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Table of contents
September 2010
The heart of the matter 1
Mobile technology is untethering healthcare and enablingthe practice of care anywhere
An in-depth discussion 3
Mobile health is creating business models that unlock
access to new players and technologies that supportpreventative, acute and chronic care
The appetite for mobile 6Three business models for mobile health 10
What this means for your business 29
Adoption of mobile health will depend on what you givefor the money
Where you are and how to start 30
Acknowledgments 32
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The heart of the matter
Mobile technology isuntethering healthcare
and enabling the practiceof care anywhere
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1The heart of the matter PricewaterhouseCoopers’ Health Research Institute
Mobile technologies hold great promise for keeping people healthy, managing diseases, andlowering healthcare costs. For years, telehealth has provided clinical services for individualswho lacked physical access: farmers in remote communities, soldiers near the battleeld,inmates in prison. Now, these technologies have demonstrated the ability to benet almostany individual. Mobile devices are the most personal technology that consumers own. Theyenable consumers to establish personal preferences for sharing and communicating. Theycan enable health and wellness to be delivered through mass personalization.
Unfortunately, the payment wires are crossed. Providers get paid based on volume ofservices delivered, and mobile health has been shown to reduce the need for hospitaladmissions and physician ofce visits. Why would providers adopt technologies that gougetheir incomes? An industry that is paid based on volume will not adopt technologies thatreduce volume. However, new payment models enveloped in the new health reform law setup a framework to pay providers based on outcome, not volume. In this environment, mobilehealth could provide needed connections: for patients who delay care because they’re toobusy to wait in a doctor’s ofce; for physicians who don’t have enough time to spend withpatients; for device companies that want to monitor the performance of their devices; forpharmaceutical 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 valuein order for adoption to occur.
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An in-depth discussion
Mobile health is creatingbusiness models that
unlock access to newplayers and technologiesthat support preventative,acute and chronic care
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3 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
Executive summary
The mobile health industry is brimming with new health applications, devices and servicesthat are boosting individuals’ ability to connect better to their health. Forty percent ofconsumers surveyed by the Health Research Institute (HRI) said they would pay for remotemonitoring 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. Realvalue will need to be demonstrated in order for adoption to occur. And that value begins withunderstanding two key customers: the individual and the physician. New business models wilcontinue to evolve, but can t into three main categories.
The operational/clinical business model enables provider, payer, employer, medicaldevice and drug companies as well as nontraditional healthcare organizations to run theirbusiness operations better and more efciently. These include transactions and services forcustomers, 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 ow.They’re open to mobile health but believe that lack of leadership support, privacy/securityand reimbursement could be roadblocks to adoption. Key physician survey ndings that
inform the operational/clinical model were as follows:
• Mobile health can improve the use and the value of physicians’ time. One-third ofphysicians surveyed by HRI said they make decisions based on incomplete information.They believe the greatest benet of mobile devices will be to help them make decisionsfaster as they access more accurate data in real-time.
• Forty percent of physicians surveyed said they could eliminate 11% to 30% of ofcevisits through the use of mobile health technologies like remote monitoring, email, ortext messaging with patients. Such shifts could rewrite physician supply and shortageforecasts for the next decade and beyond.
• Physicians are interested in different types of applications. Primary care physicians (PCPsare most interested in prescribing medication wirelessly, and specialists, in accessingelectronic medical records (EMRs) wirelessly.
• In-person consultations are still the main method of reimbursement, but physicians aregetting limited reimbursement for phone consultations, email consults, telehealth and textPayment models that address how mobile health reduces costs are more effective, butrequire changes in delivery-care processes.
• Providers in search of additional funding should consider marketing mobile healthsolutions. According to the survey, consumers said hospitals are the preferred place tobuy mobile health products and doctors are overwhelmingly the most trusted in termsof getting health information.
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4 Healthcare unwired: New business models delivering care anywhere
The consumer products and servicesmodel enables individuals to understand keyhealth metrics and share that information
with those who matter most in their lives(e.g., family, providers, tness trainers).HRI survey ndings showed:
• Cell phones are a ubiquitous deviceto inform and activate consumers.The simple act of texting has pickedup momentum, with nearly 80% ofMedicaid patients texting regularly, thehighest rate of all other insured anduninsured individuals.
• Healthcare could learn from other markets
in which consumers pay a premium forinstant gratication. The HRI surveyshowed that individuals who delayedcare more than ve times in the last yearare more willing to pay out-of-pocket fordoctor visits, electronic or in-person.
• Only half of consumers surveyed saidthey would buy mobile technology fortheir health, so it’s important to knowwho these consumers are. Of those, 20%say they would use it to monitor tnessor wellbeing and 18% want their doctors
to monitor their health conditions. While40% of respondents would be willing topay for a monthly mobile phone serviceor device that could send information totheir doctor, they would prefer to pay lessthan $10 for the monthly mobile phoneservice and less than $75 for the device.
• Physicians agree that patient complianceis a major obstacle and 88% would liketheir patients to be able to monitor theirhealth on their own. Weight and bloodsugar topped the list, with vital signs notfar behind.
• Markets for mobile health arecounterintuitive:
- Even though surveys show womenmake most health decisions for thefamily, the HRI survey showed thatmen are twice as likely as women touse their cell phone to get health-related reminders.
- Even though patients who are in poorhealth would seem to be targets ofthese applications, the survey showedthat consumers who are in good healthare more likely to pay for them.
- Even though most Americans areinsured through group health policies,the survey showed that individualpolicy holders were more likely tobuy mobile health applications and topay out of pocket for electronic visitswith physicians.
- Even though physicians aren’tcurrently using email and text as oftenas they’d like to for simple patientcommunications, they are highlyskilled in this area. Physicians use
mobile Internet more than twice thatof other consumers, according to theHRI survey.
Infrastructure business modelsconnect, secure and speed up informationand services.
• Integration. Health systems are largelyignoring the importance of integratingmobile health into other IT efforts, such asEMRs. Two-thirds of physicians surveyedsaid they are using their personal devicesfor mobile health solutions that aren’tconnected to their practice or hospitalIT systems.
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5
Mobile health efforts from multiple stakeholders
Stakeholder Target health-related issue Who Mobile health solution
Employer Rising healthcare costs
of self-insured employers
Safeway Competition among locations to promote
healthy lifestyles and incentives for lowering
healthcare premiums for employees
Provider Efciency in coordinating
care/physician work ow
Good Shepherd
Health System
Developed own iPhone app to help
physicians access patient records, track
vitals, order medication and coordinate
with care team
Provider Physician to physician
consultation to enhance
patient care
Physicians from
Duke, Harvard
and JTCC
Virtual physician network for video mobile
consults, starting with cardiology and
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
network or checking claims
Aetna Mobilizing “doc” nder and claims check
Pharma Patient compliance in
diabetes monitoring
Bayer Digital glucose monitor (DIDGET) that
integrates with the Nintendo game console
Retail pharma Cost information and
prescription management
cumbersome to obtain
CVS Caremark iPhone app for prescription drug information
and member management of prescription
rells, history, and retail location nder
Telecom Bandwidth and capacity
constraints on hospital
networks
Verizon 4G and more robust Wi-Fi networks to
allow for increased capacity for image
and data transfer
Retail Access to remote
monitoring devices
Best Buy Partnership with Meridian Health to explore
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
• Security. When physicians were askedabout barriers to adopting mobile healthin the HRI survey, “worried about privacy
and security” was the top answer,cited by one-third of PCPs and 41%of specialists.
• Bandwidth. Hospital IT networks arestruggling under the need for morebandwidth to support rapidly expanding
data transactions and exchanges.
