health trends - inVentiv Health

Marketing
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Consumer
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D i g i ta l
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H e a lt h
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At the core of our innovation practice is a simple idea: Knowing
how people’s expectations are changing lets us capture new market
health, each with clues into new possibilities and examples of brands that
got there first.
brands, and experiences that doctors and patients encounter in their
everyday lives.
Over time, those clues combine and connect to reveal trends, a new
kind of inspiration for creating experiences in the moments before our
customers realize they need them. And months and years before our
competitors realize the same thing.
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We find them in practices around the world and in the technologies,
C o n s u me r
consumer expectations. In this report, you’ll find the top eight trends in
and pictures that shift our understanding of what people want right now.
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shifts that are changing marketing, healthcare, digital experience, and
We start by uncovering clues. Clues are data points, great stories, quotes
M a r keti n g
Our fifth annual series of trends reports includes insights into the big
Di g ital
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opportunities, take smart risks and spur innovation.
H ealth
Overview
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Abigail Schmelzer
Alex Brock
Andrea Evans
Angela Cua
Azul Ceballos
Bruce Rooke
Campbell Hooper
Charles DiSantis
Chelsea Bailey
Duncan Arbour
Eduardo Menendez
Eric Davis
Fred Harrison
James Tomasino
Jeffrey Giermek
Jeffery Wilks
Jessie Brown
Joe DeSalvo
John Mucha
Joy Hart
Julie Valka
Kathryn Bernish-Fisher
Kevin Nalty
Leigh Householder
Luke Hebblethwaite
Matt Groom
Mike Martins
Nick Bartlett
Nicole Sordell
Pavithra Selvam
Phil Storer
Richard Martin
Rick Summa
Sam Cannizzaro
Sarah Brown
Sayeed Anwar
Scott Raidel
Stefanie Jones
Zach Gerber
Core
Contributors
We’re following eight trends that show how
healthcare experiences will change in 2015.
HE
AL
TH
1.
Patient 1’s and 0’s
2.
Innovation From Insiders
3.
Carrot and Stick Healthcare
4.
Remote Attention
5.
Disillusioned Doctors
6.
Wedging Learning In
7.
DIY Diagnosis
8.
The New Competition
1.
Innovation from
insiders
In Short
176%
Venture funding of digital
health is growing significantly,
outpacing other healthcare
sectors like software, biotech and
medical devices.
39%
2013 vs 2012
2014 vs 2013
—PwC MoneyTree; digital health data
based on Rock Health analysis
Last year it looked like pharma might
be left behind in the wave of innovation
changing healthcare experience. Now,
more and more industry leaders are
getting in the game.
Accelerating experience
innovation
The industry that has long-invested in early biotech
innovation is now in the market for early experience
innovation. In 2014, Abbott, Boehringer Ingelheim,
Genentech and GE partnered with Rock Health, a leading
funder of healthcare technology startups.
In Germany, Bayer went even farther, evolving their
Grants4Apps crowdsourcing initiative into a true digital
health accelerator. Each of five startups will receive
50,000€ and 3.5 months in-house at Bayer for less than
a 10% loss in equity. The accelerator’s first investments
included wearable health sensors, a smart pill bottle, and
home monitoring systems.
—VentureBeat, 2014
1.
INNOVATION FROM
INSIDERS
Bridging medicine and experience
(Finally) co-creating with our customers
The biggest surge of experience innovation
In 2014, Novartis led that field. What started
In 2015, we predict market research budgets
Genentech was one of the biggest first
this year will continue to be product design
as simple licensing of Google’s passive
will start to decline as co-creation becomes
movers, working actively with patient
that blurs the lines between healthcare and
glucose-sensing contact lens quickly
more and more central to how pharma
communities from PatientsLikeMe to
technology evolution.
became a pipeline of product possibilities
creates new experiences.
Crohnology to MediGuard to improve their
on the platform, including an autofocus
clinical trials.
feature for people living with presbyopia.
Sanofi has a really compelling program for
nurses that is focused on listening to how its
customers solve their own challenges. The
Connecting Nurses website has brought
together 14 million nurses from over 130
countries to share their ideas on how to
bridge the gaps in healthcare and resources
that happen around the world.
