The Anatomy of Modern Healthcare A look into the trends, populations and products at play.
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Table of Contents 1 Following the healthcare financials 2
Understanding the consumer and the context
18
Navigating the decentralization of care delivery
19
Surveying spend industry wide 3
Approaching health decisions from the “consumer mindset” 20
Show me the money — and where it goes
4
Augmenting the experience with telehealth
21
Funding progress in the flyover state
5
Benefits of telehealth: Removing the stigma from care
22
What innovation means for healthcare costs
6
Beyond pay-for-performance 7
The evolution of digital health
23
Shift to value for consumers and risk for providers
8
Fostering innovation in healthcare
24
Deconstructing MACRA 9
[Innovation Area] Wearables
25
What MACRA means for leaders
10
[Innovation Area] Healthcare design
26
Determining care value 11
[Innovation Area] Technical convergence
27
Buying wellness
[Innovation Area] Connected health tech development
28
What defines successful digital health technologies?
30
Sustaining past volatility in the digital health space
31
Forward
The consumerization of healthcare
12
13
Helping healthcare consumers get their “money’s worth” 14 Setting a minimum expectation for success
15
Elevating the experience of the care consumer
16
Creating a consumer-centric healthcare system
17
Table of Contents Collecting, managing and benefiting from healthcare data
32
Growing healthcare data volume 33 Causes for concern in health data security
34
Medicine gets precise
35
The problem with precision 36 Precision medicine meets population health
37
The opportunity: Pay less for more
38
Many sizes fit many
39
Reimagining the system 40 Redirecting the course of modern care
42
References 44
Forward
From valuing care, defining and delivering it, to preventing the onset of medical conditions that drain the resources of the system, more questions than answers face a health industry in flux. Different stakeholders, from big pharma to consumers to physician networks, offer up different answers. Continued conversation and synthesis will distill the options with the greatest potential to balance cost, quality, outcomes and access. The trends and analysis featured herein were presented at MobCon Digital Health 2016.
1
Following the healthcare financials
2
Surveying spend industry wide Assessing the cost of healthcare today feels akin to watching a lottery reward increase, month by month and year by year. By 2020, consumer healthcare spend is predicted to reach $6.5 billion.1 And, despite paying double the healthcare expenditures compared to equally progressive nations including Germany, Norway and Sweden, the US ranks eleventh in a combined measure of quality, access, equality and efficiency of care.2 Maintaining health represents a significant cost for businesses as well. In the 2015 fiscal year, Medtronic spent $1.6 billion in research and development investment.3 Lottery players have a measure of faith. They know at a given point, chosen individual(s) will win the advertised amount, and the process will begin again. For healthcare, the ROI is less certain. Countries and consumers are investing heavily in good health. Annually, the United States spends nearly $9,000 per person on healthcare costs.4 Increasingly, stakeholders are questioning whether our healthcare investments are paying off.
3
Show me the money — and where it goes
Chronic disease management and procedural inefficiencies in the system represent two of the largest magnets for healthcare spending. Eight out of every ten dollars spent on healthcare in the United States funds the treatment and maintenance of chronic diseases.5 MobCon Digital Health keynote Sheri Dodd, Vice President & General Manager of Medtronic Care Management Services, also noted the vast opportunities that exist to maximize healthcare efficiencies related to infrastructure and operations. Jacob Best, Director of Medical Networks for Grand Rounds, echoed this sentiment.
Rather than waiting for EHR interoperability, health systems are seeking to improve
Satiating the super-users 99% of the healthcare costs in the country are linked to 1% of the population. Managing the challenges and access issues faced by these super-users represents one way forward to drive down cost and decrease health-related GDP spend, expected to rise by 2024.6
processes, centralize entry and add technology that supports the consumer experience.
4
Funding progress in the flyover state
Mapping 2015 MN health investments Most funded subsectors: Medical device and digital health7
Positioned in the center of the country, Minnesota has been uniquely developed as a medical device hub able
$302 M
medical device investments, raised by 46 companies
$67.1 M
to respond to and interact with trends from both coasts. In 2015, health technology investment in Minnesota reached $434.9M, posting a second consecutive year over $430M. A record $189M of that was invested in Q4. Of note, medical device and digital health companies led the field in securing investment.
digital health investments, raised by 22 companies
5
What innovation means for healthcare costs Financial CY 2013-20168 2.2% For the first time since before 2013, costs related to outpatient procedures will decline in 2016 due
1.8%
to efficiency gains in the process.
