Report Identifies Top Health Issues for Industry

1. Do-It-Yourself Healthcare

        US consumers and clinicians are ready to embrace a significant expansion of the personal medical kit in 2015, due to technological innovation, the public’s need for convenience, and a drive to deliver lower-cost care. In response, technology companies are building intuitive mobile medical         devices and apps that monitor vital signs, analyze blood and urine, track medication adherence, and more. Consumers are also taking more charge of their own care. The survey found that 20% of doctors said that they already prescribe nutrition and weight loss mobile health apps, said  Dr. Gebreyes.

As a result:

• Hospitals and other healthcare providers should incorporate do-it-yourself tools into efforts to engage patients

• Health information technology systems must have secure and open platforms to handle data streaming from many sources, including personal health devices

  • Payment should move in the direction of rewarding algorithmically-derived care insights that lead to better outcomes

  • New entrants and traditional healthcare providers should collaborate on the development and commercialization of these technologies

  2. Making the Leap from Mobile App to Medical Device

  In 2015, the FDA is poised to review a record number of mobile health apps as digital health companies respond to demand for more sophisticated mobile health products. Under the FDA’s mHealth approach, the agency will oversee apps that serve as “medical devices and whose functionality could pose a risk to a patient’s safety if the mobile app were to not work as intended.” In addition, products that do not need regulatory approval may enter the market with greater ease and at lower cost. The app market is highly saturated, and is filled with 50,000 free and nearly free products. According to the report, 86% of clinicians believe mobile apps will become important to physicians for patient health management over the next 5 years. She said implications of these factors include:

  • Regulatory approval may provide a competitive edge, and can set one firm apart from others in a crowded field

  • Consumers and providers may benefit from an app’s formulary or pharmacy

  • Partnerships marrying product development with regulatory ex- pertise may be best positioned for success

  3. Balancing Privacy and Convenience

  The report highlighted that during the summer of 2014, more than 5 million patients had their personal data compromised in health system privacy breaches. Health records contain personal, financial, and medical data, and can command up to $1300 per record on the black market. Consumer desire to have access to their data in real-time on their mobile devices is increasing. Almost 25% of all companies detected >50 security incidents in the past year. The HRI consumer survey found that >65% of respondents said data security was more important to them than convenience access to imaging and test results, doctor’s notes, diagnoses, and prescriptions. Dr. Gebreyes offered the following implications of these findings:

  • Keep an eye on internal and external threats

  • Know your data and activate the right consumer protections

  • Learn from other industries; financial companies and the retail sector have experience balancing consumer convenience, privacy, and security

  4. High-Cost Patients Spark Cost-Saving Innovations

  The costliest 1% of all patients in the United States consume 20% of the nation’s healthcare spending. The report found that in 2015, these high-cost patients—including baby boomers and the chronically ill—will be the focus of the US healthcare industry under pressure to contain costs. Among the most costly patients in America are the dual eligible. Furthermore, health-care systems, insurers, and others are adopting innovative care models that can better manage high-cost patients in lower-cost care settings. Health systems are experimenting with a variety of cost-containment programs. Dr. Gebreyes reviewed 4 implications:

  • Health systems and insurers that can identify high-cost patients and efficiently coordinate their care will gain market advantage

  • Insurers and healthcare providers need to build personal engagement, social, and behavioral health capabilities to better care for this population

  • Technology can drive effectiveness and efficiency

  • The care model should incorporate “unconventional” care partners, from contractors that build ramps for fall protection to retail-based clinics

  5. Putting a Price on Positive Outcomes

  A plethora of new products are coming to market, including many high-cost drugs designed to treat serious diseases, will drive demand for new evidence and definitions of positive health outcomes. In 2015, the increasing conflict expected between drug access and affordability will create new pressure for data that demonstrate these expensive medications work better than others and are worth the premiums, according to the report. Insurers and more health systems in the new health economy are limiting access to high-priced drugs. The government is also looking to control drug costs in Medicare Part D as an increasing number of patients begin using expensive medications. Incorporating genomic information into treatment decisions remains a challenge but it also represents an opportunity to show drug effectiveness. As a result, Dr. Gebreyes said implications include:

  • Drugmakers should collaborate with health systems or integrated delivery networks to synthesize de-identified electronic health record data, claims data, and genomic data

  • As consumers shoulder more costs, new ways to promote adherence are critical

  • Communicating new evidence about drug value to key stakeholders (eg, insurers, physicians, and patients) will require additional skills

  To download the full report, please visit www.pwc.com/us/tophealthissues.—Eileen Koutnik-Fotopoulos