Healthcare Unwired
October 26, 2010
Personal Health Meetup
Agenda
Session topics
• Introduction
• The Survey
• Business Models
• Key Obstacles
• Case studies
• What this means for your business
• Q & A
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Introduction
3
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Healthcare unwired is the most comprehensive mobile health research to date by HRI
• Interviewed 35 industry leaders including:
Aetna
Sprint
Merck SeronoSafeway
Kaiser PermanenteQualcomm
Best BuyCenter for Connected Health
PNC Mount Sinai
Patient Keeper
• HRI commissioned an online survey in the summer of 2010 of 2,000 consumers and 1,000 physicians regarding their use and preference of mobile technologies in the United States
FCC
West Wireless Health Institute
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How is mobile health defined?
The ability to provide and receive healthcare treatment and preventative services outside of traditional care settings.
Mobile health tools can include
• remote patient monitors
• video conferencing
• online consultations
• personal healthcare devices
• Health information/services delivered via other channels e.g. retail
• wireless access to patient records and prescription applications using a cellphone, smartphone or wireless tablet
Slide 5
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“The basic phenomena [of mobile health] is a very powerful machine that is always networked and on the person. The key difference is on the person. Right now, mobile activities are concentrating on extending the range of existing applications.”
-- John Glaser, former chief information officer, Partners Healthcare
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The survey
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September 24, 2010
• The data• Explore consumer and clinicians’ propensity to
leverage non-traditional care channels• Explore preferences and wants of key
demographics• The context
• Access is key
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Access will be the key issue of this decadeOrganizations need to engage in new models of care delivery
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Get
Efficient
Reward
Innovate
Team Access
• Increase patient throughput by decreasing unnecessary visits through technology
• Redefine the effectiveness of DM programs
• Flow with traffic – bring access to patients
• Shift emphasis to 1st miles of health and give people “sidewalks” to guide them
• Create innovation challenges as learning opportunities that are measured and rewarded
• Transform physician/patient workflow
• Anticipate payment changes to bundled pmts for hospital and physicians
• New revenue models, new incentive structures to innovate
• Understand changes in definition of performance, measure it, manage it
• Revitalize healthcare workforce and move to team care
• Adopt flexible models of care
Source: PwC Health Research Institute Jammed Access Report
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Accessing providers is a particular challenge for Medicaid patients
9
Percentage of consumers with an ED visit in the last 12 months by insurance type
20%
15%
21%
44%
28%
0%
10%
20%
30%
40%
50%
Uninsured Employer sponsored insurance
Individual health insurance
Medicaid Medicare
Source: PwC HRI Consumer Access Survey, 2009
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Medicaid patients text the most among insured and uninsured
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Text message usage by insurance type
Source: PwC HRI Mobile Health Consumer Survey, 2010
79%
74%
68%
65%
63%
45%
43%Medicare
Veterans' health
No insurance
Individual policy
Employer-sponsored
Tricare
Medicaid
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Chronic care drives the soaring needs curve
• Patients typically enter the health system when an accident occurs or an illness is diagnosed
• The needs curve soars and patients don’t have a comprehensive guide to navigate the system
• Chronic care viewed as the hardest to obtain among emergency care, urgent care and preventive care
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What consumers value most based on health status
Source: PwC Consumer Access Survey, 2009
0%
10%
20%
30%
40%
Exercise/staying fit
Eating healthy Managing stress Access support groups
Lifestyle information (e.g.
nutrition)
Understanding treatment options
Quick access care
Second opinions by specialists
Transportation to appointments
Access to life needs (e.g. groceries)
Cost of care
Healthy Sick/Injured Chronic Illness
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Percentage of physicians who said they’ve been reimbursed for nontraditional care channels
The growth area for mobile is in chronic condition management and preventative care
Slide 12
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
14%
7% 6%
12%
5%
5%
2%
2%
6%
5%
5%
2%
3%
3%
2%
3%
Chronic condition management
Preventative care Wellness maintenance Acute care
Phone Telehealth Email Text
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88% of physicians want patients to
track/monitor their health at home.
Source: PwC Health Research Institute Physician Survey, 2010
Physicians prefer this as well
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But individuals with chronic illnesses are less/ unlikely to leverage mobile health technologies
Slide 14
Likelihood of individuals, by chronic illness status, incorporating an app into their mobile phone to track their health
No chronic illness35%Chronic illness 28%
Source: PwC Health Research Institute Consumer Survey, 2010
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Consumers want health plans to help reduce costs
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Source: PwC Consumer Access Survey, 2009
How health plans can improve access to healthcare for consumers
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Better online information
Stop denying care
Improve access (e.g. next available appointment)
Eliminate referrals / pre-authorizations
Provide larger in-network selection
Expand benefits (e.g prevention, drugs)
Reduce costs
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Research shows mobile health saves money
Slide 16
1. Max E. Stachura, MD, and Elena V. Khasanshina, MD, PhD. “Telehomecare and Remote Monitoring: An Outcomes Overview.” The Advanced Medical Technology Association, October 31, 2007, accessed July 29, 2010, http://www.advamed.org/NR/rdonlyres/2250724C-5005-45CD-A3C9-0EC0CD3132A1/0/TelehomecarereportFNL103107.pdf .
