The Mobile Experiment, Experience Trumps Youthful Enthusiasm? by Jim Bloedau

In two studies cited by our friends over at MobiHealthNews, Jonah Comstock shines up the ongoing dilemma of mobile technology finding the right fit with physicians.  Two of the studies he presents points out the importance of managing expectations for what tech can do for you and how it will fit your professional life. The 50% crash of youthful enthusiasm for iPads by medical residents at the University of Chicago laid up against the practical side of practicing medicine in the real world in the Deloitte study suggests a couple of things.  First that the adoption of mobile tech is tempered by the experience of running a medical practice, there’s a much more deliberate consensus reached about the value each innovation brings.  Also, the practice of medicine becomes very stylized when left to find it’s own way.  How tech is adopted depends on motivations and more importantly the practicalities of the value created by it. Finally, both studies below reminded me of the collegiality of medicine, to give it the ‘old college try” and to always ask, “Is this the best way to do things?”  Both of these studies could be perceived as disheartening, but under the surface they hold great promise. 

“Physician adoption of health information technology: Implications for medical practice leaders and business partners is a Deloitte survey of 613 physicians that found 43 percent of doctors use smartphones or tablets for clinical purposes, which the firm suggested included EHR access, e-prescribing, and physician-to-physician communication. Of the 57 percent of physicians that do not use their mobile devices for clinical purposes, 44 percent said that their work doesn’t provide mobile devices and they’re unwilling to use their own, 29 percent were concerned about patient privacy, and 26 percent said the apps and programs available weren’t suited to their needs. However, 22 percent of the non-users indicated a plan to use mobile health technology in the future.”

 “In another study, a JMIR study of 115 medical residents at the University of Chicago published this month compared the “hype” of iPads (the expected use prior to the roll out) with their actual use. Before the roll out, 34 percent of residents strongly agreed that the iPad would benefit patient care and 41 percent strongly agreed that it would increase ward efficiency. Four months later, 15 percent strongly agreed it had benefitted patient care and 24 percent felt it had increased efficiency. Still, overall satisfaction with the iPads was high, with 84 percent of residents believing the iPad was a good investment for the residency program.”

ACO, PCMH and All Healthcare Needs Simplification by Jim Bloedau

What can we expect when introducing digital technology to patients?  Rhonda Daniel, Sr. Manager of Market Research at CEA, summarizes their just released research on how consumers are using their smartphones and other digital devices.  Two things stand out:

• That people rapidly get rid of their single use devices if they can aggregate the same functionality on to their smartphones.
• That their initial usage tracks what their pre-purchase expectation were.

If you have already been part of the connected life style for a while and have developed comfort with the digital functionality you use daily being made mobile and on one device, then nothing new here. Now add an integrated glucometer, if you're diabetic, or blue tooth enabled scale, if you're obese or managing congestive heart failure, or a GPS tracking app to see how far you walk as you try to get healthier after a hip replacement or long hospitalization.  What we are doing is adding not only great functionality but elevated complexity to an already complex path to engaging in our health - is this any way to treat a customer? Accessing an analogue healthcare system, like a doctor's appointment, and then laying new and not so easy to use technology on top of it isn't simplifying healthcare for those who use it the most.  My call here is that we need to simplify the analogue side as we add complexity to the digital side. 

The early results from the Direct Primary Care (DPC) model where patient's pay a low monthly fee directly to a doctor and bypass the added complexity of payer involvement is suggesting this may be the right path to be explored.  Lower utilization and higher satisfaction with equal or better outcomes for both the doctor and patient is what's in the literature.  The Kaiser model also streamlines healthcare because it reduces the dual agenda independent payer/provider model to one agenda...and it works too.

HIMSS and the New Normal for Sales by Jim Bloedau

After doing nine miles on the mile long exhibit floor on the first day of the 2013 HIMSS conference that drew 38,000, I was haunted by a couple of blogs I wrote in my early days.  This was triggered primarily by what I saw and heard in the booths and from the people staffing them.  The whole idea of those blogs was to get us thinking about earning the right to have a conversation with prospective customers by establishing yourself as a resource to your customers. One way to start this was to help the buyer even before they have met you with simple, highly instructive and informative strategic content that can be delivered digitally and more importantly found through good search engine optimization practices. 

The next step and most important requirements are beautifully articulated by Tom Williams of Strategic Dynamics in his blog below.  These are sage words from the trenches and really capture how the best professionals in healthcare look for and practice the qualities that Tom talks about. You'll enjoy Tom's clarity of thought and professionalism which he is obviously passionate about...great work Tom.

Hospital Business Acumen the New Normal by Tom Williams of Strategic Dynamics

"The role of the medical sales representative is changing. Hospital consolidation means fewer accounts with more buying power. Hospitals no longer need sales representatives as the sole point of contact to provide product information, conduct in-services or quote prices. Product knowledge can be obtained instantaneously via the web without the need to sit through a PowerPoint presentation; in-services can be done by a company’s clinical specialists and product pricing can be obtained through GPOs, IDNs, RPCs and organizations like MD Buyline.

