Transcript Better Health Technologies Presentation

Remote Patient Monitoring for Disease
Management: 10 Observations About
the State-of-the-Market
Presented at
NMHCC Disease Management Congress
Chicago, Illinois
September 2002
Better Health Technologies, LLC
Vince Kuraitis JD, MBA
Harry Leider MD, MBA
www.bhtinfo.com
(208) 395-1197
Top 10 Observations
Remote Patient Monitoring (RPM)
1)
The market is extremely fragmented. RPM comes in many sizes,
shapes, flavors.
2) The value proposition of RPM is compelling!
3) Show Me the Evidence! The strength and specificity of the RPM
value proposition is unproven.
4) Customers are adopting RPM applications.
5) Cost savings (NOT quality improvement) is driving current RPM
adoption.
6) Valuation of RPM companies is unclear (market cap/sales)
7) RPM has multiple drivers AND multiple barriers.
8) Weak links in the RPM value chain
9) The immediate RPM market is being driven by niche applications
(as opposed to integrated, enterprise-wide adoption).
10) Watch for RPM’s synergy with other promising health care
information technology killer applications.
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BACKGROUND
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The Big Picture: Health Care in 2002
Relative Cost & Quality
Optimal
Quality
You
Are
Here
x
Relative
Cost &
Quality
?
Optimal
Cost
Source: Northeast Consulting Resouces
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Shifting DM Metrics:
Creating Value for Patients and Shareholders
Optimal
Quality
You
Are
Here
x
Relative
Cost &
Quality
Outcomes
?
Optimal
Cost
Source: Northeast Consulting Resouces;
Better Health Technologies, LLC
ROI
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High Variation in Chronic Care
Source: Rand Health, Taking the Pulse of Health Care in America, 1999
http://www.rand.org/publications/RB/RB4524/
Ch. 4 – Taking the First Steps
“common chronic conditions
should serve as a starting point
for the restructuring of health
care delivery”*
*IOM Report, Crossing The Quality Chasm, 3/01
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Restructure Health Care Around
Priority Conditions
•
AHRQ should identify 15-25 priority conditions (mostly chronic
conditions)
Cancer
Diabetes
Emphysema
High cholesterol
HIV/AIDS
Hypertension
Ischemic heart disease
Stroke
•
Arthritis
Asthma
Gall bladder disease
Stomach ulcers
Back problems
Alzheimer's disease and other dementias
Depression and anxiety disorders
Purchasers, health care organizations, and professional
groups should develop strategies and implement action plans
to substantially improve quality for priority conditions over the
next 5 years
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Strategic Context
Personalized Medicine
• Remote patient monitoring (RPM)
• Contact center (mail, email, call center, inperson…..)
• Appropriate treatment settings (home,
ambulatory……)
• Customer Relationship Management (CRM)
software
• Customized pharmaceuticals
• Genomic profiling and therapies
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1) The market is extremely
fragmented. RPM comes in
many sizes, shapes, flavors.
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RPM Companies
A&D Medical
ADT
Active Corporation
Advanced Bodymetrics
Applied Digital Solutions
AeroTel Medical Systems
Agilent
Alere
AMD Telemedicine
American Medical Alert
American TeleCare
Avidcare
Biotrokik
BodyMedia
Cambridge Heart
Cameron Health
CardioCom
CardioNet
Cyber-Care
CyberNet
Data Critical
Digital Angel
DMCare
Elite Care
General Electric
HealthCare Vision
HealtheTech
HealthFrontier
HealthHero Network
Heart Alert
HomMed
IGEN International
iMetrikus
InterComponentWare
IntelliServices
InterCure
iSense
Kivalo
Life Navigator
LifeLine Systems
LifeConnect
LifeLink
Lifemasters
Lifestream
M-Biotech
Medipattern
Medisana USA
Medisignal
Medtronic
Micronics
Nexan
Panasonic
Personal Electronic Devices
Polar
QRS Diagnostic
Remote Medical Corporation
Roadside Telematics Corp
Sensatex
Sensitron
Siemens
Spacelabs Medical
SportBrain
Stayhealthy
Telemed.com
Telemedicine Group
Telemedicine Solutions in Healthcare
Therasense
TransMedEx
TransMedEx
VISICU
VitalCom
VivoMetrics
Welch Allyn
Wellness Monitoring, Inc.
World Wide Video
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MEDICAL
MONITORING
MEDICAL
DEVICES
ETC.
SMART
HOUSES
REMOTE
PATIENT
MONITORING
TELEMED
DISEASE/
CONDITION
MGMT
SENSORS
FITNESS/
WELLNESS
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Medical Monitoring
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Medical Devices
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Telemedicine
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Disease Management
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Fitness/Wellness
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Sensors
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Smart Houses
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2) The value proposition of RPM is
compelling!
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3) Show Me the Evidence! The
strength and specificity of the
RPM value proposition is
unproven.
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The Evidence
• Conclusions-to-date
– RPM and clinical improvement: positive, inconclusive
– RPM and cost effectiveness: almost non-existent evidence
• AHRQ Evidence Report*:
“The evidence for the efficacy of telemedicine technology is less clear.
The problem is not that studies have strong evidence against efficacy,
but rather that their methodologies preclude definitive statements.
Many of them have small sample sizes that preclude statistical power,
and the settings of others may not be equivalent to clinical settings.
Still others focus on patient populations that might be less likely than
others to benefit from improved health services, such as people who
have complex chronic diseases.”
*Source: http://www.ahrq.gov/clinic/telemedsum.htm
• Other studies with similar conclusions
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4) Customers are adopting RPM
applications.
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5) Cost savings (NOT quality
improvement) is driving current
RPM adoption.
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3 Definitions of Chronic Disease Market Size
(Drawn to scale)
$500 M
DMSCs
$20 –$100 B
Opportunity*
* Projections by BCG and First Union
$700 B Chronic Care Patients
“Outside the
Box”
“Inside the
Box”
DMSCs (Business Model)
•
•
•
Prevent unnecessary
hospitalizations and ER visits
Save $$ short term for payor
•
•
•
Quality w/o ROI only “sells” for a
few diseases
4 to 6 top diseases
Done “to” the patient
Care coordinator = 3rd party
•
Local/regional focus
•
Outsource vs. build
DM (Care Delivery Model)
•
Optimize patient health status &
clinical outcomes
•
•
•
•
Save $$ long term for payor or patient
Health care consumerism/ patient
empowerment
100+ conditions/diseases
Done “by” the patient
•
Care coordinator = patient or doctor
•
•
Not geographically bound
Assembly from components viable
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4 Different Chronic Disease
Customer Segments Emerging
MCOs
Employers
Patients/Caregivers
Providers
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Varying Value Propositions for Chronic Care
Who cares most about ________?
MCOs
Short-term
Medical Costs
Employers
Patients/
Caregivers

