Insights on how future trends may impact society in the next decade
Predictions on how future trends may disrupt the healthcare industry
Healthcare Horizons offers a view into the future. To better understand how current and future trends may impact society in general and healthcare specifically, a number of KPMG subject matter experts were interviewed for this thought leadership content. Based on these subject matter expert views, external sources and KPMG healthcare professionals’ experiences and insights working with governments, payors and provider organizations around the world, five trend categories have been identified: technology and data, consumerism, workforce, communities, and environmental, social and governance (ESG).
The health sector has often been portrayed as slow to change, and in some cases this is true. Yet if one looks at the last couple of decades, many major transitions have occurred: a shift away from paternalistic medical culture; more intelligent electronic health records; dramatic declines in length of hospital stays; flexible workforces with more diverse skill mixes (e.g., physician assistants and specialized nursing cadres); and increased focus on work being performed at the top-of-practice. The pandemic catalyzed an even greater acceleration of change, sparking wholesale shifts toward digitally delivered care, community-driven support models, new population health surveillance techniques and mass public participation in clinical trials.
However, there is now a serious risk that healthcare systems will return to ‘business as usual,’ taking a conservative and incremental approach to transformation. This may even feel like the right thing to do, at least in the short-term: healthcare professionals are exhausted, budgets are tight, and so much change has already taken place over the last few years, but this inclination must be resisted. Waves of crises surging towards the sector mean that rapid transformation should be embraced as the ‘new normal’ in healthcare. Anything less risks leading organizations down the path towards undesirable ‘alienated’ or ‘impoverished’ scenarios.
To do so, healthcare systems should harness the power of future trends – developments that are expected to profoundly impact every industry over the next decade. Understanding and preparing for the following five key areas of change will be critical in guiding healthcare systems towards an inclusive future.
Technology and data
- Web 3.0 will bring about the decentralization of data on the internet, with power shifting to citizens
- The metaverse will create new spaces for organizations to transact and engage
- Widespread adoption of cognitive technologies (e.g., machine learning, natural language processing, speech recognition, and robotics) will facilitate seamless interactions between humans and machines
- Artificial intelligence (AI) will continue to mature, liberating workers from routine tasks and enabling greater innovation
- Increasingly complex digital twins will allow individuals and organizations to accurately simulate and predict the consequences of real-world decisions
- Demand will increase for seamless, personalized and omnichannel experiences
- Ecosystems will be consumer-centric rather than organization-centered
- Markets will converge and consolidate
- Digital platform-based consumption will become widespread
- Movement towards employee-centric organizations, in which wellbeing and employee-driven innovation are seen as vitally important
- Micro-credentialing will enable more focused skill development and accreditation within more flexible workforces
- Borderless delivery of local services will be supported by digitally enabled workforces
- Communities will be activated in addressing complex societal challenges
- Community partnerships will rise to address societal challenges
- A trend towards localism will be accompanied by, and facilitated by, the rise of global platforms
Environmental, social and governance (ESG)
- Emergence of an integrity-based economy in which people demand organizational accountability and transparency on governance, and environmental and social impact
- Increased pressure for all organizations to reduce climate impacts and carbon footprints
- Access to new sources of capital will be contingent on performance against ESG indicators
Future trends and their predicted impact upon healthcare
Digitalization is radically transforming the way people interact with the world around them. This trend will likely accelerate over the next decade with the emergence of Web 3.0. This can be thought of as the upgrade to the internet, where the current ‘read and write’ model will be replaced by a ‘read, write and own’ model, making it more democratic and increasingly decentralized. A key part of this new internet will be the metaverse, which will make it possible to experience a ‘phygital’ world, where physical and digital realities collide, creating a borderless realm that has the potential to enhance people’s lives by providing new opportunities to work, learn and play through the use of virtual and augmented reality.
We can expect to see digital transformation touching every aspect of the healthcare ecosystem in the coming years, from patient experiences to clinical and operational systems, to the skills and culture of healthcare workers. But in order to move healthcare systems towards an inclusive future, technology must be seen as a means to an end, not an end in itself. Technology will transform healthcare for the better where it empowers individuals to take charge of their own health, where it liberates healthcare professionals from routine tasks and allows them to focus on their patients, and where it enables community-driven action to address health inequities and tailor services to the needs of communities.
