Healthcare Unwired HRI PWC

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Table of contents

September 2010

The heart of the matter 1

Mobile technology is untethering healthcare and enablingthe practice of care anywhere

An in-depth discussion 3

Mobile health is creating business models that unlock

access to new players and technologies that supportpreventative, acute and chronic care

The appetite for mobile 6Three business models for mobile health 10

What this means for your business 29

Adoption of mobile health will depend on what you givefor the money

Where you are and how to start 30

Acknowledgments 32



The heart of the matter

Mobile technology isuntethering healthcare

and enabling the practiceof care anywhere



1The heart of the matter PricewaterhouseCoopers’ Health Research Institute

Mobile technologies hold great promise for keeping people healthy, managing diseases, andlowering healthcare costs. For years, telehealth has provided clinical services for individualswho lacked physical access: farmers in remote communities, soldiers near the battleeld,inmates in prison. Now, these technologies have demonstrated the ability to benet almostany individual. Mobile devices are the most personal technology that consumers own. Theyenable consumers to establish personal preferences for sharing and communicating. Theycan enable health and wellness to be delivered through mass personalization.

Unfortunately, the payment wires are crossed. Providers get paid based on volume ofservices delivered, and mobile health has been shown to reduce the need for hospitaladmissions and physician ofce visits. Why would providers adopt technologies that gougetheir incomes? An industry that is paid based on volume will not adopt technologies thatreduce volume. However, new payment models enveloped in the new health reform law setup a framework to pay providers based on outcome, not volume. In this environment, mobilehealth could provide needed connections: for patients who delay care because they’re toobusy to wait in a doctor’s ofce; for physicians who don’t have enough time to spend withpatients; for device companies that want to monitor the performance of their devices; forpharmaceutical companies that want to ensure patients are taking the medicines they need;for hospitals that don’t have the capital to build more beds.

In addition, a host of new players are developing easy to use, affordable “care anywhere”devices, services, solutions and networks that are attractive to consumers. Organizations,that want to play a role in making “care anywhere” a reality, will need to provide real valuein order for adoption to occur.



An in-depth discussion

Mobile health is creatingbusiness models that

unlock access to newplayers and technologiesthat support preventative,acute and chronic care



3 An in-depth discussion PricewaterhouseCoopers’ Health Research Institute

Executive summary

The mobile health industry is brimming with new health applications, devices and servicesthat are boosting individuals’ ability to connect better to their health. Forty percent ofconsumers surveyed by the Health Research Institute (HRI) said they would pay for remotemonitoring devices and a monthly service fee to send data automatically to their doctors.HRI estimates the annual consumer market for remote/mobile monitoring devices to be $7.7

billion to $43 billion, based on the range consumers said they would be willing to pay. Realvalue will need to be demonstrated in order for adoption to occur. And that value begins withunderstanding two key customers: the individual and the physician. New business models wilcontinue to evolve, but can t into three main categories.

The operational/clinical business model enables provider, payer, employer, medicaldevice and drug companies as well as nontraditional healthcare organizations to run theirbusiness operations better and more efciently. These include transactions and services forcustomers, whether they are clinical in nature or related to the overall management of health

HRI’s survey showed that physicians value better decision making and ease of work ow.They’re open to mobile health but believe that lack of leadership support, privacy/securityand reimbursement could be roadblocks to adoption. Key physician survey ndings that

inform the operational/clinical model were as follows:

• Mobile health can improve the use and the value of physicians’ time. One-third ofphysicians surveyed by HRI said they make decisions based on incomplete information.They believe the greatest benet of mobile devices will be to help them make decisionsfaster as they access more accurate data in real-time.

• Forty percent of physicians surveyed said they could eliminate 11% to 30% of ofcevisits through the use of mobile health technologies like remote monitoring, email, ortext messaging with patients. Such shifts could rewrite physician supply and shortageforecasts for the next decade and beyond.

• Physicians are interested in different types of applications. Primary care physicians (PCPsare most interested in prescribing medication wirelessly, and specialists, in accessingelectronic medical records (EMRs) wirelessly.

• In-person consultations are still the main method of reimbursement, but physicians aregetting limited reimbursement for phone consultations, email consults, telehealth and textPayment models that address how mobile health reduces costs are more effective, butrequire changes in delivery-care processes.

• Providers in search of additional funding should consider marketing mobile healthsolutions. According to the survey, consumers said hospitals are the preferred place tobuy mobile health products and doctors are overwhelmingly the most trusted in termsof getting health information.



4 Healthcare unwired: New business models delivering care anywhere

The consumer products and servicesmodel enables individuals to understand keyhealth metrics and share that information

with those who matter most in their lives(e.g., family, providers, tness trainers).HRI survey ndings showed:

• Cell phones are a ubiquitous deviceto inform and activate consumers.The simple act of texting has pickedup momentum, with nearly 80% ofMedicaid patients texting regularly, thehighest rate of all other insured anduninsured individuals.

• Healthcare could learn from other markets

in which consumers pay a premium forinstant gratication. The HRI surveyshowed that individuals who delayedcare more than ve times in the last yearare more willing to pay out-of-pocket fordoctor visits, electronic or in-person.

• Only half of consumers surveyed saidthey would buy mobile technology fortheir health, so it’s important to knowwho these consumers are. Of those, 20%say they would use it to monitor tnessor wellbeing and 18% want their doctors

to monitor their health conditions. While40% of respondents would be willing topay for a monthly mobile phone serviceor device that could send information totheir doctor, they would prefer to pay lessthan $10 for the monthly mobile phoneservice and less than $75 for the device.

• Physicians agree that patient complianceis a major obstacle and 88% would liketheir patients to be able to monitor theirhealth on their own. Weight and bloodsugar topped the list, with vital signs notfar behind.

• Markets for mobile health arecounterintuitive:

- Even though surveys show womenmake most health decisions for thefamily, the HRI survey showed thatmen are twice as likely as women touse their cell phone to get health-related reminders.

- Even though patients who are in poorhealth would seem to be targets ofthese applications, the survey showedthat consumers who are in good healthare more likely to pay for them.

- Even though most Americans areinsured through group health policies,the survey showed that individualpolicy holders were more likely tobuy mobile health applications and topay out of pocket for electronic visitswith physicians.

- Even though physicians aren’tcurrently using email and text as oftenas they’d like to for simple patientcommunications, they are highlyskilled in this area. Physicians use

mobile Internet more than twice thatof other consumers, according to theHRI survey.

Infrastructure business modelsconnect, secure and speed up informationand services.

• Integration. Health systems are largelyignoring the importance of integratingmobile health into other IT efforts, such asEMRs. Two-thirds of physicians surveyedsaid they are using their personal devicesfor mobile health solutions that aren’tconnected to their practice or hospitalIT systems.



5

Mobile health efforts from multiple stakeholders

Stakeholder Target health-related issue Who Mobile health solution

Employer Rising healthcare costs

of self-insured employers

Safeway Competition among locations to promote

healthy lifestyles and incentives for lowering

healthcare premiums for employees

Provider Efciency in coordinating

care/physician work ow

Good Shepherd

Health System

Developed own iPhone app to help

physicians access patient records, track

vitals, order medication and coordinate

with care team

Provider Physician to physician

consultation to enhance

patient care

Physicians from

Duke, Harvard

and JTCC

Virtual physician network for video mobile

consults, starting with cardiology and

oncology. Partnership among physicians at

Duke University Medical Center, Harvard’s

Beth Israel Deaconess Medical Center, John

Theurer Cancer Center (JTCC) and Zibbel, a

health solutions technology company.

