1. Overcoming barriers to uptake Aleix Bacardit EMEA Pharmaceuticals & Healthcare Practice London, June 2011

2. A.T. Kearney 2 Mobile Health, What is it? Mobile phonesPatients / Consumers Connected devices Healthcare professionals

3. A.T. Kearney 3 The Mobile Health Promise Better diagnose and manage disease Improve quality of life and convenience Better patient data Consumer & patient education Improve compliance Improve administrative processes Professional education

4. A.T. Kearney 4 Diabetes illustrates the potential for Mobile to revolutionise health delivery Source: A.T. Kearney Analysis 1 2 6 10 17 18 3 4 5 7 8 9 15 13 11 12 14 16 Assessment of mobile health application Sustained use Treatment initiation Seeking treatment Condition awareness “Information on conditions” “Diagnosis & Treatment” “Overall results management” High applicabilityLow applicability Illustrative

5. A.T. Kearney 5 There is no shortage of problems or solutions Europe’s top-5 The Health needs are clearTechnologies are available Prevention Awareness Early diagnosis Compliance Managing co-morbidities Avoiding unnecessary costs More phones than people Hundreds of mobile phone apps Plenty of devices with connectivity Note (1): Adults defined as population aged between 20 and 79 Various sources. A.T. Kearney analysis 1.3 mobile pp 0.4 broadbd / adult (1) 1.3 mobile pp 0.4 broadbd / adult (1) Europe’s top-5 18m diabetics $57bn 18m diabetics $57bn What lies in between?

6. A.T. Kearney 6 Bridging the gap… The Health needs are clear Technologies are available Finding the right buyer Making it work commercially Proving Value Integrating (or decommissioning) services Managing risks and regulation

7. A.T. Kearney 7 Who the buyer depends on boundaries of “health”, and by country and disease Diagnosed as Ill with a serious disease Worried Well More likely to be health system es More likely to be the consumer Aspirational Well Should be Worried Well Very likely to develop a serious disease – and know it Overweight, Unfit, Smoker, Drinker… High blood pressure, high cholesterol, obese, low respiratory function, low liver function… Atherosclerosis, Diabetes, Renal Failure, COPD… Very likely to develop a serious disease – and Don’t know Ill with a serious disease - but not Diagnosed

8. A.T. Kearney 8 Which stakeholder benefits from a Mobile Health solution will depend on how it creates value t cycy “System” Cost/ Benefit Number of patients Number of visits (per patient) Number of activities (per visit) Cost per activity xxx= Population Risk Pathway Efficiency Delivery Efficiency

9. A.T. Kearney 9 Where that value appears depends on the reimbursement system Where the burden of risk lies in the reimbursement system Global budget/ capitation Fee for service PROVIDER Risk at the provider side Simple, easy to administer Excessive (uncontrolled) use of resources Efficient use of resources Potential for patient selection, under-treatment es A myriad of systems in between Risk at the payer side PAYER

10. A.T. Kearney 10 Healthcare is an industry driven by evidence, but the evidence for Mobile Health is recognized as being very weak Source: European Commission: Strategic Intelligence Monitor on Personal Health Systems, 2010; European Commission: ICT and Aging 2010 “Obstacles, however, abound. Among them are […] the lack of clear evidence that mHealth solutions are viable on a wide scale and can deliver real efficiencies” Mobile Health for Independent Living. AARP, 2011 “Evidence of effectiveness is limited and inconsistent, evidence about cost-effectiveness negligible, implementation on wide scale is the challenge” Prof Chris Salisbury, University of Bristol, UK

11. A.T. Kearney 11 What are you trying to prove? Superior Outcome, or Non-Inferiority at Lower Cost ? Is the research hypothesis clear and realistic? Do you have the right endpoints and measures? Are they relevant to decision makers? Is the sample size big enough? Do you have the right comparator? Can you differentiate between the service and the technology? Is the study method valid? What will work best? RCT, observational study, pilot, pre/post analysis? Common mistakes in gathering evidence

12. A.T. Kearney 12 Mobile Health needs to integrate into the overall care model Consultations Treatment and Medication Diagnostics and Tests Rapid response / emergencies Training Compliance Frequency and type of contact with CM (continuously reviewed) Care Management Plan Care Providers Care Manager Patient / Carer Community and Social Care Emergency Care Therapies Acute Care Self-Care Informal Care Joint Decision- Making Self-Care Informal Care Joint Decision- Making Mobile Technologies

13. A.T. Kearney 13 Part of VALUE CHAIN The more critical the application, the more clinical and regulatory risk comes into play Critical Life-critical interventions Clinical Risk Remote monitoring — WELLNESS Remote monitoring — AMBULANCE DIAGNOSIS support Unwell Treatment monitoring At risk: Diagnosis Well: Wellness prevention Well: Health information Content AdviceData managementMed devicePhone Encryption TransmissionBilling Distribution Marketing & Sales

14. A.T. Kearney 14 A Prescription to Help Bridge the Gap … The World Today All of Us, Everywhere The Health needs are clear Technologies are available Focus on the service, not the technology. Simple is good Align the solution with the incentives and financial flows Define a clear business case, and get the stakeholders to buy into it Start with applications that don’t require large scale service integration to be successful Create a plan to build strong evidence that it works

15. A.T. Kearney 15 Thank You Aleix BACARDIT Aleix.Bacardit@atkearney.com A.T. Kearney Limited Lansdowne House Berkeley Square London W1J 6ER +44 20 7468 8000 Manager +44 20 7468 6800 Direct +44 796716 6800 Mobile