PHRs, Where We've Been, Where We're Going

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Presentation by Chilmark Research at the annual AHRQ event, Sept. '09 where we present info on current trends in PHRs, the continuing issue of low adoption and argue for new discussion on Personal Health Platforms.

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  • What is it Anytime/anywhere/any device SPIME (space & time) Personal Actionable Engaged Who is Customer All consumers How many use it Tens of millions When 2010-20??
  • PHRs, Where We've Been, Where We're Going

    1. 1. PHRs: Where We’ve Been, Where We’re Going By: John Moore, Managing Partner [email_address]
    2. 2. Three Take-Aways <ul><li>Healthcare in Transition & the Move Online </li></ul><ul><ul><li>Implications </li></ul></ul><ul><li>PHRs Today </li></ul><ul><ul><li>Adoption/Drivers </li></ul></ul><ul><ul><li>Challenges </li></ul></ul><ul><ul><li>Successes </li></ul></ul><ul><li>PHRs Tomorrow </li></ul><ul><ul><li>Platforms </li></ul></ul><ul><ul><li>mHealth </li></ul></ul><ul><ul><li>Death of PHRs </li></ul></ul>
    3. 3. Macro Trends Reshaping Healthcare <ul><li>Growing Consumerism in Healthcare </li></ul><ul><ul><li>Employee Accountability & Cost Sharing </li></ul></ul><ul><ul><ul><li>Out of Pocket Expense Yr’00: $200B, Yr’07: $267B </li></ul></ul></ul><ul><ul><li>Disintermediation of Care </li></ul></ul><ul><ul><ul><li>Retail Clinics, eVisits, MedTourism, Virtual Labs </li></ul></ul></ul><ul><li>Information Liberation </li></ul><ul><ul><li>Traditional: PubMed, Mayo, WebMD </li></ul></ul><ul><ul><li>Crowd-sourced: Wiki(s), Blogs, Twitter, Communities </li></ul></ul><ul><li>Stimulus Bill & Healthcare Reform </li></ul><ul><ul><li>Unprecedented $$$ to Digitize Healthcare </li></ul></ul><ul><ul><li>Comparative Effectiveness </li></ul></ul>
    4. 4. While Consumers Increasingly Go Online for Health Info… Source: Pew Research 2006 74% of all adults are online Now One of the Top Activities on the Net
    5. 5. Few Manage Health Records on Net Source: Forrester Research Q2’08 Survey n= 5,242 Today, Meager 3.3% iManage PHI
    6. 6. Three Dominate PHR Models <ul><li>Direct to Consumer => Manage Records </li></ul><ul><ul><li>Consumer has Full Control </li></ul></ul><ul><ul><ul><li>Consumer self-populates, disconnect </li></ul></ul></ul><ul><ul><li>Small ISVs with Little Market Influence </li></ul></ul><ul><ul><ul><li>CapMed, Medikeeper, PassportMD </li></ul></ul></ul><ul><li>Payer/Employer Sponsored => Lower MLRs </li></ul><ul><ul><li>Consumer has Limited Control </li></ul></ul><ul><ul><ul><li>Trust issues, portability </li></ul></ul></ul><ul><ul><li>Focus on HRAs, Health & Wellness, Disease Mgmt </li></ul></ul><ul><ul><ul><li>Incentives common to drive adoption </li></ul></ul></ul><ul><li>Provider Sponsored => Customer Retention </li></ul><ul><ul><li>Consumer has Limited Control </li></ul></ul><ul><ul><ul><li>Little portability, modest tools, incomplete longitudinal record </li></ul></ul></ul><ul><ul><li>Present Labs, Meds, Discharge </li></ul></ul><ul><ul><ul><li>Facilitate transactional processes </li></ul></ul></ul>
    7. 7. PHR Adoption is Widely Dispersed Mix Provider Provider Payer Payer ISV Provider Provider Type Client defined, claims-based HRA & alerts Rarely portable WebMD 500K WebMD Countless RYO MyChart HealthAtoZ ActiveHealth RYO (VistA) MyChart PHR Platform Similar to KP Portability w/Google 100K Cleveland Clinic Highly variable, most simple templates Little portability 2.5M All Others Aging portal w/email Portability w/Google & HealthVault 40K BIDMC Claims-based, part of new OptumHealth Div. Portability w/HealthVault ~200K United Health Grp Focus on HRA, DM, aggressive build-out Portability w/HealthVault ~780K Aetna EMR portal, Not portable 650K Veteran’s Admin EMR portal w/email & transaction services Portability w/HealthVault 3.0M+ Kaiser-Permanente Features No. of Users Entity
