1. Mobile Health
Effectively Monetizing mHealth Services and
Applications
Callum Bir
Director, Life Science & Healthcare
cbir@deloitte.com +65 91001595
August 2011

2. Contents
1 What do consumers want?
2 Who‟s willing to pay for what?
3 Opportunities for health & wellness consumers
4 mHealth for Chronic Disease Management
5 Who will operate vs. Innovators?
6 What are some of the Plays in Asia?
©2011 Deloitte Touche Tohmatsu Limited

3. Technology will change lifestyle of
chronic care patient and enable self-care....

4. What Citizens want?
Interest in online tools and services and in
tools and aids to support self-managed care
4 ©2011 Deloitte Touche Tohmatsu Limited

5. Interest varies by generation and country in using a smart phone or PDA to
monitor their health if they are able to access medical records and download
information about their medical condition and treatments.
©2011 Deloitte Touche Tohmatsu Limited

6. Consumers are highly interested in using a medical device that would
enable them to check their condition and send information to their doctor
electronically through a computer or cell phone via the Internet
6 Deloitte ©2011 Deloitte Touche Tohmatsu Limited

7. And why can „t
Patient led we book appointments
with PcP / Hospitals?
Growth drivers
• 20% of all new phones sold is smart-phone
• Asia has fastest growing affluent class and
middle class
• Largest % current customer segment
• 2% apps on HC and 7% on Life Style
Barriers
• Does not address broad population (for now)
• Significant gaps in adoption of technology in
provider settings
7 ©2011 Deloitte Touche Tohmatsu Limited

8. Technology-enabled
Self-Care self-care
Growth drivers
• Downloads of Healthcare iPhone apps
• Emerging patient portals and pilots across the
region
Barriers
• Lack of awareness of benefits
• Data Governance, Ownership, and regulatory
frameworks still needs to be worked out
• Lack of Sustainable business models
• Still in early stages of development
8 ©2011 Deloitte Touche Tohmatsu Limited

9. Regular follow-up, Mobile Monitoring ,
Chronic Care Lifestyle Lifestyle choices for chronic patients
Growth drivers
• Increased access to healthcare and health-
related information, particularly for hard-to-
reach populations
• Increase mobile (voice) coverage and adoption
Barriers
• Relatively untapped market
• Limitation on care delivery on phone
http://www.youtube.com/user/ProjectHealthDesign#p/u/16/VNdkgOuui00
9 ©2011 Deloitte Touche Tohmatsu Limited

10. Personal monitoring device to alert
Evidence Based Care and guide to make improvements
in health or treat a condition.
Growth drivers
• Significant innovation in Med Tech industry
• Rapidly growing Chronic Disease patients in
Asia
• Improved ability to diagnose and track diseases
Barriers
• Lack of complete end-to-end operator service
• Largely Silo approach till date
http://www.youtube.com/user/ProjectHealthDesign#p/u/12/rYkuswN8wMY
10 ©2011 Deloitte Touche Tohmatsu Limited

11. Prevention of Chronic Diseases?
< 20 % of high risk citizens participate in wellness programs
11 ©2011 Deloitte Touche Tohmatsu Limited

12. Use of applications is expected
Keeping Healthy to increase threefold by 2012
(=600 mil applications)
Growth drivers
• Payers are most interested to keep people
healthy!
• Technology enabled incentive / rewards to
change behavior
• Expanding Wellness market (eg, spa, yoga)
Barriers
• Still a relatively small market today in Asia
despite high growth
12 ©2011 Deloitte Touche Tohmatsu Limited

13. Privacy concerns vary between countries
Concern about privacy of Health information stored online
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14. mHealth in Asia is Poised for an accelerated growth
• Greater EHR adoption by hospitals, physicians and allied
health provider
• Increasing regulatory clarity around standardization of
health records, privacy protections and provider liability
• Increasing MCD capacity and functionality
mHealth
• Decreasing cost of MCDs (scalability) in tandem with Acceletors
payer incentives for their us
• Increasing consumerism in health care
• Increasing focus on Health Reforms due to raising costs
and citizen expectation
14 Deloitte ©2011 Deloitte Touche Tohmatsu Limited

15. Mobile Health Opportunities in Asia
Prevention
& Wellness
Disease /
Condition
Benefit / Health Outcome
Monitoring
Remote
Consulting
Consumerism
&
Convenience
15 Complexity ©2011 Deloitte Touche Tohmatsu Limited

16. Mobile Health Opportunities & Barriers in Asia
Opportunity Growth Drivers Barriers Case Studies / Examples
• Increasing consumer
demand for mobile
• Drawing parallel to
“commerce” • Does not address
Singapore taxi booking
• 20% of all new phones broad population
Consumer system using SMS and
sold is smart-phone • Significant gaps in
Driven iPhone.
• Asia has fastest growing adoption of technology
Healthcare • Why can‟t we book
affluent class and in provider settings
appointments with PcP /
“middle class”
Hospitals?
• Largest % current
customer segment
• Increased access to
healthcare and health-
• Relatively untapped
related information,
Remote market • Case studies include
particularly for hard-to-
Consulting • Limitation on care Ghana & Indonesia.
reach populations
delivery on phone
• Increase mobile (voice)
coverage and adoption
• Significant innovation in • US: Fifty percent of
Med Tech industry consumers want a
• Lack of complete end-
Disease / • Rapidly growing Chronic personal monitoring
to-end operator service
Condition Disease patients in Asia device to alert and guide
• Largely Silo approach
Monitoring • Improved ability to them to make
till date
diagnose and track improvements in their
diseases health or treat a condition.
16 ©2011 Deloitte Touche Tohmatsu Limited

17. Mobile Health Opportunities & Barriers in Asia
Opportunity Growth Drivers Barriers Case Studies / Examples
Prevention & • Increased focus by • Still a relatively small • > More than 200 million
Wellness Payers of Healthcare, market today in Asia mHealth applications
Market including Employers, despite high growth are in use today, and
Private Payers, that number is expected
Governments due to to increase threefold by
rising costs. 2012**
• Expanded access to
ongoing medical
education and training
for health workers
• Increased awareness &
fast growing wellness
market (eg, spa, yoga)
Mobile • Downloads of • Lack of awareness of • Researchers at Kaiser
Personal Healthcare iPhone apps benefits Permanente in Colorado
Health • Emerging patient • Data Governance, discovered 58 % of
Record portals and pilots across Ownership, and hypertension patients
the region regulatory frameworks using mPHRs lowered
still needs to be worked their blood pressure to
out healthy levels within 6
• Lack of Sustainable months, compared to 38
business models % receiving conventional
• Still in early stages of treatment
development
17 ©2011 Deloitte Touche Tohmatsu Limited
**Pyramid Research

18. In the short-term, we must not ignore the opportunities to gain efficiencies
in Life Sciences and Healthcare companies for their key operations
Life Sciences Companies Health Care Provider
Clinical Trials Efficiencies in Clinical and
• Patient Diaries Administration
• CRAs • Revenue Cycle Management
• Medication Management
Sales & Marketing Improved Patient Experience
•Next Gen Sales Force
Transformation mHealth • Streamline communication
• e-Detailing • Personalized communication
Others Increase Quality of Care &
• New level of Capturing Safety Patient Safety
Data (PV) • Enable physicians greater access to
data, anytime, anywhere.
• Stronger Compliance Regiment
• Improved evidence based decision
• DTC making
©2011 Deloitte Touche Tohmatsu Limited

19. mHealth, serves as inextricable access point to a broader eHealth
ecosystem, owing to huge mobile penetration and reach
Tremendous reach…. …and Impact
Technology and health-related statistics for
developing countries (M) Philippines
5,300
Phoned Reminders for
5000 TB Treatment : 90%
did remember to take
their medication
4000
Peru Uganda
3000
2,293 Health workers SMS-based
use mobile phones to HIV/AIDS awareness
2000 send quiz led to an
SMS messages increase of nearly
with real 40% people for
1000 time data HIV/AIDS
testing.
305 S. Africa
11
0 SMS Message
Hospital Computers Mobile Population campaign promoting
Beds Phones HIV/AIDS awareness
resulted tripling of
Call Volume to
HIV/AIDS
Source : Business Monitor International (BMI), International Telecommunications Union, World
Bank‟s World Development Indicators, and the United Nations; Deloitte analysis helpline
19 ©2011 Deloitte Touche Tohmatsu Limited

20. Mobile penetration as compared to online penetration is almost 5 to 6
times in few of the big Asia Pac economies…
Online vs. Mobile subscribers (2009)
Mobile phone penetration….
Internet Mobile Ratio/
users users Multiple •China has the world‟s largest cell phone
subscribers at 707 million in 2009
North
0.25B 0.27B 1.1X •Asia Pacific had 46% of the global total
America
subscriptions
Asia Pacific 0.82B 1.30B 1.5X
Smartphone penetration…
• Reached 40 percent across
World 1.73B 3.40B 2.0X Southeast Asia in Q4 2009.
•Singapore‟s smart-phone touches to
Europe 0.42B 1.06B 2.5X about 75%
Indonesia 0.03B 0.16B 5.0X
India 0.06B 0.40B 6.0X
20 Source: ITU, JP Morgan, Deloitte analysis ©2011 Deloitte Touche Tohmatsu Limited

