2. Michael J. Barrett Managing Partner Critical Mass Consulting mbarrett@CriticalMassConsulting.com www.CriticalMassConsulting.com Wireless Technology and the De-Institutionalization of Health Care The Wireless Future of Health IT New America Foundation CTIA – The Wireless Association March 23, 2009

3. Self-care, home care and mobile care have roots and relevance 18 th C: Health care happens mostly at home and work 19 th C: Health care professionalizes and institutionalizes 1950: 40% of MD visits are still house calls 1965: Medicare includes home health, with a low profile 1980s: Chronic conditions emerge as huge cost drivers 1990s: 90% of diabetes care is self-care 1996: Kaiser launches online health site for members 1999: Early remote patient monitors come to market 2002: Healthcare Unbound (over) 2

4. 2002: Healthcare Unbound The centralizing forces of the 1900s will yield to the decentralizing forces of the 2000s. Technology assisting, innovators will light out from 20 th Century settings – hospitals, doctors offices and nursing homes – in order to de- institutionalize healthcare. Technology in, on, and around the body that frees care from formal institutions. Technology-enabled self-care, home care and mobile care have inescapably populist dimensions, rebalancing power and control towards the grassroots. 3 Source: Michael J. Barrett, Healthcare Unbound, Forrester Research, Dec. 17, 2002

5. Remote patient monitoring – system components Source: Continua Alliance Patient Community 4

6. 5 Why should you care? Beneficiaries with chronic conditions as % of all beneficiaries Source: Medical Expenditure Panel Survey (MEPS), 1998, cited in Robert Wood Johnson Foundation, Chronic Conditions: Making the Case for Ongoing Care (Dec. 2002) = Public payers = 27% 39% 40% 44% 85% 87% Uninsured Medicaid only Private ins. All Americans Medicare Private payers Medicare/Medicaid

7. 5-year forecast: Americans access to smart consumer devices Source: Forrester Research, The State Of Consumers And Technology: Benchmark 2008 (82%) (78%) (51%) (78%)% 6

8. How far will the trend go? Wireless-only households, 2007 OK – 26.2% UT – 25.5% NE – 23.2% AK – 22.6% SD – 6.4% DE – 5.7% CT – 5.6% VT – 5.1% DC – 20.0% 7 Source: CDC, Wireless Substitution: State-Level Estimates from the National Health Interview Survey 2007

9. What wireless brings to the party Learning is most likely if people get immediate, clear feedback. … Well- designed systems tell people when they are doing well and when they are making mistakes. -- Thaler and Sunstein, Nudge (2008) Ubiquity Feedback 8

10. Still, for most things today were wired, not wireless Base: 44,959 North American adults with a mobile phone Source: Forrester Research, The State Of Consumers And Technology: Benchmark 2008 Percent of North American adult users of a cell phone/smart phone or handheld wireless device who do the following at least once a month 9

11. What wireless cant do (yet) Work to mission-critical perfection (network coverage, battery life, privacy, etc.) Maintain the cell phones form factor (who cares!) Create the business models – ways to pay for services Harmonize ubiquity with Medicares homebound requirement Change human behavior when feedback mechanisms are imperfect and feedback itself is necessary but not sufficient 10

12. Michael Barrett Critical Mass Consulting mbarrett@CriticalMassConsulting.com 781-674-0097 Thank you! 11