UCB is one we’ll be watching in 2015. They
Boehringer Ingelheim partnered with Propeller
recently partnered with MC10 to find new
Health to attach a smart sensor to the back
uses for their stretchable, electronic Biostamp
of its inhaler. They’ll be passively collecting
technology. It’s like a temporary tattoo that can
information to uncover new insights into
track biometrics, muscle strength, motion, etc.
nonadherence—insights that can be solved
Currently, MC10’s major partner is Reebok.
with more innovations in digital health.
They’re working together to create a mesh
cap that fits under a sports helmet to detect
We have a new, intriguing opportunity
to listen to those customers with the
latest Rx rating and review site, which
launched in mid-2014. Wired editor
Thomas Goetz created the site called
Iodine to crowdsource effectiveness data
on drugs and guide consumers about drug
purchasing decisions.
concussions and monitor impacts. At UCB, the
possibilities become even bigger, dramatically
changing what we can learn in clinical trials and
how we can support patients on therapy.
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2.
Percent of physicians
emailing with patients:
Patient 1’s
and 0’s
70%
68%
46%
Germany
Italy
France
39%
Spain
38%
United Kingdom
38%
United States
­—­Manhattan Research, 2013, 2014
In Short
Today’s doctor-patient
relationships include emails,
text, electronic medical records,
website portals, and, oh yeah, the
occasional conversation.
“My impressions from speaking to
friends who have been patients is that
nowadays they rarely get the doctor’s
undivided attention because of doctor
focus on the computer.”
—Dr. Ken Grauer, a family practitioner
The doctor will see you in
your inbox now
It turns out not every interaction
office into the day-to-day lives of
with your doctor requires a paper
people who need help, explains
gown. More and more physicians
that email improves efficiency
are connecting with their patients
for doctors and removes the
pre- and post-visit via email, text
frustration of phone tag. “Making
message and secure portal.
myself available via email gives my
patients a sense of direct access to
No surprise, patients prefer it. In
me,” he said. “It sends a message
fact, a recent survey by Catalyst
that I care and that I’m available
Healthcare found that 93% of
to answer questions in a timely
adults prefer to go to a doctor
manner. It builds a bond between
that offers email communication.
us that has tangible benefits for my
Many would even pay more
patients’ health.”
for it: 25% said they would still
prefer a doctor who uses email
A recent study from Kantar Media
communication even if there was a
found that nurse practitioners are
$25 fee per episode.
even more likely than doctors to
reach out to their patients in the
Dr. Joseph C. Kvedar, a
inbox.
dermatologist and founder of the
Center for Connected Health, a
These interactions are truly
Harvard-affiliated organization
incremental, supportive
that aims to move healthcare
healthcare. In a retrospective
from the hospital and doctor’s
study of 2,357 patients, the Mayo
2.
PATIENT 1’S
AND 0’S
Clinic found that there was no significant change in the frequency of office visits for patients who
connected with their doctors via the network’s electronic messaging system.
A new screen, a new barrier
Electronic health records may increase the
But a new role could change all of that.
In large networks, many of these personal messages go through
long-view that doctors have into their patients’
portals. Kaiser Permanente has one of the largest. 4 million of its
health, but they can really decrease the short
A growing number of physicians are hiring
9.1 million member network use Kaiser’s online health management
view across the exam room. Physicians and
scribes to do the data entry for them.
platform, My Health Manager. According to Kaiser’s annual report,
patients alike report that the computers and
Those scribes team up with the physician
34.4 million lab test results were viewed online, 14.7 million secure
tablets used to operate EHR systems create a
throughout the day—seeing patients,
emails were sent, 3.6 million online appointment requests were
new barrier between doctor and patient.
suggesting which codes to use, sending
made, and 14.8 million online prescriptions were refilled.
electronic prescriptions to the patient’s
Many, including Kevin R. Campbell, a cardiac
pharmacy on the doctor’s behalf, and
But Kaiser expects the platform to do more than improve
electrophysiologist who blogs as KevinMD,
generating referral letters to specialists.
communications. They want to improve outcomes, too. Of the
worry that the new focus on data input will
members who used the lifestyle features of the portal, 56% said
interrupt the doctor-patient relationship. “We
The impact is positive for both sides of the
they lost weight and 58% said they quit smoking. Insomniacs even
must continue to practice the art of medicine,
exam. Patient satisfaction scores increase.
reported increasing their nightly sleep by 32 minutes on average.
which requires that we actually talk and listen
Physicians see an average of one additional
to our patients,” Campbell said. “We must not
patient per hour, and all of the charts are
forget the value of interacting with patients,
completed by the end of the day (which means
looking them in the eye, and providing them
no homework).
undivided attention. Computers, laptops, and
Of the members who
used the lifestyle
features of the Kaiser
portal, 56% said
they lost weight and
58% said they quit
smoking.
iPads in exam rooms foster distractions.”
