Healthcare trends for 2021
Three areas to watch as America braces for a COVID cure
Forecasting healthcare trends for the ensuing year in standard times usually considers examing the current focus’s effect while balancing future needs. But we do not live in normal times. Forecasting during a global health pandemic is driven by one constant need: a safe, effective coronavirus vaccine delivered to a massive population. COVID will continue to be a massive demand for 2021, but two other major areas will most likely emerge — one that affects how healthcare is delivered, the other on how care is administered.
The cure for COVID
This week, news broke that Pfizer’s COVID-19 vaccine is more than 90 percent effective was initially met with excitement and optimism. The headline was promising, delivering almost full prevention of symptomatic illness. However, the full details of the study analysis have not yet been released. This void has left scientists and physicians with questions on the individuals enrolled in the testing. What were their ages and backgrounds? We know that the virus produces the most risk for children, pregnant women, those with compromised immune systems, pre-existing conditions, co-morbidities, and seniors. Would this vaccine also be effective in protecting against possible reinfection?
One win for the Pfizer vaccine trial was that this uses new messenger-RNA (mRNA) technology. This delivery system trains the immune system to target the “spikes” (spike protein) of coronavirus versus using a small dose of the virus to allow the body to fight and overcome the infection. Much of what we have learned about mRNA vaccines comes from research on cancer, where the oncology field uses tumor mRNA to activate the body’s T-cells (part of the immune system) to destroy cancer tumors. Researchers in this area admit that there are many unknowns in mRNA, like whether these vaccines can trigger a strong and safe immune response in humans that doesn’t produce side effects like inflammation or aggravate the infection.
The hope in the coronavirus research is that mRNA would turn the healthy body cells into hunters, almost an anti-virus force preventing those receiving the vaccine dose from becoming infected with SARS-CoV-2, the virus that causes COVID-19. Another sign of encouragement with an mRNA vaccine is that it is easier to mass-produce than traditional vaccines. Scientific experts estimate just a few months instead of the standard 1-2 years for manufacturing.
Lost in the excitement of the first COVID vaccine candidate’s advancement to market where the challenges with the distribution issues. For one, the Pfizer vaccines must be administered within five days after being thawed from their subzero storage temperatures. If not, the shots go bad. This creates a logistics challenge, not only in creating a deep-freeze storage/transfer network to transport the drug but also vaccination centers that have the proper storage equipment. The World Health Organization has stated their goal to raise almost $20 billion to purchase vaccines for poorer countries. Even with assistance funds, there will be many areas that cannot afford to build proper facilities or are simply too distant for safe, reliable transport. Moderna, one of the many other possible COVID vaccine candidate drugmakers, shared that it expects to have news on the data of the first analysis of its testing by the end of the month. As the picture clears on the effectiveness of possible vaccines and how the drugs are adminstered, we can understand the point made by health experts that there will mostly be multiple vaccines for COVID.
New healthcare horizons
Searching for the possible silver lining during the pandemic points to the expanded role of technology in healthcare. “This will be a growing part of how we bring care to more people,” states Dr. Connor Healey, a board-certified cardiologist with Capital Cardiology Associates. “While telehealth is great for primary providers, it can be a challenge for specialty physicians. In cardiology, it’s difficult to provide virtual type meetings without having access to EKG or vital information on patients if they are at home.” However, like many healthcare providers in the United States, Capital Cardiology shifted our focus to include virtual visits as an option for patients during the pandemic. This will continue to grow as telehealth services improve to include features like Bluetooth stethoscopes and diagnostic equipment that can be administered by a technician or provider working with the patient and simultaneously reviewed by a physician connected at a remote location.
Mobile health has emerged in the form of wearable activity & fitness trackers and remote monitoring, which offers physicians and healthcare providers the opportunity to watch patient health data in real-time. Mobile health also incorporates Health Apps, user-centric programs, and software installed on smartphones, tablets, and wearables that connect a vast amount of data into one reporting module. The Apple Health app, for example, takes information from devices and displays them in one place. We live in a time where your healthcare provider can quickly glance at the Health app on your iPhone to get information on changes in your activity, cholesterol or blood pressure, or sleeping patterns.
The downside of collecting health data is privacy and security issues. Many legal experts predict that with integrated data collection, like the Apple Health app, the same devices used in smart home technology to turn on lights or the heating and air conditioning place our data at-risk to hackers. As it is referred to by tech giants (Apple, Google, and Microsoft), Big Data puts millions of personally identifiable health records on servers and storage devices out of reach of the individual user. The collection and usage of this user’s data will continue to be a legal and policy concern until there are clear regulations on how much medical information is covered under user agreements in the fine print on the apps and devices we use. American consumers are pushing for more control over how our data is used, who has access to it and want to be able to make decisions on how a company can interact with us in advertising and marketing generated from using their product.
While the Affordable Care Act (ACA) is the law of the land, there continue to be legal challenges on the largest healthcare legislation that impacts over 23 million Americans. Currently, the future of the ACA is before the United States Supreme Court in the case California vs. Texas, an argument to overturn the ACA in its entirety. “That will have long-term consequences beyond the presidential election cycle,” pointed out Dr. Healey. President-elect Biden called for building on the ACA during his recent campaign, vowing to continue to give Americans a public option to affordable health insurance, increasing tax credits to lower premiums, and expand coverage to low-income Americans. “It’s imperfect; I get that. There are a lot of bipartisan accomplishments that everyone agrees on. Allowing young people to keep their parents’ coverage until they are 26. Eliminating pre-existing conditions. Problems with transparency in health care plans and coverage. These are all excellent moves. I don’t see any strong impotence to change them. If you make the ACA in general illegal or reverse it, you are rolling back those advances. Furthermore, what is the alternative plan?”
Ultimately, the future of healthcare in 2021 and beyond revolves around offering patient-focused care that improves health and quality of life. As a physician engaged in actively improving his patients’ outcomes, Dr. Healey points to an important lesson he learned during the COVID pandemic. “Social determinants of health should not be barriers to healthcare. Many of us see this on a day-to-day basis and can at least enact some form of change, even if it’s just simply having the conversation. If we are still having this talk in ten years, then what have we done?” The entire healthcare system is committed to advancing awareness and education initiatives that create healthier citizens and communities. From adding sidewalks in our neighborhoods to smoking cessation programs to promoting annual health visits and flu vaccinations, public health officials, healthcare providers, and health insurance are investing resources in creating value in individual citizens taking an active role in their daily health.