Health insurer Finding physicians in

network or checking claims

Aetna Mobilizing “doc” nder and claims check

Pharma Patient compliance in

diabetes monitoring

Bayer Digital glucose monitor (DIDGET) that

integrates with the Nintendo game console

Retail pharma Cost information and

prescription management

cumbersome to obtain

CVS Caremark iPhone app for prescription drug information

and member management of prescription

rells, history, and retail location nder

Telecom Bandwidth and capacity

constraints on hospital

networks

Verizon 4G and more robust Wi-Fi networks to

allow for increased capacity for image

and data transfer

Retail Access to remote

monitoring devices

Best Buy Partnership with Meridian Health to explore

consumer access to healthcare monitoring

devices through retail stores and determine

the opportunity to leverage existing

customer service team for installation and

technical support.

An in-depth discussion PricewaterhouseCoopers’ Health Research Institute

• Security. When physicians were askedabout barriers to adopting mobile healthin the HRI survey, “worried about privacy

and security” was the top answer,cited by one-third of PCPs and 41%of specialists.

• Bandwidth. Hospital IT networks arestruggling under the need for morebandwidth to support rapidly expanding

data transactions and exchanges.




The appetite for mobile

Mobile health is creating new value: lessexpensive solutions, new ways to managecare, and better health outcomes. However,

new business models are required to unlockaccess to technologies and players thatsupport preventative, acute and chronic care.

The market for mobile Internet is boomingalthough healthcare solutions are still tryingto t in. While only about 8% of Americanadults have mobile Internet access, themarket is growing rapidly, fueled by fasterand faster connection speeds. As Figure 1shows, the market is estimated to quadruplebetween 2010 and 2014, according toPricewaterhouseCoopers’ estimates.

The next generation of technology supportsdownloads up to 7Mbps (compared tothe current 1.5Mbps). With the number ofbroadband households in the United Statesprojected to increase from 75.6 millionin 2009 to 113.8 million in 2014, moreinformation will be able to be exchangedat the home. 1

To try to better connect the $2-trillion healthindustry and its consumers, the FederalCommunications Commission (FCC) has

established a new healthcare taskforceto focus its national broadband efforts onconnectivity through health IT solutionslike e-care to improve access/utilization,care coordination and ensure privacy andsecurity. 2 Its active discussions with theFood and Drug Administration (FDA) willdetermine the FCC’s role of regulatinggeneral purpose communication and theFDA’s jurisdiction over devices used formedical purposes. “While no nal decisionshave been made, the goal of our agenciesis to remove the barriers to innovationthat could help open up a range of newprevention and healthcare solutions,” saidMohit Kaushal, MD, the FCC’s healthcare

director. Kaushal added, “The two endsof converging solutions from the telecomindustry and the healthcare industry create

a middleground that needs clarity andtransparency.” The impact of their decisionscould affect the speed of innovation as wellas the investment in innovation. 3

To date, more than 10,000 medical andhealthcare/tness-related applications areavailable for download to smartphonesand hundreds of other devices. 4 Fortypercent of consumers surveyed by HRIsaid they would pay for remote monitoringdevices and a monthly service fee to senddata automatically to their doctors. HRI

estimates the annual consumer marketfor remote/mobile monitoring devicesto be $7.7 billion to $43 billion, based onthe range consumers said they would bewilling to pay.

The new digital health environment islaced with its own lexicon—mobile health(“mHealth”), digital health, telehealth,eHealth—but the “basic phenomena is a verypowerful machine that is always networkedand on the person. The key differenceis on the person,” said John Glaser,

former chief information ofcer, PartnersHealthcare. “Right now, mobile activitiesare concentrating on extending the range ofexisting applications.” Glaser discusses threeclasses of activities: communication (e.g.,SMS, email), transactions (e.g., changinga ight, booking a hotel) and knowledge(e.g., getting directions, health information).“You need to start from the need and buildup—mobile could be an avenue or it maynot be. For example, a child who has asthmaand needs to track her daily capacity resultsdoesn’t just need a piece of technology. Sheneeds support from her parents.” This pointsout a forth class of activity—the need forintegration of all aspects of a solution.

1 PricewaterhouseCoopers Global Entertainment and Media Outlook 2010-2014.2 U.S. Federal Communications Commission. National Broadband Plan: Connecting America (2009). Chapter 10, accessed on August 23, 2010,

http://www.broadband.gov/plan/10-healthcare/.



7

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

0.0

Mobile Internet access revenue

Projected mobile Internet access revenue

Source: PricewaterhouseCoopers Entertainment and Media Outlook, 2010–2014

Mobile Internet access revenue: fees paid by consumers to Internet service providers orto wireless carriers for Internet access via mobile devices.

Figure 1: Mobile Internet access market

in billions $

0.70.1

1.42.1

3.3

4.8

6.8

9.4

12.7

3 Neil Versel, “FDA, FCC discuss medical smartphone apps as industry adjusts to regulatory culture,” FierceMobileHealthcare, July 27, 2010,accessed August 23, 2010, http://www.ercemobilehealthcare.com/story/fda-fcc-discuss-medical-smartphone-apps-industry-adjusts-regulatory-culture/2010-07-27.

4 “Apple iTunes App Store Metrics, Statistics, and Numbers for iPhone Apps,” last modied August 23, 2010, http://148apps.biz/app-store-metrics/?mpage=catcount.





Clearly, mobile health offers benets to bothbusy patients and busy physicians. Severalresearch studies show that mobile healthapplications reduce provider revenues(See Figure 2). Hospitals, physicians andother providers are paid primarily by volume,generally referred to as a “fee-for-service”business model; the more you do, themore you are paid.

Despite an explosion of wirelesstechnologies, patient visits outside ofin-person consults remain infrequentlyreimbursed. HRI’s physician survey

showed phone consultations for chronicdisease management lead the pack whilewellness and maintenance was the leastreimbursed (See Figure 3).

And while some industries have gured outways to get paid for electronic transactionsand services (e.g., music downloads),healthcare has not. The third-party payersystem reduces the role of consumers. Publicand private health insurers are primarilyresponsible for paying for healthcare, andthey generally have not pushed for adoption.

“The technology of telehealth is well aheadof the socialization of the telehealth idea andwe are at a tipping point for utilization tobegin taking off,” said David Jacobson, staffvice president of Business Development,

State Sponsored Business at WellPoint.

5 Max E. Stachura, MD, and Elena V. Khasanshina, MD, PhD. “Telehomecare and Remote Monitoring: An Outcomes Overview.” The AdvancedMedical Technology Association, October 31, 2007, accessed July 29, 2010, http://www.advamed.org/NR/rdonlyres/2250724C-5005-45CD-A3C9-0EC0CD3132A1/0/TelehomecarereportFNL103107.pdf.

6 “Cleveland Clinic/Microsoft Pilot Promising; Home Health Services May Benet Chronic Disease Management.” March 1, 2010, accessed on August25, 2010, http://my.clevelandclinic.org/media_relations/cleveland_clinic_pilot_with_microsoft_promising.aspx.

Figure 2: Early research shows mobile health reduces provider revenues

Where What Result

Diabetes Pennsylvania Post dischargeremote monitoring

42% drop in overall costper patient 5

Cleveland Cell phone size wirelesstransmitter transferringvital signs to electronichealth record

71% increase in number ofdays between ofce visits6

Congestiveheart failure

Trans-EuropeanNetwork-Home-

Care ManagementSystem

Remote monitoring ofpatients who received

implantable cardiacdebrillators

35% drop in inpatient lengthof stay; 10% reduction in

ofce visits; 65% drop inhome health visits 7

Chronicobstructivepulmonarydisease

Canada Remote monitoring ofpatients with severerespiratory illness

Reduced hospital admissionsby 50%; acute homeexacerbations by 55%;hospital costs by 17% 5



9

7 John G.F. Cleland, MD, Amala A. Louis, Alan S. Rigby, PhD, Uwe Janssens, MD, Aggie H.M.M. Balk, MD, and others. “Noninvasive HomeTelemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death,” Journal of the American College of Cardiology45,no.10 (2005): 1654.

