Enabling Healthy Decisions

This is one of those terms that is thrown around a lot just like Medical Management or Disease Management.

I thought it would be helpful to define the 3.

Population Health Management (PHM) is…

“Programs targeted to a defined population that use a variety of individual, organizational, and societal interventions to improve health outcomes” (Mathematica Policy Research Issue Brief, August 2011)

Medical Management (MM) is…

“The general term often applied to the practices of utilization management (UM), case management (CM), and disease management (DM), alone or in combination with each other.” (Trends and Practices in Medical Management: 2001 Industry Profile)

Disease Management (DM) is…

“An approach to healthcare that teaches patients how to manage a chronic disease.” (Disease Management on About.com)

Is that clear as mud?

In today’s world, everything is patient-centric so that doesn’t differ between the three. Obviously, DM is a part of MM, but I rarely hear people talk about MM as a part of PHM which it seems to be to me. But, I don’t think of most MM type programs taking on the macro level change that PHM implies to me. PHM implies things like public health or broad programs like BlueZones. It implies looking at things like plan design, incentives, social trends, workplace culture, and other aspects of change that are necessary to create change and sustain change.

Here’s the Care Continuum Alliance’s full description of PHM (or as they call it here – population health improvement):

Key components of the population health improvement model include:

• Population identification strategies and processes;
  
• Comprehensive needs assessments that assess physical, psychological, economic, and environmental needs;
  
• Proactive health promotion programs that increase awareness of the health risks associated with certain personal behaviors and lifestyles;
  
• Patient-centric health management goals and education which may include primary prevention, behavior modification programs, and support for concordance between the patient and the primary care provider;
  
• Self-management interventions aimed at influencing the targeted population to make behavioral changes;
  
• Routine reporting and feedback loops which may include communications with patient, physicians, health plan and ancillary providers;
  
• Evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall population health.
  

The population health improvement model:

• Encourages patients to have a provider relationship where they receive ongoing primary care in addition to specialty care;
  
• Complements the physician/practitioner and patient relationship and plan of care across all stages, including wellness, prevention, chronic, acute and end-of-life care;
  
• Assists unpaid caregivers, such as family and friends, by providing relevant information and care coordination;
  
• Offers physicians additional resources to address gaps in patient health care literacy, knowledge of the health care system, and timeliness of treatment;
  
• Assists physicians in collecting, coordinating and analyzing patient specific information and data from multiple members of the health care team including the patients themselves;
  
• Assists physicians in analyzing data across entire patient populations;
  
• Addresses cultural sensitivities and preferences of individuals from disparate backgrounds;
  
• Promotes complementary care settings and techniques such as group visits, remote patient monitoring, telemedicine, telehealth, and behavior modification and motivation techniques for appropriate patient populations.
  

And, if you read articles about PHM, these macro issues don’t seem to be the focus. The focus seems to be mostly on the technology to accomplish PHM. There are obvious challenges and key success factors there. (Recent commentary on PHM.)

Medicare offers people free preventative care which includes a variety of things:

• Abdominal aortic aneurysm screening
• Alcohol misuse screenings and counseling
• Bone mass measurements (bone density)
• Cardiovascular disease screenings
• Cardiovascular disease (behavioral therapy)
• Colorectal cancer screenings
• Depression screenings
• Diabetes screenings
• Diabetes self-management training
• Glaucoma tests
• HIV screenings
• Mammograms (screening)
• Nutrition therapy services
• Obesity screenings and counseling
• One-time “Welcome to Medicare” preventive visit
• Pap tests and pelvic exams (screening)
• Prostate cancer screenings
• Sexually transmitted infections screening and counseling
• Shots:
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
• Tobacco use cessation counseling
• Yearly “Wellness” visit

(This list is from http://www.medicare.gov/coverage/preventive-and-screening-services.html.)

