Healthcare Unbound: How Close Are We to a Tipping Point? Opening Keynote Presentation July 2007 San Francisco, CA Vince Kuraitis JD, MBA Better Health.

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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I. Network Effects and HU Markets

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Network Effects(Tipping Point)

Source: Shapiro, C. Varian, H. Network Effects 1998

http://www.inforules.com/models/m-net.pdf.pdf


$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



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



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



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/



The Cats are Herding:Medical Home Model Gaining Momentum



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



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!



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



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



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/

http://e-caremanagement.com/connecting-the-dotsgoogle-health-promises-to-create-and-dominate-next-generation-phrs/

http://e-caremanagement.com/connecting-the-dotsgoogle-health-promises-to-create-and-dominate-next-generation-phrs/


• 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)




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

http://www.welshconfed.org/reso/1776/image/Why%20we%20need%20fewer%20beds.pdf

http://www.dip-home.de/wise/liste_autoren.asp?ASuchbegriff1=Lademann%2C+Julia

http://www.cfpc.ca/cfp/2004/Jul/vol50-jul-editorials-2.asp

http://www.australianprescriber.com/magazine/20/4/88/9

http://europa.eu.int/information_society/eeurope/ehealth/conference/2003/doc/pappasissis.ppt




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



What would happen at your company if someone said:

“We adjusted last year’s market numbers and concluded we

were off by $140 Billion.”



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%



III. Lessons Across HU Segments



• 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?


END



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?


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

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Healthcare Unbound: How Close Are We to a Tipping Point? Opening Keynote Presentation July 2007 San Francisco, CA Vince Kuraitis JD, MBA Better Health.

Documents

personal health records

home slide

rpm slide

google health

success slide

personal health records

platform slide

momentum slide