“Government programs currently don’t payfor several of the applications that couldhelp boost outcomes. Key barriers are

around licensing regulations and determiningwhat Medicare is going to pay for,” addedCarolyn Carter, who leads the WellPointCalifornia telemedicine program.

Roy Swackhamer, chief informationofcer of SCAN Health Plan, points outthat payers want to see evidence. “Everyoneis doing pilots, but it needs to be scaled soa physician with 500 congestive heart failurepatients can take advantage of the data.We need predictive algorithms that canbe used with data aggregation tools in

order to analyze trends and performpredictive analysis.”

Understanding how to use such informationhinges on applying a business model thatmarries technology to nancial reward andcreating new work ows that move fromanalog to digital health delivery. “Thereare lots of dashboards; however, there’s notenough attention paid to the people doingthe work,” said Mark Moftt, former chiefinformation ofcer, Good Shepherd HealthSystem in Longview, Texas. “Once we

developed a customized iPhone applicationthat allowed physician access to patientinformation and decision-making, wehad those who were willing to pay for halfof the device just so they could usethe application.”

Much of the momentum behind mobilehealth has been from companies outsidehealth—technology and telecommunicationscompanies that are looking to expand theirfootprint in the health industry through mobiletechnologies. The opportunities can extendto many other stakeholders—from health andtness companies or gyms that can integratepersonal data tracking with mobile phones to

entertainment companies who connectwith people through health e-games. Figuringout what role to play as a business beginswith understanding the failures and painpoints that are occurring in the currentsystem for two key groups: the individualand the physician.

Source: PricewaterhouseCoopers

HRI Physician Survey, 2010

Figure 3: Reimbursement of care

through nontraditional channels

by number of physicians

Chronicconditionmanagement

Wellnessmaintanence

Preventativecare

Acutecare

Text

EmailTelehealth

Phone

31

61

45

138

34

19

51

21

58

27

19

21

118

47

51

72





Three business models for mobile health

Mobile health encompasses a wide array ofcompanies that sell products and servicesin health and wellness through technology

applications. We see a plethora of pilotsdotting the landscape. Providers areincorporating mobile into their work ows ofcaring for patients, some even developingtheir own applications and spinningthem off as businesses. Health plans areexperimenting with mobile as a way toreach out to their members for transactionsand new ways to engage them in healthybehaviors. Employers are text-messagingemployees in their health promotion/ monitoring campaigns. Pharmaceutical andlife sciences companies are using mobile

to support drug adherence. Interestingly, allsectors are converging in patient-centeredcare models that ignore venue-based,volume-based payment.

Current business models fall into one ofthese three categories:

• Operational/clinical capabilities

• Consumer products and services

• Infrastructure to connect, secure andspeed up information and services

Operational/clinical

The oft-repeated goal of “bending the costcurve” is being taken seriously by manyproviders, payers, device companies andpharmaceutical makers. Health reformis rearranging the incentives, shifting thepayment system to one that rewardsperformance and outcomes rather thanvolume. In this environment, the greaternancial rewards go to organizations that

demonstrate savings over traditional healthdelivery. Mobile health applications canexpand access and reduce costs and insome cases, do both at the same time—a twofer that is rare in healthcare.

As more payers turn to performance-basedpay, the business model for providers andpharma/device companies centers on

improving care through connectivity andbetter information that leads to healthieroutcomes and greater efciency. Forexample, Merck Serono created double-digitgrowth in a pipeline of generic injectabledrugs that were long off-patent.(See opposite page)

Mobile health can improve use andvalue of physicians’ time

In looking at reducing traditional costs,the focus immediately goes to providers.

Physicians are generally paid by task. Theirtime is valuable but often wasted on tasksthat could be automated, eliminated orreduced in scope through mobile health.For example, more than half of physicianssurveyed by HRI said a signicant portionof ofce visits could be eliminated throughmobile health, which could improve accessfor patients and ease the number ofin-person visits from chronic care patients.Forty percent of physicians said they couldeliminate 11% to 30% of ofce visits throughthe use of mobile health technologies like

remote monitoring, email, or text messagingwith patients.

Such shifts could rewrite physician supplyand shortage forecasts for the next decadeand beyond. A recent study by the MayoClinic’s Department of Family Medicinesupports this view. During the two-yearstudy, e-visits were able to replace in-ofcevisits in 40% of the 2,531 cases. In the study,patients logged on to a secure online portal,where they had detailed histories taken and

were able to upload pictures and other lesas needed. Physicians responded within24 hours and patients could access theportal to view results. 8

8 Steven C. Adamson, MD, and John W. Bachman, MD. “Pilot Study of Providing Online Care in Primary Care Setting.” Mayo Clinic Proceedings85,no.8 (2010): 704-710, doi:10.4065/mcp.2010.0145.




In a ve-year journey to reinvigorate aportfolio of generic, off-label or abandoneddrugs, one pharmaceutical company found

digital/mobile technology could signicantlyboost patient adherence. While pharmacompanies typically focus on new drugdevelopment, Switzerland-based MerckSerono found that it could create double-digit growth in a pipeline of generic injectabledrugs that were long off-patent. The strategycentered on “adding value to the productsyou already have,” said Don Cowling, vicepresident and managing director of MerckSerono, UK and Ireland. “The future is behindus.” Cowling said his team realized that thegrowth market for pharmaceuticals is in

adherence rather than nding new patientssince half of all scripts are never lled and halfof those are never taken. “People don’t buycompliance; they buy pharmacoeconomicoutcome,” Cowling added.

With six therapy areas of focus, includingneurology, fertility, and growth therapies,Merck Serono developed a smart electronicinjection device with two-way Bluetoothcapability that could track all injectionsmade. Nurses made reminder calls within

30 minutes of a missed injection. Forexample, at one point, the number ofinjection-site reactions was growing inpatients taking one of the therapies. Afterchanging the needle depth requirement by3mm, the dropout rate improved by 10%.

Real-time data gathering and feedbackthrough mobile technology boosted Merck’sbusiness case for mobile health. The strategyhelped the company gain over 50% of newpatients for several therapy areas, grow38% in a static growth hormone market, and

decrease 20% of its workforce while doublingthe volume of work and create a platform forfuture therapeutics to be administered.

Lessons learned:

1. Take a systems approach to providingresults by personalizing the care delivery

experience through technology andprovider support/communication andconnecting payment to clearly articulatedpayment goals.

2. Look in past products/services fora pipeline that may not have beenmaximized.

3. Partner with payers and gain clarity onexpected results for payment.

4. Consider the value propositions of:

“Either make money, help other peoplesave money, or save lives.”