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6 Healthcare unwired: New business models delivering care anywhere
The appetite for mobile
Mobile health is creating new value: lessexpensive solutions, new ways to managecare, and better health outcomes. However,
new business models are required to unlockaccess to technologies and players thatsupport preventative, acute and chronic care.
The market for mobile Internet is boomingalthough healthcare solutions are still tryingto t in. While only about 8% of Americanadults have mobile Internet access, themarket is growing rapidly, fueled by fasterand faster connection speeds. As Figure 1shows, the market is estimated to quadruplebetween 2010 and 2014, according toPricewaterhouseCoopers’ estimates.
The next generation of technology supportsdownloads up to 7Mbps (compared tothe current 1.5Mbps). With the number ofbroadband households in the United Statesprojected to increase from 75.6 millionin 2009 to 113.8 million in 2014, moreinformation will be able to be exchangedat the home. 1
To try to better connect the $2-trillion healthindustry and its consumers, the FederalCommunications Commission (FCC) has
established a new healthcare taskforceto focus its national broadband efforts onconnectivity through health IT solutionslike e-care to improve access/utilization,care coordination and ensure privacy andsecurity. 2 Its active discussions with theFood and Drug Administration (FDA) willdetermine the FCC’s role of regulatinggeneral purpose communication and theFDA’s jurisdiction over devices used formedical purposes. “While no nal decisionshave been made, the goal of our agenciesis to remove the barriers to innovationthat could help open up a range of newprevention and healthcare solutions,” saidMohit Kaushal, MD, the FCC’s healthcare
director. Kaushal added, “The two endsof converging solutions from the telecomindustry and the healthcare industry create
a middleground that needs clarity andtransparency.” The impact of their decisionscould affect the speed of innovation as wellas the investment in innovation. 3
To date, more than 10,000 medical andhealthcare/tness-related applications areavailable for download to smartphonesand hundreds of other devices. 4 Fortypercent of consumers surveyed by HRIsaid they would pay for remote monitoringdevices and a monthly service fee to senddata automatically to their doctors. HRI
estimates the annual consumer marketfor remote/mobile monitoring devicesto be $7.7 billion to $43 billion, based onthe range consumers said they would bewilling to pay.
The new digital health environment islaced with its own lexicon—mobile health(“mHealth”), digital health, telehealth,eHealth—but the “basic phenomena is a verypowerful machine that is always networkedand on the person. The key differenceis on the person,” said John Glaser,
former chief information ofcer, PartnersHealthcare. “Right now, mobile activitiesare concentrating on extending the range ofexisting applications.” Glaser discusses threeclasses of activities: communication (e.g.,SMS, email), transactions (e.g., changinga ight, booking a hotel) and knowledge(e.g., getting directions, health information).“You need to start from the need and buildup—mobile could be an avenue or it maynot be. For example, a child who has asthmaand needs to track her daily capacity resultsdoesn’t just need a piece of technology. Sheneeds support from her parents.” This pointsout a forth class of activity—the need forintegration 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,
http://www.broadband.gov/plan/10-healthcare/.
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2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
0.0
Mobile Internet access revenue
Projected mobile Internet access revenue
Source: PricewaterhouseCoopers Entertainment and Media Outlook, 2010–2014
Mobile Internet access revenue: fees paid by consumers to Internet service providers orto wireless carriers for Internet access via mobile devices.
Figure 1: Mobile Internet access market
in billions $
0.70.1
1.42.1
3.3
4.8
6.8
9.4
12.7
3 Neil Versel, “FDA, FCC discuss medical smartphone apps as industry adjusts to regulatory culture,” FierceMobileHealthcare, July 27, 2010,accessed August 23, 2010, http://www.ercemobilehealthcare.com/story/fda-fcc-discuss-medical-smartphone-apps-industry-adjusts-regulatory-culture/2010-07-27.
4 “Apple iTunes App Store Metrics, Statistics, and Numbers for iPhone Apps,” last modied August 23, 2010, http://148apps.biz/app-store-metrics/?mpage=catcount.
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8 Healthcare unwired: New business models delivering care anywhere
Clearly, mobile health offers benets to bothbusy patients and busy physicians. Severalresearch studies show that mobile healthapplications reduce provider revenues(See Figure 2). Hospitals, physicians andother providers are paid primarily by volume,generally referred to as a “fee-for-service”business model; the more you do, themore you are paid.
Despite an explosion of wirelesstechnologies, patient visits outside ofin-person consults remain infrequentlyreimbursed. HRI’s physician survey
showed phone consultations for chronicdisease management lead the pack whilewellness and maintenance was the leastreimbursed (See Figure 3).
And while some industries have gured outways to get paid for electronic transactionsand services (e.g., music downloads),healthcare has not. The third-party payersystem reduces the role of consumers. Publicand private health insurers are primarilyresponsible for paying for healthcare, andthey generally have not pushed for adoption.
“The technology of telehealth is well aheadof the socialization of the telehealth idea andwe are at a tipping point for utilization tobegin taking off,” said David Jacobson, staffvice president of Business Development,
State Sponsored Business at WellPoint.
5 Max E. Stachura, MD, and Elena V. Khasanshina, MD, PhD. “Telehomecare and Remote Monitoring: An Outcomes Overview.” The AdvancedMedical Technology Association, October 31, 2007, accessed July 29, 2010, http://www.advamed.org/NR/rdonlyres/2250724C-5005-45CD-A3C9-0EC0CD3132A1/0/TelehomecarereportFNL103107.pdf.
6 “Cleveland Clinic/Microsoft Pilot Promising; Home Health Services May Benet Chronic Disease Management.” March 1, 2010, accessed on August25, 2010, http://my.clevelandclinic.org/media_relations/cleveland_clinic_pilot_with_microsoft_promising.aspx.
Figure 2: Early research shows mobile health reduces provider revenues
Where What Result
Diabetes Pennsylvania Post dischargeremote monitoring
42% drop in overall costper patient 5
Cleveland Cell phone size wirelesstransmitter transferringvital signs to electronichealth record
71% increase in number ofdays between ofce visits6
Congestiveheart failure
Trans-EuropeanNetwork-Home-
Care ManagementSystem
Remote monitoring ofpatients who received
implantable cardiacdebrillators
35% drop in inpatient lengthof stay; 10% reduction in
ofce visits; 65% drop inhome health visits 7
Chronicobstructivepulmonarydisease
Canada Remote monitoring ofpatients with severerespiratory illness
Reduced hospital admissionsby 50%; acute homeexacerbations by 55%;hospital costs by 17% 5
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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 HomeTelemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death,” Journal of the American College of Cardiology45,no.10 (2005): 1654.
“Government programs currently don’t payfor several of the applications that couldhelp boost outcomes. Key barriers are
around licensing regulations and determiningwhat Medicare is going to pay for,” addedCarolyn Carter, who leads the WellPointCalifornia telemedicine program.
Roy Swackhamer, chief informationofcer of SCAN Health Plan, points outthat payers want to see evidence. “Everyoneis doing pilots, but it needs to be scaled soa physician with 500 congestive heart failurepatients can take advantage of the data.We need predictive algorithms that canbe used with data aggregation tools in
order to analyze trends and performpredictive analysis.”
Understanding how to use such informationhinges on applying a business model thatmarries technology to nancial reward andcreating new work ows that move fromanalog to digital health delivery. “Thereare lots of dashboards; however, there’s notenough attention paid to the people doingthe work,” said Mark Moftt, former chiefinformation ofcer, Good Shepherd HealthSystem in Longview, Texas. “Once we
developed a customized iPhone applicationthat allowed physician access to patientinformation and decision-making, wehad those who were willing to pay for halfof the device just so they could usethe application.”
