By In the last 18 months there has been a deafening noise around the use of mobile technology in addressing some of the challenges facing health care today in this country. Although there are many definitions of what the “killer app” for mHealth is dependent on the vendor you ask. One common impression that is pervasive is that mobile technology solutions will somehow play a key role in re-shaping health care in this country and continue worldwide.
Unfortunately, the overwhelming majority of mobile solutions for health care have a common thread in that the lion's share are aimed at disease and disease management of some type. From the recent FDA approval of a one specific vendor’s diabetes solution to the myriad of mobile devices to record biometric measurements of all types there are more mobile technology and remote monitoring applications for health care than all other healthcare applications combined with an estimated 2,000 today and growing (Naish, 2010). From “I Tweet Your Weight” to “Fertility Monitor”, “Sleep Aid”, “Acne App”, to finally “Baby’s Coming” if you have a situation with your health some innovative engineer has created an “App For That” (Naish, 2010).
Here in the United States with the appearance of grant money for the Regional Extension Centers, Beacon Projects, Health Information Exchanges and Meaningful Use projects has provided mobile application providers for health care yet another venue to create value propositions that further confuse the vision for these products and services. No matter how cool the mobile app for health care may seem the real challenge for mobile technology solution providers is finding a clear definition of what it is they provide, to whom they sell, what the business model is, and most importantly why will the consumer utilize their products and services.
A recent article that appeared in MobiHealthNews posed the question; “Is mHealth at the Peak of Inflated Expectations?” which by all estimations is a fair question (Dishman, 2010). As with many new innovations that sweep the consumer market, mobile technologies have created an environment where a large disruption has taken place in a relatively short period of time. There is great utility in this type of disruption for the health care market where communication and engagement is sorely lacking and when compared to the pure consumer markets is almost non-existent. The article suggests that perhaps “mHealth” has quickly become so confused in it’s definition that is may have has lost any comprehensible value proposition as well as the definition of any sustainable business model (Dishman, 2010). Perhaps the largest threats to the survival of this fledgling market are the facts that the tangible value proposition and sustainable business models have become so muddled the target market is beginning to be immune to the message. The initial intent of many of these mHealth products may have been to increase quality of life for those termed the “Sick and Savvy” by the Deloitte study last year as well as decrease the costs associated with managing chronic care. However these targets seemed to have been forgotten in a haze of meaningful use and EMR/EHR technologies that will solve all the health systems ills (Keckley & Eselius, 2008). What has become critical at this juncture is a more honest open dialogue around how mHealth and its utility become as watered down as many other past solutions in health care information technology.
The development around mobile technologies for health care is at an ever increasing rate and many “cool” applications are being demonstrated, however, the unfortunate backlash of this type of approach is that you end up with a lot of cool technology and no real consistent user base.
The truth is that there have been many FDA approved devices that were Bluetooth enabled devices developed to support mobility and convenience and to this day this author found not one in the US that has been adopted by consumers at any sustainable level. Many device manufacturers have produced really cool devices that can connect via Bluetooth or WiFi to measure weight, activity, blood oxygen levels and every other biometric measurement you can think of with little consumer adoption. This is not because the technology was not really cool and would save millions if not billions in health care costs. Take, for example, the readmission avoidance of CHF (Congestive Heart Failure) patients or improved management of diabetes: There is little argument these are huge areas of opportunity. It is not a question of opportunity, however, but rather a matter of a technology that has no broad market acceptance and vendors with little understanding about consumers.
The “Build It and They Will Come” because it's cool attitude is not the approach for these technologies. Such an approach will not magically create a business model for sustainability within this market segment. If there is to be success for mobile in healthcare, then a more pragmatic approach will have to be developed that involves close examination of what consumers will use today or what they are beginning to use today.
