The Dawn of a New Age in

Healthcare
An early look at the market for networked devices in
mHealth
March 2010

© 2010 Accenture All Rights Reserved.

Analysts forecast strong growth for mHealth

Manhattan Research: 81% of physicians

to own smartphones by 2012

Berg Insight: Home Health Monitoring

Triple Tree: Global market for remote market (wired & wireless) $11 billion in
patient monitoring at $3 billion, growing US and Europe, growing at 10%
to $8 billion by 2012 annually

Aggressive market forecasts signal explosive growth of wireless

technology in the healthcare industry

© 2010 Accenture All Rights Reserved. 2

 Cost efficiencies from mHealth address rapidly
rising healthcare costs due largely to chronic
disease

• Point of care tools can reduce risk and US National Health Expenditures
errors (trillions)
• The increased adoption of Electronic $5.0 Projected
$4.5
Medical Records, and the use of digital $4.0
communications saves time and $3.5
Actual
$3.0
reduces cost $2.5
• Remote monitoring and self-assessment $2.0
$1.5
can reduce the need for office visits $1.0
$0.5
• Patient disease management and $0.0
prevention can help avoid costly
treatments
Source: http://mobihealthnews.com Source: http://www.cms.hhs.gov/NationalHealthExpendData

Chronic disease accounts for 75% of Chronic diseases account for 60%
healthcare spending in the US, and of deaths worldwide and 80% in lower
95% for those 65+ under Medicare and middle income countries

300 million people in the US and EU have a chronic disease that could be
more effectively managed through remote healthcare monitoring
Chronic disease source: http://www.usatoday.com/news/health
© 2010 Accenture All Rights Reserved. 3
mHealth can help with improving quality of care
for aging populations while reducing costs

Key Factors
• By 2020, the US is expected to have a
shortage of 1 million registered nurses
• Baby Boomers are living longer and
elderly individuals determined to live
independently are at risk
• Care through a nursing home or assisted
facility is costly and often goes against
the wishes of the elderly
• Adult children of elderly parents are
looking for better ways to manage their
parents care and the ability to respond
quickly to problems
Sources: http://www.nursesinternational.us/hospitalnursingshortage.html
Source: UN http://www.un.org/esa/population/publications/worldageing

Mobile enabled care giver systems can provide independence for the
elderly and peace of mind for their loved ones

© 2010 Accenture All Rights Reserved. 4

 Accenture market research focuses on the
application of networking to new devices –
including devices for mHealth

Industry Mobile Network Operators Tech Forwards

• 12 respondents • 1,000 respondents – US,

• 22 respondents in mHealth China, India, Japan, Brazil,
• Senior mobile network
• Managers responsible for operator (MNO) executives UK, Germany, France, Italy,
product development Spain
• Thought leaders in embedded
– Device makers area • Own at least 4 networked
– Providers devices and use at least 4
• US, Europe, Asia Internet services
– Insurers
– Other participants • Incidence of about one-third of
• Part of a large study of the all online survey respondents
market for networked mobile • Evenly divided between
devices men/women and 18-35/>35

© 2010 Accenture All Rights Reserved. 5

Research methodology on embedded mobile
technologies for healthcare

Accenture and the GSMA conducted research on the embedded mobile market
between November 2009 and February 2010 to assess the opportunity and main
barriers to its development.

Interviews were conducted with technologically innovative corporations and mobile

network operators
• 65 corporate innovators across NA, Europe and Asia covering four vertical markets:
– Automotive
– Digital Home
– Energy
– Healthcare
• 12 thought leaders in embedded mobile from mobile network operators across NA,
Europe and Asia

This presentation reports the findings for the Healthcare market

© 2010 Accenture All Rights Reserved. 6

From the industry perspective, mHealth is
poised to take off

19 out of 22 healthcare respondents say networking technology is “very

important” to their firms’ competitive future
• Actively developing networked devices or services that depend on networked
devices
• Primary targets: Chronic diseases and eldercare
Mobile Network Operators are aggressively building out their capabilities
to help outside companies build, deploy and market networked devices
• Establishing stand-alone “embedded” organizations
• Targeting healthcare along with energy (Smart Meters) and automotive applications
• Developing new technology platforms
• Collaborative approach to pricing and risk sharing