56%
58%
Lost Weight
Quit Smoking
—Medscape, 2014
"Aspects of current EHRs that were particularly common sources of
dissatisfaction included poor usability, time-consuming data entry,
interference with face-to-face patient care, inefficient and less fulfilling
work content, inability to exchange health information, and degradation of
clinical documentation."
—RAND Corporation for the American Medical Association, 2013
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2.
PATIENT 1’S
AND 0’S
Like many other healthcare text
programs, the short messages showed
an impact. And, they broke through to
underserved communities:
It’s not just young mothers
who are benefiting from
SMS support. Teams at
practices and hospitals,
like the Montefiore Medical
Center, are using texting to
support patient relationships.
The text Rx
82%
One of the longest-running and most well-known text-for-health initiatives is the Text4Baby program created by a public-private partnership that includes Johnson & Johnson, National Healthy
Mothers, Healthy Babies Coalition, and others. Women can sign up for the service by texting
Text4Baby moms
BABY (or BEBE for Spanish) to 511411. Then they receive text messages, timed to their due date,
with helpful tips that educate them about their pregnancy and getting ready for the new baby.
3x
82% learned about
were 3x more likely to
medical warning
believe that they were
signs they did not
prepared to be new
know.
mothers compared to
nonusers.
An interactive text-message
based care management
system at Montefiore was able
to create a 40% improvement
in appointment adherence
and modest improvement
in medication and care plan
adherence.
Montefiore extended its
use of the Sense Health
platform to pre-scripted but
customizable messages that
busy Medicaid care managers
65%
could send to patients to
make them feel like they are
getting more of the individual
65% reported they
talked to their doctor
about a topic they
read on a Text4Baby
message.
attention they wanted.
A higher percentage
of Text4baby
participants live in
zip codes with the
—California State University San
Marcos National Latino Research
Center survey, 2013
Sense Health, 2014
highest levels of
poverty compared
to the overall US
distribution.
Nearly half reported
their household
income was $16,000
or less.
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3.
The 1990s shift: Changing the
number of people choosing
expensive brand-name drugs.
Carrot and stick
healthcare
In 2015, benefit design will
change behavior the way
plan design did in the 1990s.
70%
10%
In Short
Financial incentives changed how
doctors practice medicine. Now brands
from insurers to retail are betting they can
use them to shift something even bigger:
Pre-Penalties
For Choosing
Generics
Post-Penalties
For Choosing
Generics
everyday human behavior.
—Healthcare incentive expert,
Francois de Brantes, 2013
3.
carrot and stick
healthcare
The biggest lever in
healthcare
84%
Treating people with chronic conditions accounts for
84% of healthcare costs. Governments, payers and
employers are using both financial rewards and penalties
Treating people with
to try to encourage healthier behaviors. At Cigna, that
chronic conditions
means engaging 14 million members in a digital health
accounts for 84% of
coaching program that offers mobile tools, social media
healthcare costs.
engagement, gamification, and rewards. At Pennsylvania
State University, it’s a $100 monthly surcharge for
employees who don’t complete a biometric screening
and an online wellness profile. One Midwestern hospital
chain even announced it would deduct money from
employees’ paychecks for unhealthy behavior, such as
being overweight.
Fat tax or skinny spif?
