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Overcoming barriers to uptake
Aleix BacarditEMEA Pharmaceuticals & Healthcare Practice
London, June 2011
A.T. Kearney 2
Mobile Health, What is it?
Mobile phones Patients / Consumers
Connected devicesHealthcare
professionals
A.T. Kearney 3
The Mobile Health Promise
Better diagnose and manage
disease
Improve quality of life and
convenience
Better patient data
Consumer & patient education
Improve compliance
Improve administrative
processes
Professional education
A.T. Kearney 4
Diabetes illustrates the potential for Mobile to revolutionise health delivery
Source: A.T. Kearney Analysis
Example Type 2 Diabetes Scenario
Targeted local disease awareness marketing
programme
2
Medicine and patient appointment reminders by patient preference channel (SMS, letter,
phonecall)
12
Downloadable profiling tool to identify high risk patients in GP records3
In-practice consultation and blood glucose test. Diagnosis
and patient educated on condition
5
Remote glucose, health and medicines
(online) monitoring
10
Exception reports to GP13
Reminders of monitoring requirements (screening for complications and risk
factors)14
16Patient reward and recognition
programme, e.g. Gym discounts
Week 1 daily patient follow-up using tele-
consultation
9
Diabetes nurse clinic and enrolment and training in
education / support programme
Compilation of personal care plan using down
loadable form
8
7Patient
assigned to MDT including
medicines expert.
Initiation of drugs
4
Out-bound tele-recruitment service to encourage high-
risk patients to present
ILLUSTRATIVE
15Nurse in-home / online / telephone patient
consultation17
Patient monitors cost of care and medicines
11
Medicines delivered
6Patient improves own knowledge
(through interactive online resources)
Practitioners kept up to date with training
and interactive online ‘Q&A discussions’
1
Patients keep in touch through social networking sites
18
1
2
6
10
17
18
3
4
5
7
8
9
15
13
11
12
14
16
EDUCATIONE INTERVENTIONI SUPPORTS
Assessment of mobile health application
Sustained use
Treatment initiation
Seeking treatment
Condition awareness
“Information on conditions”
“Diagnosis & Treatment”
“Overall results management”
High applicability Low applicability
Illustrative
A.T. Kearney 5
There is no shortage of problems or solutions
Europe’s top-5
The Health needs are clear Technologies are available
Prevention Awareness Early diagnosis Compliance Managing co-
morbidities Avoiding
unnecessary costs
More phones than people
Hundreds of mobile phone apps
Plenty of devices with connectivity
Note (1): Adults defined as population aged between 20 and 79Various sources. A.T. Kearney analysis
1.3 mobile pp0.4 broadbd /
adult(1)
Europe’s top-5
18m diabetics$57bn
What lies in
between?
A.T. Kearney 6
Bridging the gap…Th
e H
ealt
h n
eed
s a
re c
lear
Tech
nolo
gie
s a
re a
vailab
le
Finding the right buyer Making it work commercially Proving Value Integrating (or decommissioning)
services Managing risks and regulation
A.T. Kearney 7
Who the buyer depends on boundaries of “health”, and by country and disease
Diagnosed as Ill with a serious disease
Worried Well
More likely to be health systemMore likely to be the consumer
Aspirational Well
Should be Worried Well
Very likely to develop a
serious disease – and
know it
Overweight, Unfit, Smoker, Drinker…
High blood pressure, high cholesterol, obese, low respiratory function,
low liver function…
Atherosclerosis, Diabetes, Renal Failure,
COPD…
Very likely to develop a
serious disease – and Don’t know
Ill with a serious
disease - but not Diagnosed
A.T. Kearney 8
Which stakeholder benefits from a Mobile Health solution will depend on how it creates value
“System” Cost/Benefit
Number of
patients
Number
of visits (per
patient)
Number of
activities (per visit)
Cost per
activityx x x=
PopulationRisk Pathway Efficiency
Delivery Efficiency
A.T. Kearney 9
Where that value appears depends on the reimbursement system
Where the burden of risk lies in the reimbursement system
Global budget/capitatio
n
Feefor
service
PROVIDER
Risk at the provider side
• Simple, easy to administer
• Excessive (uncontrolled) use of resources
• Efficient use of resources
• Potential for patient selection, under-treatment
A myriad of
systems in
between
Risk at the payer side
PAYER
A.T. Kearney 10
Healthcare is an industry driven by evidence, but the evidence for Mobile Health is recognized as being very weak
Source: European Commission: Strategic Intelligence Monitor on Personal Health Systems, 2010; European Commission: ICT and Aging 2010
“Obstacles, however, abound. Among them are […] the lack of clear evidence that mHealth solutions are viable on a wide scale and can deliver real efficiencies”Mobile Health for Independent Living. AARP, 2011
“Evidence of effectiveness is limited and inconsistent, evidence about cost-effectiveness negligible, implementation on wide scale is the challenge”Prof Chris Salisbury, University of Bristol, UK
A.T. Kearney 11
What are you trying to prove?
• Superior Outcome, or Non-Inferiority at Lower Cost ?
• Is the research hypothesis clear and realistic?
Do you have the right endpoints and measures?
• Are they relevant to decision makers?
• Is the sample size big enough?
Do you have the right comparator?
• Can you differentiate between the service and the technology?
Is the study method valid?
• What will work best? RCT, observational study, pilot, pre/post analysis?
Common mistakes in gathering evidence
A.T. Kearney 12
Mobile Health needs to integrate into the overall care model
• Consultations• Treatment and Medication• Diagnostics and Tests• Rapid response / emergencies• Training • Compliance• Frequency and type of contact with
CM (continuously reviewed)
Care Management Plan
Care Providers
Care Manager
Patient / Carer
Community and Social
Care
Emergency Care
Therapies
Acute Care
Self-CareInformal Care
Joint Decision-Making
Mobile Technologies
A.T. Kearney 13
Part of VALUE CHAIN
Commercial services Network Device Value-added services
The more critical the application, the more clinical and regulatory risk comes into play
CriticalLife-critical
interventions
Clinical Risk
Remote monitoring — WELLNESS
Remote monitoring — AMBULANCE
DIAGNOSIS support
UnwellTreatment monitoring
At risk:Diagnosis
Well:Wellness
prevention
Well:Health
information
Content
AdviceData managementMed devicePhone
Encryption
TransmissionBilling
Distribution
Marketing & Sales
A.T. Kearney 14
A Prescription to Help Bridge the Gap …
The WorldToday
All of Us, Everywhere
Th
e H
ealt
h n
eed
s a
re c
lear
Tech
nolo
gie
s a
re a
vailab
le
Focus on the service, not the technology. Simple is good
Align the solution with the incentives and financial flows
Define a clear business case, and get the stakeholders to buy into it
Start with applications that don’t require large scale service integration to be successful
Create a plan to build strong evidence that it works
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