Prediction: Health data will be decentralized, coveted and traded by individuals, including by patients
There will be an explosion in the volume of data generated by health organizations and individuals well into the next decade. This will likely be driven by two key factors:
- Increasing cognitive capabilities enabling more natural and intuitive interactions between humans and machines, such as natural language processing systems to automatically convert patient interactions (in person, virtual or written) into coded medical records.
- Increasing utilization of remote monitoring and wearables by consumers and health organizations.
The distinctive feature of an ‘inclusive’ healthcare scenario is how data is stored and used. Instead of health data being harvested and monetized by private organizations, new technology will empower individuals and communities with greater control over their data.
Individuals will be able to store their health data from multiple sources in personal online data stores (PODS). These decentralized forms of online data storage will offer greater levels of security, privacy and control for individuals. PODs will also offer a solution to healthcare providers, alleviating the issue of interoperability between systems and the burden of protecting huge quantities of patient data.
Individuals will likely have the opportunity to pool their data in decentralized autonomous organizations (DAOs). These member-owned and led organizations allow virtual communities to control what happens to their data democratically through a system of discussion and voting. DAOs can choose to trade or monetize their data, use their data to improve health outcomes and/or to address health inequities, in accordance with the wishes of their membership.
The ability to pool large amounts of data, along with emerging techniques such as speech-to-text and machine learning, can allow health organizations to derive new insights into activity, vital signs, and wellbeing. This will create a step change in health organizations’ ability to forecast, predict, segment and target care. Quantum computing and digital twins (virtual representations of patients) will be used to predict and prevent diseases, identify complications and refine and tailor treatment options. Pooled data and the technologies discussed in this section are also likely to accelerate and reduce the cost of clinical trials and research – quickly leading to a shift from insights about what works for cohorts of similar patients into truly individualized diagnoses and treatments.
Signal of change:
In Israel, Kahn-Sagol-Maccabi (KSM) is the research and innovation center of Maccabi Healthcare Services, one of the country’s HMOs. Given that the HMO started using EMRs more than 30 years ago, provides KSM with a high-quality data set that includes stable and longitudinal demographic patient data (including lab results, clinical visit records, pharmacy purchases, scans, images) and 750,000 bio bank samples.1KSM uses big data and AI technology and partners with academic institutions, pharmaceutical and tech companies, and startups to discover research and medical breakthroughs such as research on naturally acquired COVID-19 immunity,2 and work to develop personalized AI-based therapies for depression.3
Prediction: A significant amount of healthcare will be delivered remotely, with the use of hospitals restricted to acute and emergency treatment
The step change in the use of data driven care will be accompanied by a similar shift in the use of technology, as more devices currently housed in hospitals will be adapted for home use. The use of virtual wards will likely become commonplace, allowing healthcare professionals to remotely monitor individuals from their homes. Wearable and implantable monitors will also be used for patients with chronic diseases, allowing for greater prevention and early intervention.
Seamless omnichannel experiences will likely be created around patients who will be helped by virtual assistants, powered by artificial intelligence. As virtual reality (VR) and augmented reality (AR) tools and digital platforms (intermediaries that facilitate interactions between and among stakeholders such as individuals, application providers and partners) are embraced by people globally, use of these technologies will also spread to the healthcare sector. With the aid of haptics (technology that can recreate touch-based experiences), clinicians may even be able to conduct examinations virtually.
Coupled with more advanced in-hospital robotics and drones, health systems will see their spending on technology rise, but this may be offset by a decline in spending on estate and buildings, with a significant amount of hospital-based care shifting to new settings, including community based and virtual environments.
Accelerating technological change and generational shifts in attitudes and use of technology are producing a rapid change in the expectations that individuals have of their healthcare systems. The first of the wealthier, and often less deferential, Baby Boomers are approaching an age at which they will need more care, while younger generations will start to engage with health systems that don’t meet their expectations for instant access, seamless and personalized experiences, and global connectivity. This will likely coincide with a growth in the proportion of people having an interest in new technology, including those over the age of 75 whose digital adoption and proficiency rapidly increased due to the pandemic.
Prediction: New entrants will compete with existing healthcare players, taking up a substantial part of the market
There is currently a wave of interest and investment in the healthcare sector from major corporations in the technology, retail, consumer goods and wellness industries. Many see healthcare as an area ripe for disruption, and it is true that as consumer expectations move faster than health systems’ ability to deliver, many gaps are opening up for new entrants. Platform technologies may allow new players to attract healthcare consumers for certain services, before scaling those services globally.
