White paper written by Kulin Marketing on the telehealth and mhealth space that is filled with startups. Contact us at info@kulinmareting.com to purchase a printed version of this white paper.

1.
Startup the Right Way
White Paper:
Connected Health: A Startup Phenomena
Written by Kulin Marketing
A Marketing Team For Startups.
www.KulinMarketing.com
February 2012
For questions, comments, or to start marketing the right way Contact:
info@kulinmarketing.com

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The Economics of Connected Health
There is a demand for a new type of healthcare. One that is more affordable at
higher quality. There are 133 million people who suffer from 1 chronic
condition in the U.S. These 133 million attribute to 75% of the total healthcare
cost in the U.S. (U.S CDC and Prevention). Not only is that a daunting fact for
our healthcare spending, but for chronically ill patients as well. A solution to
decreasing healthcare costs starts with addressing the reason why there is a
problem in the first place, patient health. If patients were healthier and had lower
claim rates issued with payors, less cost would be attributed to them and payors
could roll the cost savings over into premium discounts for lower risk patients.
Furthermore, the demand for higher quality, lower cost healthcare increases as
we see the general public aging and the number of healthcare providers
decreasing.
As economics teaches us, when there is a demand in the marketplace there is an
opportunity to supply it with revenue generating products or services. This
opportunity has been noticed within the healthcare space. In the first decade of
the 2000’s we saw medical tourism attempt to meet the demand, but fall short at
delivering improved quality while lowering costs. Recently, there has been a
wave of new innovative provider and payor structures such as Qliance and
MedLion. These structures are built on the model of charging monthly rates for
prevention services. The added value is that patients will have abundant access to
primary care, which will decrease future chronic conditions. It is thought that
these models are ahead of their time. However, they are trying to supply the
demand. Another group of businesses include a myriad of InfoTech products.
The umbrella of InfoTech includes connected health technologies such as
telehealth, which predominately connects patients to providers using the
internet, and mHeath, which primarily enables patients to manage their own
health via mobile devices.
Connected Health: Telehealth and mHealth
Telehealth and mHealth companies are both attempting to increase the quality
of healthcare for patients, and to some extent they are succeeding. Both
companies are using technology to connect patients with the means to increase
their healthcare. Additionally, both types of technologies have developed remote

3. Kulin Marketing – White Paper: Marketing for startups www.KulinMarketing.com
monitoring tools, an industry that earned $126.8m in 2010 and is estimated to
reach $294.9m in 2015.
TeleHealth
Kulin Marketing Founder, Elizabeth Kulin, worked for Preferred Global Health
(PGH) in 2005, working closely with Boston based Harvard Medical, an affiliate
of Partners Healthcare and Partner’s Telemedicine departments. PGH worked
with Partners TeleHealth program to connect patients living outside of the
United States with leading physicians located at Dana Farbar, Brigham and
Women’s, and Massachusetts General Hospital. At that time, the devices used to
connect were email, fax, and phone. Since that time, the telehealth technology
has been developed to connect remote patients with more physicians, at lower
costs and quicker rates. For example, the TeleHealth startup Health Spot is
installing medical check up Kiosks (Care4 Stations) in drug stores that enable
physicians to conduct a physical with a patient remotely via video and other
devices such as a connected health blood pressure medical device.
mHealth
Unlike Telehealth, which has been structurally developing for an estimated 10
years, mHealth has recently displayed a surge of new technologies for startups.
From a broad view, mHealth technologies enable users to do 3 things: set goals,
track progress, and integrate a motivational program that will attempt to change
their behavior using social and/or monetary influences.
Some mHealth technologies include only setting goals and tracking progress, and
some encompass all 3 functions. For example, Goals.com enables users to set
goals, track, and schedule SMS reminders, but lacks social and/or monetary
motivators. On the other hand, HealthSeeker (the Facebook app) uses social
influence to motivate users in a fun way, and Lose it! (a mobile app and web
platform) helps people lose unwanted weight via peer support. These are great
examples of web and mobile apps that successfully incorporate all 3 functions in
their technology products. MHealth startups can be vastly different in business
model, connection strategies and market positioning strategies.
Types of mHealth Business Models
• Web platforms
o For example: Virgin Healthmiles

