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2015 Health Trends

2015 Health Trends: New challenges for a changing industry

In the second of their 4-part annual trend report series, GSW takes a closer look at healthcare. From evolutions in doctor-patient relationships to strategies in benefit design to the changing mind-set of physicians, a new landscape takes shape.

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2015 Health Trends

  2. 2. 20 15 HEALTH TRENDS Our fifth annual series of trends reports includes insights into the big shifts that are changing marketing, healthcare, digital experience, and consumer expectations. In this report, you’ll find the top eight trends in marketing, each with clues into new possibilities and examples of brands that got there first.
  3. 3. 20 15 HEALTH TRENDS Abigail Schmelzer Alex Brock Andrea Evans Angela Cua Azul Ceballos Bruce Rooke Campbell Hooper Charles DiSantis Chelsea Bailey Duncan Arbour Eduardo Menendez Eric Davis Fred Harrison James Tomasino Jeffrey Giermek Jeffrey Wilks Jessie Brown Joe DeSalvo John Mucha Joy Hart Julie Valka Kathryn Bernish-Fisher Kevin Nalty Leigh Householder Luke Hebblethwaite Matt Groom Mike Martins Nick Bartlett CORE CONTRIBUTORS Nicole Sordell Pavithra Selvam Phil Storer Richard Martin Rick Summa Sam Cannizzaro Sarah Brown Sayeed Anwar Scott Raidel Stefanie Jones Zach Gerber
  4. 4. At the core of our innovation practice is a simple idea: Knowing how people’s expectations are changing lets us capture new market opportunities, take smart risks, and spur innovation We start by uncovering clues. Clues are data points, great stories, quotes, and pictures that shift our understanding of what people want right now. We find them in practices around the world and in the technologies, brands, and experiences that doctors and patients encounter in their everyday lives. Over time, those clues combine and connect to reveal trends, a new kind of inspiration for creating experiences in the moments before our customers realize they need them. And months and years before our competitors realize the same thing. 20 15 HEALTH TRENDS
  5. 5. We’re following eight trends that show how healthcare experiences will change. Innovation From Insiders Patient 1’s and 0’s Carrot and Stick Healthcare Remote Attention Disillusioned Doctors Wedging Learning In DIY Diagnosis The New Competition THE TRENDS 1. 2. 3. 4. 5. 6. 7. 8.
  6. 6. 1. IN SHORT Last year it looked like pharma might be left behind in the wave of innovation changing healthcare experience. Now, more and more industry leaders are getting in the game.
  7. 7. 1. INNOVATION FROM INSIDERS 39% 2013 vs 2012 176% 2014 vs 2013 Venture funding of digital health is growing significantly, outpacing other healthcare sectors like software, biotech and medical devices. —PwC MoneyTree; digital health data based on Rock Health analysis
  8. 8. ACCELERATING EXPERIENCE INNOVATION 1. INNOVATION FROM INSIDERS The industry that has long invested in early biotech innovation is now in the market for early experience innovation. In 2014, Abbott, Boehringer Ingelheim, Genentech, and GE partnered with Rock Health, a leading funder of healthcare technology startups. In Germany, Bayer went even farther, evolving their Grants4Apps crowdsourcing initiative into a true digital health accelerator. Each of five startups will receive 50,000€ and 3.5 months in-house at Bayer for less than a 10% loss in equity. The accelerator’s first investments included wearable health sensors, a smart pill bottle, and home monitoring systems. —VentureBeat, 2014
  9. 9. BRIDGING MEDICINE AND EXPERIENCE 1. INNOVATION FROM INSIDERS The biggest surge of experience innovation this year will continue to be product design that blurs the lines between healthcare and technology evolution. In 2014, Novartis led that field. What started as simple licensing of Google’s passive glucose-sensing contact lens quickly became a pipeline of product possibilities on the platform, including an autofocus feature for people living with presbyopia. UCB is one we’ll be watching in 2015. They recently partnered with MC10 to find new uses for their stretchable, electronic Biostamp technology. It’s like a temporary tattoo that can track biometrics, muscle strength, motion, etc. Currently, MC10’s major partner is Reebok. They’re working together to create a mesh cap that fits under a sports helmet to detect concussions and monitor impacts. At UCB, the possibilities become even bigger, dramatically changing what we can learn in clinical trials and how we can support patients on therapy. Boehringer Ingelheim partnered with Propeller Health to attach a smart sensor to the back of its inhaler. They’ll be passively collecting information to uncover new insights into nonadherence—insights that can be solved with more innovations in digital health.