After understanding what consumers will use, the next step is to figure out who will pay for these solutions and why. Ask any vendor at any mHealth tradeshow who their customer is and invariably they will say health plans, employer groups, large disease management companies and (in some instances) the integrated delivery systems. This is not entirely the right answer. If you sit down and have a conversation with any of these target market organizations, what you will begin to discover is that they all have a keen interest in mobile health and remote monitoring solutions. In fact, many have already begun internal development of products and strategies along these lines. However, the one question many of today's mHealth vendors do not answer for these constituents is how to solve the consumer engagement and adoption issue. This is the real question that you never hear a straight answer to -- largely because the average mHealth vendor has no real grasp on who their customer is.
The business models quoted by many mHealth vendors are the same business models that health plan technology vendors have played to for over a decade: The old "per member per month" model. If you cannot drive engagement and adoption this business model will not work either, and the two go hand in hand. Although it sounds reasonable that someone with a chronic disease would use these technologies because it will help them to manage their disease to live healthier with less expense and less discomfort the fact of the matter is this is not true. The available market today that would adopt these technologies in their current form is very small. It certainly wouldn't represent hundreds of millions of dollars. It is vital to the survival of the mHealth market to re-examine the business models currently being supported and make adjustments accordingly to drive growth.
So what are the answers?
Certainly there is widespread agreement (and enough incremental success) that some mHealth ventures are likely to survive in this vertical. Who these companies are is less important than what is going to happen in the industry in order for the market segment to survive. First the technology must begin to converge to a platform approach and not a gadget/device approach. As a reader of technology trade journals, blogs and books you understand that eventually devices become a commodity and the margins on those devices becomes less and less. mHealth should evolve to support what this author has termed as “Lifestyle Health Management.”
Instead of having a Bluetooth glucometer, pedometer, weight scale and oximeter from different vendors the segment needs to focus on communication standards, which make these devices become ubiquitous. I as a consumer want to go to my neighborhood corner drugstore or large retailer and pick from a number of devices in one package with services included at one price that I can afford just as many consumers go and purchase a glucometer or blood pressure cuff. The mHealth vendors can then change their focus to building Lifestyle Management Packages that can be purchased through a health care professional, health plan, retail outlet or directly over the counter when no prescription is needed. These packages could contain just the device with connectivity to a small tracking software all the way up to a fully integrated platform where multiple biometric readings are being tracked via mHealth or remote monitoring solutions along with medication therapy management, health care encounters, care plans, and health record information. The consumer should drive the decision making process in conjunction with their care team which in turn gets us back to where we started, adoption and engagement.
Without some convergence and transparency in the mHealth market segment we will begin to build information silos just as we have in other segments of the health information system market place. Let us not repeat the same mistakes of the past by ignoring the individual consumer and building solutions that are proprietary and based on cool factor instead of the consumer engagement factor. The companies to be left standing when the dust settles on this market will be of two types, those who consolidate and converge and those who are the targets of consolidation. The larger Pharmaceutical industry has shown a real interest in increasing consumer engagement so they very well may be one possible candidate for a force behind convergence. These companies are looking for changing business models that can help them to evolve and create new sustainable business models around consumer engagement and currently have the considerable resources to make a difference. Many believe that the health plan market space may have the resources and interest to be another force behind convergence however this author is not convinced that this market’s contraction and protectionist approach around core business in these times of reform will afford them this opportunity with some exceptions obviously.
Next is who will be the targets of convergence in the mHealth market place? One answer might be those vendors who create solutions that are open and interoperable with transparency to existing back end systems, and focused on the consumer and the ease of acquisition and use. Consumers of health care solutions purchase for many reasons most of which are based on emotion. “Every Senior Citizen should have Life Alert!” or “I have fallen and I can’t Get Up”, the “Hoveround give you your life back” are all consumer marketing messages used for attracting consumers to purchase devices based on emotion. The emotions tied to helping a loved one or himself or herself avoid a physical injury or death in a crisis are pretty powerful but do not loose track of the real issue which is how easy the solutions are to use.
