1. What is the top challenge or obstacle facing health care today?
Kulleni: I see two major challenges. Reducing waste and improving health equity. Waste makes up about 25% of the $4 trillion the US spends on health care each year. Our existing care models were built around either the location of care (e.g., hospital-based, retail, virtual health), the type of physician (e.g., primary care, specialty care), and the payment model (e.g., fee for service). Over the next 20 years, we expect to see significant changes in the health care business model that will slash much of this waste. We expect hospitals will be smaller, more specialized, and used for complex surgeries and emergency services. More routine procedures will take place in outpatient facilities, retail locations, or even in the patient’s home. At the same time, improving health equity could have a significant impact on quality, outcomes, and costs of health care. Addressing issues such as systemic racism, bias, and drivers of health (factors outside of health care that impact one’s health like food insecurity) could help someone access needed care.
Kim: I agree that there is a need to reduce waste. Another challenge is tied to our continued drive towards precision medicine. Health and science organizations often have access to vast amounts of clinical, research, biospecimen, and patient-reported data and they are trying to determine how to make that data meaningful. How can big data, analytics, data science, and research platforms be used and utilized to develop more effective precision therapeutics and get them to patients faster? Turning the vision of precision medicine, underpinned and supported by currently disparate data sets, into a reality is a huge piece of the puzzle.
2. What does the health care sector have to gain by addressing health equity?
Kim:Racial equity, including health equity, is a priority for the Biden administration. In an executive order in January, each agency was asked to determine if any of their programs or policies perpetuate systemic barriers to opportunities and benefits for people of color and other underserved groups. There is momentum in the federal sector and in the commercial sector to change the status quo. When we don’t address health equity, what we tend to get is higher costs and more waste because we are treating individuals when it is too late to have meaningful interventions in their health. For many, this is a topic that has always been on their radar, but it really hasn’t been prioritized until now.
Kulleni:When I was working as an ER physician, I saw the manifestation of health inequities through individual biases, structural biases, and barriers to care. Some patients received a different level of care based on their race, ethnicity, or gender. The COVID-19 pandemic highlighted many of the health inequities that Black, Latinx, and other ethnic minorities have experienced for years. Before we can improve health outcomes, we should first address health inequity. Health inequity is especially apparent along lines of race, with Black, Indigenous, and People of Color (BIPOC) experiencing barriers that lead to poorer health overall when compared to white populations. There is also an opportunity for health care and life sciences companies to improve health equity within their organizations. If you don’t have different groups represented in leadership and throughout the organization, it can be difficult to design equitable therapies, equitable products, or equitable services.
3. What has you most optimistic about the future of health care?
Kim: The pandemic exposed broad inequities in health care, which has allowed for a more open and thoughtful dialog on this topic. I’m optimistic that this tragedy will lead to meaningful change—whether that is for veterans or the unhoused or people from at-risk communities. We are seeing a lot of enthusiasm and investment in the things that matter most to the people and the communities we serve. I envision a future that is rooted in both precision care and equitable care.
Kulleni: We are on the cusp of a digital revolution where technology can make it possible to identify disease long before symptoms surface or prevent disease altogether. At-home tests, apps, mobile devices, and related technologies are giving consumers new ways to diagnose, monitor, and manage their health. The data generated by devices on our wrists, our fingers, embedded in our clothes, or even in our bodies can provide unprecedented real-time insight into our health and well-being. We already have smart watches that can detect heart arrythmia, skin temperature, sleep patterns, even blood-glucose levels. Stakeholders are already beginning to focus on digital literacy, embedded bias, and infrastructure inequities. That could help reduce health inequities related to technology. With these considerations in focus, I am very optimistic about the direction health care is headed.
4. What does health care disruption mean to you?
Kulleni: Health care consumers, who are armed with technology and detailed data about their health, have enormous potential to disrupt the existing health care business model. Access to extensive external databases and digital decision-making tools could help them make routine diagnoses and treatment decisions with the same precision as a highly educated physician. Consumer-empowerment could be a disruptive force. The next step is to disrupt the existing treatment model. A patient with a sore throat, for example, might use a $2 home test to confirm a strep infection. Getting an amoxicillin prescription, however, still requires the patient to schedule an appointment with a doctor, travel to the office, find a parking spot, and sit in a waiting room (often among coughing and sneezing patients). This outdated model has typically been driven by the belief physicians need to protect the individual from themselves and the care delivery system. But this system is inefficient and typically adds cost, rather than value, to the system.
Kim: I agree with Kulleni about the disruptive role the empowered consumer will play. The health care system has historically been paternalistic. People generally didn’t know much about their health or the variables that might influence their health, and typically went to the doctor only when they were sick. The doctor was seen as an all-knowing person who explained what was wrong and what to do to treat it. Today, we are moving into an age where people have more access to their health data, and they understand their health status. They participate more holistically with their care team as shared decision makers. As a consumer, there are a lot of health factors that I can test or measure from home. An individual can test their A1C and monitor their diabetes or pre-diabetes. We can check blood pressure every day and share that information with a physician. Many of us wear watches that allow us to have simplified EKGs and monitor for atrial fibrillation. Increased understanding of genetics, genomics, and personalized medicine can further disrupt the existing health care model. Federal agencies will likely have a role in determining how to manage these disruptors and regulate these new areas while ensuring patients are safe and that their information is protected.
5. What motivates you to keep doing the work that you do?
Kim: My father died of cancer when I was 12-years-old. Within a year after being diagnosed…he was gone. I realized at a young age that there is a need to do things better and faster in health care. Each of us is a potential patient or a potential caregiver. The impact of getting health care right in this country is astronomical from a cost perspective and a human perspective. I probably became a scientist because I lost my father at such a young age. I have a Ph.D. in virology and have been able to spend time with some of the leading experts in various science and health topics. There is tremendous power in bringing together this knowledge and expertise, and I realize what we can accomplish, and the suffering we can prevent, when we put all of our collective knowledge and insight together.
Kulleni: As a former ER doctor, I can attest that there is nothing more inspiring or rewarding than intervening in someone’s life when they are in dire need of help. Many of the patients who came to the ER were repeat customers, and my team and I team performed the same invasive and intensive treatments. Many of these patients wouldn’t have wound up in the hospital if they had received the right upstream interventions. As a consultant working with hospitals, I’m motivated to see them embrace the vision we have for the future of health. Over the next 20 years, we expect that the definition of ‘health’ will be much broader than it is today. It will include mental, emotional, social, spiritual, and financial well-being, as well as physical health.