The Too Informed Patient from Marketplace on Vimeo.
Produced by Gregory Warner and Mara Zepeda. Created by Sebastienne Mundheim ofWhite Box Theatre, acted by Charles DelMarcelle and Doug Greene, and voiced by two actors from Philadelphia’s Pig Iron Theatre Company. (HAT TIP – The good folks at TDWI)
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Takeaway: mHealth developers expect the importance of app stores to diminish. mHealth apps will predominantly be distributed through traditional healthcare channels by 2015.
Our firm, Berlin-based research2guidance, conducted a global mHealth developer survey in order to identify emerging trends in this new market.
One of the most striking results of the survey was that leading mHealth developers believe that in the years to come mHealth applications will cease to be distributed primarily through the app stores as is currently the case, and that traditional healthcare distribution channels like hospitals and specialized healthcare product vendors will become the predominant distribution channels.
This would represent a significant shift when compared to the market today, as the smartphone app store model has been the key driver behind the initial success of mHealth applications over the last two years.
More than half of all respondents (53%) believe that app stores are currently the best distribution channel followed only by healthcare websites (49%). Traditional health distribution channels like doctors (34%), hospitals (31%) and pharmacies (16%) are ranked as second and third tier distribution channels today. Despite the fact that mobile operators are regarded as players who will help the mHealth market to grow, they are not seen as appropriate distribution channels either now or in the future.
Q: What are the best distribution channels for mhealth solutions today?
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Remember the penguin problem described by economists?
No one moves unless everyone moves, so no one moves.
Overcoming the penguin problem has a lot to do with creating expectations. A recent writing by Dr. James O’Connor in Physician Practice expresses a voice from the physician community that I’ve never heard before. His essay is entitled “Meaningful Use — Doctors Have No Choice
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Physicians Have No Choice Other Than to Adopt EHRs?
Dr. O’Connor argues that physicians are effectively being forced into adopting EHRs. He cites facts and reaches a powerful conclusion:
1. CMS penalties begin in 2015.
2. What if you won’t or don’t accept Medicare/Medicaid patients (13 percent of practices in 2009, up from 6 percent in 2004? In August, four major insurers (Aetna, Highmark, United Health Group, and Wellpoint) announced that, at a minimum, they will link their pay-for-performance programs to federal meaningful use criteria. Other insurers are likely to follow.
3. Do you run one of the increasing number of “boutique” or VIP practices that work on a cash-only basis? The American Board of Medical Specialties (ABMS) released a statement in August saying that they intend to link meaningful use of health information technology into the ABMS Maintenance of Certification© program.
4. You don’t care about being board certified? (Sound of crickets chirping.) The Final Rule gives states the authority to impose additional requirements that promote compliance with meaningful use. As reported in Physicians Practice, the state of Massachusetts may take away your license to practice medicine in 2015 unless you demonstrate meaningful use of an EHR system. In Maryland, private insurers will be required to build incentives for acquisition of EHRs and penalties for not adopting them into their payment structure.OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.
On October 18 2010, Dr. Blumenthal published a letter to EHR vendors titled "Health IT and Disparities" urging them to “include providers who serve minority communities in their sales and marketing efforts”. Reiterating the assumed benefits of Health IT to both quality of care and efficiency of care delivery, the National Coordinator for Health Information Technology stressed the importance of EHR vendors working together “to provide EHR adoption opportunities for physicians and other healthcare providers working within underserved communities of color”. This is obviously an important and welcome appeal. Physicians who provide care for impoverished minority communities usually lack the means to purchase EHRs and perhaps some EHR vendors will heed Dr. Blumenthal’s request and make special arrangements for these doctors and their clinics. The stimulus incentives may also help. But how about those who serve equally impoverished populations and are practically barred from incentives?
In my home State of Missouri there are about 350 Rural Health Clinics (RHC) serving a state which with very few exceptions is one big Medically Underserved Area/Population (MUA/MUP) which is a geographical area or a population designated by the Health Resources and Services Administration (HRSA) as having: too few primary care providers, high infant mortality, high poverty and/or high elderly population. For the uninitiated, RHCs are designated by CMS and have to meet certain requirements. The practice has to be located in a rural area and it has to provide team care, which is all the rage now, meaning that a Nurse Practitioner or a Physician Assistant and a Certified Nurse Midwife have to be on premise and team up with the physician in providing patient care. RHCs can be independent practices or they can be owned by rural hospitals. Either way RHCs are paid by Medicare differently than a practice without RHC designation. RHCs are required to submit reports of their operational costs and their total number of visits. Based on these two parameters the reimbursable cost per visit is calculated by Medicare. The entire process is complex and subject to rules, regulations and caps. The main point here is that RHC providers are not reimbursed according to the regular Medicare physician fee schedule and therefore will be unable to receive EHR incentives under Medicare. A few RHCs may qualify for Medicaid incentives, but in most cases they don’t have the prerequisite 30% Medicaid patients.
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