Health Research Institute
Healthcare
unwired
New business models delivering care anywhere
Table of contents
The heart of the matter
1
Mobile technology is untethering healthcare and enabling
the practice of care anywhere
An in-depth discussion
3
Mobile health is creating business models that unlock
access to new players and technologies that support
preventative, acute and chronic care
The appetite for mobile
6
Three business models for mobile health
10
What this means for your business
29
Adoption of mobile health will depend on what you give
for the money
Where you are and how to start
30
Acknowledgments
32
September 2010
The heart of the matter
Mobile technology is
untethering healthcare
and enabling the practice
of care anywhere
Mobile technologies hold great promise for keeping people healthy, managing diseases, and
lowering healthcare costs. For years, telehealth has provided clinical services for individuals
who lacked physical access: farmers in remote communities, soldiers near the battlefield,
inmates in prison. Now, these technologies have demonstrated the ability to benefit almost
any individual. Mobile devices are the most personal technology that consumers own. They
enable consumers to establish personal preferences for sharing and communicating. They
can enable health and wellness to be delivered through mass personalization.
Unfortunately, the payment wires are crossed. Providers get paid based on volume of
services delivered, and mobile health has been shown to reduce the need for hospital
admissions and physician office visits. Why would providers adopt technologies that gouge
their incomes? An industry that is paid based on volume will not adopt technologies that
reduce volume. However, new payment models enveloped in the new health reform law set
up a framework to pay providers based on outcome, not volume. In this environment, mobile
health could provide needed connections: for patients who delay care because they’re too
busy to wait in a doctor’s office; for physicians who don’t have enough time to spend with
patients; for device companies that want to monitor the performance of their devices; for
pharmaceutical companies that want to ensure patients are taking the medicines they need;
for hospitals that don’t have the capital to build more beds.
In addition, a host of new players are developing easy to use, affordable “care anywhere”
devices, services, solutions and networks that are attractive to consumers. Organizations,
that want to play a role in making “care anywhere” a reality, will need to provide real value
in order for adoption to occur.
The heart of the matter
PricewaterhouseCoopers’ Health Research Institute
1
An in-depth discussion
Mobile health is creating
business models that
unlock access to new
players and technologies
that support preventative,
acute and chronic care
Executive summary
The mobile health industry is brimming with new health applications, devices and services
that are boosting individuals’ ability to connect better to their health. Forty percent of
consumers surveyed by the Health Research Institute (HRI) said they would pay for remote
monitoring devices and a monthly service fee to send data automatically to their doctors.
HRI estimates the annual consumer market for remote/mobile monitoring devices to be $7.7
billion to $43 billion, based on the range consumers said they would be willing to pay. Real
value will need to be demonstrated in order for adoption to occur. And that value begins with
understanding two key customers: the individual and the physician. New business models will
continue to evolve, but can fit into three main categories.
The operational/clinical business model enables provider, payer, employer, medical
device and drug companies as well as nontraditional healthcare organizations to run their
business operations better and more efficiently. These include transactions and services for
customers, whether they are clinical in nature or related to the overall management of health.
HRI’s survey showed that physicians value better decision making and ease of work flow.
They’re open to mobile health but believe that lack of leadership support, privacy/security
and reimbursement could be roadblocks to adoption. Key physician survey findings that
inform the operational/clinical model were as follows:
• Mobile health can improve the use and the value of physicians’ time. One-third of
physicians surveyed by HRI said they make decisions based on incomplete information.
They believe the greatest benefit of mobile devices will be to help them make decisions
faster as they access more accurate data in real-time.
• Forty percent of physicians surveyed said they could eliminate 11% to 30% of office
visits through the use of mobile health technologies like remote monitoring, email, or
text messaging with patients. Such shifts could rewrite physician supply and shortage
forecasts for the next decade and beyond.
• Physicians are interested in different types of applications. Primary care physicians (PCPs)
are most interested in prescribing medication wirelessly, and specialists, in accessing
electronic medical records (EMRs) wirelessly.
• In-person consultations are still the main method of reimbursement, but physicians are
getting limited reimbursement for phone consultations, email consults, telehealth and text.
Payment models that address how mobile health reduces costs are more effective, but
require changes in delivery-care processes.
• Providers in search of additional funding should consider marketing mobile health
solutions. According to the survey, consumers said hospitals are the preferred place to
buy mobile health products and doctors are overwhelmingly the most trusted in terms
of getting health information.
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
3
The consumer products and services
•
Markets for mobile health are
model enables individuals to understand key
counterintuitive:
health metrics and share that information
with those who matter most in their lives
--
Even though surveys show women
(e.g., family, providers, fitness trainers).
make most health decisions for the
HRI survey findings showed:
family, the HRI survey showed that
men are twice as likely as women to
•
Cell phones are a ubiquitous device
use their cell phone to get health-
to inform and activate consumers.
related reminders.
The simple act of texting has picked
up momentum, with nearly 80% of
--
Even though patients who are in poor
Medicaid patients texting regularly, the
health would seem to be targets of
highest rate of all other insured and
these applications, the survey showed
uninsured individuals.
that consumers who are in good health
are more likely to pay for them.
•
Healthcare could learn from other markets
in which consumers pay a premium for
--
Even though most Americans are
instant gratification. The HRI survey
insured through group health policies,
showed that individuals who delayed
the survey showed that individual
care more than five times in the last year
policy holders were more likely to
are more willing to pay out-of-pocket for
buy mobile health applications and to
doctor visits, electronic or in-person.
pay out of pocket for electronic visits
with physicians.
•
Only half of consumers surveyed said
they would buy mobile technology for
--
Even though physicians aren’t
their health, so it’s important to know
currently using email and text as often
who these consumers are. Of those, 20%
as they’d like to for simple patient
say they would use it to monitor fitness
communications, they are highly
or wellbeing and 18% want their doctors
skilled in this area. Physicians use
to monitor their health conditions. While
mobile Internet more than twice that
40% of respondents would be willing to
of other consumers, according to the
pay for a monthly mobile phone service
HRI survey.
or device that could send information to
their doctor, they would prefer to pay less
Infrastructure business models
than $10 for the monthly mobile phone
connect, secure and speed up information
service and less than $75 for the device.
and services.
•
Physicians agree that patient compliance
• Integration. Health systems are largely
is a major obstacle and 88% would like
ignoring the importance of integrating
their patients to be able to monitor their
mobile health into other IT efforts, such as
health on their own. Weight and blood
EMRs. Two-thirds of physicians surveyed
sugar topped the list, with vital signs not
said they are using their personal devices
far behind.
for mobile health solutions that aren’t
connected to their practice or hospital
IT systems.
4
Healthcare unwired: New business models delivering care anywhere
• Security. When physicians were asked
• Bandwidth. Hospital IT networks are
about barriers to adopting mobile health
struggling under the need for more
in the HRI survey, “worried about privacy
bandwidth to support rapidly expanding
and security” was the top answer,
data transactions and exchanges.
cited by one-third of PCPs and 41%
of specialists.
Mobile health efforts from multiple stakeholders
Stakeholder
Target health-related issue
Who
Mobile health solution
Employer
Rising healthcare costs
Safeway
Competition among locations to promote
of self-insured employers
healthy lifestyles and incentives for lowering
healthcare premiums for employees
Provider
Efficiency in coordinating
Good Shepherd
Developed own iPhone app to help
care/physician work flow
Health System
physicians access patient records, track
vitals, order medication and coordinate
with care team
Provider
Physician to physician
Physicians from
Virtual physician network for video mobile
consultation to enhance
Duke, Harvard
consults, starting with cardiology and
patient care
and JTCC
oncology. Partnership among physicians at
Duke University Medical Center, Harvard’s
Beth Israel Deaconess Medical Center, John
Theurer Cancer Center (JTCC) and Zibbel, a
health solutions technology company.