The much discussed question is: Which
exercise, most of the enrollees gradually met
one works better? How these incentives
their fitness goal of walking 5,000 steps per day
are framed—as benefits for healthy-weight
through an internet-tracked walking program.
people or penalties for overweight people—
makes a big difference. Rewards become less
Another approach may be reaching across
effective over time, but penalties can be seen
industries to punish food instead of people.
as stigmatizing and punishing, making it even
A growing number of European countries,
harder for people to make a healthy change.
including Denmark and France, have already
imposed a tax on unhealthy food and drinks. A
While people prefer the carrot design, the
tax of at least 20% placed on sugar-sweetened
sticks do seem to have an impact. Researchers
drinks could drop obesity rates by 3.5% and
from the University of Michigan Health System
prevent 2,700 heart-related deaths each year,
found that when faced with having to pay up
according to the study.
to 20% more for health insurance or do more
—Partnership to Fight Chronic Disease, 2014
Changing role of retail
One unexpected location for these new rewarding programs is the local drug store. Those
stores increasingly want to be seen as a healthcare destination. That means they’re evolving their
“minute clinics” designed to deliver fast-pass healthcare into full primary care suites offering
everything from pain management clinics in the UK to chronic disease care in the US.
And, they’re changing their rewards to match. What were once simple savings cards that rewarded
shoppers with coupons and discounts for their shopping behavior are now delivering rewards based
on shoppers’ health behaviors. If you walk those aisles enough, you might even get a step-based
-3.5%
- 2,700
A recent study found that a tax of at least 20% placed on
sugar-sweetened drinks could drop obesity rates by 3.5%
and prevent 2,700 heart-related deaths each year.
—Association for Psychological Science, 2013
—Behavioral Translational Medicine, 2013
—British Medical Journal, 2012
reward in store!
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4.
REMOTE
ATTENTION
The number of doctorpatient video consults in
the US will nearly triple
over the next year.
130M
16M
5.7M
2014
2015
2018
—Parks Associates, 2014
In Short
For years, patients have complained
Filling the gaps of modern medicine
that their medical interactions were
The eHealth Stakeholder Group in Europe has been one of many to clarify the need for new
rushed and impersonal. Today they’re
kinds of healthcare interactions. Their “Widespread Deployment of Telemedicine Services in
finding the kind of attention they want
Europe” report pointed to three shifts creating new gaps:
at home from a growing number of
remote and telesupport services.
More people
Growing elderly
Not enough
Urgent need for
living with
population,
healthcare
more efficient,
supported by
workers (the
impactful
(multiple) chronic
conditions, often
+
fewer resources
starting at a
paid for by the
younger age.
shrinking tax
+
total number is
actually falling in
=
healthcare.
European states).
base.
Beyond the demographic shifts, there are real experience gaps
in medicine, ones that leave patients feeling disconnected and
unready to manage their own care.
4.
remote
attention
Video Visits Are Replacing
Traditional Healthcare
46%
Take-home support
Health systems around the world are looking
In the US, the Geisinger Health Plan was
“Doctor On Demand” users
to telemonitoring to support patients—and
able to use remote monitoring to reduce
were asked what services they
outcomes—at home.
readmissions by 38% for congestive heart
would have used if they didn’t
have access to the DOD app.
35%
Urgent Care
Dr. Ed Brown, CEO of the Ontario
on the dollar for the system.
Telemedicine Network (OTN), has partnered
12%
Primary Care
failure patients and deliver an ROI of $3.30
ER
7%
Nothing
Face-to-face video medicine
Nearly one million US families used video
The overall reach of telehealth has grown
consultations with physicians last year. That number
substantially. In 2014, Parks Associates reported
is expected to explode in the next few years.
that 42% of broadband households in the United
States had used some type of online healthcare
The consumer preference for video connections
communications and that many had used it
with doctors over phone calls is staggering.
multiple times. Gartner believes we’re at a real
American Well, one of the leading providers of
tipping point, predicting the global telehealth
telehealth, reported that 94% of its customers
market will be more than $27 billion by 2016,
chose video over telephone. This isn’t a trend
tripling in growth since 2010.
limited to young families: American Well’s core
customer base includes the US Department of
Many urgent care systems and primary care
Veterans Affairs, Rite Aid, United Healthcare,
practices are integrating telehealth into their
WellPoint and various Blues plans.
offerings. Even Google is making telehealth part
of its search service through Helpouts, its video
Mobile may have been the tipping point for the
chat service and directory. Helpouts makes it easy
switch. A quick click of a camera phone is infinitely
for all kinds of experts to offer a live consultation to
easier to figure out than installing a webcam ever
searchers. Increasingly, those experts are doctors,
was. In that same report, American Well calculated
like the One Medical Group.
with regional healthcare authorities in
Patients used a Bluetooth-connected weight
Ontario to enroll patients with congestive
scale that included interactive voice surveys
heart failure and COPD into a remote
about shortness of breath, swelling, appetite
monitoring program. “We’re providing
and prescription medication management
them with remote monitoring tools in their
designed to detect acute events before they
homes and asking them questions based
happen. Weight data and survey answers
on clinical guidelines to track their progress
were transmitted to the patients’ care team,
on a daily basis. Then their nurses track
allowing them to respond to warning signs.
that data,” he explained. The tools include
—PwC, 2013
—AMC Health, 2014
devices like remote pulse oximeters and
blood pressure cuffs.
