Healthcare Unbound: How Close Are We to a Tipping Point? Opening Keynote Presentation July 2007 San Francisco, CA Vince Kuraitis JD, MBA Better Health.
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Healthcare Unbound:How Close Are We to a Tipping Point?
Opening Keynote Presentation
July 2007 San Francisco, CAVince Kuraitis JD, MBA
Better Health Technologies, LLChttp://e-CareManagement.com blog (208) 395-1197
What’s the right metaphor for HU?
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Overview
I. Network Effects and HU Markets
II. How Close Are We To A Tipping Point?A. No Sightings B. Remote Patient Monitoring (RPM)C. Medicare Disease ManagementD. 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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Network Effects(Tipping Point)
Source: Shapiro, C. Varian, H. Network Effects 1998
$34 B Market for Healthcare Unbound Technologies
$0
$10
$20
$30
$40
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
ADL/elder Chronic Acute
Total
Acute
Chronic
ADL/elder $0.35
$US(billions)
$0.37 $0.47 $0.59 $0.73 $0.98 $1.2 $1.6 $2.0 $2.4 $3.0 $3.7
$0.10 $0.13 $0.22 $0.38 $0.65 $1.2 $3.8 $12.1 $23.1 $26.3 $25.7 $26.7
$0.00 $0.00 $0.00 $0.00 $0.01 $0.02 $0.65 $2.0 $3.6 $3.5 $3.0 $3.2
$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?
• 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. No Sightings B. Remote Patient Monitoring (RPM)C. Medicare Disease ManagementD. Personal Health Records (PHRs) E. 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://e-caremanagement.com/first-official-report-on-medicare-health-support-dm-pilot-finds-virtually-no-evidence-of-success/
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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-dotsgoogle-health-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
Hospital at Home Dates Back to the 1960s
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Current HU Tech & Apps Are A Collective Platform to Support HAH
• EHRs• Telemedicine• Niche apps • Remote Patient Monitoring
• Disease Management• Personal Health Records• Mobile telehealth• Health 2.0• Etc
Hospital At Home
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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
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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• 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
What’s the right metaphor for HU?
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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 ClientsPre-IPO CompaniesHealthPostCardiobeat EZWebSensitronLife NavigatorMedical Peace Stress Less DiabetesManager.com CogniMed Caresoft Benchmark Oncology SOS Wireless Click4Care eCare Technologies The Healan GroupFitsenseElite Care Technologies
Established organizationsIntel Digital Health GroupSamsung Electronics, South Korea -- Global Research Group -- Samsung Advanced Institute of Technology -- Digital Solution CenterMedtronic -- Neurological Disease Management -- Cardiac Rhythm Patient ManagementAmedisysSiemens Medical SolutionsPhilips ElectronicsJoslin Diabetes CenterGSKDisease Management Association of America PCS Health SystemsVarian Medical SystemsVRIWashoe Health SystemS2 SystemsCorpHealthPhysician IPACentocor
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