deloitte callum bir - mhealth ibc

Callum Bir Director, Life Science & [email protected] +65 91001595August 2011

Mobile Health Effectively Monetizing mHealth Services and Applications

mailto:[email protected]

©2011 Deloitte Touche Tohmatsu Limited

Contents

What do consumers want?

Who’s willing to pay for what?

Opportunities for health & wellness consumers

mHealth for Chronic Disease Management

Who will operate vs. Innovators?

1

2

3

4

5

What are some of the Plays in Asia? 6

Technology will change lifestyle of chronic care patient and enable self-care....

©2011 Deloitte Touche Tohmatsu Limited4

What Citizens want?Interest in online tools and services and in

tools and aids to support self-managed care


Interest varies by generation and country in using a smart phone or PDA to monitor their health if they are able to access medical records and download information about their medical condition and treatments.


Consumers are highly interested in using a medical device that would enable them to check their condition and send information to their doctor electronically through a computer or cell phone via the Internet

6 Deloitte


Patient ledAnd why can ‘t

we book appointments with PcP / Hospitals?

Growth drivers

• 20% of all new phones sold is smart-phone • Asia has fastest growing affluent class and

middle class• Largest % current customer segment• 2% apps on HC and 7% on Life Style

Barriers

• Does not address broad population (for now)• Significant gaps in adoption of technology in

provider settings


Self-Care

Growth drivers

• Downloads of Healthcare iPhone apps • Emerging patient portals and pilots across the

region

Barriers

• Lack of awareness of benefits • Data Governance, Ownership, and regulatory

frameworks still needs to be worked out • Lack of Sustainable business models• Still in early stages of development

Technology-enabled self-care


Chronic Care Lifestyle

Growth drivers

• Increased access to healthcare and health-related information, particularly for hard-to-reach populations

• Increase mobile (voice) coverage and adoption

Barriers

• Relatively untapped market • Limitation on care delivery on phone

http://www.youtube.com/user/ProjectHealthDesign#p/u/16/VNdkgOuui00

Regular follow-up, Mobile Monitoring , Lifestyle choices for chronic patients


Evidence Based Care

Growth drivers

• Significant innovation in Med Tech industry• Rapidly growing Chronic Disease patients in

Asia• Improved ability to diagnose and track diseases

Barriers

• Lack of complete end-to-end operator service • Largely Silo approach till date

http://www.youtube.com/user/ProjectHealthDesign#p/u/12/rYkuswN8wMY

Personal monitoring device to alert and guide to make improvements

in health or treat a condition.


Prevention of Chronic Diseases?< 20 % of high risk citizens participate in wellness programs


Keeping Healthy Use of applications is expected to increase threefold by 2012

(=600 mil applications)

Growth drivers

• Payers are most interested to keep people healthy!

• Technology enabled incentive / rewards to change behavior

• Expanding Wellness market (eg, spa, yoga)

Barriers

• Still a relatively small market today in Asia despite high growth


Privacy concerns vary between countries Concern about privacy of Health information stored online


mHealth in Asia is Poised for an accelerated growth

14 Deloitte

• Greater EHR adoption by hospitals, physicians and allied health provider

• Increasing regulatory clarity around standardization of health records, privacy protections and provider liability

• Increasing MCD capacity and functionality

• Decreasing cost of MCDs (scalability) in tandem with payer incentives for their us

• Increasing consumerism in health care

• Increasing focus on Health Reforms due to raising costs and citizen expectation

mHealth Acceletors


Mobile Health Opportunities in Asia

15

Consumerism &

Convenience

Disease / Condition Monitoring

Prevention & Wellness

Ben

efit

/ Hea

lth O

utco

me

Complexity

Remote Consulting


Mobile Health Opportunities & Barriers in Asia

16

Opportunity Growth Drivers Barriers Case Studies / Examples

Consumer Driven Healthcare

• Increasing consumer demand for mobile “commerce”

• 20% of all new phones sold is smart-phone

• Asia has fastest growing affluent class and “middle class”

• Largest % current customer segment

• Does not address broad population

• Significant gaps in adoption of technology in provider settings

• Drawing parallel to Singapore taxi booking system using SMS and iPhone.

