Tag: mHealth

Oscar and the Emergence of Consumer-Centric Healthcare | Sherpas in Blue Shirts

As I’ve blogged before, the healthcare space is at the cusp of a transformative change. Consumers are assuming greater ownership, control, and responsibility of health outcomes. Consequently, the decision making is shifting to the individual. Consumption patterns have undergone a significant change owing to disruptive mobile computing, rapid adoption of social media, next-generation sales/engagement channels, and ‘‘anytime-anywhere’’ information access. As individual consumers (patients and physicians) become more empowered, healthcare is transitioning to a principally patient-centric operating paradigm, with focus on cost, efficacy, and equity.

Analogous to what Uber has done to transportation, in progressive (and controversial) ways, there is a fundamental transformation in healthcare, placing patients at the center of all the action. These changes are reflected in the way reimbursements are distributed (moving from volume-based to outcome-based) and the onset of personalized medicine therapies based on real-world evidence. These gamut of changes are also aided by various cultural and socio-economic forces. The disruptive shift – from a healthcare provider-centric to a more customer-centric model – is driving significant healthcare investments in digital enablers of consumerization – social media, mobility, analytics, and cloud.

Healthcare consumerization levers

The New Kid on the Block

These winds of change have given rise to an immense opportunity to cater to this new patient-centric paradigm leveraging next-generation technology channels and enablers. Which brings us to Oscar, a New York-based health insurance start-up. Health insurance in the United States has conventionally been complex and non-transparent. With the advent of PPACA and health insurance exchanges (HIX), there has been a greater sense of accountability. Oscar aims to bring big data/analytics, design thinking, and transparency to the often-puzzling world of health insurance, making it smart, intuitive, and simple for consumers.

The idea for Oscar was born when one of its co-founders received his health insurance bill and realized that none of it made sense to him. The complexity and high entry barriers to health insurance can be gauged from the fact that Oscar was the first new health insurance provider to launch in the state of New York in more than a decade. The start-up sells coverage to individuals through insurance marketplaces in New York and New Jersey. The insurance plans offer free basic care including doctor visits, phone calls with doctors, preventative care, and generic drugs.

The company is backed by seasoned venture investors Peter Thiel and Vinod Khosla as it attempts to bring Silicon Valley mojo to health insurance. It was co-founded by venture capitalist Josh Kushner (an early stage investor in Warby Parker and Instagram), Kevin Nazemi (a Microsoft veteran), and Mario Schlosser (MIT Media Lab and hedge fund experience). The company’s strong digital health ethos is reflected in the senior leadership team – CTO Fredrik Nylander is a former Tumblr executive, Dave Henderson (ex-Cigna and EmblemHealth) is Oscar’s president of insurance, board member Charlie Baker is former CEO of Harvard Pilgrim Health Care, and senior medical executive hires from EmblemHealth, a leading health plan in New York state.


What’s different?

Oscar’s value proposition is on being a more personalized health insurance provider, with a strong sense of convenience and personal attention, aided by marketing, design, and consumer service practices that are aligned to the needs of the millennial generation. It has a sizable emphasis on telemedicine (offering it free of charge), and lets customers speak to doctors 24×7 with a goal of 10 minute wait time or less. To help answer medical questions, the company has doctors on call to chat online or over the telephone with customers. Oscar also lets customers check prices for procedures ahead of time and offers three free in-person doctor visits and free generic drugs.

The company faced minor bumps in the beginning with poor reviews and complaints (an average Yelp rating of 2 stars), but has instituted a feedback input mechanism based on customer interactions. The company aims to productize every customer interaction by implementing feedback as soon as it receives it. It has a slew of partners and tie-ups in line with its strategic focus.

In December 2014, Oscar announced a partnership with Misfit (a wearable tech company), by offering members free fitness trackers, along with Amazon gift cards, as part of an attempt to incentivize healthy behavior and bring down employee healthcare costs. Oscar also offers services at many hospitals and retail locations such as New York CVS CareMark. It is a health insurance company that resembles a technology start-up rather than a faceless insurance behemoth, sort of a health insurance start-up for “born digital” natives.

