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?
Overview DM/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 Convergence Home 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 Technology When 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