Now, while HHS says that over 32M people used these services in 2011, this is only 66% of Medicare beneficiaries. This varies by state with 48.1% of people in Wyoming taking advantage of this benefit while 71.1% of people in Delaware take advantage of the benefit.

I’m not sure of the root cause, but I suspect a lot of it has to do with education. Beneficiaries don’t understand what’s free. They don’t understand how to take advantage of the benefit, and physicians aren’t reinforcing this.

I was just watching the Verizon advertisement where they show data in a few ways. While their charts are all basically the same, it made me think about different ways of representing the same data. We all know that this is an important thing as we evaluate the effectiveness of different programs.

Let me highlight four different ways of representing two data elements. In this case, I’m comparing two programs. The first program (A) had a yield of 20% and the second program (B) had a yield of 23%.

• I could say that Program B was 3 percentage points better than Program A.
• I could say that Program B was 15% better than Program A.

I could show the data in two different charts where I simply change the y-axis.

I love where the future of healthcare technology is going.  If you missed the Health 2.0 Conference this week, you can see a lot of the presentations now online for FREE!  It’s very cool.

At the same time, I think this infographic from the Institute of Medicine reinforces some of the key points.

I keep seeing buzz about the Big Bird comment about PBS from the Presidential Debate from last week. As always, I interpret things differently. To me, this shows Romney’s willingness to make tough and perhaps unpopular decisions (like raising taxes for the Middle Class). At some point, these things may be critical.

Sure…the PBS budget may be small, but at some point, we as a country need to focus on how we cut costs to reduce our deficit. (See US debt clock.)

This reminds me a lot of the discussions we used to have to have as a PBM with employers or labor unions about their benefits. It goes back to the basic framework of “you can’t have your cake and eat it too”. Everyone wants to have a broad network of providers. Everyone wants to have an open formulary. Everyone wants to have the broadest benefits at the lowest cost without increasing their contribution every year.

Just by cutting a drug or a provider from your benefit may seem small, but the savings add up. (Like Big Bird or PBS.)

But, this is the problem we have in healthcare. How do we make enough small decisions to add up to real savings? How do we do this without upsetting everyone and impacting satisfaction (or is that simply life)?

The statistic that I like to point out is that more people have access to mobile devices than people who have access to toothbrushes. I know that sounds crazy to us Americans, but that’s apparently a global reality (in so much as statistics don’t lie). And, people seem lost without their smartphones so they have them within a few feet of them almost 24 hours a day.

Combine that with several trends, and you can begin to understand why Qualcomm Life predicts that by 2020 there will be 160 million Americans who will be monitored and treated for medical conditions remotely.

1. There will be a shortage of doctors (at least in certain geographies).
2. Technology continues to be more and more ubiquitous. (Just look at this amazing video)
3. Telemedicine is becoming more normal.
4. Big data continues to be a huge focus with lower data costs, greater integration, and ultimately more and more predictive models to interpret real-time data.

So, as I pointed out the other day about the value of the mobile data for a healthcare underwriter, that same data can be used to create a systemic intervention system for monitoring and intervening with consumers to drive behavior change. AND, since the data and delivery method is mobile, the interventions can be highly personalized based on when, how, what channel, etc. to improve engagement rates. I can even know who influences your behavior change and how to get them to encourage you to change behavior (peer pressure) or who you monitor and can influence you based on their recommendations.

I’m not sure I’m ready to go as far as Dr. Ron Loeppke from US Preventative Medicine who said

“These mobile apps that are emerging are going to be a predominant part of how health care is delivered going forward.” (Smartphones Take Wellness Engagement To New Levels by Elizabeth Galentine)

BUT, I do believe that over time that this will become the increasingly dominant channel for interventions and behavior change. Ultimately, your mobile phone number may be a more valued data point than your Social Security number.

There are so many attention grabbing ways of beginning this post…

• Millions of parents deal drugs to their kids
• 44% of teens have friends who abuse drugs
• An increase in free drugs
• Kids are stealing their parents drugs stashes
• 200M pounds of drugs left in the open for kids to find
• 10 deaths per 100,000 people from drugs

Would you have guessed that all of these are talking about prescription drugs?