The future

Since commencing operations in July 2013, Oscar has had a reasonable start. It had about 15,000 members and estimated revenues of U$72 million in 2014. It doubled that member base to 30,000 in January 2015, with one month of enrollment left to go. Oscar is seeking approval to enter California’s individuals exchange by 2016. The primary litmus test for Oscar is going to be the same as for any health plan – managing risk, keeping premiums reasonable, maintaining margins, handling payer-provider convergence, and improving health outcomes. Oscar is a prime example among modern companies looking to shape consumer-driven healthcare in the United States leveraging next-generation technology. As it looks at a reported valuation of significantly more than US$1 billion (implying a handsome 14x sales multiple!), the bet might just pay off.

Photo credit: Oscar

Embrace the Berg: the Real Power Lies Beneath the Surface | Gaining Altitude in the Cloud

As we’ve noted in previous blogs and white papers, mobility can unleash the next wave of healthcare productivity and provide dynamic channels to foster wellness.

Yet, in the complex healthcare environment, mobility is more than just crafting a mobile app for the iTunes Store. To us, that is just the tip of the iceberg, since the infrastructure and institution must be readied to accommodate mobility and capture the full power of mobile two-way data streams through seamless integration of data, companion devices, legacy apps, web interfaces and internal processes to optimize workflow while maintaining robust security and compliance. All this is critical, as in healthcare, conflicting and less than fully current data can lead to devastating impacts.

While a simple clinician/facility locator app can be created and deployed with a minimal amount of effort, something like a context-aware mobile video consult demands clean instant access to a “complete single record of truth.” To provide that, the infrastructure must be upgraded to support the roaming bandwidth demands, a streamlined access process needs to be instituted, patient records must capture the most current feeds from a variety of data sources and be presented in a context-aware workflow that intuitively supports decision-making, and any entry must properly interface with legacy apps, and securely and surely prompt the desired follow-on actions. And all this must be done without comprising data privacy.

Disregarding the needed investments below the surface can at best lead to a bland, unappealing healthcare mobility offering. At worst, it can lead to devastating medical and information errors. While there are numerous, productive baby steps along the way that incrementally accumulate to fully unleash the power of mHealth, healthcare companies should develop a clear vision, supported by a robust organization and investment plan, to bring it successfully to fruition.

Where Are the Opportunities in Health Insurance Mobility? | Gaining Altitude in the Cloud

Mobility in the health insurance industry has been an extremely hot topic during the past several months; white papers on the subject abound, the media is hyping it, all major IT service providers have announced service offering expansions, and a multitude of high-tech startups are hoping to capitalize on the expected spike in spending. Despite all this activity and buzz, what is the actual potential of mobility for payers in the health insurance industry?

In fact, there are many opportunities to leverage mobility in both the business to business (B2B) and business to consumer (B2C) segments across the payer value chain.

Health Insurance Mobility: Myriad B2B and B2C Opportunities for Payers throughout the Value Chain

There are efficiency gains from further minimizing paper-intensive processes, and time savings from capturing data real-time with built-in error-checking. Revenue growth potential by harnessing mobility’s advantages of immediacy, ubiquity and unique personal engagement to capture buyers and members attention and build brand loyalty. Wellness improvements through using the GPS/accelerometer and other features of mobile devices along with the power of social media. This has a double-edged benefit for payers; mobility-enhanced wellness can be most appealing to the younger and more-educated demographics which are the most profitable segments, and can move others to an improved and thus less costly health state.

Mobility presents great potential opportunities and gains for the healthcare payer industry. While there are inherent differences between the B2B and B2C segments across the healthcare value chain processes, those payers that leverage the right opportunities for their unique strategic growth plans stand to reap significant rewards.

To learn more, please read the Everest Group Executive Point of View: Health Insurance Mobility: Myriad B2B and B2C Opportunities for Payers Throughout the Value Chain.

Will mHealth Finally Kill the Cliché? | Gaining Altitude in the Cloud

Healthcare IT has long been accused of being 10 years behind other industries, with hospitals being another five years behind that. This cliché has been around for so long, it is almost an axiom. And while (like with most clichés) there is, unfortunately, more than a bit of truth, we firmly believe that with the growing push and pull demands of healthcare mobility, this cliché’s days are numbered.

