What Can Mobile Health Learn From Mobile Commerce?

Mobile health is the next wave. We should learn from Ikea.

Consultants at Booze recently released a report on the growth of mobile commerce, m-commerce. http://www.strategy-business.com/article/00053?pg=3  Retailers are creating imaginative ways for shoppers to have a better shopping  experience and, in so doing, drive sales. IKEA. the furniture giant, allows customers to first create a virtual model of the room they are buying furniture for, by entering the dimensions, and then load 3-D models of items to see how well the pieces fit. Mobile health, mHealth, is following the same pathway and could learn a thing or two from m-commerce merchants.

The report mentions that m-commerce numbers will surely grow rapidly, if only because the penetration of smartphones (a category that includes the iPhone, Android, BlackBerry, and others) is expected to increase from 17 percent in the U.S. and 15 percent in the E.U. today to 74 percent and 43 percent, respectively, by 2014. By 2013, as many as half the consumers in a typical retail store will use their smartphones for shopping.

Likewise, more and more patients will use their phones to access and experience healthcare. Imagine your patient tweeting their friends in real time about what they've experienced in the PACU.

Or, sending cell phone images of reception areas, birthing suites and even their doctors. Booz found that  conversion rates (turning browsing into sales) increase by as much as 240 percent when consumers view ratings and reviews while shopping. The same will happen in healthcare.

The objective of m-health products and services are the same as they are for m-commerce: to improve the customer/patient experience, to provide information, to make it easier to access and use your products and to create loyalty.

In a short time, we've gone from Sears catalogues, a game changer in its time, to mcommerce. Mhealth will follow.

Required Medical Disclosures For Physicians

When it comes to working with industry, keep your karma clean.

Working with industry comes with strings. The Patient Protection and Affordable Care Act, signed into law on March 23, 2010,  includes a number of provisions including a requirement that all pharmaceutical and medical device manufacturers publicly post on a website all payments or transfers of value from the manufacturer to a health care professional or institute. Some companies, like Allergan, have taken it a step further and entered into a Corporate Integrity Agreement with the feds. (http://www.allergan.com)

The present oversight environment demands that you disclose and make transparent your interactions with industry and any financial interests that result from that interaction. Here are some things to do to be sure you don't get caught with your stock options down.

Keep score

Be sure to keep an updated inventory of your consulting engagments, contracts and activities and  how you were compensated in cash, stock or some other financial instrument

Disclose

If you are an employee of an organization, like a univeristy of hospital chain, it is likely that you will get  a friendly (hopefully) reminder from your compliance officer to submit your conflict of interest statement. They will review it and get back to you if they see problems.

Don't study or use what you own

Big ticket conflicts make headlines. If you are being paid as a consultant to an orthopedic company and use lots of their products, beware. If you give lectures on depression to docs who like to eat expensive steaks and drink top shelf wines for free, and, you are the biggest prescriber of antidressants in your galaxy, that will raise a red flag.

Disclose your activity to peers and others

When you publish something or give a talk, disclose your interests. If you participate in medical legal activities, like expert witness participation, understand that your commercial interests will come under the magnifying glass of opposing counsel. Likewise, if you agree to work with one company, you will usually be asked to sign something saying that you will not work with another company where there might be a conflict.

When working with industry, it's best be safe than sorry. Doctors hate to flunk tests. The worst one to flunk is the New York Times test.

Change Creates Opportunity. Here's Where To Look.

Looking for love in all the right places.

Many years ago I was the ENT doc seeing patients at the Gates Clinic. The clinic was an on-site healthcare facility for employees of the Gates Rubber Plant in Denver and I worked there one day a week as a contract doc. The clinic is now gone, the plant became condos next to a light rail station and I moved on. The other day I received a request from someone asking me if I know anyone offering on-site care to employees. Henry Kaiser would have been proud.

None of us needs to be told that the US healthcare system is undergoing change. Designed for yesteryear and  showing signs of dysfunction and age, our system is cracking under the strain of an aging population, escalating costs and technological progress.

Things have changed in several important ways:

• Health Insurance Reform and changes to the Reimbursement model
• Decentralized patient –centered care
• Downsizing /rightsizing the healthcare workforce
• Electronic medical records, healthcare information exchanges and data analytics/BI
• Acute to preventive care
• Disconnected to integrated care
• Medical travel: The search for value-based care
• Mobile health
• The emergence of non-US markets for biomedical innovation
• Increasing regulatory scrutiny
• The changing intellectual property landscape
• New healthcare delivery models : telemedicine, concierge medicine, hospitalists
• Physician-industry conflict of interest and transparency requirements

These market shifts can be lumped into four categories, each an opportunity for you to make a difference.

The first is healthcare information technology. The infrastructure emerging has four basic components: electronic medical records, health information exchanges, data analytics and business intelligence and telehealth/telemedicine. They all serve as elements of a rapidly evolving national healthcare information architecture that will be second nature to your doctor wannabee daughter who is now in high school. Using the system will be as easy as putting your card in an ATM machine in Nairobi and getting US dollars.

The second category are those changes and models designed to deliver care more efficiently and effectively than the present face-to-face model, where the patient has to come to a structure to see the doctor. Examples include on-site clinics located in businesses, disease management facilities, intermedicate care clinics and pharmacy based offices.

The third group attempts to make billing and collection better, faster and cheaper. Processes like identity verification and authorization, real time benefits verification, dependent validation and benefits comparisons are designed to make sure the right person is getting paid the right amount for the right reasons.

Finally, the ground is shifting under the biomedical innovation infrastructure. Changes in regulatory rules concening manufacturing, marketing, FDA approval and intellectual property are but a few of the manifestations.