The offer of “better, faster, cheaper” may be attractive to many consumers – as well as payers, providers and governments – and lead to increased competition for patient care and data, as well as partnerships and consolidation between these new and existing players. The end result will be that these new entrants will compete with existing healthcare players, taking up a substantial part of the market, creating a different, competitive and more globalized healthcare sector in which customer experience is put on a par with clinical outcomes causing ecosystems to shift towards being consumer-centric rather than organization-centered. Many existing organizations will face difficult choices about whether they wish to acquire or be acquired. For some, public private partnerships will be the way forward, enabling them to deliver higher quality health services at the same or less cost. For others, however, new entrants will mean that existing players will be left to take care of more vulnerable and complex populations, endangering the financial and workforce sustainability of services in the future.
Prediction: The volume of apps and VR/AR-based programs prescribed will equal the volume of drugs prescribed
Contrary to popular belief, there are many forms of technology that the healthcare sector adopts relatively quickly – new treatments and pharmaceuticals and, to some extent, surgical devices and techniques as well. The same cannot be said for consumer-facing technologies, particularly apps that have been an everyday part of health management for millions of patients over the past decade, but almost always without any integration into formal health systems.
These circumstances will begin to change rapidly in the coming decade, as more secure means of linking and sharing data becomes accepted, and providers compete increasingly on customer experience and keeping patients well rather than caring for them when sick. Adoption of isolated apps will gradually shift towards integrated, interoperable ecosystems, with the best apps funded and prescribed just as pharmaceuticals are today. Helped by AR and VR techniques, gamification and behavioral health will become the ‘secret sauce’ of the most successful health organizations, as well as design intuitive interfaces and passive mechanisms to ensure that those with low digital literacy are not left behind. The result will lead to the volume of apps and VR/AR-based programs prescribed equaling the volume of drugs prescribed.
Signal of change: Prescribed apps in action
Globally, chronic pain is one of the leading causes of disability. Virtual reality holds much promise as a nonpharmacological treatment. Recently in a regulatory first in the United States, a VR-based system that uses cognitive behavioral therapy and other behavioral methods has been approved as a treatment for those with chronic lower back pain.4,5
Although technology is changing healthcare, it is, and will remain, a people-driven business. But the growing demand for care and the immense stresses placed on the healthcare workforce have worsened the global workforce crisis. In response, the same tired approaches are often proposed: to either hire, or train, more doctors and nurses. But there are only a finite number of healthcare professionals in the world, while current training approaches are lengthy. To address these challenges the healthcare workforce of the future will consist of a more diverse array of roles and people will be trained differently. To support inclusive healthcare systems, organizations will become employee-centric, improving digital enablement to liberate health professionals from routine work, and supporting the workforce to build the skills they need for the future.
Prediction: A hybridized and micro-credentialed workforce will function based on their skills, not their roles
With rising service demand and a critical global shortage of traditional healthcare cadres such as doctors and nurses, healthcare systems will seek to adopt the next progression of the existing trends of task-sharing and micro-credentialing. With micro-credentialing, workforce planning will no longer be done on the basis of “tasks for physicians and nurses,” but rather an extensive list of tasks to be performed, with every worker individually classified according to their specific skills, training and performance. This means that non-clinical or even lay workers will be trained and ‘micro-credentialed’ for various tasks.
In the future, a significant amount of healthcare tasks will be conducted through micro-credentialing. Individuals will learn bite-sized content focused on development of a specific skill, demonstrate competency through an assessment and have a ‘credential’ issued to provide recognized verification of the skill. This will be a fundamental shift from the current professional silos and guilds of most health systems but will create tremendous flexibility in three ways. First, the ability to rapidly increase, decrease or pivot the health workforce far quicker than current systems, which can take up to 10 years to train specialist doctors or nurses. Secondly, the emphasis on keeping skills constantly up-to-date and assessed rather than relying on undergraduate education as the primary ‘credential’ for most clinicians. Thirdly, the ability to validate patients, peers and caregivers more formally as a vital and legitimate part of the health workforce.
Prediction: A globalized health workforce will offer 24/7, 365-day care, with complex cases delivered globally
The shift to ‘micro-credentialing’ will eventually need to happen at scale if workers are to benefit from career progression and transferability of their skills. Alongside the drive towards integrated care, this will lead to more staff moving to ‘system employment’ rather than organizational employment in the coming years. Micro-credentialing will also tap into a new, more informal workforce pool, helping to free up traditional healthcare staff so that they can work across the care continuum, while providers can achieve maximum productivity from staff time.