Mobility in healthcare will place demands on IT that will both force upgrades and elevate IT’s business impact in ways never seen before – thus making upgrade funding possible. Just a few examples:

  • mHealth applications that can enable direct entry, which boosts clinician productivity and revenue potential
  • Gamification that provides uniquely engaging ways to distill care information and entice people into improved wellness
  • Cost savings, and patient comfort benefits, from remote viewing and remote sensors

Clearly, mobility will strain existing capabilities on not only wireless infrastructure but also servers and most substantially the data integration structures, in order to provide timely and accurate information as individuals move within facilities and across the country. Thus, the push is on to update and upgrade IT.

But while there have always been “pushes” on IT (demand always exceeds budgets), what makes us optimistic that the upgrades will actually begin to catch-up with other industries is the emerging “pull” from the business side of healthcare. A recent anecdote well illustrates this potential for IT transformation. A nursing home/assisted living operator approved a system-wide installation and upgrade across its facilities to support mobile data entry. Given the tight margins and the very thin IT budgets (typically less than one percent of revenue), this major initiative was demanded and funded by clinical operations, and cost justified by a one percent increase in therapist billable hours.

As this and the other examples above suggest, there are major direct business benefits from instituting robust and useful healthcare mobility.

If “An Apple a Day Keeps the Doctor Away,” can mHealth Apps Bring Patients and Healthcare Folks Together? | Sherpas in Blue Shirts

The February 1866 edition of Notes and Queries magazine includes this: “A Pembrokeshire proverb;  Eat an apple on going to bed, and you’ll keep the doctor from earning his bread.” Since then a number of variants of the rhyme have been coined, up to our present-day “An apple a day keeps the doctor away.”

Just as apples have a numerous benefits – they contain Vitamin C, reduce tooth decay by cleaning one’s teeth and killing off bacteria, and may even protect brain cells against neuro-degenerative disorders like Alzheimer’s Disease, as has been suggested by Cornell University researchers – mHealth apps serve multiple purposes including promotion of wellness and communicating with healthcare providers, payers, and pharmacists.

Indeed, many of the country’s large healthcare providers and payers are offering patient-focused smart phone applications that will change the way information is exchanged between member patients and their physicians, hospital providers and payer companies. These are being marketed as tools that will strengthen the patient and provider relationship by allowing direct interaction with physicians.

As more applications emerge, the relationship is driven by smart phone technology and applications are at the patient’s fingertips, will this change the dynamic of how healthcare is accessed and delivered?

Eighty-one percent of physicians now report that they use a smart phone, and they are as pervasive with today’s patient population, according to a recent Manhattan Research study. The applications allow physicians to consult with their patients outside of the office, and physicians are providing good feedback on them. Yet these applications will need to increase efficiency and demonstrate workflow optimization, if they are to become a staple of how healthcare communications will be transformed in the future.

There is a rush to the top among healthcare organizations for the development and availability of mobile technology. They want to be viewed as leaders for providing mHealth for their members and constituents, thus guarding against loss of market share. But this begs the following questions:

  1. Will this development outpace potential FDA regulations?
  2. Will this provide enough convenience to be adopted and used by consumers?
  3. Can it be controlled so that accuracy, quality, and privacy issues are addressed?
  4. What does it replace as the transformation evolves?

Even though this is moving at a rapid pace, it will need to be evaluated and the end state defined. How quickly can any large healthcare payer or provider deploy this rapidly changing and disruptive technology? What will be required of the governance structure needed to support, maintain, and monitor the pervasive use of sensitive data?

I’d love to hear your thoughts. And in the near future I’ll share more of mine, and update you on movement in and traction gained in this exciting space!