Health insurer
Finding physicians in
Aetna
Mobilizing “doc” finder and claims check
network or checking claims
Pharma
Patient compliance in
Bayer
Digital glucose monitor (DIDGET) that
diabetes monitoring
integrates with the Nintendo game console
Retail pharma
Cost information and
CVS Caremark
iPhone app for prescription drug information
prescription management
and member management of prescription
cumbersome to obtain
refills, history, and retail location finder
Telecom
Bandwidth and capacity
Verizon
4G and more robust Wi-Fi networks to
constraints on hospital
allow for increased capacity for image
networks
and data transfer
Retail
Access to remote
Best Buy
Partnership with Meridian Health to explore
monitoring devices
consumer access to healthcare monitoring
devices through retail stores and determine
the opportunity to leverage existing
customer service team for installation and
technical support.
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
5
The appetite for mobile
Mobile health is creating new value: less
director. Kaushal added, “The two ends
expensive solutions, new ways to manage
of converging solutions from the telecom
care, and better health outcomes. However,
industry and the healthcare industry create
new business models are required to unlock
a middleground that needs clarity and
access to technologies and players that
transparency.” The impact of their decisions
support preventative, acute and chronic care.
could affect the speed of innovation as well
as the investment in innovation. 3
The market for mobile Internet is booming
although healthcare solutions are still trying
To date, more than 10,000 medical and
to fit in. While only about 8% of American
healthcare/fitness-related applications are
adults have mobile Internet access, the
available for download to smartphones
market is growing rapidly, fueled by faster
and hundreds of other devices. 4 Forty
and faster connection speeds. As Figure 1
percent of consumers surveyed by HRI
shows, the market is estimated to quadruple
said they would pay for remote monitoring
between 2010 and 2014, according to
devices and a monthly service fee to send
PricewaterhouseCoopers’ estimates.
data automatically to their doctors. HRI
estimates the annual consumer market
The next generation of technology supports
for remote/mobile monitoring devices
downloads up to 7Mbps (compared to
to be $7.7 billion to $43 billion, based on
the current 1.5Mbps). With the number of
the range consumers said they would be
broadband households in the United States
willing to pay.
projected to increase from 75.6 million
in 2009 to 113.8 million in 2014, more
The new digital health environment is
information will be able to be exchanged
laced with its own lexicon—mobile health
at the home. 1
(“mHealth”), digital health, telehealth,
eHealth—but the “basic phenomena is a very
To try to better connect the $2-trillion health
powerful machine that is always networked
industry and its consumers, the Federal
and on the person. The key difference
Communications Commission (FCC) has
is on the person,” said John Glaser,
established a new healthcare taskforce
former chief information officer, Partners
to focus its national broadband efforts on
Healthcare. “Right now, mobile activities
connectivity through health IT solutions
are concentrating on extending the range of
like e-care to improve access/utilization,
existing applications.” Glaser discusses three
care coordination and ensure privacy and
classes of activities: communication (e.g.,
security. 2 Its active discussions with the
SMS, email), transactions (e.g., changing
Food and Drug Administration (FDA) will
a flight, booking a hotel) and knowledge
determine the FCC’s role of regulating
(e.g., getting directions, health information).
general purpose communication and the
“You need to start from the need and build
FDA’s jurisdiction over devices used for
up—mobile could be an avenue or it may
medical purposes. “While no final decisions
not be. For example, a child who has asthma
have been made, the goal of our agencies
and needs to track her daily capacity results
is to remove the barriers to innovation
doesn’t just need a piece of technology. She
that could help open up a range of new
needs support from her parents.” This points
prevention and healthcare solutions,” said
out a forth class of activity—the need for
Mohit Kaushal, MD, the FCC’s healthcare
integration of all aspects of a solution.
1
PricewaterhouseCoopers Global Entertainment and Media Outlook 2010-2014.
2
U.S. Federal Communications Commission. National Broadband Plan: Connecting America (2009). Chapter 10, accessed on August 23, 2010,
6
Healthcare unwired: New business models delivering care anywhere
Figure 1: Mobile Internet access market
in billions $
12.7
9.4
6.8
4.8
3.3
2.1
1.4
0.7
0.1
0.0
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Mobile Internet access revenue
Projected mobile Internet access revenue
Mobile Internet access revenue: fees paid by consumers to Internet service providers or
to wireless carriers for Internet access via mobile devices.
Source: PricewaterhouseCoopers Entertainment and Media Outlook, 2010-2014
3
Neil Versel, “FDA, FCC discuss medical smartphone apps as industry adjusts to regulatory culture,” FierceMobileHealthcare, July 27, 2010,
culture/2010-07-27.
4
metrics/?mpage=catcount.
An in-depth discussion
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7
Figure 2: Early research shows mobile health reduces provider revenues
Where
What
Result
Diabetes
Pennsylvania
Post discharge
42% drop in overall cost
remote monitoring
per patient 5
Cleveland
Cell phone size wireless
71% increase in number of
transmitter transferring
days between office visits 6
vital signs to electronic
health record
Congestive
Trans-European
Remote monitoring of
35% drop in inpatient length
heart failure
Network-Home-
patients who received
of stay; 10% reduction in
Care Management
implantable cardiac
office visits; 65% drop in
System
defibrillators
home health visits 7
Chronic
Canada
Remote monitoring of
Reduced hospital admissions
obstructive
patients with severe
by 50%; acute home
pulmonary
respiratory illness
exacerbations by 55%;
disease
hospital costs by 17% 5
Clearly, mobile health offers benefits to both
And while some industries have figured out
busy patients and busy physicians. Several
ways to get paid for electronic transactions
research studies show that mobile health
and services (e.g., music downloads),
applications reduce provider revenues
healthcare has not. The third-party payer
(See Figure 2). Hospitals, physicians and
system reduces the role of consumers. Public
other providers are paid primarily by volume,
and private health insurers are primarily
generally referred to as a “fee-for-service”
responsible for paying for healthcare, and
business model; the more you do, the
they generally have not pushed for adoption.
more you are paid.
“The technology of telehealth is well ahead
Despite an explosion of wireless
of the socialization of the telehealth idea and
technologies, patient visits outside of
we are at a tipping point for utilization to
in-person consults remain infrequently
begin taking off,” said David Jacobson, staff
reimbursed. HRI’s physician survey
vice president of Business Development,
showed phone consultations for chronic
State Sponsored Business at WellPoint.
disease management lead the pack while
wellness and maintenance was the least
reimbursed (See Figure 3).
5 Max E. Stachura, MD, and Elena V. Khasanshina, MD, PhD. “Telehomecare and Remote Monitoring: An Outcomes Overview.” The Advanced
0EC0CD3132A1/0/TelehomecarereportFNL103107.pdf.
6
“Cleveland Clinic/Microsoft Pilot Promising; Home Health Services May Benefit Chronic Disease Management.” March 1, 2010, accessed on August
8
Healthcare unwired: New business models delivering care anywhere
“Government programs currently don’t pay
Figure 3: Reimbursement of care
for several of the applications that could
through nontraditional channels
help boost outcomes. Key barriers are
by number of physicians
around licensing regulations and determining
what Medicare is going to pay for,” added
Carolyn Carter, who leads the WellPoint
31
California telemedicine program.
61
Roy Swackhamer, chief information
officer of SCAN Health Plan, points out
that payers want to see evidence. “Everyone
34
is doing pilots, but it needs to be scaled so
27
45
a physician with 500 congestive heart failure
47
patients can take advantage of the data.
19
We need predictive algorithms that can
19
138
21
be used with data aggregation tools in
51
51
order to analyze trends and perform
118
predictive analysis.”
