Did Partners HealthCare get leapfrogged by modern mHealth technology?
A recent blog post provided a fascinating look into how one of the world's leading health systems is thinking about leveraging patient-generated data. The post was penned by Dr. Joseph Kvedar, the Director of the Center for Connected Health at Partners Healthcare. Like many progressive health systems, Partners is preparing for a move to risk-based population contracts, which require strong patient engagement and remote monitoring components. According to Kvedar, "Partners Healthcare believes that patient-generated data is critical to our future."
From Vertical Integration to Bespoke Platform
Partners has been innovating in remote monitoring programs for over a decade. The initial programs focused on congestive heart failure (CHF), but later expanded to include hypertension and diabetes. Partners' first generation of technology vendors provided connected scales, blood pressure cuffs, oximeters, and other devices in complete end-to-end solutions that combined hardware, software, and data services into a single package. Partners was happy because the pre-integrated solutions freed them to focus on what they do best: showing clinical efficacy. The vendors were happy because the vertically-integrated packages were sold at premium prices. As Partners moved from CHF to diabetes and hypertension, the ROI on the high-priced solutions started to break down. In an attempt to fashion a lower-cost solution, Partners put together its own platform for consuming data from a variety of devices and hubs. Today, data from this platform is integrated into Partners' EMR system and is also available to patients via their patient portal.
On the Wrong Side of History
If all health systems in this country was as forward-thinking as is Partners, the grade of the healthcare cost curve would sharply descend. That is to say, taxpayers and employers would save a meaningful amount of money if care providers reorient chronic disease care around prevention and wellness. This is not controversial. That said, the Partners' bespoke integration platform is already a relic of a bygone era. What is the new platform? Chances are, you are holding it in your hand right now.
When Partners began its remote monitoring programs, the iPhone was still a glimmer in Steve Job's eye. Those that were skeptical when Steve Jobs took the stage to announce the iPhone in 2007 should be forgiven for underestimating the smartphone. Smartphone adoption has surpassed virtually all expectations and has become the most rapidly-adopted technology in history. Here are some telling charts from MIT Technology Review:
Today, more Americans have smartphones than don't. Two of three of mobile phone sales are smartphones. Pew Research reports growing adoption among every age, income, and education category. More than a third of individuals with an annual household income of less than $30,000 have smartphones. Not only is mobile quickly becoming ubiquitous, it is also the preferred medium for patient self care.
Partners' approach of building a data warehouse platform with "open APIs" for vendors to send data back to the mothership is becoming anachronistic. Modern applications and devices all have open APIs and standard data formats. Sensor makers shouldn't have to write to evert health system's API. The center of the data universe should be the patient and not the health system. To that end, health systems should provide their patients with an easy-to-use app that is capable of collecting data from a wide variety of devices. From a patient's perspective, connecting to a sensor or wearable should be as simple as typing in a username and password. Yes, mobile platforms still have data storage and analytics back ends, but these are simplified and less expensive in mobile platforms compared with traditional data warehouses. Finally, this scenario enables patients to own their data and share it with whomever they like.
The Case for Engaging All Patients, Not Just the Sickest 5%
By providing patients with a mobile app, health systems can support health tracking, patient education, and other components of self care, even in the absence of sensors and connected devices. We also know that the majority of chronic disease patients track their health. It is not hard to make a case for engaging all patients, not just the sickest 5%
- Why not? The incremental cost of an app download is close to zero.
- The sickest 5% is not a static group. Some portion of next year's sickest 5% are hiding in the this year's 95%.
- Mobile can improve patient satisfaction across all patients. (see ROI)
- Mobile can help reduce readmissions across all patients. (see ROI)
- Don't relegate your patients in the 95% group to an unengaging patient portal. Engagement can drive loyalty. (see ROI)
Focus on Mobile Penetration, Not FitBit Penetration
The bulk of Partners' blog post involves much handwringing about how few of the sickest 5% actually use connected sensors like FitBit. Dividing the world into sensor users and non-sensor users is a false dichotomy. The most important variable is whether or not the sickest 5% of patients have smartphones. Evidence is mounting that many of them do. Smartphone penetration is higher when caregivers are included. In a pure risk world, the cost of an unplanned admission can be $10,000. The beauty of remote monitoring is preventing the need for an admission. So if a CHF patient's wireless scale shows a sudden spike in weight, the health system has a chance to react before the costly inpatient care cycle kicks in. Subsidizing a $99 FitBit scale for your smartphone-owning CHF patient in the top 5% of sickest patients presents a slam dunk ROI even if your intervention avoids just 1 admission in 20.
The Bottom Line
Smart health systems will follow Partners' lead in embracing patient-generated data as a means of thriving under pay-for-value contracts. The smartest health systems will recognize that the ubiquity and openness of the mobile ecosystem presents a leap frog opportunity that delivers patient-centered remote monitoring at fraction of the cost from just a few years ago.