Pharma company uses Bluetooth and nurse remindercalls to boost adherence of injectables

Outcomes

• Sales growth in declining, off-patent brand

• Sales force reduction

• Smaller administrative cost with improved margins

• Enhanced patient outcomes at lower cost

• Better clinical integration

• More care provided in home settings at lower cost

Merck Serono: “Intelligent care” usingmobile health to reinvigorate pipeline and

generate patient outcomes

Molecular diagnostic screening to identify patientswho would benet from treatment

Wireless easypod™ device to inject drug, record numberof doses administered, and share data with clinicians

Nurse call center intervenes when notied by device

of patient non-compliance or problem

Clinical nurses in physician’s ofce assist intreating patient

Electronic health record integration of patient information

Value-based reporting to payer demonstrating patientcompliance and improved patient outcomes

System-basedPersonalized Value driven






Remote monitoring could be a key way toreduce ofce visits. Eighty-eight percentof physicians said they would like theirpatients to be able to track and/or monitortheir health at home (See Figure 4). They aremost interested in having patients monitorweight and blood sugar but also see value inhaving them monitor such vital signs as bloodpressure as well as physical activity andother health-related information. Consumersindicated their top priorities would be weightand vital signs (See Figure 5).

Remote monitoring also could reducehospital spending, a goal of bothgovernment and private payers. Remotemonitoring could be especially effective at

reducing hospital readmissions. Researchhas shown that one-fourth of all Medicarepatients are readmitted within 30 days.However, beginning in October 2012,Medicare will no longer pay for certainhospital readmissions and will begin topublish hospital readmission rates. Already,some commercial health plans are alsobeginning to pay for remote monitoringdevices to reduce their readmission costs.9

Work ow is important to physiciansbecause they get paid only for the patients

they treat. So, they’re keenly interested inefciency. Accessing information whereand when it is needed is a top challengefor physicians, according to the HRI survey.

9 Neil Versel. “ WellPoint, Aetna, and Humana pilot remote monitoring to cut readmissions.” FierceHealthcare, July 29, 2010, accessed August 23,2010, http ://www.ercehealthcare.com/story/wellpoint-aetna-and-humana-pilot-remote-monitoring-technology-cut-hospitalization/2010-07-29.

Source: PricewaterhouseCoopers HRI Physician Survey, 2010

Figure 4: Physicians wanting patients to track/monitor health at home

65%: Weight

61%: Blood sugar

57%: Vital signs (e.g., blood pressure, heart rate, respiratory rate)

54%: Exercise/physical activity

36%: Calories/fat content taken in

36%: Pain level

35%: Sleep patterns

28%: Cardiac rhythm

17%: Bladder control

16%: Acid reflux/indigestion

13%: Digestive health

12%: No

88%: Yes




Currently, one-third of physicians saidthey make decisions based on incompleteinformation for nearly 70% of their patients.Specialists and PCPs nd that their biggestobstacle when seeing patients or runningtheir practice is accessing information whenand where they need it (See Figure 6). Onlyhalf of physicians surveyed access EMRswhile visiting and treating their patients.“Meaningful use” requirements, which gointo effect in 2011 and require interoperableuse of EMRs, are expected to improve timelyaccess to information.

Yet mobile health solutions will have toensure that they aren’t making physiciansless productive. Physicians want to seeexceptions in the data, not all the data.Too much information could actuallyslow care down. Hospitals can help thephysicians who bring in patients by lteringthe data they send electronically. “Forexample, a physician who has seen patientswith chest pain that have inconsistentoutcomes, can query for every patient overthe age of 55 who came in with chest painand was given aspirin. This potentially allows

Consumers

Physicians

Source: PricewaterhouseCoopers HRI Physician and Consumer Surveys, 2010

Figure 5: What consumers and physicians want to track regarding health

Weight Vital

signs

Calories/

fat taken in

Exercise/

physicalactivity

Sleep

patterns

Blood

sugar

Acid reflux/

indigestion

Digestive

health

10%

20%

30%

40%

50%

60%

70%



15

hospitals to improve outcomes or work owsbased on the data,” said Johnny Milaychev,product manager of New Wave Software, aveteran clinical integration vendor.

Another example is e-prescribing whereinphysicians’ most common orders areautomatically populated on their devices,said Donald Burt, MD, chief medical ofcerof PatientKeeper, a physician informationtechnology rm. He said PatientKeeper’s25,000 daily physician users spend 20% of

their days on mobile devices. He added thatexperienced nurses can post order requestson physicians’ phones and they can signor modify them wherever they are. Bothspecialists and PCPs have a high degree ofinterest in e-prescribing (See Figure 7).

Having information at their ngertips ensuresphysicians that their time is used moreeffectively. Of physicians who are usingmobile devices in their practices, 56%said the devices expedite their decision-

Accessing information when/where needed

Increasing face-to-face time with patients

Increasing patient compliance

Decreasing communication between physicians

Obtaining easier communication channels to patients

Other

Primary Care Physician

Specialists


Figure 6: Biggest obstacle when seeing patients or running practice

43%

29%

18%

27%

16%

24%

12%

7%

5%

8%

5%

5%





making and nearly 40% said they decreaseadministrative time (See Figure 8). MountSinai Hospital in Ontario, Canada connectedits physicians to EMRs through their iPhones.Its VitalHub program has changed the way its

physicians work; they pull up patient charts,labs, medical references and radiologyimages. “Chart applications from leadingvendors may have a robust backend, butthe physician experience is weak. They arestruggling with making the chart somethingeasy to deal with. How do we help our

clinicians who are going to multiple placesfor locating information? We go to them,”said Teek Dwivedi, chief information ofcer at

Mount Sinai Hospital. The hospital spun outthe intellectual property of Vital Hub into aseparate external company with plans to offerthe platform model to other institutions on acommercial basis.

Mobile health could drive up volume,creating disincentives

People are busy, and sometimes they don’ttake care of themselves because they don’thave the time. Individuals who delayedcare more than ve times during the past

year because it took too long to get anappointment are more willing than thosewho didn’t delay care to pay out-of-pocketfor electronic doctor visits (58% vs. 43%).In some cases, physicians have startedtheir own electronic medical practices inwhich they charge patients $50 for eachconsultation. Those who delayed the mostcare have different preferences for how they’dlike their physicians to contact them forsimple communications. Those who delayedmore than ve times prefer communicationthrough cell phone, email, text message,

and Facebook more than those that neverdelayed care during the past year (See Figure9). Non-traditional communication avenuesand electronic doctor visits could be newways of reaching individuals who don’tengage proactively in their care.

Willingness to pay out-of-pocket continues tobe a main barrier to mobile health adoption.Less than half of both Medicaid and Medicarepatients would be willing to pay out-of-pocketfor electronic doctor visits. Consumers want

low-cost solutions and those in very goodhealth are the most likely to track metrics ona mobile device application, creating morechallenges in reaching the highest users ofthe healthcare system—those in poor healthwith chronic diseases.



PCP: Primary Care Physician

Figure 7: Physician interest in performing

various tasks wirelessly

Prescribing medication

83%86%

82%

PCP

Specialist=

Access EMRs

86%PCP

Specialist=

83%

Total

88%

Monitor patients in hospital

74%PCP

Specialist=

69%

75%

Initiate/track referrals

63%PCP

Specialist=

65%

62%

Monitor patients outside the hospital

57%PCP

Specialist=

65%

54%

Communicating with patients

60%PCP

Specialist=

61%

59%




Consumer products/services

The consumer market can be a high-volume,high-value, low-price market where mildproof of efcacy can lead to rapid adoption.

“For consumers, mobile is a synonym forindependence,” said Yan Chow, director ofthe Innovation and Advanced TechnologyGroup at Kaiser Permanente. “I think that theability to be independent and get data whenand where you need it gives consumersa lot of freedom. Having consumers be atthe center of their own care is a concept

Kaiser has been working with for a longtime. It gives us the chance to build a newrelationship with our members.” RajeevKapoor, former global managing directorof Verizon Connected Healthcare, added,“The paradigm of healthcare has changed.

You used to bring the patient to the doctor.

Now you take the doctor, hospital, and entirehealthcare ecosystem to the patient.”

