Healthcare and Oncology: Are We a Taxi Industry Living in an Uber World?

Dawn Holcombe, MBA, FACMPE, ACHE
President, DGH Consulting, South Windsor, CT

Healthcare is a highly competitive industry that continues to undergo significant changes, including an increase in digital technologies and other innovations that offer patients new ways to customize their care and find more convenient options for health services tailored to their needs, lifestyles, and finances. As these advancements usher in a new area of healthcare, we need to ask ourselves, “Are we missing the boat?” “Are we about to lose the battle for patient healthcare in the same way that taxis have gradually lost their market for the traveling public to on-demand transportation services such as Uber?”

The current costs of healthcare in the United States are unsustainable. Many individuals cannot afford insurance premiums, copays, and coinsurance. Employers are struggling to meet the rising costs of healthcare benefits and insurance. Providers are facing significant reimbursement and payment cuts. Something has to give. The most obvious solution is to transform our current delivery systems of care to a more predictive, cohesive, population health management approach that can smooth gaps in care and focus more on disease prevention.

As we move toward this new approach, the roles and responsibilities of healthcare providers are bound to change. Traditionally, physicians and hospitals (especially those involved in oncology care) wait for patients to develop diseases and then initiate treatment. The Centers for Medicare & Medicaid Services Oncology Care Model program actively encourages practices to transform themselves into more proactive management support systems for patients between active chemotherapy appointments. The Medicare Merit-Based Incentive Payment System requires physicians to evaluate their relative costs and value to the Medicare program in comparison with other professionals, with mandatory financial penalties to those in the bottom tiers. Although we are continually searching for new ways to offer value-based care to our patients, we must be cognizant of the fact that others may be making better progress in terms of finding effective ways to reduce overall costs of care.

Assessing the Cost of Patient Complexities and Comorbidities

The presence of comorbidities or advanced disease can significantly increase the cost of a patient’s care. The National Association of Managed Care Physicians Medical Directors Institute 2018 Oncology Profile Study, which assessed the total healthcare costs for patients with cancer in 4 distinct markets, showed a 10fold increase in total average costs per member as patient complexities and comorbidities of care increased. Average costs per member rose from $10,114 for members with the lowest level of complexity and no comorbidities, to $39,804 for members with cancer with some complexity or a comorbidity, to $58,715 for those with more advanced disease and additional comorbidities. Patients with metastatic disease and multiple comorbidities comprised just 2.8% of the members in the analysis, but with an average cost of $103,783, they represented 16% of the total costs of care for all members.1

Individual oncology practices and cancer centers may find it challenging to remain clinically aligned with their patients or other providers (primary and specialty), which can make it more difficult to keep good lines of communication open for the management of patients with complications and/or comorbidities. We are limited by the technology and data streams that currently exist in our internal systems, which are also predominantly provider-centric. This is where the door may be left wide open for disruption in the healthcare chain.

The New Era of Digitally Driven Healthcare

Large entities, with market capitalizations approximately $750 billion to $1 trillion or more, are moving into the healthcare arena, and in models and directions that do not follow the traditional physician/hospital care delivery model. Some of the ways in which these companies are working to capture part of the healthcare market are as follows.

  • Apple has been moving into digital disruption in healthcare that could transform the whole system to center around the consumer, rather than the provider. Analysts expect to see Apple introduce a broad range of medical-grade wearables, such as hearing aids, monitors for blood pressure, glucose, or sleep.2 As Apple leverages its data and technology into personal health records, it could use that as a platform for new data generation (eg, wearables, monitors), data storage (eg, apps and personal health records), applications (eg, third-party apps and kits), and eventually services (eg, telemedicine, coaching, chatbots).3
  • Alphabet (Google’s parent company) invested $375 million last year in a Medicare Advantage insurer (Oscar Health) with a full insurance services portfolio, from claims systems to mobile applications. This will enable a move into population health and concierge teams.4
  • Microsoft has moved into the realm of chatbots with the 2017 unveiling of Health Bot, a software as-a-service offering within Microsoft’s Azure Marketplace product. This software may advance the use of artificial intelligence to pose sensitive health questions, and interface seamlessly with Skype, Cortana, Facebook, Slack, and others. Previewed by partners that include the University of Pittsburgh Medical Center, Aurora Health Care, and Premera Blue Cross, Health Bot integrates conversational flows with symptom-­checkers, triage protocol data­bases, health plan benefits and ­eligibility, previous conditions, appointment scheduling, and provider searches. Although chatbots such as these are not intended to replace medical professionals, they do have the potential to dramatically change how healthcare professionals utilize their time and interact with patients.5
  • Amazon has been making steady advances into the healthcare system for several years. In 2018 alone, we saw the acquisition of PillPack (an online pharmacy); the use of blockchain technology in a cloud-based claims and payments network for payers and providers; the healthcare venture of Haven (formed by Amazon, Berkshire Hathaway, and JPMorgan); the investment with Google in Aiva (a startup that uses smart speakers to connect patients and seniors with healthcare providers); its investment in at-home medical devices (Choice); its foray into generic pharmaceuticals with Auro­health (over-the-counter products now available through Amazon); and a myriad of other healthcare ventures.6 Haven has hired a substantial team from across the national healthcare field to transform healthcare for the 1.2 million combined workers of the joint venture. In the process, they are likely to have significant influence on the transformation of the $3.5-trillion healthcare industry in general.7

