Archive | Technology RSS feed for this section

2013 PBMI Presentation On Pharmacy Need To Shift To Value Focus

Today, I’m giving my presentation at the PBMI conference in Las Vegas.  This year, I choose to focus on the idea of shifting from fee-for-service to value-based contracting.  People talk about this relative to ACOs (Accountable Care Organizations) and PCMHs (Patient Centered Medical Homes) from a provider perspective.  There have been several groups such as the Center For Health Value Innovation and others thinking about this for year, but in general, this is mostly a concept.  That being said, I think it’s time for the industry to grab the bull by the horns and force change.

If the PBM industry doesn’t disintermediate itself (to be extreme) then someone will come in and do it for them but per an older post, this ability to adapt is key for the industry.  While the industry may feel “too big to fail”, I’m not sure I agree.  If you listened the to the Walgreens / Boots investor call last week or saw some of things that captive PBMs and other data companies are trying to do, there are lots of bites at the apple.  That being said, I’m not selling my PBM stocks yet.

So, today I’m giving the attached presentation to facilitate this discussion.  I’ve also pre-scheduled some of my tweets to highlight key points (see summary below).

 

Planned PBMI Tweets

59% Of MDs Want To Know About Employer Care Mgmt Efforts

I just came across this survey data from January of 2010 where the Midwest Business Group on Health (MBGH) did a survey of physicians. I found it really interesting. Let me pull out a few points with some comments…

  • 72% of physicians agree that employers should have a role in improving and maintaining the health of their employees with chronic disease. [Since they ultimately are the one paying the bill, this seems like a reasonable expectation in today’s world.]
  • 59% believe that they should be informed about employer efforts to help their patients manage chronic conditions. [This is increasingly becoming important as we move from a Fee-For-Service (FFS) world to a value-based or outcomes-based healthcare environment.]
  • 46% agree that employers should have a role in helping employees adhere to their medication and treatment regimes. [Since MDs generally don’t view this as their task, if it’s not someone acting on behalf of the employer, I wonder who they think should be doing this.]
  • 32% agree that employers should play no role in the health of patients. [With healthcare impacting productivity and global competitiveness, I think this is an unreasonable expectation.]
  • 61% want the employer to provide physicians with information on what is available to patients so they can counsel them on the value of participation. [How would they want this information and what would they do with it?]
  • 49% would like to receive workplace clinical screening results to reduce redundancies in testing. [Do the other 51% want duplicative testing?]
  • 48% want to receive actionable reports (e.g., screening results, health coaching reports) to support them in treating patients. [I would hope so. If the employer (or really their proxy) is managing the patient in a chronic program, why wouldn’t the physician want this data?]
The study went on to say that physician’s want employers to provide support around weight loss, smoking cessation, flu shots, and other broad programs. They also want the employer to focus on lifestyle change and health improvement not the chronic disease itself. This makes sense, but in general employees are more focused on trusted information coming from their physician not their employer so there’s a clear gap here. (See graph from Aon Hewitt’s 2011 Health Care Survey, New Paths. New Approaches.)

Only 50% Of Healthcare Companies Respond To Twitter Messages – Test Results

12 Of 23 Companies

As I mentioned a few weeks ago (2/2/13), I wanted to test and see if healthcare companies would respond to consumers via Twitter. To test this, I posted a fairly general question or message on Twitter to see the response (see below). Of the 23 companies that I sent a message to, only 12 of them ever responded even after 6 of them received a 2nd message. Those results are shared below. What I also wanted to look at was the average time to respond along with which group was more likely to respond.

  • PBMs – All of the 3 PBMs that I reached out to responded. (This could be biased by my involvement in this space since two of them e-mailed me directly once I posted a comment.)
  • Pharmacies – Only 2 of the 4 retail pharmacies that I reached out to responded.
  • Disease Management Companies – Only 1 of the 3 that I reached out to responded. (I was surprised since Alere often thanks me for RT (re-tweeting) them, but didn’t respond to my inquiry.)
  • Managed Care – 5 of the 7 companies that I reached out to responded. (For Kaiser, they responded once I changed from @KPNewscenter to @KPThrive.)
  • Health Apps or Devices – Only 1 of the 5 companies that I reached out to responded. (This continues to surprise me. I’ve mentioned @FitBit on my blog and in Twitter numerous times without any response or comment.)
  • Pharmaceutical Manufacturers – Only 1 of the 3 companies that I reached out to responded. (This doesn’t surprise me since they are very careful about social media. @SanofiUS seems to be part of the team that has been pushing the envelope, and they were the ones to respond. I thought about Tweeting the brands thinking that those might be monitored more closely, but I didn’t.)

I will admit to being surprised. I’m sure all of these companies monitor social media so I’m not sure what leads to the lack of response. [I guess I could give them the out that I clearly indicated it was a test and provided a link to my blog so they could have chosen not to respond.]

Regardless, I learned several things:

  1. Some companies have a different Twitter handle for managing customer service.
    1. @ExpressRxHelp
    2. @AetnaHelp
    3. @KPMemberService
  2. Some companies ask you to e-mail them and provide an e-mail.
  3. Some companies tell you to DM (direct message) them to start a dialogue.

From a time perspective, I have to give kudos to the Prime Therapeutics team that responded in a record 2 minutes. Otherwise, here’s a breakout of the times by company with clusters in the first day and approximately 2 days later.

Company

Response Time (Hrs:Min)

Prime Therapeutics

0:02

Aetna

1:12

LoseIt

1:19

Healthways

2:07

Walmart

3:01

Express Scripts

8:35

Kaiser

29:22

BCBSIL

47:32

OptumRx

47:39

BCBSLA

48:18

Sanofi

53:30

I guess one could ask the question of whether to engage consumers via Twitter or simply use the channel more as a push messaging strategy. The reality is that consumers want to engage where they are, and there are a lot of people using Twitter. While it might not be the best way to have a personal discussion around PHI (Protected Health Information) given HIPAA, it certainly seems like a channel that you want to monitor and respond to. It gives you a way to route people to a particular phone number, e-mail, or support process.

