MHEALTH

MARTIN MADAUS

The Four Topics

3

mHealth Promise

3 5/12/2015

1. Tool to Improve Healthcare Delivery – transactional efficiency, access and processing of information

2. Breakthrough Innovation: ability to positively affect patient behavior resulting in major health outcome improvements

4

mHealth - Not a New Idea The medical tricorder

(ca. 1964) Portable, easy to use Instant health assessment Cost effective Validated for outer space

5

mHealth - Breakthrough Benefits

“Delivering of healthcare or healthcare related information through the use of mobile devices – or short “connected health”

• Patient engagement/empowerment • Healthcare cost reduction • Better health outcomes

Breakthrough Innovation X-Rays

Breakthrough Innovation - Biotech Drugs

20+ Years to Achieve Broad Adoption for Major Healthcare Innovations

• Major health Impact • Changed standard of care • Major investments made to realize potential • Initial incumbent resistance

Relevant Issues in Healthcare

• Understanding disease demographics

• Entrenched models and changes

• Cost pressures and waste

• Selling into healthcare systems

• Changing incentives

$500b+ Opportunity in US

210

190 130

105

75

55

Waste in US Healthcare - B $ UnnecessaryServices

Excess Adm. Cost

Inefficient deliveryof services

High Prices

Fraud

Missed Prevention

Selling Into Healthcare Land (US) Highly Simplified Vendor Perspective

Final Product

Analytical and clinical

performance

Regulatory Approval

510k, PMA

Payment Coverage/amount

In patient/out patient

Adoption and publication from

Key Opinion leader

Health economics

impact analysis

Financing model/ Contracting

Customer training and installation

After sale service

Product Sale

Physicians Control Most Clinical Health Information Clinical decision making is enabled by 5 major activities across different setting in the Health care system

Content Origination

Generation

Aggregation

Interpretation

Info Distribution

Activities Examples

Physician orders a test

MRI is generating test results

Results are collected and stored Physician(s) analyze and interpret clinical content relevant to the patient and decide on advice, intervention, further analysis

Applications, hardware, people transport clinical content to relevant stakeholders

mHealth Could Democratize the Control of Clinical Health Information

Activities Examples mHealth Potential

Content Origination

Generation

Aggregation

Interpretation

Info Distribution

Physician orders a test

MRI is generating test results Results are collected and stored

Physician(s) analyze, interpret Content, decide on advice, intervention, further analysis

Applications, hardware, distribution to relevant stakeholders

Patient initiates testing

Patient generates data with smart phone

Patients personal secure cloud based medical record

Physician, nurse, algorithm, Patient advises, decides Secure website distributes actionable information to Patient/family members via mDevices

Patient Empowerment Vision Drivers and Barriers

Drivers • Engaged and motivated

patients

• Digital access and fluency

• Actionable information

• Easier, better experience than current

• Incentives

Barriers • Patients not interested,

capable, lack of understanding

• Health care insurance

• Physician centric healthcare system

• Other priorities

Rule No.1 in the healthcare business: follow the money Incentive Behavior M-health Implications

Patient Stay healthy, get healthy, reduce cost, easy access

inconsistent Free apps for information, tracking and reminding

Provider (Physician, hospital)

Fee for service Fixed payment/patient

Volume, specialize Limit time/expense per patient

Validated and integrated mHealth product productivity tools

Payor – Public Provide quality care within cost constraints

Control expenses, assure access and quality

mHealth productivity and wellness and compliance tools (cost avoidance)

Payor – Private Deliver profit to shareholders Manage financial risk, compete for attractive segments

mHealth productivity and wellness and compliance tools (cost avoidance)

Healthcare Supplier

Deliver profit to share holders Targets most profitable segments

Promotional tool Product extensions Potential for standalone mHealth products

• Participants barriers • Products that work for the digital immigrant

• Organizational barriers • IT – step child of health care investment • IT adoption productivity paradox • Incentives – follow the money • Paternalistic mindset

• Policy, regulatory barriers, liability • Who can be trusted? • Liability – inaccurate diagnosis, data error, malpractice

suits • IP questions

• Performance barriers- hype vs. reality

Barriers to Adoption - Overview

Barriers to Adoption

• Participants barriers • Age and inertia to change unhealthy behavior/compliance