In some cases, organizations are mobilizingapplications that they’ve already hostedonline. For example, Aetna made its mostpopular transactions, such as physician“doc” nder and claims check, available onmobile devices. “We have an overarchingmember experience strategy that is focusedon providing clear, timely, and usefulinformation that helps members makeinformed healthcare decisions,” noted Meg

McCabe, Aetna’s vice president, consumermarketing and product. “Our technologyis about transparency and engagement atany level, and over time we’ll build strongerrelationships with our members,” added


Figure 8: Percent of physicians surveyed who said mobile health

would have these impacts

56%

Expedite decision

making

Decrease time it

takes for

administrative

tasks

39%

Increase

collaboration

among

physicians

36%

Allow more time

with patients

26%

Have not affected

my day-to-daywork

24%




Michael Mathias, Aetna’s chief technology

ofcer. “The days of mass communicationare over. We can now deliver customizedcommunications through mobile apps, online,telephonically, or through the mail basedon our understanding of how each memberwants to be communicated with.”

Targeting the mobile health consumers

Only half of consumers surveyed by HRI saidthey would buy mobile technology for theirhealth, so it’s important to know who theseconsumers are. Of those, 20% say they

would use it to monitor tness/wellbeingand 18% want their doctors to monitor theirhealth conditions (See Figure 10). While 40%of respondents would be willing to pay for amonthly mobile phone service or device thatcould send information to their doctor, they

would prefer to pay less than $10 for the

monthly mobile phone service and less than$75 for the device.

Mike Weckesser, director of emergingbusiness-health solutions at Best Buy,points out the challenges of consumerprice expectations related to mobile healthtechnology. “In our consumer research,although consumers identied a pricethreshold, they also expected the payer toreimburse them for those purchases, therebyslanting the data.”

Though many consumers have nevertaken advantage of existing mobile healthtechnologies, 85% of those that havecommunicated with their doctor by meansother than face-to-face were satised withtheir discussion.

Figure 9: Preferred communication method for routine tasks

by those who delayed care

Never delayed care

in the past year

Delayed care

>5 times in thepast year

Source: PricewaterhouseCoopers HRI Consumer Survey, 2010

Text message

4%

11%

Email

23%25%

Cell phone

20%

26%

Facebook

2%

6%

Home phone

47%

26%




The HRI survey revealed key markets to target

for mobile health services and products.

• Men. Men are twice as likely as womento use their cell phone to get healthrelated reminders. More men surveyedhave Internet service on their phone thanwomen do. Men are three times morelikely to check their sports, stocks andmedical records and twice as likely tocheck restaurant ratings, news headlinesand get health-related reminders. Theyalso are more willing to incorporatean application into their cell phone to

monitor their health (36% vs. 27%). So,this means that solutions for early marketadoption should focus on pain points thatare important for men.

• Individual health insurance

policyholders. This small, but growinggroup of insured, is the most likely to

incorporate an application into their cellphones to monitor their health. Likewise,they are the most willing to pay out-of-pocket for electronic doctor visits withnearly one-third saying they would bewilling to pay more than $25 per visit.Consistently, they are also willing topay the most for monthly services ofhealthcare mobile phone applications andremote monitoring devices and services.Supporting targeting of these individualsis that 40% report having at least onechronic disease. In addition to those

covered by individual health insurancepolicies, half of uninsured individualswould be willing to pay out-of-pocket forelectronic visits and 42% of the uninsuredhave a chronic disease.

• The healthy. Consumers who reportedto be in very good health are the mostlikely to incorporate an application intotheir cell phones to monitor their health,while consumers with chronic diseasesare the least likely. After Nike led withits Nike+ running sensor that links to an

iPod or iPhone, more personal monitoringdevices have hit the market that enableconsumers to track personal health,tness, and wellbeing metrics.

For example, the Zeo, a personal sleepanalysis device, consists of a wirelessheadband, bedside display, and email-based personalized coaching programand analytical tools. It identies periodsof wake, REM, light, and deep sleepand produces a score each morningrelating to an individual’s sleep quantityand quality. Likewise, the Fitbit Tracker,a small device worn clipped to clothing,tracks calories burned, steps taken,

ource: PricewaterhouseCoopers

HRI Consumer Survey, 2010

Figure 10: Most important reasons

onsumers would buy mobile

health technology

Monitor fitness/

wellbeing:

20%

11%: Monitor previous

condition

18%: Have doctor

monitor condition

from afar

51%:

I would not buy mobile

health technology



10 Near eld communication is short-range wireless interaction among devices and PCs.

Health system, retailer, wireless company teamto improve palliative care

Physicians in New Jersey thought there mustbe a better way to ease the pain of cancerpatients. After collaborative conversations

with the leadership of Meridian HealthSystem, the idea for an innovative pain journal was born. The journal’s intent was toallow patients to record and communicatetheir pain while resting at home. With moreaccurate communication, physicians couldbetter understand the pain medicationneeds of their patients.

The health system didn’t think insurers wouldpay for such a device, but maybe patientsmight—if it was affordable. With this as abusiness model, an unusual but powerful

collaboration came together:

• Clinical expertise: Meridian Health, ave-hospital health system in New Jersey(a teaching hospital, children’s hospital,home health and rehab centers). Most ofthe health system’s 1,600 physicians are inprivate practice, with half in primary careand 100 physicians on staff.

• Technology expertise: Cypak, a neareld communication (NFC) 10 company

that creates consumer tools• Retail/tech support: Best Buy, an

international retailer of consumerelectronics and technical support

The collaboration developed a productcalled iMPak’s Health Journal for Pain, anelectronic diary in which patients are givenan auditory queue and answer two or threequestions regarding their pain via buttons onthe device. The device is a tri-fold, with eachsection measuring approximately 4 inches

by 6 inches. During ofce visits, physiciansdownload the information, or it can bedownloaded at home into a web portal orpersonal health record. To pair with the health

journal, iMPak is developing a smart pill

dispenser that monitors adherence. Basedon the doctors’ preferences, they can bealerted to uctuations or outliers in reporting.

“This may actually allow the physician toincrease the billing fee from a level three andfour to a level four and ve,” said SandraElliott, Meridian Health’s director of consumertechnology and service development.

Including Best Buy in the collaboration wasa key strategy. “We have learned that we,as a health system, don’t truly understandthe retail marketplace,” added Elliott. “BestBuy does and people go to them for theirtechnology. The wireless networks are goingto be a major part of getting technology in the

hands of consumers, and we wanted to beable to leverage Best Buy’s retail knowledgeas well as their Geek Squad for installation.

As a health system, our job is to take care ofpeople. We need to come up with strategiesto get service fees and technology pricesdown. Our challenge is to think about howto manage an increasing patient populationwithout building new buildings.”

Lessons learned

1. Partnering with those who see patients asconsumers. Retailers of consumer healthelectronics can allow providers to focuson their core services while leveragingthe expertise of other industries liketechnology and retail.

2. Focusing product development on themost critical pain point. Individual andclinician testing is key to developing auseful product.

3. Creating with a future platform in mind. A exible platform enables a varietyof applications spanning multipledisease states.

Healthcare unwired: New business models delivering care anywhere20




distance traveled and sleep quality. Italso wirelessly syncs with a PC where thetracked data is automatically uploaded to

a tness and nutrition website. In additionto these devices, numerous mobile deviceapplications are available free or for a feethat track blood sugar, blood pressure,cholesterol, and pain readings, countcalories and tness activities, and sendmedication reminders. Consumers cantrend data over time and send emails totheir doctors on demand. Consumersare now able to monitor a whole host ofhealth indicators on the go.