21
Understanding how to use such information
72
hinges on applying a business model that
58
marries technology to financial reward and
creating new work flows that move from
analog to digital health delivery. “There
are lots of dashboards; however, there’s not
Chronic
Preventative
Wellness
Acute
enough attention paid to the people doing
condition
care
maintanence
care
the work,” said Mark Moffitt, former chief
management
information officer, Good Shepherd Health
System in Longview, Texas. “Once we
Text
developed a customized iPhone application
Email
that allowed physician access to patient
Telehealth
Phone
information and decision-making, we
had those who were willing to pay for half
of the device just so they could use
Source: PricewaterhouseCoopers
the application.”
HRI Physician Survey, 2010
Much of the momentum behind mobile
health has been from companies outside
health—technology and telecommunications
entertainment companies who connect
companies that are looking to expand their
with people through health e-games. Figuring
footprint in the health industry through mobile
out what role to play as a business begins
technologies. The opportunities can extend
with understanding the failures and pain
to many other stakeholders—from health and
points that are occurring in the current
fitness companies or gyms that can integrate
system for two key groups: the individual
personal data tracking with mobile phones to
and the physician.
7
John G.F. Cleland, MD, Amala A. Louis, Alan S. Rigby, PhD, Uwe Janssens, MD, Aggie H.M.M. Balk, MD, and others. “Noninvasive Home
Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death,” Journal of the American College of Cardiology
45,no.10 (2005): 1654.
9
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
Three business models for mobile health
Mobile health encompasses a wide array of
As more payers turn to performance-based
companies that sell products and services
pay, the business model for providers and
in health and wellness through technology
pharma/device companies centers on
applications. We see a plethora of pilots
improving care through connectivity and
dotting the landscape. Providers are
better information that leads to healthier
incorporating mobile into their work flows of
outcomes and greater efficiency. For
caring for patients, some even developing
example, Merck Serono created double-digit
their own applications and spinning
growth in a pipeline of generic injectable
them off as businesses. Health plans are
drugs that were long off-patent.
experimenting with mobile as a way to
(See opposite page)
reach out to their members for transactions
and new ways to engage them in healthy
Mobile health can improve use and
behaviors. Employers are text-messaging
value of physicians’ time
employees in their health promotion/
monitoring campaigns. Pharmaceutical and
In looking at reducing traditional costs,
life sciences companies are using mobile
the focus immediately goes to providers.
to support drug adherence. Interestingly, all
Physicians are generally paid by task. Their
sectors are converging in patient-centered
time is valuable but often wasted on tasks
care models that ignore venue-based,
that could be automated, eliminated or
volume-based payment.
reduced in scope through mobile health.
For example, more than half of physicians
Current business models fall into one of
surveyed by HRI said a significant portion
these three categories:
of office visits could be eliminated through
mobile health, which could improve access
• Operational/clinical capabilities
for patients and ease the number of
in-person visits from chronic care patients.
• Consumer products and services
Forty percent of physicians said they could
• Infrastructure to connect, secure and
eliminate 11% to 30% of office visits through
speed up information and services
the use of mobile health technologies like
remote monitoring, email, or text messaging
with patients.
Operational/clinical
The oft-repeated goal of “bending the cost
Such shifts could rewrite physician supply
curve” is being taken seriously by many
and shortage forecasts for the next decade
providers, payers, device companies and
and beyond. A recent study by the Mayo
pharmaceutical makers. Health reform
Clinic’s Department of Family Medicine
is rearranging the incentives, shifting the
supports this view. During the two-year
payment system to one that rewards
study, e-visits were able to replace in-office
performance and outcomes rather than
visits in 40% of the 2,531 cases. In the study,
volume. In this environment, the greater
patients logged on to a secure online portal,
financial rewards go to organizations that
where they had detailed histories taken and
demonstrate savings over traditional health
were able to upload pictures and other files
delivery. Mobile health applications can
as needed. Physicians responded within
expand access and reduce costs and in
24 hours and patients could access the
some cases, do both at the same time—
portal to view results. 8
a twofer that is rare in healthcare.
8
Steven C. Adamson, MD, and John W. Bachman, MD. “Pilot Study of Providing Online Care in Primary Care Setting.” Mayo Clinic Proceedings
85,no.8 (2010): 704-710, doi:10.4065/mcp.2010.0145.
10
Healthcare unwired: New business models delivering care anywhere
Pharma company uses Bluetooth and nurse reminder
calls to boost adherence of injectables
In a five-year journey to reinvigorate a
Lessons learned:
portfolio of generic, off-label or abandoned
1. Take a systems approach to providing
drugs, one pharmaceutical company found
results by personalizing the care delivery
digital/mobile technology could significantly
experience through technology and
boost patient adherence. While pharma
provider support/communication and
companies typically focus on new drug
connecting payment to clearly articulated
development, Switzerland-based Merck
payment goals.
Serono found that it could create double-
digit growth in a pipeline of generic injectable
2. Look in past products/services for
drugs that were long off-patent. The strategy
a pipeline that may not have been
centered on “adding value to the products
maximized.
you already have,” said Don Cowling, vice
president and managing director of Merck
3. Partner with payers and gain clarity on
Serono, UK and Ireland. “The future is behind
expected results for payment.
us.” Cowling said his team realized that the
4. Consider the value propositions of:
growth market for pharmaceuticals is in
“Either make money, help other people
adherence rather than finding new patients
save money, or save lives.”
since half of all scripts are never filled and half
of those are never taken. “People don’t buy
compliance; they buy pharmacoeconomic
outcome,” Cowling added.
Merck Serono: “Intelligent care” using
mobile health to reinvigorate pipeline and
generate patient outcomes
With six therapy areas of focus, including
neurology, fertility, and growth therapies,
Molecular diagnostic screening to identify patients
Merck Serono developed a smart electronic
who would benefit from treatment
injection device with two-way Bluetooth
Wireless easypod™ device to inject drug, record number
capability that could track all injections
of doses administered, and share data with clinicians
made. Nurses made reminder calls within
Nurse call center intervenes when notified by device
30 minutes of a missed injection. For
of patient non-compliance or problem
example, at one point, the number of
Clinical nurses in physician’s office assist in
injection-site reactions was growing in
treating patient
patients taking one of the therapies. After
Electronic health record integration of patient information
changing the needle depth requirement by
3mm, the dropout rate improved by 10%.
Value-based reporting to payer demonstrating patient
compliance and improved patient outcomes
Real-time data gathering and feedback
Personalized
System-based
Value driven
through mobile technology boosted Merck’s
business case for mobile health. The strategy
helped the company gain over 50% of new
Outcomes
patients for several therapy areas, grow
38% in a static growth hormone market, and
• Sales growth in declining, off-patent brand
decrease 20% of its workforce while doubling
• Sales force reduction
the volume of work and create a platform for
• Smaller administrative cost with improved margins
future therapeutics to be administered.
• Enhanced patient outcomes at lower cost
• Better clinical integration
• More care provided in home settings at lower cost
An in-depth discussion
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11
Figure 4: Physicians wanting patients to track/monitor health at home
88%: Yes
65%: Weight
61%: Blood sugar
57%: Vital signs (e.g., blood pressure, heart rate, respiratory rate)
54%: Exercise/physical activity
36%: Calories/fat content taken in
36%: Pain level
35%: Sleep patterns
28%: Cardiac rhythm
17%: Bladder control
16%: Acid reflux/indigestion
13%: Digestive health
12%: No
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
Remote monitoring could be a key way to
reducing hospital readmissions. Research
reduce office visits. Eighty-eight percent
has shown that one-fourth of all Medicare
of physicians said they would like their
patients are readmitted within 30 days.
patients to be able to track and/or monitor
However, beginning in October 2012,
their health at home (See Figure 4). They are
Medicare will no longer pay for certain
most interested in having patients monitor
hospital readmissions and will begin to
weight and blood sugar but also see value in
publish hospital readmission rates. Already,
having them monitor such vital signs as blood
some commercial health plans are also
pressure as well as physical activity and
beginning to pay for remote monitoring
other health-related information. Consumers
devices to reduce their readmission costs.9
indicated their top priorities would be weight
and vital signs (See Figure 5).