Today’s healthcare environment demands a new type of sales professional to meet the ever-changing industry challenges. Hospital professionals want “account managers” who are business literate and can navigate through the new normal. These individuals must have a working knowledge of the function and operation of a hospital, and thrive and grow in a world of uncertainty. Account managers must have keen insight and the ability to articulate how their product and/or service provide measurable results to support the clinical and financial proposition to the key buying influences.

We call it “Hospital Business Acumen” and it requires a special type of sales professional- one that has market, business and product knowledge, along with insight, logic and mental agility. These business skills are recognized by hospital professionals when a salesperson demonstrates four (4) key competencies:

• Financial Literacy- This encompasses how a hospital manages its revenues and costs to achieve a net margin. This requires the sales professional to have a general understanding of business principles with the ability to interpret the numbers on a hospital’s financial statement. Their also experts in understanding payor mix and the hospitals reimbursement strategy especially with the new payer scenarios.
• Market Insight – All hospitals function in a complex eco-system of providers, payors and patients - each with differing needs. The political climate, social values and culture, economic conditions, population demographics, technology development, physical environment, regulatory agencies and payors are all factors that shape a hospital’s strategy, structure and execution. All of these evolve and change constantly. Sales professional need to have more than a passing familiarity with each of these factors and how ACOs are rapidly changing the healthcare landscape.
• Operational Understanding – Traditionally sales professionals have been excellent at calling on physicians, individual departments (silos) and materials management. Today there are a variety of other stakeholders involved in the purchase decision such as value analysis teams and purchasing committees and each brings their own logic and emotion to the buying process. Different skills and proficiencies are required to connect with them and understand their business needs, buying process, pre-conceived solutions and desired results.
• Understanding of Metrics- Financial and operational metrics abound within hospitals. Key is understanding what is measured, why it’s measured, and how to affect each measurement both positively and negatively. The ability to impact metrics especially those that affect positive patient outcomes, reimbursement, net margin and risk mitigation gains the attention of the C-Suite.

The sales professional of today needs to stand out as a trusted advisor or risk being seen as a commodity that provides no value. Sales professionals with business acumen are able to elevate their discussions to business issues and they stay far away from features and benefits."

As business confidants they are informative when describing to value analysis committees how their product positively affects patient outcomes, collaborative when negotiating with Supply Chain Managers and comfortable in discussions of ROI, NPV, TCO and other financial metrics with the CFO. They are experts at ensuring that their value proposition is sound with each stakeholder in the buying process. When asked to present their solution they are comfortable with clinicians, committees, the C-Suite or the Governing Board. How competent is your sales organization in understanding the roles and function of a hospital?

HIMSS 2013 - Remote Monitoring Rising...Slowly by Jim Bloedau

Where on the remote monitoring adoption curve the vendors exhibiting at HIMSS 2013 were was the focus of my attention at this year’s conference. Keeping in mind that a large part of HIMSS’ audience are large IDNs and “chiefs” of the care continuum who are leading the automation and innovation efforts, history has shown that what vendors were showing is a reflection of what the market is asking for.  Here’s what I saw.

Remote Monitoring Devices: Remote monitoring was limited to the garden variety of BP, O2Sat, peak flow, weight and communication hubs.  Although some vendors have not migrated their monitoring devices to wireless (Cardiocom) the newer wireless devices stood out.  Among these, Numera appears to have the longest list of device partners and most modern wireless lineup of vendors of the group.  They have also positioned themselves with an ultra modern update of the ancient “help I can’t get up” personal emergency response (PERS) device that can delineate between real falls and just someone dropping it, geo-locate and make the call for help – a very nice product.  It will be interesting to track how the market matures around this and other remote monitorin technology that includes long term players Honeywell “Hommed”, Bosch “Health Buddy” and the market leader Philips “Healthcare at Home”.

Population Health Management:  Population health management was one of the top three buzz words on the exhibit floor.  This was limited more to the professional side and was mostly a renaming of disease management.

What fits into this category is the advent of intelligent home health hubs that can individualize suggested wellness steps based upon the answers of a couple of simple questions. These questions may lead to what to do suggestions and feedback loops showing progress trending, mood trending, calendaring or medication adherence. These hubs are rudimentary  and intended for the aging at home patient who is not technologically savey.  The daily questions they offer have branching logic that is used to determine what content to serve up based on a profile of you - similar to adds that Google search individualizes for you.  It is an exploratory way to keep the content fresh and engaging to prevent user fatigue and patient's slipping back into unhealthy habits. 

Another vein of population management is “patient engagement”- another prevalent buzz word - which uses behavioral design thinking to get us to be better at healthy habits. When speaking with Philips, the term “behavioral science” came up several times when talking about their DirectLife product.  One of the leaders in behaviorial design for healthcare application is the Persuasive Technology Lab at Stanford and being led by BJ Fogg and his "Behavior Design" model - interesting and attacks the biggest problem in healthcare - compliance.

Amoung the leading EHR vendors, there was a paucity of remote care technology.  The exception was Epic who demoed MyChart Bedside, a tablet concept for the home, where the patient can be monitored and manage activities of daily living (ADL) like “meals on wheels.”   

Implications: Clearly both of these examples indicate the beginnings of a trend from a one to many delivery of healthcare to a one to one "engagement."  We already see this 1-2-1 in our daily online lives as ads are served up to us based on some mysterious database somewhere being common.   This is also the beginning of a platform model for healthcare where the consumer/patient also creates value by becoming a source of data that allows individualization of message for better wellness and if physiologic monitoring is included, preemptive interventions that avoid acute care episodes.  What I saw at the conference is that everyone is very focused on ICD 10, Meaningful Us, ACO/PCMH and EHR implementations.  What I heard was that all see the possibility and value of BYOD, mHealth and remote care technology, but lacked of bandwidth to do much with it now.  

JP Morgan Not Like the Digital Health Summit at CES by Jim Bloedau

I spent an annual couple of days at the concurrent JP Morgan and OneMedPlace investment conferences this week in San Francisco. The JPM conference is exactly as it has always been – very crowded with successful public companies chumming the waters for stock support, funding or take over.  GE, MedAssets, AthenaHealth, Greenway, Express Scripts, Wellpoint were the more prominent high-tech healthcare companies and a whole channel dedicated to large provider organizations with many major health systems like InterMountain, Catholic Health and Kaiser presenting.

The OneMedPlace conference remains mostly an early stage startup show with lab, diagnostics, implantables, device and pharma companies pitching for funding. The discussion panels here were the most interesting to the emerging remote care technology markets – I’ve listed panel highlights below. The one disappointment was that although there was frequent reference to the goals of remote care, the agenda was a bit thin on companies representing this emerging market.

The one overarching theme across both of these conferences was the response to a healthcare market that is seeing and will continue to see increasing margin squeeze as it shifts from fee-for-service to value-based payment schemes.  No one denied that this genie is out of the bottle for good, but some anticipated a bit of opportunistic pullback in federal funding for some programs just as future funding for health exchanges not yet started were cut as part of the recent “fiscal cliff” settlement in Washington.

Within the subtext of this theme, a couple of very strong clinical imperatives were repeatedly expressed by the investment community.  First, the story about your product must improve clinical and fiscal outcomes by multiples of less cost to generate funding and create magnetism in the market.  Secondly, healthcare is driven by technology and this orientation is shifting to the “delivery of two separate products - health and care” rather than just tech.  As one panelist stated, "If you are not thinking about this, then you need to go sit on a rock and rethink what you are doing."

As anticipated, these investment conferences were very pragmatic and tuned in to what will be successful in the market.  When laying them up against HIMSS (what is working in the health IT market) and the Digital Health Summits at CES or Health 2.0 conference in San Francisco (what could work in the health IT/social/mobile market), the glaring fact is that there is a wide and sobering gap between the "what is" and "what could be" camps that takes some experienced healthcare thinking to navigate. 

Ultimately, to get our products to market successfully we come down to answering questions and working the problems.  Who likes consuming healthcare, why and why not? How are we going to incent the patient to stay engaged and be compliant with best practices? How can tech be molded to fit our lives and yet help us optimize health and care for less? 

Interesting Panels:

The JOBs Act: Passed with bipartisan support, the JOBS Act (Jumpstart Our Business Startups)  panel covered the major provisions of the act that is intended to ease the security regulations for funding small and emerging businesses.  A deeper dive into this act by the “Crowdfunding” panel pointed to the Reg. D provisions of the JOBs Act which is seen as a pivot point for securing funding for emerging healthcare and life science companies. Among the key points made, the easing of the prohibition of general solicitation under Reg. D will dramatically improve growth company access to investors and opens up new avenues to use the Internet and social media to reach investors. For start-ups, crowdfunding could radically change the traditional seed capital fundraising process.  The SEC is still writing the enforcement rules for this 2012 act and should present a final guidance this spring.

Bootstrapping Funding: The “Bootstrapping Funding” panel started with the bold statement that traditional medical device business models are shifting from only being based on reimbursement to a stronger private pay position.  The squeeze on provider margins not just in the US but globally as the worldwide “boomer” birth curve progresses is the main driver of this trend.  This format is very similar to what has already happened in the EU and thus touted as an easier market to launch in. However, panelists strongly guided that you have to be very careful as to which country you try to launch in, Turkey is not like Germany. The FDA can be of great help introducing you to distributors offshore. 

Connected Health: This panel of investors saw big data, predictive genomics, disease registry, senior living/telemed and connectivity platforms as interest areas again driven by anticipated tightening of healthcare margins. Enterprise IT and the wellness/fitness niches have lost their glimmer, they are staying away from those.