Much of the momentum behind mobilehealth has been from companies outsidehealth—technology and telecommunicationscompanies that are looking to expand theirfootprint in the health industry through mobiletechnologies. The opportunities can extendto many other stakeholders—from health andtness companies or gyms that can integratepersonal data tracking with mobile phones to
entertainment companies who connectwith people through health e-games. Figuringout what role to play as a business beginswith understanding the failures and painpoints that are occurring in the currentsystem for two key groups: the individualand the physician.
Source: PricewaterhouseCoopers
HRI Physician Survey, 2010
Figure 3: Reimbursement of care
through nontraditional channels
by number of physicians
Chronicconditionmanagement
Wellnessmaintanence
Preventativecare
Acutecare
Text
EmailTelehealth
Phone
31
61
45
138
34
19
51
21
58
27
19
21
118
47
51
72
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10 Healthcare unwired: New business models delivering care anywhere
Three business models for mobile health
Mobile health encompasses a wide array ofcompanies that sell products and servicesin health and wellness through technology
applications. We see a plethora of pilotsdotting the landscape. Providers areincorporating mobile into their work ows ofcaring for patients, some even developingtheir own applications and spinningthem off as businesses. Health plans areexperimenting with mobile as a way toreach out to their members for transactionsand new ways to engage them in healthybehaviors. Employers are text-messagingemployees in their health promotion/ monitoring campaigns. Pharmaceutical andlife sciences companies are using mobile
to support drug adherence. Interestingly, allsectors are converging in patient-centeredcare models that ignore venue-based,volume-based payment.
Current business models fall into one ofthese three categories:
• Operational/clinical capabilities
• Consumer products and services
• Infrastructure to connect, secure andspeed up information and services
Operational/clinical
The oft-repeated goal of “bending the costcurve” is being taken seriously by manyproviders, payers, device companies andpharmaceutical makers. Health reformis rearranging the incentives, shifting thepayment system to one that rewardsperformance and outcomes rather thanvolume. In this environment, the greaternancial rewards go to organizations that
demonstrate savings over traditional healthdelivery. Mobile health applications canexpand access and reduce costs and insome cases, do both at the same time—a twofer that is rare in healthcare.
As more payers turn to performance-basedpay, the business model for providers andpharma/device companies centers on
improving care through connectivity andbetter information that leads to healthieroutcomes and greater efciency. Forexample, Merck Serono created double-digitgrowth in a pipeline of generic injectabledrugs that were long off-patent.(See opposite page)
Mobile health can improve use andvalue of physicians’ time
In looking at reducing traditional costs,the focus immediately goes to providers.
Physicians are generally paid by task. Theirtime is valuable but often wasted on tasksthat could be automated, eliminated orreduced in scope through mobile health.For example, more than half of physicianssurveyed by HRI said a signicant portionof ofce visits could be eliminated throughmobile health, which could improve accessfor patients and ease the number ofin-person visits from chronic care patients.Forty percent of physicians said they couldeliminate 11% to 30% of ofce visits throughthe use of mobile health technologies like
remote monitoring, email, or text messagingwith patients.
Such shifts could rewrite physician supplyand shortage forecasts for the next decadeand beyond. A recent study by the MayoClinic’s Department of Family Medicinesupports this view. During the two-yearstudy, e-visits were able to replace in-ofcevisits in 40% of the 2,531 cases. In the study,patients logged on to a secure online portal,where they had detailed histories taken and
were able to upload pictures and other lesas needed. Physicians responded within24 hours and patients could access theportal to view results. 8
8 Steven C. Adamson, MD, and John W. Bachman, MD. “Pilot Study of Providing Online Care in Primary Care Setting.” Mayo Clinic Proceedings85,no.8 (2010): 704-710, doi:10.4065/mcp.2010.0145.
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11 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
In a ve-year journey to reinvigorate aportfolio of generic, off-label or abandoneddrugs, one pharmaceutical company found
digital/mobile technology could signicantlyboost patient adherence. While pharmacompanies typically focus on new drugdevelopment, Switzerland-based MerckSerono found that it could create double-digit growth in a pipeline of generic injectabledrugs that were long off-patent. The strategycentered on “adding value to the productsyou already have,” said Don Cowling, vicepresident and managing director of MerckSerono, UK and Ireland. “The future is behindus.” Cowling said his team realized that thegrowth market for pharmaceuticals is in
adherence rather than nding new patientssince half of all scripts are never lled and halfof those are never taken. “People don’t buycompliance; they buy pharmacoeconomicoutcome,” Cowling added.
With six therapy areas of focus, includingneurology, fertility, and growth therapies,Merck Serono developed a smart electronicinjection device with two-way Bluetoothcapability that could track all injectionsmade. Nurses made reminder calls within
30 minutes of a missed injection. Forexample, at one point, the number ofinjection-site reactions was growing inpatients taking one of the therapies. Afterchanging the needle depth requirement by3mm, the dropout rate improved by 10%.
Real-time data gathering and feedbackthrough mobile technology boosted Merck’sbusiness case for mobile health. The strategyhelped the company gain over 50% of newpatients for several therapy areas, grow38% in a static growth hormone market, and
decrease 20% of its workforce while doublingthe volume of work and create a platform forfuture therapeutics to be administered.
Lessons learned:
1. Take a systems approach to providingresults by personalizing the care delivery
experience through technology andprovider support/communication andconnecting payment to clearly articulatedpayment goals.
2. Look in past products/services fora pipeline that may not have beenmaximized.
3. Partner with payers and gain clarity onexpected results for payment.
4. Consider the value propositions of:
“Either make money, help other peoplesave money, or save lives.”
Pharma company uses Bluetooth and nurse remindercalls to boost adherence of injectables
Outcomes
• Sales growth in declining, off-patent brand
• Sales force reduction
• Smaller administrative cost with improved margins
• Enhanced patient outcomes at lower cost
• Better clinical integration
• More care provided in home settings at lower cost
Merck Serono: “Intelligent care” usingmobile health to reinvigorate pipeline and
generate patient outcomes
Molecular diagnostic screening to identify patientswho would benet from treatment
Wireless easypod™ device to inject drug, record numberof doses administered, and share data with clinicians
Nurse call center intervenes when notied by device
of patient non-compliance or problem
Clinical nurses in physician’s ofce assist intreating patient
Electronic health record integration of patient information
Value-based reporting to payer demonstrating patientcompliance and improved patient outcomes
System-basedPersonalized Value driven
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13 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
Remote monitoring could be a key way toreduce ofce visits. Eighty-eight percentof physicians said they would like theirpatients to be able to track and/or monitortheir health at home (See Figure 4). They aremost interested in having patients monitorweight and blood sugar but also see value inhaving them monitor such vital signs as bloodpressure as well as physical activity andother health-related information. Consumersindicated their top priorities would be weightand vital signs (See Figure 5).
Remote monitoring also could reducehospital spending, a goal of bothgovernment and private payers. Remotemonitoring could be especially effective at
reducing hospital readmissions. Researchhas shown that one-fourth of all Medicarepatients are readmitted within 30 days.However, beginning in October 2012,Medicare will no longer pay for certainhospital readmissions and will begin topublish hospital readmission rates. Already,some commercial health plans are alsobeginning to pay for remote monitoringdevices to reduce their readmission costs.9
Work ow is important to physiciansbecause they get paid only for the patients
they treat. So, they’re keenly interested inefciency. Accessing information whereand when it is needed is a top challengefor 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 23,2010, http ://www.ercehealthcare.com/story/wellpoint-aetna-and-humana-pilot-remote-monitoring-technology-cut-hospitalization/2010-07-29.