  10. 10. (FINALLY) CO-CREATING WITH OUR CUSTOMERS 1. INNOVATION FROM INSIDERS In 2015, we predict market research budgets will start to decline as co-creation becomes more and more central to how pharma creates new experiences. Genentech was one of the biggest first movers, working actively with patient communities from PatientsLikeMe to Crohnology to MediGuard to improve their clinical trials. Sanofi has a really compelling program for nurses that is focused on listening to how its customers solve their own challenges. The Connecting Nurses website has brought together 14 million nurses from over 130 countries to share their ideas on how to bridge the gaps in healthcare and resources that happen around the world. We have a new, intriguing opportunity to listen to those customers with the latest Rx rating and review site, which launched in mid-2014. Wired editor Thomas Goetz created the site called Iodine to crowdsource effectiveness data on drugs and guide consumers about drug purchasing decisions.
  11. 11. IN SHORT Today’s doctor-patient relationships include emails, text, electronic medical records, website portals, and, oh yeah, the occasional conversation. “My impressions from speaking to friends who have been patients is that nowadays they rarely get the doctor’s undivided attention because of doctor focus on the computer.” —Dr. Ken Grauer, a family practitioner 2.
  12. 12. 2. PATIENT 1’S AND 0’S Percent of physicians emailing with patients: 70% 68% 46% 39% 38% 38% Italy France Germany Spain United Kingdom United States —Manhattan Research, 2013, 2014
  13. 13. 2. PATIENT 1’S AND 0’S In a recent survey from Catalyst Healthcare found that 93% of adults prefer to go to a doctor that offers email communication. THE DOCTOR WILL SEE YOU IN YOUR INBOX NOW It turns out not every interaction with your doctor requires a paper gown. More and more physicians are connecting with their patients pre- and post-visit via email, text message, and secure portal. No surprise, patients prefer it. In fact, a recent survey by Catalyst Healthcare found that 93% of adults prefer to go to a doctor who offers email communication. Many would even pay more for it: 25% said they would still prefer a doctor that uses email communication even if there was a $25 fee per episode. Dr. Joseph C. Kvedar, a dermatologist and founder of the Center for Connected Health, a Harvard-affiliated organization that aims to move healthcare from the hospital and doctor’s office into the day-to-day lives of people who need help, explains that email improves efficiency for doctors and removes the frustration of phone tag. “Making myself available via email gives my patients a sense of direct access to me,” he said. It sends a message that I care and that I’m available to answer questions in a timely manner. It builds a bond between us that has tangible benefits for my patients’ health.” 93%
  14. 14. 2. PATIENT 1’S AND 0’S Of the members who used the lifestyle features of the Kaiser portal, 56% said they lost weight and 58% said they quit smoking. A recent study from Kantar Media found that nurse practitioners are even more likely than doctors to reach out to their patients in the inbox. These interactions are truly incremental, supportive healthcare. In a retrospective study of 2,357 primary care patients who connected with their doctors through an online patient portal, the Mayo Clinic found that there was no significant change in the frequency of office visits. In large networks, many of these personal messages go through portals. Kaiser Permanente has one of the largest. 4 million of its 9.1 million member 56% Lost Weight 58% Quit Smoking network use Kaiser’s online health management platform, called My Health Manager. According to their annual report, 34.4 million lab test results were viewed online, 14.7 million secure emails were sent, 3.6 million online appointment requests were made, and 14.8 million online prescriptions were refilled. But Kaiser expects the platform to do more than improve communications. They’re after improving outcomes, too. Of the members who used the lifestyle features of the portal 56% said they lost weight and 58% said that they quit smoking. Insomniacs even reporting increasing their nightly sleep by 32 minutes on average.
