New travel ecosystems could expand patient access to health care, but self-driving cars that avoid accidents could mean empty emergency rooms. The future of mobility will bring big changes to the health care sector: how should providers, insurers, and others adapt?
Introduction: home and ambulance services
The way Americans seek and receive health care seems to change so often that it's hard to keep up. Providers are taking financial risks for people, are evaluating ways to improve access and outcomes, and are prioritizing the consumer experience.
On the outside, leading to the doctor's office, the changes are likely to be even more dramatic as the way people and things travel from point A to point B moves toward mobility that is ****enjoyable, autonomous and seamlessly integrated. The convergence of these shifts could have a very real impact on patients, providers and more, which could change the way health is managed and communities are organized.
Even as U.S. health care stakeholders react to and plan for a wide variety of challenges and opportunities, they should consider taking into account and capitalizing on mobility trends. Imagine this future:
Demand for trauma care declines as partially and fully self-driving cars become increasingly mainstream and as road crashes decrease;
Client access to health care increases as consumers gain new options with their current health care providers and as health care providers develop mobile networks that allow them to engage with consumers;
The dynamics of the healthcare supply chain have fundamentally changed with the creation of flexible transportation networks and the disruption of existing models, resulting in more efficient supply networks.
Business models are unlikely to remain stable in this new world, and healthcare organizations should start adapting to these changes now. By 2030, more than 10 percent of miles driven in the U.S. could be ****enjoying self-driving cars, according to an analysis by Deloitte.
This paper explores how these changes will occur and how healthcare providers and supporters can position themselves in a health ecosystem based on autonomy and *** enjoyment of mobility. We consider the rapid nature of the changes and their potential impact on healthcare, exploring the ways in which mobility is moving towards a more seamless, integrated and multi-modal future. Finally, we look at the key areas where these changes could most transform healthcare, from fewer accidents to improved supply chains, and examine how health systems can prepare to capitalize on the future of mobility.
The future of mobility
A range of technological and societal forces - including the emergence of connected, electric and self-driving cars and a shift in the way people travel - have begun to profoundly change the way people and goods get around, impacting many industries. Just as the rise of the private automobile has facilitated the consolidation of healthcare,*** hedonic mobility and self-driving cars are expected to drive the next major shift in healthcare. The new mobility ecosystem can support the adoption of decentralized care models and improve on mobility models that have long delivered mixed results for population health.
As these trends evolve, four concurrent "future states" may emerge in a new mobility ecosystem, stemming from the intersection of who owns the vehicle and who operates it (see Figure 1).
Private Driving: In this vision of the future, private ownership remains the norm as consumers choose the privacy, flexibility, security and convenience that comes with owning a vehicle. While incorporating driver assistance technologies, this future state assumes that fully automated driving will not completely replace driver-controlled vehicles.
***HEADLESS DRIVER DRIVING: The second future state of the future sees the continued growth of ****healthy mobility vehicles through ridesharing ****healthy and cars ****healthy. The scale of the economy and increasing competition are driving the expansion of ****shared vehicle services to new geographic areas and more specialized customer segments. As ***shared mobility services meet a greater percentage of local transportation needs, multi-vehicle households can begin to reduce the number of vehicles they own, while others may eventually abandon ownership altogether.
PERSONALLY OWNED AUTOMOBILITY: Autonomous driving technology is proving to be viable, safe, convenient, and affordable, yet private ownership still dominates. Drivers still prefer to own their own vehicles, but seek driverless capabilities for safety and convenience purposes. In the future, highly customized and personalized vehicles will cater to families or individuals with special needs.
***Enjoy Autonomous Driving: the fourth state of the future anticipates a convergence of autonomous driving and vehicle ****enjoyment trends. Travel management companies and fleet operators can offer a variety of passenger experiences to meet a wide range of needs at different price points. This future state will take off first in urban areas and then expand to the suburbs, thus providing seamless mobility across modes that is faster, cheaper, cleaner, safer and more convenient than today.
These four scenarios may co-exist, but the overall trend is likely to be toward a transportation ecosystem that will provide ***shared multimodal mobility that is enabled by ***shared self-driving cars (but not exclusively comprised of ***shared cars). Nonetheless, healthcare organizations and communities should still be preparing for and working on several of these future countries, perhaps simultaneously, each with different implications.