As Dave Chase said in his Forbes article “Patient engagement is the blockbuster drug of the century”, this is critical for healthcare companies to figure out.

The CVS Caremark team told me that they actively monitor these channels and engage with people directly. I also talked with one of the people on the Express Scripts social monitoring team who told me that they primarily use social media to disseminate thought leadership and research, but that they actively try to engage with any member who has an actionable complaint. They want to be where the audience is and to quickly take the discussion offline.

If you want to see the questions I asked along with the responses, I’ve posted them below…

The Prescribing Apps ERA – Will Clinicians Be Ready? #mHealth

Dr. Kraft (@daniel_kraft) recently spoke at FutureMed and talked about the prescribing apps era.  I’ve talked about this concept many times, and I agree that we are rapidly moving in that direction.  And, there’s lots of buzz about whether apps will change behavior and how soon we’ll see “clinical trials” or published data to prove this.

From this site, you can get a recap, but here are the key points that he made:

1) Mobile Phones (quantified self) are becoming constant monitoring devices that create feedback loops which help individuals lead a healthy lifestyle.  Examples include; monitoring glucose levels, blood pressure levels, stress levels, temperature, calories burned, heart rate, arrythmias. Gathering all this information can potentially help the patient make lifestyle changes to avoid a complication, decrease progression of a particular disease, and have quality information regarding his physical emotional state for their physician to tailor his treatment in a more efficient manner.

2) The App prescription ERA:  Just as we prescribe medications prescribing apps to patients will be the future. The reason why this is important is that apps created for particular cases can help the patients understand their disease better and empower them to take better control.

3) Gamification: using games in order to change lifestyle, habits, have been mentioned before. A very interesting concept was that created in the Hope Labs of Stanford. The labs created a game in which children would receive points after there therapeutic regiment, once points were optioned they could shoot and attack the tumor. Helping with the compliance rate of the treatments

4) Lab on a chip and point of care testing

5) Artificial Intelligence like Watson and its application in medicine.

6) Procedure Simulation: Several procedures done by medical professionals follow (not 100%) a see one, do one teach one scenario.  Probably very few people agree with this concept and that is why simulation has great potential. In this case residents, fellows in training can see one, simulate many and then when comfortable do one.

7) Social Networks and Augmented Reality

At the same time, a recent ePocrates study hammered home the point that while this is taking off physicians don’t have a mechanism for which ones to recommend and why.

According to the Epocrates survey, more than 40 percent of physicians are recommending apps to their patients. In terms of the apps being recommended, 72 percent are for patient education, 57 percent are lifestyle change tools, 37 percent are for drug information, 37 percent are for chronic disease management, 24 percent are for medical adherence and 11 percent are to connect the patient to an electronic health record portal.

Physicians also have several different sources for identifying which apps to recommend to their patients. According to the survey, 41 percent get advice from a friend or colleague, while 38 percent use an app store, another 38 percent use an Internet search engine, 23 percent learn of an app from another patient or patients, and 21 percent use the app themselves.

That said, the survey also notes that more than half of the physicians contacted said they don’t know which apps are “good to share.”

As I’ve discussed before, this is somewhat of the Wild West.  Patients are buying and downloading apps based on what they learn about.  They’d love for physicians, nurses, pharmacists, and other trusted sources to help them.  But, those clinicians are often not technology savvy (or at least many of the ones who are actively practicing).  There are exceptions to the norm and those are the ones in the news and speaking at conferences.

IMHO…consumers want to know the following:

  1. Which apps make sense for me based on my condition?
  2. Will that app be relevant as I move from newly diagnosed to maintenance?
  3. Should I pay for an app or stick with the free version?
  4. Is my data secure?
  5. Will this app allow me to share data with my caregiver or case manager?
  6. Will this app have an open API for integration with my other apps or devices?
  7. Is it intuitive to use?
  8. Will this company be around or will I be able to port my data to another app if the company goes away?
  9. Is the information clinically sound?
  10. Is the content consumer friendly?
  11. Is it easy to use?
  12. Is there an escalation path if I need help with clinical information?
  13. Will my employer or health plan pay for it for me?
  14. Is my data secure?

And, employers and payers also have lots of questions (on top of many of the ones above):

  1. Is this tool effective in changing behavior?
  2. Should I promote any apps to my members?
  3. Should I pay for the apps?
  4. How should I integrate them into my care system?
  5. Do my staff need to have them, use them, and be able to discuss them with the patient?  (Do they do that today with their member portal?)

mhealth_infographic_large

Would A Robot Therapist Solve Your Problem?

Wired had an article recently about how robots are replacing people over time.  The article talked about TUG which is a robot used in hospitals.  It also mentioned MindMentor.com which it called the site of the world’s first robot therapist.  Interestingly, it says that after a 1-2 hour session, that 47% of patients said that their problems were solved.  From the 2008 article, it sounds like there’s some opportunities for improvement in terms of NLP, avatars, and other technologies.

That seems high.  I would think it would take more sessions.  Additionally, I would think that people don’t get their problems solved that easily.

While this solution is on sabatical (due to lack of funding), the article went on to talk about USC’s Bandit robot for kids with autism.

Google Glass Plus The Checklist Manifesto

I continue to think about all the cool ways that Google Glass could be used to change healthcare.  Here’s my thought from today.

You could combine The Checklist Manifesto concept with Google Glass to allow surgeons to be reminded of the things they need to do with a patient while they were during the encounter or during the procedure.

