Platform Wars! Opening Keynote. The Confluence Of Healthcare Unbound And Health IT: Nurturing A New Business Ecosystem

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1 Opening Keynote Platform Wars! The Confluence Of Healthcare Unbound And Health IT: Nurturing A New Business Ecosystem Vince Kuraitis JD, MBA Better Health Technologies, LLC blog (208)

2 1) What is the dominant social networking platform company? 2) What is the dominant care coordination platform company? 2

3 Opening Keynote A Manifesto for Healthcare s Disruptive Innovation of the Decade: Open EHR Technology Platform(s) and Ecosystem Vince Kuraitis JD, MBA Better Health Technologies, LLC blog (208)

4 Overview I. Sometimes the Questions Are More Important Than the Answers... II. Let s Talk About Platforms... III. Let s Revisit a Central Debate in Tech Circles: Walled Gardens vs. The Open Web IV. Health IT Evolution: 1) Closed/Monoliths 2) Walled Gardens 3) Open Platforms V. The Future Vision for Care Coordination Platforms: Personal Perspectives 4

5 Care Coordination Platforms I. Sometimes the Questions Are More Important Than the Answers... 5

6 Care Coordination Platforms The Questions are More Important than the Answers Will there be one or more dominant platforms? Will care coordination platforms evolve from EHRs? stand aone SW? elsewhere? What is the relevant geography for care coordination networks and platforms? Will doctors multihome their workflow on multiple platforms? Is there potential for winner-take-all markets or platforms? Will walled garden or open platforms provide greater value in healthcare? Where are the greatest value creation opportunities? Is explosive growth of Healthcare Unbound (HU) technologies dependent on emergence of health IT and/or dominant care coordination platforms? What is payers role in adoption? 6

7 II. Let s Talk About Platforms... 7

8 Value Creation vs. Value Capture Platform or App? 8

9 rd A Decade of Opening Up Platforms to 3 Party App Developers 9

10 Platform Multiple Connotations/Definitions Manufacturing, e.g, truck/suv Information/communication tech, e.g., Windows Business models/strategy 10

11 Platforms can leverage more than one layer in a technical stack Is it a platform or an app? False dichotomy Think hierarchically 11

12 IT Evolution: 1) Closed, 2) Walled Garden 3) Open Cohesive / Collaborative 3 Open Platform & Apps New Business Ecosystem 2 Walled Garden (Value Network) Fragmented 1 Closed Closed Open Technology Architecture 12

13 Opening Keynote A Manifesto for Healthcare s Disruptive Innovation of the Decade: Open EHR Technology Platform(s) and Ecosystem Vince Kuraitis JD, MBA Better Health Technologies, LLC blog (208)

14 Candidates for a Healthcare Care Coordination Platform EMR/EHR Existing medical management workflow SW Social networks HIE ACO Mobile Payer/MultiPayer other? 14

15 Are Physicians Amenable to Multihoming Their Workflow Platform(s)? Single homing -- tendency for customers to prefer single platform Multihoming tendency for customers to accept multiple platforms Implications: tendency toward single homing is one factor that creates potential for winner-take-all (or most) market 15

16 What s the Relevant Geographic Market for Care Coordination Networks & Platforms? National/International? Regional? 16

17 Why are Payers So Key in Adoption of Care Management Platforms? 1) One payer with 10% regional market share tries to dictate adoption of proprietary evidence based guidelines (e.g., for diabetes care). 2) Multiple payers with 30% regional market share (but not including Medicare) collaboratively influence development and implementation of evidence based guidelines. 3) Multiple payers with 75% market share (including Medicare) collaborate in creating public-utility like infrastructure for care and care management 17

18 III. Let s Revisit a Central Debate in Tech Circles: Walled Gardens vs. The Open Web A Case Study in Disruptive Innovation: Apple iphone & Google/Android 18

19 19

20 Apple ios and Google Android From 0% to 62% Market Share in 4 Years 20

21 Walled Garden 21

22 22

23 Apple HQ

24 What s a Walled Garden (WG)? Controls users access to content and services Restricts the user s navigation within particular areas (applications) Not all alike: differing heights and levels of permeability to the walls. 24

25 Walled Garden (WG): Apple iphone/ios/ipad/ietc. Chronology March 7, 2007: Apple introduces iphone product March 2, 2008: Apple opens API to developers April 2011: 398 K apps 25

26 Business model Open API Virtually every other aspect closed Integrated hardware/software platform Non-swappable applications Exclusive distribution of apps. Restriction on carrier choice Restrictions and controls on developers Multiple revenue sources -- HW $$, developer $$, app store Highly controlled user experience 26

27 Google Android Operating System-Open Source SW Platform Open Handset Alliance: 30+ companies Google Android open source SW Multiple handset developers bring hardware Open API 20+ smartphones on the market use Android OS 176 K Android apps Google maintains control points, e.g., see visionmobile.com/blog/2010/04/is-android-evil/ 27

28 Google can give away Android because......we make money, and lots of it, it turns out, from advertising on mobile phones. Eric Schmidt, CEO, Google 28

29 Apple & Google Have Created A New Smartphone Business Ecosystem 29

30 IV. Health IT Evolution: 1) Closed/Monoliths 2) Walled Gardens 3) Open Platforms 30

31 Three-stage evolution of HIT Cohesive / Collaborative 3 Open Platform & Apps New Business Ecosystem 2 Walled Garden (Value Network) Fragmented 1 Closed Closed Open Technology Architecture 31