These companies are not alone. Facebook and Uber have announced their involvement with healthcare. Virtual health clinics, without a ­physician or a nurse, have opened in Arizona Safeway stores. Using artificial intelligence and augmented reality, these kiosks gather symptoms and vitals and determine a possible diagnosis for a patient. US Food and Drug Administration–approved wireless devices are used to collect medical measurements for temperature; ear, nose, and throat images; chest sounds; and blood oxygen content. Virtual visits with clinicians occur via telemedicine, and these professionals can provide prescriptions electronically. A phlebotomist on staff in the clinics takes blood and conducts regular ­laboratory tests, helps patients, and cleans the clinic between visits.8

It may be tempting to counter these healthcare incursions with the belief that oncology care is somehow exempt. However, we need to remember that every major revolution in industry began with new entrants. The compelling common themes of these new entrants are technology, revenue, and data. When technology can be adapted to allow consumers to self-monitor, the incidence of disease is likely to decline. When consumers can self-monitor, self-screen, and self-­manage, the ability to detect diseases at more manageable stages is likely to lead to not only lower costs of care, but different modes of delivery of care. If we rely on patients to come to us rather than adapting to changes that involve direct connection and data input from our patients, we may be left behind.

More Changes on the Horizon

The diagnosis and treatment of cancer may also be just a discovery away from dramatic change. Vaccines, immunotherapy, and oral treatments offer alternatives to traditional labor-intensive infusions and injections. Pharmacy standards, narrowing networks, increased technology demands, and the need to be part of a larger network that encompasses consumer-centric wellness, prevention, screening, primary, and, as a last resort, specialty care or hospitalization, may redefine not only health­care in general, but oncology care in just a few years.

Technology and innovation transformed the transportation industry in a short time period. We are already seeing what could be bellwether changes happening in healthcare. Will we catch the tide and stay ahead of the curve or will we miss the boat and get left behind? It is too soon to tell. However, now is the time to keep our eyes open and remain aware. Forewarned is forearmed.


  1. Holcombe D, Riley S. NAMCP Medical Directors Institute 2018 Oncology Profile Study: the importance of patient management, total overall costs of care, patient acuity and provider collaboration for managing oncology costs. November 2018. Accessed May 14, 2019.
  2. Darie T, Bloomberg. Apple’s healthcare take could be $313 billion by 2027, analysts say. April 8, 2019. Accessed May 14, 2019.
  3. CB Insights. Apple is going after the healthcare industry, starting with personal health data. January 8, 2019. Accessed May 14, 2019.
  4. Beaton T. Alphabet, Google’s parent organization, has invested $375 million in Oscar Health to fast track the payer’s new Medicare Advantage offerings. August 16, 2018. Accessed May 14, 2019.
  5. Wiggers K. Microsoft’s Healthcare Bot service becomes generally available in Azure Marketplace. February 7, 2019. Accessed May 14, 2019.
  6. Paavola A. Amazon moves into healthcare: a 2018 timeline. December 20, 2018. Accessed May 14, 2019.
  7. Farr C. Everything we know about Haven, the Amazon joint venture to revamp health care. March 13, 2019.­amazon-jpmorgan-berkshire-revamp-health-care.html. Accessed May 14, 2019.
  8. Innes S. Safeway stores offering health care powered by artificial intelligence. April 22, 2019.­artificial-intelligence-ai-advinow-medical-akosmd/2592743002/. Accessed May 14, 2019.

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