health trends - inVentiv Health
Transcription
health trends - inVentiv Health
Marketing | Consumer | D i g i ta l | H e a lt h 20 15 h e a lt h trends he al th 20 15 H E A LT H trends 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. | 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. | 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 | opportunities, take smart risks and spur innovation. H ealth Overview 20 15 H E A LT H trends 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. 20 15 H E A LT H trends 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 20 15 H E A LT H trends 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. 20 15 H E A LT H trends 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! 20 15 H E A LT H trends 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. 20 15 H E A LT H trends 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 20 15 H E A LT H trends 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) 20 15 H E A LT H trends 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 20 15 H E A LT H trends 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 20 15 H E A LT H trends 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]