...and many factors will influence the depth, breadth and speed of health care’s badly needed transformation, as costs escalate, the global population ages and the developing world demands better and more available access to care. Luckily, we’ve seen smart mobility’s impact before. Again and again, in so many industries, smart mobile devices and their applications have transformed the way people live, work and play. This is because mobile devices act as the linchpin for the other technology megatrends, delivering into people’s hands the critical information and insight they need in a given moment, wherever they are. The information and insights may be produced via social networks, analytics or both; they may be processed and stored in a public or private cloud. And they’re delivered via smart mobile devices and apps.
This report complements the work done for Ernst & Young’s Global Life Sciences Center’s study, Progressions, The third place: health care everywhere (see page 53, “Source notes”).
Progressions presents a clear vision of how behavioral change and moving health care out of hospitals and doctors’ offices to wherever patients are will play key roles in improving health care outcomes, expanding access and lowering cost. In researching our own report, we synthesized the insights of our Global Technology Center professionals with extensive secondary research — and again, we saw innumerable examples of the smart mobile “linchpin” dynamic described above at work to bring about the Progressions vision of “health care everywhere.”
Technology companies able to bring to market products and services that accelerate the global health care industry toward that vision may well be positioned to participate in an historic technology-enabled solution to one of humanity’s most pressing problems — as well as an historic growth opportunity. With this in mind, we invite you to explore the results of our synthesis in the “Overview” that follows and four subsequent drill-downs examining the effects of this mHealth transformation on health care consumers — patients, physicians, providers and payers.
Overview
The coming global mHealth transformation
Current situation
As a series of seemingly unmanageable challenges continues to plague global health care, industry stakeholders — from patients to physicians, providers and payers — are increasingly turning to mobile technologies to play a key role in the “cure.” Managing chronic disease and related unhealthy lifestyle choices has left governments in developed nations to struggle with unsustainable levels of health care cost, while millions in the developing world suffer or die beyond the reach of traditional health care.
Meanwhile, behavioral change and treating patients outside the four walls of traditional provider institutions have evolved as core to a health care industry vision of treating patients wherever they are (the third place),1 while enhancing patient outcomes and lowering cost. This is where smart mobile technology comes in: its ubiquity (90% of the world’s population was within reach of a mobile network in 2010)2 and the proven ability of smartphones and tablets to effect behavioral change have placed smart mobility at the center of an information technology-enabled vision of health care’s future.
Mobility leads multiple technologies ready to enable health care
In fact, multiple technology megatrends support smart mobility’s health care role, including cloud computing (which could provide mobile access to health information and applications), social networks (which have already begun to provide patient centric information sharing and peer support) and big data analytics (which could provide anywhere, anytime diagnostic insights). And importantly, these technologies are ready to help now. Their value in support of the three primary goals driving health care change — lowering cost, improving outcomes and increasing access — has been demonstrated in a multitude of small pilots and related examples, although these generally lack the size and control group comparisons that health care industry stakeholders require before widespread adoption.
Health care approaching a tipping point
Technology’s readiness to support the rapidly evolving new global health care vision is important because the industry is approaching a tipping point. According to the Ernst & Young report Progressions, “Health care’s stakeholders — governments, regulators, employers, payers, nonprofits — are aware that the system is broken and that we need a new system for delivering, consuming and paying for care.”3 Figure 1 (page 8) suggests the unsustainability of the current health care model, with multiple stakeholders (who can have differing incentives) and siloed information flows. This is a global issue, even though the topic may be hottest right now in the US, where health care costs have reached 17.9% of gross domestic product (GDP).4 But costs are at 8% to 9% of GDP and growing in most European countries, and are already at 4.5% in China and growing rapidly.5 The Progressions report cites the cost of chronic disease care as
the major global cost factor, accounting for 75% of health care costs. Other research suggests chronic care costs will continue to grow from a substantial burden into “a staggering one over the next two decades.”
The sheer size of the population accessing health care is increasing as well, with growing incomes in emerging nations and the expansion of health care coverage in the US. There, for instance, health care legislation is in the implementation phase, with state and federal governments setting up health-insurance exchanges and other mechanisms intended to bring coverage to an additional 30 million uninsured Americans.7 While no panacea, health information technology (HIT) is increasingly seen as one way to address the additional demands this new population will place on the already strained US health care system.
Throughout the health care system, questions of “who pays?” and “how much?” are on the table. For instance, some are
seeing a shift in the purchase of medical devices from physicians to more cost-conscious hospital buyers, requiring changes as far-reaching as design simplification and cost-reduction. Policies encouraging generic drugs as a matter of cost reduction are the subject of continual legal battles — with some pharmaceutical companies arguing that research and development funds hang in the balance. There is also widespread acknowledgement that many health care
payment and incentive systems don’t work because they encourage the “wrong” behavior, particularly in the US where costs are highest. There, pay-for-service models likely have contributed to the high cost by focusing medical professionals on actions that generate reimbursements, such as office visits, tests and surgical procedures, rather than outcomes — i.e., healthier health care consumers. “This system evolved, in part, because it rewarded activities that were tangible and easily measured by claims data such as encounters, admissions or procedures. Before electronic medical records (EMRs) were adopted, even quality measures were measured by surrogate process markers such as the fact that a lab [test] was done — not what the lab result indicated,” says Dr. Bill Fera, Advisory — Performance Improvement (PI), Health Care, Ernst & Young.
Changing health care incentives could boost mobile adoption …
Now, however, new forms of pay-for performance health care models are
emerging, such as Accountable Care Organizations (ACOs) and patient-centered medical homes, to incent outcomes oriented behavior on the part of physician practices and larger health care providers (i.e., hospitals and hospital networks). Mobile technology that enables remote monitoring of patients and that provides
patients with rapid access to medical clinicians when questions arise is expected to play a key role in such organizations.
For example, just such a tele-health trial in the UK, where the government is the primary payer and provider of health care, yielded a 15% reduction in doctor’s office visits, a 20% reduction in emergency admissions, a 14% reduction in the need for planned admissions and — most strikingly — a 45% reduction in mortality rates. “Patient satisfaction in that trial also was very high,” notes Kenny O’Neill, Advisory — PI, Ernst & Young. “Some patients started calling the main unit their ‘little nurse sitting in the corner,’ they liked it that much. It gave them a bit of control back, where before they were more reliant on their caregiver,” explains O’Neill.
… and mobile adoption could boost outcomes-oriented incentives
But despite its critical role in improving outcomes, technology’s ability to provide a digital record that demonstrates the relationship between care and outcomes is equally important. Explains Dr. Fera: “The first time managed care was attempted in the US, primarily as HMOs [health maintenance organizations], most of the clinical record was on paper and bonuses or rewards were based strictly on spend. Essentially, I could be financially rewarded if I were to withhold care. There was no quality aspect, because it could not be readily measured.”
You cand find the entire version of the study in the attached pdf document.