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• Mobile apps
o For example: RunKeeper
• Tangible products/ fitness device (might have websites and/or apps)
o For example: Switch to Health ($24.95), Fitbit ($99), Nike Fuel
Band ($149.00)
Connection Strategies
• Enterprise Partnership
o Positioning: Keeping employees healthy and enterprise benefit
costs down.
o For example: Virgin Healthmiles, Limeade, Redbrick
o Pros: Can reach user audience directly through HR departments.
Can partner with employee executives to motivate users
monetarily.
o Cons: There are a limited number of companies in the USA that
can afford to implement employee wellness programs.
• Payor Partnership
o Positioning: A wellness prevention tool
o For example: Everymove
o Pros: Can reach target audience directly through payor network,
position as a prevention tool, and motivate a change in the payor’s
members via monetary reviews or discounts on premiums.
o Cons: Will have to target payors and convince them that mHealth,
as a prevention tool, will decrease claims in the long term. Also,
limited target market that caps at payor’s network.
• Direct to Consumers
o Positioning: many direct to consumer mHealth brands focus on a
vertical, such as diabetes, and position themselves in line. This also
enables the company to target a vertical the vertical and be unique
in a crowded mHealth space.
o For example: HealthSeeker (diabetes), MapMyFitness (fitness
enthusiastic)
o Pros: Can target the largest market to potentially make high
revenues.
o Cons: Must invest in marketing to reach specific target markets,
active acquisitions, and retain users.

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The wave of these types of technologies has been so massive, that there have
been tens of thousands of new businesses developed. A startup phenomenon is
truly occurring.
A Startup Phenomena
In 2011 the healthcare industry began using technology devices to capture
health information in a coded format. It has been determined by the InfoTech
healthcare industry that we are currently experiencing the “capture of
information” stage. The next stage involves InfoTech products utilizing the
captured information to improve the quality of healthcare for the specific opt-ed
in patients. Subsequently, it is believed that we will see a development of
technology and innovations to improve overall global health. I would argue that
telehealth, and predominately mHealth, technologies are attempting to execute
stage 2 at the same time as they capture information. For example, thousands of
mHealth applications are used on mobile devices by millions of users who not
only allow the technology to collect their health information, but also allow the
technology to attempt to change their health related behaviors. The plethora of
new technology companies developing and operating mobile health applications
are truly meeting the demand for a new type of healthcare. In 2010 it was stated
that over 17,000 mHealth applications had been developed. That is over 17,000
startups! Startups that have created a solution to a problem, and have supplied
the demand. However, just like any other startup, their potential for success
largely relies on the action of their target market, the individual patient.
The Dependencies
Just as it always has, healthcare must be met halfway by patients. Not only do the
customers of connected health have to be able to access the technologies, but
they must also use them.
In order for connected health solutions to be successful, patients must have
access to the technology platforms they operate (on the internet and mobile
devices). This requirement depends on social economics, and is forecasted to
be a realistic accomplishment. It was stated by the Nielsen Company in

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September 2010 that, “28 percent of all cell phone users have a Smartphone”,
and in February 2012 Entrepreneur magazine stated that, “More people in the
U.S. will access the web via mobile devices than via computers by 2015”. It has
also been measured that the most popular mHeath app (CardioTracker), has
been installed on smart phones between 1 million and 5 million times.
Therefore, in the United States this first hurdle of adoption for connected health
technologies looks to be achievable. At the same time, it is obvious that the
supply and demand of this space has not yet reached its equilibrium. This is
because patients have a history of neglecting to take the actions necessary to
improve their health, even when they have access to health improving tools. It is
a fact that even when threatened with life threatening conditions, many patients
do not take their medications. Only 45% of heart attack survivors take their
medication. Lack of self-care costs the healthcare industry over $100 billion in
unnecessary costs per year. How can connected health help?
The Solutions
Connected health startups must do the following:
1. Educate patients that tools are available that can increase their quality of
health, and of life, at lower costs than traditional healthcare management
regiments.
2. Motivate patients to take action and use the new technologies available.
3. Motivate patients to continue usage.
a. iHealth Connections published a study that showed that smokers
were three times as likely to quit when a monetary variable ($400)
was introduced as a prize.
Each of these three steps should be supported by product development and
marketing.
Execute a Plan: Product Development & Marketing
Product Development
In order to develop a product that patients can use to improve personal
healthcare, the product’s functionality must actually do so. In some way, the
technology must connect the user with the relevant support that their specific

