HEALTH

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15

HEALTHTRENDS

MARKETING

CONSUMER

DIGITAL

HEALTH

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15

HEALTHTRENDS

Our fifth annual series of trends reports includes insights into the

big shifts that are changing marketing, healthcare, digital

experience, and consumer expectations. In this report, you’ll find

the top eight trends in marketing, each with clues into new

possibilities and examples of brands that got there first.

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HEALTHTRENDS

Abigail Schmelzer

Alex Brock

Andrea Evans

Angela Cua

Azul Ceballos

Bruce Rooke

Campbell Hooper

Charles DiSantis

Chelsea Bailey

Duncan Arbour

Eduardo Menendez

Eric Davis

Fred Harrison

James Tomasino

Jeffrey Giermek

Jeffrey Wilks

Jessie Brown

Joe DeSalvo

John Mucha

Joy Hart

Julie Valka

Kathryn Bernish-Fisher

Kevin Nalty

Leigh Householder

Luke Hebblethwaite

Matt Groom

Mike Martins

Nick Bartlett

Nicole Sordell

Pavithra Selvam

Phil Storer

Richard Martin

Rick Summa

Sam Cannizzaro

Sarah Brown

Sayeed Anwar

Scott Raidel

Stefanie Jones

Zach Gerber

CORE

CONTRIBUTORS

At the core of our innovation

practice is a simple idea:Knowing how people’s expectations are changing lets us capture new

market opportunities, take smart risks, and spur innovation

We start by uncovering clues. Clues are data points, great stories,

quotes, and pictures that shift our understanding of what people want

right now. We find them in practices around the world and in the

technologies, brands, and experiences that doctors and patients

encounter in their everyday lives.

Over time, those clues combine and connect to reveal trends, a new

kind of inspiration for creating experiences in the moments before our

customers realize they need them. And months and years before our

competitors realize the same thing.

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HEALTHTRENDS

Innovation From Insiders

Patient 1’s and 0’s

Carrot and Stick Healthcare

Remote Attention

Disillusioned Doctors

Wedging Learning In

DIY Diagnosis

The New Competition

We’re following eight trends that show how

healthcare experiences will change.

THE

TRENDS

1.

2.

3.

4.

5.

6.

7.

8.

1.

IN SHORT

Last year it looked like

pharma might be left behind

in the wave of innovation

changing healthcare

experience. Now, more and

more industry leaders are

getting in the game.

1.INNOVATION FROM

INSIDERS

39%

2013 vs 2012

176%

2014 vs 2013

Venture funding of

digital health is growing

significantly, outpacing

other healthcare sectors

like software, biotech

and medical devices.

—PwC MoneyTree; digital health data

based on Rock Health analysis

ACCELERATING EXPERIENCE INNOVATION

1.INNOVATION FROM

INSIDERS

The industry that has long invested in early biotech innovation is now in the market for early

experience innovation. In 2014, Abbott, Boehringer Ingelheim, Genentech, and GE

partnered with Rock Health, a leading funder of healthcare technology startups.

In Germany, Bayer went even farther, evolving their Grants4Apps crowdsourcing initiative

into a true digital health accelerator. Each of five startups will receive 50,000€ and 3.5

months in-house at Bayer for less than a 10% loss in equity. The accelerator’s first

investments included wearable health sensors, a smart pill bottle, and home monitoring

systems.

—VentureBeat, 2014

BRIDGING MEDICINE

AND EXPERIENCE

1.INNOVATION FROM

INSIDERS

The biggest surge of experience

innovation this year will continue

to be product design that blurs

the lines between healthcare

and technology evolution.

In 2014, Novartis led that field.

What started as simple licensing

of Google’s passive glucose-

sensing contact lens quickly

became a pipeline of product

possibilities on the platform,

including an autofocus feature

for people living with presbyopia.

UCB is one we’ll be watching in 2015.

They recently partnered with MC10 to

find new uses for their stretchable,

electronic Biostamp technology. It’s like

a temporary tattoo that can track

biometrics, muscle strength, motion,

etc. Currently, MC10’s major partner is

Reebok. They’re working together to

create a mesh cap that fits under a

sports helmet to detect concussions

and monitor impacts. At UCB, the

possibilities become even bigger,

dramatically changing what we can

learn in clinical trials and how we can

support patients on therapy.

Boehringer Ingelheim partnered with

Propeller Health to attach a smart

sensor to the back of its inhaler.

They’ll be passively collecting

information to uncover new insights

into nonadherence—insights that

can be solved with more innovations

in digital health.

