Healthcare Unbound: How Close Are We to a Tipping Point? Opening Keynote Presentation July 2007  San Francisco, CA Vince K...
What’s the right metaphor for HU?
Overview <ul><li>Network Effects and HU Markets </li></ul><ul><li>How Close Are We To A Tipping Point? </li></ul><ul><ul><...
I. Network Effects and HU Markets
Network Effects (Tipping Point) Source: Shapiro, C. Varian, H.  Network Effects  1998
$34 B Market for Healthcare Unbound Technologies Total Acute Chronic ADL/elder $0.35 $US (billions) $0.37 $0.47 $0.59 $0.7...
Key Questions <ul><li>How close are we to a tipping point in various segments of the HU market? </li></ul><ul><li>What’s t...
II. How Close Are We To A Tipping Point? <ul><li>No Sightings  </li></ul><ul><li>Remote Patient Monitoring (RPM) </li></ul...
II A.  No Sightings <ul><li>EHRs </li></ul><ul><li>Telemedicine </li></ul><ul><li>Niche apps (few network effect markets) ...
II B. Remote Patient Monitoring (RPM) Bottom line: 2008 could be a breakthrough year for RPM
2008 could be a breakthrough year for RPM <ul><li>Continua begins to address major challenges </li></ul><ul><ul><li>Intero...
II C. Medicare Disease Management <ul><li>Bottom line:  </li></ul><ul><ul><li>One year ago a tipping point (Medicare Healt...
Medicare DM: Virtually No Evidence of Success <ul><li>Medicare Health Support appeared to be the favorite son demo to expa...
The Cats are Herding: Medical Home Model Gaining Momentum
The Medical Home Incorporates HU Tech & Apps <ul><li>Proposed payment framework for the Medical Home model includes $$ for...
Medicare Medical Home Demonstration (MMHD) <ul><li>December 2006 – Congresses passes MMHD </li></ul><ul><li>MMHD  similari...
II D. Personal Health Records (PHRs)  <ul><li>Bottom line:  </li></ul><ul><ul><li>Despite significant activity, the curren...
PHR Background <ul><li>2 models of PHRs </li></ul><ul><ul><li>Stand alone </li></ul></ul><ul><ul><li>Tethered: typically t...
Source:  Markle Foundaton   A Common Framework for Networked Personal Health Information ,   2006.  See also: RWJF Project...
Google Health– A Next Generation PHR (detective work and tea leaf reading) <ul><li>The Current Market Structure for Person...
<ul><li>GH’s Anticipated Technology Model  </li></ul><ul><ul><li>Patient centric  </li></ul></ul><ul><ul><li>A personal he...
 
<ul><li>Three Potential Leverage Points </li></ul><ul><ul><li>A GH platform could simultaneously create AND dominate  next...
II E. The Biggest (Eventual) Tipping Points of All <ul><li>Mobile Telehealth </li></ul><ul><ul><li>60+ companies  </li></u...
Hospital at Home Dates Back to the 1960s
 
Current HU Tech & Apps Are A Collective Platform to Support HAH <ul><li>EHRs </li></ul><ul><li>Telemedicine </li></ul><ul>...
<ul><li>What would happen at your company if someone said: </li></ul><ul><li>“ We adjusted last year’s market numbers and ...
Elaborate Proof of a Hypothesis..... <ul><li>The Willie Sutton Theory of Hospital-At-Home </li></ul><ul><li>Projected  201...
III. Lessons Across HU Segments
<ul><li>We are interdependent </li></ul><ul><ul><li>Importance of HIT </li></ul></ul><ul><ul><ul><li>Interoperability </li...
What’s the right metaphor for HU?
END
Better Health Technologies, LLC <ul><li>Technology and health care delivery are shifting:   </li></ul><ul><ul><li>From: Ac...
BHT Clients <ul><li>Pre-IPO Companies </li></ul><ul><li>HealthPost </li></ul><ul><li>Cardiobeat  </li></ul><ul><li>EZWeb <...