2. Cleveland Clinic/Microsoft Pilot Promising; Home Health Services May Benefit Chronic Disease Management.” March 1, 2010, accessed on August 25, 2010, http://my.clevelandclinic.org/media_relations/cleveland_clinic_pilot_with_microsoft_promising.aspx .
3. 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.
Where What Result
Diabetes Pennsylvania Post discharge remote monitoring
42% drop in overall cost per patient1
Cleveland Cell phone size wireless transmitter transferring vital signs to electronic health record
71% increase in number of days between office visits2
Congestive heart failure
Trans-European Network-Home-Care Management System
Remote monitoring of patients who received implantable cardiac defibrillators
35% drop in inpatient length of stay; 10% reduction in office visits; 65% drop in home health visits3
Chronic obstructive pulmonary disease
Canada Remote monitoring of patients with severe respiratory illness
Reduced hospital admissions by 50%; acute home exacerbations by 55%; hospital costs by 17%1
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Source: PwC Health Research Institute Physician Survey, 2010
One-third of physicians surveyed said they make decisions based on incomplete information.
What do physicians want?
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Physicians want to perform more tasks wirelessly
Slide 18
86%83% 74%
63% 60%58%
AccessEMRS
Prescribemeds
Monitor patientsin hospital
Initiate/trackreferrals
Communicatewith patients
Monitorpatientoutside hospital
Source: PwC Health Research Institute Physician Survey, 2010
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What do consumers want?
Slide 19
Source: PwC HRI Consumer Survey, 2010
20%: Monitor fitness/ wellbeing:
18%: Have doctor monitor condition from afar
11%: Monitor previous condition
51%: I would not buy mobile health technology
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Approximately 40% of consumers said they would be willing to pay for remote monitoring devices and a monthly service fee to send data automatically to their physicians.
HRI estimates the annual consumer market for mobile/remote monitoring devices to be $7.7 to $43 billion
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Source: PwC HRI Mobile Health Consumer Survey, 2010
* 41% of consumers willing to pay for a monthly subscription
The market is big and growing
40%* 3%$15–19
$20–30
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Business Models
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September 24, 2010
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New business models will have different goals to address customer pain points
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Operational/clinicalFocuses on internal operations of an organization – running and growing the business (e.g., financial, clinical performance, customer experience).
Goal: TransactionEnable the exchange or query of information to accomplish discrete tasks
Goal: KnowledgeProvide new information for decision-making
Goal: CommunicationEnable dialogue or information dissemination
Goal: IntegrationUnify services, products and/ players to form a whole solution
Source: PwC Health Research Institute
ConsumerPhysician
Health systemHealth insurer
EmployerPharma/device
InfrastructureFocuses on securing, connecting and speeding up health-related information exchange (e.g., platforms, software, bandwidth).
Consumer products and servicesServices related to individuals that span across health/ fitness, preventive care, acute care and chronic care (e.g., apps, fitness devices and games, personal sensors/ monitoring).
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Key Obstacles
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September 24, 2010
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Healthcare Unwired is not without challenges
• Adoption
• Channels – direct vs. indirect
• Propensity - demographics
• Security/Privacy
• More points of data interception
• More integration/players
• Data needed for rich functionality
• Device limitations
• Operations
• Beyond the device
• ‘Sea of Red’
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Case Studies
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September 24, 2010
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Case Study: Hawaiian health plan members embrace online physician consults
Hawaii Medical Service Association generated over 1000 encounters in the first five months of their Online Care program.
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September 24, 2010
Average session time 10.3 minutes
Peak times 43% of consultations occur between 8am and 4pm. Another 43% of
consultations occur between 8pm and 12am.
Demographics The most common user is female (63%) between the ages of 26 and 45.
Demand for services • 79% of consultations are for primary care physicians.
• Upper respiratory and infections are the most common issues raised by
patients.
• Other common issues include cough, nausea, urinary tract infections,
strep throat, acute conjunctivitis, fever and diarrhea.
• The tool is also being used by physicians to manage chronic disease
with established patients.
User satisfaction • 85% of consumers rate their experience as “excellent” or “good”
• 89% of physicians rate their experience as “excellent” or “good”
Source: PwC Health Research Institute Jammed Access Report
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Case study: Hospital creates and spins off mobile platform app for accessing medical records
• Business challenge: Enhance the physician/clinician experience and increase their ease of access to patient information
• Collaborators: Mount Sinai technology team and physicians
• Solution: Mount Sinai Hospital in Toronto developed VitalHub, an iPhone application portal that connects physicians to 66 other applications within its hospital. Mount Sinai spun out the intellectual property of VitalHub into a separate external company with plans to offer the platform model to other institutions on a commercial basis.
