MHEALTH
MARTIN MADAUS

The Four Topics

3
mHealth Promise
35/12/2015
1. Tool to Improve Healthcare Delivery –
transactional efficiency, access and processing of
information
2. Breakthrough Innovation: ability to positively
affect patient behavior resulting in major health
outcome improvements

4
mHealth - Not a New Idea
The medical tricorder
(ca. 1964)
Portable, easy to use
Instant health assessment
Cost effective
Validated for outer space

5
mHealth - Breakthrough Benefits
“Delivering of healthcare or healthcare related information through the
use of mobile devices – or short “connected health”
• Patient engagement/empowerment
• Healthcare cost reduction
• Better health outcomes

Breakthrough Innovation X-Rays

Breakthrough Innovation - Biotech Drugs

20+ Years to Achieve Broad Adoption
for Major Healthcare Innovations
• Major health Impact
• Changed standard of care
• Major investments made to realize potential
• Initial incumbent resistance

Relevant Issues in Healthcare
• Understanding disease demographics
• Entrenched models and changes
• Cost pressures and waste
• Selling into healthcare systems
• Changing incentives

$500b+ Opportunity in US
210
190130
105
75
55
Waste in US Healthcare - B $
Unnecessary
Services
Excess Adm. Cost
Inefficient delivery
of services
High Prices
Fraud
Missed Prevention

Selling Into Healthcare Land (US)
Highly Simplified Vendor Perspective
Final
Product
Analytical and
clinical
performance
Regulatory
Approval
510k, PMA
Payment
Coverage/amount
In patient/out
patient
Adoption and
publication from
Key Opinion
leader
Health
economics
impact analysis
Financing model/
Contracting
Customer training
and installation
After sale service
Product
Sale

Physicians Control Most Clinical Health Information
Clinical decision making is enabled by 5 major activities across different setting in the Health care system
Content Origination
Generation
Aggregation
Interpretation
Info Distribution
Activities Examples
Physician orders a test
MRI is generating test results
Results are collected and stored
Physician(s) analyze and interpret clinical
content relevant to the patient and decide on
advice, intervention, further analysis
Applications, hardware, people transport
clinical content to relevant stakeholders

mHealth Could Democratize the Control of
Clinical Health Information
Activities Examples mHealth Potential
Content Origination
Generation
Aggregation
Interpretation
Info Distribution
Physician orders a test
MRI is generating test results
Results are collected and stored
Physician(s) analyze, interpret
Content, decide on advice, intervention,
further analysis
Applications, hardware, distribution to
relevant stakeholders
Patient initiates testing
Patient generates data with
smart phone
Patients personal secure cloud
based medical record
Physician, nurse, algorithm,
Patient advises, decides
Secure website distributes actionable
information to Patient/family members
via mDevices

Patient Empowerment Vision
Drivers and Barriers
Drivers
• Engaged and motivated
patients
• Digital access and fluency
• Actionable information
• Easier, better experience than
current
• Incentives
Barriers
• Patients not interested,
capable, lack of
understanding
• Health care insurance
• Physician centric healthcare
system
• Other priorities

Rule No.1 in the healthcare business: follow the money
Incentive Behavior M-health Implications
Patient Stay healthy, get healthy,
reduce cost, easy access
inconsistent Free apps for information,
tracking and reminding
Provider
(Physician,
hospital)
Fee for service
Fixed payment/patient
Volume, specialize
Limit time/expense
per patient
Validated and integrated
mHealth product
productivity tools
Payor – Public Provide quality care within
cost constraints
Control expenses,
assure access and
quality
mHealth productivity and
wellness and compliance
tools (cost avoidance)
Payor – Private Deliver profit to shareholders Manage financial
risk, compete for
attractive segments
mHealth productivity and
wellness and compliance
tools (cost avoidance)
Healthcare
Supplier
Deliver profit to share holders Targets most
profitable segments
Promotional tool
Product extensions
Potential for standalone
mHealth products

• Participants barriers
• Products that work for the digital immigrant
• Organizational barriers
• IT – step child of health care investment
• IT adoption productivity paradox
• Incentives – follow the money
• Paternalistic mindset
• Policy, regulatory barriers, liability
• Who can be trusted?
• Liability – inaccurate diagnosis, data error, malpractice
suits
• IP questions
• Performance barriers- hype vs. reality
Barriers to Adoption - Overview