The nurses are also trained to be health
Telemedicine continues to grow in
coaches who can help patients understand
popularity with doctors:
their disease and set goals to improve their
• 60% of healthcare providers use
health status. “Nurses are pretty used to
telling people what to do,” Brown said. “This
is different because they’re empowering
patients to set their own goals.”
The program has reduced hospitalization
rates by two-thirds and reduced emergency
room visits by 70%.
two-way video
• 55% use image-sharing technology
• 46% of healthcare providers use
multiple telemedicine technologies
• 25% use remote patient monitoring
• 20% use their smartphones for
telemedicine
—HIMSS survey, 2014
that 60% of its customers used their smartphone or
tablet for their video visits.
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5.
Cardiologist Sandeep Jauhar
says today’s physicians see
themselves not as the “pillars
of any community” but as
“technicians on an assembly
line,” or “pawns in a moneymaking game for hospital
administrators.”
Disillusioned
Doctors
—”Doctored,” Dr. Sandeep Jauhar, MD
In Short
Who wouldn’t want to be a
The employee physician
doctor? Most doctors. This
once aspirational profession is
Remember the doctors many of today’s
Doctors tend to have access to more
now shouldered with growing
practicing physicians grew up with? It
support and get reimbursed at a
was a golden age of medicine. They
higher rate when they’re in a network
were heroes. Life expectancy was
or physician group. So, many have left
increasing. There were huge firsts, like
solo and small practices and moved
the heart-lung bypass. And doctors
into big ones.
levels of unhappiness,
disillusionment and burnout.
generally set their own course—
customizing their practice, fees and
A recent survey by healthcare staffing
hours around their communities and the
firm Jackson Healthcare found that
lives they wanted to lead.
not only are hospital acquisitions
of physician practices up (52% of
Then things started to change.
hospitals plan to acquire practices in
2013 compared with 44% in 2012), the
“The rate of severe diabetes
complications in patients of
doctors who rate high on a
standard empathy scale is 40%
lower than in patients with
low-empathy doctors.”
Questions about fraud and waste
majority of those deals—70%, in fact—
sparked new rules and bureaucracies
are initiated by doctors looking to sell.
—”What Doctors Feel,” Dr. Danielle Ofri, MD
join up.
designed to make medicine less
expensive and more uniform.
Many of these new mega employers
Governments have issued more
set factory-like goals for their employee
mandates for record keeping and
physicians, like seeing a set number of
reporting. Payers have set fees lower
patients per day.
and lower. The only way to keep up is to
5.
disillusioned
doctors
Modern medical conveyor belt
Just sick of it
Lots of new medical professionals are entering the
That balancing act is tricky across specialties. In a
Here’s the big number: 78% of 13,500 physicians
practice, and fewer and fewer of them are MDs. Instead
recent essay, “Doctors Tell All—and It’s Bad,” The
surveyed are “somewhat pessimistic or very pessimistic
a growing number of physician assistants and nurse
Atlantic’s Meghan O’Rourke wrote, “Studies estimate
about the future of the medical profession.” And, 84% of
practitioners are helping those MDs make the medical
that today’s doctors and ‘hospitalists’—medical
physicians agree that the medical profession is in decline.
home model real. They’re each working to the top of
practitioners who do most of their work in hospitals—
their skill sets and then handing a patient off when she
spend just 12 to 17 percent of their day with patients.
In “A Doctor’s Declaration of Independence,”
needs even more expertise or speciality care.