In complex situations – such as those which arise in almost every profession and industry today – the solutions to problems are technical and demanding. There are often a variety of different ways to solve a problem. It’s all too easy to get so caught up dealing with all these complexities that the most obvious and common sense immediate solutions are not tried first. To overcome this problem, take a leaf from the commercial aviation industry and develop checklists people can use to make sure every base is covered quickly and concisely. Checklists are a forgotten or ignored business tool. It’s time for them to come in from the cold. 

“Here, then, is our situation at the start of the twenty-first century:We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And with it, they have accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields – from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us. That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our human inadequacies. And there is such a strategy – though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies. It is a checklist.”

(This is from this PDF on The Checklist Manifesto.)

Here’s an example of a checklist from the WHO.

 

How To Improve Good Cholesterol (HDL) If Drugs Don’t Work

The Wall Street Journal on 1/8/13 had an article called “New Rules for Boosting Good Cholesterol” which shared the results of a recent study on medications that improve HDL (or Good Cholesterol).

“Not all HDL are created the same” was what Roger Newton, chief science officer of Esperion said.

“If you raise HDL in non-pharmacologic ways, it really does help you” says Steve Kopecky, a Mayo Clinic cardiologist.

The points made in the article can be summarized in the following:

  • Improving good cholesterol is important.
  • People with high HDL face fewer heart attacks (according to the Framingham Risk Score)
  • Multiple trials to improve HDL with drugs have failed
  • People may need to raise good cholesterol by behavior change

This should lead to 3 questions:

  1. What should be my HDL or Good Cholesterol? From the Mayo Clinic on Good Cholesterol:

  1. What can I do to improve my Good Cholesterol without drugs? From the WSJ article:

Activity

HDL Increase

Exercise

4 mg/dL

Drink Alcohol (in Moderation)

2-4 mg/dL

Quit Smoking

5 mg/dL

Lose Weight

1 mg/dL per 3-6 lbs

Eat Fish And Olive Oil

3-5 mg/dL

Avoid Carbohydrates

8 mg/dL

  1. What are my risks and the value of medications? For that, I found two online risk tools.

Here’s a simple one that uses the Farmingham study to estimate your risk of having a heart attack.

Here’s another one from over in Europe that’s focused on the value of statins and hosted by the Cleveland Clinic. It takes more inputs but then gives you several outputs. (A nice algorithm to integrate with something like iBlueButton or your care management system perhaps to warn you of risks without having you input a bunch of data.)

FitBit Review Summary – Device, Apps, And Suggestions

In the spirit of the Quantified Self movement and in order to better understand how mHealth tools like FitBit can drive behavior change, I’ve been using a FitBit One for about 6 weeks now. I’ve posted some notes along the way, but I thought I’d do a wrap up post here. Here’s the old posts.

Those were focused mostly on the device itself. Now I’ve had some time to play with the mobile app. Let me provide some comments there.  And, with the data showing a jump in buyers this year, I expect this will be a hot topic at the Consumer Electronics Show this week.

  • The user interface is simple to use. (see a few screenshots below)

  • I feel like it works in terms of helping me learn about my food habits. (Which I guess shouldn’t be surprising since research shows that having a food diary works and another recent study showed that a tool worked better than a paper diary.) For example, I learned several things:
    1. I drink way too little water.
    2. I eat almost 65% of my calories by the end of lunch.
    3. Some foods that I thought were okay have too many calories.
  • In general, the tracking for my steps makes me motivated to try to walk further on days that I’m not doing good.
  • The ease of use and simple device has helped me change behavior.  For example, when I went to go to dinner tonight, I quickly looked up my total calories and saw that I had 600 calories left.  Here’s what I ate for dinner.  (It works!)

Meal

But, on the flipside, I think there are some simple improvement options:

  1. I eat a fairly similar breakfast everyday which is either cereal with 2% milk and orange juice or chocolate milk (if after a workout). [In case you don’t know, chocolate milk is great for your recovery.] Rather than have to enter each item, FitBit could analyze your behavior and recommend a “breakfast bundle”. (and yes, I know I could create it myself)
  2. Some days, I don’t enter everything I eat. When I get my end of week report, it shows me all the calories burned versus the calories taken in. That shows a huge deficit which isn’t true. I think they should do two things:
    1. Add some type of daily validation when you fall below some typical caloric intake. (Did you enter all your food yesterday, it seemed low?)
    2. Then create some average daily intake to allow you to have a semi-relevant weekly summary.
  3. The same can be true for days that you forget to carry your device or even allowing for notes on days (i.e., was sick in bed). This would provide a more accurate long-term record for analysis.
  4. The food search engine seems to offer some improvement opportunities. For example, one day I ate a Dunkin Donuts donut, but it had most types but not the one I ate. I don’t understand that since there’s only about 15 donuts. But, perhaps it’s a search engine or Natural Language Processing (NLP) issue. (I guess it could be user error, but in this case, I don’t think so.)
  5. Finally, as I think about mHealth in general, I think it would be really important to see how these devices and this data is integrated with a care management system.  I should be able to “opt-in” my case manager to get these reports and/or the data.

The other opportunity that I think exists is better promotion of some things you don’t learn without searching the FitBit site:

  • They’re connected with lots of other apps.  Which ones should I use?  Can’t it see which other ones I have on my phone and point this out?  How would they help me?
  • There’s a premium version with interesting analysis.  Why don’t they push these to me?

I also think that they would want an upsell path as they rollout new things like the new Flex wristband revealed at CES.

And, with the discussions around whether physicians will “prescribe” apps, it’s going to be important for them to be part of these discussions although this survey from Philips showed that patients continue to increasingly rely on these apps and Dr. Google.

Philips_Health_Infographic_12%2012_F3

Finally, before I close, all of this makes me think about an interesting dialogue recently on Twitter about Quantified Self.