The Medicine Abuse Project (at www.drugfree.org) is trying to get this word out and find a way to change this. The basic points of their messaging:

1. Safeguard your medications…lock them up and throw extra ones away.
2. Talk to your kids about drugs and the risk of abusing legal and illegal drugs.

Despite all the articles about the changing gender roles, there is still the common belief that 80% of healthcare decisions are made by women. I guess I would assume that men would be more involved in their healthcare which either points out a major engagement issue or something more systemic (or just a self-perpetuating myth).

The She-Conomy site reinforces this fact, and I also saw it in a PharmaVOICE article (9/12) recently which highlighted the report – Seven Lenses for Marketing Health to Women.

That article had several interesting facts in it. One which caught my attention was the following…

“30% of Facebook users in this study said receiving brand messages from a pharmaceutical company via Facebook would be a good way to communicate with them.” (That seems really high to me.)

On the flipside, I tend to believe the data point that 78% of respondents would feel more in control of their health with a mobile app to provide information…making the case for Happtique even more important.

I found the following in a Kaiser Family Foundation report. (KFF often being a source of truth for me.)

Women are the health care leaders for their families. Women take charge of the vast majority of routine health care decisions and responsibilities for their children, and on top of their everyday family obligations, over one in 10 women care for a sick or aging relative. Meeting these multiple obligations is demanding and leaves many women concerned about meeting all their family and work commitments as well as managing their own health.

• Eight in 10 mothers/guardians say they take on chief responsibility for choosing their children’s doctors (79%), taking them to appointments (84%), and ensuring they receive follow-up care (78%). Mothers are also primarily responsible for decisions about their children’s health insurance (57%).
  
• Similar to men, one in four women feel a lot of stress from career (24%) and financial concerns (23%). Women are significantly more likely than men to be very stressed about managing their own health needs and those of their parents.
  
• One in 10 women (12%), compared to 8% of men, cares for a sick or aging relative, often an ill parent. The majority of caregivers report that they perform a range of tasks, including housework (91%), transportation (83%), and various financial decisions (66%). Many also assist with medical and physical care, such as administering medicines or shots (58%), as well as routine activities such as bathing and dressing (42%).
  
• Caregivers themselves contend with a host of health challenges. Four in 10 are low-income, nearly half (46%) have a chronic health condition of their own, and one in five non-elderly caregivers are uninsured.
  
• A sizable share (29%) of caregivers provide assistance full-time, spending more than 40 hours per week as a caregiver. This is even more common among low-income caregivers, 44% of whom report assisting their relative for over 40 hours weekly.
  

Interestingly, this ties into a discussion I was having the other night about whether men or women are more adherent to their medications and whether that is a relevant segmentation factor in designing an intervention strategy. The data I’ve seen says women are less likely to be adherent than men, but the company I was talking to believed their data pointed the other way. Here’s a few articles on the topic:

• http://www.pharmatimes.com/article/12-03-20/US_women_prescribed_more_drugs_than_men_but_take_less_study.aspx
• http://eurjhf.oxfordjournals.org/content/11/11/1092.full
• http://well.blogs.nytimes.com/2011/06/20/keeping-score-on-how-you-take-your-medicine/
• http://scholar.harvard.edu/nkc/files/2011_caregiver_adherence_j_am_pharm_assoc.pdf

And from the CVS Caremark 2008 Trends Rx Report –

I know lots of people are skeptical or against healthcare reform.

A report that just came out says that Romney’s plan would lead to 72M uninsured by 2022. I have no idea if that’s a reasonable analysis, but any more uninsured should be a problem for us as a country. They wait to get care leading to bigger long term issues under Medicaid and Medicare. They over-utilize the emergency room. And, as a first world country, we should want to have everyone getting a basic level of preventative care to prevent long-term issues and higher costs and improve out quality of life.