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  • HealthcareUnbound

    1. 1. Healthcare Unbound: How Close Are We to a Tipping Point? Opening Keynote Presentation July 2007 San Francisco, CA Vince Kuraitis JD, MBA Better Health Technologies, LLC http://e-CareManagement.com blog (208) 395-1197
    2. 2. What’s the right metaphor for HU?
    3. 3. Overview <ul><li>Network Effects and HU Markets </li></ul><ul><li>How Close Are We To A Tipping Point? </li></ul><ul><ul><li>No Sightings </li></ul></ul><ul><ul><li>Remote Patient Monitoring (RPM) </li></ul></ul><ul><ul><li>Medicare Disease Management </li></ul></ul><ul><ul><li>Personal Health Records (PHRs) </li></ul></ul><ul><ul><li>The Biggest (Eventual) Tipping Points of All </li></ul></ul><ul><ul><ul><li>Mobile telehealth </li></ul></ul></ul><ul><ul><ul><li>Health 2.0 </li></ul></ul></ul><ul><ul><ul><li>Hospital at Home </li></ul></ul></ul><ul><li>Lessons Across HU Market Segments </li></ul>
    4. 4. I. Network Effects and HU Markets
    5. 5. Network Effects (Tipping Point) Source: Shapiro, C. Varian, H. Network Effects 1998
    6. 6. $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)
    7. 7. Key Questions <ul><li>How close are we to a tipping point in various segments of the HU market? </li></ul><ul><li>What’s the closest thing to a “sighting” of a tipping occurring? </li></ul><ul><li>Why is this important? Will HU </li></ul><ul><ul><li>Remain an interesting, sexy topic for the 6 o’clock news to run a feature, or </li></ul></ul><ul><ul><li>Become mainstream to health and medical care? </li></ul></ul>
    8. 8. II. How Close Are We To A Tipping Point? <ul><li>No Sightings </li></ul><ul><li>Remote Patient Monitoring (RPM) </li></ul><ul><li>Medicare Disease Management </li></ul><ul><li>Personal Health Records (PHRs) </li></ul><ul><li>The Biggest (Eventual) Tipping Points of All </li></ul><ul><ul><li>Mobile telehealth </li></ul></ul><ul><ul><li>Health 2.0 </li></ul></ul><ul><ul><li>Hospital at Home </li></ul></ul>
    9. 9. II A. No Sightings <ul><li>EHRs </li></ul><ul><li>Telemedicine </li></ul><ul><li>Niche apps (few network effect markets) </li></ul>
    10. 10. II B. Remote Patient Monitoring (RPM) Bottom line: 2008 could be a breakthrough year for RPM
    11. 11. 2008 could be a breakthrough year for RPM <ul><li>Continua begins to address major challenges </li></ul><ul><ul><li>Interoperability of devices </li></ul></ul><ul><ul><li>Pricing (indirectly) </li></ul></ul><ul><li>But other challenges remain </li></ul><ul><ul><li>IT/integration </li></ul></ul><ul><ul><li>Reimbursement/business model </li></ul></ul><ul><ul><li>Licensure/regulatory issues </li></ul></ul>
    12. 12. II C. Medicare Disease Management <ul><li>Bottom line: </li></ul><ul><ul><li>One year ago a tipping point (Medicare Health Support) was on the horizon </li></ul></ul><ul><ul><li>Today, it’s back to square one </li></ul></ul><ul><ul><li>Market shift toward integration of care providers </li></ul></ul>
    13. 13. Medicare DM: Virtually No Evidence of Success <ul><li>Medicare Health Support appeared to be the favorite son demo to expand DM into Medicare </li></ul><ul><ul><li>MHS has attracted worldwide attention </li></ul></ul><ul><ul><li>Legislation requires roll out if successful </li></ul></ul><ul><li>Elements of MHS model </li></ul><ul><ul><li>Focus on highest cost/risk population (frail elderly) </li></ul></ul><ul><ul><li>Disease management -- carve out to private companies & health plans ( vs. CCM) </li></ul></ul><ul><ul><li>Guaranteed 5% savings business model </li></ul></ul><ul><ul><li>Short term ROI </li></ul></ul><ul><ul><li>Randomized control trial </li></ul></ul><ul><li>Results to-date: virtually no evidence of success. See http://e-caremanagement.com/first-official-report-on-medicare-health-support-dm-pilot-finds-virtually-no-evidence-of-success/ </li></ul>