© 2010 Accenture All Rights Reserved. 7

Examples of projects mHealth respondents
are undertaking

• Devices that monitor vital signs associated

with diabetes, asthma, heart conditions,
Parkinson‟s and other diseases
• Eldercare devices to detect falls, track
behavior changes and locate Alzheimer's
patients
• Personalized databases that collect and
analyze device data
• Video conferencing between doctor and
patient
• Services that link consumer devices to
hospital networks

© 2010 Accenture All Rights Reserved. 8

Builders of mHealth applications are breaking
through the barriers that have constrained the
industry in the past

Barriers holding back mHealth…

1 • Coming to grips with ambiguous funding source – provider,

payer, consumer
Business Model • Finding benefits that more than offset networking costs

2 • Moving from “every project unique” to best practices

Interoperability
& • Standards slowly converging to enable “plug and play”
Standards

3 • Poised to move beyond early adapter consumers

Market Readiness • Developers becoming more proficient in networking technology

© 2010 Accenture All Rights Reserved. 9

Industry comments on business model

1 “ That has to do with healthcare reimbursement, which, historically and to the

present time has been reimbursement for procedures, not reimbursement for
preventative or monitoring type solutions. … Proof has to be generated that cost
savings do, in fact, come with the use of networking technology.
- Health Insurer
Business Model

“ The biggest issue is the cost of deploying life science devices on the wireless
network – every device can't be another $49.95 monthly subscription.
- Component maker

2
Interoperability “ There is currently no way to get reimbursement in the healthcare space for
technology that enables monitoring from a distance, but this is being resolved by
getting Medicaid and Medicare to pay for it.
& - Health monitoring company

“
Standards
The biggest challenge for our networked application is determining who is going to
pay for it. Is it the employer? The insurance company? A government agency?
Or is the model that we're testing: the consumer pays out of pocket for
supplemental care?
3 - Healthcare provider

Market Readiness “ It is not clear who pays for these things on an ongoing basis, or who will fund the
initial investments and the infrastructure. It's going to be resolved largely when
people use retail consumer business models, not healthcare services business
models. Most of the people in the industry are thinking like healthcare providers as
opposed to retailers of consumer products.
- Component maker

© 2010 Accenture All Rights Reserved. 10

Industry comments on interoperability and
standards

1 “ Let‟s say you have a blood pressure cuff, a weight scale, and a blood glucose
meter. The blood glucose meter might work with the blood pressure cuff, but not
with the weight scale. You find yourself using what you can, instead of what you
want to. When you talk about technology platforms you have the same sort of
issue with going on with PDMA, GSM or Bluetooth. Every company has different
Business Model standards and different radios and different platforms.
-Healthcare provider

2 “ We are having a lot of trouble with interoperability from various vendors who have
different platforms. There is a lot of behind-the-scenes work to make sure
everything plugs and plays together, and that costs a lot of money.
- Healthcare provider
Interoperability
&
Standards “ The market today is very fragmented. There are no device class standards that
matter in this space. There are no end-to-end standards. Every network requires
individual certification. There are no standards for Wi-Fi or the wireless personal
area network. Fragmentation on connectivity, fragmentation on application and
fragmentation on tools are very significant problems.
- Component maker
3
Market Readiness
“ Standards is a problem because there are so many of them, and it's difficult to keep
up with them all. Nothing's plug and play, so it's almost like starting over with a new
development each time you have to work in this space – whether it's networking or
the other things that require standards. I think the government's going to have to
become fairly prescriptive in the standards area because I don't think the market
will do it.
- Healthcare provider

© 2010 Accenture All Rights Reserved. 11

Industry comments on market readiness

1 “ We're finding that the sales and marketing channels geared toward the medical or
healthcare industries are very highly fragmented.
- Device maker

Business Model
“ Right now, with the technologies around mobile, we‟re only reaching people who
are very tech-savvy and using Twitter, etc. That is such a narrow piece of the
market we want to reach, and it‟s really not our target market because the people
we most need to reach are people who are lower income, less educated, and with
the worst health outcomes.
2 - Public Health Organization

