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Three more predictions for you today. Sometimes predictions are easy, follow the money or lack of it. 

 The pandemic exposed business models that are too reliant on a single stream of revenue. In healthcares case it was Fee for Service models. What does that mean for 2021?

The Teledoc/Livongo deal was pretty spectacular. What drove that valuation? What can that tell us about where value is going to be created in the Health Tech space?

Equity was a major theme at the JP Morgan conference. How could it not be. What is one area where equity in healthcare can make progress by writing a check? Not only healthcare but education as well. Where will the federal government invest? 

I share my thoughts on Today in Health IT, but I'd love to hear your thoughts below. It's your turn to make a prediction.


This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Today in Health it, the story is predictions part two. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. I wanna thank our sponsor for today's Sirius Healthcare. They reached out about this time last year and said we'd love what you're doing and really appreciate your mission to develop the next generation of health IT leaders.

The rest is history, as they say. If you believe in our mission as well and wanna support the show, please shoot a note to partner at this weekend, health Alright, now onto today's story. You know, yesterday I shared my first round of predictions, and if you haven't heard those, you can go back and listen to the yesterday's show.

Uh, today I'm gonna get out there a little bit more and I'm gonna, uh, you know, uh, take some of the trends that we're seeing and make some, uh, I don't know, let's just say swing for the fences, kinds of predictions. So let's start with the first one. The first one is the Race to the home really heats up.

You know, we're gonna be in our homes for most of 2021, which was longer than most of us anticipated, and it's creating a new set of habits. Fee for service was exposed last year as a dangerous business model during a pandemic, and, and really a Biden administration for that matter. Uh, health system boards are looking at diversification.

They want a revenue stream. Every other industry has figured this out. Wall Street rewards this. I mean, you're seeing this today with, uh, Disney stock. Disney has a, an ongoing revenue stream as opposed to the parks, which is sort of transactional. They have an ongoing revenue stream now, uh, through their Disney Plus.

And you also have, apple has figured this out. So Apple has an ongoing revenue stream and you see their valuations just continue to climb. So you have that going on in, in, in all the other industries. And in healthcare, what it looks like is, uh, value-based care capitation or risk-based arrangements are the key words that you're gonna need to remember.

It's a moniker for taking the health risk of patients in exchange for a monthly revenue stream, you get paid on outcomes and, and keeping people healthy. These arrangements flip the economics of healthcare and it changes how care is delivered. You know, stay in contact with a patient as opposed to, uh, waiting until they need you.

You're trying to keep them healthy and prevent incidents. This has already driven up the valuations. People talk about a, a frothy market, but the Livongo deal with Teladoc was beyond frothy and it was driven by this trend. Best Buy is a healthcare company that, that also happens to sell appliances and electronics.

They've repurposed their geek Squad to set up hospital at home, and, and they're, uh, making investments in health home monitoring companies. Think about that. Best Buy the healthcare company. This will drive investments into the market. Innovation is going to follow, uh, someone is gonna figure out that the existing health system is not prepared for this change, and they're going to explore standing up an arm that just delivers home care.

And remote patient monitoring. Uh, you know, this is more than just four docs in a bunker with, with some monitors. This is a practice of docs that specializes in home care being delivered through digital tools. This could be what, uh, mercy and Intermountain have in mind when they set up their, their, uh, digital hospitals.

That really remains to be seen. Uh, there are a couple of predictions here. You just, if you just weeded through all of the things I just said, you know, the home becomes the new locus of care. Uh, investments are gonna follow in a big way. We're gonna see crazy amounts of money chasing this. So there's a couple of, uh, predictions right there.

Uh, a health system is going to step up and create a, a home practice. And, uh, so we're gonna see a, a handful of the, of the leaders get out in front of this. And I think another one, a prediction that you could take from this is there's gonna be a lot of health systems that get dis intermediated even further when they can't do this effectively.

And some third party steps up in their market. Um, okay. So, you know, there you go. That's, that's the first one. And the first one is that, uh, the, the race to the home heats up in healthcare. Alright, for the next prediction, if you think that one was too safe, I'm gonna swing for the fences a little bit here.

Uh, I'm gonna talk about the, uh, dis mediators who are coming into the market. You know, Walmart's strategy is pretty well known. Uh, they're in the scaling phase of theirs. CVS is pretty clear as well. There's really no need to predict anything there. Um, and we're gonna take a look at the wild card, which is Amazon.

But first let me just touch on those first two a little bit. You know, the, the Walmart and CVS are lead leading the death by a thousand cuts strategy to healthcare. Neither one of 'em wants the high acuity care. The hospitals can have the high risk, high margin business. It's, it's theirs, it's yours. I. Uh, you know, it's all the other profitable stuff that they continue to be targeting and going after.

