Overcoming barriers
to uptake
Aleix Bacardit
EMEA Pharmaceuticals
& Healthcare Practice
London, June 2011
Mobile Health, What is it?
Mobile phones
Connected devices
Patients /
Consumers
Healthcare
professionals
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The Mobile Health Promise
Consumer & patient
education
Better diagnose and
manage disease
Improve compliance
Improve
administrative
processes
Better patient data
Professional
education
Improve quality of
life and convenience
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Diabetes illustrates the potential for Mobile
to revolutionise health delivery
Illustrative
Condition
awareness
Seeking
treatment
Treatment
initiation
Sustained
use
Assessment of mobile
health application
Example Type 2 Diabetes Scenario
Practitioners kept up
to date with training
and interactive online
‘Q&A discussions’
1
Targeted local disease
awareness marketing
programme
3
2
5
Patient improves
own knowledge
(through interactive
online resources)
In-practice consultation and
blood glucose test. Diagnosis
and patient educated on
condition
4
5
Medicine and patient
appointment reminders
by patient preference
channel (SMS, letter,
phonecall)
4
10
6
2
3
1
Out-bound telerecruitment service
to encourage highrisk patients to
present
ILLUSTRATIVE
Downloadable profiling tool to identify
high risk patients in GP records
Remote glucose,
health and medicines
(online) monitoring
12
7
8
13
Patient
11
assigned to 7
MDT including
Medicines delivered
medicines
8
9
expert.
Week
1
daily
patient
Initiation of
follow-up using teledrugs
consultation
Diabetes nurse clinic and
enrolment and training in
Nurse in-home / online / 15
education / support
telephone patient
programme
consultation Patient reward
Compilation of personal
and recognition
care plan using down
programme, e.g. Gym
loadable form
discounts
6
Exception
reports to GP
Reminders of monitoring
requirements (screening
for complications and risk
14
factors)
Patients keep in touch through
social networking sites
18
17
16
Patient monitors cost of
care and medicines
9
10
11
12
13
14
15
16
17
E
EDUCATION
“Information on
conditions”
Source: A.T. Kearney Analysis
I
INTERVENTION
“Diagnosis &
Treatment”
S
SUPPORT
“Overall results
management”
18
High applicability
Low applicability
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There is no shortage of problems or solutions
The Health needs are clear
Technologies are available
Europe’s top-5
Europe’s top-5
18m diabetics
$57bn






Prevention
Awareness
Early diagnosis
Compliance
Managing co-morbidities
Avoiding unnecessary
costs
Note (1): Adults defined as population aged between 20 and 79
Various sources. A.T. Kearney analysis
1.3 mobile pp
0.4 broadbd / adult(1)
What lies in
between?
 More phones than
people
 Hundreds of mobile
phone apps
 Plenty of devices with
connectivity
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
Finding the right buyer

Making it work commercially

Proving Value

Integrating (or decommissioning) services

Managing risks and regulation
Technologies are available
The Health needs are clear
Bridging the gap…
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Who the buyer depends on boundaries of
“health”, and by country and disease
Overweight, Unfit,
Smoker, Drinker…
High blood pressure,
high cholesterol, obese,
low respiratory function,
low liver function…
Aspirational
Well
Atherosclerosis,
Diabetes, Renal Failure,
COPD…
Very likely to
develop a
serious disease
– and know it
Diagnosed as Ill
with a serious
disease
Very likely to
develop a
serious disease
– and Don’t
know
Ill with a serious
disease - but not
Diagnosed
Worried Well
Should be
Worried Well
More likely to be the consumer
More likely to be health system
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Which stakeholder benefits from a Mobile Health solution
will depend on how it creates value
Population
Risk
“System”
Cost/
Benefit
=
Number
of
patients
Delivery
Efficiency
Pathway Efficiency
x
Number
of visits
(per
patient)
x
Number
of
activities
(per visit)
x
Cost
per
activity
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Where that value appears depends on the reimbursement
system
PAYER
Where the burden of risk lies in the reimbursement system
Risk at the payer side
Risk at the provider side
Fee
for
service
• Simple, easy to
administer
• Excessive
(uncontrolled)
use of resources
PROVIDER
Global
budget/
capitation
A myriad
of systems
in between
• Efficient use
of resources
• Potential for
patient selection,
under-treatment
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Healthcare is an industry driven by
evidence, but the evidence for Mobile
Health is recognized as being very weak
“Evidence of effectiveness is
limited and inconsistent,
evidence about cost-effectiveness
negligible, implementation on
wide scale is the challenge”
Prof Chris Salisbury, University of Bristol, UK
“Obstacles, however, abound.
Among them are […] the lack of
clear evidence that mHealth
solutions are viable on a wide
scale and can deliver real
efficiencies”
Mobile Health for Independent Living. AARP, 2011
Source: European Commission: Strategic Intelligence Monitor on Personal Health Systems, 2010; European Commission: ICT and Aging 2010
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Common mistakes in gathering evidence
 What are you trying to prove?
• Superior Outcome, or Non-Inferiority at Lower Cost ?
• Is the research hypothesis clear and realistic?
 Do you have the right endpoints and measures?
• Are they relevant to decision makers?
• Is the sample size big enough?
 Do you have the right comparator?
• Can you differentiate between the service and the technology?
 Is the study method valid?
• What will work best? RCT, observational study, pilot, pre/post analysis?
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Mobile Health needs to integrate into
the overall care model
Care
Providers
Mobile Technologies
Care
Manager
Community and
Social Care
Therapies
Emergency
Care
Patient /
Carer
Care Management Plan
•
•
•
•
•
•
•
Consultations
Treatment and Medication
Diagnostics and Tests
Rapid response / emergencies
Training
Compliance
Frequency and type of contact with
CM (continuously reviewed)
Self-Care
Informal Care
Joint DecisionMaking
Acute
Care
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The more critical the application, the more clinical and
regulatory risk comes into play
Clinical Risk
Critical
Remote monitoring — AMBULANCE
Life-critical
interventions
Unwell
Treatment
monitoring
At risk:
DIAGNOSIS support
Diagnosis
Well:
Wellness
prevention
Remote monitoring — WELLNESS
Well:
Health
information
Commercial
services
Billing
Network
Transmission
Marketing & Sales
Device
Phone
Value-added services
Med device Data management
Advice
Encryption
Distribution
Content
Part of VALUE CHAIN
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A Prescription to Help Bridge the Gap …
 Focus on the service, not the
technology. Simple is good
 Align the solution with the incentives
and financial flows
 Define a clear business case, and get
the stakeholders to buy into it
 Start with applications that don’t
require large scale service integration
to be successful
 Create a plan to build strong
evidence that it works
The World





Technologies are available
The Health needs are clear
All of Us,
Everywhere
Today
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Thank You
Aleix BACARDIT
Aleix.Bacardit@atkearney.com
Manager
+44 20 7468 6800 Direct
+44 796716 6800 Mobile
A.T. Kearney Limited
Lansdowne House
Berkeley Square
London W1J 6ER
+44 20 7468 8000
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