Apple, Google, and Samsung are all vying to win over the health-conscious consumer. Will they manage to disrupt the healthcare business model?

Health is rapidly emerging as the new frontier for disruptive consumer technology. There is little doubt that consumers are hungry to use digital technologies to help manage and improve their health. Experts project that 500 million smartphone users worldwide will be using a healthcare app by 2015, and 50 percent of the more than 3.4 billion smartphone and tablet users will have downloaded mobile health apps by 2018.¹ Clearly, there is high potential in the B2C model of digital health, where consumers are starting to actively manage their health to stay well and keep away from the doctor’s office.

To date, the majority of health apps have been quite basic, with mostly manual input of biometric data and limited ability to integrate and analyze data streams from multiple apps and devices. However, this is all set to change with the entrance of some of the market’s biggest technology and digital players.

Apple recently announced the launch of “HealthKit,” which aims to bring together biometric and other health data into a single platform. When combined with the rumored new iWatch, this technology has the potential to radically shift the goalposts.

Of equal significance are the announcements of competing initiatives from Samsung and Google. Samsung launched its Simband, a smart health device that will enable constant biometric monitoring from the consumer’s wrist and real-time feedback on how the body is performing. Samsung is also creating a secure open-data platform to allow developers to download data from any device or digital source, effectively creating a health data powerhouse. Google is launching Google Fit, an open-source Android platform approach to track health and fitness biometric data, compatible with a host of monitoring devices and its own smart watches.

Other large technology providers are also looking to unlock the potential of integrating the physical and digital worlds: AT&T, Cisco, GE, IBM, and Intel recently formed the Industrial Internet Consortium with the express intent of unleashing the power of big data.

This is lining up to be the next battleground for these giants. The question is, will this wave of digital innovation have the same disruptive impact on healthcare as it has on other industries, undermining the business models of established players but offering unrivaled opportunities for new innovators? And ultimately, will the consumer win?

Lifestyle management has a huge impact on mortality

Consumer behavior is the single most important determinant of health and contributor to premature death. Decisions that consumers make about their lifestyle, nutrition, and adherence to therapy drive 40 percent of the contribution to premature death. Other determinants, such as genetic disposition, environment, social circumstances, and healthcare, account for the rest.² Therefore, enabling consumers to take charge of their behavior and choices through health insight could have a dramatic impact on individual quality of life and population health.

Medical professionals have long known that lifestyle, exercise, and diet can raise or lower the risk of heart disease and diabetes, but now even diseases such as dementia are known to be influenced by physical activity. In the United States, some insurers are reimbursing intensive behavioral therapy for obese patients, including changes to diet and exercise. In the United Kingdom, general practitioners can prescribe exercise therapy to patients through local qualified trainers. Is this the beginning of a shift to “prescribe” behavioral change as much as therapies?

Digital health players have stumbled on a gold mine: digital intervention to influence behavioral changes opens up nonclinical ways to improve health. By enabling consumers to change their eating habits and fitness, they can bring about measurable improvements in health and wellness without having to set foot in the highly regulated medical market.

Consumers to define success in the digital health market

In the digital health space, there are many channels to influence consumer behavior. Wikipedia is now the most used health site by consumers and doctors alike. The critical success of the health social network PatientsLikeMe has shown how influential peer and close networks can be in producing behavioral change. Relatively simple pedometer devices such as Fitbit have been a commercial success, commanding a significant premium because consumers value social media features that allow them to receive peer motivation and community support. Consumers are rewarding apps that make their close connections and social networks a collaborator in their well-being.

Once all this data is at their fingertips, though, what will consumers do with it?

Digital technology will enable behavioral change

Despite the efforts of both governments and the medical profession, people still smoke, consume unhealthy food, become overweight, and don’t exercise. Why would any of the new technology change this? The main reason why a consumer-led approach might be more successful than previous ones is that it addresses their failures head-on.

