End of the Runway for Gadget Pageantry and Other Radical Health Predictions

By Jeff Margolis

Where is the consumer? This is not a game of "hide and seek" in health care, but rather the critical missing element needed to have a fully functioning health care system. Getting the consumer involved -- as a consumer, not just as a patient -- is essential to spur change. It's exciting to see consumers' role in health care evolve as they internalize the reality of taking on more financial responsibility for their health and, in turn, demanding greater affordability, convenience and choice. But what does this mean for the future?

As someone who is passionate about curing the health care system, I've spent significant time and energy strategizing about where we need to go from here. Here are three consumer health-centric predictions that may be a little surprising to some, a little irritating to others and hopefully stimulating to all.

Prediction 1: Efforts To Extend Existing Health IT Platforms to Consumers Will Prove Necessary, but Insufficient

Over the past decade or so, there has been a massive focus on electronic health records, spurred on by considerable governmental incentives. We have had success converting paper charts to digital form and are starting to do a better job of building patient-centered workflows. This should be applauded, given the longstanding analog nature of clinical care. And in the genre of benefits administration and payment systems, nearly complete electronic data exist regarding diagnoses and medical procedures for the purpose of paying claims. Yet somehow, this progress has people making the quantum leap to say, "Let's layer patient portals on top of EHRs or member portals on top of claims systems and 'engage' the consumer."

There are two fundamental issues with that approach. First, regarding clinical systems, let's acknowledge that we are still in the early days of moving from a doctor-centric model to a patient-centered model. Our industry needs to concentrate on doing a great job of coordinating patient care among medical professionals, which we are not generally doing yet. And second, both clinical and benefits systems were built for exchanging data between and among health care business entities (e.g., physician practices, hospitals, health plans and pharmacies), not for interacting with an end-consumer. 

From a technology perspective, there is certainly goodness in unlocking certain types of data from these existing systems and making the information available to consumers. But, we really don't have a platform genre that connects consumers to both the traditional parts of the "sickcare" system and the full range of consumer-facing health-related activities that we can access on a day-to-day basis. Such a platform would help consumers maximize the value of their benefits, achieve their optimal health status at the lowest reasonable cost and get rewarded for being engaged in positive health and economic behaviors.

A new enterprise-level platform needs to emerge with all these assets brought together and personalized to consumers to help them optimize their health in a complementary way to the clinical system. And that platform needs to understand and respect the existing types of necessary platforms in the industry and ultimately help them interconnect at the consumer level so that we don't find ourselves fragmented.

Prediction 2: Private Exchanges Will Rapidly Become Commoditized

We are seeing a massive scramble in the industry to create private exchanges -- large employers investing in their own; brokers who are trying to evolve the traditional role of routing people through their agents; and health plans who want to shore up their direct-to-consumer positioning in the industry.

It's all good intentioned and rational, but in a lot of ways we are going back to the future. It wasn't that many years ago that a preponderance of employees were offered what we then called "cafeteria plans," in which there is a defined dollar amount for contributions and consumers choose between carrier A or B and plan type X or Y.

At the end of the day, the private exchanges, like shopping sites of any type, need to describe what the benefits product is, what it includes and what it costs. And they are going to have to be able to tie that back to consumers' real cost based on what methods of funding are available to the consumer.

Even though there is a lot of activity going on here, I predict that a third-party technology player will take the lead. Many years ago, companies built their own power plants to ensure that they had an adequate supply of electricity. Then, utilities emerged that obviated the need for everybody to build their own.

I've been in health care for a long time and successfully built health IT companies that standardize and systematize workflows -- even across competing entities -- so I do not underestimate the complexities of what needs to be put in place. But the truth is, commercially available technology platforms that can be used many, many times across different types of entities and can handle the volume and stress of the health care system will supersede individual efforts. And both private companies and the government should embrace this lower cost alternative.

In the long run, it will be the thoughtfulness of the benefits products themselves and what's included in them beyond today's traditional "sickcare" benefits that will become the differentiators, but the shopping platform itself will become efficient and commoditized.

Prediction 3: The 'Gadget Pageant' Will Fade

Let's face it, we have this really cool thing going on right now that I call the "gadget pageant." There are some wonderful and inspiring tracking devices coming from big and small companies, which has created the much-ballyhooed "Quantified Self" movement. I, admittedly, own a bunch of them. However, we are starting to see price and brand wars, which will logically lead to consolidation and margin reductions for dedicated consumer tracking devices within the next couple of years. And the ability of these devices to maintain their novelty is simply not a reality. In my youth, everybody had to have a mood ring -- an earlier foray into biofeedback.

However, the point I want to make here is not so much chasing the latest gadget, it's to make people thoughtful about the ultimate usefulness intent of the devices. I've spent a lot of time educating people about the difference between technology and applied technology. I believe we are currently focusing too much on the device technology and not enough on the systematic application of the data generated by these devices for the overall good of the consumer.

What we really need to be thinking about is if the data don't help the consumer win -- nobody wins. If it's not personalized to the consumer, if it's not presented in the way the consumer wants it presented, and if their health information is not safe and secure, then people will become uninterested or even feel as if they're being nagged. These gadgets need to tie into the total health care ecosystem for that individual by providing personalized guidance and incentives based on their overall health and benefits, and recognize that while it is initially interesting to report on the number of times their spouse, kids or dog woke them up in the night, it's not that helpful. We need to apply the technology to help people optimize their health and use the data to guide them to healthier behaviors over the long-term.

I predict that we will see a number of attempts at data consolidation that emanate from these devices. Some will come from retailers who are trying to build well-intentioned healthful communities, but also want to sell more products. Some will come from health care industry players, who will hope to interweave device data into chronic illness management and health and wellbeing programs. As these trends occur, we're going to see a lot of movement here to partnership and licensing models for data integration into consumer engagement platforms and less investment propagating the gadget pageant.

Final Thoughts

Whether or not these predictions ring true or resonate with you, we can all agree that health care is undergoing a transformation today like never before. All of us in this industry have an awesome responsibility to drive change and greater health care value for everyone. 


Original article appeared in iHealthbeat in February 2015