Work flow is important to physicians
because they get paid only for the patients
Remote monitoring also could reduce
they treat. So, they’re keenly interested in
hospital spending, a goal of both
efficiency. Accessing information where
government and private payers. Remote
and when it is needed is a top challenge
monitoring could be especially effective at
for physicians, according to the HRI survey.
9
Neil Versel. “ WellPoint, Aetna, and Humana pilot remote monitoring to cut readmissions.” FierceHealthcare, July 29, 2010, accessed August 23,
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
13
Figure 5: What consumers and physicians want to track regarding health
70%
60%
50%
40%
30%
20%
10%
Weight
Vital
Calories/
Exercise/
Sleep
Blood
Acid reflux/ Digestive
signs
fat taken in physical
patterns
sugar
indigestion health
activity
Physicians
Consumers
Source: PricewaterhouseCoopers HRI Physician and Consumer Surveys, 2010
Currently, one-third of physicians said
Yet mobile health solutions will have to
they make decisions based on incomplete
ensure that they aren’t making physicians
information for nearly 70% of their patients.
less productive. Physicians want to see
Specialists and PCPs find that their biggest
exceptions in the data, not all the data.
obstacle when seeing patients or running
Too much information could actually
their practice is accessing information when
slow care down. Hospitals can help the
and where they need it (See Figure 6). Only
physicians who bring in patients by filtering
half of physicians surveyed access EMRs
the data they send electronically. “For
while visiting and treating their patients.
example, a physician who has seen patients
“Meaningful use” requirements, which go
with chest pain that have inconsistent
into effect in 2011 and require interoperable
outcomes, can query for every patient over
use of EMRs, are expected to improve timely
the age of 55 who came in with chest pain
access to information.
and was given aspirin. This potentially allows
14
Healthcare unwired: New business models delivering care anywhere
Figure 6: Biggest obstacle when seeing patients or running practice
Primary Care Physician
29%
Specialists
43%
Accessing information when/where needed
27%
18%
Increasing face-to-face time with patients
24%
16%
Increasing patient compliance
7%
12%
Decreasing communication between physicians
8%
5%
Obtaining easier communication channels to patients
5%
5%
Other
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
hospitals to improve outcomes or work flows
their days on mobile devices. He added that
based on the data,” said Johnny Milaychev,
experienced nurses can post order requests
product manager of New Wave Software, a
on physicians’ phones and they can sign
veteran clinical integration vendor.
or modify them wherever they are. Both
specialists and PCPs have a high degree of
Another example is e-prescribing wherein
interest in e-prescribing (See Figure 7).
physicians’ most common orders are
automatically populated on their devices,
Having information at their fingertips ensures
said Donald Burt, MD, chief medical officer
physicians that their time is used more
of PatientKeeper, a physician information
effectively. Of physicians who are using
technology firm. He said PatientKeeper’s
mobile devices in their practices, 56%
25,000 daily physician users spend 20% of
said the devices expedite their decision-
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
15
Figure 7: Physician interest in performing
clinicians who are going to multiple places
various tasks wirelessly
for locating information? We go to them,”
said Teek Dwivedi, chief information officer at
Mount Sinai Hospital. The hospital spun out
the intellectual property of Vital Hub into a
Total
separate external company with plans to offer
PCP
83%
the platform model to other institutions on a
=
86%
Specialist
88%
commercial basis.
Access EMRs
PCP
86%
Mobile health could drive up volume,
=
83%
Specialist
82%
creating disincentives
Prescribing medication
People are busy, and sometimes they don’t
take care of themselves because they don’t
PCP
69%
=
74%
have the time. Individuals who delayed
Specialist
75%
care more than five times during the past
Monitor patients in hospital
year because it took too long to get an
PCP
65%
appointment are more willing than those
=
63%
who didn’t delay care to pay out-of-pocket
Specialist
62%
for electronic doctor visits (58% vs. 43%).
Initiate/track referrals
In some cases, physicians have started
PCP
61%
their own electronic medical practices in
=
60%
which they charge patients $50 for each
Specialist
59%
consultation. Those who delayed the most
Communicating with patients
care have different preferences for how they’d
PCP
65%
like their physicians to contact them for
=
57%
Specialist
54%
simple communications. Those who delayed
more than five times prefer communication
Monitor patients outside the hospital
through cell phone, email, text message,
and Facebook more than those that never
delayed care during the past year (See Figure
PCP: Primary Care Physician
9). Non-traditional communication avenues
Source: PricewaterhouseCoopers
and electronic doctor visits could be new
HRI Physician Survey, 2010
ways of reaching individuals who don’t
engage proactively in their care.
making and nearly 40% said they decrease
Willingness to pay out-of-pocket continues to
administrative time (See Figure 8). Mount
be a main barrier to mobile health adoption.
Sinai Hospital in Ontario, Canada connected
Less than half of both Medicaid and Medicare
its physicians to EMRs through their iPhones.
patients would be willing to pay out-of-pocket
Its VitalHub program has changed the way its
for electronic doctor visits. Consumers want
physicians work; they pull up patient charts,
low-cost solutions and those in very good
labs, medical references and radiology
health are the most likely to track metrics on
images. “Chart applications from leading
a mobile device application, creating more
vendors may have a robust backend, but
challenges in reaching the highest users of
the physician experience is weak. They are
the healthcare system—those in poor health
struggling with making the chart something
with chronic diseases.
easy to deal with. How do we help our
16
Healthcare unwired: New business models delivering care anywhere
Figure 8: Percent of physicians surveyed who said mobile health
would have these impacts
56%
Expedite decision
making
39%
36%
Decrease time it
takes for
Increase
administrative
collaboration
26%
tasks
among
24%
physicians
Allow more time
Have not affected
with patients
my day-to-day
work
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
Consumer products/services
You used to bring the patient to the doctor.
Now you take the doctor, hospital, and entire
The consumer market can be a high-volume,
healthcare ecosystem to the patient.”
high-value, low-price market where mild
proof of efficacy can lead to rapid adoption.
In some cases, organizations are mobilizing
applications that they’ve already hosted
“For consumers, mobile is a synonym for
online. For example, Aetna made its most
independence,” said Yan Chow, director of
popular transactions, such as physician
the Innovation and Advanced Technology
“doc” finder and claims check, available on
Group at Kaiser Permanente. “I think that the
mobile devices. “We have an overarching
ability to be independent and get data when
member experience strategy that is focused
and where you need it gives consumers
on providing clear, timely, and useful
a lot of freedom. Having consumers be at
information that helps members make
the center of their own care is a concept
informed healthcare decisions,” noted Meg
Kaiser has been working with for a long
McCabe, Aetna’s vice president, consumer
time. It gives us the chance to build a new
marketing and product. “Our technology
relationship with our members.” Rajeev
is about transparency and engagement at
Kapoor, former global managing director
any level, and over time we’ll build stronger
of Verizon Connected Healthcare, added,
relationships with our members,” added
“The paradigm of healthcare has changed.