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
Figure 4: Physicians wanting patients to track/monitor health at home
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
88%: Yes
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14 Healthcare unwired: New business models delivering care anywhere
Currently, one-third of physicians saidthey make decisions based on incompleteinformation for nearly 70% of their patients.Specialists and PCPs nd that their biggestobstacle when seeing patients or runningtheir practice is accessing information whenand where they need it (See Figure 6). Onlyhalf of physicians surveyed access EMRswhile visiting and treating their patients.“Meaningful use” requirements, which gointo effect in 2011 and require interoperableuse of EMRs, are expected to improve timelyaccess to information.
Yet mobile health solutions will have toensure that they aren’t making physiciansless productive. Physicians want to seeexceptions in the data, not all the data.Too much information could actuallyslow care down. Hospitals can help thephysicians who bring in patients by lteringthe data they send electronically. “Forexample, a physician who has seen patientswith chest pain that have inconsistentoutcomes, can query for every patient overthe age of 55 who came in with chest painand was given aspirin. This potentially allows
Consumers
Physicians
Source: PricewaterhouseCoopers HRI Physician and Consumer Surveys, 2010
Figure 5: What consumers and physicians want to track regarding health
Weight Vital
signs
Calories/
fat taken in
Exercise/
physicalactivity
Sleep
patterns
Blood
sugar
Acid reflux/
indigestion
Digestive
health
10%
20%
30%
40%
50%
60%
70%
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hospitals to improve outcomes or work owsbased on the data,” said Johnny Milaychev,product manager of New Wave Software, aveteran clinical integration vendor.
Another example is e-prescribing whereinphysicians’ most common orders areautomatically populated on their devices,said Donald Burt, MD, chief medical ofcerof PatientKeeper, a physician informationtechnology rm. He said PatientKeeper’s25,000 daily physician users spend 20% of
their days on mobile devices. He added thatexperienced nurses can post order requestson physicians’ phones and they can signor modify them wherever they are. Bothspecialists and PCPs have a high degree ofinterest in e-prescribing (See Figure 7).
Having information at their ngertips ensuresphysicians that their time is used moreeffectively. Of physicians who are usingmobile devices in their practices, 56%said the devices expedite their decision-
Accessing information when/where needed
Increasing face-to-face time with patients
Increasing patient compliance
Decreasing communication between physicians
Obtaining easier communication channels to patients
Other
Primary Care Physician
Specialists
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
Figure 6: Biggest obstacle when seeing patients or running practice
43%
29%
18%
27%
16%
24%
12%
7%
5%
8%
5%
5%
An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
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16 Healthcare unwired: New business models delivering care anywhere
making and nearly 40% said they decreaseadministrative time (See Figure 8). MountSinai Hospital in Ontario, Canada connectedits physicians to EMRs through their iPhones.Its VitalHub program has changed the way its
physicians work; they pull up patient charts,labs, medical references and radiologyimages. “Chart applications from leadingvendors may have a robust backend, butthe physician experience is weak. They arestruggling with making the chart somethingeasy to deal with. How do we help our
clinicians who are going to multiple placesfor locating information? We go to them,”said Teek Dwivedi, chief information ofcer at
Mount Sinai Hospital. The hospital spun outthe intellectual property of Vital Hub into aseparate external company with plans to offerthe platform model to other institutions on acommercial basis.
Mobile health could drive up volume,creating disincentives
People are busy, and sometimes they don’ttake care of themselves because they don’thave the time. Individuals who delayedcare more than ve times during the past
year because it took too long to get anappointment are more willing than thosewho didn’t delay care to pay out-of-pocketfor electronic doctor visits (58% vs. 43%).In some cases, physicians have startedtheir own electronic medical practices inwhich they charge patients $50 for eachconsultation. Those who delayed the mostcare have different preferences for how they’dlike their physicians to contact them forsimple communications. Those who delayedmore than ve times prefer communicationthrough cell phone, email, text message,
and Facebook more than those that neverdelayed care during the past year (See Figure9). Non-traditional communication avenuesand electronic doctor visits could be newways of reaching individuals who don’tengage proactively in their care.
Willingness to pay out-of-pocket continues tobe a main barrier to mobile health adoption.Less than half of both Medicaid and Medicarepatients would be willing to pay out-of-pocketfor electronic doctor visits. Consumers want
low-cost solutions and those in very goodhealth are the most likely to track metrics ona mobile device application, creating morechallenges in reaching the highest users ofthe healthcare system—those in poor healthwith chronic diseases.
Source: PricewaterhouseCoopers
HRI Physician Survey, 2010
PCP: Primary Care Physician
Figure 7: Physician interest in performing
various tasks wirelessly
Prescribing medication
83%86%
82%
PCP
Specialist=
Access EMRs
86%PCP
Specialist=
83%
Total
88%
Monitor patients in hospital
74%PCP
Specialist=
69%
75%
Initiate/track referrals
63%PCP
Specialist=
65%
62%
Monitor patients outside the hospital
57%PCP
Specialist=
65%
54%
Communicating with patients
60%PCP
Specialist=
61%
59%
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17 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
Consumer products/services
The consumer market can be a high-volume,high-value, low-price market where mildproof of efcacy can lead to rapid adoption.
“For consumers, mobile is a synonym forindependence,” said Yan Chow, director ofthe Innovation and Advanced TechnologyGroup at Kaiser Permanente. “I think that theability to be independent and get data whenand where you need it gives consumersa lot of freedom. Having consumers be atthe center of their own care is a concept
Kaiser has been working with for a longtime. It gives us the chance to build a newrelationship with our members.” RajeevKapoor, former global managing directorof Verizon Connected Healthcare, added,“The paradigm of healthcare has changed.
You used to bring the patient to the doctor.
Now you take the doctor, hospital, and entirehealthcare ecosystem to the patient.”
In some cases, organizations are mobilizingapplications that they’ve already hostedonline. For example, Aetna made its mostpopular transactions, such as physician“doc” nder and claims check, available onmobile devices. “We have an overarchingmember experience strategy that is focusedon providing clear, timely, and usefulinformation that helps members makeinformed healthcare decisions,” noted Meg
McCabe, Aetna’s vice president, consumermarketing and product. “Our technologyis about transparency and engagement atany level, and over time we’ll build strongerrelationships with our members,” added
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
Figure 8: Percent of physicians surveyed who said mobile health
would have these impacts
56%
Expedite decision
making
Decrease time it
takes for
administrative
tasks
39%
Increase
collaboration
among
physicians
36%
Allow more time
with patients
26%
Have not affected
my day-to-daywork
24%
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18 Healthcare unwired: New business models delivering care anywhere
Michael Mathias, Aetna’s chief technology
ofcer. “The days of mass communicationare over. We can now deliver customizedcommunications through mobile apps, online,telephonically, or through the mail basedon our understanding of how each memberwants to be communicated with.”
Targeting the mobile health consumers
Only half of consumers surveyed by HRI saidthey would buy mobile technology for theirhealth, so it’s important to know who theseconsumers are. Of those, 20% say they
would use it to monitor tness/wellbeingand 18% want their doctors to monitor theirhealth conditions (See Figure 10). While 40%of respondents would be willing to pay for amonthly mobile phone service or device thatcould send information to their doctor, they
would prefer to pay less than $10 for the
monthly mobile phone service and less than$75 for the device.
Mike Weckesser, director of emergingbusiness-health solutions at Best Buy,points out the challenges of consumerprice expectations related to mobile healthtechnology. “In our consumer research,although consumers identied a pricethreshold, they also expected the payer toreimburse them for those purchases, therebyslanting the data.”