(FINALLY) CO-CREATING

WITH OUR CUSTOMERS

1.INNOVATION FROM

INSIDERS

In 2015, we predict market research

budgets will start to decline as co-

creation becomes more and more

central to how pharma creates new

experiences.

Genentech was one of the biggest first

movers, working actively with patient

communities from PatientsLikeMe to

Crohnology to MediGuard to improve

their clinical trials.

Sanofi has a really compelling program for nurses that is

focused on listening to how its customers solve their own

challenges. The Connecting Nurses website has brought

together 14 million nurses from over 130 countries to share

their ideas on how to bridge the gaps in healthcare and

resources that happen around the world.

We have a new, intriguing opportunity to listen to those

customers with the latest Rx rating and review site, which

launched in mid-2014. Wired editor Thomas Goetz created

the site called Iodine to crowdsource effectiveness data on

drugs and guide consumers about drug purchasing decisions.

IN SHORT

Today’s doctor-patient relationships include emails,

text, electronic medical records, website portals,

and, oh yeah, the occasional conversation.

“My impressions from

speaking to friends who

have been patients is that

nowadays they rarely get

the doctor’s undivided

attention because of

doctor focus on the

computer.”

—Dr. Ken Grauer,

a family practitioner

2.

2.PATIENT 1’S

AND 0’S

Italy France Spain United Kingdom United StatesGermany

70% 68% 46% 39% 38% 38%

Percent of physicians

emailing with patients:

—Manhattan Research, 2013, 2014

THE DOCTOR WILL SEE YOU IN YOUR INBOX NOW

2.PATIENT 1’S

AND 0’S

It turns out not every interaction with your doctor

requires a paper gown. More and more physicians

are connecting with their patients pre- and post-visit

via email, text message, and secure portal.

No surprise, patients prefer it. In fact, a recent

survey by Catalyst Healthcare found that 93% of

adults prefer to go to a doctor who offers email

communication. Many would even pay more for it:

25% said they would still prefer a doctor that uses

email communication even if there was a $25 fee per

episode.

Dr. Joseph C. Kvedar, a dermatologist and founder

of the Center for Connected Health, a Harvard-

affiliated organization that aims to move healthcare

from the hospital and doctor’s office into the day-to-

day lives of people who need help, explains that

email improves efficiency for doctors and removes

the frustration of phone tag. “Making myself available

via email gives my patients a sense of direct access

to me,” he said. It sends a message that I care and

that I’m available to answer questions in a timely

manner. It builds a bond between us that has

tangible benefits for my patients’ health.”

In a recent survey from Catalyst Healthcare

found that 93% of adults prefer to go to a

doctor that offers email communication.

93%

2.PATIENT 1’S

AND 0’S

A recent study from Kantar Media found that nurse

practitioners are even more likely than doctors to

reach out to their patients in the inbox.

These interactions are truly incremental, supportive

healthcare. In a retrospective study of 2,357 primary

care patients who connected with their doctors

through an online patient portal, the Mayo Clinic

found that there was no significant change in the

frequency of office visits.

In large networks, many of these personal messages

go through portals. Kaiser Permanente has one of

the largest. 4 million of its 9.1 million member

network use Kaiser’s online health management

platform, called My Health Manager. According to

their annual report, 34.4 million lab test results were

viewed online, 14.7 million secure emails were sent,

3.6 million online appointment requests were made,

and 14.8 million online prescriptions were refilled.

But Kaiser expects the platform to do more than

improve communications. They’re after improving

outcomes, too. Of the members who used the

lifestyle features of the portal 56% said they lost

weight and 58% said that they quit smoking.

Insomniacs even reporting increasing their nightly

sleep by 32 minutes on average.

Lost Weight

56%

Quit Smoking

58%

Of the members who used the

lifestyle features of the Kaiser

portal, 56% said they lost

weight and 58% said they quit

smoking.

2.PATIENT 1’S

AND 0’S

"Aspects of current EHRs that were particularly

common sources of dissatisfaction included poor

usability, time-consuming data entry, interference with

face-to-face patient care, inefficient and less fulfilling

work content, inability to exchange health information,

and degradation of clinical documentation."

—RAND Corporation for the American Medical Association, 2013

A NEW SCREEN, A NEW BARRIER

2.PATIENT 1’S

AND 0’S

Electronic health records may increase the long view

that doctors have into their patients’ health, but they

can really decrease the short view across the exam

room. Physicians and patients alike report that the

computers and tablets used to operate EHR systems

create a new barrier between doctor and patient.

