IMS Research forecasts that health providers and payers won't drive growth in wireless-enabled remote health monitoring by 2016; it's consumers who will demand and pay for 80% of devices four years from now. IMS says that, "The demand for self-monitoring one's health is growing much faster than that for telehealth implementation. Even without healthcare systems that are adapted for this, consumers want to be able to monitor and manage their own health at home."
I am an N of 1. In my personal life, I'm an early adopter of health self-monitoring, regularly using a Wi-Fi scale, a turbocharged pedometer and a sleep device. Using these devices has become habit-forming for me and has had a positive impact on my health and in lowering risk factors.
However, even though I'm a convert in my personal life, through my professional lens, I find the IMS forecast optimistic when considered against several barriers to consumer adoption for do-it-yourself remote health monitoring. These factors include:
- Peoples' motivation to change and sustain positive health behaviors;
- The relatively low level of self-tracking currently being done by consumers; and
- Gaps between what physicians want people to measure versus what people actually want to track.
Ultimately, remote health monitoring is more of a team sport than a solo one.
First, the Forecast
IMS Research's report, titled "Wireless Opportunities in Health and Wellness Monitoring," points to 10 "connectivity technologies" providing wireless capabilities for remote health monitoring, from Bluetooth (classic and low energy) to ZigBee and Wi-Fi, among others. The forecast looks into health monitors (for tracking blood pressure and blood glucose, for example) and fitness monitors (including heart rate, pedometers, "foot pod" step sensors and others).
Health providers in what IMS Research terms "managed telehealth systems" will grow to become 20% of the remote monitoring market in 2016. The remaining 80% of the market will be paid for by consumers.
Self-Health Tracking Is Still Quite Limited
Only 27% of adult Internet users track their own health data online, according to a Pew Internet & American Life survey conducted in September 2010. People who self-track tend to be younger, between ages 18 and 30, based on the 2011 Edelman Health Barometer survey.
PricewaterhouseCoopers found that there are differences between what health metrics consumers and physicians want to track. For example, many more physicians want consumers to track blood sugar, exercise and weight, while consumers are less interested in measuring these factors compared with food tracking and digestive health.
The Heavy Lifting of Behavior Change
Two-thirds of people try to make a positive health behavior change each year, but half of them return to the negative health behavior, according to the 2011 Edelman Health Barometer survey. The other half sustain their behavior change. Why do people return to the behaviors they try to change? For one in three people, it's due to the enjoyment of the negative behavior; another 20% say they're addicted to or dependent on that behavior. Furthermore, 18% are looking for more immediate gratification, saying they didn't experience benefits soon enough.
Health, it is coming to be recognized, is social. Check out Nicholas Christakis' research documented in his book Connected, discussing social network influences on health and well-being. For example, a person's chance of becoming obese increases by 57% if he or she has a friend who is obese. A resilient social network can make a big difference in people creating healthy habits. On the upside, about 50% of U.S. adults used social media for some aspect of health care, according to the 2011 consumer survey from the PwC Health Research Institute.
The Promise of Nudges, Coupled With Technology
Research into "nudges" and value-based health plan design could help bolster individual self-tracking for health. Three-quarters of employers will offer wellness programs in 2012, with a majority including biometric screening and weight management, based on an employer survey from PwC. Over one-half of employers also will offer programs targeting diabetes that provide incentives of cash, gift cards or reductions in annual premiums.
Such "nudges" are becoming more common among large employers, many of whom are engaging in a reinvigorated approach to wellness in the workplace. The new approaches to employee wellness has begun to incorporate both carrots and sticks. For example, Trek, the bicycle manufacturer, in 2009 began to link its contribution toward an employee's health insurance premium (worth about $269 biweekly) to his or her participation in health risk assessments, biometric screening, coaching and nutrition classes.
Remote Health Monitoring Is a Team Sport
Technology alone won't inspire or sustain behavior change among consumers. Bonnie Spring of the Northwestern University Feinberg School of Medicine's Department of Preventive Medicine and colleagues published a study in the May 28 issue of the Archives of Internal Medicine that found remote health coaching and financial incentives together can help people increase their intake of fruits and vegetables and maintain healthy behavior changes. Remote health coaching was done through a mobile personal digital assistant that people used to record their behaviors. The incentive was a $175 payment for meeting the goals for two targeted behaviors: increasing fruits and vegetables, as well as physical activity.
Over the past three years, the annual Consumer Electronics Show in Las Vegas has showcased more and more tools and devices for people to use for personal health tracking. At the same time, mobile health applications have proliferated in the iTunes store. MobiHealthNews has projected that the number of iPhone health apps for consumers will exceed 13,000 by July 2012. However, with the exception of a handful of nutrition/food apps that count calories and track fitness, there isn't much solid evidence yet that downloads equate to sustained use or changed health behaviors on their own.
Increasingly, health providers are being incentivized by health plans -- both commercial health plans through employer plan sponsors and public health plans via Medicare, Medicaid and the Department of Veterans Affairs -- to keep people out of acute care beds and healthy in the community, all motivated by stemming hospital readmissions and taking on the responsibilities of accountable care.
Prescriptions for information therapy and remote monitoring will be coupled with devices for people to use in their own home and on-the-go. It will be difficult to tell whether demand for remote monitoring will be consumer-led or provider-led. Remote health monitoring is and will continue to be a team sport.