1.7%
For MobCon Digital Health keynote Dr. Kaveh Safavi, Senior Managing Director for Accenture, healthcare of the present remains heavily reliant on expert labor.9 Innovation offers a path forward to better utilize specialized labor, thereby keeping the cost of unit-care low. (0.3%)
2013
2014
2015 2016
6
Beyond pay-for-performance
As healthcare continues to transition from the fee-forservice to a pay-for-performance model, MobCon Digital Health speakers predict bonuses and penalties will be increasingly tied to outcomes.
In just 1 year, ACOs were able to generate over $380 million in healthcare savings.10 Pay-for-performance doesn’t represent the end of the healthcare industry’s exploration of reimbursement models. It’s the start. Speaker Sheri Dodd expects value-based care delivery will continue to evolve. This will be driven by industry efforts to manage the effect of bundled payments for episodic care and begin to push the boundaries even further to a system where payment occurs on a person-byperson basis within defined populations.11
7
Shift to value for consumers and risk for providers
For the healthcare industry, 2018 and 2019 will be years of reckoning, as the goals set by the US Department of Health and Human Services come due. This includes initiatives focused on hospital value-based purchasing, reducing hospital readmission rates and linking Medicare payments to alternative payment models.
90%
of traditional Medicare payments will be tied to quality via
50%
of fee-for-service Medicare payments will be
programs including the Hospital Value-Based Purchasing
tied to quality or value via Accountable Care
and Hospital Readmissions Reduction Programs
Organizations or bundled payments12
8
Deconstructing MACRA
The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) created two value-based payment tracks for physicians that take effect in 2019.13 Merit-Based Incentive Payment System. MIPS, as it’s known within industry circles, combines payfor-performance systems into a single program. Value will be assessed by pre-defined metrics including meaningful EHR use, clinical improvement, resource use and quality. Alternative Payment Models. APMs offer new methods to pay for care to Medicare users. From launch through 2024, participating healthcare providers will be given a single incentive payment. The system offers
$
“increased transparency of physician-focused payment models,” according to the Centers for Medicare & Medicaid Services.14
9
What MACRA means for leaders
Transparency wins.
Organizations will be compensated for clarity of physician-focused payment models.15
Partnerships sustain. Because more payments are at risk, MACRA implicitly incentivizes organizations to meet the outlined financial objectives.16
10
Determining care value Much has been written about understanding value from the provider perspective. This isn’t enough, according to Kaveh Safavi. Instead, the healthcare industry should seek to assess value from the perspective of the segment with buying power — i.e. the care consumer.17 Understanding the modern care consumer begins by differentiating them from the historical patient. In today’s healthcare climate, “patient” has become synonymous with a more passive receiver of care compared to an empowered consumer with choices and — increasingly — the ability to see a practitioner in more convenient retail locations. Care consumers are concerned with more than the quality of care as measured by outcomes. They are equally interested in the quality of care as measured by flexibility and accessibility, asking,18 “Do the care options fit me and my routine?” As these options increase, care consumers have the agency to rethink how and where they receive care.
How patients vs. consumers define value18 Patient
Care consumer
Location of care
Clinic
Flexible (including retail/remote)
Convenience
Disrupts routine
Fits routine
Motivation
“Have to”
“Want to”
Agency
Limited
Maximized 11
Buying wellness Who shoulders the burden of healthcare? Increasingly, it’s the consumer. From 2006 through 2014, the proportion of consumers enrolled in high deductible health savings plans grew by a factor of five.20 In today’s healthcare climate, consumers are physically and fiscally accountable for their care. That means their opinion holds more power for providers and practitioners.
How is the healthcare space adapting to satisfy the tide of consumer opinion?
12
The consumerization of healthcare
13
Helping healthcare consumers get their “money’s worth”
Assessing the value of healthcare, often pure cost/ affordability is the metric of choice. For Kaveh Safavi, the question is framed incorrectly. Rather than asking providers to drive down the cost of care to create less expensive options, Safavi argues consumers simply want their money’s worth. When asked what determines “value,” the 2011 Quintiles New Health Report found approximately 35% of patients said “neither cost nor outcome.”21 This presents the industry with a very different question.