You know, they really see their strategy as getting in between the consumer and, and the high acuity care. They're gonna manage that care. They're gonna manage the day-to-day. They want, I. The transactional part of the business, and it really doesn't matter to them if it's a digital or physical play, although what we're seeing them do today effectively is start to build out the, the, uh, the physical play.

CVS delivered, you know, more tests than anyone else in the country. They're gonna probably do more vaccines than anywhere else in the. Walmart is scaling up their, uh, you know, we used to have their clinics in the, uh, in the Walmarts themselves, and now you're seeing them in the parking lots and their full scale buildings that are designed to best practices.

I mean, you have everything. You have dental, you have mental health, you have imaging, you have lab, you name it. Primary care, obviously you have, it's all in that building. Plus, I think you're gonna see CVSs is already a payer. I think you're gonna see Walmart, uh, enter that space as well. That takes us to Amazon.

What is Amazon going to do? And again, this one's a little out there, but I, I want to, I want to get it out there and start talking about it. And I think that, uh, this year you're gonna hear Amazon, uh, start, you're gonna hear rumors and you're gonna hear, uh, rumblings that Amazon is gonna start talking about an insurance option that is an insurance option that they can sell.

I don't know if they'll do it through partnership. It, you know, . They'll explore a lot of different things, but I think that's what you're gonna hear them talk about. I think they're gonna get into the commercial care business in the next couple of years. I think this is a natural next step for a company that is building out its Amazon care model for its employees.

You know, they're not gonna get into the market until they're ready, which may not be until 2023. But it is the trajectory that they are on. They first have to, you know, scale the Amazon care model for their employees and, you know, so what is Amazon Care? It's, it's really a combination of digital tools, uh, partnerships, analytics, and uh, concierge service.

Let's say it's those things, right? It's, it's going on your phone, making an appointment with a doctor, the doctor actually showing up at your place of work and, uh, providing care, prescribing drugs, whatever. Uh, it, it really is a concierge level service for, uh, employers and large employers. So when Haven broke up, everyone's like, oh, that's the end of Haven.

The promise is gone. Uh, I, you could read it that way. I, I read it as, uh, uh, you know, an impossible combination of, of three different cultures. And what you're seeing is the real innovator of this group, Amazon continue to push this forward. I think once they scale the Amazon care practice, uh, they're gonna seek to sign on corporations and small businesses to gain scale in markets around this, what I think is a, a fairly lucrative business.

Amazon isn't the player that providers and payers have to worry about today. But that doesn't keep them off the threat landscape. They are clearly on the threat landscape going forward, and not only for providers, but also for payers. Alright, let's close this out with a quick one and this one's a little bit more down to earth.

I actually talked about this yesterday on the, this week in health it, uh, Newsday show, so you can hear it there as well. And it, this is really about the digital divide. The digital divide was exposed last year, . In a new way, and I think in 2021, you're gonna see the federal government step in to address this, and it's gonna be couched in conversations around equity and, uh, fairness and um, and access and those kinds of things to education and healthcare.

The digital divide was, uh, horrific in 2020. I mean, we sent all these children home. To take classes online from home only to learn that, uh, many did not have broadband and many did not have computers to access that broadband. And they were encouraged not to go to the local spots where they would normally go to get broadband on their phones and whatnot.

So you have the, the divide really showed up in education. The divide also showed up in healthcare in that a lot of the calls were not connected. And there was challenges with getting to rural areas and during a pandemic that is, uh, that, I mean, that's a serious gap that exists. So this is gonna be elevated to a national conversation.

I think it's gonna be funded through infrastructure projects. If there is a major infrastructure project, which I believe there will be in 2021 or 2022 coming out of this administration. I think it's gonna have a significant digital component to it, a a significant build out, and that will address some of the aspects of the digital divide that exists today.

To be honest with you, I don't know how somebody functions in today's society without the digital tools in broadband that are necessary to look for a job that are necessary to find the best care that are necessary to, I don't know. I. Talk to your teacher online. So I think this is something that as a nation, we will address in the next two years.

Those are my three predictions for today. Race For the Home, heats up. Amazon is start to herd, talking about insurance and getting into that market, and the federal government addresses the digital divide. That's all for today. If you know of someone that might benefit from our channel, please forward them a note.

They can subscribe on our website this week,, or wherever you listen to podcast Apple, Google Overcast, Spotify, Stitcher. . You get the picture wherever where we wanna thank our channel sponsors who are investing in our vision to develop the next generation of health IT leaders, VMware, hillrom, and Starbridge Advisors.

Thanks for listening. That's all for now.

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