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October 03, 2010

mHealth, markets and cold, hard cash

Last month, PricewaterhouseCoopers issued a report, Healthcare Unwired, examining the market for mobile health monitoring devices, reminder services, etc. among both health care providers and the general public.  One of the big take-away points seems to be that 40% of the general public would be willing to pay for mobile health, or mHealth, devices or services ranging from reminders to data uploads; and the reaction by insiders is either joy (40% is good) or dismay (40% is not enough).  PwC estimated the mHealth market to be worth somewhere between $7.7 billion and $43 billion per year, based on consumers' expressed willingness to pay. Deloitte recently issued a report on mPHRs, as well -- and there is tremendous interest in this space, as discussed in John Moore's recent post over at Chilmark Research.  I agree with John's wariness with respect to the mHealth hype; there is certainly something happening out there, but significant questions remain: What exactly is going on?  Is there reason to be interested in this stuff or is it just something shiny and new?  Can mHealth improve health care status and/or health care quality and/or reduce health care costs?

As a society, across generational divides, we are continuing to move in the direction of greater comfort with electronic communication and mobile devices, and we have the desire and readiness to use these tools in managing our health care -- there are numerous studies and reports out there supporting these conclusions beyond the latest from PwC and Deloitte.  The infrastructure is moving in the right direction, though there are still significant bumps in the road, e.g., lack of a universally-accepted data set for PHR data (the CCD/CCR divide, epitomized by the Microsoft HealthVault/Google Health adoption of these different health data standards).  In a growing effort to overcome some of the interoperability issues in this space, HealthVault recently announced that it will be joining forces with the Continua Health Alliance, thus making a large number of mHealth devices capable of uploading data directly into individuals' HealthVault PHRs.  This is -- potentially -- a huge development; we have yet to see how it will play out.  As HealthVault continues to grow its "white-label" PHR market among health care providers (growth goosed in part by the meaningful use regulations), its ubiquity, paired with the utility of the Continua standards, and the growing adoption of these tools both by health care providers and the general public, will turn mHealth from a geek-fest into a tool, or set of tools, used by all.

Clearly, this is the wave of the future, and the interest in mHealth is not just as a plaything for the early adopter.  Eventually, we will stop calling it mHealth -- it will simply be part of "health." (See Susannah Fox's post on a similar sea change in thinking about the term "e-patient" -- if we are all educated, empowered and engaged in our own health care, then we are all patients, and perhaps need the appellation "e-patient" no longer.) 

As mHealth edges into the mainstream, it must continue to demonstrate its utility.  As it does so, its potential for success should not be measured by the dollars individuals are willing to shell out, but by the savings to the health care system that it enables.  There should be no market for mobile health devices and apps that cannot be counted on to increase health care quality and/or reduce health care cost.  If they don't do one or both of thoise two things, then they could still be sold -- but as toys, not as meaningful health care tools.

The value of SMS messaging (text messages) is highlighted by Jane Sarasohn-Kahn in her review of the PwC report, and has been studied by Kaiser Permanente in as mundane an application as appointment reminders, where the potential for significant savings was identified. 

Savings should be created by those efficiencies, and the price for the tools should be paid by the beneficiaries of those savings -- the health care payors: public and private sector insurers (i.e., Medicare, Medicaid and commerical insurers), self-insured employers and self-paying individuals, and health care provider organizations paid on some basis other than fee-for-service (and we hope this last group will be growing, thanks to the growing emphasis on sharing fiscal responsibility for health care quality with provider organizations).  

David Harlow
The Harlow Group LLC
Health Care Law and Consulting


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Major challenges of mHealth platforms in terms of service quality and trustworthiness have been articulated in the following papers .

1. Service quality of mHealth platforms: Development and Validation of a Hierarchical Model using PLS

2. Trustworthiness in mHealth information services: An assessment of a hierarchical model with mediating and moderating effects using PLS

3. mHealth : An Ultimate Platform to Serve the Unserved

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