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
17
Figure 9: Preferred communication method for routine tasks
by those who delayed care
Home phone
Email
Cell phone
47%
26%
26%
25%
23%
20%
Never delayed care
Text message
Facebook
in the past year
Delayed care
> 5 times in the
11%
6%
past year
4%
2%
Source: PricewaterhouseCoopers HRI Consumer Survey, 2010
Michael Mathias, Aetna’s chief technology
would prefer to pay less than $10 for the
officer. “The days of mass communication
monthly mobile phone service and less than
are over. We can now deliver customized
$75 for the device.
communications through mobile apps, online,
telephonically, or through the mail based
Mike Weckesser, director of emerging
on our understanding of how each member
business-health solutions at Best Buy,
wants to be communicated with.”
points out the challenges of consumer
price expectations related to mobile health
technology. “In our consumer research,
Targeting the mobile health consumers
although consumers identified a price
Only half of consumers surveyed by HRI said
threshold, they also expected the payer to
they would buy mobile technology for their
reimburse them for those purchases, thereby
health, so it’s important to know who these
slanting the data.”
consumers are. Of those, 20% say they
would use it to monitor fitness/wellbeing
Though many consumers have never
and 18% want their doctors to monitor their
taken advantage of existing mobile health
health conditions (See Figure 10). While 40%
technologies, 85% of those that have
of respondents would be willing to pay for a
communicated with their doctor by means
monthly mobile phone service or device that
other than face-to-face were satisfied with
could send information to their doctor, they
their discussion.
18
Healthcare unwired: New business models delivering care anywhere
Figure 10: Most important reasons
•
Individual health insurance
consumers would buy mobile
policyholders. This small, but growing
health technology
group of insured, is the most likely to
incorporate an application into their cell
phones to monitor their health. Likewise,
Monitor fitness/
they are the most willing to pay out-of-
wellbeing:
20%
pocket for electronic doctor visits with
nearly one-third saying they would be
willing to pay more than $25 per visit.
18%: Have doctor
Consistently, they are also willing to
monitor condition
pay the most for monthly services of
from afar
healthcare mobile phone applications and
remote monitoring devices and services.
Supporting targeting of these individuals
is that 40% report having at least one
11%: Monitor previous
chronic disease. In addition to those
condition
covered by individual health insurance
51%:
policies, half of uninsured individuals
I would not buy mobile
would be willing to pay out-of-pocket for
health technology
electronic visits and 42% of the uninsured
have a chronic disease.
Source: PricewaterhouseCoopers
•
The healthy. Consumers who reported
HRI Consumer Survey, 2010
to be in very good health are the most
likely to incorporate an application into
their cell phones to monitor their health,
while consumers with chronic diseases
are the least likely. After Nike led with
The HRI survey revealed key markets to target
its Nike+ running sensor that links to an
for mobile health services and products.
iPod or iPhone, more personal monitoring
devices have hit the market that enable
• Men. Men are twice as likely as women
consumers to track personal health,
to use their cell phone to get health
fitness, and wellbeing metrics.
related reminders. More men surveyed
have Internet service on their phone than
For example, the Zeo, a personal sleep
women do. Men are three times more
analysis device, consists of a wireless
likely to check their sports, stocks and
headband, bedside display, and email-
medical records and twice as likely to
based personalized coaching program
check restaurant ratings, news headlines
and analytical tools. It identifies periods
and get health-related reminders. They
of wake, REM, light, and deep sleep
also are more willing to incorporate
and produces a score each morning
an application into their cell phone to
relating to an individual’s sleep quantity
monitor their health (36% vs. 27%). So,
and quality. Likewise, the Fitbit Tracker,
this means that solutions for early market
a small device worn clipped to clothing,
adoption should focus on pain points that
tracks calories burned, steps taken,
are important for men.
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
19
Health system, retailer, wireless company team
to improve palliative care
Physicians in New Jersey thought there must
dispenser that monitors adherence. Based
be a better way to ease the pain of cancer
on the doctors’ preferences, they can be
patients. After collaborative conversations
alerted to fluctuations or outliers in reporting.
with the leadership of Meridian Health
“This may actually allow the physician to
System, the idea for an innovative pain
increase the billing fee from a level three and
journal was born. The journal’s intent was to
four to a level four and five,” said Sandra
allow patients to record and communicate
Elliott, Meridian Health’s director of consumer
their pain while resting at home. With more
technology and service development.
accurate communication, physicians could
better understand the pain medication
Including Best Buy in the collaboration was
needs of their patients.
a key strategy. “We have learned that we,
as a health system, don’t truly understand
The health system didn’t think insurers would
the retail marketplace,” added Elliott. “Best
pay for such a device, but maybe patients
Buy does and people go to them for their
might—if it was affordable. With this as a
technology. The wireless networks are going
business model, an unusual but powerful
to be a major part of getting technology in the
collaboration came together:
hands of consumers, and we wanted to be
able to leverage Best Buy’s retail knowledge
as well as their Geek Squad for installation.
• Clinical expertise: Meridian Health, a
As a health system, our job is to take care of
five-hospital health system in New Jersey
people. We need to come up with strategies
(a teaching hospital, children’s hospital,
to get service fees and technology prices
home health and rehab centers). Most of
down. Our challenge is to think about how
the health system’s 1,600 physicians are in
to manage an increasing patient population
private practice, with half in primary care
without building new buildings.”
and 100 physicians on staff.
• Technology expertise: Cypak, a near
field communication (NFC) 10 company
Lessons learned
that creates consumer tools
1. Partnering with those who see patients as
• Retail/tech support: Best Buy, an
consumers. Retailers of consumer health
international retailer of consumer
electronics can allow providers to focus
electronics and technical support
on their core services while leveraging
the expertise of other industries like
technology and retail.
The collaboration developed a product
called iMPak’s Health Journal for Pain, an
electronic diary in which patients are given
2. Focusing product development on the
an auditory queue and answer two or three
most critical pain point. Individual and
questions regarding their pain via buttons on
clinician testing is key to developing a
the device. The device is a tri-fold, with each
useful product.
section measuring approximately 4 inches
by 6 inches. During office visits, physicians
3. Creating with a future platform in mind.
download the information, or it can be
A flexible platform enables a variety
downloaded at home into a web portal or
of applications spanning multiple
personal health record. To pair with the health
disease states.
journal, iMPak is developing a smart pill
10 Near field communication is short-range wireless interaction among devices and PCs.
20
Healthcare unwired: New business models delivering care anywhere
distance traveled and sleep quality. It
that stable glucose levels are a huge
also wirelessly syncs with a PC where the
issue. Tackling this issue with remote
tracked data is automatically uploaded to
monitoring devices, if successful, could
a fitness and nutrition website. In addition
potentially prevent people at risk from
to these devices, numerous mobile device
crossing the line to becoming diabetic.”
applications are available free or for a fee
that track blood sugar, blood pressure,
“Employers can use mobile health to
cholesterol, and pain readings, count
keep their employees healthy,” said
calories and fitness activities, and send
Brad Wolfsen, Safeway’s vice president
medication reminders. Consumers can
of Strategy and Health Initiatives. The
trend data over time and send emails to
retail grocer, with 1,775 stores in North
their doctors on demand. Consumers
America and 186,000 workers, has seen
are now able to monitor a whole host of
no increase in its healthcare costs for
health indicators on the go.
the past five years and is constantly
looking for ways to innovate in the areas
• Healthy but likely to slip in health
of benefits, incentives and engagement
status. Consumers and physicians
of employees. Safeway’s team-based
agreed on two of the top three health
JumpStart wellness program uses text
metrics they would most like to track:
messaging. The connectivity for all
Joseph Kvedar, MD, director of the Center for Connected Health at Partners
HealthCare in Boston emphasized that while “sensor technology may rapidly
be becoming commoditized, integration with EMR and data aggregation
systems is not something we have seen done well. We need to get better at
gathering information, adding logistical software to get to the intersection of
all the data and population health management.”
weight and vital signs (e.g., blood
employees was a motivator for the 2,500
pressure, heart rate, respiratory rate).
participants, who lost 2.6% of weight
Where they differ is that consumers
over 10 weeks. “Mobile is the technology
rank calories/fat taken in as the third
of choice for team-based programs with
metric they would most like to track,
or without an incentive. The real-time
and physicians ranked blood sugar ahead
information allows us to build profiles of
of vital signs. Eric Topol, director of the
employee information instead of getting
Scripps Translational Science Institute
only point information,” said Wolfsen.
and vice chairman of the West Wireless
Health Institute, cautioned that, “patients
• Certain chronic-illness groups of
may not understand the importance of
patients. Those with chronic diseases did
glucose monitoring. Many patients need
say, however, that better access to their
to be trained as to what causes large
health information and regular feedback
swings in blood sugar and when they are
from their doctors would make them
over and undershooting. Physicians know
feel more in control of their own health.