Health/Quality of Life
Clinical Quality
Peace of Mind/Monitoring
Productivity
Convenience/Time Savings
New Revenue Source
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Providers
Varying Value Propositions for Chronic Care
Who cares most about ________?
MCOs
Short-term
Medical Costs
Employers

Patients/
Caregivers
Providers

Health/Quality of Life

Clinical Quality

Peace of Mind/Monitoring



Productivity
Convenience/Time Savings

New Revenue Source

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Varying Value Propositions for Chronic Care
Who cares most about ________?
MCOs
Short-term
Medical Costs
Employers

Patients/
Caregivers
Providers

Health/Quality of Life

Clinical Quality

Peace of Mind/Monitoring



Productivity
Convenience/Time Savings

New Revenue Source

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6) Valuation of RPM companies is
unclear (market cap/sales)
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Valuation of Health Care Sectors
Differs Dramatically
7) RPM has multiple drivers AND
multiple barriers.
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Trends Fueling RPM
1. Health care consumerism
2. Medical error reduction/quality improvement initiatives
3. Connectivity infrastructure: transaction processing lays
the foundation for e-care
4. DM “assembly” model gaining prevalence (vs. making or
buying)
5. IT – data warehousing, data mining
6. Clinical work flow automation software
7. ASPs: particularly suited for health care
8. HIPAA = standardized data
9. eHR: employers connecting with employees
10. Physicians accept the Internet, particularly for clinical
applications
11. HMOsRUs.com: Defined contribution/eHealth Insurance
12. Medicare reform
Barriers to RPM
•
•
•
•
Reimbursement
HIPAA: Privacy/confidentiality issues
Physician resistance
Technology maturity
–
–
–
–
Infrastructure
Bandwidth
Standards
Friendly user interfaces
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8) Weak links in the RPM value
chain:
Reimbursement
Mobility (wireless)
Point-of-care access
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9) The immediate RPM market is
being driven by niche
applications (as opposed to
integrated, enterprise-wide
adoption).
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Mobile Computing Apps
•
•
•
•
•
•
Charge capture and coding
Prescription writing
Clinical documentation
Lab order entry/results reporting
Decision support
Alert messaging and communications
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10) Watch for RPM’s synergy with
other promising health care
information technology killer
applications.
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Scanning the Horizon – Possible
Killer Apps
•
•
•
•
•
•
•
Medical information sites for physicians
Wireless reference, ordering and coding systems
EMR (Electronic Medical Records)
Voice recognition
Physician patient email
Telehealth in the patient's home
Expert systems for decision-support
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SUMMARY &
IMPLICATIONS
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• RPM – early, promising
• Value propositions
– Initially cost savings
– Multiple others
• Need for industry collaboration
– Evidence of RPM effectiveness
– Improving reimbursement
– Rapid development of synergistic, complementary apps
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END
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Better Health Technologies
• Strategy, business models, partnerships
• Disease/care management and e-health
• Consulting/Business Development
•
E-Care Management News
– Complimentary e-newsletter
– 3,000+ subscribers in 27 countries worldwide
– www.bhtinfo.com/pastissues.htm
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Recent BHT Clients
• Pre-IPO Companies
– Life Navigator (remote monitoring connectivity and health intermediary
services)
– DiabetesManager.com (Internet diabetes DM)
– CogniMed (highest cost/risk patient management software)
– Caresoft (consumer focused DM)
– Benchmark Oncology (oncology DM)
– SOS Wireless (cellular phone technology)
– Click4Care (Internet DM)
•
Established organizations
– Medtronic -- Neurological DM (medical devices/chronic disease solutions)
-- Cardiac Rhythm Patient Management
– Disease Management Association of America (trade association)
– PCS Health Systems (PBM)
– Varian Medical Systems (oncology equipment & systems)
– VRI (behavioral health care management services)
– Washoe Health System (integrated delivery system)
– S2 Systems (medical transaction processing software)
– CorpHealth (MBHO)
– Physician IPA
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– Centocor (biopharma)
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