  15. 15. 2. PATIENT 1’S AND 0’S "Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation." —RAND Corporation for the American Medical Association, 2013
  16. 16. A NEW SCREEN, A NEW BARRIER 2. PATIENT 1’S AND 0’S Electronic health records may increase the long view that doctors have into their patients’ health, but they can really decrease the short view across the exam room. Physicians and patients alike report that the computers and tablets used to operate EHR systems create a new barrier between doctor and patient. Many, including Kevin R. Campbell, a cardiac electrophysiologist who blogs as KevinMD, worry that the new focus on data input will interrupt the doctor-patient relationship. “We must continue to practice the art of medicine, which requires that we actually talk and listen to our patients,” Campbell said. “We must not forget the value of interacting with patients, looking them in the eye, and providing them undivided attention. Computers, laptops, and iPads in exam rooms foster distractions.” But a new role could change all of that. A growing number of physicians are hiring scribes to do the data entry for them. Those scribes team up with the physician throughout the day—seeing patients, suggesting which codes to use, sending electronic prescriptions to the patient’s pharmacy on the doctor’s behalf, and generating referral letters to specialists. The impact is positive for both sides of the exam. Patient satisfaction scores increase, physicians see an average of one additional patient per hour, and all the charts are completed by the end of the day (which means no homework). —Medscape, 2014
  17. 17. THE TEXT RX 2. PATIENT 1’S AND 0’S One of the longest-running and most well-known health text initiatives is the Text4Baby program created by a public-private partnership that includes Johnson & Johnson, the National Healthy Mothers, the Healthy Babies Coalition, and others. Women can sign up for the service by texting BABY (or BEBE for Spanish) to 511411. Then they receive text messages, timed to their due date, with helpful tips that educate them about their pregnancy and getting ready for the new baby.
  18. 18. 2. PATIENT 1’S AND 0’S Like many other healthcare text programs, the short messages showed an impact. And, they broke through to underserved communities: 82% 65% 82% learned about medical warning signs they did not know. 65% reported they talked to their doctor about a topic they read on a Text4Baby message. Text4Baby moms were 3x more likely to believe that they were prepared to be new mothers compared to nonusers. A higher percentage of Text4baby participants live in zip codes with the highest levels of poverty compared to the overall US distribution. Nearly half reported their household income was $16,000 or less.
  19. 19. 2. PATIENT 1’S AND 0’S IT’S NOT JUST YOUNG MOTHERS WHO ARE 40% BENEFITING FROM SMS SUPPORT. Teams at practices and hospitals, like the Montefiore Medical Center, are using texting to support patient relationships. An interactive text message-based care management system at Montefiore was able to create a 40% improvement in appointment adherence and modest improvement in medication and care plan adherence. They extended the Sense Health platform to pre-scripted but customizable messages that busy Medicaid care managers could send to patients to make them feel like they were getting more of the individual attention they wanted. —California State University San Marcos National Latino Research Center survey, 2013 Sense Health, 2014 Montefiore’s text message system created a 40% improvement in appointment adherence
  20. 20. 3. IN SHORT Financial incentives changed how doctors practice medicine. Now brands from insurers to retail are betting they can use them to shift something even bigger: everyday human behavior.
  21. 21. 3. CARROT AND STICK HEALTHCARE 70% Pre-Penalties For Choosing Generics 10% Post-Penalties For Choosing Generics In 2015, benefit design will change behavior the way plan design did in the 1990s. The 1990’s shift: changing the number of people choosing expensive brand-name drugs. —Healthcare incentive expert, Francois de Brantes, 2013
  22. 22. THE BIGGEST LEVER IN HEALTHCARE Governments, payers, and employers are using both financial rewards and penalties to try to encourage healthier behaviors. At Cigna, that means engaging 14 million members in a digital health coaching program that offers mobile tools, social media engagement, gamification, and rewards. At Pennsylvania State University, it’s a $100 monthly surcharge for employees who don’t complete a biometric screening and an online wellness profile. One Midwestern hospital chain even announced it would deduct money from employees’ paychecks for unhealthy behavior, such as being overweight. —Partnership to Fight Chronic Disease, 2014 84% Treating people with chronic conditions accounts for 84% of healthcare costs. 3. CARROT AND STICK HEALTHCARE
  23. 23. CHANGING ROLE OF RETAIL 3. CARROT AND STICK HEALTHCARE One unexpected location for these new rewarding programs is the local drug store. Those stores increasingly want to be seen as a healthcare destination. That means they’re evolving their “minute clinics” designed to deliver fast-pass healthcare into full primary care suites offering everything from pain management clinics in the UK to chronic disease care in the US. And, they’re changing their rewards to match. What were once simple savings cards that rewarded shoppers with coupons and discounts for their shopping behavior are now delivering rewards based on shoppers’ health behaviors. If you walk those aisles enough, you might even get a step-based reward in store!
