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Michael J. Barrett
Managing Partner
Critical Mass Consulting
www.CriticalMassConsulting.com
Wireless Technology and the De-Institutionalization of Health Care
“The Wireless Future of Health IT”New America FoundationCTIA – The Wireless AssociationMarch 23, 2009
Self-care, home care and mobile care have roots and relevance
≤18th C: Health care happens mostly at home and work 19th C: Health care professionalizes and institutionalizes 1950: 40% of MD visits are still house calls 1965: Medicare includes home health, with a low profile 1980s: Chronic conditions emerge as huge cost drivers 1990s: “90% of diabetes care is self-care” 1996: Kaiser launches online health site for members 1999: Early “remote patient monitors” come to market 2002: Healthcare Unbound (over)
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2002: Healthcare Unbound
“The centralizing forces of the 1900s will yield to the decentralizing forces of the 2000s. Technology assisting, innovators will light out from 20th Century settings – hospitals, doctors’ offices and nursing homes – in order to de-institutionalize healthcare.”
“Technology in, on, and around the body that frees
care from formal institutions.”
Technology-enabled self-care, home care and mobile care have inescapably populist dimensions, rebalancing power and control towards the grassroots.
3Source: Michael J. Barrett, ”Healthcare Unbound,” Forrester Research, Dec. 17, 2002
Remote patient monitoring – system components
Source: Continua Alliance
Patient Community
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Why should you care?
Beneficiaries with chronic conditions as % of all beneficiaries
Source: Medical Expenditure Panel Survey (MEPS), 1998, cited in Robert Wood Johnson Foundation, “Chronic Conditions: Making the Case for Ongoing Care” (Dec. 2002)
=
Public payers=
27%
39%
40%
44%
85%
87%
Uninsured
Medicaid only
Private ins.
All Americans
Medicare
Private payers
Medicare/Medicaid
5-year forecast: Americans’ access to “smart” consumer devices
Source: Forrester Research, “The State Of Consumers And Technology: Benchmark 2008”
(82%) (78%)
(51%)
(78%)%
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How far will the trend go? Wireless-only households, 2007
OK – 26.2%UT – 25.5%NE – 23.2%AK – 22.6%
SD – 6.4%DE – 5.7%CT – 5.6%VT – 5.1%
DC – 20.0%
7Source: CDC, “Wireless Substitution: State-Level Estimates from the National Health Interview Survey” 2007
What wireless brings to the party
“Learning is most likely if people get immediate, clear feedback. … Well-designed systems tell people when they are doing well and when they
are making mistakes.”
-- Thaler and Sunstein,
Nudge (2008)
Ubiquity Feedback
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Still, for most things today we’re wired, not wireless
38
14
11
7
6
6
3
2
Text message
Access Internet
IM
Look for info.
Read news
Check finances
Buy music
Base: 44,959 North American adults with a mobile phone Source: Forrester Research, “The State Of Consumers And Technology: Benchmark 2008”
Percent of North American adult users of a “cell phone/smart phone or handheld wireless device” who do the following at least once a month
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What wireless can’t do (yet)
Work to mission-critical perfection (network coverage, battery life, privacy, etc.)
Maintain the cell phone’s “form factor” (who cares!) Create the “business models” – ways to pay for services Harmonize ubiquity with Medicare’s homebound requirement Change human behavior when feedback mechanisms are
imperfect and feedback itself is necessary but not sufficient
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