Change behavior by engaging with consumers as people, not disease states

Among the big players, Apple’s entry into the digital health market is promising, rooted in the company’s ability to create products that people really want to own and use and that relate to their aspirations for a better life. This approach is a world away from that of healthcare institutions, which place the disease, rather than the patient, at the center of their approach. The question that remains is whether Google and Samsung will be able to create products that have the same level of consumer appeal, which will be vital to ensure mass market conversion.

Platforms that promote open innovation will benefit consumers

To be meaningful, biometric data needs to be analyzed in the context of the patient’s past and current health state. For example, borderline high blood pressure may not be cause for concern in the average consumer, but it is potentially dangerous for pregnant women because it can be a precursor to pre-eclampsia, a condition that can imperil mother and child.

Digital health platforms will need to be able to combine multiple streams of data and past patient health history to be powerful. Up until now, this has been a major limiting factor in the usefulness of digital health apps. Apple is planning to create a platform for health app innovation, allowing developers to create a health app and access biometric data through a single platform. Samsung is creating a secure, open platform for health data exchange. Developers on Samsung’s platform will be able to access huge stores of consumer health data and extract it in the way they want to power their own apps. This could have huge potential for powering algorithms and analyzing real-world patient data.³

No one has landed on the right business model

Technology providers, pharmaceutical manufacturers, consumer health organizations, and a host of health monitoring independents are all vying for a position in this emerging market, though none has yet established a market-leading business model. While each has some of the capabilities needed to be successful, they all have shortcomings. Life science companies understand the disease and healthcare context, but lack technology capabilities or knowledge of consumer behavior. Consumer health companies understand consumer behavior, but do not have strengths in technology or medicine. Technology companies can create devices, but they lack the medical expertise to power meaningful algorithms.

The future of digital health: salesforce.com?

In the near future, the target business model for digital health could well go down the road of a salesforce.com, where companies could get access to a platform of services, integrating the ones they need to create an end-to-end solution. For instance, a company could purchase access to IT backbone, connectivity, and data storage, using them to customize the apps and devices necessary to configure their service and power their algorithms.

The market of wearable bands, sensors, and platforms is saturating quickly. And progress is being made to create non-invasive sensors for health monitoring of chronic conditions. It is possible that within a year, a consumer might be able to assemble an entire remote management suite for chronic illnesses such as COPD from the App Store and Amazon.⁴

Digital health players must innovate or become redundant

Apple, Google, and Samsung’s entry into the health monitoring market could have a dramatic effect on the dynamics of the market for health and wellness monitoring. What is really game-changing about their approach is its seamless integration of the device, data, and back-end IT. They are all proposing open platforms to allow entrepreneurial providers, both small and large, access to a global audience as part of a new virtual health ecosystem. And the technology they offer has proved to be secure, stable, and scalable.

Furthermore, disruptive ideas will now have a mass market outlet. A company called Grand Rounds already offers second opinions from global medical experts. What will enterprises like this be able to achieve with access to full patient data sets and an app that consumers can download from the App Store or Android’s Play Store?

The question all players are asking is who is the consumer to focus on? Is it the 18- to 35-year-old digitally savvy and social media plugged cohort, or is it the 36 to over-50 set of health-conscious consumers, who have the discretionary income and motivation to improve their health?

The elephant in the code: who owns the data?

Another question is, who owns the biometric data and who will be able to use it for insight? Traditionally, healthcare providers have housed patient data in paper files in institution-based electronic records. In the digital realm of the future, consumer biometric data will sit in the cloud, ready to be pulled down into algorithms to power apps that feed the information back to consumers and healthcare professionals (see sidebar: Making Sense of an Ocean of Data). Today most European countries specify that this data should not leave individual country confines, and regulators are struggling to come to terms with the concept of the cloud. If patients believe the data is theirs and they have the right to share it with third parties, how can regulators seek to control this space?

Sidebar

Making sense of an ocean of data

Consider the insights that could accrue from combining streams of biometric data with information from a patient’s medical record.

Weight management

Situation: Biometric data shows that a middle-aged woman consumes more calories, particularly simple carbohydrates (which are associated with weight gain), on days when her hydration levels are low and she is relatively sedentary. She consumes the most calories on days when she has slept poorly the night before.