7. Kulin Marketing – White Paper: Marketing for startups www.KulinMarketing.com
area of health requires. Many mHealth apps do this by focusing on a target
market vertical such as Ginger.io for Diabetes and Ubiqi for migraines.
Marketing
Like any other startup business, connected health startups should develop a
marketing plan. A marketing plan can be used to determine positioning, strategy,
and tactics to reach, activate, and retain users. The most critical part of a
marketing plan for mHealth startups is positioning. For instance, with over
17,000 platforms online and apps on mobile devices, it is critical for a startup in
this space to be unique in order to stand out among the crowd and win customer
acquisitions. Different business models and connection strategies have helped set
apart some early mHealth technologies, but new businesses in the space will have
to be very creative in the future as exponential growth is expected to occur over
the next 3 years. Finding ways to be unique through product development can
enable an mHealth brand to obtain a unique positioning and become an indirect
competitor to other mHealth technologies. The next steps are to choose which
tactics can effectively support your objectives and reach your target audience.
Reach, Active, and Retain Users
Tim Cascio wrote the blog post, “Mobile Marketing: 50 Ways to Promote Your
iPhone App” in 2009. It is a helpful list of ideas on how a company can promote
their new mobile app. In an effort to reach users and obtain signups, a process
of trial and error tactics may occur. Always follow the mentality of Eric Ries
(author of ‘The Lean Startup’) when debating if a tactic is worth the investment,
and ask yourself not “can we do this?” but “should we do this?” Some connected
health startups with recent success in acquiring signups have used traditional
marketing to drive users to their connected health technology locations, web
platforms, and/or apps. Inbound marketing is also a successful tactic, and can
not only increase signups, but brand equity as well. Once reach has been
established, use a strong call to action to motivate acquisition. To establish user
loyalty, listen to your users’ feedback and lean on your product development
team to add new ways users can easily use your technology to reach their
healthcare goals.
Never Stop Innovating

8. Kulin Marketing – White Paper: Marketing for startups www.KulinMarketing.com
There will be opportunities to extend your connected health technology.
Business development teaches us that products and services expansions have
these choices:
• The same product in the same market
• The same product in a new market
• A different product in the same market
• A different product in a new market
Future product proliferation could enable today’s connected health startups to
sell their same products in new markets such as a different location, and/or a
variation of their product to the same market, for instance, a second target
vertical.
The end result will be a startup phenomenon that successfully establishes a new
industry of profitable businesses, hundreds of thousands of jobs, and possibly a
new type of healthcare that enables higher quality of life for the entire global
population.

9. Kulin Marketing – White Paper: Marketing for startups www.KulinMarketing.com
References:
• http://www.touchbriefings.com/ebooks/A1v2rp/ihealth12/resources/index
.htm?referrerUrl=http%3A%2F%2Fwww.linkedin.com%2Fshare%3FviewLin
k%3D%26sid%3Ds771268694%26url%3Dhttp%253A%252F%252Fwww%
252Etouchbriefings%252Ecom%252Febooks%252FA1v2rp%252Fihealth12
%252F%26urlhash%3DMyTO%26pk%3Dmember-
home%26pp%3D%26poster%3D37656291%26uid%3D555493110988145
0496%26trk%3DNUS_UNIU_SHARE-title
• http://healthcareitnews.com/news/mhealth-apps-forecast-increase-
threefold-2012
• http://ehealth.eletsonline.com/2012/01/“3g-is-creating-wonders-in-
healthcare-domain”-thierry-zylberberg-executive-vice-president-orange-
healthcare-
division/?utm_source=feedburner&utm_medium=feed&utm_campaign=F
eed%3A+ehealthelets+%28eHEALTH%29&utm_content=Google+Reader
• http://www.touchbriefings.com/ebooks/A1v2rp/ihealth12/resources/index
.htm?referrerUrl=http%3A%2F%2Fwww.linkedin.com%2Fshare%3FviewLin
k%3D%26sid%3Ds771268694%26url%3Dhttp%253A%252F%252Fwww%
252Etouchbriefings%252Ecom%252Febooks%252FA1v2rp%252Fihealth12
%252F%26urlhash%3DMyTO%26pk%3Dmember-
home%26pp%3D%26poster%3D37656291%26uid%3D555493110988145
0496%26trk%3DNUS_UNIU_SHARE-title
www.KulinMarketing.com
The group of consultants that make up Kulin Marketing believe startups strengthen the economy.
Each member uses their specialty in marketing to help startups change the world.