Though many consumers have nevertaken advantage of existing mobile healthtechnologies, 85% of those that havecommunicated with their doctor by meansother than face-to-face were satised withtheir discussion.
Figure 9: Preferred communication method for routine tasks
by those who delayed care
Never delayed care
in the past year
Delayed care
>5 times in thepast year
Source: PricewaterhouseCoopers HRI Consumer Survey, 2010
Text message
4%
11%
23%25%
Cell phone
20%
26%
2%
6%
Home phone
47%
26%
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19 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
The HRI survey revealed key markets to target
for mobile health services and products.
• Men. Men are twice as likely as womento use their cell phone to get healthrelated reminders. More men surveyedhave Internet service on their phone thanwomen do. Men are three times morelikely to check their sports, stocks andmedical records and twice as likely tocheck restaurant ratings, news headlinesand get health-related reminders. Theyalso are more willing to incorporatean application into their cell phone to
monitor their health (36% vs. 27%). So,this means that solutions for early marketadoption should focus on pain points thatare important for men.
• Individual health insurance
policyholders. This small, but growinggroup of insured, is the most likely to
incorporate an application into their cellphones to monitor their health. Likewise,they are the most willing to pay out-of-pocket for electronic doctor visits withnearly one-third saying they would bewilling to pay more than $25 per visit.Consistently, they are also willing topay the most for monthly services ofhealthcare mobile phone applications andremote monitoring devices and services.Supporting targeting of these individualsis that 40% report having at least onechronic disease. In addition to those
covered by individual health insurancepolicies, half of uninsured individualswould be willing to pay out-of-pocket forelectronic visits and 42% of the uninsuredhave a chronic disease.
• The healthy. Consumers who reportedto be in very good health are the mostlikely to incorporate an application intotheir cell phones to monitor their health,while consumers with chronic diseasesare the least likely. After Nike led withits Nike+ running sensor that links to an
iPod or iPhone, more personal monitoringdevices have hit the market that enableconsumers to track personal health,tness, and wellbeing metrics.
For example, the Zeo, a personal sleepanalysis device, consists of a wirelessheadband, bedside display, and email-based personalized coaching programand analytical tools. It identies periodsof wake, REM, light, and deep sleepand produces a score each morningrelating to an individual’s sleep quantityand quality. Likewise, the Fitbit Tracker,a small device worn clipped to clothing,tracks calories burned, steps taken,
ource: PricewaterhouseCoopers
HRI Consumer Survey, 2010
Figure 10: Most important reasons
onsumers would buy mobile
health technology
Monitor fitness/
wellbeing:
20%
11%: Monitor previous
condition
18%: Have doctor
monitor condition
from afar
51%:
I would not buy mobile
health technology
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10 Near eld communication is short-range wireless interaction among devices and PCs.
Health system, retailer, wireless company teamto improve palliative care
Physicians in New Jersey thought there mustbe a better way to ease the pain of cancerpatients. After collaborative conversations
with the leadership of Meridian HealthSystem, the idea for an innovative pain journal was born. The journal’s intent was toallow patients to record and communicatetheir pain while resting at home. With moreaccurate communication, physicians couldbetter understand the pain medicationneeds of their patients.
The health system didn’t think insurers wouldpay for such a device, but maybe patientsmight—if it was affordable. With this as abusiness model, an unusual but powerful
collaboration came together:
• Clinical expertise: Meridian Health, ave-hospital health system in New Jersey(a teaching hospital, children’s hospital,home health and rehab centers). Most ofthe health system’s 1,600 physicians are inprivate practice, with half in primary careand 100 physicians on staff.
• Technology expertise: Cypak, a neareld communication (NFC) 10 company
that creates consumer tools• Retail/tech support: Best Buy, an
international retailer of consumerelectronics and technical support
The collaboration developed a productcalled iMPak’s Health Journal for Pain, anelectronic diary in which patients are givenan auditory queue and answer two or threequestions regarding their pain via buttons onthe device. The device is a tri-fold, with eachsection measuring approximately 4 inches
by 6 inches. During ofce visits, physiciansdownload the information, or it can bedownloaded at home into a web portal orpersonal health record. To pair with the health
journal, iMPak is developing a smart pill
dispenser that monitors adherence. Basedon the doctors’ preferences, they can bealerted to uctuations or outliers in reporting.
“This may actually allow the physician toincrease the billing fee from a level three andfour to a level four and ve,” said SandraElliott, Meridian Health’s director of consumertechnology and service development.
Including Best Buy in the collaboration wasa key strategy. “We have learned that we,as a health system, don’t truly understandthe retail marketplace,” added Elliott. “BestBuy does and people go to them for theirtechnology. The wireless networks are goingto be a major part of getting technology in the
hands of consumers, and we wanted to beable to leverage Best Buy’s retail knowledgeas well as their Geek Squad for installation.
As a health system, our job is to take care ofpeople. We need to come up with strategiesto get service fees and technology pricesdown. Our challenge is to think about howto manage an increasing patient populationwithout building new buildings.”
Lessons learned
1. Partnering with those who see patients asconsumers. Retailers of consumer healthelectronics can allow providers to focuson their core services while leveragingthe expertise of other industries liketechnology and retail.
2. Focusing product development on themost critical pain point. Individual andclinician testing is key to developing auseful product.
3. Creating with a future platform in mind. A exible platform enables a varietyof applications spanning multipledisease states.
Healthcare unwired: New business models delivering care anywhere20
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21 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
distance traveled and sleep quality. Italso wirelessly syncs with a PC where thetracked data is automatically uploaded to
a tness and nutrition website. In additionto these devices, numerous mobile deviceapplications are available free or for a feethat track blood sugar, blood pressure,cholesterol, and pain readings, countcalories and tness activities, and sendmedication reminders. Consumers cantrend data over time and send emails totheir doctors on demand. Consumersare now able to monitor a whole host ofhealth indicators on the go.
• Healthy but likely to slip in health
status. Consumers and physiciansagreed on two of the top three healthmetrics they would most like to track:
weight and vital signs (e.g., bloodpressure, heart rate, respiratory rate).Where they differ is that consumersrank calories/fat taken in as the thirdmetric they would most like to track,and physicians ranked blood sugar aheadof vital signs. Eric Topol, director of theScripps Translational Science Instituteand vice chairman of the West WirelessHealth Institute, cautioned that, “patientsmay not understand the importance ofglucose monitoring. Many patients needto be trained as to what causes largeswings in blood sugar and when they areover and undershooting. Physicians know
that stable glucose levels are a hugeissue. Tackling this issue with remotemonitoring devices, if successful, could
potentially prevent people at risk fromcrossing the line to becoming diabetic.”
“Employers can use mobile health tokeep their employees healthy,” saidBrad Wolfsen, Safeway’s vice presidentof Strategy and Health Initiatives. Theretail grocer, with 1,775 stores in North
America and 186,000 workers, has seenno increase in its healthcare costs forthe past ve years and is constantlylooking for ways to innovate in the areasof benets, incentives and engagement
of employees. Safeway’s team-basedJumpStart wellness program uses textmessaging. The connectivity for all
employees was a motivator for the 2,500participants, who lost 2.6% of weightover 10 weeks. “Mobile is the technologyof choice for team-based programs withor without an incentive. The real-timeinformation allows us to build proles ofemployee information instead of gettingonly point information,” said Wolfsen.
• Certain chronic-illness groups ofpatients. Those with chronic diseases didsay, however, that better access to theirhealth information and regular feedbackfrom their doctors would make themfeel more in control of their own health.
