes the content based on a series of macro-drivers that we identified as the main forces of change in the overall marketplace. The drivers help shape markets and trends that can impact different segments of the market in profoundly different ways. What follows is a brief description of the six key drivers that frame our map.

  • Consumerization: For well over a decade, healthcare organizations (HCOs) have been pushing for a more “consumer” focused system that resembles other markets beyond healthcare. For many, this may be a euphemism for higher out-of-pocket costs for patients and consumers. In other contexts, it most certainly means adopting products and services that improve access, quality of care, transparency and a number of other qualities valued across the economy.
  • Bending the Cost Curve: Value-based care has become a growing share of the overall contracts with providers, and the ethos of better outcomes at a lower cost has become the mantra for healthcare in general. Analytic and digital health tools have proliferated, in part due to their perceived role in addressing the need to bring down costs while improving outcomes.
  • Omnichannel Care: The COVID-19 crisis created a tremendous opportunity for virtual care providers to prove their utility under lockdown conditions and beyond. The past two decades have shown that healthcare is no longer a matter of accessing care through a clinic or hospital alone; social media, mobile apps, IoT, and other virtual tools have become mainstream ways of accessing care beyond the physical clinic.
  • Democratization of Data: This driver can actually encompass a number of areas from the use of low-cost, layperson-managed analytics and machine learning tools, to the emerging, contested debates over who owns the data, who controls it and who should ethically profit from patients’ data? From regulators to new startups, different organizations have different views of the multiple axes of use and control over data. Cybersecurity and governance frameworks for managing data securely figure prominently here as the risks increase as data liquidity increases.
  • Public Health-Health IT, Bridging the Gaps: The pandemic brought home the issue of lack of investment in public goods like public health. It highlighted the need for better data exchange and cooperation across public health and health IT to enable more resilient health systems and public health responses to the next health crisis. Going forward, governments will need to think hard about strategic investments to upgrade public health surveillance systems and reporting while also integrating these efforts with the broader health system without compromising privacy and security. Trust in our systems was dealt a major blow and this area will need considerable investment to avoid the mistakes of the past.
  • Digital Transformation: Digital transformation across industries has generally been driven by the adoption of mobile platforms, cloud, and AI in different configurations that change the end-user experience and offering more personalized services at scale, replacing traditional approaches and/or outdated technologies. The personalization of care delivery rests upon the digital transformation of the entire healthcare industry, from health systems to life sciences to the individual.

These drivers play out across a number of verticals that we have chosen to examine including: Ambulatory Care, Hospital Systems and Providers, Long-Term and Post-Acute Care, Home Health, Clinical Research and Life Sciences, Employers/Payers, and Government. We track the trends for each market segment and how drivers interact for each stakeholder.

Big Stories in the Map

We highlight a number of intersections of trends that we think are emerging “big stories” with the potential to shift market dynamics or create opportunities and challenges for different players in the healthcare ecosystem. From cybersecurity threats to the growing role of platform economies such as Amazon, Google, and Microsoft in the healthcare arena, to payer-provider convergence, to the techlash against major platforms, norms and the shifting politics of healthcare, given broader changes in society and the economy. Black Lives Matter helped shed light on the differential impact of the pandemic on communities of color and the need to address institutional racism. Private equity acquisitions of hospitals are changing access to care in rural America. VC and PE together have provided a pipeline of funding to digital health unlike any financing we have seen in the past. What will the long-term impact of these trends be?

Personas and the Future of Health IT Map

As mentioned above, we also provide a Persona Toolkit that acts like an additional layer to our map. It is also a tool for understanding the differential impact the trends and drivers may have on diverse individuals and communities.  It is important to remember that we may inhabit all or any of these personas at different points in life, or even concurrently at times. But framing these personas individually when utilizing our map will enable users to surface unmet needs that may arise from the intersection of trends and drivers. Our Persona Toolkit includes the following general archetypes:

  • Consumer: We utilize the consumer persona to understand health seeking behaviors when individuals are focused on wellness and consumer goods that address health needs, as well as when an individual is comparing health benefits or plans from an employer, or for their self-purchase on an exchange. A consumer’s frame of reference is tilted towards maintaining health and prevention while also considering the financing of healthcare in general.
  • Patient: When individuals are managing either an acute or chronic illness, their focus is on how they interact with the care system to receive cost-effective care. This persona is primarily concerned with questions such as: Who is best able to help treat my condition? Who can perform the surgery required? What is the overall cost of care? What is my share/co-pay? Access to care is also a critical issue, especially in rural areas and depressed urban locales. Patients, especially those with chronic conditions, may also seek out advocacy groups and peer-to-peer networks to better understand their disease and best practices for managing it.
  • Caregivers: Many of us will need to care for a sick relative or friend at some point in our lives and this often results in significant time and financial commitments to adequately meet the needs of the patient. It is recognized that the caregiver economy for cancer alone amounts to nearly $470B annually as well as a primary reason for absenteeism. During President Biden’s campaign he highlighted the need to provide more support for those providing care.
  • Citizens: In the 1990s anthropologists began to notice that there were new social groupings based on a shared biological or medical experience such as Chernobyl (radiation poisoning) and HIV activists pushing for rights to care or new medications. They coined the term biocitizenship, or medical citizenship, to describe this phenomenon. With the rise of mobile phones, sensors and citizen science this trend has only grown in importance. But now we also have conspiracy theories that motivate anti-vaccine ideologies. Distrust in institutions is becoming a factor in how people think about health insurers, the government, and biopharma companies. Rather than sweep this under the rug, we think that this is an important persona or subjectivity to consider, particularly as the politics of data become more complex.

We hope that the combination of our Future of Health IT Map and the Personas Toolkit will be invaluable resources for sensemaking in the healthcare space and that this will inform and inspire new conversations.

Conclusion

Chilmark Research will be introducing our map in later this summer to provide a way to visualize the research we conduct in a map-like format to facilitate brainstorming and strategy development across a very complex field that is impacted by a broad range of technological, social and policy changes. While users of our research will readily recognize the drivers and trends we identify, it is rare to see thoughtful analyses of the differential impacts of these market shifts on different stakeholders. It is our objective that through this map and supporting documentation, organizations of all sizes with a stake in the healthcare ecosystem will find this map useful for their own strategic deliberations.