Creating a Unicorn in Mobile Health: Moving from Efficacy to Scalability.

Over the past 10 years, the healthcare industry has been shifting and positioning to try and find the right combination of solutions and technology to help increase the quality of care while doing more with less. At the same time the challenge of increasing adherence, improving outcomes and reducing costs remained. With efficacy established, Mobile Health is transitioning into a phase that integrates an array of Digital Health tools that gives us new ability to reach more patients than ever before.

10 years ago we didn't have:

     - EHR / EMR / Analytics
     - Reimbursement
     - IoT and SAAS Platforms
     - Band / Watch Technology
     - Sensor Miniaturization & Big Data
     - Smart Phones & Tablets
     - Shift POCT to Home
     - Move to Pay for Performance
     - Meaningful Use 3 / MACRA / MIPS

With many of these factors in place, or coming soon, we now have a great opportunity to move the industry from Efficacy to much needed Scalability.

More importantly, with the emergence of Meaningful Use 3 (which requires that 5% of data coming into electronic records to be “Patient Generated”), new Reimbursement Codes, new ACO models, MACRA and MIPS, and more – enterprises that are financially responsible for patient populations MUST have access to cost effective tools in order to achieve the best outcomes to make their business models work.

Doctors don't need more data, but the EMR / EHR and Analytic Systems do – and this data must be collected in an efficient, cost effective way, that fits into the clinical workflow and the business economics!

Over the past 10 years, traditional Remote Patient Monitoring solutions have proven up to a 70% reduction in re-hospitalization by monitoring discharged patients at home. However, expense has always been an issue, with a perceived high Total Cost of Ownership (TCO), it was only cost effective for deployment with the heavy spenders – probably about 5% of the population.

There is demand for a solution that can be deployed across a much larger population, at the lowest cost possible, to collect the greatest amount of actionable data – in order to feed the Analytics systems, help achieve the better outcomes and reduce associated healthcare costs. Smart phones and apps play a part, but are not the total answer, especially when dealing with the Medicare and Medicaid populations who make up the 20% that consume 80% of healthcare costs today (reference: M2M Cellular Hubs vs. Smart Phones)

Over the years, the lack of Interoperability with EMR / EHRs has stifled the propagation of Mobile Health, not to mention misaligned solutions out there that are over engineered or simply do not fit business models and address use cases. (reference: The Uninvited Guest and iReturned)

Many large companies, like chip makers, telecom and cloud software providers, entered the Connected Health market 10 years ago, seeking MILLIONS of customers / subscribers. When the healthcare system responded with hundreds of units in pilots, these companies went to the sidelines to wait for the market to emerge, which perpetuated an environment of unmet need. The resulting gaps have  created the new opportunities we have today. (reference:  I See Whitespaces)

The need has emerged for "Lighter" solutions to be created that can reach a bigger population in the most economical way.  (reference: IVRs in Remote Care, The Big Bang Theory, The 8020 Rule and Healthy Dynamism)  Many of these factors need to be incorporated into new and innovative platforms in order to scale across a much larger population of patients.

I personally believe we are approaching a “triple witching” in Healthcare that makes the next 18 months or so (through 2019) ripe to produce a “Unicorn” in Mobile Health that will take many of these observations / factors – and mold them into a model that addresses the scalability issues in a "Lite" way and seizes upon the market need and demand:

     (1) Reimbursement / MU3 / MACRA / MIPS by 2018 / 2019

     (2) SAAS / IoT Technology / Cloud / Mobile Objects / Best Practices

     (3) Solutions required to Make Financial Models Work 

With this Triple Witching in place and the “Best Practices” and “Lessons Learned” over the past decade, there is an opportunity to develop a solution that will meet the demands of the market.

Our new venture, Life365 has developed a platform that factors in all these variables to provide a "Lite" solution that addresses these needs. The Rain Platform could enable a patient to leave the hospital with a low cost wearable “Sensor Band” and a box of disposable intelligent strips, controlled from the Cloud in order to avoid readmission. The patient can stay connected to their provider in a “lite” way to greatly improve adherence while extending clinical resources and reducing costs. Life365 is not the science, but the platform and voice for all these great solutions to come to market in a business model and eco-system that works economically.

The Life365 / Rain Solution incorporates the following characteristics and functionality:

Engagement Driven / User Centered

First and foremost, solutions / platform going forward must be engagement driven.   Many solutions offer Predictive Analytics and Precision Medicine targeting therapy, but we feel if it is not effectively driven by Engagement Analytics, it will have sub-optimal results.  Individuals must be engaged on their own terms, using the "I am Human"? model, to help reach maximum adoption and adherence. The Life365 Personalyze? system looks at the engagement and environment of the Patient, Caregiver and Devices in order to make recommendations to achieve higher adherence.

80/20 Rule

No solution can address the needs of 100% of any patient population. Heavier equipment, and more user intensive solutions for home can address maybe 5% of the population, but in order to get to a higher percentage – up to 25-30% – different approaches must be utilized: using lighter equipment, wearable sensors, smart disposables – or maybe NO equipment needs to be deployed at all if an IVR call or text message works. Based on the Engagement Analytics, maybe IVR calls, Emails with incentives would be enough to engage the patient. “Think Lite / Deliver Lite” – Lite Home Care Delivery solutions.

