Emerging mHealth: Paths for growth A global research study about the opportunities and challenges of mobile health from the perspective of patients, payers and providers www.pwc.com/mhealth We live in a world that’s connected wire- Industrialisation of the healthcare lessly with almost as many cellular phone sector, already in motion, and driven by subscriptions as there are people on the technologies such as electronic medical planet. According to the International records, remote monitoring and commu- Telecommunication Union, there were nication platforms, etc. is in many ways almost 6 billion mobile phones in use the prerequisite for the flourishing of worldwide in late 2011.1 The ubiquity mHealth. Patient-centric, ‘care anywhere’ is of mobile technology offers tremendous becoming a reality. opportunities for the healthcare industry to address one of the most pressing global Healthcare is moving towards a precision- challenges: making healthcare more acces- based model—or ‘personalised medicine’. sible, faster, better and cheaper. As a result of greater understanding of the human genome, together with other Unlike many other forms of communica- personalised technologies, the industry tion, such as the Internet, mobile health will likely transform—as have many (mHealth) will likely have a greater effect other industries—to one that is predic- on how care is delivered for three reasons: tive, personalised, participatory, and preventive.2 mHealth will be a major David Levy, MD • Mobile devices are ubiquitous and factor in providing personal toolkits Global Healthcare Leader personal; that will ultimately help those manage • Competition will continue to drive lower predicted vulnerabilities, chronic illness, pricing and increase functionality; and and episodic acute conditions. Enabled by technology, connectivity and data, mass • Mobility by its very nature implies that customisation is on the horizon allowing users are always part of a network, mHealth solutions to flourish. which radically increases the variety, velocity, volume and value of informa- In recognition of these accelerating tion they send and receive. factors, PwC commissioned the Economist Intelligence Unit (EIU) to examine the Even before the advent of mobile connec- current state and potential of mHealth, tivity the distinct lines between traditional barriers to adoption, and opportunities health sectors were blurring and new for companies seeking growth in the business models were emerging. mHealth mHealth space. The result is the following is dropping into a ‘perfect storm’, enabling report based on surveys and interviews and accelerating three major global trends with key subject matter experts conducted already in play in healthcare. by the EIU. Regulatory reform driven by demographic In addition to the EIU’s analysis, PwC changes, such as ageing and chronic provided its own commentary on best illness, is redressing the balance between practices and strategic considerations for public and private sector participation in companies active in the mHealth arena healthcare. More and more, the public noted in the report as ‘PwC Perspectives’. sector, while seeking to optimise access We hope that these insights, coupled and quality, is looking towards the private with the survey findings and interviews sector for innovation and efficiency. summarised in the pages to come, are mHealth enables both sectors in this useful in helping the stakeholders in the regard, helping to improve access and industry understand, plan and participate quality while at the same time providing in this inevitable yet exciting new future. dramatic innovation and cost reduction opportunities. 1 Number of mobile phones end of 2011: 2 Lee Hood, “Vision for Systems Medicine: 5.98bn. International Telecommunication Predictive, Personalized, Preventive and Union (ITU). Key Global Telecom Indicators Participatory (P4)” http://sis.org/cases2007/ for the World Telecommunication Service SIS2007ConferenceHighlights-Hood/docs/ Sector, 2012. HoodLeroy.pdf Table of contents 2 List of interviewees 3 Executive summary Sidebar: About the research 4 Introduction: Not so fast? The current landscape Expectation versus reality 8 Colliding interests, competing visions The centre of the battlefield Sidebar: Early adopters: driven or desperate? 18 Healthcare innovation: A school of patience 24 Emerging markets, emerging solutions Greater need and fewer options Emerging solutions Sidebar: A tale of two countries—India and the UK 32 From technology to solutions worth buying Finding and proving a need From incremental to disruptive change Picking up the tab Sidebar: Does it work? Does that matter? 