Opportunities for providers with new mobility
Even as the future of mobility evolves, healthcare providers and other stakeholders are investing to improve health outcomes and patient experience. Changes in mobility have the potential to impact healthcare in a number of areas, which are examined in more detail below:
Anticipated reductions in vehicular accidents will impact the need for trauma care
Reduced air pollution indirectly impacts health
Changes in patient mobility may help to address unmet issues
Making clinical supply chains and purchasing Opportunities for more efficient management
If there are fewer accidents, then fewer people will need trauma care
The dominance of driver-driven vehicles places a heavy burden on the healthcare system. In 2012 alone, more than 2.5 million people visited U.S. emergency rooms as a result of automobile accidents, at a lifetime medical cost of $18 billion. Globally, approximately 1.25 million road traffic deaths occur each year. As advanced collision avoidance systems and self-driving cars increasingly hit U.S. roadways, accident rates and the associated financial, social, and health burdens are likely to lessen. 94 percent of accidents are caused by human error, and automakers are counting on self-driving cars to eliminate the vast majority of accidents. Studies have shown that advanced driver assistance features, such as lane departure warnings, can reduce injury crash rates by more than 20 percent. However, as self-driving cars and other safety-enhancing improvements (e.g., connected infrastructure) will coexist with older systems and vehicles***, the realization of safety benefits is likely to be counterproductive. Some researchers predict that road safety may actually worsen in the meantime, but the end result may be safer.
With fewer accidents, the need for trauma care may decline. Car crashes and traffic accidents are the second most common reason for emergency room visits in the U.S., accounting for about 10 percent of all injury-related visits, a figure second only to falls. This may amplify the healthcare industry's focus on promoting overall population health and preventive care. In a world of fee-for-service, reduced demand for emergency room and trauma care services can reduce health system revenues. But if health systems share the risk of total health care costs with payers, they should see some savings from better patient health.
Cleaner air and shorter commutes can improve health.
Besides potentially reducing the most obvious effects of accidents, an increase in the EV fleet could also reduce pollution and its harmful health effects, especially in densely populated urban areas. According to data from about 3,000 cities, nearly 80 percent of the population living in urban areas is exposed to air pollution, much of which can be attributed to vehicle emissions exceeding the World Health Organization's recommendations, which increases the risk of a variety of respiratory illnesses, strokes and lung cancer. In Organization for Economic Co-operation and Development (OECD) countries alone, ambient air pollution - about 50 percent of which comes from road traffic - was responsible for more than 7 million years of life lost in 2010.
The researchers linked commuting, especially car commuting, to sleep deprivation, increased stress and fatigue, even after factors such as age, income and occupation were taken into account. The study also linked long-distance commuting to obesity, poor cardiovascular health, high blood pressure, self-reported tension and negative moods at night. Such a trend allows commuters to let go of the steering wheel each morning and evening to improve their health.
New travel technologies and modes can help address some of these challenges. Analysts expect plug-in electric vehicles to account for 10 percent of U.S. light-duty vehicle sales by 2025, followed by faster penetration rates that can be achieved thanks to falling battery prices, global regulatory changes and synergies between electric drivetrains and self-driving car systems.
Combined with a better integrated transportation network that enables multimodal travel and encourages active transportation, the result could be a reduction in chronic health conditions, such as asthma, high blood pressure, and obesity, associated with long-distance commuting that relies on the internal combustion engine.
With the potential reduction in disease incidence due to pollution, health systems should anticipate potential changes in the mix of patient conditions and care needs, which could affect everything from the number of respiratory specialists needed to investments in oncology. However, because the need for trauma care is likely to be lower due to fewer anticipated incidents, health systems that bear the financial risk of total care costs will benefit financially from lower disease incidence.
Expanding patient mobility improves access
Patient absenteeism remains a persistent challenge for health systems, with appointment miss rates ranging from 18 percent to more than 30 percent in many large clinics, resulting in financial burdens and decreased efficiency. Access to transportation is often a key barrier to care, especially for chronic conditions that require regular appointments. As the authors of a recent meta-analysis on the issue note, "Overall, these studies suggest that lack of or inaccessible transportation may be associated with reduced health care utilization, lack of access to routine care, and missed medical appointments, especially for those from lower economic backgrounds." ?
In the short term, vulnerable populations such as the elderly, disabled or carless would have greater access to health care if carpooling and car ****ing were more common. Mobility companies can partner with health plans and providers to provide specialized transportation services and improve point-to-point and last-mile ****sharing solutions to make critical services more accessible to people living in transportation deserts. In some cases, Medicaid and other insurance programs may even cover such rides. For example, Lyft has partnered with health insurers to provide non-emergency patient transportation, thereby reducing wait times and cost per trip. 21 MedStar?Health, a nonprofit health system in Maryland and the District of Columbia, has a partnership with Uber to allow patients to use carpooling services and set reminders for medical appointments through the MedStar website. Those who don't have access to the Uber smartphone app can call the system's health advocate to arrange transportation.22 (Telemedicine is another way to help close the gap in healthcare management, although it presupposes that patients have access to and are comfortable with connected technologies, such as computers and broadband Internet.
