AWS Startups Blog

The Demand for mHealth Applications (part 1)

Guest post by Christopher Crosbie MPH, MS


The mobile health market is growing rapidly. As smartphones have become ubiquitous, “apps” that are targeted at consumer health have proliferated the market and adoption is accelerating. At the same time, healthcare payment reform is rapidly pushing healthcare providers towards electronic measurement requirements such as collecting outcome metrics, using telemedicine, and home health monitoring. In the first part of this two-part series, I show how these two industry trends have created major demand for mobile health (mHealth) applications, which soon will become a key component of our healthcare environment.

Source: http://rockhealth.com/reports/digital-health-2015-midyear/

Source: http://rockhealth.com/reports/digital-health-2015-midyear/

The Internet of…Humans

According to a recent Rock Health report, in just the first half of 2015, 136 mobile health companies have each raised more than $2 million in VC funding. In addition, five mobile health IPOs alone created $11 billion in market capitalization. The top companies in this space today are geared towards personal activity tracking followed by applications that offer new, mobile ways to receive consultations from medical providers. The latter can be referred to as remote patient visits, and many of the leaders in this classification, such as Pager and HealthTap, are already leveraging AWS technology.

The personal activity tracking category of mHealth is a great start to mobilizing healthcare. Startups such as Validic are building cloud-based technology platforms that connect patient-recorded data from digital health applications, devices, and wearables to key healthcare companies such as Cerner and Medidata. However, there is ongoing research to move mobile applications past the “wellness consumer” and into routine, standardized clinical treatment as well.

The management of diabetes, a disease affecting over 29 million people in the United States, is a prime example of how this shift has already begun. Clinical trials have proven that patients with type 2 diabetes who use a mobile application that offers coaching and data collection will have an improved outcome. One of the companies leading in the diabetes mHealth space is Omada Health. They have also produced outcomes showing that total engagement is over 58% higher with their application compared to a leading commercial weight loss program, and that participants in their program almost double the weight loss of those using in-person diabetes prevention programs.

The mobile diabetes story does not end with coaching applications. Historically, diabetic patients have needed to use a pinprick several times a day to measure their blood levels. More recently, continuous glucose monitoring (GCM) devices, which rely on a sensor inserted with a 27-gauge needle just below the skin of the abdomen to measure the interstitial fluid which lies just below the skin, are able to alleviate some of the blood draws that used to be necessary. Now, these GCMs are moving towards using the smartphone as a hub for data collection and reporting. Diabetes in mobile health is the first of many diseases and health applications that will move away from targeting the individual consumer motivated to be healthy and toward real clinical care. Diabetes has proven its use case and is likely to be one of the first diseases with applications targeted at consumers who will begin to look toward the cloud as a way to capture historical data, run advanced analytics, and transfer data back to the physician.

However, it is unlikely that the lives improved by mobile applications will be limited to just diabetic patients. Mobile technologies are rapidly being adopted in standard hospital workflows. For example, AirStrip Technologies have begun to use the Apple Watch as a way to give physicians remote monitoring of their pregnant patients in labor and delivery wards who are hooked up to fetal heart and contraction monitoring equipment. Other startups such as CareMerge have developed analytics offerings that improve the communication between patients and their entire network of care providers.

The key to getting more mobile applications such as these adopted into standard care is clinical validation. One Mayo Clinic study that verified the feasibility of using mobile devices to achieve the same standard of clinical diagnosis is an example of the level of clinical validation needed.

A US Government Advocate for Healthcare Mobility

The US regulatory and payment agencies are acknowledging this mHealth shift and are producing new guidance materials that not only help ensure the safety of consumers, but also allow enough room for startups and enterprises alike to bring new innovations to market in this space. The healthcare industry bases much of its IT roadmap on the combination of statutory obligations and reimbursement policies defined by the Centers for Medicare and Medicaid (CMS). As regulatory agencies continue placing a large emphasis on mHealth requirements over the next 1–5 years, it can be expected that the industry will follow accordingly.

Some examples of these requirements include:

  • Patient-Centered Medical Homes (PCMH), which are programs where physicians and other healthcare professionals come to the home. These programs are now required to electronically capture and report data equivalent to that found in the EMR (example: must have capability to submit data to immunization registries from a home visit).
  • Under the HITECH Act, a program called Meaningful Use (MU) was created to incentivize EMR adoption. In 2017, this program will move into its third stage and, although not finalized, is expected to have rules specific to capturing data from the home as well as requirements to collect ongoing outcome metrics. Initially, providers who meet these requirements will be given incentive payments, but soon after the policy will change such that providers will incur financial penalties for not meeting these requirements. Additionally, there are metrics within the second stage of Meaningful Use such as “secure messaging,” “patient electronic access,” and “patient specific education” that may also encourage more mHealth applications as MU stage 2 moves into the penalization phase.
  • CMS is expanding the use of telemedicine billing codes that can be used to gain reimbursement for consultations done with mHealth applications. This is a significant opportunity for providers to use mHealth applications to provide more consultations to patients who may not have otherwise come for a physician visit. One application of this is the Emergency Department (ED), where a substantial percentage of patients who are discharged and given instructions to see a physician for a subsequent follow up skip those appointments. Additionally, many patients who come to the ED end up LWBS (left without being seen) due to long wait times. Telemedicine applications are expected to address issues such as these and provide a strategy to increase consultation payments.
  • CMS now offers providers the option to become an Accountable Care Organization (ACO), which is based on a voluntary agreement between providers to give coordinated care and base their payments on patient outcomes instead of by procedure. This model requires mHealth for both the collection of outcome metrics to prove better outcomes as well as to prevent unnecessary costs such as avoidable ED readmission.

In addition to these regulatory changes that are pushing more mHealth applications into a clinical setting, mHealth also provides an opportunity to reach more individuals while they are healthy. Today, healthcare is episodic — individuals typically interact with the health system only when they are sick. Tomorrow, thanks to mHealth and ongoing monitoring capabilities, providers may find new ways to engage with patients when they are not yet sick. This not only will create more opportunities for payment, but also will improve patient health and well-being.

Finally, as smartphone use gains widespread adoption in third-world countries, there is a growing need for mHealth applications that can reach individuals who may otherwise struggle to receive critical care.

In the next post, I’ll discuss some of the barriers that mHealth faces — and how they can be overcome with the help of AWS.