Health Barometer

One

For mobile health to become “business as usual,” physicians and patients alike must be empowered to use mHealth technology. This revolution is in its early stage—and hinges on the smartphone.

Throughout the Summit it was clear that attendees, largely health care, business and industry leaders, see mHealth as a paradigm shift that hinges on smartphones, and an opportunity to take more and better control over their health – and reign in its costs.  

At his keynote address, Dr. Eric Topol, Vice Chairman of the West Wireless Health Institute, argued that a smartphone should be a required tool for every physician, as well as every person. And Health and Human Services Secretary Kathleen Sebelius opened the Summit by pointing out that for the first time, in 2011, more than half of the cell phones sold in the United States were smartphones, signaling a turning point and opportunity.

Every day new technological advances are moving medicine away from the likes of paper records, expensive procedures and even stethoscopes. In fact, during his keynote address, Dr. Eric Topol performed an echocardiogram on himself with a handheld device.

Two

The business of mHealth is complicated, and no unifying successful business model has been identified.

Defining success in mHealth can be tricky. While some innovations are successful in improving health, and others are enjoyable and addicting to use, not many are profitable. In fact, venture capitalist Lisa Suennen blogged that she couldn’t find anyone at the conference who could name an mHealth company that has more than $10 million in annual revenues.

The success of mHealth rests upon articulating a clear value proposition to a multitude of stakeholders: The health care system is so complicated that convincing just one party to effectively use mobile is not enough. Consumers rarely pay for their own care; providers are reliant on reimbursements; and big companies can be slow to join the bandwagon.

Tom Watlington, CEO of mHealth startup Sotera, put it this way: “Truly disruptive change is something that people resist, and many of the disruptive technologies in this space are undermining the businesses of the major players in the industry. No big technology company is going to go out and invent a disruptive technology which undermines their core business.” 

Three

The U.S. government’s role in mHealth is evolving, serving as a catalyst for innovation in some cases and as a barrier in others. Particularly, issues of regulation and FDA approval are still very problematic for many mHealth start-up companies.

Government as a Barrier to Innovation:

• FDA regulation is a problem for mobile health development because the approval process has not yet caught up to technology. While a long and healthy life can be facilitated by an mHealth innovation, creating regulatory standards to balance positive outcomes with potential dangers is still a ways off.
• Payors also pose a challenge, as they require randomized efficacy trials that are very difficult for small start-up companies to conduct.
• Doctors may not want to adopt new technologies that Medicare and Medicaid will not reimburse, especially if technology replaces procedures they currently are paid for conducting. This will likely change starting in late 2012, when provisions in the health reform law go into effect, which attempt to shift the current payment mechanism to reward outcomes instead of the number of procedures conducted. (Healthcare.gov fact sheet on the new rules here.)

Government as a Catalyst for Innovation:

• HHS Secretary Sebelius said the role of government in mHealth is to act as a catalyst. Sebelius cited the government incentives for electronic health record adoption as an example of effective government “encouragement.”
• The government has issued several innovation “challenges,” offering prize money for developers who create apps to help people manage their health. Surgeon General Regina Benjamin announced a new challenge at the event, asking developers create apps that are easy and enjoyable for Americans to use in their everyday lives.
• The government has also partnered with private companies to promote health through mobile technologies, the most successful of which is Text4Baby – a text-messaging program for expectant mothers facilitated by Johnson & Johnson (disclosure: Edelman client) and several mobile phone carriers. The new SmokeFreeTXT program is targeted at preventing teens from smoking.

Four

Undeveloped and emerging countries have a large role to play in mHealth. Mobile technologies have the potential to save millions of lives by allowing health care professionals to leapfrog over traditional development phases. In addition, these markets facilitate low-cost solutions that can be applied in the developed world.

Many mHealth innovations are well and widely used in underdeveloped and emerging countries because the infrastructure to support traditional health systems simply doesn’t exist. In some parts of Africa, more people have cell phones than have shoes. mHealth is a way to reach the populations of underdeveloped nations to disseminate health information or track diseases. Internationally, text messages remain the best way to communicate, as most cell phones are not smartphones.

This model has led to “reverse innovation” in which less expensive, easy-to-use innovations used abroad gain adoption in developing markets.

As physician and blogger Kent Bottles, M.D., points out, GE is a company hoping to benefit from reverse innovation. To date the company has developed a $1,000 handheld ECG for use in India and a $15,000 portable ultrasound for use in rural China. He writes, “These devices are much more affordable and rugged than their American counterparts, and they are now being sold in the United States.”

For additional coverage of the mHealth Summit:
mHealth Summit Insider
Chilmark: mHealth: Seemingly Stuck in Neutral
MedCity: 10 Startups from mHealth 2011
Health Populi: Value and values will drive the adoption of mobile health
MobiHealth News: How many mHealth startups make $10M a year?