How can healthcare be more
What determines consumer value?22 + Simplicity + Coordination + Synchronicity + Personalization + Consistency + Security + Transparency
valuable for the consumer?
14
Setting a minimum expectation for success
When travelers fly, the expectation exists that they will move from point A to point B safely. This minimal expectation of technical competency then removes outcome from the value calculation. Instead, the quality of the experience is assessed by other intangibles including ease, simplicity and comfort. Safavi argues the same type of calculation should exist in healthcare.
Providers’ ability to create compassionate care environments will set them apart from the competition and build brand loyalty rather than their technical ability to deliver the care.
15
Elevating the experience of the care consumer Technology has afforded modern consumer brands a critical choice: They can deliver the service as it has always been done, or, they can reimagine the system. Take transportation as an example. Consumers without a car, bicycle or moped who wanted to travel between two
As more hospital reimbursements
locations in a city, but didn’t want to use public transit would have hailed
are linked to consumer feedback,
a taxi just ten years ago. Timing and quality of the service was variable.
the healthcare industry is more
Uber revolutionized the experience. The process differed in slight but
accountable to consumers than
meaningful ways.
ever before.
Consumers wanted control.
“If the toilets are
They can hail vehicles from the mobile app.
dirty and the food is
Consumers wanted ease.
cold, you’re going to
Uber drivers call to check-in with you.
get a bad score.” Sheri Dodd, Vice President &
Consumers wanted comfort.
General Manager, Medtronic Care
Water is often offered and music can be synced right from a smartphone.
Management Services
16
Creating a consumer-centric healthcare system Dale Cook, MobCon Digital Health speaker and Learn to Live CEO, identified the following traits of a consumer-centric system:23 + Online + On-the-go + Easy to transact Keeping these traits in mind, healthcare can learn much from the consumer brand space to create valuable end-to-end experiences rather than episodic care.24 Healthcare has already begun to transition to facilitate more consumer-friendly interactions.25 + Decentralization of access points + Convergence of retail and medicine + Value delivered in the physical and virtual spaces + Data generation to inform and shape the experience
17
Understanding the consumer and the context
For healthcare players, understanding the needs of the consumer isn’t enough, according to Shawn Oreschnick, Logic PD Director of Analytics and Research Services. The contexts for health monitoring/ maintenance along with care delivery are equally important. Other MobCon Digital Health speakers advocated the need to
Components shaping
build new processes to match how people want to consume care.
the context
Jacob Best referenced the use of virtual services to connect with consumers and refer care options before any services are received.
+ Price
Previously, for many, care referral was handled at the departmental
+ Features
level, divorcing it from process and consistency.
+ Use cases + Access points
Specialist interaction represents another example of industry
+ Competitive landscape
players understanding and adapting to consumer context. For many
+ Regulatory
consumers, healthcare and otherwise, time is their most valuable commodity. Technologies that allow consumers and specialists to meet before travel time is invested, especially when seeking care across state lines, offer an advantage for consumers that may sway their care decision if they are considering two providers.26
18
Navigating the decentralization of care delivery Telehealth offers one avenue for healthcare providers to decentralize care delivery. The appetite in the marketplace is ripe for the implementation of more remote service options. According to the American WellŽ Telehealth Index: 2015 Consumer Survey, 64% would see a doctor by video.27 Beyond that, by 2018, 37% of employers will offer telehealth.28 By 2020, there could be an estimated 158 million telehealth sessions taking place as part of the care curriculum.29 Increasing the placement of care delivery sites represents a secondary method of decentralization. Walmart, for example, aims to position its brand as number one in the care delivery space. There are 130 million visits to the emergency room annually. By comparison, there are 20 million more visits to Walmart locations each week. Walmart isn’t attempting to displace the market. They are simply responding to the needs of consumers.30
19
Approaching health decisions from the “consumer mindset”
Brands like Walmart are wise to consider expansion into the healthcare market. There is much brand loyalty/ mindshare up for grabs and (currently) low patient loyalty for healthcare providers.31 According to Johns Hopkins,
23% of the consumer market has seen three or more different providers in the span of two years.32 Walmart isn’t the only one. Walgreens, CVS, Target and Whole Foods are also housing appointment areas within retail locations. These new usages of existing spaces represent examples of the care ecosystem evolving to better meet consumer needs.