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
21
Because 70% of people with two or
Figure 11: Text message usage
more chronic diseases own cell phones,
by insurance type
there is an opportunity for developers
to expand their targeting of the chronic
disease population. 11 In addition, females
are just as likely to buy a mobile health
43%
technology for themselves as they are
Medicare
for a family member or friend, while men
are more likely to purchase a mobile
45%
health technology for a friend or family
Veteran’s health
member rather than themselves (41%
63%
vs. 39%). However, patients with chronic
No insurance
diseases are less willing to pay out-of-
65%
pocket for electronic visits with their
Individual policy
doctor (48% vs. 52%).
68%
Employee-sponsored
Hospitals/health systems, preferred
74%
place for individuals to buy mobile
Tricare
health products
79%
Hospitals and health systems are the
Medicaid
preferred suppliers of health-related
products for both men and women, though
50% of physicians have never prescribed
a remote monitoring device and said
Source: PricewaterhouseCoopers
they don’t have enough information on
HRI Consumer Survey, 2010
mobile health. Likewise, the doctor is still
overwhelmingly the most trusted source
of healthcare information (71%), though
physicians report the second biggest
reminders and other simple communications,
obstacle when running their practices is
and Medicare patients are no less likely
not being able to increase face-to-face
than other individuals to want to receive
time with their patients as they would like
communications from their doctor over email.
to. Mobile can be an avenue through which
patients can receive health information from
the source they trust the most, though from
Medicaid patients are most likely to
a mobile adoption standpoint, one-third
use text messages
of physicians cite not having enough
Text messaging has emerged as an effective
information as a barrier to adopting mobile
way to reach a wide population. Nearly
health in their practice.
half of Medicare patients and almost 80%
of Medicaid beneficiaries who own mobile
Consumers are starting to prefer their doctor,
phones say they text regularly (See Figure
nurse, or hospital communicate with them
11). Wolfsen, of Safeway, pointed out, “If
through means other than phone calls,
you look at this segment of the population,
with 23% preferring email for appointment
11 Jane Sarasohn-Kahn, M.A., M.H.S.A. “How Smartphones Are Changing Health Care for Consumers and Providers.” California Healthcare
22
Healthcare unwired: New business models delivering care anywhere
they tend to have less access to digital
of healthcare is Evernote, where users can
information and do not necessarily have
organize anything from personal notes,
web access. Mobile can be used to reach
web clippings, electronic documents and
these individuals.” Medicaid individuals
pictures on a private online site. It has
also have the highest percentage (58%) of
an optical character recognition (OCR)
those sending/receiving more than six text
capability so users can locate their items
messages per day. Text messaging can be
by a key-word search. New information is
another channel for health related reminders
automatically synched when an account is
or remote medical monitoring.
accessed via mobile or traditional web.
Key infrastructure markets
Infrastructure
•
Security. When physicians were asked
Hospitals are increasingly feeling the
about barriers to adopting mobile health
constraints of outdated wireless networks.
in the HRI survey, “worried about privacy
Adequate infrastructure is needed to
and security” was the top answer, cited by
support high capacity and bandwidth
one-third of PCPs and 41% of specialists.
mobile systems within hospitals. New
However, Bill Braithwaite, M.D., who
healthcare-dedicated frequencies and
developed the HIPAA regulations when he
4G wireless networks are some of the
was with HHS in the mid-1990s, suggests
ways telecommunication companies are
that data on mobile platforms can be
enhancing the infrastructure of hospitals
secure with the right measures. “Multi-
to support advancements in wireless
factoral authentication provides a higher
technology. While we all use multiple
level of assurance that the user is who
platforms everyday in all aspects of our
he or she claims to be,” said Braithwaite,
lives, like Microsoft Windows, Facebook, the
who is now chief medical officer of
iPhone and the iTunes store, we rarely stop
Anakam, a security software company.
to notice what a platform is or how it works.
However, such an understanding is critical
“There are three factors that can be
to understand the type of infrastructure
used to identify you as the proper user:
required to drive the innovations necessary
something you know, something you
for the adoption of mobile health and
are and something you have,” added
wellness solutions.
Braithwaite. “Commonly, username and
password are used, but both are instances
In addition, developers are focusing on
of a single factor, something you know. For
platforms to allow for the greatest flexibility
stronger authentication, the user must also
of applications and devices. Platforms
present a second factor, which could be
enable many technologies and players
something you have, such as a registered
to participate in mobile health. There are
ID card or cell phone, or something you
several models of platforms with key
are, such as a finger print or voice print.”
characteristics that include the core,
peripherals and interfaces. As companies
The financial services industry uses similar
determine their roles in the digital world,
security measures for online banking along
they could become hubs into which other
with behind-the-scenes location login
services connect. A simple example outside
monitoring. “Messaging about our banking
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
23
Drug company creates iPhone app for patients
with Gaucher’s disease to enhance care, speed
insurance approval
When Shire’s drug, VPRIV, for Type 1
Shire’s goal was to get the patients to
Gaucher’s Disease was approved by the
ultimately drive physician adoption of the
FDA in 2010, it targeted the fewer than
OnePath app: “We started with the patients
5,000 patients in the U.S. with the incurable
because our patients—they are a motivated
chronic genetic disease. This small and
patient group.” Shire’s focus currently is
well-informed community of patients, who
enhancing the relationship between the
receive biweekly infusions, cheered the news
patient and their doctor. “We are not in
of a second drug for them. “The Gaucher
the loop. We don’t have access to any of
community is a very vocal customer base
the data. The patients can communicate
that will advocate fiercely because they went
with us through the app if they want to or
for so many years before treatment,” said
have to.” Shire is currently developing a
Ned Kitfield, associate director, U.S. VPRIV
complementary physician app: “Our goal is
Marketing and Commercial Operations. For
to create something valuable and enhance
Shire, the business model for mobile health
the relationship between the physician
was one that empowered an already vocal
and patient.”
patient community with a tool to manage
various aspects of their disease. The result
was a robust app, called OnePath, that
Lessons learned
tracks patient health metrics, provides real-
time information to physicians and connects
1. Patient adoption can drive physician
patients to dedicated case managers who
adoption; in small disease populations,
streamline insurance coverage issues.
physicians may be more open to the
OnePath also includes news, calendars,
preferences of their individual patients.
and “iGau,” which helps patients track
2. Patients want more information at their
therapeutic goals. iGau allows the patient to
fingertips. The iGau tracker empowers the
track bone pain, haemoglobin levels, liver
patient with information on health metrics
volume, platelet count, and spleen volume.
to help them and their doctor make more
Patients can take this information to their
informed decisions regarding treatment.
regular doctor visits “Many patients have
Tools that help patients manage their
been treated for years but don’t have an
entire disease could create allegiance to
easy way of recording these records. They
a particular therapy.
will say, ‘Yes, I feel better,’ but the doctor
wants to know what the actual results are.”