    14. 14. The Cats are Herding: Medical Home Model Gaining Momentum
    15. 15. The Medical Home Incorporates HU Tech & Apps <ul><li>Proposed payment framework for the Medical Home model includes $$ for: </li></ul><ul><ul><li>coordination of care </li></ul></ul><ul><ul><li>health information technology </li></ul></ul><ul><ul><li>secure e-mail and telephone consultation; </li></ul></ul><ul><ul><li>remote monitoring of clinical data using technology. </li></ul></ul><ul><li>Medicare Medical Home Demonstration </li></ul>
    16. 16. Medicare Medical Home Demonstration (MMHD) <ul><li>December 2006 – Congresses passes MMHD </li></ul><ul><li>MMHD similarity to MHS: high cost, chronic patients; multiple comorbidities </li></ul><ul><li>MMHD differences from MHS </li></ul><ul><ul><li>No requirement of 5% guaranteed savings </li></ul></ul><ul><ul><li>Physicians can keep 80% of savings </li></ul></ul>
    17. 17. II D. Personal Health Records (PHRs) <ul><li>Bottom line: </li></ul><ul><ul><li>Despite significant activity, the current PHR market is fragmented with no tipping point in sight </li></ul></ul><ul><ul><li>BUT.....Google Health is a wildcard! </li></ul></ul>
    18. 18. PHR Background <ul><li>2 models of PHRs </li></ul><ul><ul><li>Stand alone </li></ul></ul><ul><ul><li>Tethered: typically to a health plan, provider, employer </li></ul></ul><ul><li>Each has challenges </li></ul><ul><li>The “populating the PHR with data” problem </li></ul><ul><li>200 PHRs on the market </li></ul><ul><li>Generations of PHRs </li></ul><ul><ul><li>1st generation: PHR as “APPLICATION” -- an online repository of personal health information (PHI) </li></ul></ul><ul><ul><li>Next generation – PHR as PLATFORM </li></ul></ul>
    19. 19. 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
    20. 20. Google Health– A Next Generation PHR (detective work and tea leaf reading) <ul><li>The Current Market Structure for Personal Health Information (PHI). Your PHI is </li></ul><ul><ul><li>Scattered everywhere </li></ul></ul><ul><ul><li>Not in standardized formats suitable for a global information economy </li></ul></ul><ul><li>Elaboration: http://e-caremanagement.com/connecting-the-dotsgoogle-health-promises-to-create-and-dominate-next-generation-phrs/ </li></ul>
    21. 21. <ul><li>GH’s Anticipated Technology Model </li></ul><ul><ul><li>Patient centric </li></ul></ul><ul><ul><li>A personal health URL </li></ul></ul><ul><ul><li>Automated data mechanisms to gather and store PHI </li></ul></ul><ul><ul><li>Interoperable technical standards: XML and the Continuity of Care Record (CCR) standard </li></ul></ul><ul><ul><li>A user interface </li></ul></ul><ul><ul><li>Appropriate security and confidentiality measures </li></ul></ul><ul><ul><li>Value added functionality (over time) </li></ul></ul>
    22. 23. <ul><li>Three Potential Leverage Points </li></ul><ul><ul><li>A GH platform could simultaneously create AND dominate next generation PHRs. </li></ul></ul><ul><ul><li>Google Health promises to overcome the “populating the PHR” challenge </li></ul></ul><ul><ul><ul><li>Automated data feeds </li></ul></ul></ul><ul><ul><ul><li>The Continuity of Care Record standard as the MP3 of PHI </li></ul></ul></ul><ul><ul><li>Potential for rapid, dramatic network effects </li></ul></ul>
    23. 24. II E. The Biggest (Eventual) Tipping Points of All <ul><li>Mobile Telehealth </li></ul><ul><ul><li>60+ companies </li></ul></ul><ul><ul><li>Possible tipping point sighting: LifeComm (2008) </li></ul></ul><ul><li>Health 2.0 </li></ul><ul><li>Hospital at Home </li></ul>