Which Health Apps Show Up On Most Top App Lists?

At this time of year, you’ll see lots of “top apps” lists.  MobiHealth put together a list of the top 80 apps, but I also wanted to look across a variety of lists and see if there were any common apps mentioned. 

We’re still early in this mHealth world, but it is a key topic which will change how physicians interact with their patients as one MD talks about on Kevin MD’s blog

After looking at a recent CNN Money Magazine article called “Tap Here for Better Health”, I also looked at the following lists:

Obviously, each of these writers had different criteria, but there were 8 applications that appeared more than once across these lists:

  1. Lose It
  2. Fooducate
  3. Runkeeper
  4. ZocDoc
  5. Cardiio
  6. Sleep Cycle
  7. Endomondo
  8. My Fitness Pal

If interested, you can also see the list of most helpful apps from the Modern Healthcare survey that Jane Sarasohn-Kahn highlights in her blog.  Most of those seem less “sexy” than the typical lists that you see.

 

Most-important-mobile-apps-Mod-HC-Dec-12-300x225

The apps that show up on these lists have changed over the past few years although Endomondo appears on this 2010 list and on several of these recent lists.

All I Want For Christmas (in Healthcare Technology)

Merry-Christmas-christmas-32793643-2560-1920

As I think about our healthcare system, there are lots of things I’d like that would be useful in improving patient outcomes.  So, beyond the obvious things that we’d all like such as:

  • Elimination of waste
  • A true healthcare not sick care system
  • Aligned incentives
  • Alignment of outcomes and quality with cost

Here’s what’s at the top of my list from a technology perspective.

  1. Food App.  I’d like a food app that did the following:
    • Allowed me to scan in food that I buy and eat
    • Allowed me to take a picture of my food and estimate the calorie count
    • Allow me to enter a restaurant and use geo-tagging to push to me the best things to eat on the menu
    • Allow me to dynamically manage my food choices based on my diagnoses
    • Push coupons to me at the store based on what I eat and what I might
  2. Open Enrollment Tool.  I’d like a tool that helped me optimize which benefit to enroll in based on:
    • Historical utilization patterns of Rx and medical and projected spend based on tools like the Johns Hopkins ACG model
    • A configuration engine to help me optimize on key factors that matter to me (out-of-pocket versus convenience…for example)
  3. Engagement Scoring.  I’d like a way to understand the likelihood of an individual member to engage based on each of the following:
  4. Communications Tailoring Learning Algorithm.  I’d like a learning system that continuously updated the engagement score based on Internet usage along with consumer feedback and smart phone data.
  5. Physician Integration.  I’d like to see consumer data and claims data integrated with physician data into one shared system that the physician, the member, and the broader care team could all share and access.  I’d also like that data to include both structured and unstructured (i.e., notes) data that fed an overall patient care algorithm to identify gaps-in-care and predict intervention points for improving outcomes.
  6. Smart Phone Data Integration.  I continue to believe that the smart phone data is a huge set of information that could be used to tell me things like:
    • Activity
    • Sleeping patterns
    • Social behavior
    • Preferred channel
    • Personal goals
    • Stress
  7. Google Glasses For Healthcare.  I continue to believe that the virtual world and the physical world will become more ubiquitous.  Google Glasses have an opportunity to accelerate that.  I’d love to see how to leverage these in unique ways to improve the patient and physician communication chasm.

On a related note, I’d love to find a technology that allowed me to take all my blog posts and tweets and configure them by topic into an e-book.  That seems like something logical.

Google Glasses…I Can’t Wait!

For those of you that have read my blog for a while, I’ve talked about the possibility of augmented reality glasses several years ago before Google was talking about their offering (at least publicly).  I still think one very cool use for this (in healthcare) is to create augmented reality shopping “paths” through grocery stores that are focused by disease state.  For example, a diabetic could be guided to buy the best foods for them in the store.

You could also capture things that send them real-time to your case manager.

You could virtually pull a care-giver into your physician encounter.

Lots of exciting opportunities.

Here’s a cool video that some of you may have seen on Google Glasses which may be a consumer product before too long.

Diabetes Innovation – mHealth; Quantified Self; Business Model

I’m not a diabetic, but I’ve been researching the topic to understand the space and what innovation is occurring around diabetes. This is a space where there are lots of applications, tools, devices, communities, and research. The ADA estimates the total US cost at $218B with very high prevalence. If you expand that on a global scale, the costs and impact is staggering.

  • Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes.
  • Diagnosed: 18.8 million people
  • Undiagnosed: 7.0 million people
  • Prediabetes: 79 million people*
  • New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.

So, what’s being done about it? And, what opportunities exist? I think you’ve certainly seen a lot of innovation events being sponsored by pharma and others.

You’ve seen a shift from drug to engagement for a few years as evidenced in this old post about Roche – http://www.diabetesmine.com/2009/10/a-visit-to-the-roche-new-concept-incubator.html

You’ve seen a proliferation of diabetes apps. (A prime opportunity for Happtique.)

From my traditional PBM/Pharmacy focus, you’ve seen several efforts there:

Obviously, Medco (pre-Express Scripts acquisition) thought enough of this space to buy Liberty Medical.

I pulled some screen shots and examples into a deck that I posted on SlideShare. I’d welcome people’s thoughts on what’s missing or what are the key pain points from a diabetes perspective (e.g., not integrated devices).

While I was doing my research, I found a few interesting things worth sharing.

Several interesting studies:

Some good slide decks:

Additionally a few videos:

I also posted some diabetes infographics on my blog – https://georgevanantwerp.com/2012/12/13/more-diabetes-infographics/

And, while I started to pull together a list of diabetes twitter accounts below, you can follow @AskManny’s list with 360 people already tagged in it. https://twitter.com/askmanny/diabetes

My starting twitter List:

Interview With BodyMedia CEO at mHealth Summit #mhs12

BodyMedia 1

Last week at the mHealth Summit in DC, I had a chance to sit down and visit with Christine Robins who is the CEO of BodyMedia. (see bio below)  One of the most exciting things (mentioned at the end) is their new disposable solution coming out.