    8. 8. PHRs: What Are They Good For? <ul><li>EMC </li></ul><ul><ul><li>Adoption: Over 50% of Employees </li></ul></ul><ul><ul><li>Benefit: Lower MLRs = Lower Healthcare Costs </li></ul></ul><ul><ul><ul><li>NET: $50M in 4 years </li></ul></ul></ul><ul><li>Kaiser-Permanente </li></ul><ul><ul><li>Adoption: Over 50% of Members with Internet Access </li></ul></ul><ul><ul><li>Benefit: Cost Savings via Fewer Office Visits </li></ul></ul><ul><li>Indiana University </li></ul><ul><ul><li>Adoption: Over 40% of Entering Class </li></ul></ul><ul><ul><li>Benefit: Lower Admin Costs, Student Engagement </li></ul></ul>All Depends on Who You Ask!
    9. 9. Top 3 Challenges to Adoption <ul><li>Data </li></ul><ul><ul><li>Getting it, Cleansing it, Sharing it </li></ul></ul><ul><li>Trust </li></ul><ul><ul><li>Privacy & Security </li></ul></ul><ul><ul><li>Providence </li></ul></ul><ul><li>Value </li></ul><ul><ul><li>Personal </li></ul></ul><ul><ul><li>Actionable </li></ul></ul><ul><ul><li>Relevant </li></ul></ul>Consumer Engagement Begins Here
    10. 10. “Health Clouds” on the Horizon Data Sources Secure Repository Applications Multiple tools/widgets, communications??? Very Good Tools Perceived value? High Adoption Farther down the road High Personalization Still under development Medium Portability Adoption of Open Systems and standards High Interoperability Strong consumer control of data High Control Virtually any pertinent data source High Data Source(s) Notes Potential Attributes
    11. 11. Health is Mobile! <ul><li>Explosive Growth in Use </li></ul><ul><ul><li>Over 1B AppStore Downloads </li></ul></ul><ul><ul><li>iPhone Rep. 0.7% of All Internet Traffic </li></ul></ul><ul><li>Over 30K Apps </li></ul><ul><ul><li>Nearly 1.5K are Health Focused </li></ul></ul><ul><li>Every Major Mobile OS Now has App Market </li></ul><ul><li>And Still Only mHealth1.0 </li></ul>
    12. 12. Evolution Accelerates PHR Adoption 2008 Gen 3: Data Aggregation (Health Clouds Form) Gen 4: Personal, Actionable & Mobile Gen 2: Online & Connected 2011 Gen 1: Isolated 2003 1992 Time User Value Proposition Adoption 2000 (Online) 20 1992 40 80 Users (Millions) Low High
    13. 13. Generation 4: “Convergence” Personal, Actionable, Connected Value: About Me, By Me, With Me, For Me
    14. 14. What to Watch <ul><li>Traction of Platform Plays </li></ul><ul><ul><li>Data Sources (agreements) </li></ul></ul><ul><ul><ul><li>E.g., Cleveland-Google, KP-MS </li></ul></ul></ul><ul><ul><ul><li>New HIPAA Extensions </li></ul></ul></ul><ul><ul><li>Consumer Adoption </li></ul></ul><ul><ul><ul><li>Sub-group types </li></ul></ul></ul><ul><ul><li>Developer Adoption </li></ul></ul><ul><ul><ul><li>Popular apps/services </li></ul></ul></ul><ul><li>Employer Successes </li></ul><ul><ul><li>Demonstrable ROI </li></ul></ul><ul><li>All Things mHealth </li></ul><ul><ul><li>Smartphones change equation </li></ul></ul><ul><ul><ul><li>Biometrics play key role </li></ul></ul></ul>
    15. 15. Looking Into the Future… <ul><li>Biometric Devices Become a Critical Data Source </li></ul><ul><li>HIEs will Serve Citizens as Well </li></ul><ul><li>Data Liquidity & Quality will Prove Challenging </li></ul><ul><li>Meaningful Use Requirement May Backfire </li></ul>Biggest Challenge: Sourcing Quality Data
    16. 16. Final Thoughts… <ul><li>Time to Ditch PHR Term </li></ul><ul><ul><li>Consumers NOT Interested in Digital File Cabinet </li></ul></ul><ul><li>Personal Health Platforms (PHP) are Future </li></ul><ul><ul><li>Personal, Actionable Data </li></ul></ul><ul><li>Education Critical </li></ul><ul><ul><li>What’s in it for me? </li></ul></ul><ul><li>Without Consumer Engagement, HIT Adoption may be DOA </li></ul><ul><ul><li>Stimulus Funding is Not Enough to Move Needle </li></ul></ul>
    17. 17. <ul><li>The First Wealth is Health </li></ul><ul><li>-Ralph Waldo Emerson </li></ul><ul><li>The Best Way to Predict the Future is to Create it </li></ul><ul><li> - Peter Drucker </li></ul>

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