The rest of the time is devoted to processing forms,
Dr. Daniel Craviotto wrote about the daily struggle:
reviewing lab results, maintaining electronic medical
“I don’t know about other physicians but I am tired—
records, dealing with other staff.”
tired of the mandates, tired of outside interference,
In “The Physician Assistant Will See You,” Barbara
12-17%
It’s estimated that medical
practitioners who do most of their
work in hospitals spend just 12 to
17% of their day with patients.
tired of anything that unnecessarily interferes with the
Moran looked into this in-practice referral system,
‘Like it or not, medicine is now a team sport,’ observes
For patients, what’s missing is missed. Atul Gawande,
way I practice medicine. No other profession would
Dr. Reid B. Blackwelder, president of the American
a surgeon and professor at Harvard Medical School,
put up with this kind of scrutiny and coercion from
Academy of Family Physicians. As his practice moves
explains that how patients feel about their medical
outside forces. The legal profession would not. The
to team-based care, he may delegate more well-child
interactions really does influence the efficacy of the
labor unions would not. We as physicians continue to
visits to P.A.s or nurse practitioners. He enjoys seeing
care they receive and that doctors’ emotions about
plod along and take care of our patients while those on
his healthy patients, he said, ‘but the paperwork takes
their work in turn influence the quality of the care they
the outside continue to intrude and interfere with the
78% of 13,500 physicians surveyed
a lot of time — as a physician, my time may be better
provide. The patient-doctor relationship is still the
practice of medicine.”
are “somewhat pessimistic or very
spent with a patient who is critically ill.’ And he can still
heart of medicine.
78%
pessimistic about the future of the
keep his relationship with the healthier children, he
Almost 50% of doctors report symptoms of burnout —
said, ‘by a quick visit at the end.’”
emotional exhaustion, low sense of accomplishment,
medical profession.”
detachment. In “Burnout and Satisfaction With
"I wouldn't do it again, and it has nothing to do with the money. I get too little respect from patients, physician
colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients.
Working up patients in the ER these days involves shotgunning multiple unnecessary tests (everybody gets a CT!)
despite the fact that we know they don't need them, and being aware of the wastefulness of it all really sucks the
love out of what you do. I feel like a pawn in a moneymaking game for hospital administrators. There are so many
other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we
thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade."
Work-Life Balance Among US Physicians Relative to
the General US Population,” the authors found that
“Burnout is more common among physicians than
among other US workers. Physicians in specialties at the
84%
front line of care access seem to be at greatest risk.”
—The Physicians Foundation, 2012
84% of physicians agree that the
medical profession is in decline.
—Doctor on Sermo
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6.
Web traffic to HCP sites for
digital devices
Wedging
Learning In
Non-mobile
Phones
Tablets
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
Time of Day
In Short
CME on the couch
The world of medicine is
changing faster than ever.
Our collaborators at Palio-Ignite created an interesting healthcare professional
Busy healthcare professionals
layer over some recent data from Google about when people use their various
are left to try to find a way to
fit it all in.
devices. The new curves show traffic to healthcare professional websites by
device and time of day. Look at that big spike in tablet usage right around 8PM in
the chart above.
It coincides with how we’re increasingly seeing those doctors
use different screens for different behaviors. But it also
shows the new environment doctors are learning in.
They likely are browsing healthcare content, but in
what context? At that hour, for many, it’s potentially
surrounded by the welcome distraction of family
life. (Perhaps Frozen is playing for the 30th time in
the background?) Not exactly study hall.
The moments they
do make for new
education are wedged in
between appointments
or surrounded by
distraction.
It’s a behavior we originally called multitasking, but
today that always-on, anywhere, anytime behavior has
left our culture in a permanent state of mild (to major)
distraction. The challenge is even greater in medicine,
where new screens, new tools, new requirements,
and the fast growth of information are leaving doctors
overloaded and only partially connected.
6.