  24. 24. 3. CARROT AND STICK HEALTHCARE FAT TAX OR SKINNY SPIF? The much discussed question is: Which one works better? How these incentives are framed—as benefits for healthy-weight people or penalties for overweight people—makes a big difference. Rewards become less effective over time, but penalties can be seen as stigmatizing and punishing, making it even harder for people to make a healthy change. While people prefer the carrot design, the sticks do seem to have an impact. Researchers from the University of Michigan Health System found that when faced with having to pay up to 20% more for health insurance or do more exercise, most of the enrollees gradually met their fitness goal of walking 5,000 steps per day through an Internet-tracked walking program. Another approach may be reaching across industries to punish food instead of people. A growing number of European countries, including Denmark and France, have already imposed a tax on unhealthy food and drinks. A tax of at least 20% placed on sugar-sweetened drinks could drop obesity rates by 3.5% and prevent 2,700 heart-related deaths each year, according to the study.
  25. 25. 3. CARROT AND STICK HEALTHCARE -3.5% +2,700 A recent study found that a tax of at least 20% placed on sugar-sweetened drinks could drop obesity rates by 3.5% and prevent 2,700 heart-related deaths each year. —Association of Psychological Science, 2013 —Behavioral Translational Medicine, 2013 —British Medical Journal, 2012
  26. 26. 4. IN SHORT For years, patients have complained that their medical interactions were rushed and impersonal. Today they’re finding the kind of attention they want at home from a growing number of remote and telesupport services.
  27. 27. 4. REMOTE ATTENTION The number of doctor-patient video consults in the US will nearly triple over the next year. 5.7M 2014 16M 130M 2015 2018
  28. 28. 4. REMOTE ATTENTION FILLING THE GAPS IN MODERN MEDICINE The eHealth Stakeholder Group in Europe has been one of many to clarify the need for new kinds of healthcare interactions. Their “Widespread Deployment of Telemedicine Services in Europe” report pointed to three shifts creating new gaps: More people living with (multiple) chronic conditions, often starting at a younger age Growing elderly population, supported by fewer resources paid for by the shrinking tax base Not enough healthcare workers (the total number is actually falling in European states) Urgent need for more efficient, impactful healthcare + + = Beyond the demographic shifts, there are real experience gaps in medicine, ones that leave patients feeling disconnected and unready to manage their own care.
  29. 29. 4. REMOTE ATTENTION 46% Primary Care Urgent Care Video Visits Are Replacing Traditional Healthcare “Doctor On Demand” users were asked what services they would have used if they didn’t have access to the DOD app. Nothing 35% 7% 12% ER
  30. 30. 4. REMOTE ATTENTION FACE-TO-FACE VIDEO MEDICINE Nearly one million US families used video consultations with physicians last year. That number is expected to explode in the next few years. The consumer preference for video connections with doctors over phone calls is staggering. American Well, one of the leading providers of telehealth, reported that 94% of its customers chose video over telephone. This isn’t a trend limited to young families: American Well’s core customer base includes the US Department of Veterans Affairs, Rite Aid, United Healthcare, WellPoint and various Blues plans. Mobile may have been the tipping point for the switch. A quick click of a camera phone is infinitely easier to figure out than installing a webcam ever was. In that same report, American Well calculated that 60% of its customers used their smartphone or tablet for their video visits. The overall reach of telehealth has grown substantially. In 2014, Parks Associates reported that 42% of broadband households in the United States had used some type of online healthcare communications and that many had used it multiple times. Gartner believes we’re at a real tipping point, predicting the global telehealth market will be more than $27 billion by 2016, tripling in growth since 2010. Many urgent care systems and primary care practices are integrating telehealth into their offerings. Even Google is making telehealth part of its search service through Helpouts, its video chat service and directory. Helpouts makes it easy for all kinds of experts to offer a live consultation to searchers. Increasingly, those experts are doctors, like the One Medical Group.
