mHealth: JailBreaking Healthcare

Thanks to some more travel delays I finally got round to watching this video of a talk at a mHealth event held at Stanford in September and I’d thoroughly recommend it:

My notes/thoughts:

Chris Wadsen, PWC

(4.50) “Mobile Health is going to become ubiquitous in healthcare just like the internet is ubiquitous in every part of business… …you won’t be able to have any healthcare, whether personally provided yourself or provided by your clinician that will not have a mobile health component to it

Oh how I wish more big firms where taking this guys advice! Some of the market reports I read from other firms (eg. Forrester) are so out of touch with this reality it’s unreal.

(5:30) “Part of what I’ve identified as the challenge is that when we talk about mobile health there is this immediate jump to thinking that we have to have it integrated with the physician and the reality is the standard that a physician has for adoption of any technology is very very high. They want to see double blind studies, they want to see 5 years of clinical data, they want to have insurance reimbursement or they won’t touch it with a barge pole, and so when you have these very high standards the adoption of a new technology is going to be fairly slow… …we need to focus on whether it is a consumer that has lower standards and faster to market or a clinical opportunity or an infrastructure opportunity

Not so sure that mHealth has to neccessarily go without Doctors if it wants to be adopted… surely (as we’re demonstrating here at 3G Doctor) you can get Doctors onside if you just show that it’s unequivocally better than what they are already doing eg. uninformed telephone advice calls where there are no detailed written records being kept or shared with patients. Why can’t mHealth companies leverage those “very very high” standards that patients know Doctors have to add value?

(12:00) I think the underlying problem in Chris’ argument is that he’s confused applications with services. For example he’s focusing on “Dumb apps” when he should be looking for “smart services”. Thankfully Anand Iyer (at 42:00) made up for this by explaining how companies can close the loop and add value by taking patients through a care journey.

At 1:12:00, Chris does a great job of explaining to Wilson To, Founder of MobiLife, the innovators dilemna and how it applies to mHealth developers eg. “my model of innovation suggests that you have got to create some tension to create innovation. So the beginning of innovation is failure, failure that turns to pain, pain turns to innovation and innovation turns to growth and that’s the cycle of innovation. So unless you’re creating some tension in the system you’re probably aren’t creating an innovation that is going to be rapidly adopted“.

He goes on to explain an important question that I think every mHealth entrepreneur should be defining – in my own words: “who’s lunch are you trying to eat”

(19:20) “In our research we found the price point a consumer would pay for a mobile health solution out of their own pocket to be generally less than $10… …a mHealth device has to be less than $75

I make no secret of how these guesstimates annoy me eg. McKinsey peddled some similar nonsense at last years MWC. Whilst I understand markets need direction from professionals like Chris I cannot see any value in these numbers as historical mobile VAS price points would indicate these are very low eg. imagine in 1995 if I told you I was going to be selling polyphonic “crazy frog” ringtones for more than a retail store was selling boxed original artist albums.

Why has the device got to be >$75? Didn’t most mobile analysts think that the ARPU of mobiles was pretty much in freefall until before the iPhone shook things up? What if the “device” is just another feature of a new smartphone (e.g a sleep analysis tool that makes it able to provide a smart alarm waking us at the optimal time). How much more would customers be prepared to pay for this if it was integrated into their plan? Remember in the world of US mobile it’s all about subs and $5 per month is worth $120 over a 24 month contract.

And that’s before we even consider the wide range of variables eg. what if this feature slowed hardware replacement cycles because the smart alarm got more accurate over time? Less hardware susbsidies would dramatically increase MNO profits.

Anand Iyer, CEO, WellDoc

(15:00) Anand Iyer introduced himself as a type II diabetic patient and made the key point by highlighting how positive outcomes underline everything before summarising the clinical benefits of using a service that runs on even the most basic low cost mobile phones. He went on to make some great points:

> (50:00) How (with the help of a WellDoc/AstraZeneca case study) Pharmaceutical firms are “taking a leaf out of Cisco’s book” and leveraging mHealth as the means to sell a solution rather than a drug.

> (58:00) Explained how the FDA didn’t have an idea how to classify their product… …but they now have someone in charge of “User Experience“. He went on (1:00:00) to explain how he’s now advising the FDA on how they can stop being “viewed as a barrier to innovation and start fostering innovation

> (1:02:00) Explained how the FDA view risk as (Probability of occurance) x (severity level)

> (1:06:00) Explains how WellDoc are doing the “dirty work” and enabling providers to mate clinical goals with financial bonuses.

> (1:17:00) Explains in a few mins the WellDoc story of how they dismissed “technology for technologies sake” and rejected bluetooth gadgets and instead developed a solution that created a 1 pager patients can give their Doctors that incorporates 3 months of clinical data that says “Hey Doc, Here’s where I was, Here’s where I am, Here’s what’s changed, This is what you ought to do against evidenced based medicine… …but you’re the expert do what you think is best

Michelle Synder, SVP Strategic Marketing of Epocrates

(1:05:00) Explained how Epocrates are generating some of their $90m annual revenues from health plans by helping drive prescriptions of generics and massive savings in drug bills. It always surprises me how few mHealth companies are talking about this massive opportunity. If I was at a large healthcare provider I’d be chucking mobile phone based clinical textbook content at my employees in an effort to drive these savings.

(1:14:00) Don’t miss “the Epocrates story” for some great lessons eg “Doctors aren’t technophobes they just don’t find most technology solves their pain points or fits with their workflow“… …”Doctors are moving around“.

It’s also interesting to hear about why the Apple iPhone proved to be the turning point for their business model: “in the past we had to get Doctors to buy a device… …today most Doctors have a device“. I think a similar hurdle is going to be faced by lots of US mHealth companies as they begin to appreciate that most patients don’t have iPhones.

About David Doherty
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