This week I presented as part of the Mobile Health track at the ePatients Connections conference in Philadelphia. The track's chair was the inimitable Jane Sarasohn-Kahn, a noted health economist and commentator. Sarasohn-Kahn kicked off the afternoon with a sweeping presentation that covered a number of important aspects of the mobile health landscape. Below are a few excerpts from her presentation:
On Who pays, Reimbursement, and Self-pay
"When we talk about markets as economists, we always think about demand, which is need through the lens of ability or willingness to pay. That’s why I'm always bringing up reimbursement payment. That has been the real barrier for a lot of healthcare, not just health technology and IT adoption. It's a particular barrier for mobile health.
"Again as an economist, I think about how people are incented or nudged to take good care of themselves. People know what the right thing to do is, but still we’re seeing people delaying care. They delay a visit to the doctor and it’s not just for a mammogram. We’re talking about people who feel sick, who aren’t getting necessary tests and treatments. And it's because of what probably seems silly to you and me — because we make plenty of money in this room — it's because of a $20 or $30 co-pay. 'Hey, it’s my husband’s birthday -- gotta buy the Norelco razor -- that $30 is going to the birthday gift.' This is real life, and between the two coasts lots of people make these decisions. They are not pretty some of the time. I’ve been known to say, people think they make what are smart, short-term fiscal decisions, which lead to bad long-term physical outcomes, and that is particularly true in this recession."
On the Chronic Care Model Vs. Participatory Health
"If you know of the Robert Wood Johnson Foundation, then this is a model some of you know: The chronic care model. This was put together back in 1998. That means we have been trying to skin this cat for a long, long time. The chronic care model talks about the patient at the bottom left of the model as an informed and activated patient. Can you imagine that in 1998 the conceivers of this talked about an "informed" and "activated" patient? And again, how many years later are we still wrestling with it?
"In the new model, now that we have an underpinning thanks to the Internet, cloud computing and the increasingly adopted EHR, we can start to see lots of arrows going back and forth between different stakeholders in the health ecosystem. This will move us to what many people, including ePatient Dave and [Pew Internet Research's] Susannah Fox and myself, are always talking about: The participarotry health model. Patients informed and activated? Yes, but also connected back to the health system!
"A lot of apps that you can download on your iPhone — and I’ve got plenty of them on my beloved iPhone — don’t connect to my doctor, because I’m a shoemaker’s child with no shoes. My doctor here at suburban Philadelphia... does not have an EHR yet. Even my doctor doesn’t have it and I get this stuff! But I love him and he’s a great doctor and he will have his EHR next year. So my apps don’t connect back to him, but I can’t wait until they do. He’s a little concerned about that, but he’ll get used to it.
"This is the paradigm that I’m thinking about when we talk about mobile health. In the best possible sense this would be nirvana. Mobile health is not just about being mobile within the home, with my husband, my kid, a friend, my clinician, my health coach, my clinician, my diabetes educator. It includes whoever I choose to include in my ecosystem."
On the disempowered, dazed and confused
"According to an Edelman study from two years ago, one in five people are t0o disempowered, dazed and confused when it comes to their own health. Another one in five is reactionist and don't engage until they have a more serious problem, but they aren’t going to be proactive. At best, then, about three in five might do something proactive. Might!"
On the "most important source for health engagement"
"The other important data point that came out in the Edelman study was that the most important source of health engagement information going forward was something people called 'conversations with my doctor'. Not 'a lecture from my doctor', not 'a prescription from my doctor'—a conversation with my doctor, which means the doctor has to be willing to have a conversation. Now we love working with doctors, we love connecting with doctors, but doctors right now think I have to be reimbursed to have more than a two minute conversation. In health reform, if it stays in place the way it is, depending on what happens in November — in terms of bundled payments, pay for performance, accountable organizations and medical homes — there should be incentive for doctor’s to have longer conversations and adoption of connected health strategies and protocols.
"Finally, just a key little data point that came out from McKinsey last year: When you ask people globally what sort of mobile health program they want, they say: I want to see my doctor on the phone. Interestingly enough."