    24. 25. Hospital at Home Dates Back to the 1960s
    25. 27. Current HU Tech & Apps Are A Collective Platform to Support HAH <ul><li>EHRs </li></ul><ul><li>Telemedicine </li></ul><ul><li>Niche apps </li></ul><ul><li>Remote Patient Monitoring </li></ul><ul><li>Disease Management </li></ul><ul><li>Personal Health Records </li></ul><ul><li>Mobile telehealth </li></ul><ul><li>Health 2.0 </li></ul><ul><li>Etc </li></ul>Hospital At Home
    26. 28. <ul><li>What would happen at your company if someone said: </li></ul><ul><li>“ We adjusted last year’s market numbers and concluded we were off by $140 Billion.” </li></ul>
    27. 29. Elaborate Proof of a Hypothesis..... <ul><li>The Willie Sutton Theory of Hospital-At-Home </li></ul><ul><li>Projected 2014 U.S. Annual Hospital Costs = $1 Trillion </li></ul><ul><li>Projected HU 2015 market of $34 B = 3.4% </li></ul>1.14 3.0%
    28. 30. III. Lessons Across HU Segments
    29. 31. <ul><li>We are interdependent </li></ul><ul><ul><li>Importance of HIT </li></ul></ul><ul><ul><ul><li>Interoperability </li></ul></ul></ul><ul><ul><ul><li>Transportability of PHI </li></ul></ul></ul><ul><ul><li>Integration of care providers </li></ul></ul><ul><li>Are PHRs are the best candidate for a common technology platform? </li></ul><ul><li>The issue isn’t whether HU succeeds, it’s when </li></ul><ul><li>Actions </li></ul><ul><ul><li>Support the Continuity of Care Record standard </li></ul></ul><ul><ul><li>Join Continua </li></ul></ul>
    30. 32. What’s the right metaphor for HU?
    31. 33. END
    32. 34. Better Health Technologies, LLC <ul><li>Technology and health care delivery are shifting:  </li></ul><ul><ul><li>From: Acute and episodic care delivered in hospitals and doctors’ offices </li></ul></ul><ul><ul><li>To: Chronic disease and condition management delivered in homes, workplaces, and communities </li></ul></ul><ul><li>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? </li></ul>
    33. 35. BHT Clients <ul><li>Pre-IPO Companies </li></ul><ul><li>HealthPost </li></ul><ul><li>Cardiobeat </li></ul><ul><li>EZWeb </li></ul><ul><li>Sensitron </li></ul><ul><li>Life Navigator </li></ul><ul><li>Medical Peace </li></ul><ul><li>Stress Less </li></ul><ul><li>DiabetesManager.com </li></ul><ul><li>CogniMed </li></ul><ul><li>Caresoft </li></ul><ul><li>Benchmark Oncology </li></ul><ul><li>SOS Wireless </li></ul><ul><li>Click4Care </li></ul><ul><li>eCare Technologies </li></ul><ul><li>The Healan Group </li></ul><ul><li>Fitsense </li></ul><ul><li>Elite Care Technologies </li></ul><ul><li>Established organizations </li></ul><ul><li>Intel Digital Health Group </li></ul><ul><li>Samsung Electronics, South Korea </li></ul><ul><li>-- Global Research Group </li></ul><ul><li>-- Samsung Advanced Institute of Technology </li></ul><ul><li>-- Digital Solution Center </li></ul><ul><li>Medtronic </li></ul><ul><li>-- Neurological Disease Management </li></ul><ul><li>-- Cardiac Rhythm Patient Management </li></ul><ul><li>Amedisys </li></ul><ul><li>Siemens Medical Solutions </li></ul><ul><li>Philips Electronics </li></ul><ul><li>Joslin Diabetes Center </li></ul><ul><li>GSK </li></ul><ul><li>Disease Management Association of America </li></ul><ul><li>PCS Health Systems </li></ul><ul><li>Varian Medical Systems </li></ul><ul><li>VRI </li></ul><ul><li>Washoe Health System </li></ul><ul><li>S2 Systems </li></ul><ul><li>CorpHealth </li></ul><ul><li>Physician IPA </li></ul><ul><li>Centocor </li></ul>

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