This medium-term trend may rapidly be eclipsed by a truly global market for health workers. The rise of AR and VR will allow health professionals to work for systems around the globe, or even for multiple systems at the same time, without the need to move abroad. The widespread adoption of micro-credentialing is a key enabler of this, with employees adopting protocols required by each system for their respective patients (as is already the case in multi-payer systems where clinicians adapt care according to a patient’s insurer).
Virtual care workers won’t only be employed to see patients but also to supervise. For example, a specialist surgeon from a center of excellence might observe and advise a surgeon from a less specialized center using a VR headset that allows them to ‘see what they see’ in real time. Within communities, the same principles can be applied to support those in informal care roles. VR and AR offer the opportunity to ‘help the helpers,’ providing engaging and immersive training, as well as emotional support through buddying and virtual communities, while micro-credentialing would offer formal recognition of their skills.
Around the world, powerful economic, social, and environmental forces are affecting inequality.6 While governments are most often seen as solely responsible for creating more equitable societies and protecting the most vulnerable, there is increased acknowledgement that these complex problems may be best addressed through collaboration. Government institutions, public bodies and community organizations all have a role to play, as do the very communities and individuals that are concerned. It is communities themselves that will provide the democratic mandate, the cultural insight, and the social capital necessary to make long-term and lasting change in addressing health inequities, embedding prevention, and improving health outcomes.
Prediction: Caring communities will be the single biggest driver of improved health and care
The most impactful ‘new’ innovation to many health systems will be communities themselves as they will be empowered to take on responsibility for keeping their own populations healthy and be given far greater direct power over their formal health system than in the past, including shifts to local decision-making and mechanisms of direct democracy. Such community leadership and control of health organizations is already a reality in many Indigenous communities in Australia and Canada.
Communities will work with healthcare organizations and government bodies to address issues related to the social determinants of health, many of which disproportionately impact marginalized and vulnerable groups. Common data sharing platforms can provide timely insights, while artificial intelligence and machine learning technologies can be used to identify at-risk populations through risk stratification and segmentation. This will enable community groups to create or tailor interventions to address specific local needs and work in culturally sensitive contexts.
Signal of change: Community-controlled health organizations
In Australia, 144 Aboriginal Community Controlled Health Organisations (ACCHOs) deliver holistic, comprehensive and culturally appropriate healthcare services to almost 410,000 Aboriginal and Torres Strait Islander peoples.7 Services are delivered through fixed, outreach and mobile clinics operating in urban, rural and remote settings. ACCHOs are initiated and operated by local Aboriginal communities and controlled through locally elected Boards of Management.8
In British Columbia, Canada, the governance structure for First Nations health services belong to First Nations communities.9The First Nations Health Authority (FNHA) plans, designs, manages and funds the delivery of health programs to over 200 diverse communities across the province. The FNHA delivers primary healthcare and other community-based services (largely focused on health promotion and disease prevention) through more than 130 medical health centers and nursing stations.10
Prediction: An expanded role will be given to primary healthcare, but in a totally new form
Primary care will have an essential role as the central coordinator of local health ecosystems, and key actors in converting population health data and insights into action. The shift towards this type of expanded care will require a significant change in the way in which primary care is provided and organized. Primary care will be part or a continuum of care that moves between complex and acute care on one hand, and community services and or self-supporting individuals on the other hand. Primary care will no longer be based on the current independent clinic or practice model. Primary care will be integrated into larger networks and organizations of community and social services that take collective responsibility and action in keeping populations healthy.
The health sector relies on public trust to function effectively. Historically, this trust has largely been taken for granted in most jurisdictions, as health organizations generate so much value and good will through the care they deliver. In the coming years, however, this relationship of trust is likely to come under greater pressure. Public perceptions of which institutions do and do not deserve trust are shifting as an integrity-based economy emerges, one in which people align themselves with organizations’ values, purposes and ethics. In this new world, trust is not defined purely by the quality of the interactions with organizations but by peoples’ judgments of whether organizations are living up to their ethical, environmental, and social responsibility promises. Many of the potential scandals facing health organizations are predictable – modern slavery in the supply chain, the mountain of single-use plastics, equitable access to care, and healthcare’s carbon footprint. Within this context, health organizations are likely to find their appeals that “but we heal the sick” begin to lose currency. A great deal more effort and energy will therefore be spent preventing, planning for, and responding to threats to the sector’s integrity.