20
Augmenting the experience with telehealth
Other speakers predicted the use of telehealth won’t completely replace in-person care, but would instead augment the experience.34 For Kaveh Safavi, telehealth isn’t just a tool to treat the unserved or underserved, it also offers the ability to expand care possibilities for the already served by blending the physical and virtual worlds. How?35
Increased understanding:
One-to-many:
Easier access:
Via telehealth, patients can see
Telehealth creates the ability to
In many specialties, care professionals
images at the same time as doctors
facilitate a one-to-many relationship.
are underrepresented compared to the
by observing the video screen.
This could involve one doctor
patients requiring attention.
conferencing with many patients or many doctors advising one patient. The latter model has come to be the gold standard in cancer treatment.
21
Benefits of telehealth: Removing the stigma from care
Beyond increased understanding and access, the decentralization of care also offers the possibility to remove the stigma from seeking care in the first place, according to MobCon Digital Health speaker Dale Cook. Mental illness is one such condition with associated stigma. One hundred and fifty million people suffer from mental disorders nationally, according to one article published in the New England Journal of Medicine.36 Yet three-fourths of the population doesn’t see a therapist, citing the associated social label, lack of accessibility due to geography and high costs for all parties (consumers, payers, providers and employers).37 Digital treatments based on the pillars of cognitive behavior therapy like Learn to Live, offer a more consumer-centric approach to care by considering why care was avoided and adjusting to match.
22
The evolution of digital health
23
Fostering innovation in healthcare
The industry has come a long way since the introduction of what was arguably one of the first digital health devices in healthcare — the pacemaker.38 Since then, over 100 mobile health apps have been cleared for medical use, and MobCon Digital Health speakers estimate the healthcare IoT market will exceed $30 billion in the coming decade.39 The progress thus far has been great, but so is the future potential for savings. Experts estimate $300 billion by leveraging digital health devices.
According to Sheri Dodd, three variables are needed to maintain or accelerate our pace of innovation. 1. Improved outcomes 2. Expanded access 3. Optimized costs and efficiencies
24
[Innovation Area] Wearables The wearables subsector represents one area where industry forecasters predict growth. Some estimate the wearables market will grow to 601 million connected devices by 2020.40 MobCon Digital Health speaker Lauren Smith, Policy Counsel for the Future of Privacy Forum, cited the electronic sensor created at the University of Illinois that could be printed on the skin to measure electrical signals from muscles and brain activity along with hydration and temperature.41 Connected wearable devices worldwide from 2015 to 202042
601
600m 489
500m 373
400m 261
300m 167
200m 100m 0m
97
2015
2016
2017
2018
2019
2020
25
[Innovation Area] Healthcare design Within the Mayo Clinic Center for Innovation, designers are exploring methods to increase healthcare productivity while offering patients new treatment options. White space within practitioners’ schedules between larger appointments was one such opportunity the team identified.
Case Study: Mayo Clinic Center for Innovation To take advantage of existing white space, the team conceived, designed and developed a technology platform allowing providers to meet with patients virtually between in-person appointments, thereby increasing the productivity of every involved care professional. The microCONSULT platform pairs doctors with requests from care consumers based on real-time availability. Colors
By-the-numbers 9 minutes: Average length of each consult 118: Calculated savings in days for patients
Why it works? The microCONSULT platform accommodates patients who want to move faster than the conventional system allows.
within the solution signify whether the doctors are busy, unavailable or on-call.
26
[Innovation Area] Technical convergence
The HIMSS 2016 Connected Health Survey found 52% of hospitals leverage three or more connected health technologies in care delivery. Nearly half of the hospitals surveyed forecast increased usage of connected health technologies in the next few years.43
27
[Innovation Area] Connected health tech development The incentive to leverage data being collected as a part of the quantified self movement has never been greater — recognize warning signs for catastrophic health events, save lives. Leading software brands Apple and Google are making huge leaps to transform the wealth of connected data into distilled insights for patients and providers.
Developing a connected health ecosystem Apple
Apple
Apple
Apple
Health
HealthKit
Fit
Fit SDK
ResearchKit
CareKit
iOS application
Software
Android
Software
SDK for
SDK for
(excluding iPad)
development kit
application
development
population
population
kit for Android
research apps
research apps
Provides access
Provides access
that is impossible
that is impossible
Centralized hub
Not an application
for all health data
Centralized hub
health
for all health data
applications
A set of tools Users add, edit,
for developers to
without
without
delete and share
make applications
counterpart to
counterpart to
technology
technology
data between
that share and
Apple Health
Apple HealthKit
apps
integrate health apps 28
[Innovation Area] Connected health tech development
By building these tools and creating centralized hubs for health data, Apple and Google are helping bridge the gap from data collection to its usage in medical research and treatment by allowing easier access with less custom development needed.