3. A small, close-knit disease population
can be a good target for a mobile device
“The patients have infusions every other
application as well as connect to social
week. We wanted to create an application
media communities (e.g., Patients Like
that would empower them with information,
Me). The Gaucher community is tight-knit
allow them to communicate with us
and motivated, as many remember not
more easily, and ultimately be able to
having any treatment available.
also communicate with their physicians.”
Throughout development of the app, Shire
reached out to the tight-knit Gaucher’s
community for advice “We really try to involve
members of the patient community, whether
in a formal test setting or an informal poll.”
24
Healthcare unwired: New business models delivering care anywhere
security assurance program is key on the
Figure 12: How integrated are
customer side,” said Tom Trebilcock, vice
physician mobile device apps with
president e-business and payments
hospital IT systems?
at PNC Financial Services. “You need to
first establish trust and assurance with
the customer.”
Very integrated
PCPs
9%
•
Integration. Of the physicians who are
using mobile applications and devices,
Specialists
7%
63% are using personal devices that are
Somewhat integrated
PCPs
not connected to their office or hospital
34%
IT systems (See Figure 12). Hospitals in
general have not put mobile connectivity
Specialists
27%
at the top of their IT list— 30% of
Not integrated at all
PCPs
physicians said their hospitals or practice
57%
leaders will not support the use of mobile
health devices.
Specialists
66%
Joseph Kvedar, MD, director of the
Center for Connected Health at Partners
HealthCare in Boston emphasized that
while “sensor technology may be rapidly
PCPs: Primary Care Physicians
becoming commoditized, integration
Source: PricewaterhouseCoopers
HRI Physician Survey, 2010
with EMR and data aggregation systems
is not something we have seen done
well. We need to get better at gathering
information, adding logistical software to
get to the intersection of all the data and
population health management.”
Telecom vendors are, however, working
on interoperability for their customers.
Vendors may not be ready to help
Qualcomm recently developed a
either. In a PwC survey of hospital CIOs,
cellular module that allows online
42% said they believed their device
health data, from wearable medical
connectivity vendors were unprepared or
devices, to connect and exchange
How do we help our clinicians that are going to multiple places for locating
information? We go to them.
—Teek Dwivedi
they did not know if they were prepared
information through several interfaces.
to assist them with medical device
“Qualcomm’s platform has the capability
interoperability. Such interoperability
to link the body area network devices
will be required in the later stages of
like a smart Band-Aid to personal
achieving meaningful use compliance.
area networks like wifi to wide area
An in-depth discussion
PricewaterhouseCoopers’ Health Research Institute
25
cellular networks and the Internet,”
geared toward mobilizing physicians
said Don Jones, vice president of
and eliminating bandwidth constraints
business development, health and life
is with Calgary Scientific and its ResMD
sciences. You can mix and match in
application. “We’re taking a $100K
many different ways.”
workstation and bringing it to a mobile
device like EVO that can display images
• Increasing bandwidth. Hospitals are
such as a 3-D brain scan,” said Tim
starting to feel the crunch of outdated
Donahue, vice president of Industry
wireless systems. Without a robust
Solutions at Sprint. “The network is as
infrastructure in place, care providers
important as the device,” he added. “EVO
cannot utilize high-bandwidth mobile
has a 1GHz processor in the device and
healthcare technology. Sprint is using an
needs a robust 3G or 4G environment to
infrastructure model to help providers
effectively use that kind of information.
extend their ability to provide care
Even Wi-Fi networks run into capacity
outside of the hospital. One partnership
and mobility constraints.”
26
Healthcare unwired: New business models delivering care anywhere
What this means for your business
Adoption of mobile health
will depend on what you
give for the money
Mobile technology is changing the way we think about entertainment, connect with peers
and drive our cars. However, it’s yet to pierce the ingrained practices of healthcare. Some
innovators like Eric Topol, MD, a leader in wireless medical innovations and director of the
Scripps Institute and vice chairman of the West Wireless Health Institute, say benefitting from
mobile technology starts with thinking differently about how to measure success: “When
you measure success of a remote monitoring device for diabetes, it’s helpful to think about
whether you’re talking about the short-term outcome of improving time in the normal glucose
range or a longer term effect such as preventing kidney failure. The surrogate measurement
of improved time in the normal range could be enough of an outcome to warrant the use of
the monitoring device.”
Physicians and consumers see mutual value in mobile health. And those intersections lead
to opportunity. For example, physicians are interested in remote monitoring and consumers
are willing to pay for it. Figure 13 depicts additional consumer and physician attitudes
toward mobile health.
Figure 13: Where physicians and consumers meet
How consumers feel
Summary
How physicians feel
56% like the idea of
Nontraditional appointments
45% said Internet
remote care and 41% would
Doctors and consumers are open to
visits would expand
prefer to have more of their
nontraditional appointments (e.g.,
access to patients
care via mobile
phone conversations, online visits,
and communication through secure
online portals).
27% said medication
31% said they use or
Using text
reminders via text would
would like to use text for
be helpful
There may be opportunities to incorporate
routine administrative
text messaging for simple communications
communications
between the provider and consumer.
Administrative communications
23% prefer providers
66% said they use
communicate by email for
Doctors and consumers are interested
or would like to use
appointment reminders/
in using email to communicate about
email for administrative
simple communications
administrative tasks (e.g., appointment
communications
reminders), but doctors appear to be
more eager.
40% said they
57% said they want to
Paying for mobile health
would pay for remote
monitor patients outside
There is a consumer market for remote
monitoring device with
the hospital
monitoring devices that send data to the
a monthly service fee
healthcare professional.
Source: PricewaterhouseCoopers HRI Physician and Consumer Surveys, 2010
What this means for your business
PricewaterhouseCoopers’ Health Research Institute
29
Where you are and how to start
Whether you’re thinking about mobile health,
5.
Value proposition: Create the value
planning for mobile health or leading mobile
proposition that identifies, quantifies
health, defining and understanding the
and measures the cost, convenience,
customer(s) will enable you to determine
confidence and compensation from
the most appropriate business model.
outcome improvements from the
Each model may target one or more of
mobile solution
the following goals: providing a better
transaction, giving more knowledge, easing
6.
Platform: Identify an existing platform or
communication and/or integrating solutions
the need to create a new platform upon
and information (See Figure 14). Consider
which the new mobile solution should be
these steps when identifying and executing
launched and the partners required for
on the mobile health opportunity:
the platform components
1. Customer: Identify the specific market
7.
Business model: Create the business
segment for mobile applications
model that delivers the value proposition
(consumer, employer, provider, pharma,
by leveraging existing or creating new
device, payers, etc.)
payment options
2. Pain points: Identify the current failure
8.
Develop and launch: Develop and
and pain points that mobile solutions
launch the mobile offering for the target
can more effectively address for the
market through pilots and then full
target market
launch based upon realizing metrics
and milestones of successful adoption
3. Work flow: Identify how the current
processes, practices and work flow
9.
Data mining: Mine real-time data and
would change by the application
information to create increasing value
of mobile solutions to provide a
for all stakeholders
better outcome
10. Scale: Expand the platform and
4. Vision: Create a vivid visualization of
business model to address the larger
the mobile solution and the
and adjacent markets
characteristics of the offering that
would create greater value
30
Healthcare unwired: New business models delivering care anywhere
Figure 14: Mobile health business models
Business models
Operational/clinical
Focuses on internal operations of an
organization—running and growing
the business (e.g., financial, clinical
performance, customer experience).
Goal: Transaction
Consumer products and services
Enable the exchange or
Services related to individuals that span across
query of information to
health/fitness, preventative care, acute care
accomplish discrete tasks
and chronic care (e.g., apps, fitness devices
and games, personal sensors/monitoring).
Infrastructure
Focuses on securing, connecting
and speeding up health-related
information exchange (e.g.,
platforms, software, bandwidth).