I’ll admit that I was initially a skeptic of healthcare reform, but I think it’s a reasonable solution. Not perfect. As I’ve argued for a while, it only focused on quality and access but not cost. I would have started with access first. But there are several very positive parts of healthcare reform regardless of what some people believe.

• Support for technology
• Support for preventative care
• Accountable Care Organizations
• No lifetime limits
• No denial of coverage due to pre-existing conditions
• Pharma reimbursement during the donut hole
• At least 85% of what you pay for healthcare must be spent on medical costs (not administrative)
• No single payer

WorldOne Interactive has some interesting data from provider surveys on their website. This one jumped out at me.

• 87% of MDs polled would recommend a text message based adherence solution to their patients
  

At the same time, I also thought this one was really important since the question is always whether the physicians want to know adherence data or not. Based on my old post, I didn’t think that MDs would want this type of data since they generally don’t seem to value PBM interventions.

• 80% of MDs polled would find it useful to get periodic e-mail reports about their patients therapy compliance.
  

I thought this was an interesting factoid which I got today and is from The Physician’s Foundation report.

Here are a few other findings…

• In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
• Over 59 percent of physicians indicate passage of the Patient Protection and Affordable Care Act (i.e., “health reform”) has made them less positive about the future of healthcare in America.
• Over 82 percent of physicians believe doctors have little ability to change the healthcare system.
• Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now.
• Over 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs or that that any quality/cost gains will not be worth the effort.
• Physicians are divided on the efficacy of medical homes, and many (37.9 percent) remain uncertain about their structure and purpose.
• Over 47 percent have significant concerns that EMR poses a risk to patient privacy

I get about 3-4 requests to connect in LinkedIn each week. Maybe one of them is from someone I know. It seems like a lot of people attribute the number of contacts you have to value while the reality is that it’s the value of your relationships which matters. And, while you might be limited to a theoretical maximum of real friends, I think you can have an expanded professional network which is larger but doesn’t include anyone and everyone who can spell your name.

That being said, I’ve worked in several industries and several parts of the country (and tend to enjoy networking) so I have a big network in LinkedIn (>1,000). But, I constantly review it to see if things are getting old or if the person that I worked with on a deal has simply faded away. In the last year, I’ve dropped over 300 people that I had previously connected with.

So, like I’ve done with the blog and Twitter and Facebook, I figured I would post on how and why I use LinkedIn.

I joined LinkedIn very early since I had two friends who knew the founder. My personal uses for it have been:

• To stay in contact with past colleagues
• To share information from a work perspective
• To share contacts for networking
• To help find resources or people for projects
• To network for sales and/or jobs

The keys to using it are:

• Have a complete profile
• Get recommendations
• Give recommendations
• Provide updates
• Use keywords
• Connect it with things like Slideshare or your blog (no longer Twitter)
• Join groups (easiest way to expand your reach within the tool)

But, there are lots of professionals out there who will tell you how to optimize its use. For corporate purposes, I think Hubspot puts out a lot of great information and data.

The key for me is believing that if I reach out to someone in my network they will know who I am and be willing to respond or help the person I’m routing to them.

So…If you’re going to reach out to me in LinkedIn, tell me why you want to connect, and expect to get the following response…

“Thanks for your offer to connect. My rule is that we have to connect IRL (in real life) first. If you want to do that, you can call or e-mail me.”

Whether you’re a political junkie or not, if you’re in the healthcare industry, the political landscape has become increasingly important over the past decade.

• Healthcare represents 18% of our GDP
• The government pays for 45% of all medical costs
• PPACA is going to transform the healthcare landscape (in some form)
• Medicare will have to be reformed at some point
• Over 14M people are employed in healthcare (almost 9% of the working population)

And, with the government being the primary payer, they have the ability to drive trickle down changes through everyone’s care. So, even if you don’t work in the industry, but you’re a patient, you should care. What happens in DC will change healthcare which will affect you either today or in the future.