  31. 31. 4. REMOTE ATTENTION TAKE-HOME SUPPORT Health systems around the world are looking to telemonitoring to support patients—and outcomes— at home. Dr. Ed Brown, CEO of the Ontario Telemedicine Network (OTN), has partnered with regional healthcare authorities in Ontario to enroll patients with congestive heart failure and COPD into a remote monitoring program. “We’re providing them with remote monitoring tools in their homes and asking them questions based on clinical guidelines to track their progress on a daily basis. Then their nurses track that data,” he explained. The tools include devices like remote pulse oximeters and blood pressure cuffs. The nurses are also trained to be health coaches who can help patients understand their disease and set goals to improve their health status. “Nurses are 66% Ontario Telemedicine Network’s remote monitoring program has reduced hospitalization rates by 66%. pretty used to telling people what to do,” Brown said. “This is different because they’re empowering patients to set their own goals.” The program has reduced hospitalization rates by two-thirds and reduced emergency room visits by 70%. In the US, the Geisinger Health Plan was able to use remote monitoring to reduce readmissions by 38% for congestive heart failure patients and deliver an ROI of $3.30 on the dollar for the system. Patients used a Bluetooth-connected weight scale that included interactive voice surveys about shortness of breath, swelling, appetite and prescription medication management designed to detect acute events before they happen. Weight data and survey answers were transmitted to the patients’ care team, allowing them to respond to warning signs. —PwC, 2013 —AMC Health, 2014
  32. 32. 4. REMOTE ATTENTION Telemedicine continues to grow in popularity with doctors: 60% 60% of healthcare providers use two-way video 55% 55% use image-sharing technology 46% 46% of healthcare providers use multiple telemedicine technologies 25% 25% use remote patient monitoring 20% 20% use their smartphones for telemedicine
  33. 33. 5. IN SHORT Who wouldn’t want to be a doctor? Most doctors. This once aspirational profession is now shouldered with growing levels of unhappiness, disillusionment and burnout. “The rate of severe diabetes complications in patients of doctors who rate high on a standard empathy scale is 40% lower than in patients with low-empathy doctors.” —”What Doctors Feel,” Dr. Danielle Ofri, MD
  34. 34. 5. DISILLUSIONED DOCTORS Cardiologist Sandeep Jauhar says today’s physicians see themselves not as the “pillars of any community” but as “technicians on an assembly line,” or “pawns in a money-making game for hospital administrators.” —”Doctored,” Dr. Sandeep Jauhar, MD
  35. 35. 5. DISILLUSIONED DOCTORS THE EMPLOYEE PHYSICIAN Remember the doctors many of today’s practicing physicians grew up with? It was a golden age of medicine. They were heroes. Life expectancy was increasing. There were huge firsts, like the heart-lung bypass. And doctors generally set their own course— customizing their practice, fees and hours around their communities and the lives they wanted to lead. Then things started to change. Questions about fraud and waste sparked new rules and bureaucracies designed to make medicine less expensive and more uniform. Governments have issued more mandates for record keeping and reporting. Payers have set fees lower and lower. The only way to keep up is to join up. 70% 70% of acquisitions of physician practices are inititated by doctors looking to sell. Doctors tend to have access to more support and get reimbursed at a higher rate when they’re in a network or physician group. So, many have left solo and small practices and moved into big ones. A recent survey by healthcare staffing firm Jackson Healthcare found that not only are hospital acquisitions of physician practices up (52% of hospitals plan to acquire practices in 2013 compared with 44% in 2012), the majority of those deals—70%, in fact—are initiated by doctors looking to sell. Many of these new mega employers set factory-like goals for their employee physicians, like seeing a set number of patients per day.
