My goal while attending the mHealth Summit in Washington DC this week is to understand the business models behind the companies at the forefront of this exciting emerging field.

At the top of my list of panel discussions to attend was Business Model Challenges for the Deployment of mHealth Solutions: The Provider Perspective featuring the following very influential mHealth thought leaders:

Zia Agha – VA San Diego Healthcare Systems

Julie Kling – Humana, Inc.
Eric Fennel – Center for Medicare and Medicaid Services, CMMI
James Brehm – Compass Intelligence, LLC
Steve Heilman – Norton Healthcare

The first presenter was Julie Kling, mobile business lead at Humana, which is one of the most impressive organizations on the mHealth landscape, particularly among payer groups. Kling, the mobile business executive lead at Humana, discussed four major categories of mobile strategy inputs at Humana – customer, brand, business and trends. The company is very much focused on developing mHealth products that have a direct consumer use and benefit, particularly with regards to the specifics of their plans and coverage (i.e. copay for specific services or pharmaceuticals).

Humana has internally developed over a dozen dedicated mobile apps across numerous categories. Of all health insurance providers, Humana is by far the most innovative player in the mobile space as far as I am concerned, and their early embrace of games for health is just one example of the company’s innovative edge.

According to Kling, “eVisits” are in early stages across the US, using real-time or asynchronous services, on-demand web-based video conferencing, and usually for non-emergent questions, prescription processing and chronic disease management. Mobile technology has evolved by leaps and bounds in other industries–the healthcare industry is only just beginning to leverage it.

Next up was Eric Fennel from the Center for Medicare and Medicaid Innovation Center.  The center was established to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid and CHIP while preserving or enhancing the quality of care.

The program’s mission can be summed up in their Three I’s Strategy:

-Incentives – Test new care and payment models
-Improvement – Rapidly serve better care
-Ideas – Innovate and create new models

The models the Innovation Center will test require fundamental changes in the structure of healthcare delivery. Unfortunately, we did not get a chance to hear what CMS envisions these changes will look like.

Next we heard from James Brehm of Compass Intelligence, a market research firm focused on the wireless health sector. James estimated the total size of the US wireless healthcare market to be approximately $12 billion, a much larger number than I have seen anywhere else before but encouraging nonetheless.

One point Brehm made that I thought was particularly interesting was that healthcare today, like it or not, is like buying a car without knowing how much its going to cost. Its almost impossible to even imagine making such a consequential purchase without knowing the long-term costs, but I think the metaphor is apt and highlights the glaring flaws in the current delivery model.

Small practices or rural practices are characterized by older physicians who are very comfortable with their practice and don’t have a ton of interest in mobile, but are willing to learn. Many large and urban practices are the opposite, with younger more aggressive physicians who embrace mobile technology in practice.

Standards and collection of data need to be standardized and training around these new devices, services, processes and procedures is also necessary. Best practices are currently unclear to physicians and providers and will slowly be established.

Finally, Steve Heilman, CMIO at Norton Healthcare, an integrated delivery network of 5 hospitals with several hundred physicians, highlighted the fact that core infrastructure is a key challenge faced by providers, as is mobile device management, specifically the management of many devices across many platforms, a point I touch on further below.

One exciting and hopeful fact Heilman shared from his experiences as a CMIO is that telemedicine consults have proven to pay just as well as an office visit. However, its not easy to sell the infrastructure necessary to provide face-to-face telemedicine services to hospital CEOs.

Mobile technology provides market differentiation and sets an organization apart, but groups need to be prepared to manage the culture shift this engenders. When you begin offering these innovative solutions patients will come to expect them all the time, and its not always easy to consistently provide technology that is in early stages and evolving literally day-to-day.

Data ownership was raised as a critical issue. Who owns patient data? I think the consensus among panelists was clearly that patients own their data, but little was shared about what each individuals organization does to provide patients with assurance that the data belongs to them.

One particularly good question asked by an audience member was, “What proof points do you need to see before you start adopting technologies in your organization and how long does it take to make those decisions?”  To sum up the panelists responses, right now we are undergoing a culture change on the provider side. Health plans are testing these models because they want to achieve greater efficiency. If we (as providers) can provide mobile services that help us better compete you can be sure we will adopt these technologies.

Obviously, integration of all of these emerging devices is also a critical aspect of developing sustainable mHealth business models and it seemed clear that all of the panelists had experiences in this respect that proved more challenging than they maybe had anticipated.

Heilman closed his presentation by asserting “we are trying to become as device agnostic as possible, because its the wild wild west out there right now with everyone bringing their own mobile device to work”, though I got the distinct impression that this is a reluctant effort due to the expense and complexity involved with supporting hundreds of different devices. He emphasized the need for hospitals to be able to support these mobile devices, but it is no small investment to build the internal capabilities to provide such support to hundreds of different devices running various operating systems.

This is a critical point because most providers don’t mandate physicians use specific devices. Physicians are going out and buying their own mobile devices which they hope to use in practice but often times they find their hospital does not support said device.

In response to a question from an app developer about what advise the panel has for first time health app developers, Julie Kling echoed Heilman when she recommended first and foremost that companies develop device agnostic applications.

All in all, the panel was a bit disappointing since very little regarding the actual business models of the presenting organizations was actually shared. I came away from the panel with very little new knowledge. A business model to me answers one of two questions, and often times both; (1) How do we make money? and/or (2) How do we save money? Sadly, there was little to be gleaned from the speakers regarding the actual business models they have attempted to deploy, successful or not.