Reimbursement pain is so last-year. The 2008 Connected Health Symposium was, I thought, a somewhat gloomy affair -- gnashing of teeth and hand wringing over government and insurer footdragging, limited market penetration, and still no reimbursement for remote monitoring and other telehealth technologies. This year, despite a worsening economy, the mood was much perkier.
The planets are aligning for connected health. In 2009, attendee spirits were no doubt bolstered by not-yet-finalized health legislation that includes a large dosage of technology 'stuff', the stimulus dollars which included a staggering $17 billion for health-related tech spending, some modifications that have been made to Medicare coding for telehealth, and last, but most, the healthcare segment is a thriving segment star in an otherwise battered economy firmament.
We've come a long way from DrKoop. Spirits were up about the growing interest in enabling technologies by the medical community. A few morsels from Mark Bard of Manhatten Research whose business is to quantify: Two in three adults have high speed access (that's 157.5 million people); there are 80 million users of 'Health 2.0' aka using the health-related Internet.* Most folks are symptom checking -- only 15 million of them are 'content creators'. And MD accessing of the Internet has doubled from 4 to 8 hours per week (checking drug information, selectively using e-mail or other tools, though not ePrescribing). Nine in ten doctors in 2009 said the Internet is 'essential to my practice or practice efficiency.'
Center for Connected Health has results. One of the more interesting sessions was a report by Dr. Joseph Kvedar proving better outcomes for patients in connected health programs -- like Diabetes Connect, SmartBeat, and Connected Cardiac Care. By providing patients with devices to help them track their status (glucometer, weight scale, blood pressure cuff, oximeter) and by monitoring their progress, they have seen a clear drop in readmission and heard feedback from at-risk elderly participants that the Cardiac Care program, for example, made them feel both tethered and comforted.
We've got a long way to go. My sense from the event is that 'telehealth' is obsolete, long live eEverything and mobile madness. Welcome to the world of smart phones for the care community, web dashboards of everything, sensors on our body, reminders in our home. But as Dr. Joseph Coughlin of the MIT Age Lab and others observed, the large institutions (hospitals and provider systems, technology vendors) are still and will always be deeply invested in preserving the status quo of the way they work, as he said, 'designing for reimbursement.'
The 'Kindlecation' of healthcare. Replacing last year's woe-is-me worry about revenue, many ideas were batted about for improving the business model beyond same-old -- including the discussion of 'free' health information through a mobile phone, lowering the prices of devices and selling service, hybrid business models of reimbursed and out-of-pocket service. There was a great deal of chatter about retail sales of chronic disease devices, whether through Best Buy or CVS.
The 'elephant' in the room - aging. Admittedly I have a vested (and different) perspective, but I saw more of the chronic disease management discussion reflecting the reality of an aging demographic. And I heard growing awareness of overlapping segments of chronic disease management, wellness, health information, and aging consumers and their caregivers. The perspective of patients as people with needs beyond their disease specific care -- not so much. Maybe next year.
Winners and frogs. As I listened to a panel discussion among a broad range of industry execs, it seems to me that the winners in the world of Connected Health are those that make the infrastructure -- Qualcomm (wireless everything), Verizon (mobile everything), Cisco (in their words, 'Connecting Everything'). Next to win will be the software-as-a-service vendors, so easily re-configurable and replacing what didn't work with what does. Manufacturers of telehealth equipment, however, like Honeywell must reinvent repeatedly or recede in importance as the web, cheap and disposable sensors and lower priced devices pick up where proprietary telehealth monitoring left off. And the real frogs in cold water? Medical center models of care delivery that place the doctors in the center of the universe, while the Patient (most of the time a Person) finds the 'treatment' -- medical, alternative, informational, behavioral, and personal -- that they want and deserve.
Attendence in a slumped travel economy was impressive -- with 1000 attendees (10% of them speaking and many from outside the US), 37 exhibiters, and 29 sponsors. Donna Cusano summarized many of the sessions and some key technologies in the attached TelecareAware blog.
* Put Health 2.0 into a search bar and read some interesting top results about what Health 2.0 is believed to be.