At the same time, I think most people in Washington DC are living in Disneyland. Government salaries continue to go up. Employment continues to go up. They have pension plans. They have robust health insurance offerings. Real estate has stayed strong. They don’t really understand what the rest of country is experiencing.

So, if I were coaching either campaign, I would point out that it’s always about finding simple messages that convey very strong points. That’s not easy, but I think we all want some basic things:

1. A financially stable country in which we have a legitimate chance to be economically successful.
2. An infrastructure which provides education for our kids and the overall workforce.
3. A safe neighborhood and country in which to live and where our rights as outlined in the Declaration of Independence are protected.
4. Leaders who use our tax money as if it was their own money when making decisions.
5. A country where hard work is rewarded and there’s a safety net to protect us when we get sick.

So, I guess you could ask what that has to do with healthcare…

• Healthcare costs are one of the big drivers of bankruptcy.
• Healthcare policy (or lack of it) drives a huge amount of waste.
• Lack of sleep, commuting times, cost constraints, stress, exercise, and diet are all correlated with health which is a huge burden on our global competiveness.

BUT, I do think there is macro-economic element here some of which is done differently in other countries (if you believe there is something to learn from them).

• What if we required employees to use all their vacation time each year? Would this decrease stress which is a driver of several healthcare issues? Would this decrease unemployment?
• What if we limited the work week to 45 or 50 hours? Would that decrease unemployment? Would that increase people’s involvement in their families? Would this increase time spent exercising? Would it increase hours slept?
• What if we created incentives to help people move for work? Would this decrease commute times and improve health and the amount of dinners people eat with their families (and not from fast food)?
• What if we limited school hours and the amount of homework and mandated recess? Would this increase exercise, decrease childhood obesity, and impact overall health?

Of course, all my practical business friends would tell me that this would kill our global competitiveness. And, my skeptical friends would point out that this would create more time, but we wouldn’t use that time to improve our health. Others of you would point out that companies would just look for more productive workers not hire more people.

But, I would argue that if we plan to differentiate ourselves on innovation and creativity then health is very important. Health already represents more of the cost of a car then the steel and more of the cost of coffee than the beans. The WHO has now said that obesity is the number one healthcare issue to tackle globally. It impact presenteeism. It impact absenteeism. And, your creativity is limited when you don’t sleep due to stress or other healthcare issues which is often magnified in the sandwich generation.

All of these things impact us in many ways. Of course, I think this would make a great campaign discussion…

“I’ll decrease unemployment and improve our economy by increasing use of vacation time, limiting work hours, and creating tax incentives to drive down obesity and improve our overall satisfaction with life. Doing this will make us a more innovative country and drive sustained competitive advantage within a global marketplace.”

We always hear about how little time the average primary care physician (PCP) spends with a patient although some research shows it’s actually going up. At the same time, there is a debate about whether healthcare reform will push us into a massive physician shortage which seems to exist in some areas already. I keep hearing about more and more things that the PCP should be doing during this encounter.

• They should be counseling on medication adherence.
• They should be addressing gaps-in-care.
• They should be handling prior authorizations real-time using a computer system.
• They should provide the patient with Ix (information therapy) steering them to apps and articles for them to understand their treatment.
• They should be coordinating with the patient’s care manager.
• They should be screening everyone for obesity.
• They should be screening everyone for alcohol abuse.

It was the last two that were recent recommendations for the US Preventative Services Task Force that prompted me to comment here. I’ve heard everything from about 8 minutes to 15 minutes per patient encounter and complaints about the amount of time spent on documentation and administration continuing to go up. So, how does a physician add in all these different tasks into this already short time window when patient already leave confused and not remembering most of what the physician told them.

Of course, concierge medicine and other physician practices are trying to change this in certain pockets. And, ideally Accountable Care Organizations (ACOs) or Patient Centered Medical Homes (PCMHs) where the focus is less on volume and more on outcomes have a chance to change this.

