RamaOnHealthcare August 14, 2020
RamaOnHealthcare and Praveen Suthrum discussed on the trends influencing Gastroenterology and all of healthcare.
Praveen Suthrum is the co-founder and president of NextServices. The company provides a platform that medical practices need to thrive while facing tougher reimbursements, higher operating costs, and increased regulation.
RamaOnHealthcare: Congratulations on your new book, Scope Forward: The Future of Gastroenterology Is Now in Your Hands. Why did you decide to write about gastroenterology?
Praveen Suthrum: Thank you Rama. When you look at one aspect of medicine sufficiently in depth, you begin to understand the trends influencing all of healthcare. For example, consider artificial intelligence. It’s one thing to talk about AI in healthcare in general but quite another thing to understand how computer vision is shaping the field of endoscopy. Such an exploration offers a lot more depth.
Scope Forward was written on the momentum of an earlier primer I wrote called Private Equity in Gastroenterology. The book on private equity led to many conversations with industry leaders and I began to understand what gastroenterologists were grappling with. It also became clear that I could help people ask different questions. Instead of asking, how could we stay safe from disruption? we could begin to ask, how do we disrupt ourselves before something else does? The answers to those questions take us down completely different paths. Think of Scope Forward as a tool to explore the answers to the second question.
In 2012, I sat in a self-driving car when it was still a research project for Google. Back then most of the auto industry dismissed autonomous vehicles. Today there is no major automaker that doesn’t have a self-driving division. Gastroenterology is at that point right now. Some of the technologies have the potential to cause widespread disruption. Most of the field is oblivious to the extent to which advanced technologies might affect them.
Many clients of my company NextServices are gastroenterologists. I wanted a way to communicate to them and the wider industry to act sooner than later. I wanted to show them the future through the lens that I was already seeing. I wanted to inspire action.
RamaOnHealthcare: You’ve explored many trends in the book from technology to business. Let’s talk about exponential technologies first. How is it affecting gastroenterology?
Praveen Suthrum: Yes, the trends we discuss in Scope Forward cut across technological, business, and societal areas.
The impact of exponential technologies such as DNA testing, artificial intelligence, and the microbiome. In the last couple of decades, gastroenterologists have largely relied on screening colonoscopy to detect colon cancer. But now DNA testing services offer tests that screen for colon cancer via a stool sample. There is plenty of research underway to detect not just cancer of the colon but fifteen types of cancers using a blood sample. That field is called liquid biopsy. Consider the business disruption that this may cause to gastroenterologists who do not adapt.
Artificial intelligence in endoscopy is now able to point to polyps (growths in the gut) and even classify them. If an AI is able to show and tell you what’s cancerous, consider how that might impact the training and role of an endoscopist. Also think about what would happen if insurances link reimbursements to quality and count of polyp detection and removal. Everyone would be compelled to rely on AI.
The important thing to remember about exponential technologies is that they are not developing in isolation. The growth of one field affects the other. Advances in sensors improves robotics. Advances in robotics makes advanced endoscopic surgery possible. In the coming years, we will see a rapid multiplication of these technologies. That will result in an exponential change in gastroenterology and all of healthcare.
RamaOnHealthcare: What about business consolidation? Has there been a lot of private equity activity in gastroenterology?
Praveen Suthrum: Yes, private equity (PE) has fueled consolidation within gastroenterology and many other specialties in healthcare. When I wrote my earlier book Private Equity in Gastroenterology, there were five PE transactions in gastroenterology. Not surprisingly, my predictions about consolidation played out throughout 2019. There were 16 transactions during the year. In 2020, there are already four or more, including a PE platform that went live in the middle of COVID-19.
In the earlier years, there were smaller groups in every specialty. But it is getting increasingly hard to stay small – especially in metropolitan areas. Big hospital systems are consolidating. Insurance companies are consolidating. What private equity has done is to fuel a trend that is already underway in the rest of healthcare. CVS and UnitedHealth Group are two of the country’s largest consolidators. CVS has taken the consumer route to consolidation. And UnitedHealth Group has taken the system route to consolidation. The rest of healthcare is falling into one of these two camps: consumer or system.
