Wireless Technology and the De-Institutionalization of Health Care

1. Wireless Technology and the De-Institutionalization of Health Care “The Wireless Future of Health IT” New America Foundation CTIA – The Wireless Association March 23, 2009 Michael J. Barrett Managing Partner Critical Mass Consulting mbarrett@CriticalMassConsulting.com www.CriticalMassConsulting.com

2. Self-care, home care and mobile care have roots and relevance • ≤18th C: Health care happens mostly at home and work • 19th C: Health care professionalizes and institutionalizes • 1950: 40% of MD visits are still house calls • 1965: Medicare includes home health, with a low profile • 1980s: Chronic conditions emerge as huge cost drivers • 1990s: “90% of diabetes care is self-care” • 1996: Kaiser launches online health site for members • 1999: Early “remote patient monitors” come to market • 2002: Healthcare Unbound (over)

3. 2002: Healthcare Unbound Technology-enabled self-care, home care and mobile care have inescapably populist dimensions, rebalancing power and control towards the grassroots. “The centralizing forces of the 1900s will yield to the decentralizing forces of the 2000s. Technology assisting, innovators will light out from 20th Century settings – hospitals, doctors’ offices and nursing homes – in order to de-institutionalize healthcare.” “Technology in, on, and around the body that frees care from formal institutions.” Source: Michael J. Barrett, ”Healthcare Unbound,” Forrester Research, Dec. 17, 2002

4. Remote patient monitoring – system components Patient Community Source: Continua Alliance

5. Why should you care? Beneficiaries with chronic conditions as % of all beneficiaries Uninsured 27% Private payers = Medicaid only 39% = Public payers Private ins. 40% All Americans 44% Medicare 85% Medicare/Medicaid 87% Source: Medical Expenditure Panel Survey (MEPS), 1998, cited in Robert Wood Johnson Foundation, “Chronic Conditions: Making the Case for Ongoing Care” (Dec. 2002)

6. 5-year forecast: Americans’ access to “smart” consumer devices (82%) (78%) (78%)% (51%) Source: Forrester Research, “The State Of Consumers And Technology: Benchmark 2008”

7. How far will the trend go? Wireless-only households, 2007 OK – 26.2% UT – 25.5% NE – 23.2% AK – 22.6% DC – 20.0% SD – 6.4% DE – 5.7% CT – 5.6% VT – 5.1% Source: CDC, “Wireless Substitution: State-Level Estimates from the National Health Interview Survey” 2007

8. What wireless brings to the party • Ubiquity • Feedback “Learning is most likely if people get immediate, clear feedback. … Well-designed systems tell people when they are doing well and when they are making mistakes.” -- Thaler and Sunstein, Nudge (2008)

9. Still, for most things today we’re wired, not wireless Percent of North American adult users of a “cell phone/smart phone or handheld wireless device” who do the following at least once a month Base: 44,959 North American adults with a mobile phone Source: Forrester Research, “The State Of Consumers And Technology: Benchmark 2008”

10. What wireless can’t do (yet) • Work to mission-critical perfection (network coverage, battery life, privacy, etc.) • Maintain the cell phone’s “form factor” (who cares!) • Create the “business models” – ways to pay for services • Harmonize ubiquity with Medicare’s homebound requirement • Change human behavior when feedback mechanisms are imperfect and feedback itself is necessary but not sufficient

11. Thank you! Michael Barrett Critical Mass Consulting mbarrett@CriticalMassConsulting.com 781-674-0097