Healthcare Unbound: How Close Are We to a Tipping Point Opening Keynote Presentation

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Healthcare UnboundHow Close Are We to a Tipping
Point?Opening Keynote Presentation

• July 2007
  San Francisco, CA

Vince Kuraitis JD, MBA Better Health
Technologies, LLC http//e-CareManagement.com
blog [phone]
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Whats the right metaphor for HU?
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Overview

• Network Effects and HU Markets
• How Close Are We To A Tipping Point?
• No Sightings
• Remote Patient Monitoring (RPM)
• Medicare Disease Management
• Personal Health Records (PHRs)
• The Biggest (Eventual) Tipping Points of All
• Mobile telehealth
• Health 2.0
• Hospital at Home
• Lessons Across HU Market Segments

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I. Network Effects and HU Markets
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Network Effects(Tipping Point)
Source Shapiro, C. Varian, H. Network Effects
1998
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34 B Market for Healthcare Unbound Technologies
US (billions)
ADL/elder
0.35
0.37
0.47
0.59
0.73
0.98
1.2
1.6
2.0
2.4
3.0
3.7
Chronic
0.10
0.13
0.22
0.38
0.65
1.2
3.8
12.1
23.1
26.3
25.7
26.7
Acute
0.00
0.00
0.00
0.00
0.01
0.02
0.65
2.0
3.6
3.5
3.0
3.2
Total
0.45
0.50
0.69
0.97
1.4
2.1
5.7
15.7
28.7
32.3
31.7
33.6
(Numbers have been rounded)
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Key Questions

• How close are we to a tipping point in various
  segments of the HU market?
• Whats the closest thing to a sighting of a
  tipping occurring?
• Why is this important? Will HU
• Remain an interesting, sexy topic for the 6
  oclock news to run a feature, or
• Become mainstream to health and medical care?

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II. How Close Are We To A Tipping Point?

• No Sightings
• Remote Patient Monitoring (RPM)
• Medicare Disease Management
• Personal Health Records (PHRs)
• The Biggest (Eventual) Tipping Points of All
• Mobile telehealth
• Health 2.0
• Hospital at Home

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II A. No Sightings

• EHRs
• Telemedicine
• Niche apps (few network effect markets)

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II B. Remote Patient Monitoring (RPM)

• Bottom line 2008 could be a breakthrough year
  for RPM

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2008 could be a breakthrough year for RPM

• Continua begins to address major challenges
• Interoperability of devices
• Pricing (indirectly)
• But other challenges remain
• IT/integration
• Reimbursement/business model
• Licensure/regulatory issues

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II C. Medicare Disease Management

• Bottom line
• One year ago a tipping point (Medicare Health
  Support) was on the horizon
• Today, its back to square one
• Market shift toward integration of care
  providers

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Medicare DM Virtually No Evidence of Success

• Medicare Health Support appeared to be the
  favorite son demo to expand DM into Medicare
• MHS has attracted worldwide attention
• Legislation requires roll out if successful
• Elements of MHS model
• Focus on highest cost/risk population (frail
  elderly)
• Disease management -- carve out to private
  companies health plans ( vs. CCM)
• Guaranteed 5 savings business model
• Short term ROI
• Randomized control trial
• Results to-date virtually no evidence of
  success. See http//e-caremanagement.com/first-off
  icial-report-on-medicare-health-support-dm-pilot-f
  inds-virtually-no-evidence-of-success/

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The Cats are HerdingMedical Home Model Gaining
Momentum
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The Medical Home Incorporates HU Tech Apps

• Proposed payment framework for the Medical Home
  model includes for
• coordination of care
• health information technology
• secure e-mail and telephone consultation
• remote monitoring of clinical data using
  technology.
• Medicare Medical Home Demonstration

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Medicare Medical Home Demonstration (MMHD)

• December 2006 Congresses passes MMHD
• MMHD similarity to MHS high cost, chronic
  patients multiple comorbidities
• MMHD differences from MHS
• No requirement of 5 guaranteed savings
• Physicians can keep 80 of savings

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II D. Personal Health Records (PHRs)

• Bottom line
• Despite significant activity, the current PHR
  market is fragmented with no tipping point in
  sight
• BUT.....Google Health is a wildcard!

