The Rapid Expansion of DTC Healthcare

Preventive care is recognized as the most effective strategy for health care cost reduction. Screening for early signs of heart disease, cancer, maintenance of diabetes and allergies and prevention of infectious diseases can be done without a supervising physician. Direct-to-consumer (DTC) laboratory testing allows individuals to order tests directly from a laboratory without going through their healthcare provider, and often at lower cost. The number of companies providing direct-to-consumer diagnostic testing is rapidly growing, along with the range of health information provided by these tests. Ancestry (genealogy) testing is an example. And so are new devices for cardiac monitoring. 

Experts anticipate a near-term explosion in the DTC marketplace. DTC healthcare already was a US$700 billion industry in 2020, including over-the-counter drugs. The Mark Cuban Cost Plus Drug Company, PBC (MCCPDC) is nearing one million customers. An analysis of 2011-1019 records from Rock Health Digital Database, showed that 252 (21%) of 1214 digital health companies pursued a direct-to-consumer strategy. The pandemic has accelerated this growth. According to research by Deloitte, the number of people using virtual healthcare rose from 15% to 19% from 2019 to early 2020, then jumped to 28% in April 2020. On average, 80% were likely to have another virtual visit, even post COVID-19 and said they will use this type of care again. Latest data showed that consumers’ appetite for virtual health and digital health tools continued to steadily increased, although there was significant variation in physician adoption. 

Human touch remains central to care delivery. In the 2022 Deloitte Survey of US Health Care Consumers, 70% of respondents who had a virtual visit in 2022 (vs. 67% in 2020) thought that the quality of virtual care was as good as in person, but only 73% (vs. 82% in 2020) thought they were able to connect with the clinician the same way they would in-person. Integration of data from patients' wearables and their self-reported outcomes into health records also experienced a setback. 

The global market for Direct-to-Consumer (DTC) testing was predicted to grow from $1.4 billion in 2020 to $2.6 billion by 2025. There were cautionary cases of uBiome and Theranos, there are quackery labs, but as the industry matures and moves toward utilization of clear clinical metrics, and as the capabilities of technology advance, DTC testing will me more and more impactful. There are DTC companies that offer the tests and biometric screenings that a physician would typically order as part of a routine annual physical, such as a complete blood count, comprehensive metabolic panel, urinalysis, and cardiovascular and diabetes risk assessment. Ultalabs, JasonHealth, discounted labs, drsays and privatemdlabs all allow to self-order laboratory tests and Quest and Labcorps locations. 

No more uncomfortable questions for a blood test prescription. No doctor visit needed to gettest results - they will be emailed instead. Consumers pay up front and know exactly what they are paying for. Unfortunately, the same cannot be said for many other healthcare services.

Genetic counseling for patients who are pursuing genetic testing in the absence of a medical indication, referred to as elective genomic testing (EGT), is becoming relatively common. More people are using technology to monitor their health, measure fitness, and order prescription refills. Before COVID-19, there was a slight decline in people who were willing to share their health data—but during the pandemic, new data showed that people are more comfortable sharing data during a crisis

REFERENCES

Cohen AB, Mathews SC, Dorsey ER, Bates DW, Safavi K. Direct-to-consumer digital health. The Lancet Digital Health. 2020 Apr 1;2(4):e163-5.

Stoffel M, Greene DN, Beal SG, Foley P, Killeen AA, Shafi H, Terrazas E. Direct-to-Consumer Testing for Routine Purposes. Clinical Chemistry. 2022 Sep;68(9):1121-7.

2022 Global health care sector outlook | Deloitte

deloitte-nl-healthcare-consumer-centered-future-of-health.pdf

https://www.beckershospitalreview.com/lab/lab-test-market-shifting-from-provider-driven-to-consumer-driven.html

Technology 2018

2018 should be very exciting for science and technology. 

Recent years were filled with groundbreaking projects and the stars may be aligning for something really big, driven by advances in software and hardware.

Danger, Will Robinson!!! or injury prevention with sensors and algorithms

Health is determined by many factors including:

• Behavior (Physical Activity, Eating habits, Tobacco or substance abuse, responsible sexual choices, etc)
• Mental Health 
• Injury and Violence 
• Environmental Quality 
• Preventative measures such as immunization 
• Access to Health Care

All these factors are quantifiable, predictable and preventable. Injuries are most likely to be  perceived as “accidents” and “acts of fate”,  but they depend on the same determinants as other health factors: individual behavior, social and physical environment.  The likelihood of injuries -  unintentional ones and those caused by acts of violence - can be computed from physical location (estimations for USA¹ are a good example), gene-environment interactions², prior medical history, and physical traits³.