Joseph Kvedar, MD, director of the Center for Connected Health at PartnersHealthCare in Boston emphasized that while “sensor technology may rapidlybe becoming commoditized, integration with EMR and data aggregationsystems is not something we have seen done well. We need to get better atgathering information, adding logistical software to get to the intersection ofall the data and population health management.”
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22 Healthcare unwired: New business models delivering care anywhere
Because 70% of people with two or
more chronic diseases own cell phones,
there is an opportunity for developers
to expand their targeting of the chronicdisease population.11 In addition, females
are just as likely to buy a mobile health
technology for themselves as they are
for a family member or friend, while men
are more likely to purchase a mobile
health technology for a friend or family
member rather than themselves (41%
vs. 39%). However, patients with chronic
diseases are less willing to pay out-of-
pocket for electronic visits with their
doctor (48% vs. 52%).
Hospitals/health systems, preferred
place for individuals to buy mobile
health products
Hospitals and health systems are the
preferred suppliers of health-related
products for both men and women, though
50% of physicians have never prescribed
a remote monitoring device and said
they don’t have enough information on
mobile health. Likewise, the doctor is still
overwhelmingly the most trusted source
of healthcare information (71%), though
physicians report the second biggestobstacle when running their practices is
not being able to increase face-to-face
time with their patients as they would like
to. Mobile can be an avenue through which
patients can receive health information from
the source they trust the most, though from
a mobile adoption standpoint, one-third
of physicians cite not having enough
information as a barrier to adopting mobile
health in their practice.
Consumers are starting to prefer their doctor,nurse, or hospital communicate with them
through means other than phone calls,
with 23% preferring email for appointment
reminders and other simple communications,
and Medicare patients are no less likely
than other individuals to want to receive
communications from their doctor over email.
Medicaid patients are most likely to
use text messages
Text messaging has emerged as an effective
way to reach a wide population. Nearly
half of Medicare patients and almost 80%
of Medicaid beneciaries who own mobile
phones say they text regularly (See Figure11). Wolfsen, of Safeway, pointed out, “If
you look at this segment of the population,
Source: PricewaterhouseCoopers
HRI Consumer Survey, 2010
Figure 11: Text message usage
by insurance type
Medicare
43%
Veteran’s health
45%
No insurance
63%
Individual policy
65%
Employer-sponsored
68%
Tricare
74%
Medicaid
79%
11 Jane Sarasohn-Kahn, M.A., M.H.S.A. “How Smartphones Are Changing Health Care for Consumers and Providers.” California Healthcare
Foundation, April 2010, accessed August 23, 2010, http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf.
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23 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
they tend to have less access to digitalinformation and do not necessarily haveweb access. Mobile can be used to reach
these individuals.” Medicaid individualsalso have the highest percentage (58%) ofthose sending/receiving more than six textmessages per day. Text messaging can beanother channel for health related remindersor remote medical monitoring.
Infrastructure
Hospitals are increasingly feeling theconstraints of outdated wireless networks.
Adequate infrastructure is needed tosupport high capacity and bandwidthmobile systems within hospitals. Newhealthcare-dedicated frequencies and4G wireless networks are some of theways telecommunication companies areenhancing the infrastructure of hospitalsto support advancements in wirelesstechnology. While we all use multipleplatforms everyday in all aspects of ourlives, like Microsoft Windows, Facebook, theiPhone and the iTunes store, we rarely stopto notice what a platform is or how it works.However, such an understanding is critical
to understand the type of infrastructurerequired to drive the innovations necessaryfor the adoption of mobile health andwellness solutions.
In addition, developers are focusing onplatforms to allow for the greatest exibilityof applications and devices. Platformsenable many technologies and playersto participate in mobile health. There areseveral models of platforms with keycharacteristics that include the core,peripherals and interfaces. As companies
determine their roles in the digital world,they could become hubs into which otherservices connect. A simple example outside
of healthcare is Evernote, where users canorganize anything from personal notes,web clippings, electronic documents and
pictures on a private online site. It hasan optical character recognition (OCR)capability so users can locate their itemsby a key-word search. New information isautomatically synched when an account isaccessed via mobile or traditional web.
Key infrastructure markets
• Security. When physicians were askedabout barriers to adopting mobile healthin the HRI survey, “worried about privacyand security” was the top answer, cited by
one-third of PCPs and 41% of specialists.However, Bill Braithwaite, M.D., whodeveloped the HIPAA regulations when hewas with HHS in the mid-1990s, suggeststhat data on mobile platforms can besecure with the right measures. “Multi-factoral authentication provides a higherlevel of assurance that the user is whohe or she claims to be,” said Braithwaite,who is now chief medical ofcer of
Anakam, a security software company.
“There are three factors that can be
used to identify you as the proper user:something you know, something youare and something you have,” addedBraithwaite. “Commonly, username andpassword are used, but both are instancesof a single factor, something you know. Fostronger authentication, the user must alsopresent a second factor, which could besomething you have, such as a registeredID card or cell phone, or something youare, such as a nger print or voice print.”
The nancial services industry uses similarsecurity measures for online banking alongwith behind-the-scenes location loginmonitoring. “Messaging about our banking
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24 Healthcare unwired: New business models delivering care anywhereHealthcare unwired: New business models delivering care anywhere24
When Shire’s drug, VPRIV, for Type 1Gaucher’s Disease was approved by theFDA in 2010, it targeted the fewer than
5,000 patients in the U.S. with the incurablechronic genetic disease. This small andwell-informed community of patients, whoreceive biweekly infusions, cheered the newsof a second drug for them. “The Gauchercommunity is a very vocal customer basethat will advocate ercely because they wentfor so many years before treatment,” saidNed Kiteld, associate director, U.S. VPRIVMarketing and Commercial Operations. ForShire, the business model for mobile healthwas one that empowered an already vocalpatient community with a tool to manage
various aspects of their disease. The resultwas a robust app, called OnePath, thattracks patient health metrics, provides real-time information to physicians and connectspatients to dedicated case managers whostreamline insurance coverage issues.OnePath also includes news, calendars,and “iGau,” which helps patients tracktherapeutic goals. iGau allows the patient totrack bone pain, haemoglobin levels, livervolume, platelet count, and spleen volume.Patients can take this information to theirregular doctor visits “Many patients have
been treated for years but don’t have aneasy way of recording these records. Theywill say, ‘Yes, I feel better,’ but the doctorwants to know what the actual results are.”
“The patients have infusions every otherweek. We wanted to create an applicationthat would empower them with information,allow them to communicate with usmore easily, and ultimately be able toalso communicate with their physicians.”Throughout development of the app, Shire
reached out to the tight-knit Gaucher’scommunity for advice “We really try to involvemembers of the patient community, whetherin a formal test setting or an informal poll.”
Shire’s goal was to get the patients toultimately drive physician adoption of theOnePath app: “We started with the patients
because our patients—they are a motivatedpatient group.” Shire’s focus currently isenhancing the relationship between thepatient and their doctor. “We are not inthe loop. We don’t have access to any ofthe data. The patients can communicatewith us through the app if they want to orhave to.” Shire is currently developing acomplementary physician app: “Our goal isto create something valuable and enhancethe relationship between the physicianand patient.”
Lessons learned
1. Patient adoption can drive physicianadoption; in small disease populations,physicians may be more open to thepreferences of their individual patients.
2. Patients want more information at theirngertips. The iGau tracker empowers thepatient with information on health metricsto help them and their doctor make moreinformed decisions regarding treatment.
Tools that help patients manage theirentire disease could create allegiance toa particular therapy.