  36. 36. 5. DISILLUSIONED DOCTORS MODERN MEDICAL CONVEYOR BELT Lots of new medical professionals are entering the practice, and fewer and fewer of them are MDs. Instead a growing number of physician assistants and nurse practitioners are helping those MDs make the medical home model real. They’re each working to the top of their skill sets and then handing a patient off when she needs even more expertise or speciality care. In “The Physician Assistant Will See You,” Barbara Moran looked into this in-practice referral system, ‘Like it or not, medicine is now a team sport,’ observes Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians. As his practice moves to team-based care, he may delegate more well-child visits to P.A.s or nurse practitioners. He enjoys seeing his healthy patients, he said, ‘but the paperwork takes a lot of time — as a physician, my time may be better spent with a patient who is critically ill.’ And he can still keep his relationship with the healthier children, he said, ‘by a quick visit at the end.’” That balancing act is tricky across specialties. In a recent essay, “Doctors Tell All—and It’s Bad,” The Atlantic’s Meghan O’Rourke wrote, “Studies estimate that today’s doctors and ‘hospitalists’—medical practitioners who do most of their work in hospitals— spend just 12 to 17 percent of their day with patients. The rest of the time is devoted to processing forms, reviewing lab results, maintaining electronic medical records, dealing with other staff.” For patients, what’s missing is missed. Atul Gawande, a surgeon and professor at Harvard Medical School, explains that how patients feel about their medical interactions really does influence the efficacy of the care they receive and that doctors’ emotions about their work in turn influence the quality of the care they provide. The patient-doctor relationship is still the heart of medicine.
  37. 37. 5. DISILLUSIONED DOCTORS "I wouldn't do it again, and it has nothing to do with the money. I get too little respect from patients, physician colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients. Working up patients in the ER these days involves shotgunning multiple unnecessary tests (everybody gets a CT!) despite the fact that we know they don't need them, and being aware of the wastefulness of it all really sucks the love out of what you do. I feel like a pawn in a moneymaking game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade." —Doctor on Sermo
  38. 38. 5. DISILLUSIONED DOCTORS 12-17% It’s estimated that medical practitioners who do most of their work in hospitals spend just 12 to 17% of their day with patients. 78% 78% of 13,500 physicians surveyed are “somewhat pessimistic or very pessimistic about the future of the medical profession.” 84% 84% of physicians agree that the medical profession is in decline.
  39. 39. 5. DISILLUSIONED DOCTORS JUST SICK OF IT Here’s the big number: 78% of 13,500 physicians surveyed are “somewhat pessimistic or very pessimistic about the future of the medical profession.” And, 84% of physicians agree that the medical profession is in decline. In “A Doctor’s Declaration of Independence,” Dr. Daniel Craviotto wrote about the daily struggle: “I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.” Almost 50% of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment. In “Burnout and Satisfaction With Work- Life Balance Among US Physicians Relative to the General US Population,” the authors found that “Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.”
  40. 40. 6. IN SHORT The world of medicine is changing faster than ever. Busy healthcare professionals are left to try to find a way to fit it all in. The moments they do make for new education are wedged in between appointments or surrounded by distraction.
  41. 41. 6. WEDGING LEARNING IN CME ON THE COUCH Our collaborators at Palio-Ignite created an interesting healthcare professional layer over some recent data from Google about when people use their various devices. The new curves show traffic to healthcare professional websites by device and time of day. Look at that big spike in tablet usage right around 8PM in the chart above. It coincides with how we’re increasingly seeing those doctors use different screens for different behaviors. But it also shows the new environment doctors are learning in. They likely are browsing healthcare content, but in what context? At that hour, for many, it’s potentially surrounded by the welcome distraction of family life. (Perhaps Frozen is playing for the 30th time in the background?) Not exactly study hall. It’s a behavior we originally called multitasking, but today that always-on, anywhere, anytime behavior has left our culture in a permanent state of mild (to major) distraction. The challenge is even greater in medicine, where new screens, new tools, new requirements, and the fast growth of information are leaving doctors overloaded and only partially connected.
  42. 42. 6. WEDGING LEARNING IN Web traffic to HCP sites for digital devices
  43. 43. 6. WEDGING LEARNING IN THE RESEARCH MOUNTAIN These multitasking healthcare providers are up against pretty big odds. It turns out new medical knowledge is already doubling every three years and is projected to double every 73 days by 2020. That’s a lot of information! EHR and genomic data are amplifying the growth of data sets, publications and possibilities. Just 10 years after the completion of the Human Genome Project, 2014 brought the $1,000 genome. That cost decreased five orders of magnitude in 10 years. That’s not linear, it’s logarithmic. In the next year we’ll produce more genomic data than ever before in human history. (No pressure.) And, that’s just one kind of medical information—so many more are exploding, too.