32 Illustrative CGC Principles Mapped to Evolution of HIT (Value Network) Fragmented New Business Ecosystem Collaborative Data portability Minimize switching costs Avoid lock-in based on proprietary, non-interoperable technology Low barriers to entry for app developers Affordable Value to patients and payers Collaborative business model Closed Open Technology Architecture Use of Internet and web technologies Modular/component architecture: platforms + apps Open standards Data portability Application portability Private and secure 32

33 Defining Moments in Platform Evolution Cohesive / Collaborative Shared Workflow New Business Ecosystem (Value Network) Fragmented Opened API & Shared Data Closed Open Technology Architecture 33

34 1) Closed, 2) Walled Garden 3)Open Platforms + Apps Cohesive / Collaborative 3 Open Platform & Apps New Business Ecosystem 2 Walled Garden (Value Network) Fragmented 1 Closed Closed Open Technology Architecture 34

35 Health IT Examples Cohesive / Collaborative Practice Fusion Cerner Allscripts Helios Medicity Covisint Alere Many EMRs others New Business Ecosystem (Value Network) Kaiser Fragmented Epic Closed Open Technology Architecture 35

36 Value Creation vs. Value Capture Cohesive / Collaborative Maximum Value Creation New Business Ecosystem (Value Network) Fragmented Maximum Value Capture Closed Open Technology Architecture 36

37 Next Stage of HIT Evolution: Competition Between Walled Garden and Open Platforms Cohesive / Collaborative Collaborative Healthcare Business Ecosystem 3 Open Platform & Apps 2 Walled Garden (Value Network) Fragmented 1 Closed Closed Open Technology Architecture 37

38 V. The Future Vision for Care Coordination Platforms: Personal Perspectives 38

39 Care Coordination Platforms The Questions are More Important than the Answers Dominant platform(s)? Yes*, 90% Will care coordination platforms evolve from EHRs? standalone SW? elsewhere? EHRs, 50% Regional or national networks? Regional 80% Will doctors multihome? No, 90% Potential for winner-take-all markets? National -- No, 80% Regional Yes, some, 70% Walled garden or open platforms? Tossup Value creation opportunities? HU tech + other apps, 90% HU tech explosive growth dependent on emergence of dominant care coordination platforms? Yes, 70% MultiPayer? Yes, 70% * Reflects Vince s personal POV with a probability percentage 39

40 Many Lessons From Social Media (& other) Platforms Sterling Ledet https://plus.google.com/ /posts/mcnu7yzrmgg

41 ...the healing professions are in the midst of a major sea-change, a once-in-a-century shift: We re moving from medicine practiced as individual heroism to medicine as a team sport Brent James MD, Intermountain Healthcare 41

42 Brief Bio Vince Kuraitis Vince Kuraitis JD, MBA is Principal and founder of Better Health Technologies, LLC (http: //e-caremanagement.com). BHT consults to companies in developing strategy, partnerships and business models for clinical care and care management platforms/applications delivered in homes, workplaces, and communities. BHT s clients -- both established organizations and early-stage companies -- include: Intel Digital Health Group, Philips Electronics, Amedisys, Joslin Diabetes Center, Ascension Health System, Samsung Electronics, Siemens Medical Solutions, Medtronic, Varian Medical Systems, Disease Management Association of America, and many others. Vince brings 25 years health care experience in multiple roles: President, VP Corporate Development, VP operations, management consultant, and marketing executive. His consulting and work projects span 100+ different health care organizations, including hospitals, physician groups, medical devices, pharma, health plans, disease management, e-health, IT, and others. Vince speaks frequently at industry conferences and corporate events. He has been the opening keynote speaker at the Healthcare Unbound conferences between 2004 and 2010 and has spoken at about 35 conferences in the past 3 years. He has experience leading strategic planning retreats for Boards and physicians. Vince s experience includes: Principal, Better Health Technologies; President, Health Choice (medical call center), VP Corporate Development and VP Specialty Operations, Saint Alphonsus Regional Medical Center; Regional Director of Marketing, National Medical Enterprises (hospital chain with 100 facilities); Senior Consultant, Amherst Associates, national health care management consulting company. His education includes MBA and JD degrees from UCLA, and a BS degree in business administration from USC. Contact:

43 BHT Clients Pre-IPO Companies Established organizations RMD Networks HealthPost Cardiobeat EZWeb Sensitron Life Navigator Medical Peace Stress Less DiabetesManager.com CogniMed Caresoft Benchmark Oncology SOS Wireless Click4Care ecare Technologies The Healan Group Fitsense Elite Care Technologies MedSpeed Intel Digital Health Group Samsung Electronics, South Korea -- Global Research Group -- Samsung Advanced Institute of Technology -- Digital Solution Center Amedisys Ascension Health System Midmark Medtronic -- Neurological Disease Management -- Cardiac Rhythm Patient Management Siemens Medical Solutions Philips Electronics Joslin Diabetes Center GSK Disease Management Association of America PCS Health Systems Varian Medical Systems VRI Washoe Health System S2 Systems CorpHealth Physician IPA Centocor Healthwise Clinical Groupware Collaborative 43

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