The idea of using communications technology in health care delivery has been popular for about 30 years but the benefits of telemedicine, and its mobile phone sibling, mHealth, are yet to materialize. While the high-cost medical sector of the developed world inches toward using communication technology to lower costs, governments, international agencies, nongovernmental organizations, and a few for-profit companies are attempting to use technology to deliver minimum levels of care in the developing world. Conferences (e.g., mHealth Summit), initiatives (e.g., USAID Mobile Alliance), academic projects (e.g., Open mHealth), consultants (e.g., DiMagi), and student-initiated ventures (e.g., Click Diagnostics) abound, but, as usual, I wonder what effort may have demonstrated success in delivering an improvement to health affordably, that is, at a price people are wiling and able to pay, since my prejudice, possibly mistaken, is that a proven business model is a powerful way to effect large-scale change.
Here in the US, where most care is paid for through third parties (the government or insurers), a handful of start-up companies see a business opportunity in substituting “teleconsultation” for doctor visits, the idea that we harried insurees are more likely to use our cell phones (or computers) to address minor, non-emergency health concerns than to see a doctor, before the problems become serious and more costly to treat. These companies offer phone consultations with physicians who provide advice, recommend treatment options, and prescribe medication when appropriate. Examples are Consult-a-doctor (Consult), Teladoc (Teladoc), and Easy Health MD (Easy Health). The leading company, that is, the one that looks like it will be profitable in the near future is American Well (American Well) which has built an online system that connects consumers with physicians immediately and for physicians to connect to specialists in real time. The company is four years old and has 90 employees and four large providers as customers: Hawaii Medical Service Association, the Hawaii franchise of Blue Cross Blue Shield; Blue Cross Blue Shield of Minnesota; OptumHealth, a unit of private health insurance giant, UnitedHealth Group; and TriWest Healthcare Alliance, a Phoenix-based health plan for military personnel and their families (Xconomy article). As the name implies, all well and good for the US where 16% of the GDP involves health care, but what about the rest of the world? (I should note that in the above-cited article the American Well CEO says the company is considering how to expand internationally into underserved markets.)
Googlin’ about, I found that the developing world complement to US teleconsultation is the “health hotline” and an excellent 2009 report on its use and potential by the GSMA Development Fund (GSMA DF) which is part of GSMA, the trade association of mobile phone service providers. The report, called “A Doctor in Your Pocket” (GMSA DF report), points out that health hotlines are used by more than 10 million people in Mexico, India, Pakistan and Bangladesh and new systems are being set up in the Middle East, the Caribbean, Latin America, and Southeast Asia. Moreover, most have a for-profit model and typically involve a government agency, healthcare provider, and a mobile phone service provider. The report focuses on four established systems and provides useful data on use, scaling, staffing, customer satisfaction, challenges, and opportunity for and limits to growth. Some additional interesting points are:
- the hotlines handle up to 50,000 calls per day;
- calls are answered by a mix of medical professionals and trained agents, e.g., MedicalHome in Mexico uses 15 doctors and 100 agents per shift to answer 10,000 calls per day;
- the users are about 50/50 rural or urban poor and middle class;
- revenue is by fee per call (two of the four) or monthly subscription;
- all are affiliated with health care providers and in some cases offer discounts on services;
- liability is not seen as a major risk and in part because medical malpractice suits are rare; and
- potential revenue is through fees to outside providers for referrals and prescription issuing.
The bottom line of the authors is that while such hotlines are improving the access to medical care for under-served populations, especially the rural poor, there are constraints to increasing their scale, including operational challenges and affordability, and that some regulation (standard-setting) is needed to support market growth.
The authors did not address the investment opportunity and start-up activity but I would think that most of the GSMA’s members have developed or seen medical hotline business plans. Apparently, one of the report’s author wrote on of these plans since he, along with three others, started a company in India in May of this year, mHealth Ventures (mHealth Ventures), which is offering a subscription-based service called Meradoctor. It has two low-cost plans and about 900 families as customers to date (USAID blog post). One opportunity is for the top-tier, rest-of-world hospitals and medical centers to expand their patient base to their countries’ mid- and low-income groups through a patient hotline. After all, there are just so many wealthy locals and medical tourists to treat.