3. A small, close-knit disease populationcan be a good target for a mobile deviceapplication as well as connect to socialmedia communities (e.g., Patients LikeMe). The Gaucher community is tight-knitand motivated, as many remember nothaving any treatment available.
Drug company creates iPhone app for patientswith Gaucher’s disease to enhance care, speedinsurance approval
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25
security assurance program is key on thecustomer side,” said Tom Trebilcock, vicepresident e-business and payments
at PNC Financial Services. “You need torst establish trust and assurance withthe customer.”
• Integration. Of the physicians who areusing mobile applications and devices,63% are using personal devices that arenot connected to their ofce or hospitalIT systems (See Figure 12). Hospitals ingeneral have not put mobile connectivityat the top of their IT list— 30% ofphysicians said their hospitals or practiceleaders will not support the use of mobile
health devices.
Joseph Kvedar, MD, director of theCenter for Connected Health at PartnersHealthCare in Boston emphasized thatwhile “sensor technology may be rapidlybecoming commoditized, integrationwith EMR and data aggregation systemsis not something we have seen donewell. We need to get better at gatheringinformation, adding logistical software toget to the intersection of all the data andpopulation health management.”
Vendors may not be ready to helpeither. In a PwC survey of hospital CIOs,42% said they believed their deviceconnectivity vendors were unprepared or
they did not know if they were preparedto assist them with medical deviceinteroperability. Such interoperabilitywill be required in the later stages ofachieving meaningful use compliance.
Telecom vendors are, however, working
on interoperability for their customers.Qualcomm recently developed acellular module that allows onlinehealth data, from wearable medicaldevices, to connect and exchange
information through several interfaces.“Qualcomm’s platform has the capabilityto link the body area network deviceslike a smart Band-Aid to personalarea networks like wi to wide area
An in-depth discussion PricewaterhouseCoopers’ Health Research Institute
Source: PricewaterhouseCoopers
HRI Physician Survey, 2010
Figure 12: How integrated are
physician mobile device apps with
hospital IT systems?
Very integrated
Somewhat integrated
Not integrated at all
PCPs
9%
PCPs
34%
PCPs
57%
Specialists
7%
Specialists
27%
Specialists66%
PCPs: Primary Care Physicians
How do we help our clinicians that are going to multiple places for locatinginformation? We go to them.
—Teek Dwived
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26 Healthcare unwired: New business models delivering care anywhere
cellular networks and the Internet,”said Don Jones, vice president ofbusiness development, health and life
sciences. You can mix and match inmany different ways.”
• Increasing bandwidth. Hospitals arestarting to feel the crunch of outdatedwireless systems. Without a robustinfrastructure in place, care providerscannot utilize high-bandwidth mobilehealthcare technology. Sprint is using aninfrastructure model to help providersextend their ability to provide careoutside of the hospital. One partnership
geared toward mobilizing physiciansand eliminating bandwidth constraintsis with Calgary Scientic and its ResMD
application. “We’re taking a $100Kworkstation and bringing it to a mobiledevice like EVO that can display imagessuch as a 3-D brain scan,” said TimDonahue, vice president of IndustrySolutions at Sprint. “The network is asimportant as the device,” he added. “EVOhas a 1GHz processor in the device andneeds a robust 3G or 4G environment toeffectively use that kind of information.Even Wi-Fi networks run into capacityand mobility constraints.”
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What this means for your business
Adoption of mobile healthwill depend on what you
give for the money
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29
Mobile technology is changing the way we think about entertainment, connect with peersand drive our cars. However, it’s yet to pierce the ingrained practices of healthcare. Someinnovators like Eric Topol, MD, a leader in wireless medical innovations and director of theScripps Institute and vice chairman of the West Wireless Health Institute, say benetting frommobile technology starts with thinking differently about how to measure success: “Whenyou measure success of a remote monitoring device for diabetes, it’s helpful to think aboutwhether 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 measurementof improved time in the normal range could be enough of an outcome to warrant the use ofthe monitoring device.”
Physicians and consumers see mutual value in mobile health. And those intersections leadto opportunity. For example, physicians are interested in remote monitoring and consumersare willing to pay for it. Figure 13 depicts additional consumer and physician attitudestoward mobile health.
What this means for your business PricewaterhouseCoopers’ Health Research Institute
Figure 13: Where physicians and consumers meet
How consumers feel Summary How physicians fee
Nontraditional appointments
Doctors and consumers are open tonontraditional appointments (e.g.,phone conversations, online visits,and communication through secureonline portals).
56% like the idea of
remote care and 41% would
prefer to have more of their
care via mobile
27% said medication
reminders via text would
be helpful
45% said Internet
visits would expand
access to patients
31% said they use or
would like to use text for
routine administrative
communications
Administrative communications
Doctors and consumers are interestedin using email to communicate aboutadministrative tasks (e.g., appointmentreminders), but doctors appear to bemore eager.
23% prefer providers
communicate by email for
appointment reminders/
simple communications
66% said they use
or would like to use
email for administrative
communications
Using text
There may be opportunities to incorporatetext messaging for simple communicationsbetween the provider and consumer.
Paying for mobile health
There is a consumer market for remotemonitoring devices that send data to thehealthcare professional.
40% said theywould pay for remote
monitoring device with
a monthly service fee
57% said they want tomonitor patients outside
the hospital
Source: PricewaterhouseCoopers HRI Physician and Consumer Surveys, 2010
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30 Healthcare unwired: New business models delivering care anywhere
Whether you’re thinking about mobile health,planning for mobile health or leading mobilehealth, dening and understanding the
customer(s) will enable you to determinethe most appropriate business model.Each model may target one or more ofthe following goals: providing a bettertransaction, giving more knowledge, easingcommunication and/or integrating solutionsand information (See Figure 14). Considerthese steps when identifying and executingon the mobile health opportunity:
1. Customer: Identify the specic marketsegment for mobile applications(consumer, employer, provider, pharma,
device, payers, etc.)
2. Pain points: Identify the current failureand pain points that mobile solutionscan more effectively address for thetarget market
3. Work ow: Identify how the currentprocesses, practices and work owwould change by the applicationof mobile solutions to provide abetter outcome
4. Vision: Create a vivid visualization ofthe mobile solution and thecharacteristics of the offering thatwould create greater value
5. Value proposition: Create the valueproposition that identies, quantiesand measures the cost, convenience,
condence and compensation fromoutcome improvements from themobile solution
6. Platform: Identify an existing platform othe need to create a new platform uponwhich the new mobile solution should belaunched and the partners required forthe platform components
7. Business model: Create the businessmodel that delivers the value propositionby leveraging existing or creating new
payment options
8. Develop and launch: Develop andlaunch the mobile offering for the targetmarket through pilots and then fulllaunch based upon realizing metricsand milestones of successful adoption
9. Data mining: Mine real-time data andinformation to create increasing valuefor all stakeholders
10. Scale: Expand the platform and
business model to address the largerand adjacent markets
Where you are and how to start
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31What this means for your business PricewaterhouseCoopers’ Health Research Institute
Source: PricewaterhouseCoopers Health Research Insititute
Figure 14: Mobile health business models
Goal: TransactionEnable the exchange or
query of information to
accomplish discrete task
Goal: CommunicationEnable dialogue or
information dissemination
Goal: KnowledgeProvide new inform
for decision-makin
Goal: IntegrationUnify services, products
and/players to form a
whole solution
Business models
Operational/clinicalFocuses on internal operations of anorganization—running and growingthe business (e.g., financial, clinicalperformance, customer experience).
Consumer products and servicesServices related to individuals that span acrosshealth/fitness, preventative care, acute careand chronic care (e.g., apps, fitness devicesand games, personal sensors/monitoring).