Case study Using off-the-shelf Apple and Android smart watches, a team of researchers from the UCSF Health eHeart Study and software engineers from Cardiogram created a deep learning algorithm it hopes will one day accurately detect atrial fibrillation — data the Apple and Google health suites are helping provide.
29
“If you understand ‘who cares,’ you will be able to position yourself in a way that will affect the patient outcome.” Sheri Dodd, MSc., Vice President & General Manager, Medtronic Care Management Services
30
Sustaining past volatility in the digital health space
Forty percent of digital health companies will be out of business in a year. It's no longer enough to solve an individual problem with health IT. Successful solutions can't add incremental costs. They must drive them down. Full integration and ease of adoption will separate the longstanding solutions from those that generate interest but can't sustain past the initial surge of investment dollars.
Case study When the team behind Sansoro
Jeremy Pierotti, CEO of Sansoro Health and winner of the 2016
Health, healthcare data integration
HIMSS Venture+Forum pitch competition, offers the following
solution provider, sought storage,
advice for entrepreneurs who seek to create solutions that bridge
they originally estimated data center
existing gaps in the care ecosystem and maintain relevancy after the
costs between $30,000-$50,000.
initial sheen of the idea has worn off.
Pierotti took his own advice and turned to Microsoft Cloud in an
1. Don’t be overly aggressive in early investment rounds.
effort to diminish the spend. They
Investors look for sustained growth.
found a storage solution that came in $29,500+ under budget.
2. Find ways to be capital sufficient.
31
Collecting, managing and benefiting from healthcare data
32
Growing healthcare data volume Healthcare has seen an exponential increase in clinical data points — some seven billion — fed by medical societies, hospitals and third-party vendors. That’s not even counting non-medical grade data generated by consumers. This data offers potential — and also potential danger for those who seek to use it. Data can paint a highly-specific picture of a patient or population. But with that detail, comes the necessity to protect it. Should an employer gain access to select health data, it may prejudice them against the employee thereby limiting mobility, earning potential and workplace comfort.45
Consumer concerns46
Industry potential
Embarrassment
Predictive care
Discrimination
Personalized care
Safety
Better outcomes
Vulnerability
Cost savings
33
Causes for concern in health data security
Storing and securing data has very real implications for consumer wellbeing in the health space. But government and watchdog agencies found health apps were functioning beyond their intended purpose. According to a Scripps Research Institute professor of genomics, 12 mHealth and fitness apps tested by the FDA were delivering data to 76 third-party companies.47 A report published by Privacy Rights Clearinghouse detailed additional vulnerabilities for users of health and fitness apps, which included sending unencrypted data without user knowledge and connecting to third-party sites without user permission. The report found 40% presented a high risk for users’ privacy.48 One study co-created by Boston Children's Hospital and the University of Cologne in Germany, alleged less than 30% of health apps available in the Google Play and iTunes store featured a privacy policy.49
34
Medicine gets precise While there is documented misuse of health data in the current system, vast potential to leverage data to help drive behavior change and tailor more personalized treatment plans also exists, as presented by MentorMate Vice President of Strategic Consulting, Craig Knighton and Be the Match Senior Manager of New Products, Caleb Kennedy. The current drug approval and prescription model represents an example of “tyranny of the mean.” Treatments are only deemed “effective” if a notable improvement is documented during clinical trials for a significant part of the population and “do no harm” to the remainder of the subjects involved in the trial.50
How can we reshape the current clinical trial model so exceptional responders are not punished for the specificity of their genomes? In the current approval model, treatments are shelved if they mark a complete turnaround in the care of certain exceptional responders while seemingly offering little benefit to the mean, hence the tyranny of treatments that exist but aren’t being offered to the populations who would benefit the most from their use. The precision medicine disciple argues we can learn just as much, if not more, from the outliers and tailor care not to the mean, but instead to a care consumer’s genetics, lifestyle and environment.51
35
The problem with precision
At the surface level, precision medicine seems to offer no financial benefit for companies currently profiting from the creation, testing and manufacturing of pharmaceuticals. If pharma is designed to benefit the largest potential population, it can be sold and prescribed to millions of care consumers compared to treatments designed for “exceptional patients� who might number in the thousands. What individuals who fail to find financial benefit for precision medicine forget is — screening to determine the efficacy of the treatment for a consumer given their genetics, lifestyle and surrounding environment offers a secondary revenue stream for pharma.