“
Interoperability
& Marketing messages have promoted the idea that networking is simple and easy.
Then people try to build their own applications without the proper expertise and
Standards
they end up as miserable failures.
- Solution provider

3 “ While our networked product is selling commercially, we are still in the

demonstration phase of the launch where we have to explain the value of why – it
makes sense immediately when you describe it to somebody, but then they still
Market Readiness have to go figure out how to use it, how to change, how they deliver care, and do it
efficiently and effectively.
- Device maker

© 2010 Accenture All Rights Reserved. 12

Persistence is revolutionizing business models
by transforming products into services

• Persistence refers to the always-on /

always-connected nature of networked
Device
devices
Device • Term coined by Accenture‟s Mobility
Device
Group
• Creates new opportunities for services-
based businesses
– Real-time data
Device Device
Healthcare – Add-on sales
Organization
– Software updates
– Device diagnostics
– Usage statistics
– Community

Device
• Central to business model discussion
Device

Device

© 2010 Accenture All Rights Reserved. 13

Comments on Persistence

“ The next version of our platform generates revenue through persistence. We think the person with the implanted
device will be the source of revenue, and there will be less reliance on the healthcare reimbursement for physicians
by tapping into a patient's willingness to pay for applications.
- Medical device maker

“ Our business model is to connect patients with their healthcare provider in a way that keeps them out of the
hospital. We engage them through back and forth interaction that includes updating their software, connecting to
the devices that they have in their home, and asking them questions such as when they took their medication or
exercised.
- Health Monitoring Company

“ Depending on the vital signs of person with a chronic illness, or how he answers a question, our system may
suggest an educational video for him to view, to learn more about his condition. The idea is to teach the patient at
point of event instead of saying two months later, “When you had your chest pain you should have done this.”
- Medical device maker

“ We collect personal health information in digital form and then depersonalize it in a way that lets us do studies that
do not violate anyone‟s privacy. For instance, how many folks in the community are suffering high blood pressure,
and what drugs are we using to treat them with?
- Healthcare provider

© 2010 Accenture All Rights Reserved. 14

mHealth will achieve critical mass once stand-
alone products give way to systems that
address more holistic patient needs

Three-fourths of healthcare respondents feel systems will be “very important” to

their own organizations within the next 3 to 5 years
• Stand-alone products just the beginning
• More holistic solutions require multiple devices and services – “It takes more
than one device to treat a patient”
It remains unclear who will develop and market these systems
• No individual device maker dominates healthcare market
• Integration may evolve as a federation of devices and Web apps
• Some see large healthcare providers as best positioned to drive market

© 2010 Accenture All Rights Reserved. 15

Comments on systems

“ The standalone product will survive, but it will be for more niche markets, such as emergency medicine where their
are very specific needs. But for holistic medicine, general health and wellness, preventative care and operation on
the daily routine level, systems will dominate over the single products. We haven't been able to get any traction with
single products. It takes more than just one product to figure out the patient.
- Healthcare provider

“ In the future stand-alone devices will connect into a larger system. There will be different health solutions that are
web-based, and that can be accessed through a simple mobile phone. Every mobile phone will get access to a
larger group of mobile help tools – not with a single application on the phone, but with a web-based set of different
applications.
- Non-profit healthcare organization

“ Stand-alone devices exist only because of the maturity curve of this technology. The need is more comprehensive.
For example, in elderly care it isn't going to be simply a blood pressure monitor within the home. It's going to be a
suite of applications that look at the gait of an individual, what they're eating, how often they're eating, and how they
taking personal care of themselves. The value is so much greater when you have the multiple data points to help in
the management of that particular situation.
- Healthcare provider

“ Systems are going to be important, but I think it will be a slow burn. At some point you'll have large health plans
and large health delivery networks, and probably some long-term care providers that will begin to aggregate and
provide their own solutions – that is, they'll look across multiple vendors' products and aggregate those products
into cloud-based services. They will make money by providing their own value-added services on top of those
products.
- Software company

© 2010 Accenture All Rights Reserved. 16

mHealth companies see Mobile Network
Operators as significant players in the
emerging healthcare ecosystem

