Chronic Disease Management/ Tech Megatrends: Chronic Disease Management/ Tech Megatrends Vince Kuraitis JD, MBA Principal and Founder Better Health Technologies, LLC


What’s the right metaphor for DM/Tech?: What’s the right metaphor for DM/Tech?


OverviewDM/Tech Megatrends: Overview DM/Tech Megatrends 1) The DM/Tech Market Opportunity is Huge! 2) The DM/Tech Market is Complex 3) 2008 Could Be a Breakout Year for Remote Patient Monitoring (RPM) 4) What’s Missing in the Market? Large Scale Platforms/Projects. A) Health Plans B) Medicare DM Demos C) Medical Home model D) PHRs/Google Health E) Mobile Platforms, e.g., Lifecomm F) Hospital at Home 5) “Behavior Change” is Becoming the Holy Grail 6) Next Generation Technologies: “You Ain’t Seen Nothing Yet” 7) Will the DM Community Be Leaders or Laggards in the Race to Interoperability?


1) The DM/Tech Market Opportunity is Huge!: 1) The DM/Tech Market Opportunity is Huge!


$34 B Market for Healthcare Unbound Technologies: $34 B Market for Healthcare Unbound Technologies 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)


2) The DM/Tech Market is Complex: 2) The DM/Tech Market is Complex


Two Seemingly Contradictory Statements: Two Seemingly Contradictory Statements Diseases/conditions x Value propositions x Technologies x User environments = Thousands of Potential Applications So Why Is Uptake of Technology in DM Taking Time? Do the Math.


Technology Convergence: Technology Convergence CONSUMER TECH INFRASTRUCTURE Internet Smart houses Personal communications devices -- PDAs, cell phones, etc. Broadband -- cable, DSL, satellite Digital cameras, video Wireless -- 802.11, Bluetooth, RFID, etc. Voice recognition etc. eHEALTH APPLICATIONS Electronic Health Records (EHRs) Personal Health Records (PHRs) Remote patient monitoring Fitness/wellness/prevention Self care support Physician/patient secure messaging Home telehealth/telecare Decision support systems e-Prescribing e-Disease Management e-Clinical Trials Predictive modeling Computerized Physician Order Entry Quality evaluation web sites Patient reminder systems etc.


Focal Points for ConvergenceHome Networks, Smart Phones, EHRs: Focal Points for Convergence Home Networks, Smart Phones, EHRs PHR/ EHR CONSUMER eHEALTH


Role of IT in Disease Management: Role of IT in Disease Management Patient Facing DM Provider Facing Patient-provider communication tools (IVR, email) Monitor Engage Intervene Educate, Coordinate, Treat Identify, Validate, Stratify, Enroll Call center Personal Health Record Predictive modeling Remote monitoring (biometric, tele-monitoring) Personal assessment tools (HRA) Educational tools (websites, audio library) Electronic Medical Record Decision support tools (CDSS) Outcomes, Feedback, Follow-up Clinical integration tools


3) 2008 Could Be a Breakout Year for Remote Patient Monitoring (RPM): 3) 2008 Could Be a Breakout Year for Remote Patient Monitoring (RPM)


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


Slide13: Promoters


...but Consider the Systemic Barriers: ...but Consider the Systemic Barriers Reimbursement HIPAA: Privacy/confidentiality issues Physician workflow Technology maturity Infrastructure Bandwidth Interoperability/Standards Friendly user interfaces


4) What’s Missing in the Market? Large Scale Platforms/Projects.: 4) What’s Missing in the Market? Large Scale Platforms/Projects. Candidates include: A) Health Plans B) Medicare DM Demos C) Medical Home model D) PHRs/Google Health E) Mobile Platforms, e.g., Lifecomm F) Hospital at Home


4A) Health Plans: 4A) Health Plans Critical assumption in Forrester analysis: health plan reimbursement tips the market Early sightings?


