World of mHealth Today and Predictions for Tomorrow (Part 1 of 2) – 9/9/11

Reader Benson asks, "What about a merger of games and patient engagement apps? Then the added layer of social connection would be an existing population of patients who have downloaded their local hospital or health plan mobile app." I agree it would be fantastic if health systems and payers could leverage the existing mobile user base to jump start social games around health. I think most of the apps from payers require users to log in for benefit info, but a lot of the hospital apps are anonymous and don’t require user registration. I’d prefer to see this led by health systems and providers, but those groups need to be motivated and paid to do it. Providers also probably need help from third parties because this is so out of their realm of expertise.

I’ve been trying to figure out what to write for this post all week and haven’t been able to get past responding to Benson’s comment above. Maybe it’s the beautiful weather outside or that I’ve had way too many out of town visitors recently or issues I’ve been having with business partners (that would make for a passionate post). I’m not sure exactly what it is, but something is distracting me.

I’ve seen stories and thought about topics related to the size of the iPad for healthcare, texting for chronic disease, haggling for lower costs at the doctor, how we use mobile for location services and Internet, and rules to evaluate the value of a mobile health app.

I surfed the Web and Twitter to find something interesting but alas, I failed. So in the end, I’m going to write a post that breaks down mHealth today and then predicts where it goes in the future. This is solely my impression of the world of mHealth, so take that with a grain of salt.

To me, the best way to look at anything in healthcare is to break it down into the relevant stakeholders and then see if there is some way to piece it back together again. Healthcare is incredibly disjointed, disconnected, and filled with powerful competing interests trying to take home a piece of an ever-growing and all-too-big pie that represents ~17% of the US GDP.

The goliaths are payers, health systems (I’m going to lump health systems, hospitals, and docs into one category even though I realize their interests aren’t really aligned), the government, and big pharma. I’m going to include retail pharmacy as well, because $300 billion in annual revenues is probably worth including. The other major player is consumers, though they don’t really realize it and aren’t engaged, informed, or organized enough to have much say.

In this context, I’ll look at how payers, health systems, and pharma are currently targeting the main users — consumers and providers. I’m not going to discuss government attempts at mobile health apps because they are mostly irrelevant.

Payers

Payers are definitely trying to figure out how to use mobile to engage consumers and (soon) to engage providers. Payers in our system really own the patient, and are typically (outside of some rare instances and certain integrated systems) the only ones with a longitudinal view of patients (sorry, all you data-sharing HIEs.)

They know, for example, all the medications that you take for which you claim insurance. PBM Medco, in what I think is a brilliant offering, has a mobile app that provides "personalized out-of-pocket costs for any prescription medication and lower-cost options based on the member’s pharmacy plan coverage". And I don’t think it is the only payer to offer something like this. What makes this appealing to me is it follows a working model from another industry, Mint, that gives users guidance that could actually save them money.

But because PBMs have pharmacy benefit information rather than medication dispensing records, how accurate is the data? People file insurance claims for some meds, but use a chain’s generic programs ($2) for others. I don’t know the percentage of prescriptions that go through claims system.

Several insurers have released mobile apps that offer access to benefit information and some basic personal health information. Humana has released several games and United Healthcare’s subsidiary Optum Health has several apps, including the game OptumizeMe that I reported about last week. This is a good article on the things that payers are doing or thinking of doing in the mobile health space.

I think payers are likely going to continue to build apps with decent adoption because they understand what the consumer needs, namely: benefit info, provider directories (local search is huge and growing over mobile – look at Pew’s recent report and Google’s acquisition of Zagat), and potential ways to save on prescriptions. For most consumers, at least the insured ones, having a mobile health app with payer integration is necessary to give you all that you need in terms of mobile access to health-related information.

In terms of payer engagement of providers through mobile apps, it’s something I’ve read that payers want to do. Features being explored include secure communications, coding assistance, and identification of gaps in care. If it provides a clear value proposition to docs and the price is right (free), then I could see this as an effective strategy.

Big Pharma

Pharma obviously has a strong interest in developing mobile apps that (a) improve consumer medication compliance, which increases refill volumes and builds brand affinity, and b) keep providers thinking about a specific drug when it comes time to prescribe.

For consumers, pharma companies have developed apps that to track meals, mood, and a host of other things related to health. Other apps are meant to educate consumers about specific conditions or medications.

A story I read and reported on in March discussed digital marketing firm Eveo, which has very strong ties to the pharma industry, building 40 mobile apps that were being called mobile patient relationship management (MPRM) apps. Categories for these apps include disease management, lifestyle focused, and treatment trackers.

Pharma companies also funded GlowCaps to help drive increased refills and also provide valuable data to the pharma companies about consumer use of medications.

On the provider side, pharma companies have developed medical calculators and educational content. They also sponsor premium content listings in Epocrates, the mobile drug reference company that went public this year, which  account for the majority of the revenue that Epocrates generates.

I think consumers will likely continue to use pharma built or funded offerings because, like payers, pharma has the money and marketing savvy to know what consumers need and want. Build a free educational app for a specific condition or a free adherence app to help people keep track of their health and people will use it. It’s the same model that pharma uses with websites and social media to "unbrand" the content so people don’t know they are sponsoring it.

I think provider usage of pharma-sponsored apps will continue because providers need medication reference apps, pharma needs provider eyeballs when they are getting ready to prescribe, and mobile app vendors need revenue beyond what providers are willing to pay for these apps.

I think most docs (although this probably varies somewhat by specialty) don’t really like launching an app that is branded on the logo or splash screen by a pharma company. But I think docs will still use it if it provides them with information that they need. It’s like taking pens and paper from drug reps because it saves on office expenses.

It also reminds me of my wife’s residency education material that is all blatantly sponsored by pharma companies. Medical departments can’t afford the crazy prices of medical texts, so why not have the drug companies pay for them?

To be continued…

I’ll finish next week with retail pharmacy and providers. After that, I’ll then try and see if I can tie it all back into a coherent picture of where things in mHealth are and where they are going. Hopefully it doesn’t end up with a mobile app space as disjointed as our health system.


Travis Good is an MD/MBA involved with health IT startups.

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