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Getting Beyond the Hype of “Disrupting Healthcare” and Focusing on Actionable Innovation

Shahid N. Shah
July 11, 2013

Getting Beyond the Hype of “Disrupting Healthcare” and Focusing on Actionable Innovation

This was a Keynote Address I gave at Healthcare Unbound 2013 and focused on what’s needed for healthcare technology innovation in a value- and outcomes-driven model.

There’s a ton of hype surrounding disruptive technology innovation in healthcare but nothing is truly making a dent in the healthcare sector the same way as disruptions have occurred in other major segments of our economy. The slow but sure march from Fee For Service Based Care to Outcomes Driven Care has certainly started but it’s neither fast enough nor substantial enough to bend the cost curve or improve value to patients in the short term.

This presentation discusses how we can get beyond the hype by focusing on actionable innovation. Specifically, I answered the following questions:

* What does innovation in healthcare mean?
* Where are the major areas in healthcare where innovation is required?

Important takeaways this session included:
* Understand PBU: Payer vs. Benefiter vs. User
* Understand why healthcare businesses buy stuff so you can build the right thing

Shahid N. Shah

July 11, 2013


  1. Getting Beyond the Hype of “Disrupting Healthcare” and Focusing on

    Actionable Innovation 10th Annual Healthcare Unbound Conference & Exhibition Shahid N. Shah, CEO
  2. NETSPECTIVE www.netspective.com 2 Who is Shahid? • Serial healthcare IT

    entrepreneur, advisor to numerous startups, blogger, healthcare futurist • 20+ years of software engineering and multi-site healthcare system deployment experience in Fortune 50 and Government sectors. • 12+ years of healthcare IT and medical devices experience (blog at http://healthcareguy.com) • 15+ years of technology management experience (government, non-profit, commercial) • 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non-profit) Author of Chapter 13, “You’re the CIO of your Own Office”
  3. NETSPECTIVE www.netspective.com 3 What’s this talk about? Questions answered •

    Is disruptive innovation in healthcare possible? • What does innovation in healthcare mean? • Where are the major areas in healthcare where innovation is required? Key takeaways • Go narrow, specialize, dive deep • Understand PBU: Payer vs. Benefiter vs. User • Understand why healthcare businesses buy stuff so you can build the right thing
  4. NETSPECTIVE www.netspective.com 4 What does “disrupting healthcare” mean? This is

    $1 Trillion and the Healthcare Market is about $3 Trillion This is $1 Billion
  5. www.netspective.com 5 No, your innovation will not disrupt healthcare. I

    promise. The good news is that doesn’t have to.
  6. www.netspective.com 6 No, your big data or mobile ideas will

    not disrupt healthcare. But if you can use them to add or extract value from the existing system, you’ll do just fine.
  7. www.netspective.com 7 No, your EHR/PHR or app will not be

    used by enough doctors or patients to disrupt healthcare. But if you can get even a fraction of them to use your software, you’ll do just fine.
  8. www.netspective.com 8 No, your innovation will not be accepted by

    permissions-oriented institutions. Find customers with a problem-solving culture willing to accept risks and reward failures.
  9. www.netspective.com 9 No, your innovation will not be easily integrated

    into regulated device-focused clinical workflows. Incumbent vendors will not entertain the potential of new legal liabilities without someone to share it with or new competition without direct compensation.
  10. NETSPECTIVE www.netspective.com 10 What I mean by “actionable innovation” You

    have made the job of identifying, diagnosing, treating, or curing diseases faster, better, or cheaper for clinicians through the use of information technology (IT) or business models. You have made the job of self-diagnosing, self- treating, or preventing diseases and improving overall wellness of patients through the use of new incentives, business models, or IT.
  11. NETSPECTIVE www.netspective.com 12 Bacteria used to kill us the most…

    Per 100k population, Historical Statistics of the United States, Millennial Edition
  12. NETSPECTIVE www.netspective.com 13 We’ve got most infections beat… …except the

    flu and pneumonia Per 100k population, Historical Statistics of the United States, Millennial Edition
  13. NETSPECTIVE www.netspective.com 14 Top killers today Heart disease Cancer Chronic

    lower respiratory diseases Top killers in 1900 Pneumonia and influenza TB Diarrhea and enteritis Infectious diseases used to kill us… …but what’s left seem only to be “manageable” not easily “curable” Per 100k population, Historical Statistics of the United States, Millennial Edition
  14. NETSPECTIVE www.netspective.com 15 Death by age group, 1900 Death by

    age group, Today From cures to management… …young people don’t dye of diseases often now http://siteresources.worldbank.org/INTHSD/Resources/topics/Health-Financing/HFRChap1.pdf
  15. NETSPECTIVE www.netspective.com 16 What Is the Business of Health Care?

    • It's always better to define a business by what consumers want than by what you can produce or build – For example, whereas doctors and hospitals focus on producing health care, what people really want is health • In the future, successful doctors, hospitals, and health systems will shift their activities from delivering health services within their walls toward a broader range of approaches that deliver health. What business are you in? The Emergence of Health as the Business of Health Care Source: http://www.nejm.org/doi/full/10.1056/NEJMp1206862
  16. NETSPECTIVE www.netspective.com 17 PBU: Payer vs. Benefiter vs. User Payer

    Benefiter User If you don’t understand the exact interplay between PBU your product will fail The payer is the person/entity that writes the check for your product. The person or group that benefits most from the use of the product. The person or group that actually uses the product.
  17. NETSPECTIVE www.netspective.com 18 What kinds of users are you targeting?

    Go narrow and deep not wide and shallow • Obesity Management • Wellness Management • Assessment – HRA • Stratification • Dietary • Physical Activity • Physician Coordination • Social Network • Behavior Modification • Education • Health Promotions • Healthy Lifestyle Choices • Health Risk Assessment • Diabetes • COPD • CHF • Stratification & Enrollment • Disease Management • Care Coordination • MD Pay-for-Performance • Patient Coaching • Physicians Office • Hospital • Other sites • Pharmacology • Catastrophic Case Management • Utilization Management • Care Coordination • Co-morbidities Prevention Management 26% of Population 4% of Costs 35% of Population 22% of Costs 35% of Population 37% of Costs 4% of Population 36% of Costs Source: Amir Jafri, PrescribeWell
  18. NETSPECTIVE www.netspective.com 19 Defining your PBU participants is really hard

    Target health sector? Number of employees? Annual sales volume? Geography? Number of hospital beds? Number of patients? Type of patients? The list goes on and on…be specific! Don’t focus on market segmentation, but do try to figure out who your customer is
  19. NETSPECTIVE www.netspective.com 20 How will your customer pay for your

    innovation? Direct Payment • Your best option • Very few truly disruptive technologies can be directly paid for by providers within the USA • Limited adoption of ‘traditional’ pay for service reimbursement for next generation technology Direct Reimbursement • Second best option • Improvements in technology are outpacing payer adoption • Reimbursement will come but its time consuming and difficult Indirect Reimbursement • Emerging option • Payer requirements for improved quality and efficiency are creating indirect incentives to adopt innovative solutions • Solutions targeting new value-based reimbursement incentives are highly useful to medical providers If you haven’t figured it out for them, customers will not figure it out for themselves
  20. NETSPECTIVE www.netspective.com 21 Where does your innovation fit? Therapies Therapeutic

    Tools Diagnostic Tools Patient Administration Patient Education Target the right market so you understand the regulatory impacts Most Regulation Least Regulation Be aware of regulations, don’t fear them, use them as a competitive advantage
  21. NETSPECTIVE www.netspective.com 22 What problem will you be solving? Improve

    medical science? Improve access to care? Reduce costs? Improve therapies? Improve diagnostics? Improve drug design? Improve drug delivery? Create better payment models? Focus on jobs that need to be done, not what you want to build
  22. NETSPECTIVE www.netspective.com 25 How to identify the best opportunities Circumstance

    • The specific problems a customer cares about • The way they assess solutions Context • Find a way to be with the customer when they encounter a problem and • Watch how they try to solve it Constraints • Develop an innovative means around a barrier constraining consumption Compensating behaviors • Determining whether a job is important enough to consider targeting • One clear sign is a customer spending money trying to solve a problem Criteria • Customers look at jobs through functional, emotional, and social lenses From “Jobs to be Done” to the “Five Cs of Opportunity Identification” Source: http://blogs.hbr.org/anthony/2012/10/the_five_cs_of_opportunity_identi.html
  23. NETSPECTIVE www.netspective.com 26 The business needs • Quality and performance

    metrics • Patient stratification • Care coordination • Population management • Surveys and other direct- from-patient data collection • Evidence-based surveillance The technology strategy • Aggregated patient registries • Data warehouse / repository • Rules engines • Expert systems • Reporting tools • Dashboarding engines • Remote monitoring • Social engagement portal for patient/family Do you have ideas in payment design? Payment models going fee for service to outcomes-driven care
  24. NETSPECTIVE www.netspective.com 27 Can you repurpose or enhance health data?

    Proteomics Genomics Biochemical Behavioral Phenotypics Economics Try to use existing data to create new diagnostics or therapeutic solutions IOT sensors Administrative
  25. NETSPECTIVE www.netspective.com 28 Some stuff not to focus on •

    Don’t go for simple incremental innovation if you can be bold and “disruptive” but make it look like you fit into the existing ecosystem nicely • Don’t look at mHealth, look at mobility in healthcare • Don’t look at apps, look at entire systems Incremental innovation is easier, disruptive innovation is probably more useful
  26. NETSPECTIVE www.netspective.com 29 Forget mobile apps, focus on health IOT

    • With all the attention being paid to mHealth there’s been an useless focus on mobile apps • For the mobile apps, instead focus on mobility in healthcare through “health internet of things (IOT)” and self-care technologies
  27. NETSPECTIVE www.netspective.com 30 Healthcare Industry Fallacies • Healthcare folks are

    neither technically challenged nor simple techno-phobes (they’re busy saving lives) • Most product decisions are no longer made by clinical folks alone, CIOs are fully involved • Complex, full-featured, products are not easier to sell than simple, stand alone tools that have the capability of interoperating with other solutions are • Hospitals will not buy unless one proves value. • Selling into doctors offices is not easy.
  28. NETSPECTIVE www.netspective.com 31 What makes your products successful • Easy

    to explain • Defendable and differentiated • Attractive partnership opportunities • Word of mouth opportunity • Potential for PR • Scaleable staff and systems • Scaleable product — build once, sell many times • Uncomplicated • Focused • Sales model is scaleable and predictable • Own relationship with and information about customers
  29. NETSPECTIVE www.netspective.com 32 Why healthcare businesses buy stuff Increase revenue

    (topline) Maintain capabilities Reduce costs (bottomline) Attract new patients Increase staff productivity Find your reason Healthcare businesses have complex buying processes – figure out why and what they buy
  30. NETSPECTIVE www.netspective.com 33 The Customer Relationship Customer Gives You Get

    • Money • Time • Energy • Commitment • Referrals • Past experience • Expectations • Knowledge You Give Customer Gets • Product • Price • Value • Convenience • Selection • Service • Warranty • Brand If you can’t figure out why they buy, see if any of the things below make sense
  31. NETSPECTIVE www.netspective.com 34 Health technology sector has many ups and

    downs Make sure you understand where your product fits in the hypecycle Source: Gartner; “Hype Cycle for Healthcare Provider Applications and Systems, 2010”