As the mHealth field was emerging four to five years ago, I went to conferences and listened to all of the enthusiastic entrepreneurs talk about self-tracking, Quantified Self, consumer enthusiasm for buying health tracking devices, etc.  For some time I had a rather unsettled feeling because what I heard in the field did not match our experience at CCH.  If we plot degree of illness vs. smart device adoption the graph looks something like this:

At Partners, the patients we are targeting for connected health programs — to improve care, increase patient self-management and decrease cost — are those sickest five percent — and they are not smart device adopters.  The quantified-selfers brimming with smart devices, measuring and monitoring their health and fitness tend not to be folks with chronic illness or patients who drive much utilization of health care dollars.

What the organizations featured in the Health Data Management piece have in common is that they are creating mobile apps/platforms to enable patients who already own smartphones and connected devices to share those data.  This approach seems less proactive to me, meaning if you have a smart device and one or more connected sensors and want to share your data with these organizations, they’d be happy to have it.  If you do not, they’ll manage you the old-fashioned way with office visits, hospitalizations, etc.  The advantage of this strategy, as noted above, is that the cost of technology falls on the patient and the organization rides the adoption curve.  However, the adoption of these technologies in sicker patients is still low.

At some point, the five percent of sickest patients will move from the top left quadrant to the top right quadrant in the graphic above.  We’ve started to see this with patients asking us for apps, using their own tablets (thank God for Skyping with grandchildren!), etc.  But there is almost no penetration of connected sensors in this population yet.  We’ve made the commitment at Partners to be more proactive in deploying devices and hubs to these patients.  We’re also thinking about how to facilitate adoption of smart devices among these patients — maybe offer coupons to facilitate the purchase of their own scales, BP cuffs, etc.

Then there is the matter of towing the regulatory line.  Many of the devices available at Best Buy or the Apple Store are not FDA approved to be used in treating illness.  Many of the smartphone apps out there are also not FDA approved.  I’m sure this is one reason Kaiser, Geisinger, et al. are creating their own.  At least one firm, iHealth, is going in this direction (their platform is FDA approved and available to consumers), and combining their consumer platform into a care delivery process seems like an intriguing option.  Qualcomm is offering the 2Net ‘hub’ as a mobile app.

So what are the two roads?  One is a proactive approach, using patient-generated data as a core part of population health management and making sure that the sickest patients have the devices to generate objective and self-reported data.  The other is perhaps a less aggressive approach, opening the APIs and allowing those with smartphones and  connected devices to bring data in.  For now, we believe that approach will generate more data from healthy, low-utilization individuals and miss the sickest five percent responsible for 40 to 50 percent of health care costs.

At some point the second path will make the most sense as more, sicker individuals will have smart devices and connected sensors.  We’re preparing for that world at Partners.

When do you think it will arrive?