• mobile access – need advanced functionality (image, video, sensors, high speed mobile) for full potential

• Smart phone based EKGs, ultrasound, PO2 measurement are very high end applications today in very early stages of development

• 16% of people over 50 have smart phones

• Patients sustained engagement and understanding

• Usability of devices and applications

Organizational Barriers

• IT – stepchild of health care investment

• IT adoption productivity paradox

• Incentives – follow the money

• Paternalistic mindset

• Trust

Innovations: Pharmacy Retail Clinics Failed to Disrupt Primary Care in the US

VS. Primary Care

Provider

Failed to disrupt: • Resistance by incumbent physicians • Legal limits in service and pay • No/little payment coverage by public

insurance

Paternalistic Mindset • Organizational barriers

• Physician resistance to potential balance of power shift from physician to patient

• Incentives: providers resistance to disruptions to their income stream

• Institutional resistance to change – other pressing priorities

Considerations • Patient access right to medical record

a law

• Coordinated and changed incentives for providers and patient incentives

• Mandate provider cost transparency

• Mandate cost sharing by patient

Barriers to adoption - Performance

Issues

• Novelty effect • Early in the transformation phase • Business model -why are people

dropping out? • Confusion: consumer product or

healthcare tool • Determine the right level of product

effectiveness evidence?

Hype vs. Reality

• +17,000 mHealth applications

• 500m expected users

• High drop rate

• Evidence of impact is limited, so far

Mobile Health – a Scenario

My medical identify is in the Cloud, my doc is on the phone, a robot is sending me messages - Who Do I Trust?

Trust based on expertise and confidentiality, experience Impacts patient compliance

Redefine trust with physician Develop new completely trusted sources

Future

26

Driving Adoption

“Potential Success

Factors”

Considerations for mHealth business models • Clarity of Purpose: it’s critical to define exactly what a mHealth based

product/service does to solve a major and actionable issue in healthcare

• Align With Important Pain Points: a major healthcare outcome improvement, reduction in patient hospitalizations, reduction of waste and errors in the delivery of care, simplification/cost reductions of major business processes, chronic disease focus

• A Sound Product: robust product/services, certified data safety standards, and clear USP, validated for targeted use, endorsed by key influencers

• Detailed Market Adoption Model: Strategy: B2C, B2B, customer segmentation, addressing specific barriers, pricing, competitive positioning

The New World of the mHealth Empowered Patient

• Focus on healthcare needs of digital natives (i.e. acute care, pregnancy, fertility, infectious diseases, genetic testing) • Capitalize on convenience, choice, quality of experience and incentives • Focus on patients that are willing to pay out of pocket partially • Endorsement by medical establishment, regulators and security experts • Partnering with employers and insurance providers

• My Quest 360 • Mobile app for diagnostic testing • Appointment scheduling • Test result reporting and interpretation • Personal Health information depository • Billing and payment

mHealth in Lab Diagnostics: World’s Largest Private Labs - Quest Diagnostics

mHealth – Conclusions The Promise:

• mHealth applications hold great promise to become key component how patients manage their health: empowerment, engagement, better choices

• It could lower healthcare cost and lead to better outcomes

The Healthcare Eco-System:

• Complex system, very local, not a free market, is designed to treat disease not manage health

• 3 key decision makers: regulators decide what can be used, physicians decide on what to do with the patient, insurance decides what to pay and how much, a long road ahead towards patient empowerment.

• Working with key healthcare decision makers to drive new product adoption is the current commercial paradigm

mHealth –Conclusions (cont’d) Barriers

• Disruption is not appealing to those who are disrupted – and they are in charge of most healthcare decision today…

• Physicians control most patients care

• mHealth products and services needs to be validated and developed to fit into the current regulatory requirements and business models

• Data privacy issues have to solved

Drivers

• Highly targeted patient group with a clear medical need to manage

• Incentives for key adoption

• Physician, regulatory, security endorsement

• Employers with active health management programs

THANK YOU

Martin Madaus

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