Healthcare Unbound:
How 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
(208) 395-1197
What’s the right metaphor for HU?
Overview
I.
II.
Network Effects and HU Markets
How Close Are We To A Tipping Point?
A. No Sightings
B. Remote Patient Monitoring (RPM)
C. Medicare Disease Management
D. Personal Health Records (PHRs)
E. The Biggest (Eventual) Tipping Points of All
•
•
•
Mobile telehealth
Health 2.0
Hospital at Home
III. 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
ADL/elder
Chronic
Acute
$40
$30
$US
$20
(billions)
$10
$0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
ADL/elder $0.35 $0.37 $0.47 $0.59 $0.73 $0.98 $1.2
Chronic $0.10 $0.13 $0.22 $0.38 $0.65 $1.2
$1.6
$2.1
$2.4
$3.0
$3.7
$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
Total $0.45 $0.50 $0.69 $0.97 $1.4
$2.0
$3.6
$3.5
$3.0
$3.2
$5.7 $15.7 $28.7 $32.3 $31.7 $33.6
(Numbers have been rounded)
Key Questions
• How close are we to a tipping point in various
segments of the HU market?
• What’s the closest thing to a “sighting” of a tipping
occurring?
• Why is this important? Will HU
– Remain an interesting, sexy topic for the 6 o’clock 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?
A.
B.
C.
D.
E.
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, it’s 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://ecaremanagement.com/first-official-report-on-medicare-health-support-dm-pilotfinds-virtually-no-evidence-of-success/
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The Cats are Herding:
Medical 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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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/connecting-the-dotsgooglehealth-promises-to-create-and-dominate-next-generation-phrs/
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• GH’s 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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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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Current HU Tech & Apps Are A
Collective Platform to Support HAH
Hospital At Home
•
•
•
•
EHRs
Telemedicine
Niche apps
Remote Patient Monitoring
•
•
•
•
•
Disease Management
Personal Health Records
Mobile telehealth
Health 2.0
Etc
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What would happen at your company if someone said:
“We adjusted last year’s 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
1.14
Projected 2014 U.S. Annual Hospital Costs = $1 Trillion
Projected HU 2015 market of $34 B = 3.4%
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3.0%
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 isn’t whether HU succeeds, it’s when
• Actions
– Support the Continuity of Care Record standard
– Join Continua
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What’s the right metaphor for HU?
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 – what’s 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
Established organizations
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
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
S2 Systems
CorpHealth
Physician IPA
Centocor
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