Sunday, February 10, 2008

Gadgets & Disease Management: The Coming Emergence of Medical Device Manufacturers in Population Care

This link to an article named Gadgets that keep you healthy made the Disease Management Blog ponder the role of medical devices in population-based health care. I'm certainly not alone in struggling with the topic, but thankfully I don't have to be like Inverness and be quite so complicated about it. The image of this eye-socket gadget internet-enabled health-vixen speaks to the topic in a much better way.

It's not uncommon for disease management programs to grapple with the role of "hardware" in their programs. Should IVR-enabled scales be offered in heart failure? Should USB-ported peak flow meters be given for free if there is an asthma diagnosis? What is the role of kits that allow home measured A1Cs? I now wonder if that thinking is becoming increasingly backwards. Maybe a better question is to ask is whether population-based health support should be included with the gadgets.

Consider one device that is the topic of the Gadget article: the glucose meter. Being VERY simplistic.....

In the "insurance" business model, meters are an a) expense, b) a mandate c) an exercise in good will d) something that has yet to be proven in prospective randomized control studies to reduce claims expense. Think deductions, co-pays, co-insurance and limits (directed at the strips).

In the "clinical revenue-based" business model, providers want a) payment, b) payment or c) payment for their support of a glucose meter. Think unbundling, coding, direct patient billing and, when all else fails, blaming managed care one more time.

In the emerging consumer-centric business model, glucose meters may well go the way of other consumer goods: either turn into commodities and die or be coupled to support services that ultimately have the potential to create more revenue for the manufacturer than the device itself. Think service contracts and value-adds that morph into an ongoing revenue stream. Smart automobile manufacturers now sell reliable transportation, not cars. Smart computer manufacturers sell information technology, not beige boxes. Should meter manufacturers sell blood glucose control? Should cardiac stent manufacturers include services that minimize the risk of re-occlusion of the involved artery? Will gastric banding manufacturers compete on the degree of weight loss at one year?

The disease management blog predicts the gadget manufacturers are creating a new chapter in disease management, characterized by mergers, acquisitions, partnerships, contracting "coopetition" and OWAs. And note the article above was from India, leading me to believe this is a global phenomenon. It will be interesting to see how the U.S. physician community and health insurers will respond. The eminently savvy readers of this blog probably have a prediction about that, and I agree with you.

Speaking of vixens, as a public service to the gender-male readers of this blog, if you are lucky to have a significant other, this is a reminder of an approaching high profile day. Gentlemen, do yourselves a favor and think at least a card. I don't know why either, but the kind with excessive romance is best and you get bonus points if she wants to show it to her girlfriends. You've been forewarned.

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