Christine Robins is currently the Chief Executive Officer of BodyMedia, Inc., a pioneering market leader in wearable body monitors. BodyMedia’s devices are unparalleled in the marketplace, and equip professionals and consumers with rich information to manage a range of health conditions impacted by lifestyle choices.

Prior to joining BodyMedia, Christine was the CEO of Philips Oral Healthcare where she led the global Sonicare® brand to significant sales and share growth. Christine also has extensive experience in a wide range of marketing and finance capacities gained during her 17 years at S.C. Johnson, where she ran notable brands such as Raid® insecticides, Glade® air fresheners, and Aveeno® skin care. With this background rooted in global multi-national companies and an entrepreneurial zeal essential to lead a high technology upstart, Chris is passionate about developing turnaround strategies, building teams, and driving innovation.

A noted speaker, Christine has delivered presentations at universities such as Harvard, Stanford and Duke, as well as keynotes at industry shows such as the Consumer Electronics Show, Health 2.0 and CTIA. She holds a degree in Marketing and Finance from the University of Wisconsin-Madison and an MBA from Marquette University.

If you’re not familiar with BodyMedia, it’s definitely a company to know from a Quantified Self perspective. They have been around since 1999 providing solutions and have 150 global studies about the effectiveness of their devices in weight loss (see one chart below). The devices that they use continue to get smaller and smaller with time and are registered with the FDA as Class II medical devices.

clinical charts_2012_updated

Their devices track 5,000 data points per minute using 4 different sensors. Here are a few screen shots from the mobile apps that they have.

bodymedia iOS 3

And, as you can see, they map well to the chart below which shows what data consumers and physicians want to track with weight, calories, physical activity, and sleep patterns.

Quantified Self 2

For food tracking, they work with MyFitnessPal which provides them with data on products you eat. I think a good example can be seen in this screen shot from the Android app.

bodymedia 4

But, honestly, a lot of what I was really intrigued by was a new offering they’re rolling out called the “PATCH” which will be a 7-day, disposable body monitoring system that does everything the full blown system does. I don’t know the price point yet, but this is really exciting as a way to pull new people into the market and to use as a strategy for setting a baseline with a patient to understand their data. It could then lead to recommendations around disease management.

Another thing that Christine talked about was they’re approach to partnering with places like the Biggest Loser and other to allow for a customized content approach to your messaging from the system. She also showed me how the device will project where you will end up at the end of the day based on your past history.

They also have a module for a coach or weight loss professional to help manage and view data across all the people they’re working with.

(And, I just grabbed this image from their website since it points out the 3 key things to weight loss.)

iBlueButton Interview At The mHealth Summit #mhs12

I had a chance to sit down and do several interviews at the mHealth Summit earlier this week in DC. I’m slow to get my interviews posted, but they were all very interesting.

One of the best was with Dr. Bettina Experton (see bio below) of Humetrix. I will admit that reading about iBlueButton doesn’t do it justice. I was confused as to what they were trying to do and why it won an award. And, while explanatory after the fact, I found the graphic below intimidating as a consumer before talking with her.

[For those of you that don’t know what BlueButton is, you should go research it here.]

Dr. Experton explained to me how broad the BlueButton initiative now is. I only knew that CMS was using it, but apparently, there are now 200 plans also using it including Aetna, United Healthcare, and Humana. What Humetrix focused on for this offering was the mobile empowerment of BlueButton allowing the patient to have control of their information in the iOS platform (i.e., your Apple products – iPhone, iPad). They provide a tool for downloading and encrypting the data – prescription, medical claims, lab, and procedures.

iBlueButton

Of course, if you’ve ever seen what this data looks like in the raw form, this wouldn’t seem very helpful. Most of us wouldn’t know what to do with this. But, as Dr. Experton showed me, they’ve rendered the data in a great GUI (graphic user interface) that really brings it to life in a readable and understandable format. For example, they translate the NDC code (used for prescriptions) into the drug name with the chemical name and the dosage. The GUI is very iPod like in terms of simplicity and ease of use.

iBlueButton 2

The iBlueButton app even will pull in patient self-reported data from a PHR (personal health record) and show it in a different color and different section so the provider can understand the sources. Of course, this was another point of confusion for me before we talked which was how would a physician get this and what would they do with it. She showed me a demonstration of the patient opting to share their data and records with the provider in real-time. Of course, this assumes the provider’s office and/or the physician is actually using a device in the presence of the patient, but we know that is changing quickly these days. (See article on survey about MD use of iPad / iPhone.) So, with their tool, I can now store and share my data. The challenge still is integrating this data into the physician’s EMR (electronic medical record), but the iBlueButton app on the provider’s device can do this. It can also print it for those physicians who still want to see the printout in their paper file.

Another thing that you see in the second set of screen shots above is that you can start to report on whether you’re using the prescriptions still that it shows you on. Assuming patients engage, this would be a great tool for medication reconciliation and adherence discussions.

I’m not the Meaningful Use expert, but Dr. Experton pointed out to me that all of this is important since meaningful use requires viewing, downloading, and transmitting capabilities. They provide all of these.

I definitely plan to download iBlueButton and my data, and I hope to use this as a tool to reinforce why any claims provider should be offering you BlueButton access to your data. This is definitely a company to watch.