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“How do we help our clinicians that are going to multiple places for locating information? We go to them.” -- Teek Dwvedi, CIO, Mount Sinai Hospital
Lessons learned:
• Focus on the physician experience from a clinical point of view, not from a technology system point of view
• Observe physicians in their daily routine to understand workflow
• Make existing applications/systems easier to use – make them simple and natural so clinicians can focus on their patients
• Require minimal or no training for new applications
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Case Study: Pharma company uses Bluetooth and nurse reminder calls to boost adherence of injectables
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Merck Serono: “Intelligent care” using mobile healthto reinvigorate pipeline and generate
patient outcomes
Personalized Systems-based Value driven
Outcomes:
• Sales growth in a declining, off-patent brand• Sales force reduction• Smaller administrative costs with improved margins
• Enhanced patient outcomes at lower cost• Better clinical integration• More care provided in home settings at lower cost
Screening
Molecular diagnosticscreening to ID
patients who couldbenefit
Inject drug
Through easypoddevice; recordsnumber of dosesadministered
Nursenotification
Call center interveneswhen notified bydevice about patientnon-compliance
EHRintegration
EHR integrationof patientinformation
Value-basedreporting
Reporting to payer,demonstratingpatient complianceand improved patientoutcomes
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Case study: Health system, retailer, wireless company team to improve palliative care
• Business challenge: Enable patients in pain to record and communicate pain while resting at home or any location
• Collaborators: Meridian Health System, Cypak, Best Buy
• Solution: iMPak’s Health Journal for Pain, an electronic diary patients use to track pain. Physicians download information during office visits, or patients can download it at home into a web portal or personal health record.
Lessons learned:
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“As a health system, our job is to take care of people. We need to come up with strategies to get service fees and technology prices down. Our challenge is to think about how to manage an increasing patient population without building new buildings.”
– Sandra Elliott, Meridian Health System
Partner with those who see patients
as consumers
Create a flexible
platform with the future in
mind
Focus product development on the most critical pain
point
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What this means for your business
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Understanding where physicians and consumers meet will help organizations identify value
Slide 31
Nontraditional appointments
Doctors and consumers are open to nontraditional
appointments (e.g., phone conversations, online visits, and
communication through secure online portals).
Using text
There may be opportunities to incorporate text messaging for
simple communications between the provider and consumer.
Administrative communications
Doctors and consumers are interested in using email to
communicate about administrative tasks (e.g., appointment
reminders), but doctors appear to be more eager.
Paying for mobile health
There is a consumer market for remote monitoring devices
that send data to the healthcare professional.
How consumers feel Summary How physicians feel
56% like the idea of remote
care and 41% would prefer to
have more of their care via
mobile
45% said Internet visits would
expand access to patients
27% said medication
reminders via text would be
helpful
31% said they use
or would like to use text for
routine administrative
communications
23% prefer providers
communicate by email for
appointment reminders/
simple communications
66% said they use
or would like to use email for
administrative
communications
40% said they would pay for
remote monitoring device
with a monthly service fee
57% said they want to
monitor patients outside the
hospital
Source: PwC HRI Mobile Health Consumer and Physician Surveys, 2010
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Consider 10 steps to identify and execute against the healthcare unwired opportunity
Slide 32
• Identify the specific market segment
Customer
• Identify the current failures that mobile solutions can address
Pain points
• Identify how current processes/practices would change
Work flow
• Create a vivid visualization of value-added characteristics of the offering
Vision
• Identify, quantify, and measure the cost, convenience, confidence, and compensation of outcome improvements
Value proposition
• Identify existing platform or create new platform and partners
Platform
• Leverage existing or creating new payment options
Business model
• Design pilots, launch, and realize metrics and milestones
Develop and launch
• Mine real-time data and information to increase value
Data mining
• Expand the platform and business model to address larger and adjacent markets
Scale
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Pharma/Device
• What types of adherence programs do you have in
place? Is mobile a part of your strategy in this area?
• What is your approach for extending the value of your
current products?
• How do you intend to maintain or increase market share
for products that are about to come off patent?
• How are you helping providers with their concerns on
patient medication compliance?
• How are you addressing security and privacy of health
information related to mobile health?
Employer
• Have you considered using mobile as a channel for
your health and wellness strategy?
• How are you engaging your employees in health
and wellness?
• In what way can your employees access care
without having to leave the worksite?
• How are you addressing security and privacy of
health information related to mobile health?
Slide 33
Payer
• What types of transactions do your members
currently use on your web that might be beneficial
to offer on a mobile platform?
• Have you considered incorporating mobile
communications into your disease management
efforts?
• How are you working with your employer
customers to manage the data of their employee
population?
• How are you addressing security and privacy of
health information related to mobile health?
Provider
• How are you incorporating mobile health into your
meaningful use of electronic health records (EHR)
strategy?
• How are you enabling physicians’ access to patient
information?
• What’s your approach on communicating with patients
regarding appointments and other administrative
matters?
• What is your strategy on increasing access for patients?
Is mobile health a part of that strategy?
• How are you addressing security and privacy of health
information related to mobile health?
Questions to consider when evaluating mobile health
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Q & A
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Thank you.
For more information
Preetham Peter, Director
Health Industries
703.863.5941
www.pwc.com/us/healthcare
www.pwc.com/us/hri
twitter.com/PwCHealth
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