• Healthy but likely to slip in health

status. Consumers and physiciansagreed on two of the top three healthmetrics they would most like to track:

weight and vital signs (e.g., bloodpressure, heart rate, respiratory rate).Where they differ is that consumersrank calories/fat taken in as the thirdmetric they would most like to track,and physicians ranked blood sugar aheadof vital signs. Eric Topol, director of theScripps Translational Science Instituteand vice chairman of the West WirelessHealth Institute, cautioned that, “patientsmay not understand the importance ofglucose monitoring. Many patients needto be trained as to what causes largeswings in blood sugar and when they areover and undershooting. Physicians know

that stable glucose levels are a hugeissue. Tackling this issue with remotemonitoring devices, if successful, could

potentially prevent people at risk fromcrossing the line to becoming diabetic.”

“Employers can use mobile health tokeep their employees healthy,” saidBrad Wolfsen, Safeway’s vice presidentof Strategy and Health Initiatives. Theretail grocer, with 1,775 stores in North

America and 186,000 workers, has seenno increase in its healthcare costs forthe past ve years and is constantlylooking for ways to innovate in the areasof benets, incentives and engagement

of employees. Safeway’s team-basedJumpStart wellness program uses textmessaging. The connectivity for all

employees was a motivator for the 2,500participants, who lost 2.6% of weightover 10 weeks. “Mobile is the technologyof choice for team-based programs withor without an incentive. The real-timeinformation allows us to build proles ofemployee information instead of gettingonly point information,” said Wolfsen.

• Certain chronic-illness groups ofpatients. Those with chronic diseases didsay, however, that better access to theirhealth information and regular feedbackfrom their doctors would make themfeel more in control of their own health.

Joseph Kvedar, MD, director of the Center for Connected Health at PartnersHealthCare in Boston emphasized that while “sensor technology may rapidlybe becoming commoditized, integration with EMR and data aggregationsystems is not something we have seen done well. We need to get better atgathering information, adding logistical software to get to the intersection ofall the data and population health management.”




Because 70% of people with two or

more chronic diseases own cell phones,

there is an opportunity for developers

to expand their targeting of the chronicdisease population.11 In addition, females

are just as likely to buy a mobile health

technology for themselves as they are

for a family member or friend, while men

are more likely to purchase a mobile

health technology for a friend or family

member rather than themselves (41%

vs. 39%). However, patients with chronic

diseases are less willing to pay out-of-

pocket for electronic visits with their

doctor (48% vs. 52%).

Hospitals/health systems, preferred

place for individuals to buy mobile

health products

Hospitals and health systems are the

preferred suppliers of health-related

products for both men and women, though

50% of physicians have never prescribed

a remote monitoring device and said

they don’t have enough information on

mobile health. Likewise, the doctor is still

overwhelmingly the most trusted source

of healthcare information (71%), though

physicians report the second biggestobstacle when running their practices is

not being able to increase face-to-face

time with their patients as they would like

to. Mobile can be an avenue through which

patients can receive health information from

the source they trust the most, though from

a mobile adoption standpoint, one-third

of physicians cite not having enough

information as a barrier to adopting mobile

health in their practice.

Consumers are starting to prefer their doctor,nurse, or hospital communicate with them

through means other than phone calls,

with 23% preferring email for appointment

reminders and other simple communications,

and Medicare patients are no less likely

than other individuals to want to receive

communications from their doctor over email.

Medicaid patients are most likely to

use text messages

Text messaging has emerged as an effective

way to reach a wide population. Nearly

half of Medicare patients and almost 80%

of Medicaid beneciaries who own mobile

phones say they text regularly (See Figure11). Wolfsen, of Safeway, pointed out, “If

you look at this segment of the population,


HRI Consumer Survey, 2010

Figure 11: Text message usage

by insurance type

Medicare

43%

Veteran’s health

45%

No insurance

63%

Individual policy

65%

Employer-sponsored

68%

Tricare

74%

Medicaid

79%

11 Jane Sarasohn-Kahn, M.A., M.H.S.A. “How Smartphones Are Changing Health Care for Consumers and Providers.” California Healthcare

Foundation, April 2010, accessed August 23, 2010, http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf.




they tend to have less access to digitalinformation and do not necessarily haveweb access. Mobile can be used to reach

these individuals.” Medicaid individualsalso have the highest percentage (58%) ofthose sending/receiving more than six textmessages per day. Text messaging can beanother channel for health related remindersor remote medical monitoring.

Infrastructure

Hospitals are increasingly feeling theconstraints of outdated wireless networks.

Adequate infrastructure is needed tosupport high capacity and bandwidthmobile systems within hospitals. Newhealthcare-dedicated frequencies and4G wireless networks are some of theways telecommunication companies areenhancing the infrastructure of hospitalsto support advancements in wirelesstechnology. While we all use multipleplatforms everyday in all aspects of ourlives, like Microsoft Windows, Facebook, theiPhone and the iTunes store, we rarely stopto notice what a platform is or how it works.However, such an understanding is critical

to understand the type of infrastructurerequired to drive the innovations necessaryfor the adoption of mobile health andwellness solutions.

In addition, developers are focusing onplatforms to allow for the greatest exibilityof applications and devices. Platformsenable many technologies and playersto participate in mobile health. There areseveral models of platforms with keycharacteristics that include the core,peripherals and interfaces. As companies

determine their roles in the digital world,they could become hubs into which otherservices connect. A simple example outside

of healthcare is Evernote, where users canorganize anything from personal notes,web clippings, electronic documents and

pictures on a private online site. It hasan optical character recognition (OCR)capability so users can locate their itemsby a key-word search. New information isautomatically synched when an account isaccessed via mobile or traditional web.

Key infrastructure markets

• Security. When physicians were askedabout barriers to adopting mobile healthin the HRI survey, “worried about privacyand security” was the top answer, cited by

one-third of PCPs and 41% of specialists.However, Bill Braithwaite, M.D., whodeveloped the HIPAA regulations when hewas with HHS in the mid-1990s, suggeststhat data on mobile platforms can besecure with the right measures. “Multi-factoral authentication provides a higherlevel of assurance that the user is whohe or she claims to be,” said Braithwaite,who is now chief medical ofcer of

Anakam, a security software company.

“There are three factors that can be

used to identify you as the proper user:something you know, something youare and something you have,” addedBraithwaite. “Commonly, username andpassword are used, but both are instancesof a single factor, something you know. Fostronger authentication, the user must alsopresent a second factor, which could besomething you have, such as a registeredID card or cell phone, or something youare, such as a nger print or voice print.”

The nancial services industry uses similarsecurity measures for online banking alongwith behind-the-scenes location loginmonitoring. “Messaging about our banking



24 Healthcare unwired: New business models delivering care anywhereHealthcare unwired: New business models delivering care anywhere24

When Shire’s drug, VPRIV, for Type 1Gaucher’s Disease was approved by theFDA in 2010, it targeted the fewer than

5,000 patients in the U.S. with the incurablechronic genetic disease. This small andwell-informed community of patients, whoreceive biweekly infusions, cheered the newsof a second drug for them. “The Gauchercommunity is a very vocal customer basethat will advocate ercely because they wentfor so many years before treatment,” saidNed Kiteld, associate director, U.S. VPRIVMarketing and Commercial Operations. ForShire, the business model for mobile healthwas one that empowered an already vocalpatient community with a tool to manage

various aspects of their disease. The resultwas a robust app, called OnePath, thattracks patient health metrics, provides real-time information to physicians and connectspatients to dedicated case managers whostreamline insurance coverage issues.OnePath also includes news, calendars,and “iGau,” which helps patients tracktherapeutic goals. iGau allows the patient totrack bone pain, haemoglobin levels, livervolume, platelet count, and spleen volume.Patients can take this information to theirregular doctor visits “Many patients have

been treated for years but don’t have aneasy way of recording these records. Theywill say, ‘Yes, I feel better,’ but the doctorwants to know what the actual results are.”