Bettina Experton, M.D., M.P.H.
President & CEO

Dr. Experton is the founder, President and CEO of Humetrix which she has led over the last 15 years on the HIT innovation path starting with the development of health risk appraisals, chronic care management software, and since the early 2000s with the development of novel mobile device-based solutions which have been deployed worldwide. A physician with over 20 years of healthcare informatics experience, Dr. Experton is the author of multiple information technology patents. At Humetrix, Dr. Experton also conducted groundbreaking health services research on the frail elderly which led to major federal legislation in the area of Medicare and managed care, and has been a national healthcare policy advisor in the US, China, and France. As a healthcare IT advisor to the French Ministry of Health, she made important contributions to the design of the newly launched French government sponsored single web-based individual health record with smart card access made available to French citizens and their physicians. Dr. Experton is an Adjunct Professor of Medicine at the University of California at San Diego, School of Medicine and a permanent member of the Faculty of the School of Medicine in Paris, after graduating Summa Cum Laude where she completed her training in Internal Medicine. In California, Dr. Experton received a Master’s degree in Public Health with a major in epidemiology from Loma Linda University School of Public Health, completed a Pediatrics internship at University of California Davis Medical Center and a Public Health residency with the State of California Department of Health Services.

What I Learned Day One at the mHealth Summit #mhs12

I only had time to attend one day of the mHealth Summit in DC. Overall, it seemed like a well attended event with a good vendor area.

But, what I saw left me with concerns about the maturity of the space.

1. Every vendor has their own portal. There was no idea of convergence or sensitivity to the care manager or provider or patient having to access multiple sites to collect data. Of course, there were a few exceptions.

2. There’s still some heavy lifting for the consumer, but it’s getting better. For example, one food application lets you scan in your food but that calorie counter isn’t integrated into any activity monitor. Another application was trying to monitor social activity for part of their depression algorithm but they weren’t leveraging the data sitting on the phone itself – numbers of calls, movement, etc.

3. There are some really creative solutions being tried but the scale of the studies is small. I was excited to see what was being done with obesity, but the case studies were less than 150 participants.

4. There are a lot of non-healthcare people jumping in which is great from an innovation perspective, but healthcare is tricky and making sure to apply consumer literacy filters to the clinical guidance you get is important. For example, I asked one vendor why he had several chronic diseases covered but ignored high cholesterol. He pointed out that he had a heart disease component, but IMHO I don’t know many people with high cholesterol that would self select into heart disease.

On the other hand, there were some really positive things.

1. The user interface on a lot of these is very elegant.

2. The devices are getting smaller and smaller with a few disposables on the way.

3. The data captured and reporting is really interesting and insightful although I’m not sure how it will all be used by patients, physicians, or companies.

4. Technology is much more scalable than people centric strategies which is critical in the US and globally.

5. Several companies really get it and are focused on device neutral approaches for capturing and disseminating data.

Overall, it reminded me of some of my concerns about the Health 2.0 movement a few years ago in terms of business models and distribution models. But, keep the innovation coming. It’s fascinating and thought provoking. But, there will definitely be a shakeout in the years to come.

My Top 11 Healthcare Predictions For 2013

It’s always fun to predict what will happen in the next year. No one is ever right, but you can hope to be directionally correct. With that in mind, here’s a few of my thoughts for what will happen in 2013…

  1. Reform (PPACA aka ObamaCare) will happen. While the Republicans will fight it, with Obama’s re-election and the Supreme Court decision. Reform will continue to happen. The states will mess up the Exchanges which will create many issues, but private exchanges will come to the “rescue”.
  2. Big Data” will be a focus at every healthcare company. What data to store? How to mine the data? What data to integrate? How to bring in unstructured data such as physician’s notes? What to do with consumer reported and consumer tracked data from all the different devices?
  3. Physicians will emerge back in the power seat. With Accountable Care Organizations and Patient Centered Medical Homes, consumers are finally becoming more aware of all the shortcomings in our sick care system. They trust their physicians although somewhat blindly given ongoing challenges with evidence-based care and quality which are often the result of our Fee For Service system (too little time) combined with an abundance of new research happening concurrently.
  4. mHealth will be the buzz word and exciting space as entrepreneurs from outside healthcare and people with personal healthcare experiences will attempt to capitalize on the technology gap and chaos within the health system. This will create lots of innovation, but adoption will lag as consumers struggle with 15,000+ apps and the sickest patients (often older patients) are the slowest to adopt.
  5. Device proliferation will go hand in hand with mHealth and with the Quantified Self movement. This will create general health devices, fitness devices, diabetes solutions, hypertension solutions, and many other devices for wellness and home monitoring for elderly patients. Like mHealth, this will foster lots of innovation but be overwhelming for consumers and lead to opportunities for device agnostic solutions for capturing data and integrating that data for payors and providers to use.
  6. The focus on incentives will shift in two ways. Technology vendors will begin to look more and more at the gamification of healthcare and how to use gaming theory and technology to drive initial and sustained engagement. At the same time, the recent ruling will allow employers to shift from rewards to “penalties” in the form of premium differentials where patients who don’t do certain things such as take biometric screenings or engage with a case manager will pay more. In 2014 and 2015, this shift will be from penalties with activity to penalties tied to outcomes.
  7. Consumer based testing will drive greater regulation. With the focus on home based testing (e.g., HIV or High Cholesterol) and the increased interest in genetic testing especially when tied to a medication, the FDA and other government agencies will have to address this market with new regulations to close gaps such as life insurance companies being able to force disclosure of genetic testing in order to get coverage (even though the testing isn’t necessarily deterministic).
  8. Clinics will prepare for 2014. With the increase number of consumers being covered in 2014, there will be an access challenge for patients to see a provider. This will drive buildout and utilization of health clinics such as TakeCare or MinuteClinic. Clinics will have to look at how to adapt their workflow to create a patient relationship which will create potential integration points with TeleHealth and bring back up the issue of whether they should or could replace the traditional Primary Care Provider (PCP) relationship or not.
  9. Telemedicine will hit a tipping point and begin to Cross the Chasm. They now have better technology and adoption within major employers. This will start to create more and more business cases and social awareness of the solution. With utilization, we will see great adoption and the increasing use of smart phones for healthcare will drive telemedicine into an accelerated growth stage.
  10. Transparency solutions will continue to be a hot area with CastLight and Change Healthcare leading the way. Their independence and consumer engagement approaches based on critical moments (i.e., pointing out how to save money on Rxs just before a refill) and using multiple channels will show high ROI which will also increase broader healthcare awareness making them part of the population health solution.
  11. Generics will no longer be a talked about issue. With generic fill rates running so high across different groups and being front page news, PBMs, pharmacies, and pharma will truly begin to move forward to embrace the specialty market with a clear vengeance (at least in the US).