• Why can’t we book appointments with PcP / Hospitals?

Remote Consulting

• Increased access to healthcare and health-related information, particularly for hard-to-reach populations

• Increase mobile (voice) coverage and adoption

• Relatively untapped market

• Limitation on care delivery on phone

• Case studies include Ghana & Indonesia.


• Significant innovation in Med Tech industry

• Rapidly growing Chronic Disease patients in Asia

• Improved ability to diagnose and track diseases

• Lack of complete end-to-end operator service

• Largely Silo approach till date

• US: Fifty percent of consumers want a personal monitoring device to alert and guide them to make improvements in their health or treat a condition.


Mobile Health Opportunities & Barriers in Asia

17

Opportunity Growth Drivers Barriers Case Studies / Examples

Prevention & Wellness Market

• Increased focus by Payers of Healthcare, including Employers, Private Payers, Governments due to rising costs.

• Expanded access to ongoing medical education and training for health workers

• Increased awareness & fast growing wellness market (eg, spa, yoga)

• Still a relatively small market today in Asia despite high growth

• > More than 200 million mHealth applications are in use today, and that number is expected to increase threefold by 2012**

Mobile Personal Health Record

• Downloads of Healthcare iPhone apps

• Emerging patient portals and pilots across the region

• Lack of awareness of benefits

• Data Governance, Ownership, and regulatory frameworks still needs to be worked out

• Lack of Sustainable business models

• Still in early stages of development

• Researchers at Kaiser Permanente in Colorado discovered 58 % of hypertension patients using mPHRs lowered their blood pressure to healthy levels within 6 months, compared to 38 % receiving conventional treatment

**Pyramid Research


In the short-term, we must not ignore the opportunities to gain efficiencies in Life Sciences and Healthcare companies for their key operations

mHealth

Clinical Trials • Patient Diaries • CRAs

Sales & Marketing•Next Gen Sales Force Transformation • e-Detailing

Others • New level of Capturing Safety

Data (PV)• Stronger Compliance Regiment • DTC

Efficiencies in Clinical and Administration • Revenue Cycle Management • Medication Management

Improved Patient Experience

• Streamline communication • Personalized communication

Increase Quality of Care & Patient Safety • Enable physicians greater access to

data, anytime, anywhere. • Improved evidence based decision

making

Life Sciences Companies Health Care Provider


mHealth, serves as inextricable access point to a broader eHealth ecosystem, owing to huge mobile penetration and reach

19

SMS Message campaign promoting

HIV/AIDS awareness resulted tripling of

Call Volume to HIV/AIDShelpline

S. Africa

Phoned Reminders for TB Treatment : 90%

did remember to take their medication

Philippines

Hospital Beds

Computers Mobile Phones

Population0

1000

2000

3000

4000

5000

11305

2,293

5,300

Tremendous reach…. …and Impact

Health workers use mobile phones to

send SMS messages

with real time data

PeruSMS-based

HIV/AIDS awareness quiz led to an

increase of nearly 40% people for

HIV/AIDS testing.

Uganda

Technology and health-related statistics for developing countries (M)

Source : Business Monitor International (BMI), International Telecommunications Union, World Bank’s World Development Indicators, and the United Nations; Deloitte analysis


Mobile phone penetration….

• China has the world’s largest cell phone subscribers at 707 million in 2009

• Asia Pacific had 46% of the global total subscriptions

Smartphone penetration…

• Reached 40 percent across Southeast Asia in Q4 2009.

• Singapore’s smart-phone touches to about 75%

Online vs. Mobile subscribers (2009)

North America 0.25B 0.27B 1.1X

Europe 0.42B 1.06B 2.5X

Asia Pacific 0.82B 1.30B 1.5X

World 1.73B 3.40B 2.0X

Internet users

Mobile users

Ratio/Multiple

Source: ITU, JP Morgan, Deloitte analysis

Indonesia 0.03B 0.16B 5.0X

India 0.06B 0.40B 6.0X

Mobile penetration as compared to online penetration is almost 5 to 6 times in few of the big Asia Pac economies…

20

Smartphone

penetration likely to

be more than 25%

across most of the key

Asian markets


…on the contrary, the current low ratio of Doctors per inhabitants is likely to worsen further

21

Number of inhabitants per doctor


Stakeholders & Benefits

22

Stakeholders Benefits

Consumers • Better care and lower costs via access to real-time information • Increased Safety & Quality of Life

Hospitals & Physicians

• A mechanism to coach consumers to make better judgments about their care and to align provider incentives with optimal patient outcomes.