4B) Medicare DM: Virtually No Evidence of Success: 4B) Medicare DM: Virtually No Evidence of Success Medicare Health Support (MHS) appeared to be the favorite son demo to expand DM into Medicare MHS has attracted worldwide attention Legislation requires roll out if successful Results to-date: Medicare DM programs are struggling. See http://e-caremanagement.com/first-official-report-on-medicare-health-support-dm-pilot-finds-virtually-no-evidence-of-success/


4C) The Cats are Herding:Medical Home Model Gaining Momentum: 4C) The Cats are Herding: Medical Home Model Gaining Momentum


The Medical Home Incorporates Disease/Care Management Tech & Apps: The Medical Home Incorporates Disease/Care Management 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 (MMHD): Medicare Medical Home Demonstration (MMHD) December 2006 – Congresses passes MMHD MMHD similarity to MHS: high cost, chronic patients; multiple comorbidities MMHD differences from MHS No requirement of 5% guaranteed savings Physicians can keep 80% of savings


4D) PHRs & Google Health: 4D) PHRs & Google Health 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


Slide22: 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): 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/


Slide24: 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)


Slide26: Three Potential Leverage Points A GH platform could simultaneously create AND dominate next generation PHRs. Google Health promises to overcome the “populating the PHR” challenge Automated data feeds The Continuity of Care Record standard as the MP3 of PHI Potential for rapid, dramatic network effects


4E) Mobile Platforms, e.g., Qualcomm’s sponsorship of LifeComm: 4E) Mobile Platforms, e.g., Qualcomm’s sponsorship of LifeComm


The Disconnect: The Disconnect Chronic Disease/Condition Management is migrating From a clinical based model Toward a behavior change model How can you optimize behavior change without 24x7x365 connectivity to the patient?


4F) Hospital at Home: 4F) Hospital at Home


Current DM/Tech & Apps Are A Collective Platform to Support HAH: Current DM/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


5) “Behavior Change” is Becoming the Holy Grail: 5) “Behavior Change” is Becoming the Holy Grail


The Holy Grail: Changing behavior to prevent disease: The Holy Grail: Changing behavior to prevent disease Interactive Data Systems All of the above plus more real time two way remote interaction between pts., disease managers, and MDs (e.g. interactive TV, implantable devices, PDAs, cell phones, other wireless technologies) Copyright © LifeMasters Supported SelfCare Inc. 2004 All Rights Reserved.


Behavior Change: Carrots vs. Sticks?: Behavior Change: Carrots vs. Sticks?


6) Next Generation Technologies: “You Ain’t Seen Nothing Yet”: 6) Next Generation Technologies: “You Ain’t Seen Nothing Yet”


The Next Generation of DM TechnologyWhen the Technology is Just “There”: The Next Generation of DM Technology When the Technology is Just “There” “Ubiquitous Health” “Sense and Simplicity” “Pervasive Computing”


7) Will the DM Community Be Leaders or Laggards in the Race to Interoperability?: 7) Will the DM Community Be Leaders or Laggards in the Race to Interoperability?


What’s the right metaphor for DM/Tech?: What’s the right metaphor for DM/Tech?


BHT Clients: BHT Clients Pre-IPO Companies HealthPost Cardiobeat EZWeb Sensitron Life Navigator Medical Peace Stress Less DiabetesManager.com CogniMed Caresoft Benchmark Oncology SOS Wireless Click4Care eCare Technologies The Healan Group Fitsense Elite Care Technologies Established organizations Intel Digital Health Group Samsung Electronics, South Korea -- Global Research Group -- Samsung Advanced Institute of Technology -- Digital Solution Center Medtronic -- Neurological Disease Management -- Cardiac Rhythm Patient Management Amedisys Siemens Medical Solutions Philips Electronics Joslin Diabetes Center GSK Disease Management Association of America PCS Health Systems Varian Medical Systems VRI Washoe Health System S2 Systems CorpHealth Physician IPA Centocor


Better Health Technologies, LLC: 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? Contact: Vince Kuraitis JD, MBA Better Health Technologies, LLC http://e-CareManagement.com blog (208) 395-1197