The Consumerization of IT may be a Bigger Problem for Business than IT | Gaining Altitude in the Cloud

King Cnut (Cnut the Great) of England, Denmark, Norway, and parts of Sweden once famously instructed the tide to refrain from rising, only to hours later find its disdain for his royal decree. Today’s CIOs find themselves faced with similar limits on their power and influence as Androids, iPhones, and iPads flood the workplace. The power of the purse cannot control these new and disruptive technologies as they are funded directly by employees. Corporate policies and other traditional control mechanisms are also being eroded or washed away in the rapid adoption of these easy to install and attach devices. Even more worrying is the ocean of ready-to-use, high-power business applications that are only one click away from installation. As enterprises find themselves waist-deep in this new reality, they are forced to accommodate these new technologies, user expectations, and business certainties.

Without belittling the significant technological and security questions this new reality poses, it is the challenge to the way enterprises do business that may have the most far-reaching implications. One of the key challenges these technologies and capabilities present is the effect they have at the interaction points between parties. Employees expect to have instant access to HR support systems and be able to conduct their interactions through mobile-enabled self-service applications. Customers have instant price look-up and competitive information at the point of purchase. Patients have their medical records on their iPhones and expect healthcare providers to be able to utilize this information yet conform with the right to privacy. Payment systems are only a Bluetooth click or barcode swipe away. The point is this: even small changes to how parties interact can create significant and sometimes surprising impacts on a firm’s structure, controls and completive models, sales channels, and governance. When these changes are imposed by the broad scale adoption of new technologies – as is the case with mobility – the question is not how to control or gate them but rather what to do now that they are here.

To further explore the extent of this impact, let’s use a major healthcare institution as an example. Healthcare is covered by strict laws that regulate how key information and data is captured, shared, and utilized. This web of regulation has contributed to the slow adoption of new information technologies across the healthcare industry, and resulted in most healthcare institutions adopting closed networks with tight controls on new devices and applications. The existing structures and polices are under attack. Patients arrive with instant access to their own data, stored on their own devices or resident in a host of cloud-based vehicles, with the reasonable expectation that clinicians utilize this information to avoid duplicate tests and take advantage of patient history. At the same time, clinicians face uncertainty on efficacy of the data, yet encounter far more educated and interactive patients. Patients are able to receive second opinions from a variety of qualified and unqualified sources in real time. When combined with changes in how clinicians (who are often independent of the provider networks) expect to interact with healthcare institutions and further complicated by payment systems that are shifting to real-time mobile-enabled devices – it is easy to see that mobility will and is changing the way medicine is and will be practiced across the entire supply chain. The organizational and business model implications look to be huge and all because nearly everyone today has the power of the Internet in their pockets.

Consumerism is Driving Healthcare Organizations’ use of mHealth, the Cloud and other Technologies | Gaining Altitude in the Cloud

At an mHealth conference I recently attended, Kaiser Permanente Information Technology’s senior vice president stated, “Our integrated model, scale and technology are providing the foundation for delivering truly real-time, personalized healthcare. That is our journey and this is our obligation.”

He hit on one extremely important point – personalized healthcare. But there’s another critical reality in the healthcare industry…consumers and consumer convenience are driving the ways in which healthcare companies will support patients’ needs, and it’s all around the technologies most of us use today.

Think about it in the context of mobile technologies. Mobile is:

  • Pervasive – 91 percent of Americans own a mobile phone and 75 percent own a PC
  • Always on – Users access their smart phone more than two hours per day
  • Simple and convenient – Little or no training is required for usage
  • Location aware – in America, 150 million GPS locator devices were sold in 2009
  • Context aware – i.e., sensor technologies such as OnStar, the in-vehicle security system

With mobile being such an integral part of our lifestyle, consumers will push for increasing mobile health (mHealth) capabilities to research, access, and pay for healthcare. And consumers’ influence on how healthcare providers leverage technological capabilities potentially extends far beyond mHealth. Questions healthcare companies must consider include: Are consumers leveraging social media to select healthcare providers, learn about service prices to enable them to negotiate with healthcare providers, etc.? Will consumers push to pay for healthcare via PayPal-type services or a smart phone application, rather than by credit or debit card? Should healthcare providers establish their own online medical condition search capabilities for their patients, including live chat with medical specialists, to help retain patients and help ensure better diagnoses? Should they build consumer-friendly, self-administering applications such as diabetic patient monitors that will administer insulin as needed based on preset dietary information? Should these be free services, or should they carry a small fee ala www.justanswer.com which gives consumers access to a wide range of medical/health professionals for a nominal cost per query?