I guess the question in my mind is whether the physician is this gatekeeper or whether chronically ill patients need a care manager / patient navigator to help them understand their benefits, take advantage of the resources available to them, leverage their care team, and understand their disease and clinical options.

I keep seeing so many articles that I don’t always have time to research them and write them up. With that in mind, I thought I would share some quick summaries and links here.

1. Harris Survey data about customer satisfaction with their healthcare experience and how things compare between technologies they have access to and technologies they want. http://www.prnewswire.com/news-releases/patient-choice-an-increasingly-important-factor-in-the-age-of-the-healthcare-consumer-169140306.html
2. Ernst & Young report on collaboration within healthcare as part of patient-centric system. http://www.prnewswire.com/news-releases/ernst–young-llp-health-care-report-explores-collaboration-as-key-to-a-patient-centric-system-169447336.html
3. NEJM article on the business of health. http://www.nejm.org/doi/full/10.1056/NEJMp1206862
4. Medication Therapy Management (MTM) as key part of patient care and emerging role of pharmacist. http://drugtopics.modernmedicine.com/drugtopics/Modern+Medicine+Now/MTM-opens-door-to-direct-patient-care/ArticleStandard/Article/detail/787897?contextCategoryId=40159
5. New obesity report. http://healthyamericans.org/report/100/
6. Aetna survey on difficulty of selecting healthcare benefits. http://www.aetna.com/news/newsReleases/2012/0917-Aetna-Empowered-Health-Index.html
7. United survey and consumers beginning to shop online for healthcare service information and pricing. http://www.businesswire.com/news/home/20120918005229/en/Consumers-Starting-Comparison-Shop-Health-Care-Services-Treatments
8. Question on another blog about relevance of ongoing use of the term e-patient. http://t.co/DaODAPpK
9. Humana and Walmart partnership. http://t.co/v27XNRXr
10. A list of 71 ideas from a brainstorming meeting. http://medcitynews.com/2012/09/71-out-of-the-box-ideas-the-healthcare-industry-would-consider-if-it-controlled-healthcare-reform/
11. Benefit cuts are worker’s top worry. http://ebn.benefitnews.com/news/benefits-cuts-reductions-gallup-2727060-1.html
12. Encouraging empathy over efficiency in healthcare. http://articles.boston.com/2012-07-15/health-wellness/32682736_1_medical-care-medical-error-patient-care
13. Report on mobile health app growth. http://www.kaloramainformation.com/about/release.asp?id=2841
14. HRAs offer best ROI in wellness programs. http://www.hrmorning.com/top-6-roi-producing-wellness-initiatives/
15. Analysis of 56 wellness studies shows big ROI. http://www.hrmorning.com/massive-study-shows-true-wellness-roi/
16. 600% wellness program ROI and facts in infographic. http://ehstoday.com/health/infographic-state-corporate-wellness-programs-america
17. Consumer Reports survey on cost savings activities by consumers to pay for prescriptions. http://www.webmd.com/health-insurance/news/20120913/more-people-cutting-corners-pay-medications
18. United study showing that quality can be 14% cheaper. http://www.unitedhealthgroup.com/newsroom/news.aspx?id=d5c1e465-c2b3-4c01-a856-bee676381ecb
19. Linking wellness incentives to outcomes. http://ebn.benefitnews.com/news/employers-link-wellness-incentives-aon-hewitt-2726732-1.html
20. 12 facts about patient engagement. http://www.dorlandhealth.com/case_management/trends/12-Surprising-Facts-About-Patient-Engagement_2405_p2.html

I got a call today from a consultant who was researching the topic of patient engagement in healthcare. I found their questions interesting and really got me thinking about the topic. I’m going to turn my thoughts into a few blog posts this week.