Look to Mobile Network Operators for…

1 • Device management and diagnostics

• Managed services
Technology • One-stop global deployment
Resources

2 • Participate in sales and marketing of devices and services

Commercial • Finance sales through up-front subsidization
Resources
• Tailor connectivity fees to individual offerings

3 • Accommodate patient mobility

Facilitation of • Manage device and service diversity at network level
Systems

© 2010 Accenture All Rights Reserved. 17

Comments on mobile operator technical
resources

1 “ We would like the wireless operator to control and service the devices that we are
putting out as part of our services in the patient's home or in their own living
environment, because that is definitely not something we want to do ourselves.
That's a service we would be more than happy to buy from someone else.
- Non-profit healthcare organization
Technology

“
Resources
If we had a service provider that offered one-stop global deployment, we could start
immediately marketing our product overseas.
- Device maker
2
Commercial
Resources
“ One-stop global deployment is a big area where the telecoms could be helpful. If I
wanted to go across Europe, I could go to my telecom company and say, “I want to
be able to set up databases for France, Croatia, or the U.K. We could do it in the
cloud with the carrier and not be in violation of healthcare law.
- Healthcare monitoring company

3 “ Currently we have to maintain the operation and maintenance of multiple servers,

multiple databases in a redundant configuration. This is a huge burden for a
company that's trying to deliver a wireless device and solution to the healthcare
Facilitation of market. A wireless carrier should be able to do this for half the cost and still make
Systems a tremendous amount of money, simply because it would be a very small
incremental investment on their part.
- Device maker

© 2010 Accenture All Rights Reserved. 18

Comments on mobile operator commercial
resources

1 “ We require persistence, but we are generally moving rather small amounts of data
around. Current pricing plans in the UK don't address this situation. So to get
persistence, you have to pay a rate that buys you a lot of data transfer. We would
like to work with the carriers to get a better price by scheduling our traffic for off
hours or doing something else to optimize our use of the network.
Technology - Non-profit healthcare organization
Resources

2
“ A telco price plan that includes up-front financing would be interesting. Something
similar to the consumer gets the phone for free if they sign up for two years. The
question is how do you tailor this to the patient care environment, which is different
from selling a chat phone to teenagers.
- Device maker

“
Commercial
Resources Mobile operators already have access to the clients or to the patients and so
leveraging that customer base would be a big plus in my mind. Financing is also a
potential interest. Particularly if there are abilities for partnerships that would
require less upfront spending on our part, maybe some sort of win-win approach
that reaches hard-to-reach audiences with a device that helps with their health and
3 is also good business for the operator .
- Public Health Organization

“
Facilitation of
Systems We tailor the whole business model, not just the pricing plan. We are totally flexible
in the business model that we„ll go into with the customer.
- Mobile network operator

© 2010 Accenture All Rights Reserved. 19

Comments on how mobile operators could
facilitate systems

1 “ What we‟re looking for is a platform that is sufficiently robust to engage a patient. It could
be a cell phone, a stand-alone device, a wireless device, a wireline device, an IVR, or a
hosted solution. We're going to have challenges from country to country on how patient
data are stored, so we're need to do cloud computing as well. In short, there's going to be
a lot of things that need to be solved by a central carrier, a central organization. The
Technology carrier already has all of those attributes available to them to help solve that problem.
Resources - Health monitoring company

2
“ We've become a very mobile population. The ability to transmit something to your
physician while you're standing in Wal-Mart is going to become more and more important.
And currently, the mobile operators have that infrastructure. They don't have it just in small
communities, they've got it across the nation and across the world. So even if they are not
the main provider, they are definitely going to be a connection point.
- Health insurer

“
Commercial
Resources The ability of a network mobile operator to put multi-class, multi-device, multi-brand
devices seamlessly into a systems approach is non-existent today. If the network operators
get their act together and start acting like a family of operators versus individual
companies, they create value from that standpoint then additional margin – services
margin will go to the network operators, not just the connectivity margin but the systems
3 services margin.
- Component maker

Facilitation of
Systems “ Systems would create a need for gatekeeper to manage the basket of services. Someone
has to make sure one party isn‟t hogging all the bandwidth, and make sure that one
person's application doesn't interfere and disable or disrupt another person's application.
So there's a need to manage this multi-application scenario. And I think that is a small and
logical extension of the communication providers' role.
- Mobile Network Operator

© 2010 Accenture All Rights Reserved. 20

A new infrastructure is needed to facilitate
systems that interoperate across devices and
regions

This new infrastructure would ideally provide:

• A standards-based home network gateway that provides a “wireless base
station” for any in-home healthcare device
• The ability for mobile networked devices to “stay connected” anywhere in the
world without incurring excessive roaming charges
• A development platform that gives developers access to families of devices and
allows them to write applications that integrate these devices
• A means for all participants to bill for services and share in revenues
The industry is approaching development of this infrastructure from several
different directions
• Many parties are developing home gateways
• Several Mobile Network Operators are developing robust development and
deployment platforms for networked devices and services
• Expectation is that individual efforts will ultimately lead to best practices and
standards

© 2010 Accenture All Rights Reserved. 21

Comments on new infrastructure needs

“ Now you have to figure out how to reach patients in different parts of the world on different networks, which is a
problem in healthcare that we don't want to deal with. We want somebody else to fix it. We don't want to do it on
our own.
- Healthcare provider

“ We need to have a unified way of dealing with the different devices and services that are available, and to integrate
them into our healthcare systems. It's too expensive to make any kind of integrations product by product. That's not
feasible in the long run.
- Non-profit healthcare organization

“ Hospitals are starting to use digital band aids to monitor patients. Pretty soon you‟ll see people being sent home
with these band aids and you‟ll see the emergence of a hundred-million unit wireless device market. They will take
advantage of the cellular networks through some kind of specialized gateway device.
- Component maker

“ There are lots of medical and other small apps that need access to a broad development community. But setting
standards too early would discourage mobile network operators from innovating and differentiating their offerings
with value-added features.
- Mobile network operator

“ If the industry could have one developer interface it would be good for us because we could sell a wider range of
products. But right now there are too many standards with respect to screen sizes, operating systems, etc.
- Mobile network operator

© 2010 Accenture All Rights Reserved. 22

Tech Forwards are a global demographic that
leads the way in the adoption of networked
devices – including healthcare devices

Owns device that connects to a network …

Total USA UK Germany France Spain Italy Japan India Brazil China
Conventional cell phone 90% 81% 84% 91% 94% 97% 96% 89% 89% 93% 87%
Laptop computer or NetBook 81% 80% 89% 91% 80% 84% 79% 69% 80% 74% 79%
A desktop PC with broadband 79% 76% 64% 61% 70% 83% 87% 76% 89% 95% 85%
Mobile music player such as iPod 74% 77% 79% 78% 62% 57% 70% 82% 87% 74% 77%
Video game player 59% 66% 72% 65% 65% 65% 62% 61% 43% 48% 39%
Smart phone such as iPhone 40% 50% 44% 50% 36% 18% 41% 35% 47% 33% 52%
Automotive device 32% 33% 39% 44% 40% 41% 50% 16% 22% 16% 19%
Any device that links TV 26% 30% 18% 25% 21% 10% 27% 17% 44% 27% 42%
A large household appliance 22% 10% 15% 22% 9% 8% 36% 29% 40% 12% 42%
A home security system 19% 9% 9% 13% 8% 16% 30% 20% 34% 23% 29%
A fitness device 18% 13% 12% 19% 10% 11% 24% 35% 27% 13% 20%
A small household appliance 17% 11% 10% 14% 3% 7% 27% 26% 28% 13% 28%
Mobile device for reading books 16% 8% 11% 9% 4% 12% 25% 12% 25% 15% 41%
An energy management system 16% 8% 10% 12% 4% 9% 25% 17% 23% 21% 27%
Medical device 10% 5% 8% 12% 2% 7% 11% 17% 20% 9% 14%
Any other device 56% 55% 57% 64% 55% 58% 53% 28% 72% 50% 65%
Mean 6.5 6.1 6.2 6.7 5.6 5.8 7.4 6.3 7.7 6.1 7.5