“The patients have infusions every otherweek. We wanted to create an applicationthat would empower them with information,allow them to communicate with usmore easily, and ultimately be able toalso communicate with their physicians.”Throughout development of the app, Shire

reached out to the tight-knit Gaucher’scommunity for advice “We really try to involvemembers of the patient community, whetherin a formal test setting or an informal poll.”

Shire’s goal was to get the patients toultimately drive physician adoption of theOnePath app: “We started with the patients

because our patients—they are a motivatedpatient group.” Shire’s focus currently isenhancing the relationship between thepatient and their doctor. “We are not inthe loop. We don’t have access to any ofthe data. The patients can communicatewith us through the app if they want to orhave to.” Shire is currently developing acomplementary physician app: “Our goal isto create something valuable and enhancethe relationship between the physicianand patient.”

Lessons learned

1. Patient adoption can drive physicianadoption; in small disease populations,physicians may be more open to thepreferences of their individual patients.

2. Patients want more information at theirngertips. The iGau tracker empowers thepatient with information on health metricsto help them and their doctor make moreinformed decisions regarding treatment.

Tools that help patients manage theirentire disease could create allegiance toa particular therapy.

3. A small, close-knit disease populationcan be a good target for a mobile deviceapplication as well as connect to socialmedia communities (e.g., Patients LikeMe). The Gaucher community is tight-knitand motivated, as many remember nothaving any treatment available.

Drug company creates iPhone app for patientswith Gaucher’s disease to enhance care, speedinsurance approval



25

security assurance program is key on thecustomer side,” said Tom Trebilcock, vicepresident e-business and payments

at PNC Financial Services. “You need torst establish trust and assurance withthe customer.”

• Integration. Of the physicians who areusing mobile applications and devices,63% are using personal devices that arenot connected to their ofce or hospitalIT systems (See Figure 12). Hospitals ingeneral have not put mobile connectivityat the top of their IT list— 30% ofphysicians said their hospitals or practiceleaders will not support the use of mobile

health devices.

Joseph Kvedar, MD, director of theCenter for Connected Health at PartnersHealthCare in Boston emphasized thatwhile “sensor technology may be rapidlybecoming commoditized, integrationwith EMR and data aggregation systemsis not something we have seen donewell. We need to get better at gatheringinformation, adding logistical software toget to the intersection of all the data andpopulation health management.”

Vendors may not be ready to helpeither. In a PwC survey of hospital CIOs,42% said they believed their deviceconnectivity vendors were unprepared or

they did not know if they were preparedto assist them with medical deviceinteroperability. Such interoperabilitywill be required in the later stages ofachieving meaningful use compliance.

Telecom vendors are, however, working

on interoperability for their customers.Qualcomm recently developed acellular module that allows onlinehealth data, from wearable medicaldevices, to connect and exchange

information through several interfaces.“Qualcomm’s platform has the capabilityto link the body area network deviceslike a smart Band-Aid to personalarea networks like wi to wide area




Figure 12: How integrated are

physician mobile device apps with

hospital IT systems?

Very integrated

Somewhat integrated

Not integrated at all

PCPs

9%

PCPs

34%

PCPs

57%

Specialists

7%

Specialists

27%

Specialists66%

PCPs: Primary Care Physicians

How do we help our clinicians that are going to multiple places for locatinginformation? We go to them.

—Teek Dwived




cellular networks and the Internet,”said Don Jones, vice president ofbusiness development, health and life

sciences. You can mix and match inmany different ways.”

• Increasing bandwidth. Hospitals arestarting to feel the crunch of outdatedwireless systems. Without a robustinfrastructure in place, care providerscannot utilize high-bandwidth mobilehealthcare technology. Sprint is using aninfrastructure model to help providersextend their ability to provide careoutside of the hospital. One partnership

geared toward mobilizing physiciansand eliminating bandwidth constraintsis with Calgary Scientic and its ResMD

application. “We’re taking a $100Kworkstation and bringing it to a mobiledevice like EVO that can display imagessuch as a 3-D brain scan,” said TimDonahue, vice president of IndustrySolutions at Sprint. “The network is asimportant as the device,” he added. “EVOhas a 1GHz processor in the device andneeds a robust 3G or 4G environment toeffectively use that kind of information.Even Wi-Fi networks run into capacityand mobility constraints.”





What this means for your business

Adoption of mobile healthwill depend on what you

give for the money



29

Mobile technology is changing the way we think about entertainment, connect with peersand drive our cars. However, it’s yet to pierce the ingrained practices of healthcare. Someinnovators like Eric Topol, MD, a leader in wireless medical innovations and director of theScripps Institute and vice chairman of the West Wireless Health Institute, say benetting frommobile technology starts with thinking differently about how to measure success: “Whenyou measure success of a remote monitoring device for diabetes, it’s helpful to think aboutwhether you’re talking about the short-term outcome of improving time in the normal glucose

range or a longer term effect such as preventing kidney failure. The surrogate measurementof improved time in the normal range could be enough of an outcome to warrant the use ofthe monitoring device.”

Physicians and consumers see mutual value in mobile health. And those intersections leadto opportunity. For example, physicians are interested in remote monitoring and consumersare willing to pay for it. Figure 13 depicts additional consumer and physician attitudestoward mobile health.

What this means for your business PricewaterhouseCoopers’ Health Research Institute

Figure 13: Where physicians and consumers meet

How consumers feel Summary How physicians fee

Nontraditional appointments

Doctors and consumers are open tonontraditional appointments (e.g.,phone conversations, online visits,and communication through secureonline portals).

56% like the idea of

remote care and 41% would

prefer to have more of their

care via mobile

27% said medication

reminders via text would

be helpful

45% said Internet

visits would expand

access to patients

31% said they use or

would like to use text for

routine administrative

communications

Administrative communications

Doctors and consumers are interestedin using email to communicate aboutadministrative tasks (e.g., appointmentreminders), but doctors appear to bemore eager.

23% prefer providers

communicate by email for

appointment reminders/

simple communications

66% said they use

or would like to use

email for administrative

communications

Using text

There may be opportunities to incorporatetext messaging for simple communicationsbetween the provider and consumer.

Paying for mobile health

There is a consumer market for remotemonitoring devices that send data to thehealthcare professional.

40% said theywould pay for remote

monitoring device with

a monthly service fee

57% said they want tomonitor patients outside

the hospital

Source: PricewaterhouseCoopers HRI Physician and Consumer Surveys, 2010




Whether you’re thinking about mobile health,planning for mobile health or leading mobilehealth, dening and understanding the

customer(s) will enable you to determinethe most appropriate business model.Each model may target one or more ofthe following goals: providing a bettertransaction, giving more knowledge, easingcommunication and/or integrating solutionsand information (See Figure 14). Considerthese steps when identifying and executingon the mobile health opportunity:

1. Customer: Identify the specic marketsegment for mobile applications(consumer, employer, provider, pharma,

device, payers, etc.)

