What the Health-Care Industry Can Learn From Technology Start-Ups

The challenge for consumer health companies, on the other hand, is somewhat different: the question for them is whether will they actually improve health, in a robust, measurable fashion, offering the disruptive innovation their founders usually promise, or will they essentially be the Vitamin Shoppes and Whole Foods Whole Body departments for tech-oriented Millennials, offering what I would characterize as generally benign placbos at extremely profitable margins.

My guess is that to the extent consumer health tech companies can make money delivering a vague notion of wellness, they will. For example, I can imagine MassiveHealth generating significant revenue by selling geographically-targeted advertisements from restaurants promoting healthy alternatives -- a business model that wouldn't require them to mess around with prickly medical product regulatory requirements.

I'm most excited, however, by the opportunity to bring consumer health products to bear in a serious way, and ask whether they can deliver measureable healthcare value, which I'd provisionally define as improving health while removing costs from the system within a five-year period -- a standard I cribbed from Stanford healthcare guru Arnold Milstein, and thus I dub the "Milstein Metric." (Milstein directs Stanford's innovative "Clinical Excellence Research Center," focused on developing better and cheaper health delivery models -- see here.)

What I like about the Milstein Metric (obviously not the only way to evaluate a new medical innovation) is that it represents a surprisingly high bar, and has a way of immediately focusing our thinking on impactful healthcare innovations. Prioritizing innovations that remove costs from our system makes sense given the urgent national need to rein in healthcare costs, a bipartisan ambition. The time period selected (five years) is admittedly somewhat arbitrary, and reflects not only the fact that patients switch payors frequently (so an investment not recouped before patients switch out is difficult to justify on financial terms), but forecasting is an inherently fragile business, and projecting years into the future is tenuous to the point of rarely being credible. An intervention that maybe kinda sorta pays off in 50 years is usually too speculative to be useful.

So the question -- highlighted in this recent Washington Post article -- is: can you make money by saving money? Phrased differently: There are literally hundreds of new devices, apps, and companies jumping into the consumer health space (see here and here); some will succeed simply because they delight users, but will any deliver real health benefits, measured by the Milstein Metric?

In general, I suspect the answer is no; Most consumer health companies are unlikely to deliver measurable health benefits. Thousands of apps will be downloaded, perhaps used for a week, and then abandoned in favor of the lastest snazzy offering.

My suspicion is that it might take an entirely different set of people, and a very different mindset to start thinking seriously about how to deploy some of these new technologies in a fashion that actually impacts health. These technologies represent the raw tools, and it will require additional insight and effort to rigorously apply these tools to the practice of medicine and the delivery of health, and use them to extract measurable value.

That's OK. I'm grateful for these tools. As I've advocated frequently (see here and here), improved patient measurement is the single most important mechanism we have to improve health, both in the short term (essentially by providing physicians and patients with more immediate feedback and enabling just the sort of iterative learning described earlier) and in the long term (by providing an extensively annotated view of human physiology, yielding fundamental new insights and enabling the development of powerful new therapeutics).

My guess is that the integration of consumer health and patient health will be driven by innovators in both the public and private sectors. Academic medical centers -- a precious source of both inquisitive physician and involved patients -- can play a critical role in orchestrating and driving this process. (Disclosure: I am co-founding the creation of one such non-profit institute, the Center for Assessment Technology and Continuous Health.) I also imagine some of the most important advances will continue to come from the private sector, extending from the start-ups I see all around me in the Bay Area, advancing promising technologies and data-analysis platforms, to the large medical products companies seeking to sharpen their focus and improve their offerings, to the payors always on the hunt for the elusive "cut costs but improve care" program, to regulators, who to their credit were among the first to recognize the need for improved patient-associated measurements (as noted here and here).

I am inspired by this integrative vision of the future, motivated by our urgent unmet healthcare needs, stimulated by the energy and passion of the entrepreneurs and inquisitive physicians and scientists I meet, and driven by the patients whose endurance has been sorely tested. It's time to deliver consumer health -- consumer health we can believe in.

Image: MassiveHealth.

Presented by

David A. Shaywitz, MD, PhD, is a director of strategic and commercial planning at a biopharmaceutical company based in San Francisco, and the co-author of Tech Tonics: Can Passionate Entrepreneurs Heal Healthcare With Technology? More

Trained as a physician-scientist and management consultant, Dr. Shaywitz has experience in clinical drug development and strategic and commercial planning. Dr. Shaywitz is co-founder of the Center for Assessment Technology and Continuous Health (CATCH), a Boston-based initiative to use improved real-world measurement to improve care and drive science. He also is co-founder of the Harvard PASTEUR program, a translational research initiative at Harvard Medical School, and a founding advisor of Sage Bionetworks, a non-for-profit medical research initiative focused on open innovation. He works at a biopharmaceutical company in San Francisco; the views expressed in his postings are his own and do not represent the views of his employer. Dr. Shaywitz is an adjunct scholar at the American Enterprise Institute. His personal website is: http://davidshaywitz.wordpress.com.

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