Many, including Kevin R. Campbell, a cardiac

electrophysiologist who blogs as KevinMD, worry

that the new focus on data input will interrupt the

doctor-patient relationship. “We must continue to

practice the art of medicine, which requires that we

actually talk and listen to our patients,” Campbell

said. “We must not forget the value of interacting

with patients, looking them in the eye, and providing

them undivided attention. Computers, laptops, and

iPads in exam rooms foster distractions.”

But a new role could change all of that.

A growing number of physicians are hiring scribes to

do the data entry for them. Those scribes team up

with the physician throughout the day—seeing

patients, suggesting which codes to use, sending

electronic prescriptions to the patient’s pharmacy on

the doctor’s behalf, and generating referral letters to

specialists.

The impact is positive for both sides of the exam.

Patient satisfaction scores increase, physicians see

an average of one additional patient per hour, and all

the charts are completed by the end of the day

(which means no homework).

—Medscape, 2014

THE TEXT RX

2.PATIENT 1’S

AND 0’S

One of the longest-running and most

well-known health text initiatives is the

Text4Baby program created by a public-

private partnership that includes

Johnson & Johnson, the National

Healthy Mothers, the Healthy Babies

Coalition, and others. Women can sign

up for the service by texting BABY (or

BEBE for Spanish) to 511411. Then they

receive text messages, timed to their

due date, with helpful tips that educate

them about their pregnancy and getting

ready for the new baby.

2.PATIENT 1’S

AND 0’S

Like many other healthcare text programs, the short messages showed an

impact. And, they broke through to underserved communities:

82% learned about

medical warning signs

they did not know.

82% 65%

65% reported

they talked to

their doctor about

a topic they read

on a Text4Baby

message.

Text4Baby moms

were 3x more

likely to believe

that they were

prepared to be

new mothers

compared to

nonusers.

A higher percentage of

Text4baby participants live in

zip codes with the highest

levels of poverty compared to

the overall US distribution.

Nearly half reported their

household income was

$16,000 or less.

2.PATIENT 1’S

AND 0’S

Teams at practices and hospitals, like the Montefiore Medical

Center, are using texting to support patient relationships. An

interactive text message-based care management system at

Montefiore was able to create a 40% improvement in

appointment adherence and modest improvement in

medication and care plan adherence.

They extended the Sense Health platform to pre-scripted but

customizable messages that busy Medicaid care managers

could send to patients to make them feel like they were getting

more of the individual attention they wanted.

—California State University San Marcos National Latino

Research Center survey, 2013

Sense Health, 2014

IT’S NOT JUST YOUNG MOTHERS WHO ARE

BENEFITING FROM SMS SUPPORT. 40%

Montefiore’s text message system

created a 40% improvement in

appointment adherence

3.

IN SHORT

Financial incentives changed

how doctors practice medicine.

Now brands from insurers to

retail are betting they can use

them to shift something even

bigger: everyday human

behavior.

3.CARROT AND STICK

HEALTHCARE

70%

Pre-Penalties

For Choosing

Generics

10%

Post-Penalties

For Choosing

Generics

In 2015, benefit

design will change

behavior the way plan

design did in the

1990s. The 1990’s

shift: changing the

number of people

choosing expensive

brand-name drugs.

—Healthcare incentive expert,

Francois de Brantes, 2013

THE BIGGEST LEVER IN HEALTHCARE

Governments, payers, and employers are using both

financial rewards and penalties to try to encourage

healthier behaviors. At Cigna, that means engaging 14

million members in a digital health coaching program

that offers mobile tools, social media engagement,

gamification, and rewards. At Pennsylvania State

University, it’s a $100 monthly surcharge for employees

who don’t complete a biometric screening and an online

wellness profile. One Midwestern hospital chain even

announced it would deduct money from employees’

paychecks for unhealthy behavior, such as being

overweight.

—Partnership to Fight Chronic Disease, 2014

Treating people

with chronic

conditions

accounts for 84%

of healthcare

costs.

84%

3.CARROT AND STICK

HEALTHCARE

CHANGING ROLE OF RETAIL

3.CARROT AND STICK

HEALTHCARE

One unexpected location for these new

rewarding programs is the local drug

store. Those stores increasingly want to

be seen as a healthcare destination. That

means they’re evolving their “minute

clinics” designed to deliver fast-pass

healthcare into full primary care suites

offering everything from pain management

clinics in the UK to chronic disease care in

the US.

And, they’re changing their rewards to

match. What were once simple savings

cards that rewarded shoppers with

coupons and discounts for their shopping

behavior are now delivering rewards

based on shoppers’ health behaviors. If

you walk those aisles enough, you might

even get a step-based reward in store!