There are many ways to prevent injuries - just say "no" to risky behaviors, wear preventative gear while playing sports or fall-optimized shoes for elderly, watch out for others engaged in similar activities... Yet, sometimes we forget to watch, don't have access to histories of others or get diverted.  Would a body sensor or a gadget with smart software be able to warn us about potential accidents ahead to help prevent accidents?  What would it need to measure?

Software and devices automatically detecting and reporting accidents already exist:

Halo Monitoring's fall detection system, for example,  consists of a chest strap and belt clip with motionOnStar or mbrace that "intelligently integrate the driver, the vehicle and the environment" - capabilities such as this will be provided in the area of next-generation health management systems like Aurametrix.
sensors, heart rate and skin temperature monitors. Although the system detects falls only after they happen, a study showed that just the fact of wearing it increases alertness of seniors and reduces the number of falls. Although fall detection systems are not as advanced as telematics for cars - like
Unprecedented accumulation of data  - such as snapshots of driving behavior or 1.2 million person-years of hip fracture observations (Kanis JA) allows development of smarter software able to predict injuries.  Logistic regression models (Kononen et al., 2011) predict seriousness of auto accidents,  first-principles mathematical models (such as AHAAH for the ear) connect forces with injuries, neural net and other data mining approaches foretell which juvenile offenders are likely to return to crime (source of  "intentional injuries"), or allow to calculate risk of fractures based on milk intake, personal history of accidents and body mass index. Self-quantifiers such as René Ghosh are able to figure out how to use their own data to predict future injuries. Using simple math (Riegel equation bringing all running logs on to a comparable level) and trend analysis, he tied his accidents to wanes following waxes in running performance. Researchers keep refining the variables predicting injuries.  Swanenburg et al., for example, predicted multiple falls for those with a history of multiple falls (odds ratio, 5.6) and use of multiple medications (odds ratio, 2.3). And there is another simple measurement of standing position helpful in prediction. Frequent fallers, indeed, have a narrower stance width than non-fallers.


In the always-connected smart-sensor-equipped future, things such as Intel's magic carpet - picking up the weight, angle and pressure of steps - will be a commodity. Gene tests predicting injuries will be integrated with data coming from our carpets, clothing, footwear and location information. And this may be sooner than you think.


References

1. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS); 2010 Mar 4 Available from: http://www.cdc.gov/injury/wisqars/index.html

2. Husted JA, Ahmed R, Chow EW, Brzustowicz LM, Bassett AS. Childhood trauma and genetic factors in familial schizophrenia associated with the NOS1AP gene. Schizophr Res. 2010 Aug;121(1-3):187-92. PMID: 20541371

3. Swanenburg J, de Bruin ED, Uebelhart D, & Mulder T (2010). Falls prediction in elderly people: a 1-year prospective study. Gait & posture, 31 (3), 317-21 PMID: 20047833

4. Kononen DW, Flannagan CA, Wang SC. Identification and validation of a logistic regression model for predicting serious injuries associated with motor vehicle crashes. Accid Anal Prev. 2011 Jan;43(1):112-22. PMID: 2109430

5. Price GR. Predicting mechanical damage to the organ of Corti. Hear Res. 2007 Apr;226(1-2):5-13. Epub 2006 Sep 15.PMID: 16978813

M-health, or who will take care of me?

What is the real way to reform Health? asks Eric Wahlgren from DailyFinance, and answers 'Wireless Technology'. The coming convergence of wireless communications, social networking and medicine will transform health care agrees The Economist.

Wireless health (also called mobile health, e-health, m-health or telemedicine) will enable your body parts to make phone calls, your shoes or carpet to consult your doctor , your bed to measure your blood sugar and your phone itself to decide on whether your mental health is deteriorating - based on how quickly you answer the phone and recognize the caller.

No more lies on how much you ate or when you took your last pill. If your heart and other organs are not yet monitored by smart devices, your doctor will listen to your lungs over the phone or check how your knees are doing in 3D.

We are shifting to digital medical era starting from the relatively modest devices to keep you healthy and fit, evolving teletracking, technology, M-health sensors, Telemedicine tools and gadgets, Health 2.0 software tools, and algorithms for health data mining.

There is far more than a list of 101 things to do with a mobile phone in healthcare first compiled a year ago - including simple SMS messaging and GPS-based applications such as Medication Reminders (SMS) and Allergy Alert Service For Asthmatics (SMS and GPS), management of Chronic conditions such as Diabetes, hospital based RFID and the use of technologies such as Bluetooth and ZigBee in health and fitness monitoring.

It's time to take health care off the mainframe says Intel's Eric Dishman in his talk on
behavioral markers, vital sign monitoring and aging care delivery: