If you’ve been working in Mobile Health or telecare, you’re probably frustrated by the slow progress being made in bringing products to market. Whilst analysts like research2guidance see a rosy future, more down to earth reviews, such as the recent 2020health report “Healthcare without walls: Delivering telehealth at scale”, and Frost & Sullivan’s “E- Healthcare Initiatives in the United Kingdom” continue to point out that very few projects have scaled up past a few tens of users.
Many reasons are put forward for that, ranging from the natural inertia of the medical industry, the barriers imposed by regulators, through to the difficulty in persuading doctors to hand over disease management to their patients.
Technology has been blamed in the past, but that’s no longer a valid reason. Over recent years there have been major advances in sensors, wireless connectivity and processing power. We certainly don’t have solutions to every problem, but there is a wide range of conditions where mHealth could provide significant benefits. So what’s holding it back?
Next week the Mobile Health Industry Review at the King’s Fund in London will be bringing experts and VCs together to talk about business models. I’ll be suggesting that mHealth isn’t the first industry to have suffered from this phenomenon. Even for disruptive technologies, it often needs an unexpected and sometimes even unconnected industry to invent and develop a new application in order to drive things to a point where the disruption can be taken up and embraced by others. One of the classic cases is the Internet. Much of the development of streaming, payment mechanisms and user interface was driven by the porn industry. Once that work was done, it was adopted by others, giving us the e-commerce, video streaming and compelling content that we now expect from every site.
So, if Mobile Health is going to get anywhere it probably needs to follow the same course and forget about conventional medical thinking, (which generally involves a doctor), and embrace some more disruptive models. To put it more bluntly, we need to find out what the equivalent of pornography is for healthcare.
You only need to look back ten years on the Internet to see how far the technology has moved. Payment mechanisms a decade ago were relatively primitive. It was a world before Paypal, when today’s giants like Amazon and Google were still Internet toddlers. Streaming video and the ability to cope with large files were still in their infancy, with RealVideo only a few years old. No-one would have believed the situation we have today, with high quality video on demand services for mobile phones and TV.
What is important to understand if you’re developing a Mobile Health business model is that the companies who are now at the forefront of delivering Internet services were not generally those leading the development of these features. Most of today’s success stories hadn’t got a business model or a customer base that was making money at that point. The industry which had that was pornography. It developed a product that people would pay for, which had little if any regulation and which needed to innovate. It succeeded and provided the foundation for many more conventional internet business models.
I’d argue that in the western world mobile Health faces a similar dilemma. We know we can do it, but most of the companies involved are trying to copy or extend their existing business models onto the internet or mobile networks. They’re not being truly disruptive. That’s largely because the management teams within these companies come from a traditional medical background. It’s similar to what we saw in the first decade of the mobile phone. The new operators were staffed with people who had grown up in conventional landline phone businesses and were fixated on the existing model of paying for calls on a per minute basis. It took a long time for them to understand the disruptive nature of SMS and move towards bundled tariffs, rather than duplicating their fixed line experience.
That’s the problem. How do we solve it? The sports and fitness market is nibbling away at one edge, but that’s a relatively small market. The bulk of the population doesn’t really engage in sport, and of those that do, an even smaller percentage are interested in instrumenting themselves up and becoming web connected. That’s not to say it’s not a profitable market, but it’s small. If we want to find opportunities with scale, we need to look into the High Street and the high circulation magazines to see what sort of “health” products people really spend their money on.
It’s not medicine as we know it. It’s alternative health, vitamin pills, dieting aids and cosmetics – the palliatives for envy, hope, despair and guilt. Fronted by men in white coats, or attractively upholstered young models, they sell the promise of a better you. Consumers lap them up, and when they fail to deliver, turn uncomplainingly to the next purveyor of high tech snake oil. That churn, and the need to grab the next customer, provides a fertile breeding ground for innovation.
These are markets which are looked down on by the medical community. That might be valid in terms of any evidence base for their efficacy, but their business models can teach the mobile health industry a thing or two.
Rather than selling an extension of today’s medical practice, they’re selling hope. In many ways it’s an attractive business model as it has no regulation beyond the most basic definition of trade description, little expectation of working from the customer perspective, which means it can only over-perform, and relies on marketing techniques that are still relatively unknown in the medical industry (although not as much as you might hope or expect – see Carl Elliott’s “White Coat, Black Hat“). The companies involved innovate regularly, without the stultifying board presence of consultants and academics who are trying to commercialise their personal great idea. Which means they often succeed.
That percentage of success is interesting. I’ve not found any hard evidence (and if anyone has it, I’d really appreciate it) about the success rates for medical start-ups, as opposed to alternative medicine start-ups. The anecdotal numbers I’ve heard are that 80% of medical start-ups fail in their first five years, whereas it’s less than 25% for alternative medicine, albeit that covers a gamut of businesses. If those number are correct, they deserve serious attention.
All of which implies that there is plenty of opportunity to learn from them. It also suggests that the technology companies that are trying to persuade the medical start-ups to embrace their technologies might do much better to look further afield. Some of the possibilities aren’t so different, but are far more likely to be purchased and used by consumers.
So think laterally. Why don’t we market connected pill dispensers for vitamins and herbal cures? What type of sensor do we need to convince someone that crystal healing is effective? How can monitoring quantum flux keep your dog healthy? Is it time to replace mHealth with mHomeopathy? However loony the application, it should be possible to measure something and feed it back, and if it’s done well the consumer will keep on paying. Once that’s cracked, the applications with real medical benefits can take advantage and try to piggy-back on that innovation.
Whatever you think of the porn industry, it gave us the internet that we have today. Whatever you think about alternative medicine, its greatest legacy could be in helping to develop appropriate models for consumer healthcare. If you’re interested, have a look at my presentation on alternative business models for mobile health and let me know what you think?