Consumers buy first and foremost because there is the recognition of a problem or need, then they research and evaluate followed by the decision to purchase and post purchase use or consumption (San Diego State University, 2010). First and foremost, mHealth vendors need adoption of their products in order to reference the adoption rates later to influence target organizations to acquire their products and services. Secondly in order to drive adoption the solutions must be targeted to appeal to the consumers, be easy to use and then be packaged for the larger purchasing organizations whether they be health plans, employer groups or disease management companies. Third focus these easy to use solutions on saving the consumer either money, time, or pain and adoption should follow.
What is the definition of Lifestyle Management? Consider the top ten applications for the iPhone as an example. All of these applications address one of the following categories social networking, gaming entertainment, location based services, and reading (Dolcourt, 2010). Now take this lesson in a health care or mHealth context. If a consumer can purchase mHealth or remote monitoring solutions easily that in turn connects them transparently to contextual information which, in turn allows them to communicate with a diverse health team in a manner consistent with broader consumer behavior (Texting) and helps them to live their lives a little easier, then as history has shown us consumers will use the product or service. This is supported by the success around the world and here in the US by simple communication programs through health texting applications that support individuals through coaching and information access models (United Nations, 2009).
In conclusion, mHealth is not an industry unto itself nor is it the be all and end all of the future of health information. It is, however, a real opportunity to drive change through the latest component of a communication and engagement channel that could change the face of how we manage our lifestyle with respect to health. mHealth is not just about Diabetes or Congestive Heart Failure but about exercise tracking, diet management, health community out reach and most important engagement. If the mHealth market participants can continue to innovate and “innovent” with the mistakes of the past in mind and the promise of the future of engagement at the lifestyle level versus the disease level then we will begin to see adoption models that rival many other health information technologies combined. This is not a market where one or two players will dominate but where partnerships are key. These partnerships should be geared toward accessibility based on consumer needs comprehending socio economic, ethnic and demographic considerations. As has been the message in this paper design with the end user in mind not necessarily the purchaser (Health Plan, Employer Group) or the cool features and functions trap. Build a business model based on different and alternative revenue models such as risk sharing and a mix of consumer and enterprise revenue models. Build the vision of the organization on attainable goals and do not attempt to be the answer to all health cares problems saving billions. And lastly collaborate with other mhealth organizations that are complimentary and competitive; you never know who might be your convergence partner.
No matter who the drivers for convergence become and no matter the players this convergence this will happen and mHealth will take it’s place as a channel for engagement and communication that will positively impact peoples lives irrespective of their health status. Much like the impending convergence of the Laptop Computer and the Mobile Phone. Whether you agree or not fact is this has already begun with the “iPad”. Consider adding services like “Skype” to an iPad and when combined with the growing availability of WiFi it is through this simple combination you have a disruptive tool to the wireless carriers created through device convergence that could be the platform for real change in health care and peoples healthcare behaviors. If mHealth vendors embrace this concept of convergence and develop around the consumer then there is a bright future for one of the most exciting developing markets in health care information technologies since the Personal Computer was introduced.
Works Cited
Dishman, E. (2010, September 2). Is mHealth at the Peak of Inflated Expectations?
Retrieved September 10, 2010, from mobihealthnews: http://mobihealthnews.com/8772/is-mhealth-at-the-peak-of-inflated-expect...
Dolcourt, J. (2010, July 28). Winners of CNET 100: Your top-10 iPhone apps. Retrieved
September 9, 2010, from cnet reviews: http://reviews.cnet.com/8301-19512_7-20011875-233.html
Keckley, P., & Eselius, L. (2008). Health Care: What’s Your Next Move? Deloitte
Development LLC. Deloitte LLP.
Naish, J. (2010, March 2). Why your phone is now the doctor in your pocket. Retrieved
September 9, 2010, from The Sunday Times: http://www.timesonline.co.uk/tol/life_and_style/health/features/article7...
San Diego State University. (2010). ROHAN Academic Computing. Retrieved
September 10, 2010, from Consumer Behavior: http://www-rohan.sdsu.edu/~renglish/370/notes/chapt05/index.htm
United Nations. (2009). Identifying the Building Blocks for Sustainable and Scalable
mHealth Programs. United nations. Washington DC: United Nations.