2. Pain points: Identify the current failureand pain points that mobile solutionscan more effectively address for thetarget market

3. Work ow: Identify how the currentprocesses, practices and work owwould change by the applicationof mobile solutions to provide abetter outcome

4. Vision: Create a vivid visualization ofthe mobile solution and thecharacteristics of the offering thatwould create greater value

5. Value proposition: Create the valueproposition that identies, quantiesand measures the cost, convenience,

condence and compensation fromoutcome improvements from themobile solution

6. Platform: Identify an existing platform othe need to create a new platform uponwhich the new mobile solution should belaunched and the partners required forthe platform components

7. Business model: Create the businessmodel that delivers the value propositionby leveraging existing or creating new

payment options

8. Develop and launch: Develop andlaunch the mobile offering for the targetmarket through pilots and then fulllaunch based upon realizing metricsand milestones of successful adoption

9. Data mining: Mine real-time data andinformation to create increasing valuefor all stakeholders

10. Scale: Expand the platform and

business model to address the largerand adjacent markets

Where you are and how to start



31What this means for your business PricewaterhouseCoopers’ Health Research Institute

Source: PricewaterhouseCoopers Health Research Insititute

Figure 14: Mobile health business models

Goal: TransactionEnable the exchange or

query of information to

accomplish discrete task

Goal: CommunicationEnable dialogue or

information dissemination

Goal: KnowledgeProvide new inform

for decision-makin

Goal: IntegrationUnify services, products

and/players to form a

whole solution

Business models

Operational/clinicalFocuses on internal operations of anorganization—running and growingthe business (e.g., financial, clinicalperformance, customer experience).

Consumer products and servicesServices related to individuals that span acrosshealth/fitness, preventative care, acute careand chronic care (e.g., apps, fitness devicesand games, personal sensors/monitoring).

Infrastructure

Focuses on securing, connectingand speeding up health-relatedinformation exchange (e.g.,platforms, software, bandwidth).

Customers

Consumer

Physician

Health system

Health insurer

Employer

Pharma/device




Acknowledgments

Bill Braithwaite, MD, PhDChief Medical Ofcer

Anakam

Donald Burt, MDChief Medical OfcerPatientKeeper

Carolyn CarterManager, Business Development,State Sponsored BusinessWellPoint

Yan Chow, MDDirector, Innovation and AdvancedTechnology Group

Kaiser Permanente

Karen Coppock, PhDSenior Program OfcerMcKesson Foundation

Don CowlingVice President and Managing DirectorMerck Serono, UK and Ireland

Tim DonahueVice President of Industry SolutionsSprint

Prateek DwivediVice President and Chief Information OfcerMount Sinai Hospital, Ontario, Canada

Sandra ElliottDirector, Consumer Technology andService DevelopmentMeridian Health

Doug Elwood, MDChief Strategy OfcerZibbel, LLC.

Henry EnglekaChief Executive OfcerZibbel, LLC.

John GlaserFormer Chief Information OfcerPartners HealthCare

Aaron GoldmuntzDirector, Business DevelopmentCardionet

Chris GrayNational Solutions Manager for HealthcareSprint

Michael HansenManaging DirectorMatchbox Ventures

Robert HavasyBusiness AnalystCenter for Connected HealthPartners HealthCare

David JacobsonStaff Vice President, Business Development,State Sponsored BusinessWellPoint

Ted Johnson, MDDirector, Division of Geriatric MedicineWesley Woods Center at Emory University

Don JonesVice President, Business DevelopmentHealth & Life SciencesQualcomm



33

Mohit Kaushal, MD, MBADirector of Connected Health,Omnibus Broadband Initiative

Ofce of Strategic Planning and PolicyFederal Communications Commission

Rajeev KapoorFormer Global Managing DirectorVerizon Connected Healthcare

Ned Kiteld Associate Director, US VPRIV Marketing,Commercial OperationsShire Human Genomic Therapies

Joseph Kvedar, MD

DirectorCenter for Connected HealthPartners HealthCare

Munesh MakhijaGeneral Manager, Communication andInformatics for GE HealthcareGE Healthcare

Michael MathiasVice President and Chief Technology Ofcer

Aetna

Meg McCabeVice President of ConsumerMarketing and Product

Aetna

Johnny MilaychevProduct ManagerNew Wave Software

Mark MofttFormer Chief Information OfcerGood Shepherd Medical Center

Roy SwackhamerChief Information OfcerSCAN Health Plan

Eric Topol, MDDirector, Scripps TranslationalScience InstituteChief Academic Ofcer, Scripps HealthVice-Chairman, West Wireless Health InstituteThe Gary and Mary West Chair ofInnovative Medicine

Professor of Translational Genomics,The Scripps Research Institute

Tom TrebilcockVice President, e-business and Payments

PNC Financial Services

Heath UmbachProduct Marketing ManagerPatientKeeper

Carrie VaroquiersPresident, McKesson FoundationVice President, Corporate Citizenship

Mike WeckesserDirector, Emerging Business–HealthSolutions

Best Buy

Brad WolfsenVice President, Strategy and Health InitiativesSafeway, Inc.

Acknowledgments PricewaterhouseCoopers’ Health Research Institute




About the research

Healthcare Unwired is the most in-depthresearch to date into mobile health

by PricewaterhouseCoopers’ HealthResearch Institute (HRI). HRI conducted35 in-depth interviews with thoughtleaders and executives representinghealthcare providers, payers, private sectortechnology organizations, academic medicalcenters, telecommunication companies,pharmaceutical and device companies,retail companies, communication rms,and employers. HRI also commissionedan online survey in the summer of 2010of 2,000 consumers and 1,000 physiciansregarding their use and preference of mobile

technologies in the United States.

Mobile health is being dened broadly asthe ability to provide and receive healthcaretreatment and preventative services outsideof traditional care settings. Mobile healthtools can include remote patient monitors,video conferencing, online consultations,personal healthcare devices, wirelessaccess to patient records and prescriptionapplications using a cellphone, smartphoneor wireless tablet. Our mobile discussionmay also include telehealth, which is moreestablished and include the physical/virtualintegration and interoperability of deviceslike heart rate monitors, pulse oximeters,wireless scales.

About PricewaterhouseCoopers

PricewaterhouseCoopers (www.pwc.com)provides industry-focused assurance,

tax and advisory services to build publictrust and enhance value for our clientsand their stakeholders. More than 163,000people in 151 countries across our networkshare their thinking, experience andsolutions to develop fresh perspectivesand practical advice.

Health Research Institute

PricewaterhouseCoopers’ HealthResearch Institute (HRI) provides newintelligence, perspectives, and analysison trends affecting all health-relatedindustries, including healthcare providers,pharmaceuticals, health and life sciences,and payers. HRI helps executive decision-makers and stakeholders navigatechange through a process of fact-basedresearch and collaborative exchange thatdraws on a network of more than 3,000professionals with day-to-day experiencein the health industries. HRI is part ofPricewaterhouseCoopers’ larger initiativefor the health related industries that brings

together expertise and allows collaborationacross all sectors in the health continuum.



Health Research Institute Advisory Team

Christopher Wasden

Managing [email protected]

Bruce [email protected]

Bo ParkerManaging [email protected]

Cliff Bleustein, [email protected]

Preetham [email protected]

William [email protected]

Maxim [email protected]

Christine FreyermuthSenior [email protected]

PricewaterhouseCoopers’Health Research Institute

Kelly Barnes

Partner, Health Industries [email protected]

David Chin, MDPrincipal (retired)[email protected]

Sandy LutzManaging [email protected]

Benjamin [email protected]

Serena FoongSenior [email protected]

Joanna BonventreResearch Analyst617.530.7563

[email protected]

Stephanie ZefferinoResearch [email protected]

Sarah HaettResearch [email protected]



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Kelly BarnesPartner, Health Industries [email protected]

Christopher WasdenManaging [email protected]

Dan GarrettPartner, Healthcare IT Practice [email protected]

William [email protected]

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