36
Precision medicine meets population health
Population health, another school of thought, approaches creating the best outcomes while managing cost from an alternative perspective, facilitating behavior change in a large population so fewer costly procedures are required to course correct later.
Conflicting paradigms In broad sweeps, population health offers the greatest benefit for the most people. What it forwards in efficiency, it lacks in personalization. By comparison, precision medicine offers the opportunity to tailor more exacting care to a smaller population. However, the potential exists to sacrifice the statistical rigor of clinical trials through a focus on outliers.52
37
The opportunity: Pay less for more discovery and personalization The cost to sequence and virtualize DNA continues to drop so much so that the available processing power can’t begin to keep up with the potential. By zeroing in on clinically-relevant and statistically-significant findings, we can offer less expensive and more custom therapies to small groups or on a patient-by-patient basis.
The challenge: Driving action
“Data in and of itself does not treat patients.� Sheri Dodd, MSc., Vice President & General Manager, Medtronic Care Management Services According to Dodd, data is the foundation for any shared savings program between payers and providers. But, without incentive to act, the opportunity crumbles.
38
Many sizes fit many
President Obama introduced the Precision Medicine Initiative in 2014 with followup to the tune of a $215 million dollar investment in his 2016 budget. The initiative aims to enable researchers access to health records, genomic information, clinical data, hospital records and more to better understand why some patients respond better to treatments than others.
Patients aren’t average. Why should their treatments be? According to Lauren Smith, the initiative represents a shift away from a “one-sizefits-all” approach to medicine and toward a new standard of care. Some entities in the health space began taking action even before the federal edict. The Mayo Clinic created the Center for Individualized Medicine in 2013.54 And, precision medicine has already begun to take hold in treating select cancers (breast and lung). Though, increasing the relevancy and breadth of individualized care will require a concerted effort for patients to volunteer their health data along with researchers’ willingness to put it to work.
39
Reimagining the system
40
“Instead of trying to refine and tweak the current system, we need to reconsider how we care for people.� Meredith DeZutter, Rose Anderson, Mayo Clinic Center for Innovation Service Designers
41
Redirecting the course of modern care
As new technologies, treatments and research methods are conceived and brought to fruition, the healthcare industry will continue to evolve. The collective — physicians, payers, providers and innovators — must also evolve, even if that means completely rethinking our approach to care. Speaker Sheri Dodd referenced the effect of the 1998 storm, Hurricane Mitch, on Honduras. The scope of damage was immense. 5,600 people lost their lives. 8,600 disappeared. 12,300 were injured. Even beyond the human toll, infrastructure in the country was decimated. 150 bridges were damaged or destroyed. The Choluteca Bridge survived the storm. The only problem? The hurricane completely redirected the course of the river. Care professionals today can’t be afraid to move as the river does.
42
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43
References 1
8
15
Legacy DNA Marketing Group.
Boston Scientific. CY2016 Medicare final Rules issued for hospital outpatient, ambulatory surgical center and physician fee schedule. (2015, November).
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
www.legacy-DNA.com
2 Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris, OECD. Nov. 2013).
https://www.bostonscientific.com/content/ dam/bostonscientific/Reimbursement/IC/2016/ FR2016%20HOPPS%20ASC%20PFS_Final%20(2).pdf
9 Safavi via Baumol WJ. The Cost Disease. Yale Univ. Press. (2012). 10 See Legacy DNA Marketing Group.
16 See Dodd. 17 Safavi, Kaveh. MobCon Digital Health Minneapolis 2016. (2016, April 26). 18 See Safavi.
3 Dodd, Sheri. MobCon Digital Health Minneapolis 2016. (2016, April 26).
11 See Dodd.
4
12
See Safavi.
US Department of Health & Human Services. Better, smarter, healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. (2015, January 26).