FAT TAX OR SKINNY SPIF?

3.CARROT AND STICK

HEALTHCARE

The much discussed question is: Which one works

better? How these incentives are framed—as

benefits for healthy-weight people or penalties for

overweight people—makes a big difference.

Rewards become less effective over time, but

penalties can be seen as stigmatizing and punishing,

making it even harder for people to make a healthy

change.

While people prefer the carrot design, the sticks do

seem to have an impact. Researchers from the

University of Michigan Health System found that

when faced with having to pay up to 20% more for

health insurance or do more exercise, most of the

enrollees gradually met their fitness goal of walking

5,000 steps per day through an Internet-tracked

walking program.

Another approach may be reaching across industries

to punish food instead of people. A growing number

of European countries, including Denmark and

France, have already imposed a tax on unhealthy

food and drinks. A tax of at least 20% placed on

sugar-sweetened drinks could drop obesity rates by

3.5% and prevent 2,700 heart-related deaths each

year, according to the study.

3.CARROT AND STICK

HEALTHCARE

-3.5% +2,700

A recent study found that a tax of at least 20% placed on

sugar-sweetened drinks could drop obesity rates by 3.5%

and prevent 2,700 heart-related deaths each year.

—Association of Psychological Science, 2013

—Behavioral Translational Medicine, 2013

—British Medical Journal, 2012

4.

IN SHORT

For years, patients have complained that their medical

interactions were rushed and impersonal. Today they’re

finding the kind of attention they want at home from a

growing number of remote and telesupport services.

4.REMOTE

ATTENTION

5.7M

2014

The number of doctor-patient video

consults in the US will nearly triple over

the next year.

2015 2018

16M

130M

4.REMOTE

ATTENTION

FILLING THE GAPS IN MODERN MEDICINE

The eHealth Stakeholder Group in Europe has been one of many to clarify the need for

new kinds of healthcare interactions. Their “Widespread Deployment of Telemedicine

Services in Europe” report pointed to three shifts creating new gaps:

More people living

with (multiple)

chronic conditions,

often starting at a

younger age

Growing elderly

population,

supported by fewer

resources paid for

by the shrinking

tax base

Not enough

healthcare

workers (the total

number is actually

falling in

European states)

Urgent need for

more efficient,

impactful

healthcare

Beyond the demographic shifts, there are real experience gaps in medicine, ones that leave

patients feeling disconnected and unready to manage their own care.

+ + =

4.REMOTE

ATTENTION

46%

Primary

Care

Urgent

Care

Nothing

35%

7%

ER

12%

Video Visits Are Replacing

Traditional Healthcare“Doctor On Demand” users were

asked what services they would

have used if they didn’t have

access to the DOD app.

4.REMOTE

ATTENTION

FACE-TO-FACE VIDEO MEDICINE

Nearly one million US families used video

consultations with physicians last year. That number

is expected to explode in the next few years.

The consumer preference for video connections with

doctors over phone calls is staggering. American

Well, one of the leading providers of telehealth,

reported that 94% of its customers chose video over

telephone. This isn’t a trend limited to young families:

American Well’s core customer base includes the US

Department of Veterans Affairs, Rite Aid, United

Healthcare, WellPoint and various Blues plans.

Mobile may have been the tipping point for the

switch. A quick click of a camera phone is infinitely

easier to figure out than installing a webcam ever

was. In that same report, American Well calculated

that 60% of its customers used their smartphone or

tablet for their video visits.

The overall reach of telehealth has grown

substantially. In 2014, Parks Associates reported that

42% of broadband households in the United States

had used some type of online healthcare

communications and that many had used it multiple

times. Gartner believes we’re at a real tipping point,

predicting the global telehealth market will be more

than $27 billion by 2016, tripling in growth since 2010.

Many urgent care systems and primary care

practices are integrating telehealth into their offerings.

Even Google is making telehealth part of its search

service through Helpouts, its video chat service and

directory. Helpouts makes it easy for all kinds of

experts to offer a live consultation to searchers.

Increasingly, those experts are doctors, like the One

Medical Group.

4.REMOTE

ATTENTION

TAKE-HOME SUPPORT

Health systems around the world are looking to

telemonitoring to support patients—and outcomes—

at home.

Dr. Ed Brown, CEO of the Ontario Telemedicine

Network (OTN), has partnered with regional

healthcare authorities in Ontario to enroll patients

with congestive heart failure and COPD into a remote

monitoring program. “We’re providing them with

remote monitoring tools in their homes and asking

them questions based on clinical guidelines to track

their progress on a daily basis. Then their nurses

track that data,” he explained. The tools include

devices like remote pulse oximeters and blood

pressure cuffs.