  44. 44. 6. WEDGING LEARNING IN REAL QUICK: ABOUT THIS RX Let’s start with the biggest number: 10 minutes. When Verilogue reviewed 70,000 exam room conversations, it found that’s how long the average physician spends with a patient. That 10 minutes is largely dominated by the physician. In fact, 64% of the conversation is physician-led; 33% is patient-led—with the small balance owned by a caregiver or partner. How much of it is dedicated to the new prescription? 99 seconds—or 13.7% of the conversation. Previous studies have pegged that Rx discussion time as even shorter. Think how many months and years we spend perfecting the messages, the Q&A, the story, all to have it boiled down into a 99-second Rush to the Rx. Beyond the minor marketing injustice, there are real reasons to wonder about the efficacy of those conversations. Our collaborator George Van Antwerp recently reminded us of the biggest one: the leaky bucket of good intentions. The entire slippery slope of adherence starts with that conversation between doctor and patient. Steve Wilkins, MPH, one of the authors of the Verilogue study, says nonadherence is “often a rational response on the patient’s part when faced with a recommendation to do something they don’t agree with—namely take a medication.” He says 50% of patients disagree at one time or another with a doctor regarding the diagnosis, severity of a condition or particular treatment. —2013 Physician-Patient Communications Benchmark from Verilogue and Steve Wilkins, MPH, of Mind the Gap and Smart Health Messaging —”Pharmacies: Improving Health, Reducing Costs,” National Association of Chain Drugstores, 2010 (based on IMS data)
  45. 45. 6. WEDGING LEARNING IN For every 100 prescriptions written 50-70 go to a pharmacy 48-66 come out of the pharmacy 25-30 are taken properly 15-20 are refilled as prescribed
  46. 46. 6. WEDGING LEARNING IN Average time spent in discussion about medications during an exam 14.9 12.6 12.4 11.1 10.6 6.5 5.5 5.2 4.6 3.5 3.5 3.2 2.9 2.5 Time Spent (in seconds)
  47. 47. 7. IN SHORT WebMD was training wheels. This new era of at-home diagnosis and health management will make experts of us all.
  48. 48. 7. DIY DIAGNOSIS 69% 69% of physicians said patients should use tech tools to help them form a diagnosis. 84% 84% of patients said they should be able to use the self-diagnosis tools. —WebMD/Medscape, 2014
  49. 49. 7. DIY DIAGNOSIS BRINGING THE LAB HOME Today you can order an at-home self-screening kit to test for everything from bowel disease to meningitis to cholesterol. New entrants go even further, letting users look at their own biology on a molecular level and basically tinker with activity, nutrition, sleep and more until they get the consistent results they want. It’s more health hacking then quantified tracking. One of our favorites is Cue. It’s a small, modular hardware system that works with iOS to let users create a simple home diagnostics lab. When it launches in early 2015, users will be able to collect tiny samples of their own saliva, blood or nasal fluid to test for five distinct molecular indicators related to inflammation, vitamin D, fertility, influenza and testosterone. Each metric has a different marker that, when measured and tracked, can be used to discover trends, monitor progress and help users gain realtime insight into their bodies. Those numbers correlate with some of the most basic questions people have about health: Why don’t I have more energy? Is it a cold or really the flu? What’s the best way to recover from an injury or live your best life with chronic disease?
  50. 50. 7. DIY DIAGNOSIS Like other trackers, Cue pulls the data into great dashboards that let users compete against themselves or collaborate with friends and strangers.