Patterns and Trends

To reach a larger number of patients cost effectively, using off the shelf solutions and consumer sensors, driven by Engagement Analytics may be all that is needed to keep someone adherent in their prescribed routines, rather than using more expensive traditional remote monitoring solutions. Exact physiological data, although important, is not always needed to produce the “best” outcome or achieve the greatest adherence with patients. We believe that taking small looks at patterns and trends can be just as effective to check if a patient is “with me” and engaged. Supplemented by friend and family care giver support – lighter touches and “nudges” can be more effective in helping drive engagement in a much more cost effective way.

Integrate into Clinical Workflow

If physiological data is collected from FDA cleared devices, in order for a solution to achieve maximum adoption, the data must integrate easily into the clinical backend and workflow of clinicians and providers to reference in patients’ electronic health records.  Lack of interoperability results in each EHR / EMR to be interfaced to individually, which stifles widespread use.

Solutions Looking for Problems

Over the past 10 years, many Mobile / Connected Health solutions have been created, often much too early – waiting for markets to emerge and efficacy to be shown – resulting in the creation of solutions that are looking for problems to solve.  Life365’s Rain platform provides the ability for these disparate solutions to be plugged in and packaged into a business model that actually works for the healthcare customers and allows the solution providers an opportunity to license their services / solutions as part of the Life365 / Rain platform.

Moving Point of Care Testing to Home

There is a great opportunity in providing a platform for Rapid Diagnostic companies to help move their Point of Care Testing (POCT) to home.  This includes embedding low cost connectivity into disposables and to enable cost effective transfer of data to the cloud and clinical backend systems using the Life365 RainBand.

Time and Attendance / Licensure

Another big need is for Home Healthcare agencies to prove / document that their clinical (and non-clinical) resources were at the patients side at home for Reimbursement and Licensure.  The RainBand has the capability of allowing a caregiver to touch their badge to the Band and to send / record time, attendance and location data to the Cloud.

Minimal Connectivity / Setup

The solution must be able to work without a Smart Phone or Tablet – after all, 60% of seniors have access to a Smart Phone, however only 10% use for more than calling or texting. It must also be able to be used within a larger population environment (i.e. Independent / Assisted Living facilities) with secure multiple users connections not requiring individual connectivity.  In addition, devices that are shipped to the users should be able to connect to the wireless system and devices in a simple, automated way with little or no interaction of the individual using a combination of wireless radios to connect to the cloud seamlessly and economically.

Unique Combination of Radios and Sensors

Sensors are getting smaller; Algorithms are getting smarter, driven by Big Data in the cloud.   The Home Medical Devices as we know them today will start to disappear with their technology going into disposables and wearables, connected to the Cloud.  In order to work effectively with the 20% that consumes 80% of healthcare, unique Radios (XBee, SigFox, BLE, NFC) and Sensors (GSR-Hydration / Stress, Green LED-Heart / Heart Rate Variability and 6 Axis Accelerometer for Steps / Calories / Impact & Fall Detection) can be packaged together in a Wearable Sensor Band to provide more meaningful data and help maximum adherence at home.  RainBand would serve to communicate with other wearables around the Body Area Network to take the data in a cost effective way to the Cloud.

Bi-Directional Cloud Connectivity on a Band

One of the biggest advantages of being able to provide “Bi-Directional” capability on a Band, is the fact that cost, size and power consumption can be reduced, instead of having to move up to a Smart Watch tied to a Smart Phone.  Imagine if you could put additional Smart Watch-like functionality on your activity tracker to keep you engaged, instead of taking it off and putting it in the drawer.  Imagine being able to put that additional functionality on the Band by a loved one from the Cloud, or suggested / driven by the Engagement Analytics system. We believe our RAIN OS will revolutionize the way IoT devices can get smaller / transparent and more intelligent, instead of having to go to more costly and power hungry processors.

Family Care Coordination

We believe that one of the main tenets is to engage the Family / Friends (non-professional care givers) in the care and support of their loved ones, is giving them tools to empower that support.   Our central Rain portal allows for adding SAAS functionality (Device, Droplets, Health Data, Reporting) to enable care coordination.  In addition, it helps transition the cost of care from financially responsible enterprises (B2B2C) to “Consumer Directed Care”.

Moving from Health & Fitness to Healthcare

Currently the Activity Tracker / Watch (typically targeting Health & Fitness) is projected to be a $5B market in the US by 2020, with a CAGR of 3.5%.   The Wearables / Mobile Health market in the US by 2020 is $49B, with a CAGR of 47.5%.  We believe there is great opportunity to partner with existing Consumer Sensors and Platforms to move them into Healthcare.  Barriers to Healthcare include:  Privacy/HIPAA, Patient Data, Regulatory, Liability, etc.   Health & Fitness companies partnering with existing Mobile Health companies seems to be a pathway to help move them into the much larger Healthcare market, for additional revenue and at the same time mitigate risk by working with companies knowledgeable in this space.

Conclusion

In our new Life365 / Rain platform and RainBand, we have incorporated the guiding principles outlined above into a solution that we believe could have the potential to be a “Unicorn in Mobile Health”.

We would like your thoughts?.

Kent