The nurses are also trained to be health coaches

who can help patients understand their disease and

set goals to improve their health status. “Nurses are

pretty used to telling people what to do,” Brown said.

“This is different because they’re empowering

patients to set their own goals.”

The program has reduced hospitalization rates by two-

thirds and reduced emergency room visits by 70%.

In the US, the Geisinger Health Plan was able to use

remote monitoring to reduce readmissions by 38% for

congestive heart failure patients and deliver an ROI

of $3.30 on the dollar for the system.

Patients used a Bluetooth-connected weight scale that

included interactive voice surveys about shortness of

breath, swelling, appetite and prescription medication

management designed to detect acute events before

they happen. Weight data and survey answers were

transmitted to the patients’ care team, allowing them to

respond to warning signs.

66%Ontario Telemedicine

Network’s remote monitoring

program has reduced

hospitalization rates by 66%.

—PwC, 2013

—AMC Health, 2014

4.REMOTE

ATTENTION

Telemedicine continues

to grow in popularity

with doctors:

60%

60% of

healthcare

providers use

two-way video

55%

55% use

image-sharing

technology

46%

46% of

healthcare

providers use

multiple

telemedicine

technologies

25%

25% use remote

patient

monitoring

20%

20% use their

smartphones for

telemedicine

5.

IN SHORT

Who wouldn’t want to be a doctor? Most

doctors. This once aspirational

profession is now shouldered with

growing levels of unhappiness,

disillusionment and burnout.

“The rate of severe diabetes complications

in patients of doctors who rate high on a

standard empathy scale is 40% lower than

in patients with low-empathy doctors.”

—”What Doctors Feel,” Dr. Danielle Ofri, MD

5.DISILLUSIONED

DOCTORS

Cardiologist Sandeep Jauhar says

today’s physicians see themselves not

as the “pillars of any community” but as

“technicians on an assembly line,” or

“pawns in a money-making game for

hospital administrators.”

—”Doctored,” Dr. Sandeep Jauhar, MD

5.DISILLUSIONED

DOCTORS

THE EMPLOYEE PHYSICIAN

Remember the doctors many of today’s practicing

physicians grew up with? It was a golden age of

medicine. They were heroes. Life expectancy was

increasing. There were huge firsts, like the heart-lung

bypass. And doctors generally set their own course—

customizing their practice, fees and hours around

their communities and the lives they wanted to lead.

Then things started to change.

Questions about fraud and waste sparked new rules

and bureaucracies designed to make medicine less

expensive and more uniform. Governments have

issued more mandates for record keeping and

reporting. Payers have set fees lower and lower. The

only way to keep up is to join up.

Doctors tend to have access to more support and get

reimbursed at a higher rate when they’re in a network

or physician group. So, many have left solo and small

practices and moved into big ones.

A recent survey by healthcare staffing firm Jackson

Healthcare found that not only are hospital

acquisitions of physician practices up (52% of

hospitals plan to acquire practices in 2013 compared

with 44% in 2012), the majority of those deals—70%,

in fact—are initiated by doctors looking to sell.

Many of these new mega employers set factory-like

goals for their employee physicians, like seeing a set

number of patients per day.

70%70% of acquisitions of

physician practices are

inititated by doctors

looking to sell.

5.DISILLUSIONED

DOCTORS

MODERN MEDICAL CONVEYOR BELT

Lots of new medical professionals are entering the

practice, and fewer and fewer of them are MDs. Instead

a growing number of physician assistants and nurse

practitioners are helping those MDs make the medical

home model real. They’re each working to the top of

their skill sets and then handing a patient off when she

needs even more expertise or speciality care.

In “The Physician Assistant Will See You,” Barbara

Moran looked into this in-practice referral system, ‘Like

it or not, medicine is now a team sport,’ observes Dr.

Reid B. Blackwelder, president of the American

Academy of Family Physicians. As his practice moves

to team-based care, he may delegate more well-child

visits to P.A.s or nurse practitioners. He enjoys seeing

his healthy patients, he said, ‘but the paperwork takes

a lot of time — as a physician, my time may be better

spent with a patient who is critically ill.’ And he can still

keep his relationship with the healthier children, he

said, ‘by a quick visit at the end.’”

That balancing act is tricky across specialties. In a

recent essay, “Doctors Tell All—and It’s Bad,” The

Atlantic’s Meghan O’Rourke wrote, “Studies estimate

that today’s doctors and ‘hospitalists’—medical

practitioners who do most of their work in hospitals—

spend just 12 to 17 percent of their day with patients.

The rest of the time is devoted to processing forms,

reviewing lab results, maintaining electronic medical

records, dealing with other staff.”

For patients, what’s missing is missed. Atul

Gawande, a surgeon and professor at Harvard

Medical School, explains that how patients feel about

their medical interactions really does influence the

efficacy of the care they receive and that doctors’

emotions about their work in turn influence the quality

of the care they provide. The patient-doctor

relationship is still the heart of medicine.

5.DISILLUSIONED

DOCTORS

"I wouldn't do it again, and it has nothing to do with the money. I get too little

respect from patients, physician colleagues, and administrators, despite good

clinical judgment, hard work, and compassion for my patients. Working up patients

in the ER these days involves shotgunning multiple unnecessary tests (everybody

gets a CT!) despite the fact that we know they don't need them, and being aware

of the wastefulness of it all really sucks the love out of what you do. I feel like a

pawn in a moneymaking game for hospital administrators. There are so many

other ways I could have made my living and been more fulfilled. The sad part is we

chose medicine because we thought it was worthwhile and noble, but from what I

have seen in my short career, it is a charade."

—Doctor on Sermo

5.DISILLUSIONED

DOCTORS

12-17%

It’s estimated that medical

practitioners who do most of

their work in hospitals spend

just 12 to 17% of their day

with patients.

78%

78% of 13,500 physicians

surveyed are “somewhat

pessimistic or very

pessimistic about the future

of the medical profession.”

84%

84% of physicians agree

that the medical profession

is in decline.

5.DISILLUSIONED

DOCTORS

JUST SICK OF IT

Here’s the big number: 78% of 13,500 physicians

surveyed are “somewhat pessimistic or very pessimistic

about the future of the medical profession.” And, 84% of

physicians agree that the medical profession is in

decline.

In “A Doctor’s Declaration of Independence,”

Dr. Daniel Craviotto wrote about the daily struggle: “I

don’t know about other physicians but I am tired—tired

of the mandates, tired of outside interference, tired of

anything that unnecessarily interferes with the way I

practice medicine. No other profession would put up

with this kind of scrutiny and coercion from outside

forces. The legal profession would not. The labor

unions would not. We as physicians continue to plod

along and take care of our patients while those on the

outside continue to intrude and interfere with the

practice of medicine.”

Almost 50% of doctors report symptoms of burnout —

emotional exhaustion, low sense of accomplishment,

detachment. In “Burnout and Satisfaction With Work-

Life Balance Among US Physicians Relative to the

General US Population,” the authors found that

“Burnout is more common among physicians than

among other US workers. Physicians in specialties at

the front line of care access seem to be at greatest

risk.”

6.

IN SHORT

The world of medicine is changing faster

than ever. Busy healthcare

professionals are left to try to find a way

to fit it all in.

The moments they do make

for new education are wedged

in between appointments or

surrounded by distraction.

6.WEDGING

LEARNING IN

CME ON THE COUCH

Our collaborators at Palio-Ignite created an interesting

healthcare professional layer over some recent data

from Google about when people use their various

devices. The new curves show traffic to healthcare

professional websites by device and time of day. Look

at that big spike in tablet usage right around 8PM in the

chart above.

It coincides with how we’re increasingly seeing those

doctors use different screens for different behaviors.

But it also shows the new environment doctors are

learning in. They likely are browsing healthcare content,

but in what context? At that hour, for many, it’s

potentially surrounded by the welcome distraction of

family life. (Perhaps Frozen is playing for the 30th time

in the background?) Not exactly study hall.

It’s a behavior we originally called multitasking, but

today that always-on, anywhere, anytime behavior has

left our culture in a permanent state of mild (to major)

distraction. The challenge is even greater in medicine,

where new screens, new tools, new requirements, and

the fast growth of information are leaving doctors

overloaded and only partially connected.

6.WEDGING

LEARNING IN

Web traffic to HCP sites

for digital devices

6.WEDGING

LEARNING IN

THE RESEARCH MOUNTAIN

These multitasking healthcare providers are up against pretty big odds. It

turns out new medical knowledge is already doubling every three years

and is projected to double every 73 days by 2020.

That’s a lot of information!

EHR and genomic data are amplifying the growth of data sets, publications

and possibilities. Just 10 years after the completion of the Human Genome

Project, 2014 brought the $1,000 genome. That cost decreased five orders

of magnitude in 10 years. That’s not linear, it’s logarithmic. In the next year

we’ll produce more genomic data than ever before in human history. (No

pressure.) And, that’s just one kind of medical information—so many more

are exploding, too.

6.WEDGING

LEARNING IN

REAL QUICK: ABOUT THIS RX

Let’s start with the biggest number: 10 minutes. When

Verilogue reviewed 70,000 exam room conversations, it

found that’s how long the average physician spends

with a patient. That 10 minutes is largely dominated by

the physician. In fact, 64% of the conversation is

physician-led; 33% is patient-led—with the small

balance owned by a caregiver or partner. How much of

it is dedicated to the new prescription? 99 seconds—or

13.7% of the conversation. Previous studies have

pegged that Rx discussion time as even shorter.

Think how many months and years we spend

perfecting the messages, the Q&A, the story, all to have

it boiled down into a 99-second Rush to the Rx. Beyond

the minor marketing injustice, there are real reasons to

wonder about the efficacy of those conversations. Our

collaborator George Van Antwerp recently reminded us

of the biggest one: the leaky bucket of good intentions.

The entire slippery slope of adherence starts with that

conversation between doctor and patient. Steve

Wilkins, MPH, one of the authors of the Verilogue study,

says nonadherence is “often a rational response on the

patient’s part when faced with a recommendation to do

something they don’t agree with—namely take a

medication.” He says 50% of patients disagree at one

time or another with a doctor regarding the diagnosis,

severity of a condition or particular treatment.

—2013 Physician-Patient Communications Benchmark from Verilogue and Steve Wilkins, MPH, of Mind the Gap and Smart Health Messaging

—”Pharmacies: Improving Health, Reducing Costs,” National Association of Chain Drugstores, 2010 (based on IMS data)

6.WEDGING

LEARNING IN

For every 100

prescriptions

written

50-70

go to a

pharmacy

48-66 come

out of the

pharmacy

25-30 are

taken

properly

15-20

are refilled as

prescribed

6.WEDGING

LEARNING IN

Average time spent in discussion about

medications during an exam

14.9 12.6 12.4 11.1 10.6 6.5 5.5 5.2 4.6 3.5 3.5 3.2 2.9 2.5

Time Spent (in seconds)

7.

IN SHORT

WebMD was training wheels.

This new era of at-home

diagnosis and health

management will make experts

of us all.

7.DIY

DIAGNOSIS

69%

69% of physicians said

patients should use tech tools

to help them form a diagnosis.

84%

84% of patients said

they should be able to use

the self-diagnosis tools.

—WebMD/Medscape, 2014

7.DIY

DIAGNOSIS

BRINGING THE LAB HOME

Today you can order an at-home self-screening

kit to test for everything from bowel disease to

meningitis to cholesterol. New entrants go even

further, letting users look at their own biology

on a molecular level and basically tinker with

activity, nutrition, sleep and more until they get

the consistent results they want. It’s more

health hacking then quantified tracking.

One of our favorites is Cue. It’s a small,

modular hardware system that works with iOS

to let users create a simple home diagnostics

lab. When it launches in early 2015, users will

be able to collect tiny samples of their own

saliva, blood or nasal fluid to test for five

distinct molecular indicators related to

inflammation, vitamin D, fertility, influenza and

testosterone. Each metric has a different

marker that, when measured and tracked, can

be used to discover trends, monitor progress

and help users gain realtime insight into their

bodies. Those numbers correlate with some of

the most basic questions people have about

health: Why don’t I have more energy? Is it a

cold or really the flu? What’s the best way to

recover from an injury or live your best life with

chronic disease?

7.DIY

DIAGNOSIS

Like other trackers, Cue pulls the data into great dashboards that let users compete against

themselves or collaborate with friends and strangers.

7.DIY

DIAGNOSIS

SHIFT IN RESPONSIBILITY

For people who believe that

healthcare is expensive and difficult

to use, DIY tools are a way to take

control back. They replace “What

could it be?” conversations in

healthcare social media with the

wisdom of science. Now a sensor on

your mattress can diagnose a sleep

issue. A blood pressure cuff

connected to your iPhone cannot

only spot a problem, it can identify its

triggers.