For every 100
prescriptions
written
50-70
go to a
pharmacy
48-66 come
out of the
pharmacy
25-30 are
taken
properly
15-20
are refilled as
prescribed
Wedging
learning in
The research mountain
Real quick: About this Rx
These multitasking healthcare providers are up against pretty big odds. It turns out new medical
Let’s start with the biggest number: 10 minutes. When Verilogue
knowledge is already doubling every three years and is projected to double every 73 days by 2020.
reviewed 70,000 exam room conversations, it found that’s how
That’s a lot of information!
long the average physician spends with a patient. That
10 minutes is largely dominated by the physician. In fact, 64% of
Average time
spent in discussion
about medications
during an exam (in
seconds)
the conversation is physician-led; 33% is patient-led—with the
Medical information is
projected to double every
73 days by 2020.
small balance owned by a caregiver or partner. How much of it is
14.9
Insurance Issues
12.6
Side Effects
12.4
Purpose
11.1
Directions
10.6
DTC Advertising
6.5
Interactions
5.5
Adherence
5.2
Obtaining
4.6
Duration
3.5
History
3.5
Allergies
3.2
Refills
namely take a medication.” He says 50% of patients disagree
2.9
Supply
EHR and genomic data are amplifying the growth of data sets, publications and possibilities. Just
at one time or another with a doctor regarding the diagnosis,
2.5
Safety
10 years after the completion of the Human Genome Project, 2014 brought the $1,000 genome.
severity of a condition or particular treatment.
dedicated to the new prescription? 99 seconds—or 13.7% of the
conversation. Previous studies have pegged that Rx discussion
time as even shorter.
Think how many months and years we spend perfecting the
messages, the Q&A, the story, all to have it boiled down into a
99-second Rush to the Rx. Beyond the minor marketing injustice,
there are real reasons to wonder about the efficacy of those
conversations. Our collaborator George Van Antwerp recently
reminded us of the biggest one: the leaky bucket of good intentions.
The entire slippery slope of adherence starts with that
1879
1889
1909
1919
1929
1939
1949
1959
1969
1977
2020
—University of Iowa, Carver College of Medicine, 2014
conversation between doctor and patient. Steve Wilkins, MPH,
one of the authors of the Verilogue study, says nonadherence is
“often a rational response on the patient’s part when faced with
a recommendation to do something they don’t agree with—
That cost decreased five orders of magnitude in 10 years. That’s not linear, it’s logarithmic. In the
next year we’ll produce more genomic data than ever before in human history. (No pressure.) And,
that’s just one kind of medical information—so many more are exploding, too.
—2013 Physician-Patient Communications Benchmark from Verilogue and
Steve Wilkins, MPH, of Mind the Gap and Smart Health Messaging
—”Pharmacies: Improving Health, Reducing Costs,” National Association of
Chain Drugstores, 2010 (based on IMS data)
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7.
DIY
diagnosis
69%
84%
69% of physicians said patients
84% of patients said
should use tech tools to help them
they should be able to use the
form a diagnosis.
self-diagnosis tools.
—WebMD/Medscape, 2014
In Short
WebMD was training
wheels. This new era of athome diagnosis and health
management will make experts
of us all.
Bringing the lab home
Today you can order an at-home self-screening kit to test for everything from bowel disease to
meningitis to cholesterol. New entrants go even further, letting users look at their own biology
on a molecular level and basically tinker with activity, nutrition, sleep and more until they get the
consistent results they want. It’s more health hacking then quantified tracking.
One of our favorites is Cue. It’s a small, modular hardware system that works with iOS to let
users create a simple home diagnostics lab. When it launches in early 2015, users will be able to
collect tiny samples of their own saliva, blood or nasal fluid to test for five distinct molecular
indicators related to inflammation, vitamin D, fertility, influenza and testosterone. Each metric
has a different marker that, when measured and tracked, can be used to discover trends,
monitor progress and help users gain realtime insight into their bodies. Those numbers
correlate with some of the most basic questions people have about health: Why don’t
I have more energy? Is it a cold or really the flu? What’s the best way to recover from
an injury or live your best life with chronic disease?
Like other trackers, Cue pulls
the data into great dashboards
that let users compete against
themselves or collaborate with
friends and strangers.
7.
diy
diagnosis
71%
Shift in responsibility
The new privacy question
For people who believe that healthcare is
People think the great debate of this decade is about privacy—what we want
expensive and difficult to use, DIY tools are a
other people and companies to know about us. We disagree. We think it’s about
way to take control back. They replace “What
transparency—how much we’re actually comfortable knowing about ourselves.
could it be?” conversations in healthcare social
media with the wisdom of science. Now a sensor
This new generation of products from both startups and category leaders are going to
on your mattress can diagnose a sleep issue. A
push all of us to answer this simple question: Do you really want to know?