Barriers to Adoption
• Participants barriers
• Age and inertia to change unhealthy behavior/compliance
• mobile access – need advanced functionality (image, video,
sensors, high speed mobile) for full potential
• Smart phone based EKGs, ultrasound, PO2 measurement are
very high end applications today in very early stages of
development
• 16% of people over 50 have smart phones
• Patients sustained engagement and understanding
• Usability of devices and applications

Organizational Barriers
• IT – stepchild of health care investment
• IT adoption productivity paradox
• Incentives – follow the money
• Paternalistic mindset
• Trust

Innovations: Pharmacy Retail Clinics Failed
to Disrupt Primary Care in the US
VS.
Primary Care
Provider
Failed to disrupt:
• Resistance by incumbent physicians
• Legal limits in service and pay
• No/little payment coverage by public
insurance

Paternalistic Mindset
• Organizational barriers
• Physician resistance to
potential balance of power
shift from physician to patient
• Incentives: providers resistance
to disruptions to their income
stream
• Institutional resistance to
change – other pressing
priorities
Considerations
• Patient access right to medical record
a law
• Coordinated and changed incentives
for providers and patient incentives
• Mandate provider cost transparency
• Mandate cost sharing by patient

Barriers to adoption - Performance
Issues
• Novelty effect
• Early in the transformation phase
• Business model -why are people
dropping out?
• Confusion: consumer product or
healthcare tool
• Determine the right level of product
effectiveness evidence?
Hype vs. Reality
• +17,000 mHealth applications
• 500m expected users
• High drop rate
• Evidence of impact is limited,
so far

Mobile Health – a Scenario

My medical identify is in the Cloud, my doc is on the phone, a
robot is sending me messages - Who Do I Trust?
Trust based on expertise and confidentiality,
experience
Impacts patient compliance
Redefine trust with physician
Develop new completely trusted sources
Future

26
Driving Adoption
“Potential Success
Factors”

Considerations for mHealth business models
• Clarity of Purpose: it’s critical to define exactly what a mHealth based
product/service does to solve a major and actionable issue in
healthcare
• Align With Important Pain Points: a major healthcare outcome
improvement, reduction in patient hospitalizations, reduction of
waste and errors in the delivery of care, simplification/cost
reductions of major business processes, chronic disease focus
• A Sound Product: robust product/services, certified data safety
standards, and clear USP, validated for targeted use, endorsed by key
influencers
• Detailed Market Adoption Model: Strategy: B2C, B2B, customer
segmentation, addressing specific barriers, pricing, competitive
positioning

The New World of the mHealth Empowered
Patient
• Focus on healthcare needs of digital natives (i.e. acute care, pregnancy,
fertility, infectious diseases, genetic testing)
• Capitalize on convenience, choice, quality of experience and incentives
• Focus on patients that are willing to pay out of pocket partially
• Endorsement by medical establishment, regulators and security experts
• Partnering with employers and insurance providers

• My Quest 360
• Mobile app for diagnostic testing
• Appointment scheduling
• Test result reporting and interpretation
• Personal Health information depository
• Billing and payment
mHealth in Lab Diagnostics: World’s Largest
Private Labs - Quest Diagnostics

mHealth – Conclusions
The Promise:
• mHealth applications hold great promise to become key component how patients manage
their health: empowerment, engagement, better choices
• It could lower healthcare cost and lead to better outcomes
The Healthcare Eco-System:
• Complex system, very local, not a free market, is designed to treat disease not manage health
• 3 key decision makers: regulators decide what can be used, physicians decide on what to do
with the patient, insurance decides what to pay and how much, a long road ahead towards
patient empowerment.
• Working with key healthcare decision makers to drive new product adoption is the current
commercial paradigm

mHealth –Conclusions (cont’d)
Barriers
• Disruption is not appealing to those who are disrupted – and they are in charge of most
healthcare decision today…
• Physicians control most patients care
• mHealth products and services needs to be validated and developed to fit into the current
regulatory requirements and business models
• Data privacy issues have to solved
Drivers
• Highly targeted patient group with a clear medical need to manage
• Incentives for key adoption
• Physician, regulatory, security endorsement
• Employers with active health management programs

THANK YOU
Martin Madaus
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