Opening Keynote

Platform Wars!The Confluence Of Healthcare Unbound And Health IT: Nurturing A New Business Ecosystem

Vince Kuraitis JD, MBA Better Health Technologies, LLChttp://e-CareManagement.com blog (208) 395-1197

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1) What is the dominant social networking platform company?

2) What is the dominant care coordination

platform company?

Opening KeynoteA Manifesto for Healthcare’s Disruptive Innovation of the Decade:Open EHR Technology Platform(s) and Ecosystem

Vince Kuraitis JD, MBA Better Health Technologies, LLChttp://e-CareManagement.com blog (208) 395-1197

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Overview I. Sometimes the Questions Are More Important

Than the Answers.... II. Let’s Talk About “Platforms”... III. Let’s Revisit a Central Debate in Tech Circles:

Walled Gardens vs. The Open Web IV. Health IT Evolution:

1) Closed/Monoliths2) Walled Gardens3) Open Platforms

V. The Future Vision for Care Coordination Platforms: Personal Perspectives

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I. Sometimes the Questions Are More Important Than the

Answers....

Care Coordination Platforms

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Care Coordination PlatformsThe Questions are More Important than the Answers

• Will there be one or more dominant platforms?• Will care coordination platforms evolve from EHRs? stand

aone SW? elsewhere?• What is the relevant geography for care coordination

networks and platforms?• Will doctors multihome their workflow on multiple

platforms?• Is there potential for winner-take-all markets or platforms? • Will walled garden or open platforms provide greater value

in healthcare?• Where are the greatest value creation opportunities? • Is explosive growth of Healthcare Unbound (HU)

technologies dependent on emergence of health IT and/or dominant care coordination platforms?

• What is payers’ role in adoption?

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II. Let’s Talk About “Platforms”...

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Value Creation vs. Value CapturePlatform or App?

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A Decade of Opening Up Platforms to 3rd Party App Developers

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PlatformMultiple Connotations/Definitions

• Manufacturing, e.g, truck/SUV

• Information/communication tech, e.g., Windows

• Business models/strategy

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• Platforms can leverage more than one layer in a technical stack

• Is it a platform or an app? – False dichotomy– Think hierarchically

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IT Evolution: 1) Closed, 2) Walled Garden 3) Open

1Closed

2Walled Garden

3Open

Platform & Apps

Technology Architecture

New Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

Opening KeynoteA Manifesto for Healthcare’s Disruptive Innovation of the Decade:Open EHR Technology Platform(s) and Ecosystem

Vince Kuraitis JD, MBA Better Health Technologies, LLChttp://e-CareManagement.com blog (208) 395-1197

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Candidates for a Healthcare Care Coordination “Platform”

• EMR/EHR• Existing medical management workflow SW• Social networks• HIE• ACO• Mobile• Payer/MultiPayer• other?

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Are Physicians Amenable to Multihoming Their Workflow Platform(s)?

• Single homing -- tendency for customers to prefer single platform

• Multihoming – tendency for customers to accept multiple platforms

• Implications: tendency toward single homing is one factor that creates potential for winner-take-all (or most) market

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What’s the Relevant Geographic Market for Care Coordination Networks & Platforms?

• National/International?• Regional?

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Why are Payers So Key in Adoption of Care Management Platforms?

1) One payer with 10% regional market share tries to dictate adoption of proprietary evidence based guidelines (e.g., for diabetes care).

2) Multiple payers with 30% regional market share (but not including Medicare) collaboratively influence development and implementation of evidence based guidelines.

3) Multiple payers with 75% market share (including Medicare) collaborate in creating public-utility like infrastructure for care and care management

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III. Let’s Revisit a Central Debate in Tech Circles: Walled Gardens vs. The

Open WebA Case Study in Disruptive Innovation:

Apple iPhone &Google/Android

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Apple iOS and Google AndroidFrom 0% to 62% Market Share in 4 Years

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Walled Garden

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Apple HQ 2015

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What’s a Walled Garden (WG)?

• Controls users’ access to content and services• Restricts the user’s navigation within particular

areas (applications) • Not all alike: differing heights and levels of

permeability to the walls.

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Walled Garden (WG): Apple iPhone/iOS/iPad/iEtc.

• Chronology– March 7, 2007: Apple introduces iPhone “product”– March 2, 2008: Apple opens API to developers– April 2011: 398 K apps

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• Business model– Open API – Virtually every other aspect closed

• Integrated hardware/software platform• Non-swappable applications • Exclusive distribution of apps. • Restriction on carrier choice • Restrictions and controls on developers

– Multiple revenue sources -- HW $$, developer $$, app store

– Highly controlled user experience

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Google Android Operating System--Open Source SW Platform

• Open Handset Alliance: 30+ companies– Google Android open source

SW– Multiple handset developers

bring hardware• Open API• 20+ smartphones on the

market use Android OS• 176 K Android apps• Google maintains “control

points”, e.g., see http://www.visionmobile.com/blog/2010/04/is-android-evil/

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Google can give away Android because...

“...we make money, and lots of it, it turns out, from advertising on mobile phones.”

Eric Schmidt, CEO, Google

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Apple & Google Have Created A New Smartphone Business Ecosystem

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IV. Health IT Evolution:1) Closed/Monoliths 2) Walled Gardens 3) Open Platforms

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Three-stage evolution of HIT

1Closed

2Walled Garden

3Open

Platform & Apps

Technology Architecture

New Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

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Illustrative CGC Principles Mapped to Evolution of HIT

Data portability Minimize switching costs Avoid lock-in based on proprietary, non-interoperable technology Low barriers to entry for app developers Affordable Value to patients and payers Collaborative business model

Use of Internet and web technologies Modular/component architecture: platforms + apps Open standards Data portability Application portability Private and secure

Technology ArchitectureClosed Open

New Business Ecosystem(Value Network)

Collaborative

Fragmented

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Defining Moments in Platform Evolution

Technology Architecture

New Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

Opened API &Shared Data

SharedWorkflow

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1) Closed, 2) Walled Garden 3)Open Platforms + Apps

1Closed

2Walled Garden

3Open

Platform & Apps

Technology Architecture

New Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

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Health IT Examples

Technology Architecture

New Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

Epic

CernerAllscripts Helios

MedicityCovisint

AlereMany EMRs

others

Practice Fusion

Kaiser

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Value Creation vs. Value Capture

Technology Architecture

New Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

MaximumValue

Creation

MaximumValue

Capture

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Next Stage of HIT Evolution: Competition Between Walled Garden and Open Platforms

1Closed

2Walled Garden

3Open

Platform & Apps

Technology Architecture

Collaborative Healthcare Business Ecosystem

(Value Network)

Closed OpenC

ohesive / Collaborative

Fragmented

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V. The Future Vision for Care Coordination Platforms:Personal Perspectives

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Care Coordination PlatformsThe Questions are More Important than the Answers

• Dominant platform(s)? Yes*, 90%• Will care coordination platforms evolve from EHRs?

standalone SW? elsewhere? EHRs, 50%• Regional or national networks? Regional 80%• Will doctors multihome? No, 90%• Potential for winner-take-all markets?

– National -- No, 80%– Regional – Yes, some, 70%

• Walled garden or open platforms? Tossup• Value creation opportunities? HU tech + other apps, 90%• HU tech explosive growth dependent on emergence of

dominant care coordination platforms? Yes, 70%• MultiPayer? Yes, 70%

* Reflects Vince’s personal POV with a probability percentage

Many Lessons From Social Media(& other) Platforms

Sterling Ledet https://plus.google.com/104681313125038107957/posts/MCNu7YzRmgg

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“...the healing professions are in the midst of a major sea-change, a once-in-a-century shift: We’re moving from ‘medicine practiced as individual heroism’ to ‘medicine as a team

sport’”

Brent James MD, Intermountain Healthcare

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Brief Bio – Vince Kuraitis• Vince Kuraitis JD, MBA is Principal and founder of Better Health Technologies, LLC (http:

//e-CareManagement.com). BHT consults to companies in developing strategy, partnerships and business models for clinical care and care management platforms/applications delivered in homes, workplaces, and communities.

• BHT’s clients -- both established organizations and early-stage companies -- include: Intel Digital Health Group, Philips Electronics, Amedisys, Joslin Diabetes Center, Ascension Health System, Samsung Electronics, Siemens Medical Solutions, Medtronic, Varian Medical Systems, Disease Management Association of America, and many others.

• Vince brings 25 years health care experience in multiple roles: President, VP Corporate Development, VP operations, management consultant, and marketing executive. His consulting and work projects span 100+ different health care organizations, including hospitals, physician groups, medical devices, pharma, health plans, disease management, e-Health, IT, and others.

• Vince speaks frequently at industry conferences and corporate events. He has been the opening keynote speaker at the Healthcare Unbound conferences between 2004 and 2010 and has spoken at about 35 conferences in the past 3 years. He has experience leading strategic planning retreats for Boards and physicians.

• Vince’s experience includes: Principal, Better Health Technologies; President, Health Choice (medical call center), VP Corporate Development and VP Specialty Operations, Saint Alphonsus Regional Medical Center; Regional Director of Marketing, National Medical Enterprises (hospital chain with 100 facilities); Senior Consultant, Amherst Associates, national health care management consulting company.

• His education includes MBA and JD degrees from UCLA, and a BS degree in business administration from USC.

• Contact: vincek@bhtinfo.com, 208-395-1197

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BHT ClientsPre-IPO CompaniesRMD NetworksHealthPostCardiobeat EZWebSensitronLife NavigatorMedical Peace Stress Less DiabetesManager.com CogniMed Caresoft Benchmark Oncology SOS Wireless Click4Care eCare Technologies The Healan GroupFitsenseElite Care TechnologiesMedSpeed

Established organizationsIntel Digital Health GroupSamsung Electronics, South Korea -- Global Research Group -- Samsung Advanced Institute of Technology -- Digital Solution CenterAmedisysAscension Health SystemMidmarkMedtronic -- Neurological Disease Management -- Cardiac Rhythm Patient ManagementSiemens Medical SolutionsPhilips ElectronicsJoslin Diabetes CenterGSKDisease Management Association of America PCS Health SystemsVarian Medical SystemsVRIWashoe Health SystemS2 SystemsCorpHealthPhysician IPACentocorHealthwiseClinical Groupware Collaborative