71% of Millennials
blood pressure cuff connected to your iPhone
believe they are already
cannot only spot a problem, it can identify its
The question becomes even more difficult when it’s connected to “real” healthcare.
triggers.
Both healthcare and technology experts are pointing to Apple’s HealthKit as the catalyst
doing everything
that finally brings patient-generated data into the healthcare ecosystem—if patients are
they can to maintain a
healthy lifestyle.
We predict this new at-home medicine will be
really ready to share it there.
particularly interesting to adult Millennials. Our
recent “The Worried Well” report, published
with Allidura and Harris Poll, pointed to a strong
desire among that generation to take healthcare
into their own hands: “It turns out that our
hulking healthcare system–with its confusing cost
structures and white-coated experts–isn’t what
Millennials are pursuing, even as they express
worry about their health. For them the question
seems to be, not, who can help me but what can
help me. They’re mashing up food trends with
high-profile cleanses and intriguing new exercise
offers to proactively live healthier lives—and keep
the doctor away. In fact, 71% believe they’re
already doing everything they can to maintain
a healthy lifestyle. These efforts show some
Millennial Mindset: “The Worried Well”
allidura.com/millennialhealth
indication that they may be attempting to avoid
traditional healthcare altogether.”
Apple’s HealthKit Mobile Platform
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8.
The new
competition
Adoption rate of wearables
parallels that of tablets.
20%
of Americans in 2012
owned a tablet after
just two years on the
market.
40%
of Americans own
one today.
2012
21%
In Short
of American adults
already own a
wearable device.
2014
?
of Americans will own
a wearable device in
two years.
We’re just a few years away
from digital therapies taking on
traditional medicines on their own
2014
2016
turf: clinical trials, formularies, and
—PwC
prescription pads.
Bouncing back from
the backlash
In 2013, we were all calling wearables the next
big thing in healthcare. Then in 2014, Nike fired
the majority of its FuelBand team. The New York
Times called wearables “digital snake oil.”
A lot of us chucked out Fitbits.
But, investors haven’t backed off. They think
the first generation just wasn’t good enough.
The new wearables will be more clinically valid,
smarter, more convenient, and more relevant to
our lives.
8.
The new
competition
That’s just the beginning
A spoon might point the way
Real digital therapies are just beginning to take shape. In three years, the investment in digital therapies
This year, Google bought a spoon. One from Lift Labs, a company that is developing
has experienced 20x growth. These are behavioral software tools that are backed by published clinical
smart utensils for people with Parkinson’s and essential tremor. It competes head-
data. Real-world outcomes. This isn’t pill+ to improve the bottom line, it is the bottom line. Within a few
on with medicines that treat the symptoms of those diseases, but does it with
years, these solutions will be listed on formulary next to pills.
absolutely no side effects. Instead, it uses active cancellation (which is currently in
noise-cancelling headphones) to stabilize larger-scale motion. They’re also looking
Digital therapies include any software or hardware designed to deliver behavioral medicine at scale to
at solutions for drinking and grooming. We might not hear more for a while, though.
tackle chronic disease and reduce healthcare costs. A few investor favorites right now include:
After the acquisition, the team went into Google’s notoriously secretive labs.
Governments and payers are looking carefully at the potential of these new solutions.
Long a first mover on digital health, the US Department of Veterans Affairs changed
its contracting template in such a way that enables it to soon begin reimbursing its
doctors for clinical grade activity trackers in some limited circumstances.
They’re focused on a number of highly specific metrics such as stance and swing
time, gait symmetry, dynamic function, cadence and cadence variability, step count,
numbers of steps per time interval, peak performance, and functional level assessment.
Mango Health’s
Omada’s Prevent program that
Kurbo’s online and mobile
mobile app that
gives prediabetics a 16-week
weight management
improves adherence
online course with 1:1 coaching
program that is safe for
by over 50% in chronic
and support built in to reduce
kids and teens between
therapeutic categories
the risk of developing type 2
the ages of 8 and 18 and
like cardiovascular
diabetes.
their families. 85% of
disease, hypertension,
beta participants saw a
and diabetes.
significant decrease in their
BMI in 10 weeks.
—Rock Health, 2014
Google bought Lift Labs, a company developing smart utensils
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To discuss this report live, request another module, or schedule
a presentation of trends, please contact Leigh Householder at
614-543-6496 or [email protected]