  51. 51. 7. DIY DIAGNOSIS SHIFT IN RESPONSIBILITY For people who believe that healthcare is expensive and difficult to use, DIY tools are a way to take control back. They replace “What could it be?” conversations in healthcare social media with the wisdom of science. Now a sensor on your mattress can diagnose a sleep issue. A blood pressure cuff connected to your iPhone cannot only spot a problem, it can identify its triggers. We predict this new at-home medicine will be particularly interesting to adult Millennials. Our recent “The Worried Well” report, published with Allidura and Harris Poll, pointed to a strong desire among that generation to take healthcare into their own hands: “It turns out that our hulking healthcare system–with its confusing cost structures and white-coated experts– isn’t what Millennials are pursuing, even as they express worry about their health. For them the question seems to be, not, who can help me but what can help me. They’re mashing up food trends with high-profile cleanses and intriguing new exercise offers to proactively live healthier lives—and keep the doctor away. In fact, 71% believe they’re already doing everything they can to maintain a healthy lifestyle. These efforts show some indication that they may be attempting to avoid traditional healthcare altogether.” Millennial Mindset: “The Worried Well”
  52. 52. 7. DIY DIAGNOSIS THE NEW PRIVACY QUESTION People think the great debate of this decade is about privacy—what we want other people and companies to know about us. We disagree. We think it’s about transparency—how much we’re actually comfortable knowing about ourselves. This new generation of products from both startups and category leaders are going to push all of us to answer this simple question: Do you really want to know? The question becomes even more difficult when it’s connected to “real” healthcare. Both healthcare and technology experts are pointing to Apple’s HealthKit as the catalyst that finally brings patient-generated data into the healthcare ecosystem—if patients are really ready to share it there. Apple’s HealthKit Platform
  53. 53. 8. IN SHORT We’re just a few years away from digital therapies taking on traditional medicines on their own turf: clinical trials, formularies, and prescription pads.
  54. 54. 8. THE NEW COMPETITION 2012 2014 —WebMD/Medscape, 2014 Adoption rate of wearables parallels that of tablets. 20% of Americans in 2012 owned a tablet after just two years on the market. 40% of Americans own them today. 21% of American adults already own a wearable device. ? 2014 2016
  55. 55. 8. THE NEW COMPETITION BOUNCING BACK FROM THE BACKLASH In 2013, we were all calling wearables the next big thing in healthcare. Then in 2014, Nike fired the majority of its FuelBand team. The New York Times called wearables “digital snake oil.” A lot of us chucked out Fitbits. But, investors haven’t backed off. They think the first generation just wasn’t good enough. The new wearables will be more clinically valid, smarter, more convenient, and more relevant to our lives. Nike’s Fuel Band
  56. 56. 8. THE NEW COMPETITION THAT’S JUST THE BEGINNING Real digital therapies are just beginning to take shape. In three years, the investment in digital therapies has experienced 20x growth. These are behavioral software tools that are backed by published clinical data. Real-world outcomes. This isn’t pill+ to improve the bottom line, it is the bottom line. Within a few years, these solutions will be listed on formulary next to pills. 20X Investment in digital therapies has experienced 20x growth in three years.
  57. 57. 8. THE NEW COMPETITION Digital therapies include any software or hardware designed to deliver behavioral medicine at scale to tackle chronic disease and reduce healthcare costs. A few investor favorites right now include: Mango Health’s mobile app that improves adherence by over 50% in chronic therapeutic categories like cardiovascular disease, hypertension, and diabetes. Omada’s Prevent program that gives prediabetics a 16- week online course with 1:1 coaching and support built in to reduce the risk of developing type 2 diabetes. Kurbo’s online and mobile weight management program that is safe for kids and teens between the ages of 8 and 18 and their families. 85% of beta participants saw a significant decrease in their BMI in 10 weeks. —Rock Health, 2014
  58. 58. 8. THE NEW COMPETITION A SPOON MIGHT POINT THE WAY This year, Google bought a spoon. One from Lift Labs, a company that is developing smart utensils for people with Parkinson’s and essential tremor. It competes head-on with medicines that treat the symptoms of those diseases, but does it with absolutely no side effects. Instead, it uses active cancellation (which is currently in noise-cancelling headphones) to stabilize larger-scale motion. They’re also looking at solutions for drinking and grooming. We might not hear more for a while, though. After the acquisition, the team went into Google’s notoriously secretive labs. Governments and payers are looking carefully at the potential of these new solutions. Long a first mover on digital health, the US Department of Veterans Affairs changed its contracting template in such a way that enables it to soon begin reimbursing its doctors for clinical grade activity trackers in some limited circumstances. They’re focused on a number of highly specific metrics such as stance and swing time, gait symmetry, dynamic function, cadence and cadence variability, step count, numbers of steps per time interval, peak performance, and functional level assessment. Google bought Lift Labs, a company developing smart utensil
  59. 59. 20 15 HEALTH TRENDS To discuss this report live, request another module, or schedule a presentation of trends, please contact Leigh Householder at 614-543-6496 or