Infrastructure
Focuses on securing, connectingand speeding up health-relatedinformation exchange (e.g.,platforms, software, bandwidth).
Customers
Consumer
Physician
Health system
Health insurer
Employer
Pharma/device
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32 Healthcare unwired: New business models delivering care anywhere
Acknowledgments
Bill Braithwaite, MD, PhDChief Medical Ofcer
Anakam
Donald Burt, MDChief Medical OfcerPatientKeeper
Carolyn CarterManager, Business Development,State Sponsored BusinessWellPoint
Yan Chow, MDDirector, Innovation and AdvancedTechnology Group
Kaiser Permanente
Karen Coppock, PhDSenior Program OfcerMcKesson Foundation
Don CowlingVice President and Managing DirectorMerck Serono, UK and Ireland
Tim DonahueVice President of Industry SolutionsSprint
Prateek DwivediVice President and Chief Information OfcerMount Sinai Hospital, Ontario, Canada
Sandra ElliottDirector, Consumer Technology andService DevelopmentMeridian Health
Doug Elwood, MDChief Strategy OfcerZibbel, LLC.
Henry EnglekaChief Executive OfcerZibbel, LLC.
John GlaserFormer Chief Information OfcerPartners HealthCare
Aaron GoldmuntzDirector, Business DevelopmentCardionet
Chris GrayNational Solutions Manager for HealthcareSprint
Michael HansenManaging DirectorMatchbox Ventures
Robert HavasyBusiness AnalystCenter for Connected HealthPartners HealthCare
David JacobsonStaff Vice President, Business Development,State Sponsored BusinessWellPoint
Ted Johnson, MDDirector, Division of Geriatric MedicineWesley Woods Center at Emory University
Don JonesVice President, Business DevelopmentHealth & Life SciencesQualcomm
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33
Mohit Kaushal, MD, MBADirector of Connected Health,Omnibus Broadband Initiative
Ofce of Strategic Planning and PolicyFederal Communications Commission
Rajeev KapoorFormer Global Managing DirectorVerizon Connected Healthcare
Ned Kiteld Associate Director, US VPRIV Marketing,Commercial OperationsShire Human Genomic Therapies
Joseph Kvedar, MD
DirectorCenter for Connected HealthPartners HealthCare
Munesh MakhijaGeneral Manager, Communication andInformatics for GE HealthcareGE Healthcare
Michael MathiasVice President and Chief Technology Ofcer
Aetna
Meg McCabeVice President of ConsumerMarketing and Product
Aetna
Johnny MilaychevProduct ManagerNew Wave Software
Mark MofttFormer Chief Information OfcerGood Shepherd Medical Center
Roy SwackhamerChief Information OfcerSCAN Health Plan
Eric Topol, MDDirector, Scripps TranslationalScience InstituteChief Academic Ofcer, Scripps HealthVice-Chairman, West Wireless Health InstituteThe Gary and Mary West Chair ofInnovative Medicine
Professor of Translational Genomics,The Scripps Research Institute
Tom TrebilcockVice President, e-business and Payments
PNC Financial Services
Heath UmbachProduct Marketing ManagerPatientKeeper
Carrie VaroquiersPresident, McKesson FoundationVice President, Corporate Citizenship
Mike WeckesserDirector, Emerging Business–HealthSolutions
Best Buy
Brad WolfsenVice President, Strategy and Health InitiativesSafeway, Inc.
Acknowledgments PricewaterhouseCoopers’ Health Research Institute
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34 Healthcare unwired: New business models delivering care anywhere
About the research
Healthcare Unwired is the most in-depthresearch to date into mobile health
by PricewaterhouseCoopers’ HealthResearch Institute (HRI). HRI conducted35 in-depth interviews with thoughtleaders and executives representinghealthcare providers, payers, private sectortechnology organizations, academic medicalcenters, telecommunication companies,pharmaceutical and device companies,retail companies, communication rms,and employers. HRI also commissionedan online survey in the summer of 2010of 2,000 consumers and 1,000 physiciansregarding their use and preference of mobile
technologies in the United States.
Mobile health is being dened broadly asthe ability to provide and receive healthcaretreatment and preventative services outsideof traditional care settings. Mobile healthtools can include remote patient monitors,video conferencing, online consultations,personal healthcare devices, wirelessaccess to patient records and prescriptionapplications using a cellphone, smartphoneor wireless tablet. Our mobile discussionmay also include telehealth, which is moreestablished and include the physical/virtualintegration and interoperability of deviceslike heart rate monitors, pulse oximeters,wireless scales.
About PricewaterhouseCoopers
PricewaterhouseCoopers (www.pwc.com)provides industry-focused assurance,
tax and advisory services to build publictrust and enhance value for our clientsand their stakeholders. More than 163,000people in 151 countries across our networkshare their thinking, experience andsolutions to develop fresh perspectivesand practical advice.
Health Research Institute
PricewaterhouseCoopers’ HealthResearch Institute (HRI) provides newintelligence, perspectives, and analysison trends affecting all health-relatedindustries, including healthcare providers,pharmaceuticals, health and life sciences,and payers. HRI helps executive decision-makers and stakeholders navigatechange through a process of fact-basedresearch and collaborative exchange thatdraws on a network of more than 3,000professionals with day-to-day experiencein the health industries. HRI is part ofPricewaterhouseCoopers’ larger initiativefor the health related industries that brings
together expertise and allows collaborationacross all sectors in the health continuum.
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Health Research Institute Advisory Team
Christopher Wasden
Managing Director646.471.6090christopher.wasden@us.pwc.com
Bruce HendersonDirector513.325.8885bruce.a.henderson@us.pwc.com
Bo ParkerManaging Director408.817.5733bo.parker@us.pwc.com
Cliff Bleustein, MDDirector646.471.2439cliff.bleustein@us.pwc.com
Preetham PeterDirector703.863.5941preetham.s.peter@us.pwc.com
William MolloiePartner619.744.8116w.molloie@us.pwc.com
Maxim DupratDirector917.405.4816maxim.m.duprat@us.pwc.com
Christine FreyermuthSenior Manager617.530.4507christine.s.freyermuth@us.pwc.com
PricewaterhouseCoopers’Health Research Institute
Kelly Barnes
Partner, Health Industries Leader214.754.5172kelly.a.barnes@us.pwc.com
David Chin, MDPrincipal (retired)617.530.4381david.chin@us.pwc.com
Sandy LutzManaging Director214.754.5434sandy.lutz@us.pwc.com
Benjamin IsgurDirector214.754.5091benjamin.isgur@us.pwc.com
Serena FoongSenior Manager617.530.6209serena.h.foong@us.pwc.com
Joanna BonventreResearch Analyst617.530.7563
joanna.bonventre@us.pwc.com
Stephanie ZefferinoResearch Analyst646.471.2867stephanie.h.zefferino@us.pwc.com
Sarah HaettResearch Analyst267.330.1654sarah.e.haett@us.pwc.com
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This publication is printed on Finch Premium Blend,containing 30% post consumer waste (PCW) ber,manufactured with 66% renewable energy andelemental chlorine-free pulp.
To have a deeper conversation about how thissubject may affect your business, please contact:
Kelly BarnesPartner, Health Industries Leader214.754.5172kelly.a.barnes@us.pwc.com
Christopher WasdenManaging Director646.471.6090christopher.wasden@us.pwc.com
Dan GarrettPartner, Healthcare IT Practice Leader610.256.2055daniel.garrett@us.pwc.com
William MolloiePartner619.744.8116w.molloie@us.pwc.com
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