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PHR Background

• 2 models of PHRs
• Stand alone
• Tethered typically to a health plan, provider,
  employer
• Each has challenges
• The populating the PHR with data problem
• 200 PHRs on the market
• Generations of PHRs
• 1st generation PHR as APPLICATION -- an online
  repository of personal health information (PHI)
• Next generation PHR as PLATFORM

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Source Markle Foundaton A Common Framework for
Networked Personal Health Information, 2006. See
also RWJF Project HealthDesign A New Vision for
Personal Health Records, May 2007
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Google Health A Next Generation PHR(detective
work and tea leaf reading)

• The Current Market Structure for Personal Health
  Information (PHI). Your PHI is
• Scattered everywhere
• Not in standardized formats suitable for a global
  information economy
• Elaboration http//e-caremanagement.com/connecti
  ng-the-dotsgoogle-health-promises-to-create-and-do
  minate-next-generation-phrs/

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• GHs Anticipated Technology Model
• Patient centric
• A personal health URL
• Automated data mechanisms to gather and store PHI
  
• Interoperable technical standards XML and the
  Continuity of Care Record (CCR) standard
• A user interface
• Appropriate security and confidentiality measures
  
• Value added functionality (over time)

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(No Transcript)
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• Three Potential Leverage Points
• A GH platform could simultaneously create AND
  dominate next generation PHRs.
• Google Health promises to overcome the
  populating the PHR challenge
• Automated data feeds
• The Continuity of Care Record standard as the MP3
  of PHI
• Potential for rapid, dramatic network effects

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II E. The Biggest (Eventual) Tipping Points of All

• Mobile Telehealth
• 60 companies
• Possible tipping point sighting LifeComm (2008)
• Health 2.0
• Hospital at Home

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Hospital at Home Dates Back to the 1960s
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(No Transcript)
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Current HU Tech Apps Are A Collective Platform
to Support HAH
Hospital At Home

• Disease Management
• Personal Health Records
• Mobile telehealth
• Health 2.0
• Etc

• EHRs
• Telemedicine
• Niche apps
• Remote Patient Monitoring

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• What would happen at your company if someone
  said
• We adjusted last years market numbers and
  concluded we were off by 140 Billion.

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Elaborate Proof of a Hypothesis.....

• The Willie Sutton Theory of Hospital-At-Home
• Projected 2014 U.S. Annual Hospital Costs 1
  Trillion
• Projected HU 2015 market of 34 B 3.4

1.14
3.0
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III. Lessons Across HU Segments
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• We are interdependent
• Importance of HIT
• Interoperability
• Transportability of PHI
• Integration of care providers
• Are PHRs are the best candidate for a common
  technology platform?
• The issue isnt whether HU succeeds, its when
• Actions
• Support the Continuity of Care Record standard
• Join Continua

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Whats the right metaphor for HU?
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END
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Better Health Technologies, LLC

• Technology and health care delivery are
  shifting 
• From Acute and episodic care delivered in
  hospitals and doctors offices
• To Chronic disease and condition management
  delivered in homes, workplaces, and communities
• BHT provides consulting, business development,
  and speaking services to assist companies
  in  1) Understanding the shift 2) Positioning
  whats the right strategy, tactics, and
  business model? 3) Integrating your offering
  into the value chain what are the right
  partnerships?

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BHT Clients

• Pre-IPO Companies
• HealthPost
• Cardiobeat
• EZWeb
• Sensitron
• Life Navigator
• Medical Peace
• Stress Less
• DiabetesManager.com
• CogniMed
• Caresoft
• Benchmark Oncology
• SOS Wireless
• Click4Care
• eCare Technologies
• The Healan Group
• Fitsense
• Elite Care Technologies

• Established organizations
• Intel Digital Health Group
• Samsung Electronics, South Korea
• -- Global Research Group
• -- Samsung Advanced Institute of Technology
• -- Digital Solution Center
• Medtronic
• -- Neurological Disease Management
• -- Cardiac Rhythm Patient Management
• Amedisys
• Siemens Medical Solutions
• Philips Electronics
• Joslin Diabetes Center
• GSK
• Disease Management Association of America
• PCS Health Systems
• Varian Medical Systems
• VRI
• Washoe Health System