Prediction: Healthcare organizations will have halved their carbon emissions and will have plans for achieving net zero
The health sector is responsible for around five percent of global emissions,11 but to date has been behind other major industries in planning for a decarbonized future.12 So far, healthcare has largely avoided the spotlight, but as society is mobilized for the immense challenge of meeting climate goals, this exceptionalism will expire. Already, 14 national health systems have committed to and begun work on achieving carbon neutral status before 2050.13 This number is likely to grow rapidly in the coming years, with a viable ‘inclusive’ scenario cutting healthcare organizations’ carbon footprint in half within a decade. Major players in the supply chain are aiming to move even faster such as life science giant, AstraZeneca who has committed to eliminate emissions by 2025 and be carbon negative across its entire value chain by 2030.14
Prediction: Financial systems will exert even greater pressure on health organizations over ESG
Investors and the financial services industry are undergoing their own transformation, from dedicated funds for ESG to embedding these criteria across everything they do. Health systems that rely on outside investment (which to some degree means all health systems) will therefore see an increasing expectation to measure, report on and improve aspects of their organizations that have previously been seen as “nice to have.” Certain financing mechanisms may even pay (or penalize) based on whether health organizations are reducing waste and greenhouse gases, paying fair wages, running diverse, inclusive and healthy workplaces, and driving change across supply chains. For staff too these factors will become increasingly important in helping to attract and retain workers.
Radical change is coming to healthcare through approaching trends in technology and data, the workforce, consumerism, communities and ESG. This will likely be highly disruptive, but under an inclusive healthcare scenario can also mean a significant shift towards personalized and empowering care that is accessible to everyone.
1 KSM Kahn Sagol Maccabi Research and Innovation Institute. (2022). Innovation and Big Data. https://www.ksminnovation.com/innovation- and-big-data
2 Gazit, S., Roei Shlezinger, R., Perez, G., Lotan, R., Peretz, A. Ben-Tov, A., Cohen, D., Muhsen, K., Chodick, G., Patalon, T. (2021). Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: Reinfections versus breakthrough infections. medRxiv. https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1.full.pdf
3 US Healthcare Journal. (2022). KSM Research and Innovation and Genetika and partner to seek AI solutions for personalization of depression treatment. https://www.ushealthcarejournal.com/article/586091878-ksm-research-and-innovation-and-genetika-partner-to-seek-ai-solutions-for-personalization-of-depression-treatment
4 Ouyang, H. (26 April 2022). Can Virtual Reality Help Ease Chronic Pain? New York Times. https://www.nytimes.com/2022/04/26/magazine/virtual-reality-chronic-pain.html
5 Food and Drug Administration. (16 November 2021). FDA authorizes marketing of virtual reality system for chronic pain reduction (News release). https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-virtual-reality-system-chronic-pain-reduction
6 United Nations Department of Economic and Social Affairs. (2020). World Social Report 2020: Inequality in a rapidly change world. https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2020/01/World-Social-Report-2020-FullReport.pdf
7 National Aboriginal Community Controlled Health Organisation. (2022) About NACCHO. https://www.naccho.org.au/about-us/
8 National Aboriginal Community Controlled Health Organisation. (2022) Aboriginal Community Controlled Health Organisations (ACCHOs). https://www.naccho.org.au/acchos/
9 First Nations Health Authority. (2022). First Nations Health Governance Structure in BC. https://www.fnha.ca/Documents/First-Nations-Health-Governance-Structure-in-BC-Placemat.pdf
10 First Nations Health Authority. (2022). First Nations Health Governance Structure in BC. https://www.fnha.ca/about/fnha-overview
11 Health Care Without Harm and ARUP. (2019). Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action. https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf
12 Roland, J., Kurek, N., Nabarro, D. (2020). Health in the climate crisis: A guide for health leaders. World Innovation Summit for Health (WISH). https://www.wish.org.qa/reports/health-in-the-climate-crisis-a-guide-for-health-leaders/
13 World Health Organization. (2021 November 9). Countries commit to develop climate-smart health care at COP26 UN climate conference. News release. https://www.who.int/news/item/09-11-2021-countries-commit-to-develop-climate-smart-health-care-at-cop26-un-climate-conference
14 AstraZeneca. (2020 January 22). AstraZeneca’s ‘Ambition Zero Carbon’ strategy to eliminate emissions by 2025 and be carbon negative across the entire value chain by 2030. Media release. https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2020/astrazenecas-ambition-zero-carbon-strategy-to-eliminate-emissions-by-2025-and-be-carbon-negative-across-the-entire-value-chain-by-2030-22012020.html#