• Support medical home initiatives

Life Science Companies

• A platform for demonstrating value (efficacy and effectiveness) of therapeutics and diagnostics within the context of an informed consumer population

• If consumers agreed to share information, the consumer-reported database unlocks potential for manufacturers to learn more about product use

Payer / Govt

• Lower costs associated with fewer admissions and emergency room visits, avoidable drug-drug interactions, avoidable over-use of medications and increased use of self-care/over-the-counter therapeutics in treating common chronic conditions

• Provides a platform to fully enable health & disease management programs

Telco

• Increased incremental revenue on top of existing voice & data revenue streams

• Opportunity to expand into infrastructure services, managed services, cloud computing and professional services

• Opportunity to own / dominate, and take the first mover advantage

23 ©2011 Deloitte Touche Tohmatsu Limited

Telco in Asia are well positioned to take a lead role in mHealth enablement

** Based on 10-15% of Asia Pacific excluding Japan mHealth Market estimates. Asia Pacific Market estimated to be 10% of global mHealth market by 2014

• Address around $100M** with 40% YoY Growth by 2014

• Leverage existing consumer branding & trust

• Build upon core strengths / heritage in public sector ***

• Leverage strengths in billing & pay-per-use models

• Leverage “long-term” capital investments in infrastructure

• Leverage existing reach & coverage in segments at affordable costs

Telco Opportunity


…and potential pathways for Telco operators

24

Step 1

Step 2

Step 3

Step 4Enabling the

administrative aspects of healthcare

Enable operational aspect of

healthcare

Develop scalable solutions

and appropriate distribution

and commercial

models

Be the connectivity

hub interlinking all

different stakeholders

One-time fee?

Advertisement Revenue?

Revenue sharingwith partner?

Government Funding?

25 ©2011 Deloitte Touche Tohmatsu Limited

Critical enablers for success in mHealth

Community Trust & Relationship

Financial Alignment &

Sustainability

Technology

Govt Alignment

• Trust in Quality & Service Delivery • Trust in Data Governance & Ownership

• Partnerships to minimize risks / exposure and play to core strength • Financial Sustainability over the long-run

• Standards / Interoperability• Privacy & Security

• Alignment with national / provincial programs • Alignment with existing national EHR programs• Alignment with changing regulations and reimbursement models


Indicative emerging mHealth partnership and pricing models…

26

+

Need Partnership construct Pricing ModelWho pays?

Remote Consultation

Co-Share between Patient / Provider

• Pay-per-use

Consumerism &

Convenience

**Dependant Service

Either Provider or Patient or Both

Eg. Booking both could pay

Pay-per-use

Revenue-sharing with Provider / Physician

1

2

Indicative

+ Revenue-sharing with Provider / Physician

**Telco could take a lead role in taking this to market

• Providers could take a lead in providing value-added services, eg. appointment

• Primary Care markets and e-Bookings could be areas where Telco could take a lead role

• Payers could also play key role enabling services


Indicative emerging mHealth partnership and pricing models…

27

Need Partnership construct Pricing ModelWho pays?

Disease Prevention

and Wellness

+ • Payers, Employer, Govt.

• Free to consumers • Devices /

Consumables charged (eg. Nike Sports Shoes)

• Telco’s $ by data-traffic & broadband

• Tax & Wellness incentives

mPHR • Payer Model

• Monthly Subscription (Chronic)

• Pay Per Use• Free but based on

“preventative points”

Governments can play a key role in creating awareness 3

5

Indicative


+ • Patient via Payer

• Monthly Subscription & Pay Per Use

4 + + $$

+ + + $$

+ Payers + Device Mnf

+ Retail / Loyalty*

This requires a complex suite of devices that are either device led or institution driven

Perhaps room for more than 1 models to work . Telco’s may play “enabler “ vs. operate PHR

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