Instead of worrying about consolidation, it is time to explore ways to make it work for all parties involved – especially patients.
RamaOnHealthcare: I was curious to learn about the Big Brothers shaping healthcare. Who are they? How would this affect the industry?
Praveen Suthrum: Well, you cannot miss them. Big insurance companies, big health systems, big technology companies, big retailers – all of them want a piece of the healthcare provider market. Consider UnitedHealth Group. The fastest growing division within United is not insurance, it is its provider business: Optum.
In the last five years, many health systems have consolidated. For example, New Jersey used to have a handful of health systems. Now, most large health systems have consolidated under Hackensack-Meridian, a $5.5 billion not-for-profit employing 6,500 doctors. Meanwhile, health systems like Geisinger are offering their own insurance.
If you observe, you have an interesting trend here where insurances are expanding into the provider space. And health systems are expanding into the insurance market. Kind of like a snake eating its own tail!
If this were not enough, you have Google, Microsoft, Amazon and other technology companies carving out their own healthcare pie. The retailers want some too. In 2019, Walmart launched its first health clinic in Georgia.
These Big Brothers are reshaping healthcare as we know it. To understand them, you must expand your lens and see the big picture.
RamaOnHealthcare: Great! You talk about patients who are biohacking their way out of disease. How does that impact gastroenterology?
Praveen Suthrum: In the book, I talk about a patient who hacked his microbiome. He took a healthy stool sample from a friend, made poop pills and consumed them in a hotel room. Over a 72-hour period, he rewired his microbiome to fix his gastrointestinal issues.
As you can imagine, doctors and the healthcare system are not trained to handle patients like him. You may find the example to be an extreme. But it is important to remember that what’s happening on the fringes usually becomes the norm in a few years.
If you have not noticed already, mindfulness has become the norm now. Patients of inflammatory bowel syndrome (IBS) are reversing their condition by using meditation apps like Calm (valued over a billion dollars). These are conditions that gastroenterologists treat today.
If the healthcare system does not keep up with changing patient preferences, I foresee them finding solutions elsewhere and/or on their own.
RamaOnHealthcare: Fantastic. Clearly, all these trends affect not just gastroenterology but all of healthcare. What has been the effect of COVID-19 on these trends?
Praveen Suthrum: Scope Forward was an invitation to make disruption into a positive outcome for the field of GI and healthcare in general. When I wrote the book, I did not see a pandemic coming. But COVID-19 has become the mother of all disruptions. It has shaken the very foundations of our healthcare system. Not just in one country but globally. COVID-19 will accelerate everything outlined in Scope Forward.
The field of gastroenterology relied on elective procedures like colonoscopy. In the book, one of the interviewers said, you cannot be “colonoscopy factories.” COVID-19 made that point very apparent. Practices could not do elective procedures at all during the peak of the pandemic.
Private equity is not stopping. After a short pause, there are plenty of deals in the pipeline now. GI doctors are realizing that they must consolidate (with or without private equity) to remain independent and strong.
Exponential technologies got a boost during COVID-19. Stool DNA testing services began using telemedicine. The field of telemedicine itself accelerated. Interestingly, I talk about Livongo and Cambia Health Solutions in the book – you cover both these companies actively in your blog.
COVID-19 has made all of us much more aware of our bodies. People realize more than ever that it is better to be proactive about health. There is an increased openness to mindfulness, yoga and other forms of healing modalities that are preventative.
RamaOnHealthcare: Praveen, thank you for these insights. I am sure the book will be greatly useful to its readers. Where can they find out more?
Praveen Suthrum: Thank you Rama. You are doing a great service to the healthcare community by helping us stay on top of trends. Thank you for doing what you do.
The book’s website will always have the latest information: it is www.Scope-Forward.com.