Combining this trend with the power of self-driving cars and connected automotive infrastructure, powertrains, or emerging players could create mobile care units that could optimize the itinerant activities of healthcare professions, dispatching doctors, nurses, and other personnel to remote care sites or patients' homes. No longer needing to be designed to the driver's needs, the vehicle's interior could use other emerging technologies, such as additive manufacturing, augmented reality, and virtual reality, to create powerful, autonomous mobile care units to perform tasks once performed in hospitals, such as 3D-printing customized on-the-spot casts of fractured bones, performing vitality tests, or consulting with specialists.
Health systems at the forefront of supporting better transportation through transit may not only reduce no-shows, but also better coordinate care and provide needed services. The patient experience may also be improved, potentially leading to higher experience scores and therefore not only improved payment for performance, but potentially improved branding in the marketplace.
Mobile technology can help optimize clinical supply chain and procurement
Patients won't be alone in switching from the migration rate after Hurricane Maria damaged a key manufacturing plant in Puerto Rico, and recent nationwide shortages of IV bags underscore the vulnerability of the healthcare supply chain. With increasing access to cheaper, faster and more flexible distribution channels, healthcare systems will be able to deliver clinical supplies more efficiently at lower costs across their provider networks.
Distribution networks powered by self-driving cars can increase the speed and predictability of transportation of goods from provider to patient or supplier. Cognitive technology combined with real-time analytics can dynamically optimize routes and leverage new or underutilized assets throughout the transportation system. Drone technology can help complement the clinical supply chain by providing just-in-time emergency supplies, such as organs.3D printing technology can take this a step further by enabling suppliers to rapidly produce clinical supplies in-house, reducing the cost and time required to procure high-priority and time-sensitive supplies.
New players may emerge as clinical supply chain managers consider shifting their focus to just-in-time production and delivery. For example, Amazon's acquisition of Whole?Foods (28) has begun to lay the real estate groundwork for competing in the $400 billion drug market, and it already plays a sizable and expanding role in medical device supply. The company can leverage its operational expertise to become a key platform for medical device and drug delivery. ***Hedonic mobility services, such as Uber Freight, could help fill gaps in the clinical supply chain.30 Companies have begun experimenting with drone delivery of medicines and other supplies in remote areas of Africa.31 Companies with the scale and expertise in distribution could use these efficiencies and on-demand consumer preferences to begin disrupting the clinical supply chain market.
Changes in travel patterns can reduce the overall cost of care for health systems that work with providers associated with these opportunities. For existing distributors, they risk disruption if they don't capitalize on these possibilities. Companies across the healthcare supply chain should consider how the future of mobility could impact their business models, including potential unintended consequences. For example, if fewer traffic accidents are caused by self-driving cars, the shortage of donor organ supply could worsen. Currently, one-fifth of transplanted organs come from crash victims. Suppliers should start looking now for alternative supply chain solutions, such as 3D bioprinting and other regenerative technologies, to prepare for the eventual reduction.
Strategizing for the future of mobile healthcare
This article suggests four new ways traveling can change the way healthcare is delivered, but that's just the beginning. Many healthcare organizations (including providers, life sciences companies and health plans) are feeling the need to respond to margin pressures and buyer and consumer expectations that they deliver better outcomes and consumer experiences.
Organizations can start by assessing the impact of different future mobility states on their current positioning to identify potential vulnerabilities and opportunities. Some may identify opportunities to apply ****enjoyed mobility and self-driving cars to current strengths (such as a strong physician network or trusted brand name) to explore innovative, low-cost models focused on staying healthy rather than treating trauma. However, this exercise may suggest that organizations must rethink their strategies to remain competitive.
For example, some organizations have taken steps related to this, such as partnering with rideshare companies to bring patients to appointments. Pilot programs such as these, as well as investments in companies testing new models of care, could allow existing health care organizations to explore innovative treatments while meeting the needs of current patients. As organizations consider where to invest, they should strive to understand:
What populations are we committed to serving?
How do we communicate the unique value and price premium of our services to healthcare consumers and payers, as opposed to potentially offering cheaper, more convenient options?
How do changes in mobility alter individuals' behavior as healthcare consumers, their ability to access healthcare, and their health status?
Which of the services we provide may become mobile, move to low-cost care sites, or become unnecessary in the future of mobility?
As healthcare organizations seek to answer these questions and test new healthcare models, the focus should be on the healthcare consumer, with a structured approach to innovation and prototyping, and where robust data-informed decision making is critical. Care delivery solutions should be designed with self-driving vehicles, ****hedonic travel and multimodal journeys in mind. If these technologies are mastered, the pace of change can be rapid, and organizations dependent on incremental change may be overcome by events without even realizing it.
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Translation source: Ralph?Judah, Josh?Lee, Adam?Hewson, Sarah?Slater: New?roads?to?the?health?care?of?tomorrow?
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This article comes from the author of the automobile home car family, does not represent the views of the automobile home position.