mhealth mobile health and consumer healthcare apps: from $1B to 25B

lots of hype, but also lots of promise difficult realities of healthcare, but also great opportunities

80 70 IT MedTech Biotech 60 $ millions 50 40 30 20 10 0-10 $3 mm $15 mm $124 mm 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14-20 years DiMasi & Grabowski. Manag & Dec Econ, 28:469-479. 2007

Healthcare IT complex expensive slow-moving risk-averse

Healthcare IT complex expensive slow-moving risk-averse Mobile Apps simple relatively inexpensive rapid dev. & adoption risk-taking

Healthcare IT + Mobile Apps all our problems are solved

Ontario spent $47B on healthcare in 2011...

$47B Ontario spent on healthcare in 2011... 43% of Ontario s budget (and growing)

and yes, demographics do play a part, 0 to 14 15 to 29 30 to 44 45 to 59 60 to 74 75 to 89 90 + 138% 53% 2011 2036 Statistics Canada. Projected Population by Age Group

$30,000 the majority of healthcare costs are end of life $25,000 $20,000 $15,000 $10,000 $5,000 Avg = $3,267 $0 <1 1 to 4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 7475 to 79 80 to 84 85 to 89 90+ Canadian Health Expenditure by Age Group, $ per capita National Health Expenditure Database, CIHI. 2010

but...5% of the population accounts for 50% of costs 100% 80% 60% 40% 20% 0% Population Costs AHRQ, Medical Expenditure Survey, 2006

62% of those high spenders are <65, most with chronic diseases, many preventable cardiovascular disease endocrine diabetes neurological respiratory disease NIHCM Medical Expenditure Survey Panel, 2009. NIHCM & Lewin Group, 2012

even though we have... targeted drugs $320B sales in 2011 * medical devices $142B NA sales in 2011 ** EHR & health IT systems $30B spent in 2011 *** *IMS Health **Kalorama ***HIMSS

even though we have... targeted drugs $320B sales in 2011 * medical devices $142B NA sales in 2011 ** EHR & health IT systems $30B spent in 2011 *** these only improve care once a patient is already in the system *IMS Health **Kalorama ***HIMSS

potential for mhealth deliver care remotely (reduce the burden & cost of infrastructure) transmit data remotely (knowledge or clinical data) use the computer in your pocket (lever its capabilities)

how? Current Future

potential for mhealth patients can better manage themselves doctors can better manage patients systems can better manage costs

mhealth app market Millions $1,400 $1,200 $1,000 $1,300 $800 $718 $600 $400 $200 $0 $94 2010 2011 2012 (est) mhealth App Revenue

investment trends Over 134 companies received >$2mm in 2012 RockHealth Reports

investment trends &

reasons for investment? Large market Lucrative Lots of Opportunity

reasons for investment? Large market Lucrative Lots of Opportunity $126B in Canada Canadian Institute for Health Information. www.cihi.ca

reasons for investment? Large market Lucrative Lots of Opportunity $2.8 T in the US Centers for Medicare & Medicaid Services. www.cms.gov

reasons for investment? Large market Lucrative high per-app $ Lots of Opportunity Research2Guidance

reasons for investment? Large market Lucrative Lots of Opportunity high returns for VC

reasons for investment? Large market Lucrative Lots of Opportunity business innovation

reasons for investment? Large market Lucrative Lots of Opportunity technical innovation

reasons for investment? Large market Lucrative Lots of Opportunity...but...

important considerations Healthcare is highly regulated Privacy stewardship of patient data Safety Health Canada & FDA Effectiveness you have to back up claims

what is regulated? Any application/device that: Displays, stores or transmits patient-specific medical device data in its original format Controls the use, function, or modes of a connected medical device Uses an attachment that captures, stores, or displays medical information Displays clinical images for diagnosis US Food & Drug Administration. www.fda.gov

what is regulated? General Requirements Registration with Regulatory Agency Labels of use & manufacturer or developer Quality Control System Adverse Event reporting Comparable Device Listing (510K, PMA) See: goo.gl/zhbhw US Food & Drug Administration. www.fda.gov

framework for mhealth high REGULATION low none to others / social CONNECTEDNESS to data

medical devices (high regulation, low connectedness) Generally dependent on some hardware Smartphone replaces the display and computation of the device; add data transmission and other capabilites Reduces cost of development by leveraging a platform

connected services (high regulation, social connection) Exchange knowledge and/or clinical information Manage the 5% causing the 50% of costs Patient to patient (patient communities) low Patient to provider (provider search) none Provider to provider (clinical workflow) to others (social) to data

extended hospital systems (high regulation, data connected) Take data out of the hospital as clinicians & other providers want to access data remotely BYOD trend Deliver new services to the hospital that previously not possible

healthcare & fitness (little regulation, social connected) Improve wellness; increasingly paid for by insurers and employers Hardware or software to leverage capabilities of the smartphone (accelerometer, barometer, GPS) Quantified Self

knowledge & service delivery (low regulation, low connectedness) Most interesting quadrant Lower cost, reduced barriers, not constrained by regulations allow development of completely new ways of delivering healthcare services take existing models and bring them into healthcare

example SMS delivered to expectant mothers timely knowledge distribution reduce $$ - by provider and to patient

a lot of people & institutions will try to do things cheaper, faster, better with mobile incremental innovation

better to find a different way to do things; could drastically improve cost, effectiveness & adoption disruptive innovation

one important note... Patient Payor Provider who benefits who pays who delivers You have to make all 3 not unhappy

app Patient Doctor Payor rewards, social reinforcement better patient care (by the patient) improved sales

what does this mean for you? lots of opportunities look for a market need look at other industries how are they using mobile can that be applied to healthcare? do one thing really well people can t ignore

if you want to know more Mobihealthnews RockHealth @EricTopol LinkedIn Digital Health Group w/ Paul Sonnier The people up here

get involved... Hacking Health Quantified Self local companies

Questions?