Customers
Consumer
Physician
Health system
Health insurer
Employer
Pharma/device
Goal: Knowledge
Provide new information
for decision-making
Goal: Integration
Unify services, products
and/players to form a
Goal: Communication
whole solution
Enable dialogue or
information dissemination
Source: PricewaterhouseCoopers Health Research Insititute
What this means for your business
PricewaterhouseCoopers’ Health Research Institute
31
Acknowledgments
Bill Braithwaite, MD, PhD
Doug Elwood, MD
Chief Medical Officer
Chief Strategy Officer
Anakam
Zibbel, LLC.
Donald Burt, MD
Henry Engleka
Chief Medical Officer
Chief Executive Officer
PatientKeeper
Zibbel, LLC.
Carolyn Carter
John Glaser
Manager, Business Development,
Former Chief Information Officer
State Sponsored Business
Partners HealthCare
WellPoint
Aaron Goldmuntz
Yan Chow, MD
Director, Business Development
Director, Innovation and Advanced
Cardionet
Technology Group
Kaiser Permanente
Chris Gray
National Solutions Manager for Healthcare
Karen Coppock, PhD
Sprint
Senior Program Officer
McKesson Foundation
Michael Hansen
Managing Director
Don Cowling
Matchbox Ventures
Vice President and Managing Director
Merck Serono, UK and Ireland
Robert Havasy
Business Analyst
Tim Donahue
Center for Connected Health
Vice President of Industry Solutions
Partners HealthCare
Sprint
David Jacobson
Prateek Dwivedi
Staff Vice President, Business Development,
Vice President and Chief Information Officer
State Sponsored Business
Mount Sinai Hospital, Ontario, Canada
WellPoint
Sandra Elliott
Ted Johnson, MD
Director, Consumer Technology and
Director, Division of Geriatric Medicine
Service Development
Wesley Woods Center at Emory University
Meridian Health
Don Jones
Vice President, Business Development
Health & Life Sciences
Qualcomm
32
Healthcare unwired: New business models delivering care anywhere
Mohit Kaushal, MD, MBA
Roy Swackhamer
Director of Connected Health,
Chief Information Officer
Omnibus Broadband Initiative
SCAN Health Plan
Office of Strategic Planning and Policy
Federal Communications Commission
Eric Topol, MD
Director, Scripps Translational
Rajeev Kapoor
Science Institute
Former Global Managing Director
Chief Academic Officer, Scripps Health
Verizon Connected Healthcare
Vice-Chairman, West Wireless Health Institute
The Gary and Mary West Chair of
Ned Kitfield
Innovative Medicine
Associate Director, US VPRIV Marketing,
Professor of Translational Genomics,
Commercial Operations
The Scripps Research Institute
Shire Human Genomic Therapies
Tom Trebilcock
Joseph Kvedar, MD
Vice President, e-business and Payments
Director
PNC Financial Services
Center for Connected Health
Partners HealthCare
Heath Umbach
Product Marketing Manager
Munesh Makhija
PatientKeeper
General Manager, Communication and
Informatics for GE Healthcare
Carrie Varoquiers
GE Healthcare
President, McKesson Foundation
Vice President, Corporate Citizenship
Michael Mathias
Vice President and Chief Technology Officer
Mike Weckesser
Aetna
Director, Emerging Business-Health
Solutions
Meg McCabe
Best Buy
Vice President of Consumer
Marketing and Product
Brad Wolfsen
Aetna
Vice President, Strategy and Health Initiatives
Safeway, Inc.
Johnny Milaychev
Product Manager
New Wave Software
Mark Moffitt
Former Chief Information Officer
Good Shepherd Medical Center
Acknowledgments
PricewaterhouseCoopers’ Health Research Institute
33
About the research
About PricewaterhouseCoopers
Healthcare Unwired is the most in-depth
research to date into mobile health
provides industry-focused assurance,
by PricewaterhouseCoopers’ Health
tax and advisory services to build public
Research Institute (HRI). HRI conducted
trust and enhance value for our clients
35 in-depth interviews with thought
and their stakeholders. More than 163,000
leaders and executives representing
people in 151 countries across our network
healthcare providers, payers, private sector
share their thinking, experience and
technology organizations, academic medical
solutions to develop fresh perspectives
centers, telecommunication companies,
and practical advice.
pharmaceutical and device companies,
retail companies, communication firms,
Health Research Institute
and employers. HRI also commissioned
an online survey in the summer of 2010
PricewaterhouseCoopers’ Health
of 2,000 consumers and 1,000 physicians
Research Institute (HRI) provides new
regarding their use and preference of mobile
intelligence, perspectives, and analysis
technologies in the United States.
on trends affecting all health-related
industries, including healthcare providers,
Mobile health is being defined broadly as
pharmaceuticals, health and life sciences,
the ability to provide and receive healthcare
and payers. HRI helps executive decision-
treatment and preventative services outside
makers and stakeholders navigate
of traditional care settings. Mobile health
change through a process of fact-based
tools can include remote patient monitors,
research and collaborative exchange that
video conferencing, online consultations,
draws on a network of more than 3,000
personal healthcare devices, wireless
professionals with day-to-day experience
access to patient records and prescription
in the health industries. HRI is part of
applications using a cellphone, smartphone
PricewaterhouseCoopers’ larger initiative
or wireless tablet. Our mobile discussion
for the health related industries that brings
may also include telehealth, which is more
together expertise and allows collaboration
established and include the physical/virtual
across all sectors in the health continuum.
integration and interoperability of devices
like heart rate monitors, pulse oximeters,
wireless scales.
34
Healthcare unwired: New business models delivering care anywhere
Health Research Institute
PricewaterhouseCoopers’
Advisory Team
Health Research Institute
Christopher Wasden
Kelly Barnes
Managing Director
Partner, Health Industries Leader
646.471.6090
214.754.5172
christopher.wasden@us.pwc.com
kelly.a.barnes@us.pwc.com
Bruce Henderson
David Chin, MD
Director
Principal (retired)
513.325.8885
617.530.4381
bruce.a.henderson@us.pwc.com
david.chin@us.pwc.com
Bo Parker
Sandy Lutz
Managing Director
Managing Director
408.817.5733
214.754.5434
bo.parker@us.pwc.com
sandy.lutz@us.pwc.com
Cliff Bleustein, MD
Benjamin Isgur
Director
Director
646.471.2439
214.754.5091
cliff.bleustein@us.pwc.com
benjamin.isgur@us.pwc.com
Preetham Peter
Serena Foong
Director
Senior Manager
703.863.5941
617.530.6209
preetham.s.peter@us.pwc.com
serena.h.foong@us.pwc.com
William Molloie
Joanna Bonventre
Partner
Research Analyst
619.744.8116
617.530.7563
w.molloie@us.pwc.com
joanna.bonventre@us.pwc.com
Maxim Duprat
Stephanie Zefferino
Director
Research Analyst
917.405.4816
646.471.2867
maxim.m.duprat@us.pwc.com
stephanie.h.zefferino@us.pwc.com
Christine Freyermuth
Sarah Haflett
Senior Manager
Research Analyst
617.530.4507
267.330.1654
christine.s.freyermuth@us.pwc.com
sarah.e.haflett@us.pwc.com
pwc.com/us/healthindustries
pwc.com/us/hri
twitter.com/PwCHealth
To have a deeper conversation about how this
subject may affect your business, please contact:
Kelly Barnes
Partner, Health Industries Leader
214.754.5172
kelly.a.barnes@us.pwc.com
Christopher Wasden
Managing Director
646.471.6090
christopher.wasden@us.pwc.com
Dan Garrett
Partner, Healthcare IT Practice Leader
610.256.2055
daniel.garrett@us.pwc.com
William Molloie
Partner
619.744.8116
w.molloie@us.pwc.com
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