Insight: The woman is eating because she is dehydrated and inactive or bored, rather than because she is actually hungry. The body can often confuse the signals for hunger and dehydration. Physiologically, the blood sugar level goes up from the intake of additional carbs, insulin spikes from the sugar quickly released by the carbs, blood pressure falls from the lack of water, and the woman feels sluggish in the post-prandial period. Poor sleep compounds this overeating with lower levels of the hormone leptin, which suppresses appetite, and higher levels of the hormone ghrelin, which stimulates appetite.

Action: The woman needs to make sure she sleeps seven to eight hours each night, drinks more water, and tracks hydration levels. She should also get up and move around every 30 minutes during sedentary periods and shift to eating complex carbs that will not cause insulin levels to shoot up.

Cardiac event risk

Situation: A seasoned triathlete in his mid-50s is interested in maintaining a high level of fitness for competitions. He tracks his heart rate during workouts and monitors his nutrition and weight. His biometric data feed shows sustained periods of heart rate over 200 beats per minute—above the maximum heart rate of about 170 beats per minute for his age group. His heart rate quickly recovers after his workouts, and he feels nothing other than the muscle soreness and fatigue associated with intense exercise. His nutrition intake tends to be high in caffeine, including espresso and caffeinated energy drinks. He has a low body mass index compared with his peers, and his patient record shows complaints of heart palpitations.

Insight: This triathlete could be at risk for a cardiovascular event. Palpitations could be a sign of underlying atrial arrhythmia (AA). If he has an undiagnosed AA, his current exercise regimen and caffeine intake put him at very high risk: high levels of caffeine increase heart rate which, coupled with the heart being taxed during very intense workouts, could trigger atrial fibrillation and lead to cardiac arrest.

Action: He should consult a cardiologist to run additional tests. If an underlying AA exists, he should modify his exercise regimen to ensure his heart rate does not exceed maximum thresholds. He should also change his diet to reduce caffeine and any other stimulants, and he should continue to monitor his heart rate and be aware of what activities cause him to experience palpitations.

Will consumers ultimately win?

Without a doubt, consumers will be spoiled for choice as providers scramble to bring to market consumer-driven digital health platforms. Any consumer with a smartphone will have access to a myriad of health apps and services, customizable to his specific needs. If providers are successful in developing powerful algorithms, then the data produced by wearables and other devices could be synthesized into real-time feedback to modify behavior and inform lifestyle choices. These apps could even be “prescribed” by healthcare professionals, escalating the importance of behavioral interventions. The UK National Health Service already has a list of “approved” healthcare apps to guide consumer choices.

Consumers, if they vocalize their needs, will also have the opportunity to influence the innovation agenda. For example, for the large community of blind and visually impaired consumers, imagine being able to apply existing technologies and real-time sensor data to improve navigation in the physical world. Think about maybe having a “smart cane” that is able to take in data from the consumer’s immediate environment and transmit it to the cloud, which then uses algorithms to combine that data with GPS tracking information to voice back to the consumer where to go, giving valuable information about the immediate surroundings and potential dangers.

However, consumers need to be very wary of what they are signing up for, particularly in terms of how their health data could be used. For example, a health insurer would have a gold mine of information to calculate the risk profile for its subscribers. In the same way that auto insurers can use driving data to adjust premiums, will health insurers be able to do the same based on consumer lifestyles? Consumers are already starting to become savvy to the power of their personal data and how to best manage and protect it in the digital world. No doubt the same will be true about their health data, particularly as the level of data becomes more personal.

While the prospects for digital health products and services are very exciting, there are still significant challenges to overcome, and the jury remains out on whether these new technologies will prove truly disruptive. Much will depend on whether devices can be developed that are able to capture biometric data with the accuracy and reliability required for medical diagnosis. It is also unclear whether health providers will really step up to the challenge of adapting an institution-centric care model to the digitally aware patient. And what about consumers: will they use ownership of their personal health data to change their relationship with health providers? Only time will tell.