If you are searching for a non-clinical career and have been unsuccessful so far, you might be looking for love in all the wrong places. Check the action in industry, healthcare IT, alternative care delivery and revenue cycle managment and you are likely to find it.

Google Tech Support For Parents (And Physicians)

If you're looking to get out of the tech support role this Christmas, Google has a site for you.

Christmas is going to have more technology gadgets than ever, and they're all going to be connected and web enabled. If you've been handing the tech support for your parents since the VCR needed to be connected, you're days of wine and roses are here.

Google staffers (Googlers) have drafted a site that teaches the most technology-challenged among us how to take a screenshot, set up an autoresponder for your email, send large files or make a phone call with your computer.

If you're smart, you may just use this on the rest of your more tech-challenged family members and staff.

Medical Travel Is Not Just About The Cost

3 Million people spent $76B finding care away from home this year.

According to a recent Frost and Sullivan research report on the medical travel business, medical tourism wil grow to be a $100 B business by the end of 2012. Hot spots include the Middle East, Asia and Germany.

Most people think cost is driving the traffic. However, a McKinsey and Company 2008 report also emphasizes that 40 per cent of medical travelers seek advanced technology, while 32 per cent seek better healthcare. Another 15 per cent seek faster medical services while only 9 per cent of travelers seek lower costs as their primary consideration.

As reimbursements for Medicaid and Medicare continue to decrease, more and more US doctors indicate they will cut back seeing patients insured by these government insurance plans,  or stop seeing them altogether. This will further fuel access, not cost , to the forefront of medical travel.

Inbound tourism is the flip side of the same coin. As US healthcare continues to get more expensive and more difficult to access, hospitals are looking for ways to fill the beds, and foreign patients fit the bill, and pay it in cash.

As I've pointed out before, these market eruptions present entrepreneurs with big opportunities. Healthcare reform might change the rules, but I don't think significantly, given the big picture patient demographic and manpower supply and demand challenges.

Global referral communications, coordination and care is a growth industry begging for talent and $100B is likely to get a lot of attention. It certainly got mine. (http://www.medvoy.com)

The SBIR Will Comfort You

How to survive the valley of death as a startup.

Getting from R/D to the market is a potentially lethal pathway, so much so it's referred to as the Valley of Death http://www.forbes.com/2005/11/17/utilities-emerging-tech-cz_1117energy_programs.html Surviving it requires a deft combination of private and public financing, preferrably without giving away the store. Probably the most common public lifeboat for companies looking for early stage financing is the SBIR/STTR program.

The SBIR/STTR program (Small Business Innovation Research Grants/Small Business Technology Transfer Grants) are administered by the Small Business Adminstration. 11 federal agencies participate in the SBIR program and 5 in the STTR program. (http://www.sbir.gov)

Combined, these programs offer over $2B dollars to companies with commercializable technology. And the best news is that the government won't take a piece of your company when they give you money.

SBIR grants are awarded as Phase I grants (about $100,000) for six months, Phase II grants (about $1M) and then Phase III. There are several variations on the theme but that's the main idea. Several companies ladder SBIR grants, accumulating precious dollars that don't dilute subsequent investors. STTR grants differ from SBIR grants in their terms and conditions and amounts of money available.

Like most government grants, the application process is tedious, extremely competitive and requires SBIR grantsmanship skills to be successful. More good news is that there are people to help. If you are interested in SBIR money, here are 3 things I'd suggest to get you started:

1.Check the websites of the SBIR program, various agencies offering them, and other clearinghouses for information, like http://www.zyn.com

2. Take an SBIR/STTR workshop when it comes to a theatre near you. I plan to attend a 2.5 day soup to nuts event in January for $250. It is worth every penny.

3. Consider hiring a consultant to help you land the grant (http//www.pbcinc.com)

Though you might walk through the valley of death, the SBIR/STTR program is there to comfort you.

Private Placement Memorandum Primer For Physicians

PPMs for PCPs.

Securities offered to the public need to be registered with the SEC. Regulation D contains three rules providing exemptions from the registration requirements, allowing some companies to offer and sell their securities without having to register the securities with the SEC.

As described in the Securities Act of 1933, securities sold in transactions "by an issurer not involving any public offering" is called a private placement. The disclosure document describing the private placement is called a private placement memorandum. Whether you are an entrepreneur considering a private placement financing or an investor looking for early stage investment opportunities, there are a few things you should know about PPMs.

PPMs describe the company, the terms of the proposed deal, the proposed uses of funds, forward looking financial statements (best guesses) and the risks associated with the financing. The risks, as required by the regulatory agencies , are usually ennumerated in excruciatingly gory detail to make sure you understand everything associated with these kinds of investments. Remember that these are not registered securities so a disclaimer contained in the PPM will state that the SEC has not passed on the accuracy of the information you receive.

Rule 505 covers private offerings not exceeding $5M within a 12-month period and allows an unlimited number of accredited investors to purchase the securities. Individual accredited investors must meet certain financial tests that include:

• A net worth, individually or with a spouse, at the time of purchase of at least $1M, and
• The individual's gross income for each of the last two years was at least $200,000 ($300,000 with spouse, with the expectation of at least the same income in the current year

If you request a PPM as a potential investor, since it is private, you will be asked to sign a confidentiality agreement stating that you will not pass on the numbered PPM to anyone else. In addition, you will be asked to sign an statement attesting to the fact that you are an accredited investor.

You should also understand that if you buy securities in a private placement, that the securities cannot be resold without registration or an exemption .

If you are interested in learning more about Regulation D offerings, check the SEC website at http://www.sec.gov/answers/regd.htm

Private placements are common way for early stage companies to raise money. Floating a private placement requires requires help from experienced, knowledgeable consultants like investment bankers or securities attorneys. If you are invited to invest in a private placement, read the documents carefully and  be sure you understand the risks and consequences of investing.