© 2010 Accenture All Rights Reserved. 23

Tech Forwards are upbeat on networked
devices and are in the early stages of
recognizing their value in health and fitness

Agree that …
Devices that connect to the Internet save me time 87%

Devices that connect to the Internet simplify my life 86%

Devices that connect to the Internet make my life

richer and more enjoyable 81%

Devices that connect to the Internet bring me

78%
closer to my friends and family

In the future, most electronic devices I purchase

76%
will connect to the Internet
Devices that connect to the Internet help me make
58%
money
Devices that connect to the Internet improve
43%
my health and fitness

© 2010 Accenture All Rights Reserved. 24

Tech Forwards are highly concerned with
security / privacy, and about half cite
interoperability as a problem area

Agree that …
I worry that devices connected to the Internet
77%
expose me to viruses and other malware

I worry that data from my devices connected to the

76%
Internet could get into the wrong hands

It will take several years for devices that connect

to the Internet to be truly useful to most people 60%

Different devices that connect to the Internet

don't work together as well as they should 54%

When I call customer support they are unable

to solve my problem 50%

I don't know who to call when things go wrong

with a device connected to the Internet 41%

It takes too much time to set up a device that

connects to the Internet 37%

© 2010 Accenture All Rights Reserved. 25

Tech Forwards favor services that consolidate
devices – which buttresses trend toward
systems

Prefer bundled services from a single provider…

Who bills me for services related to my networked devices 25% 61%

Where I go to manage my networked devices 26% 59%
Who I contact for customer support 27% 59%
Where I go on the Web to view my networked devices 30% 56%
Where I purchase my networked devices 34% 51%
Where I download applications for my networked devices 35% 51%

Prefer different Prefer single

supplier for each supplier for
networked device everything

© 2010 Accenture All Rights Reserved. 26

Concept Test: Tech Forwards respond
favorably to mHealth system for elders that
bundles multiple devices and services

Caregiver System 41% interest overall

This product is targeted to people who are 72% among caregivers to elders
responsible for looking after elders who prefer to
remain in their own homes rather than move to an Preferred payment terms
assisted living facility. (among those interested)

The system includes a set of devices that connect to $500 at time of purchase + $40 per month 46%
one another and the Internet to monitor the person's $900 at time of purchase + $30 per month 24%
vital signs (such as heart rate), level of physical $1,500 at time of purchase + $10 per month 14%
activity, and physical conditions that signal risk of A one-time payment of $2,000 with no
falling. monthly fee 16%

The system also includes devices that monitor the

environment for safety hazards such as a left-on gas Likelihood of purchase at preferred
range or water on the bathroom floor from an over-
terms (among those interested)
flowing tub.
Very likely 30%
The caregiver can monitor the person through any Somewhat likely 48%
PC or Smart Phone and can set "alerts" that notify Somewhat unlikely 19%
them of emergency situations such as a fall or other Very unlikely 4%
abnormal activity. There is a voice communications
feature that allows the parties to communicate
instantly with one another at the touch of a button.

© 2010 Accenture All Rights Reserved. 27

Tech Forwards regard software companies
and device makers as best providers of
eldercare system – MNOs still in running

Regard as excellent provider…

A software company such as Apple, Google or
Microsoft 69%

A device maker such as Sony, Nokia or Samsung 69%

The telephone company that provides your landline 45%

The wireless operator who provides your

cellphone service 44%

Your electric utility company 44%

A retailer such as Best Buy or Wal-Mart 41%

The cable operator or satellite company that

39%
provides your TV service

© 2010 Accenture All Rights Reserved. 28

Conclusions

The healthcare market is making significant investment in mHealth

• The industry is developing networked devices and services
• MNOs are investing in the embedded space
• Tech Forwards are poised to become boosters of next-generation systems
The industry is making strides in overcoming the barriers to mHealth
• Business models based on “persistence”
• Best practices that facilitate interoperability across devices and networks
• Growing comfort with technology across all stakeholders
• Pilots starting to demonstrate ROI benefits to providers and payers
Big breakthrough will come with shift from stand-alone products to systems
• Opens industry to many players – can tap into established value chains
• Order-of-magnitude improvement in healthcare productivity

© 2010 Accenture All Rights Reserved. 29