There are still a few longer term trends that I’m watching, but I don’t think that 2013 is the primary year for them.

  1. The evolving role of pharmacists within the Medical Home and with vaccines.
  2. A significant shift from mail order to 90-day at retail fulfilled by massive central fill facilities.
  3. Pharma co-opetition where they begin to collaborate at the disease state level realizing the a rising tide is good for all boats.
  4. Integration of data from all types of solutions and actions into workflow triggers that automatically create new events within the care management infrastructure using Service Oriented Architecture and Business Process Management.

FitBit One Goes To The Gym – Last Challenge

I’ve shared a few tests with you about my FitBit One which included comparisons against my Garmin and versus a pedometer. Today, I got to take it to the gym with me and tested it for distance and calorie count relative to several pieces of equipment from LifeFitness – treadmill, stationary bike, and elliptical. For the treadmill, I also looked it two ways: (1) running at an 8 minute mile pace and (2) walking at a 15 minute mile pace at a 15% slope.

As you can see before, the FitBit was much better aligned on distance with the treadmill, but it was not as aligned on calorie count. I’m have no hypothesis here. I will say that I was surprised that the uphill walking didn’t somehow register as steps. I say that because I went on an outside run the other day up and down hills, and the FitBit did a great job of tracking my uphill runs and translating that into floors climbed.

As a side note, I think this does a nice job (if you believe the equipment calorie count) on showing how a slow walk up a steep slope can burn lots of calories compared to a fast run.

FitBit vs Garmin – Test #2

As I mentioned, I got my new FitBit One the other day. I’ve been experimenting with it each day. Yesterday, I showed how it performed versus a pedometer. Today, I focused on how it performed versus my Garmin Forerunner watch that I use to track my distance and speed when running outside. While the data relative to the pedometer was pretty similar, there was a 15-16% discrepancy between the FitBit and my Garmin.

According to the Garmin, the FitBit was underestimating my distance traveled. To validate the distance, I also used www.walkjogrun.net to calculate the distance (which they estimated to be 0.82 miles).

At the same time, I also wanted to see if there was a difference between just having it sitting in the bottom of my pocket versus putting it on my belt loop. Location didn’t seem to matter.

 

(Note: This chart shows distance in miles.)

FitBit vs. Pedometer – Test One

I’ve been enjoying the FitBit One for a few days now.  I decided there were a few tests that I’d like to do.  The first one was to compare it to the step count from a pedometer that I’ve had. 

It hasn’t been a highly active day (as I’ve been working from my home office), but there doesn’t seem to be much of a difference. 

My Fitbit One Has Arrived – Challengers?

I’m a big believer in the idea of connected devices – Quantified Self movement.  While I’d love to track my data via manual input, that comes and goes.  So, over the summer, I began thinking about a device to use.  There are lots of them out there, but I’lll admit that it was hard to determine which one would be best (see one review):

For me, I decided there were several criteria:

  1. Able to track multiple activities – walking, running, biking, and steps.  (in terms of calories and raw numbers)
  2. Easy mobile and web interfaces with wireless integration.  (Mac and PC)
  3. APIs for connecting into other applications.
  4. Battery life.

I didn’t spend much time looking at the communities associated with each and how they work to motivate you to exercise.  I do think that’s important.

I also like the Striiv game idea where you earn points based on your activities (badges) to unlock more things in a virtual world.  For gamers and others, this plays into the “gamification” trends.

 

Did I pick right?  We’ll know soon, and I’ll give you an update.  But, I certainly welcome challengers.  (If you want me to try your device and compare it, let me know.)

10 Healthcare Trends To Monitor in 2013

I came across the chart below and thought I would post it with my perspective on trends for next year.

  1. “Accountable Care” in the form of CMS ACOs or Patient Centered Medical Homes will continue to expand.  I predict some companies will begin to provide the infrastructure such that providers don’t have to come up with the $2-4M in capital needed.
  2. Integrated “Big Data” looking at pharmacy, medical, lab, AND patient reported data AND physician EMR data will be the rage to mine and use in predictive models. 
  3. Consumer engagement around health will continue to be a huge focus.
  4. Obesity will continue to be an issue that people struggle with and employers begin to focus more actively on managing.
  5. mHealth in the form of mobile apps, connected devices, telemedicine, and remote monitoring will begin to move from the innovators to be a more standard component of the solutions with ROIs being more standard.
  6. The core components of health reform will remain (regardless of who wins) and the shift of people from underinsured and uninsured into the insured pool will finally be the tipping point for provider access and push growth in the clinics and telemedicine (video and phone) world. 
  7. Transparency will become something that consultants begin to mandate and try to get into contracts around pricing, claims auditing, and other services across the entire healthcare spectrum.
  8. Hospitals will continue to buy physicians and look at how they can play a more dominant regional role especially outside of the urban areas. 
  9. Consolidation will continue across all areas – providers, payers, pharmacy, pharma, technology.
  10. Investment in healthcare will continue to outpace other industries. 