From an “inner workings” standpoint, strategic aspects healthcare organizations must consider as they relate to mHealth and use of cloud computing as a delivery platform for mHealth include:

  • To what extent should they develop applications and employ methods that will allow consumers to use personal tools (e.g., iPad, iPhone and Blackberry) to access those applications?
  • What will infrastructure platforms look like, and to what extent will cloud computing play a role?
  • Will internal “App Stores” become necessary, and how will those be managed?
  • What will be the organizational impact of migration to cloud and next generation platforms – i.e., what will internal IT, roles/skills, governance, and core processes look like in a post-transformation end-state?
  • How can organizations more effectively drive improved utilization of existing assets, while cost-effectively adding new capacity via cloud or next-generation data center models?

I realize I’ve asked a lot of questions in this blog, and that was exactly my intent…healthcare companies and providers of the technological capabilities must consider these questions and many more if they are to succeed. The reality is that packaging mHealth solutions is highly challenging because of the complexities that exist in the diversity of service providers (carriers, integrators, device and appliance providers, and application developers) each of which provide vital pieces of the puzzle including network backbone, broadband, mobile integration support and maintenance, cloud computing capabilities, and application development and provision. In today’s service environment there are traditional boundaries that will have to be bridged, and success will be based on service providers’ development of an “mHealth in a box” solution set. It can be done, but it won’t be an easy task.

mHealth Providers Learning It’s All About Competitive Cooperation | Sherpas in Blue Shirts

mHealth (also written as m-health or mobile health) is a term used for the practice of medical and public health supported by mobile devices. It is fast becoming a top priority for large, complex healthcare organizations seeking to make electronic records, patient information, etc. accessible to a wide range of constituencies via the device or appliance of choice. And its importance is not to be underestimated, as it offers the mobility and flexibility necessary for the user to react instantaneously to the provider, thereby facilitating wellness and avoidance of critical outcomes that require intense and expensive treatments.

Many quality applications already exist that create opportunities for physicians and clinicians in their quest to provide efficient quality healthcare. These applications are available from any number of sources and on a variety of platforms, and are designed to keep people healthy, manage existing diseases, increase health literacy, manage medical information, and ensure medical compliance.

Yet despite the growing importance of mHealth, healthcare payer, provider and pharmaceutical service providers are finding themselves increasingly challenged to find mHealth platforms that can accommodate global 99.9999 percent availability of critical data, as well as provide different levels of information access to physicians, clinicians, pharmacists, patients, plan members and others.

Competitive Cooperation Is the Key

There are several types of mHealth providers. One is phone company carriers that offer voice, telephone and data-driven products based on a device with a set of applications (for example, Android, Blackberry, and iPhone.) Hardware provider organizations such as Dell, HP, and Apple also offer applications based on proprietary operating systems. And providers of integration services have created services based on these separate and distinct platforms (for example, Macintosh versus Microsoft.)

While these different types of mHealth providers have traditionally competed separately for new business opportunities, it is becoming abundantly clear that successful provision of mHealth services with its diversity of needs across traditional market boundaries will require a cooperative effort among these provider types. Healthcare organizations have each embraced the major carriers of choice, and have invested heavily in hardware devices and appliances including iPads, Blackberry, and Android. And most have a healthy mix of these given the individual needs of thousands of physicians and clinicians located across national organizations within diverse settings such as clinics, hospitals, billing offices, and home health.

Indeed, the provision of mHealth services is going to require unique relationships between provider organizations to address the entire spectrum from research and development, implementation, and ongoing support and maintenance to the ongoing provision of new technologies as the marketplace and regulatory compliance demands. There will not be a “one size fits all” solution, but a requirement for unique cooperation and partnerships among the client and multiple service and application providers.

Mastering the art of service provider cooperation to provide the continuum of care needs across an ever changing and somewhat controversial market space will be a formidable challenge, but is an absolute must in order for mHealth to deliver on its promise and need for availability of a robust set of tools anytime and anywhere.

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