36 Conclusion 2 Emerging mHealth: Paths for growth List of interviewees Cláudio Giulliano Alves da Costa, Claudius Metze, Business Solutions President, Brazilian Health Architect, Healthcare Unit, SAP Informatics Association Axel Nemetz, Head of Vodafone Peter Benjamin, Managing Director, mHealth Solutions, Vodafone Cell-Life Bakul Patel, Policy Adviser, US Food Dan Brostek, Head of Member and and Drug Administration (FDA) Consumer Engagement, Aetna Steinar Pedersen, Chief Executive Misha Chellam, Chief Operating Officer, Tromsø Telemedicine Consult Officer, Scanadu George Poste, Regents’ Professor Eric Dishman, Director of Health and Del E Webb Chair in Health Innovation, Intel Innovation, Arizona State University Jennifer Dixon, Director, Nuffield Trust Sangita Reddy, Executive Director of Operations, Apollo Hospitals (India) Sunderrajan Jagannathan, Head of Strategy, Siemens Healthcare India Chris Taylor, Director of the mHealth Innovation Centre, University of Martin Kopp, Head of Healthcare, SAP Manchester Ian Leslie, Professor of Computer Ozgur Turgay, Managing Director, Science, Cambridge University Acibadem Mobile Jason Mann, Head of China Healthcare, Thierry Zylberberg, Head of Orange Barclays Capital Healthcare, Orange Patricia Mechael, Executive Director, mHealth Alliance 3 Executive summary Mobile healthcare (mHealth) is “the their interests. The challenge will be Emerging markets are the trail- biggest technology breakthrough of our even greater for innovators because blazers in mHealth. Patients in these time [being used] to address our greatest the improvements that mHealth can markets are much more likely to use national challenge”, said US Health and bring—such as patient-centred care mHealth applications or services than Human Services Secretary, Kathleen and a greater focus on prevention—will those in developed countries. Similarly, Sebelius in her keynote address at the involve disruption of how healthcare is more emerging-market doctors offer 2011 annual mHealth Summit in the provided. To succeed, innovators must mHealth services than colleagues in Washington, DC area. Worldwide, the manoeuvre through culturally conserva- developed countries, and more payers technology and its promise have moved tive, highly regulated and fragmented cover these costs. The ability of these up the healthcare agenda. yet often monopolistic systems that countries to leap ahead lies in the often provide contradictory incentives. paucity of existing healthcare: there is The interest is understandable. greater demand for change and, just as Increasingly ubiquitous and powerful The diversity of interests at play important, there are fewer entrenched mobile technology holds the poten- makes an evolving landscape even interests to impede the adoption of new tial to address long-standing issues in more complex. Patients want more approaches. healthcare provision. However, such convenient provision of healthcare, effervescence in a field with few proven but they also want greater control. For Solutions, not technology, are the business models suggests that, yet again, doctors, mHealth can help provide better key to success. Widespread mHealth technology-driven hype may lead to patient care and ease their administrative adoption requires services and products expensive failures. headaches, but they are likely to resist the that appeal to current payers because loss of power implicit in greater patient patients, highly sensitive to price, will This Economist Intelligence Unit report, control. Payers already display interest in provide little income. Consumers’ sense commissioned by PwC, examines the mHealth, and the economic pressure for of entitlement with regard to health- current state and potential of mHealth more patient-centred, preventive care is care aggravates this price sensitivity. in developed and emerging markets, likely to drive them further towards the Accordingly, vendors must concentrate the ongoing barriers to its adoption and patient’s viewpoint. on solving payers’ problems. Technology the implications for companies in the is an essential, but not sufficient, tool in field. Based on the research, the key this endeavour. findings include: Expectations are high for mHealth. About the research Roughly one-half of patients surveyed In developing this report, commissioned by PwC, the Economist Intelligence Unit for this report predict that mHealth conducted two surveys in ten countries: Brazil, China, Denmark, Germany, India, will improve the convenience, cost and South Africa, Spain, Turkey, the UK and the US. The first survey asked 1,027 quality of their healthcare in the next patients—with a broad distribution of economic backgrounds, ages, levels of educa- three years (see “About the research”). tion and states of health—about their opinions on various aspects of mHealth. The Meanwhile, six in ten doctors