Are You Part Of The Quantified Self “Movement”?

I’m not sure whether to call it a movement or a trend or some other term, but I think it’s very interesting.  This idea of capturing and tracking data manually and through devices fits very well with the idea of “Know Your Numbers” in healthcare.

Here’s the descriptionof Quantified Self from Wikipedia:

The Quantified Self is a movement to incorporate technology into data acquisition on aspects of a person’s daily life in terms of inputs (e.g. food consumed, quality of surrounding air), states (e.g. mood, arousal, blood oxygen levels), and performance (mental and physical).

The movement was started by Wired Magazine editors Gary Wolf and Kevin Kelly in 2007as “a collaboration of users and tool makers who share[d] an interest in self knowledge through self-tracking”. In 2010, Wolf spoke about the movement at TED, and in May 2011 the first international conference was held in Mountain View, California.

Quantified Self is also known as self-tracking, body data and life-hacking. It is described in articles such as this one in the Economist and this in Forbes.

With an increasing amount of devices on the market that can be integrated (e.g, FitBit), we will see a huge rise in remote patient monitoring where the patient takes a greater role in this effort.  Even know you are seeing more efforts to integrate devices into the “smart home” with a focus on older patients, but I think this smart home concept will continue to grow. 

This Slideshare presentation is a nice summary…

 

 

Consumer Engagement Technology In Healthcare

Another big piece of my discussion with a consultant about consumer engagement in healthcare was from a technology perspective. Ultimately, there are three questions here:

  1. How should I think about and structure the landscape?
  2. Who are some example companies in each area?
  3. Which ones are the best to use (and for what segment of the population)?

I’m going to skip the 3rd question for now since there are business cases for any of these tools. The question is more about understanding your population and what your objectives are.

Here’s a quick model from Accenture to begin this…

But, here’s what I laid out for questions one and two. (BTW – This is my impression. There was no science here. I welcome comments and additions of companies are areas to put on the map.)

Examples of companies that I mentioned that I’ve seen, talked to, monitored, or heard of doing interesting work were:

And, ultimately, I told them what I tell many people…To see who the new companies are in these spaces look at the list of sponsors to Health 2.0, the presenters, and who’s recently gotten VC funding. This is going to capture some of the ones that are off the radar.

They had a great question to try to wrap this up which was how does this information get to the patient. That last mile is one of the big issues today. A few of the things I pointed out are:

  • Some companies like Happtique are trying to play here. This builds on some of the concepts from the Center For Information Therapy. (Prescribing information or applications)
  • As far as I know, the EMR and practice management systems aren’t doing much here – Epic, Cerner, Allscripts. Although Athena did buy a small player in this space years ago.
  • There are some companies trying to do this as part of their jump into the ACO space (e.g., Lumeris with NaviNet).

I thought I’d wrap up with this image from Chillmark Research.

Infographic On Using Twitter To Track Health Trends

I was looking up some information on using Twitter in healthcare prompted by the announcement around MappyHealth winning the HHS innovation award and found this that I thought I would share.

How And Why I Use Twitter

I often get stopped by people I know who say things like:

  • I see a lot of your tweets in LinkedIn.
  • You use Twitter. Why? I don’t really want to tell people that I’m going to eat dinner or some other miscellaneous fact.
  • Can you really get anything out of 140 characters?

So…let me share my perspective on how my use of Twitter has evolved and what I get out of it.

It took me a few tries before I found out how to use Twitter effectively.

  1. First, I tried just using it to share thoughts or opinions across a variety of topics. I didn’t find that valuable and wondered why anyone would follow me to know that.
  2. Second, I tried using it to pose questions about healthcare topics that I was interested in. That worked ok because it synched with LinkedIn, but I didn’t have enough Twitter followers for that to make a difference.
  3. Finally, I decided to just use it as a “notebook” to capture facts while I read or to bookmark articles that I found interesting. (Of course, some of this became possible as every web article now offers a “share” feature.) This works especially great when you’re at a conference and is even a good way to follow a conference that you miss.

The next thing that I had to figure out was just understanding the technology.

  1. Reading things in Twitter is ok, but a lot of people post links. Often times, it’s not that effective to be constantly going out to the links to see what they say. In comes Flipboard to save the day. (see older post here)
  2. To make things more searchable, you have to use hashtags where you put a “#” in front of a key expression or search term.
  3. Most people don’t get a lot of followers although you hear about all the celebrities with millions of followers. (see HubSpot presentation below for general Twitter statistics)

I figure it must be working for me now. I have over 1,000 followers which according to this site is true for less than 1% of people on Twitter. But, I don’t think followers is the best indication (especially since almost ½ of followers might be bots and you can buy followers). I know that it’s working for now since I can post a question and sometimes get an answer. I can connect with companies and meet people. I’ve even heard from people at conferences that they follow my feed. Probably my best experience was when I read an article early in the morning, posted a quick summary, and then had a national reporter call me to ask me for the source so he could write an AP article…all before 8 am.

Just to check, I went out to the StatusPeople application which tells you how many of your followers are bots versus simply inactive. I was pleased with the results.

Digital Dimension Of Healthcare Paper – Global, mHealth, Halvorson

I was just skimming the Digital Dimension of Healthcare whitepaper which has as one of its authors – George Halvorson from Kaiser.  There’s not a lot of new information in here if you’re well read on the space, but I like their framing of a fourth space for health delivery along with their two dimension matrix of opportunities.

The other piece that I’ll pull out here is the Six Principles that they identify:

  1. Set the direction, and commit to it
  2. Balance patient confidentiality and information sharing
  3. Empower patients
  4. Adapt payment systems
  5. Reduce barriers to regulatory approval and licensing
  6. Accelerate the healthcare evidence base

%d bloggers like this: