Disease Management Going Mobile & Retail: QUALCOMM’s Health Care MVNO

An article in Wireless Week announces the creation of a new species: a health care MVNO named LifeComm. LifeComm promises to move disease management, wellness, and fitness into new territories.

What is a MVNO?

More acronyms!  What is a MVNO? A Mobile Virtual Network Operator (MVNO) is a mobile operator that does not own its own spectrum and usually does not have its own network infrastructure. Instead, MVNOs have business arrangements with traditional mobile operators to buy minutes of use (MOU) for sale to their own customers.

You’ve seen MVNOs advertised on TV: Amp’d Mobile, Disney Mobile, ESPN Mobile.

What Will the LifeComm MVNO Do?

Here’s some information from the Wireless Week article:

The new company, which was incorporated recently under the name LifeComm, was created by QUALCOMM and several other, unnamed, partners. Don Jones, who is vice president of business development  for QUALCOMM’s’ health and life sciences unit, says the MVNO likely will launch commercially sometime in the second half of 2008.

“We don’t see it as just health care,” he says, because the MVNO also will offer services for wellness, fitness, and health maintenance.

The specific applications and services the MVNO will offer have not been determined, but Jones says the company wants to establish a brand known to provide services for anyone interested in his or her health. The target audience, he says, is predominantly going to be women ages 40 to 65 because they are “influencers” when it comes to health.

Services could involve fitness, weight management or reduction, diabetes management, and monitoring heart health, including hypertension and congestive heart disease.

Putting a MVNO together is a lot of work. 

  • Developing the business deal. Don Jones, a health care industry veteran and deal maker extraordinaire, has been talking about LifeComm for over a year. A lot of work has already been done to put this together.
  • Integrating backend applications. Today, there are many niche companies offering specialized applications targeting specific wellness, fitness and DM applications.  For example, HealthPia offers a diabetic phone, MyFoodPhone offers nutritional guidance, and CardioNet offers mobile cardiac monitoring. Presumably LifeComm would develop a technological platform to integrate these types of disparate applications.
  • Creating and rolling out retail marketing campaigns.  A MVNO is a marketing vehicle to aggregate subscribers. We should expect to see LifeComm heavily advertised. Don’t be surprised if someday LifeComm runs SuperBowl commercials. Of course, retail advertising is very expensive and raises the stakes of the game.

Is this a big deal?

Short-term: put LifeComm on your “watchful waiting” list.  The business deal is still being finalized, it will take a while to develop and tweak the applications, and signing up subscribers is a long-term proposition.

Long-term: definitely, YES!

  • LifeComm is a major sign of disease management going mobile and going retail.
  • MyFoodPhone’s slide presentation characterizes this trend as “the doctor in your pocket.”
  • There are no boundaries.  Expect LifeComm to move to international markets.
  • Remote patient monitoring (RPM) is moving beyond the elderly and homebound.  To date, most RPM activities have focused on sicker, elderly, and/or homebound patients.  LifeComm is a major effort to move RPM into the mainstream and into the community.

What other questions come to mind?

  • Will LifeComm offer a specialized health phone? or will the service work with ordinary cellular phones?
  • How much of LifeComm will be B2C? B2B? While most MVNOs are targeted directly to consumers, LifeComm could also market their offering to health plans, disease management companies, and other integrators of care management services.
  • Who will be investors and/or partners in LifeComm? So far we don’t know.
  • Will LifeComm play nicely with the other kids in the sand box? Will LifeComm unfold as a proprietary service or as an open, interoperable offering? As of today (May 17) QUALCOMM is not on the membership list of Continua Alliance. Continua’s, which has 100+ members, is focused on  “fostering independence through establishing a system of personal telehealth solutions that empower people and organizations to better manage health and wellness”.
  • Should we expect a GSM competitor (e.g., AT&T, T-Mobile) to enter the market? LifeComm has an agreement with a CDMA wireless carrier. The Wireless Week article notes that LifeComm plans to use QUALCOMM’s BREW platform, which is used by Verizon Wireless.

Welcome to the world, LifeComm!

For further reading:

49 thoughts on “Disease Management Going Mobile & Retail: QUALCOMM’s Health Care MVNO

  1. This could signal one of the most significant developments since the internet, simply because of the ubiquity of it. And that’s speaking as someone for whom the mobile phone is still seen as an unwelcome interrupter rather than an essential aid to being in communications with people.

    One of the reasons why it could herald a change the way people think about health monitoring (and health maintenance) is that bandwidth capacity is going to increase tremendously, which means more and quicker data transfer, and that’s what this development hinges on. When the phone networks crack the problems they face in achieving the standard for 4G communications, the growth could be exponential. (Part of the 4G standard requires data rate of 100 megabits per second delivered when travelling at speed. To put that into context, that’s 100 times the speed most broadband users in the UK have. It means passengers in your car being able to download a film in seconds.) With a seamless continuum of data transfer from implanted wireless health monitoring sensors that are communicating with mobile devices and thence to computers with hard-to-imagine computing capacity, your whereabouts could be tracked, your health monitored and you could be nagged about it by phone continuously.

  2. My company, Telespree Communications, has real world experience in the US mvno market. My perspective is that of someone who provides a service to several of the major mvno’s.

    The healthcare mvno “use cases” for people who have a serious health situation are compelling. The lifestyle oriented mvno idea is not.

    The reason why I draw these conclusions is that there are aspects of the mobile phone business that require any future mvno offering to be a “must have”.

    Allow me to provide a few examples:
    -Its very difficult to get people to switch carriers. (number portability has been out for a while and churn rates are actually down.) People have contracts and family plans. My company pays my cell phone bill. If I would die if I didnt switch to a healthcare mvno, i might consider it. I’d have to discuss it with my wife first.
    -Specialized phones cost a lot more. the iPhone is rumored to cost $600, I can buy a “regular phone” for certainly less than $100.
    -Distribution is a huge issue. Where do I buy this? If its expensive and specialized for diabetics, it wont be in Best Buy. If it is, will the rep know what it is?
    -I know healthcare is complicated, but mvno and carrier backoffice operations is not a “no brainer”. There is a big investment requiring special knowledge here.
    -For a mass consumer, branded approach like the “lifestyle mvno” idea, plan on investing about $500 million at a minimun if you are hugely successful.
    Virgin Mobile is hugely successful, it took them that much and they were the first one.

    I could continue, but I hope you get the idea. If there is a compelling health benefit, a healthcare mvno might be successful. Lifestyle alone doesnt seem compelling to me and would certainly require a huge investment. If you were successful in the Lifestyle segment, the carriers would copy you quickly. The true health necessity segment is small enough and specialized enough that the carriers would not likely copy a successful implementation.

    Bill deKay
    Telespree Communications

  3. bill is right. compelling content is the key and generalist apps don’t offer that to nearly the same degree as what one would find with acute situations amidst a chronic disease. Qualcomm has some experience in the medical arena including triage wireless (blood pressure) and early trials with Diabetech’s GlucoMON® wireless glucose meter and GlucoDYNAMIX gateway/rules engine.

    The sales model is tricky too so don’t expect a one-size fits all approach to work when you have things like insurance reimbursement, formulary (limited to only a few approved devices and supplies), etc…

    It is exciting to see the Q getting closer to committing to this market as it is definitely needed.

  4. This is terrific news as my company has been spending the past couple of years developing a means of interactive healthcare management using a cell phone. Using ANY cell phone for that matter. In that regard, I would obviously agree with Steve Hard’s comment that this is the “most significant development since the internet” as well as Bill Dekay’s commentary on the short comings of the MVNO model as presented. Having just come from the ATA Conference in Nashville this past week-end, everyone now seems to agree that a health management solution has to be simple, ubiquitous (in terms of equipment AND accessibility), inexpensive and take in to account an individuals everyday lifestyle; which the cell phone clearly answers (no pun intended).

    I also agree with the commentators that where LifeComm is missing the mark is that their approach requires use of specific phones, specific technology and bandwidth. Hence requiring a very specific market with high acquisition costs. Fundamentally, you are not going to get compliance or wide acceptance for that matter, if the users are required to learn new gadgets, install/configure software and change their present provider or service. People just don’t like change and the more you provide such obstacles, the farther away you will get from acceptance and compliance. When looking for people to change their behaviour (which is a fundamental element to introducing health management) the key is to break down any barriers to resistance. Solutions must take into account the behavioural side of individuals. That’s why we developed a health management application that works with whatever cellphone, carrier, a user may have (in fact our test model was 4 year old Nokia).

    Overall, as mobile health management is still rather nascent, I think its great news that Qualcomm is jumping into the fray, as it will help expedite bringing this area into the main stream.

    Howard Rosen MBA

  5. Fascinating announcement from Qualcomm and it’s interesting to hear very valid comparisons with other MVNO offerings.

    Reading the details though this is a very different type of MVNO targetig a completely different user. Women aged 45-60 have never been specifically targeted by any mobile operator.

    Such an aged consumer is also a lot more affluent than the very young consumers mobile operators have until now marketed themselves to (Martin Cooper’s Gojitterbug.com excepted).

  6. This MVNO will rewrite the book on how to be a successful MVNO.

    Unlike others (excluding Martin Coopers niche GoJitterBug.com) this will be the first mobile operator to address today’s lowest spending mobile user group those aged 50+.

    Not only has the lowest spending group got the greatest potential to start spending on mobile but this user group are also the most affluent consumers (those aged 50+ own >80% of global wealth).

  7. Perhaps it’s time someone mapped cell phone/mobile solutions to health management needs. The role of cell phone-based applications for blood glucose monitoring is reasonably clear to me but, after that, the picture gets murky. What’s the next physiological sign for which a mobile solution is both feasible and valuable? Weight monitoring does not meet the test — for my daily weigh-in, I will not be stepping on my cell phone anytime soon. Neither blood pressure monitoring nor respiratory monitoring appear to meet the dual requirements of feasibility and necessity, either.

    For the near- and mid-term, are we really talking only about portable glucometers and medication reminders? And are we even confidant about the role of mobile solutions for the latter? Is the mobile phone really the right solution for the elderly, who may prefer to get their information from devices with larger screens or from more traditional land-based telephone lines?

    Is there a chance, in other words, that the only chronic condition for which the cell phone is truly central is diabetes? If so, how large a market-limiting factor is this? And if the answer is that the cell phone can only be one part of a comprehensive monitoring solution — only one form factor among others — then what does this say about the relative strength of various potential market players and the relative wisdom of competing business models? Is there really a big role out there for telecom companies, for example?

    I don’t have any oracular answers to these questions; I’m just wondering about them on Vince’s excellent blog.

  8. Actually, I was about to suggest that diabetes is the only area that I can see a potential MVNO opportunity in wireless…and only as part of a total service package/concept for diabetic care.
    As mentioned earlier, my company provides a software platform to major mvno’s. My wife is also a CDE/RD who works with diabetics. From that vantage point I can see the need for a “diabetic focussed mvno” with the phone/monitoring device as part of a broader package of services for this unfortunately, rapidly growing market.
    As a standalone “diabetic phone”, I am not sure.

    I am sure there are other areas that might justify an mvno, but in the diabetic market there are several favorable factors.
    1. Large, growing population

  9. continued…
    2. Potential urgency of information increases value of mobility.
    3.Opportunity to share information with caregivers, family etc.
    4. Use of mobile phone as a feedback device from service provider.
    5. Opportunity to create value by integration of phone and testing devices. (its easier to carry around etc.)

  10. Think “talking buddy” for coaching and recording for food consumption and fitness (walking). Right now the population with Diabets, cardio and HBP would benefit and have lower medication costs etc. if they were engaged.

    I see the future continued rationing of medical care as an impetus to get people moving. In other words, I can spend my life savings on taking medications or I can start walking for my heart now, which causes appetitie changes which controls weight.

  11. Catherine: Spot on – this is exactly where the personal always-on mobile computing device can really excel and deliver benefits to the mass consumer market.

    A mobile phone will never be able to make us take our medication or dress us but it can encourage patient well being.

    What’s more it can also provide a more efficient and easier way to communicate with carers.

  12. In the long run, cardiac monitoring will be a killer application.

    The value proposition here is very strong life and death. How would you respond to an alert on your smart phone that says Our monitoring system suggests you might be having a heart attack go to the nearest ER. or better yet, Our monitoring system suggests that you will have a heart attack in 30 minutes go to the nearest ER to prevent it from happening. The technology for this is not perfected, but many are working on it.

    There have been barriers to mobile cardiac monitoring, including:

    * ECG leads are bulky; the gold standard is a 12 lead ECG, which is not practical for mobile monitoring. Companies are experimenting with various alternative gloves, 3 lead ECGs, chest strap devices, etc.
    * Network reliability.
    * Liability concerns

    CardioNet, which started as a niche cardiac arrhythmia monitoring company, received $110 investment in private financing in March 2006 http://www.cardionet.com/news_2007_03_26.htm . CardioNet is working to become a broader cardiac monitoring platform company.

  13. … I guess I may be naive but for this approach to succeed it has to go beyond an MVNO as discussed above, that creates restrictions. For this to work, in conjunction with other complementary services and programs, it has to be easily, inexpensively and widely accessible to all prospective users. In the end, as succinctly summarized by Catherine, it can’t be expected to make a user do anything but can encourage compliance. Which, after all, is the objective, is it not?

  14. Howard I agree that you are being naive – consider the fact that the company behind this is Qualcomm – a wolrd leading high tech company that make the key components of mobile devices. Few other companies in the US today have the ability to co-develop specific phones or to fund the acquisition of such a “very specific market with high acquisition costs”.

    The idea of making dedicated mobile devices for healthcare is a brilliant idea. There are lots of features that one might want in such a device and lots you might not want e.g. high resolution videophone for dermatology, GPS tracking technology for locating in an emergency, or encryption software for transfer of information across a public network.

    Although you seem to have had quite a good idea with Lifewire it is obvious you have already reached the limitations of using “ANY mobile phone”, for example the user interface is awkward (or impossible for an aged person with visual impairment) the device is not water resistant (so can’t accompany a patient everywhere – lots of lone elderly people fall in their bathrooms) it’s quite fragile and its got a battery chosen to work optimally for different purposes to what an health user may wish to use it for (collection of data).

    Local connectivity (eg. Bluetooth or Zigbee) is also absent in most ANY phones and so these won’t be able to communicate with other medical devices(such as pace makers, blood pressure monitors, ECG t-shirts etc.) which from the article is an important part of this offering.

    As for the debate on whether: “People just don’t like change” wasn’t that forgotten when we retired our horses and all started driving Model T’s?

    Why do you feel that someone (who probably isn’t currently using a mobile for anything) is going to want to use a 4 year old Nokia to manage their most important asset. Maybe it’s time for Lifewire to catch up with the speed of evolution of the mobile industry (18 month product replacement timeframes) and stop developing on obslete technologies.

    This is a announcement to do something in the future and in that future it will be far more confusing (not to say impossible) for customers to use 6 year old nokias to comprehensively manage their health than by changing carrier and using Qualcomm’s end-to-end one-stop-shop solution.

  15. Thanks Paul for helping me clarify my opening question as now I don’t feel naive at all but all the more resolved that we are definitely going in the right direction. In short, yes we all need to look at the future but the problems people are having are now, hence why we are looking to help people now with an off the shelf solution. That doesn’t preclude up from looking to the future, in fact we have just completed a 40 patient Trial using Java software on a GPS enabled Blackeberry, receiving real time info from a continuous monitoring glucometer transmitting via BlueTooth. But that’s not for everybody and the reality is that today, most people use older phones and don’t easily change to newer ones (but thanks for your horse and buggy analogy how long was it by the way from the first introduction of the car to its ubiquity? ).

    So our approach is why not have a solution that works today with what people already have as well as build for tomorrow?

  16. After pondering (and enjoying) the very informed comments made to date, I’ve tentatively concluded that the only near-term market (within the next five years) for mobile health services is, in fact, in diabetes. The problem, I worry, with ideas like “talking buddies” and even cardiac alerting is that they require only vanilla-flavored Internet access (or, in the case of the second, only the very occasional phone call).

    From a business vantage point, I think the question is: What health care goals are unsuited, for reasons of either feasibility or convenience, to fixed communications (Internet-, television- or telephone-based) but instead require the unique attribute of mobility? I can see the need for glucose finger-sticks on the move but, after that, the desire for mobility can be met by either ordinary Internet access to a consumer-support site or by the occasional phone call (using the word “alert” makes the act seem sexier than it really is. We’re not talking alerts here. We’re talking phone calls to my cell. In health care terms, such a phone call in an emergency could be huge but, in revenue terms, it’s small potatoes, no?).

    I don’t doubt that someday we will see mobile tie-ins to health that none of us have thought about. But I’m bothered by the lack of business prospects for the needs and goals we have thought about. I just don’t see the commercially viable use cases beyond diabetes.

    What am I missing here?

  17. Mike,

    There is a potential for a standards war here.

    Qualcomm is a company that has built a model around its proprietary CDMA telecom architecture. They have strong IP and have been very aggressive in pursuing licensing revenues.

    If I were Qualcomm, I’d at least be asking the question “Could the smartphone become THE primary access point for consumers and healthcare apps? for other applications? Mobility is essential for moving health care to the community and home, and the PC or digital home network could be an access point for home, but it can’t provide necessary ubiquitous access 24x7x365.”

    I asked the question “Will Qualcomm play nicely with the other kids in the sandbox?” This is a very important question.

    Let’s reframe the issue: is this Qualcomm taking on PC world and the digital home network world in the battle to have smartphones become consumers primary userface with digital technology.”

    This is a particularly intriguing strategy in international markets. I’ve heard Don Jones state that in the less developed world that people will only have one computer, that that will be their smartphone. The vast majority of the world’s population can’t afford to have both a PC and a smartphone — so which would you choose?

  18. P.S. In thinking about mobile use cases, I take for granted my interest in making sure the remote monitoring service or health and wellness coach has not only my fixed phone number but also my mobile phone number. Of course I want them to have both — but the telecoms are not going to build a revenue-sustaining business out of this. An economically viable mobile health service will have to be about more than using the cell phone for occasional communications between call center or provider, on the one hand, and patient or consumer, on the other, right? So where’s the What Else?

  19. Mike,

    You’re assuming that a smart phone is an incremental addition to functionality already provided by existing technologies.

    Try turning that assumption around. What if you thought of the smartphone as your primary connection to your health care support system? and your PC or land line was the incremental technology used only when it had clearly superior benefits?

    I’m don’t know that this is Qualcomm’s strategy; I’m speculating …but it could certainly be a disruptive play.

  20. One of my assumptions — challenge me if I’m wrong — is that providing Internet access on a cell phone is not disruptive. Doesn’t matter which is the dominant form factor in my neighborhood — PC, cell phone, or something else altogether — the ultimate solution in this scenario is the Internet itself, not telecommunications equipment, chips, or media.

    Even in the developing world, the telecoms will face battles on every front. Nick Negroponte and Bill Gates are already vying to produce laptops for under $100, posing challenges for telecoms not only on the matter of technology and communications platform but on the most effective form factor for consumer and patient education.

  21. Great thread… Some of you might be interested to read about the first ever end to end wireless diabetes management system clinical trial that we did in 2002 in South Texas using a dedicated mobile telemetry device with a physical connection to the glucose meter (integrated into the patient’s carrying case w test strips, lancing device, glucose tabs, syringes, etc…). This was presented at the Diabetes Technology Society’s Annual Meeting in Nov. 2003

    One of the key things we learned was that even the most ‘compliant’ (I use that term at the risk of being attacked) patients won’t push buttons or do much to learn or use additional technology. Keep in mind that diabetes is for life and anything extra will be viewed as a burden. For most patients, it has to be simple and if that means specialized wireless medical devices that automatically transmit the data then so be it. Otherwise, adoption will be too small to support a commercial venture. On the feedback side, general purpose cell phones are one of several methods that patients and their teams use for mobile diabetes interactions including self-mgmt.

    Regarding the proposed Qualcomm venture, it will be very interesting to see how they deal with Nokia who holds several patents in the world of cell phone based diabetes management.

  22. Enjoying the debate here but want to make some observations:

    Vince:good points here.

    Mke Barrett:i can only suggest it is the effects of false concensus that prevent you seeing the commercially viable opportunities beyond diabetes management. Take these 3 (RATHER EXTREME and widely considered to be unrelated to mobile care) examples:

    > 1 in 3 American women and 1 in 33 men are victims of sexual assault? Almost 45% of rape survivors are under the age of 18; 80% are under 30. Most commonly it occurs with between relations or acquaintances.

    > Testicular cancer in young men is increasing in most modern societies. When detected early it has a 98% success rate. (Removal of testicle). Reported late the outcome is much worse (after about 2 years statistically you’ll die). Fortunately most notice symptoms early.

    > Schizophrenia – great outcomes when reported and treated early (80% reporting and receiving treatment on first episode show no reoccurence) but terrible lasting effects when patients have been rejected by their friends family and maybe ended up on the street, in prison etc…

    I think you should be able to get my point here. Early intervention is what is limiting the success of today’s care systems. The pharma and surgical advances we have already available mean we’re pretty good at treating people once we have them properly diagnosed.

    If you’re wondering why the phone is so able to facilitate this intervention consider that this is the favorite communication device for these young people and the one they would most like to use when concerned about coming forward for help. Just as we may think of the mobile as something that makes life easier – they cannot think of a life without it.

    As for the uncertainty of why a healthcare MVNO is better placed to be able to do this better than a normal cellphone company – i’ll think you’ll find it’s got something to do with customer services. The professional with the highest customer service rating is the Doctor, Nurses come in close on the running. Telecom Operators
    come in somewhere near the bottom!

    Be interested in your opinions on these much wider opportunities for mobiles to make a difference…

  23. Paul,
    You describe very interesting examples of potential mobile monitoring applications.

    Will they pan out? I don’t know….and it really doesn’t matter what I think.

    If LifeComm is successful, it will become a low cost platform for experimentation for the type of apps you describe. The development costs for the platform will already have been spent, and the marginal costs of experimenting with niche applications should be fairly low.

    RPM applications today primarily have served the 5% of the population that consume 50% of health costs. These have mostly focused on home use.

    Mobile RPM will allow development of applications for the other 95% of the population — pretty exciting!!

  24. It’s interesting to see how this discussion has swing between technological and user acceptance issues. Of course they both affect each other but, chicken-and-egg-like, would getting either one right turn around shortcomings in the other, or do they need to go hand in hand?

  25. Steve, I think it’s unquestionable that they go hand in hand. Without acceptance, it’s just a piece of plastic with blinking LCD screens and without technology that works for them, there can’t be any acceptance …

  26. …. and thank-you Vince for having created this wonderful forum for the exchange of ideas on this issue. From a quick look around the web, this is by far one of the most dynamic discussions that I’ve come across.

  27. Just for kicks I thought I would share footage from an old diabetes technology segment of DLife (there is actually a weekly talk show centered on diabetes lifestyles) hosted by a former Miss America (type 1) and a few other camera ready personalities.

    For people who haven’t actually seen the Medtronic pump/meter combo or Diabetech’s GlucoMON wireless glucose meter (long range). You might also start to think about other devices for inputs and outputs like voice readings and food scales that are also demonstrated but which may not be top of mind vs blood pressure and event recorders. Ultimately, all of this stuff and more needs to work together seemlessly… at least that is the technology challenge. Making sense of it so that it is useful is the field challenge and that’s where our translation via the healthcordia programs comes in. In order to make it all work, we also had to become a wireless data service provider including all of the MVNO components minus voice/phones but carrier based wireless devices regardless. Support is a huge issue – it has to be done right.

    Nobody mentioned Leap Wireless and there Cricket prepaid service offering here? That will come into play no doubt as Q puts together their CDMA version of mobilediabetes and mobilecardiac offerings.

  28. Healthcare is an ecosystem and technology is just one facet of it. It is for this reason that Gov. Ed Rendell is creating a commission aimed at improving care for patients with chronic diseases which will however start with diabetes as its focus initially.

    First, The commission will work to create a Web-based registry that would give primary care physicians access to more complete data about their patients.
    Technology without information is fish without water
    Funding for this is with $2 million from the governor’s budget allocated to help create the registr.

    Payment changes are to be recommended by the commission that would reward a team approach to chronic care, such as having nurses, nutritionists or other health professionals work more closely with doctors.
    The chronic care commission will focus initially on diabetes, through the activities of the state diabetes action plan. This will include a plethora of initiatives, including efforts to collect and monitor data, work towards health policy changes and disseminate standards of care. Additionally, the Pennsylvania Diabetes Action Partnership – plans to work with state health officials to develop and implement the plan
    Starting with a technology without the overall strategy in place without consideration of the co-related legal financial implications is not poised for success

  29. I am please to see Qualcomm entering this market segment. It may take 5 to 10 years for this technology to be common place but it could be just a few years. There is an IT revolution going on in the health care industry and we may look at the next 10 years in health care like we looked at the last 10 years for the internet. With organizations like Veterans Administration Healthcare System – My HealtheVet, “Continua Alliance” http://www.continuaalliance.org/home and “Center for Health Care Transformation” http://www.healthtransformation.net/home/ , the health care industry is going to be revolutionized. Our health care system is sick but where there is a will, it will get better with the hard work of many dedicated people and the off the shelf technology available today.
    Examples of this revolution can be found at:

  30. One more elephant-in-the-room item needed for mobile telehealth to grow profitably and significantly: proven outcomes. My surprise in walking the floors at the ATA conference in Nashville was the lack of marketing materials trumpeting any high ROI . Many of the benefits that telehealth provides were left to the obvious logic that exciting new capabilities lead to ROI. I recently re-read a clinical trial (Young et al, Salford UK, Feb 2005) of mobile-phone-based blood glucose self-management. HbA1C is the marker for effective glucose management and needs to come down by at least 1% for the medical community to flock to it en masse, with defined savings in long term complication management. The trial acheived a creditable 0.5% effect – not exciting enough for rapid take-up, but certainly a step in the right direction. Not the stuff of compelling sales colatteral, but an indicator of where we are: still working on proving the financial benefits of mobile-phone-based care.

    The creation of Lifecomm will be a good sandbox for the development/trial of many health-related options. Thank goodness QC has the huge margins needed to support the pro-actice implementation of such catalysts. QC is an intellectual property company, making money out of the (including embedded software) that make-up mobile terminals and infrastructure. Their interest in supporting/funding , such as Lifecomm, must be primarily in growing the profits from their component sales. I do not see Lifecomm as needing to be intrinsicly successful for QC, but rather to grow healthcare interest in QC’s main margin-generating offerings. This is similar in concept to Nokia’s introduction of Club Nokia some time ago to show the MNO’s what a data offering should be like to be successful (and hence grow sales on Nokia’s data-capable products).

    One further observation: I agree that the most obvious mobile therapy-support application surrounds diabetes, where both the diagnostic and therapy are intrinsically mobile. I would add as a profitable business area, however, the whole market for improving operational efficiency through the use of cellular technology. I refer here to other intrinsicly mobile health markets such as traveling care-givers and nurse activity within nursing homes and other care facilities. These latter B2B markets can provide profits today (see http://www.phonedoctorx.com) based on clean ROI’s and also be useful incubators for future B2C (B2P?) cash flows.

  31. Another organization to look at is Wireless Life Sciences
    Qualcomm is very involved in this organization. If you go to that site or the Continua site, you can see many IT companies trying to make a difference in health care.
    50% of health care costs are due to individual choices. I believe that one reason the life expectancy is lower in the US than other industrial nations is that “we do it to ourselves.” Maybe the cell phone can be the vehicle to help us make good health and medical decisions? We shall see.

    I do not think there is going to be one magic bullet that will fix heath care but small steps by many companies (some of who will go out of business) and individuals dedicated to the improvement of health care.

    The good news is that the people that brought you the internet and the PC are getting older. They have a vested interest in improving health care. They will not just sit around hoping someone else improves the system. We live in very interesting times.

  32. Malcolm Burwell: I think you’ve hit the real problem here ROI just doesn’t seem to be happening with these technologically crude telemedicine efforts.

    I am sure that the Lifecom service will considerably outstrip the Phone DoctorX solution because people simply don’t have a webcam/Microphone/PC/Broadband Connection but we all have a mobile.

    QC are the leaders in convergence and their current 3G/CDMA offerings in the market today already do away with the need for all this patient equipment and can replace it with a small conventional looking battery powered take-it-anywhere handheld mobile device.

    The more i think about this MVNO the more i see the evolution it is going to create. I too have always admired the profitability of “Phone DoctorX” type services but i think this QC Venture is going to supersede this with a much more user-friendly and highly desirable “VideoMobile DoctorX” type solution that patients are going to really want to use.

  33. One issue that we never addressed in the mvno for HC question is legal liability. If the phone breaks or the service does not work, there can be liabilities. I noticed that Qualcomm is looking for independent funding for the mvno venture, its not Qualcomm as the service provider.
    I know this is an issue with carriers etc, from the telco industry perspective. Does anyone have any idea on how the liability issue might play out? Will the lawyers kill this idea before it gets off the ground? I am not a lawyer, so I would invite all lawyer jokes as well.

  34. “Liability” is more perception than reality:

    1) “Liability” = risk. Cars kill 40,000 + Americans every year. Do car companies stop making cars? No, you insure for the risk and reinsure for catastrophic losses. This is a cost of doing business.
    2) “Liability” is the wrong term; I’ve heard large companies fearful of publicity that could damage their brand; No one wants to be the first to have a headline read “Dick Cheney’s mobilie heart monitor fails and VP dies”.
    3) “Liability” is a smokescreen for telecoms not believing that the health care market is big enough to bother with yet
    4) Long-term, “liability” concerns become a driver for market adoption after the tipping point is reached. The standard of medical care rises; physicians will not want to answer the question in court “why DIDN’T you have your patient on a mobile monitoring system?”
    5) Q. What’s black and brown and looks good on a lawyer’s neck?
    A. A doberman pinscher
    6) Liability might be an issue for cardiac apps where minute-to-minute network reliability is ideal; however, it’s again a smokescreen for apps like diabetes, fitness, etc.

  35. Shecky,

    In this case, “perception” is reality.
    If the mobile industry players perceive that the risks are too great, the idea wont develop in the market.


  36. Two separate comments on “liability”:

    — Liability costs, assuming no prima facae negligence, in the real world usually fall to the largest company in the value chain with the deepest pockets. Thus liability actions would arrive at Nokia’s doorstep for a start-up doing remote monitoring using a Nokia handset. Generally such costs are less than $10million per case, often simply to prove Nokia was not negligent. Such a low level of costs with a low probability of occurence is typically insured away. Of course, if true negligence was involved there is no hiding… but as a healthcare company, that is something we keep a close eye on (eg. ISO9001 and similar)

    — The best way of handling liability for a small-medium telecoms company is to partner with a big name from the healthcare industry (eg. JNJ, Smith&Nephew, etc.). Not only does this direct the liability warheads away from a smaller telecomms company, it gives an educated partner to help ensure the telehealth company is using compliant processes that will keep laiability costs under control.

    I have been involved with a telehealth program inside a global 100 telecoms company and have seen the liability issue there used for only one purpose: to kill off telehealth programs using political engineering.

    Clearly healthcare companies could not be in business if the liability costs were not containable. Telecoms companies that truly commit to healthcare (eg. Lifecomm) know that they can handle them.


  37. A service from a company called Wirefile is taking off in a big way in the UK and has recently launched in the US. V-Clinic enables and dietitian or nutritionist to provide online and cell phone nutrition and fitness services. Basically, it works with any cell phone network and allows any health professional to harness the internet and cell phone networks. This means that real health professionals can get involved. I think this model will work and not just big players on closed networks.

  38. Congratulations on the discrete plug Jane,

    i always find it funny when someone doesn’t feel up to making a shameless plug and instead talks in the second person. what have you got to hide?

    By the way the Cellphone diet craze started (and possibly ended) in the US with Nutrax and MyFoodPhone.

    Real healthcare workers who want to get involved can already do so through these companies or using freely available photo upload technologies such as Mobixie or mobile applications (try Symbian)

    PS shameless self promotion on blogs can back fire…

  39. Here’s some shameless self-promotion via a new blog post by a top pediatric endocrinologist now accessing real-time formatted patient blood glucose data via his mobile phone… Key to this is that the process was hands off for both the patient and the provider – truly automated collaboration – thanks to Diabetech® technology.

  40. Looks like LifeComm has slipped to late 2009 / early 2010 according to Don Jones in a post at one of the diabetes blogs:


    Meanwhile, the GSM/GPRS version of the GlucoMON launched with direct to consumer service on January 12, 2008 in the US via https://mygluco.com

    I also updated the Experience Counts blog post found in the trackback above with a link to a letter from a pediatric endo to his peers regarding his 5 years of experience with wireless diabetes technology and our ADMS.

    Not sure what could be holding up the LifeComm launch other than the lack of a broad third party reimbursement landscape?

  41. So… the silver lining here is that an MVNO is dead, and long live the MNOs. Qualcomm is still right with it’s sequential strategy: harvest money from mobile multi-media today, next harvest mobile payment/finance, then (eventually) harvest mobile health. The wireless carriers (”MNOs”) are on this path already (see Vodafone’s MPESA financial service and the Oyster-card London Underground roll-out). They are begining to explore health also… without the need for a Lifecomm MVNO overlay (see Vodafone’s recent “acquisition” of t-plus Medical… lots more happening behind the confidentiality veil also). In tough times, when Qualcomm must control costs, cutting from its long-term strategy (mobile health & hence Lifecomm) is sensible. A lost momentum-causer for us in connected-health, though. Kevin’s right: mobile health will force itself onwards via smaller, self-contained enterprises that can weather the time needed for clinical trial work to demonstrate RoIs. Cardionet is a shining example there.

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