The first one was to look at how different constituents think about engaging the consumer and why. This is changing a lot with the shift to Patient Centered Medical Homes (PCMH) and ACOs, but in general, companies were very transactional about this in the past where it was something to be done. Now, everyone is tracking this and cares about:

1. How successful are you at engaging patients?
2. How successful are you at changing their behavior?
3. What insights about the population can you provide me?

The ultimate strategy is one that:

• Predicts who to target (the at risk patients)
• Focuses only on the patients that are likely to change behavior
• Segments the population
• Delivers personalized communications to them
• Delivers the messages at the best time to engage them
• Tracks key metrics
• Dynamically adjusts the process
• Captures learnings
• And…does this in a cost effective and scalable manner

With that set-up, here’s my someone skeptical view of who cares by constituent.

As mobile devices get smarter and smarter, there is an ongoing debate about all the data they collect and how that data is used. (For those of you that love conspiracy theories, you’ll love my line of thinking today.)

For example, imagine that the application can predict where you will be 24 hours later to within 65 feet.

Your phone can give me a pretty good proxy for all of these:

• How much do you sleep?
• How much time are you in a car?
• How much time do you spend sitting?
• How much time are you walking? How far do you walk?
• How social are you?
• Are you in a relationship?

And, the more you do certain things, the better these proxies are:

• Pictures of food, drinking, friends, etc. on Instagram
• Checking in on FourSquare
• Tweets
• Facebook posts

And, in the not too distant future, it will become a digital wallet and begin to track purchase patterns.

Skeptical? In response to a request from Representative Ed Markey, major cell phone carriers revealed that they had received more than 1.3M requests for cell-phone tracking data from federal, state, and local law enforcement officials in 2011. (Time article – The Phone Knows All) They are using your phone data to solve crimes. If you’re not a criminal, this is probably good. It takes an average of 2 days for the Marshalls Service to find a fugitive these days versus 42 days in the past.

And, unless you’re a significant anomaly, you’re not reading all the data privacy data for all the apps we’re downloading. (30B apps have been downloaded.)

The article talks about apps that collect your photos, your texts, and your contacts.

“No app is free…you pay for them with your privacy.” (Time article)

But, from a healthcare perspective, especially as we move into an individual market, this data would be invaluable to an underwriter. Just like underwriters for car insurance want to track miles driven, average speed, and other data points, healthcare underwriters would love to understand your behavior.

• They know that sleep is correlated to obesity and other problems and most people sleep with their phone next to their bed.
• They know that drive time is correlated to obesity and increases risk of an accident. They could even know if you’re texting and driving. (One app even claims to be able to tell driver from passenger.)
• They know the importance of exercise and could map your location to a gym. They could also see how many steps you take daily.
• They know that having a social network is important to behavior change so they could understand your friends and their health status.
• They know that eating meals with your family is important.
• They know that eating breakfast is important.
• They know that being happily married is correlated with health.

Heck. We already see increased accidents attributed to people walking and interacting with their smart phone.

Maybe someday that will be a requirement to get a lower rate on healthcare. Maybe the younger generation won’t care. People continue to tell me that people in their 20’s just assume that everything is public and don’t see this “Big Brother” type of use of data as invasive.

The same Time issue (9/27/12) goes on to share some interesting global statistics on mobile phones. Here’s a few highlights:

• 84% of people have their phone next to their bed (68%) or in the bedroom (16%) at night
• 1/3^rd of Americans use their mobile device while driving a car, playing with their children, attending a party, and eating at a restaurant.
• 65% of parents believe their devices make them better parents (I’m not sure I get this one at all)
• Americans use their mobile devices least of the six countries studied to do each of the following:
  • Send text messages
  • Browse the Internet
  • Listen to music
  • Search the web
  • Read news
  • Take pictures
  • Visit social networks
  • Shop
  • Receive payments
• 29% said their wireless device is always the first and last thing they look at every day (which is 15 points below the international average)
• 26% of respondents feel guilty if they don’t promptly respond to work related messages outside normal hours