21. …on the contrary, the current low ratio of Doctors per inhabitants is likely to
worsen further
Number of inhabitants per doctor
©2011 Deloitte Touche Tohmatsu Limited
21

22. Stakeholders & Benefits
Stakeholders Benefits
• Better care and lower costs via access to real-time information
Consumers
• Increased Safety & Quality of Life
• A mechanism to coach consumers to make better judgments about their care
Hospitals &
and to align provider incentives with optimal patient outcomes.
Physicians
• Support medical home initiatives
• A platform for demonstrating value (efficacy and effectiveness) of
therapeutics and diagnostics within the context of an informed consumer
Life Science
population
Companies
• If consumers agreed to share information, the consumer-reported database
unlocks potential for manufacturers to learn more about product use
• Lower costs associated with fewer admissions and emergency room visits,
avoidable drug-drug interactions, avoidable over-use of medications and
Payer / Govt increased use of self-care/over-the-counter therapeutics in treating common
chronic conditions
• Provides a platform to fully enable health & disease management programs
• Increased incremental revenue on top of existing voice & data revenue
streams
Telco • Opportunity to expand into infrastructure services, managed services, cloud
computing and professional services
• Opportunity to own / dominate, and take the first mover advantage
22 ©2011 Deloitte Touche Tohmatsu Limited

23. Telco in Asia are well positioned to take a lead role in mHealth enablement
• Address around $100M** with 40% YoY Growth by 2014
• Leverage existing consumer branding & trust
• Build upon core strengths / heritage in public sector ***
Telco
Opportunity
• Leverage strengths in billing & pay-per-use models
• Leverage “long-term” capital investments in infrastructure
• Leverage existing reach & coverage in segments at
affordable costs
** Based on 10-15% of Asia Pacific excluding Japan mHealth Market estimates. Asia Pacific
Market estimated to be 10% of global mHealth market by 2014
23 ©2011 Deloitte Touche Tohmatsu Limited

24. …and potential pathways for Telco operators
Develop Be the
scalable connectivity
solutions hub
and interlinking all
appropriate different
Enable distribution stakeholders
operational and
aspect of commercial Step 4
Enabling the healthcare models
Revenue sharing
administrative
Step 3 with partner?
aspects of
healthcare
Step 2 One-time fee?
Step 1
Advertisement
Revenue?
Government
Funding?
24 ©2011 Deloitte Touche Tohmatsu Limited

25. Critical enablers for success in mHealth
Community Trust & • Trust in Quality & Service Delivery
Relationship • Trust in Data Governance & Ownership
Financial • Partnerships to minimize risks / exposure and play to core strength
Alignment &
• Financial Sustainability over the long-run
Sustainability
• Standards / Interoperability
Technology
• Privacy & Security
• Alignment with national / provincial programs
Govt Alignment • Alignment with existing national EHR programs
• Alignment with changing regulations and reimbursement models
25 ©2011 Deloitte Touche Tohmatsu Limited

26. Indicative emerging mHealth partnership and pricing models…
Indicative
Need Partnership construct Who pays? Pricing Model
Co-Share
1 Revenue-sharing with between • Pay-per-use
Remote + Provider / Physician
Consultation Patient /
Provider
**Telco could take a lead role in taking this to
market
**Dependant
2 Service Pay-per-use
Revenue-sharing with
Consumerism + Provider / Physician
& Either
Convenience
Provider or
• Providers could take a lead in providing Patient or
value-added services, eg. appointment Both
• Primary Care markets and e-Bookings could
be areas where Telco could take a lead role Eg. Booking
• Payers could also play key role enabling both could
services pay
26 ©2011 Deloitte Touche Tohmatsu Limited

27. Indicative emerging mHealth partnership and pricing models…
Indicative
Need Partnership construct Who pays? Pricing Model
• Free to consumers
• Devices /
Governments can
Disease play a key role in
Consumables
3 Prevention + creating awareness • Payers, Em charged (eg. Nike
and ployer, Govt. Sports Shoes)
Wellness • Telco‟s $ by data-
+ Device Mnf traffic & broadband
+ Payers • Tax & Wellness
+ Retail / Loyalty*
incentives
Disease / • Monthly
4 + + $ • Patient via
Condition + $ Subscription &
Monitoring Payer
Pay Per Use
This requires a complex suite of devices that
are either device led or institution driven
• Monthly
$
Subscription
5 + + + • Payer (Chronic)
mPHR $
Model • Pay Per Use
• Free but based on
Perhaps room for more than 1 models to “preventative
work . Telco’s may play “enabler “ vs. points”
27 ©2011 Deloitte Touche Tohmatsu Limited
operate PHR

28. 28 ©2011 Deloitte Touche Tohmatsu Limited