Healthcare cathedrals and the consumer health bazaar

By Brian Dolan
03:41 am

Brian Dolan, Editor, MobiHealthNewsOne out of every three adults in the US will buy a digital health product of some kind in the next year, Gary Shapiro, the CEO of the Consumer Electronics Association (CEA), said -- citing data from an upcoming CEA survey -- during his luncheon keynote at HIMSS' mHealth Summit this week. With the exception of that prediction, Shapiro largely steered clear of the consumer health conversation and instead discussed how lowered healthcare costs could save the country from the so-called "fiscal cliff", how perverse reimbursement policies for physician visits need to be removed, and how our lawsuit-happy legal system needs to adopt a "loser pays" policy.

With the head of the largest consumer electronics association tackling systems issues, at times it seemed like the consumer health conversation at the mHealth Summit was buried.

Over the course of this past year the consumer/patient-facing digital health conversation shifted from a predominantly direct-to-consumer market to one that might leverage traditional healthcare channels. Among the drivers that steered the industry back toward the patient-provider relationship: the prospect of physicians prescribing apps, the importance of integrating data from mobile health programs with EHRs and other systems, and the push for patient engagement from forthcoming meaningful use requirements.

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Still, many speakers at the mHealth Summit championed direct-to-consumer.

Martha Wofford, Head of Aetna's Consumer Platform, praised iTriage, which Aetna bought last year, for ramping up to 8 million downloads. Wofford described that as "a tremendous number of people" and as having "far outpaced any adoption" for other direct to consumer products that Aetna had tried launching on its own. Wofford said in some instances startups understand direct-to-consumer distribution better than large companies like Aetna do.

"Large companies understand [business-to-business channels] better," Wofford said. Now that iTriage is a part of Aetna, "the marriage of the two is very exciting."

Scott Peterson, the VP of Sales for Verizon's Healthcare Practice, poked a hole in the hype surrounding health app certification and touting consumer savviness.

"Code will be written. Apps will be deployed that change the way both patients and providers get access to information. The market will sort the ones that don’t work." Peterson said that "ultimately the consumer and patient want the same thing as providers and payers: better outcomes and better care" and that "savvy consumers know which apps work; savvy payers and providers know which apps appeal to consumers."

While it may be somewhat expected that nontraditional companies, telecoms like Verizon, take a different stance than the healthcare establishment, some healthcare providers touted consumer-driven disruption, too.

Dr. Joe Kvedar, Founder and Director of Partners HealthCare's Center for Connected Health, said that he's "a fan of retail clinics because they are a glimmer of what [the future of healthcare] will look like." Kvedar said that retail clinics "took 5 percent of primary care and no one really noticed." The healthcare system is so occupied by incumbents, he said, "that have so much to lose by changing" that things won't change there first.

Vinod Khosla, founder of the investment firm Khosla Ventures, agreed:

"The right way to look at it is to say 'How does innovation happen and how do very large systems like the healthcare system change?' Most of the time change comes from the outside. Not the inside where there are too many vested interests, too many people with very good intentions who have too much experience to be unbiased," Khosla said. "They are not naive enough to ask naive questions. The answers have changed because of the circumstances -- because of technology. Healthcare innovation will be consumer-driven not doctor-driven. It will be driven by devices that power the consumer to have better data about themselves." Khosla was quick to point out that technology is an important component but not the only one: "It is necessary but not sufficient."

Health apps and smartphone-enabled medical devices today, which Khosla described as "clumsy point solutions", are just version 1.0 of digital health, he said. This is just the beginning and some of the consumer-driven services today will quickly make their way into the healthcare system. Aetna's iTriage acquisition is one key example. Khosla clearly believes there will be others soon.

Consumer health and provider-driven digital health initiatives, of course, will grow up together in parallel. Each can help drive the other in their own way.

"There are really two models for how the world works: the cathedral and the bazaar model," Khosla explained. "Bazaars evolve much faster than cathedrals do -- often because people leave cathedrals to join the bazaar. You can also be in a cathedral and help the bazaar evolve faster than any cathedral could on its own."


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