We predict this new at-home

medicine will be particularly

interesting to adult Millennials. Our

recent “The Worried Well” report,

published with Allidura and Harris

Poll, pointed to a strong desire

among that generation to take

healthcare into their own hands: “It

turns out that our hulking healthcare

system–with its confusing cost

structures and white-coated experts–

isn’t what Millennials are pursuing,

even as they express worry about

their health. For them the question

seems to be, not, who can help me

but what can help me. They’re

mashing up food trends with high-

profile cleanses and intriguing new

exercise offers to proactively live

healthier lives—and keep the doctor

away. In fact, 71% believe they’re

already doing everything they can to

maintain a healthy lifestyle. These

efforts show some indication that

they may be attempting to avoid

traditional healthcare altogether.”

Millennial Mindset: “The Worried Well”

allidura.com/millennialhealth

7.DIY

DIAGNOSIS

THE NEW PRIVACY QUESTION

People think the great debate of this decade is

about privacy—what we want other people and

companies to know about us. We disagree. We

think it’s about transparency—how much we’re

actually comfortable knowing about ourselves.

This new generation of products from both startups

and category leaders are going to push all of us to

answer this simple question: Do you really want to

know?

The question becomes even more difficult when it’s

connected to “real” healthcare. Both healthcare and

technology experts are pointing to Apple’s HealthKit

as the catalyst that finally brings patient-generated

data into the healthcare ecosystem—if patients are

really ready to share it there.

Apple’s HealthKit Platform

8.

IN SHORT

We’re just a few years away from

digital therapies taking on

traditional medicines on their own

turf: clinical trials, formularies, and

prescription pads.

8.THE NEW

COMPETITION

—WebMD/Medscape, 2014

Adoption rate of wearables

parallels that of tablets.

20%of Americans in 2012 owned a

tablet after just two years on

the market.

40%of Americans own

them today.

21%of American adults already

own a wearable device.

?

2012 2014

2014 2016

8.THE NEW

COMPETITION

BOUNCING BACK FROM THE

BACKLASH

In 2013, we were all calling wearables the next big

thing in healthcare. Then in 2014, Nike fired the

majority of its FuelBand team. The New York Times

called wearables “digital snake oil.”

A lot of us chucked out Fitbits.

But, investors haven’t backed off. They think the first

generation just wasn’t good enough. The new

wearables will be more clinically valid, smarter,

more convenient, and more relevant to our lives.

Nike’s Fuel Band

8.THE NEW

COMPETITION

THAT’S JUST THE BEGINNING

Real digital therapies are just beginning to

take shape. In three years, the investment in

digital therapies has experienced 20x

growth. These are behavioral software tools

that are backed by published clinical data.

Real-world outcomes. This isn’t pill+ to

improve the bottom line, it is the bottom line.

Within a few years, these solutions will be

listed on formulary next to pills.

Investment in digital

therapies has experienced

20x growth in three years.

20X

8.THE NEW

COMPETITION

Digital therapies include any software or hardware designed to deliver behavioral medicine at scale

to tackle chronic disease and reduce healthcare costs. A few investor favorites right now include:

Mango Health’s mobile app

that improves adherence by

over 50% in chronic

therapeutic categories like

cardiovascular disease,

hypertension, and diabetes.

Omada’s Prevent program

that gives prediabetics a 16-

week online course with 1:1

coaching and support built in

to reduce the risk of

developing type 2 diabetes.

Kurbo’s online and mobile weight

management program that is safe

for kids and teens between the

ages of 8 and 18 and their

families. 85% of beta participants

saw a significant decrease in their

BMI in 10 weeks.

—Rock Health, 2014

8.THE NEW

COMPETITION

A SPOON MIGHT POINT THE WAY

This year, Google bought a spoon. One from Lift Labs,

a company that is developing smart utensils for people

with Parkinson’s and essential tremor. It competes

head-on with medicines that treat the symptoms of

those diseases, but does it with absolutely no side

effects. Instead, it uses active cancellation (which is

currently in noise-cancelling headphones) to stabilize

larger-scale motion. They’re also looking at solutions

for drinking and grooming. We might not hear more for

a while, though. After the acquisition, the team went

into Google’s notoriously secretive labs.

Governments and payers are looking carefully at the

potential of these new solutions. Long a first mover on

digital health, the US Department of Veterans Affairs

changed its contracting template in such a way that

enables it to soon begin reimbursing its doctors for

clinical grade activity trackers in some limited

circumstances.

They’re focused on a number of highly specific metrics

such as stance and swing time, gait symmetry,

dynamic function, cadence and cadence variability,

step count, numbers of steps per time interval, peak

performance, and functional level assessment.

Google bought Lift Labs, a company developing smart utensil

20

15

HEALTHTRENDS

To discuss this report live, request another module, or schedule a

presentation of trends, please contact Leigh Householder at

614-543-6496 or leigh.householder@gsw-w.com