20
Organisation for Economic Co-operation and Development. How does health spending in the United States compare? (2015, July 7). https://www.oecd.org/unitedstates/Country-Note-UNITED%20STATES-OECD-Health-Statistics-2015.pdf
5 See Dodd. 6 CDC, American Public Health Association, Commonwealth Fund, US Census Bureau. As presented by Knighton, Craig & Kennedy, Caleb. MobCon Digital Health Presentation. (2016, April 26). 7 Medical Alley Association. 2015 Annual Investment Report. (2016, March). https://www.medicalalley.org/media/44004/2015-annual-investment-report.pdf
http://www.hhs.gov/about/news/2015/01/26/bettersmarter-healthier-in-historic-announcement-hhssets-clear-goals-and-timeline-for-shifting-medicarereimbursements-from-volume-to-value.html
19
See Dodd. 21 Quintiles, The New Health Report 2011. As presented by Safavi, Kaveh. (2016, April 26). 22
13
See Safavi.
Medicare Access and CHIP Reorganization Act, 2015.
23
14
Cook, Dale. MobCon Digital Health Presentation. (2016, April 26).
Centers for Medicare and Medicaid Service. Quality payment program: Delivery system reform, Medicare payment reform, & MACRA. (2016, April 26).
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
24 See Safavi. 25 Oreschnick, Shawn. MobCon Digital Health Presentation. (2016, April 26).
44
References 26
36
46
Best, Jacob. MobCon Digital Health Presentation. (2016, April 26).
Kessler, R. C., PhD., Demler, Olga,M.A., M.S., Zaslavsky, A. M., PhD. (2005). Prevalence and treatment of mental disorders. The New England Journal of Medicine, 35, 2515-23. As presented by Cook, Dale. (2016, April 26).
See Smith.
37 Kessler, R. C., PhD., Demler, Olga,M.A., M.S., Zaslavsky, A. M., PhD. (2005). Prevalence and treatment of mental disorders. The New England Journal of Medicine, 35, 2515-23.
loads/2015/04/Sci-Transl-Med-2015-Steinhubl.pdf
27 Telehealth Index: 2015 Consumer Survey. American Well. (2015, January). As presented by Oreschnick, Shawn. (2016, April 26).
https://www.americanwell.com/press-release/american-well-2015-telehealth-survey-64-of-consumerswould-see-a-doctor-via-video/
28 Willis Towers Watson. Current telemedicine technology could mean big savings. (2014, August). As presented by Oreschnick, Shawn. (2016, April 26). 29 Tractica, Digital health: 10 trends to watch, 1Q2016. As presented by Oreschnick, Shawn. (2016, April 26). 30 See Best. 31 See Oreschnick. 32 Johns Hopkins Medicine. ‘Doctor shopping’ by obese patients negatively affects health. (2013, May).
38 See Dodd. 39 See Dodd. 40 Statistica. Number of connected wearable devices worldwide from 2015 to 2020 (in millions). (2016, April 26). http://www.statista.
47 Muse, Evan D. Steinhubl, Steven R. Topol, Eric J. The emerging field of mobile health. (2015). http://www.stsiweb.org/wp-content/up48 Privacy Rights Clearinghouse releases study: Mobile health and fitness apps: What are the privacy risks?. Privacy Rights Clearinghouse. (2013, July 15). https://www.privacyrights.org/mobile-medical-apps-privacy-alert
49 Comstock, Jonah. Study: Less than a third of popular health apps have privacy policies. (2014, September 8). http://mobihealthnews. com/36349/study-less-than-a-third-of-popularhealth-apps-have-privacy-policies
com/statistics/487291/global-connected-wearable-devices/
50
41
Kennedy, Caleb. Knighton, Craig. MobCon Digital Health Population. (2016, April 26).
Smith, Lauren. MobCon Digital Health 2016 presentation. (2016, April 26). 42 See Statistica.
51 Exceptional Responders Initiative: Questions and Answers. National Cancer Institute. (2015, March 25). http://www.cancer.gov/news-events/
43
press-releases/2014/exceptionalrespondersqanda
HIMSS. HIMSS 2016 Connected Health Survey. (2016, March 2). http://www.himss.org/2016-con-
52
nected-health-survey
See Kennedy.
34
44
53
See Safavi.
See Dodd.
See Smith.
35
45
54
See Safavi.
See Smith.
See Kennedy.
33 See Best.
45