John Moore is a physician and technologist who's passionate about empowering patients to take the lead in their care. He is the CEO of Twine Health, a startup focused on improving the experience, clinical outcomes and costs of chronic disease care. Moore received a PhD from the MIT Media Lab, where he developed and studied technology-supported apprenticeship as a new paradigm of patient-clinician collaboration. He received both an MD and a BS in biomedical engineering from Boston University. Before attending medical school, he was a Fulbright Scholar in Belgium.
Q. What's the one promise of mHealth that will drive the most adoption over the coming year?
A. Adoption will be driven by decreasing the cost of care delivery. Many digital health tools have helped improve the quality of care and decrease the cost of downstream complications, but they often require more clinician time, which, in turn, results in an increase in the upstream cost. The winning tools will drive down the cost of care by engaging patients so deeply that they build self-efficacy, making it possible for them to take on tasks that would have previously fallen on the clinical team. These tools will also streamline collaboration, allowing clinicians to operate at increased efficiencies so they can care for larger panels, further decreasing costs.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. A new class of mHealth technology, the collaborative care platform, will not only be ubiquitous in the next five years but will catalyze the growth of many other mHealth technologies by virtue of maximizing their value.
Most patient mHealth apps and personal health records are either disconnected from the patient’s healthcare providers or crudely plugged into their systems. A collaborative care platform is designed from the ground up to support continuous teamwork between patients, clinicians, family, friends and peers. This model supports shared-decision making, meaning patients’ values are reflected in care plans and leveraged through the expertise of clinicians. The collaborative care platform allows patients to pull data from disparate apps and devices, collecting this information in one place where they can derive associations and get advice from the experts.
For example, using the collaborative care platform, a patient can create a hypertension care plan with his/her doctor, self-track at home using a smart blood pressure cuff and pedometer, pull in data from a diet tracking app, get support from a friend and work with a nurse in his/her doctor’s office. All of this can be done through connected communication tools that allow the patient and the provider to explore the data, collaboratively. This is the true promise of mHealth - the one that we always imagined. The outcome and cost improvements of this model will be tremendous and will result in a cohesive experience that will drive major adoption of the connected mHealth devices and apps.
Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?
A. As a judge in the Qualcomm Tricorder XPRIZE competition, I had the privilege of seeing some of the most advanced home diagnostics and disease tracking devices being developed. The promise of a home laboratory in which patients can track their cholesterol, hemoglobin A1C, HIV viral load and other measures through a single test with greater ease and cost-effectiveness than traditional laboratory testing is extremely exciting. This type of instant feedback is critical for success, as patients can explore the cause and effect of their behavior on their health and wellness.
Immunostaging, technology that uses blood samples to track a patients’ immune system, is another technology I am excited to see applied in the future. Because the immune system reacts to both infectious diseases as well as other foreign threats such as cancer, having a computational history of an individual's immune system and watching for changes allows for the detection of these threats before they show signs and with greater accuracy than other techniques. For example, breast cancer could be detected before a lump can be felt or before a lesion appears on a mammogram. If this technology is perfected and patients can start staging their immune systems at home using mHealth tools, the implications could be astounding.
Q. What mHealth tool or trend will likely die out or fail?
A. This year, I think we will begin to see a decline in the adoption of siloed solutions that only focus on a single disease. Although early adopter patients have been content using different apps for different health conditions, the introduction of more comprehensive experiences will drive the market to consolidation. Further, more mainstream patients will demand comprehensive experiences before they jump on board. Clinicians do not have the time to deal with multiple siloed systems that don’t provide a holistic view of the patient. To succeed, the siloed devices and apps will need to integrate into more comprehensive platforms.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. I’m surprised by the tremendous number of new fitness wearables appearing on the market, despite the fact that even the most successful companies are struggling to keep consumers engaged beyond a few months. This growth is exciting, however, because it has stimulated a mainstream consumer interest in health, by encouraging people to become comfortable with the idea of self-tracking while inspiring the development of new categories of wearables and smart medical devices. When the data from these wearables can be aggregated, compared and shared more seamlessly, long-term engagement levels will improve.
Q. What's your biggest fear about mHealth? Why?
A. My biggest fear is that we will fail to see the true benefit of mHealth tools because they are still trapped in small, short-term pilots within healthcare institutions. Despite outstanding evidence of improvements in experience, outcomes and cost with some of the latest and greatest technologies, clinical organizations have remained slow to change. It is a tragedy that some of these interventions are not being delivered to the patients that could benefit from them.
Q. Who's going to push mHealth "to the next level" – consumers, providers or some other party?
A. The one-two punch will come from the government and consumers. The first punch comes from Health and Human Services’ recent commitment to push the value-based payment model forward at an aggressive pace. By 2018, 50 percent of payments will be through alternative models (capitation, shared savings, etc.) and the vast majority of the remaining fee-for-service payments will be directly tied to quality and value. The momentum this announcement brings to mHealth offerings that are able to meet the triple aim is huge.
The second punch will come from consumers. They will demand more for their healthcare dollar. Better service, better outcomes and lower prices. With mHealth, these patients will receive care wherever and whenever they want it, rather than on the doctor’s schedule in the office. Consumers will flock to these offerings, spreading the news online, sharing their experiences and shunning the old fee-for-service delivery model. It is going to be exciting to see.
Q. What are you working on now?
A. At Twine Health, we have built a collaborative care platform that allows patients to co-create care plans with their clinicians and use the plans as a common ground for continuous collaboration with their care team: their own clinicians, a coach/care coordinator from the clinical practice, as well as their family and friends. The patient app enables self-tracking, development of self-efficacy and fluid communication with team members. It provides care across conditions and integrates data from diverse devices and apps. The coach and clinician dashboard provides powerful filters and intelligent algorithms so that they can quickly identify patients in need and swiftly lend support.
To get started, we focused our initial deployment on hypertension care. With standard care, including sporadic doctor office visits, 30 percent of patients reach their target blood pressure (<140/90) within one year. With Twine, 86 percent of patients meet this target - within three months. Standard care coordinators can support a maximum of 100 patients; Twine coaches/care coordinators can support a panel five times the size, effectively providing care to more than 500 patients, while continuing to achieve exceptional outcomes. Each patient using the Twine platform has shown tremendous improvements in health while also representing a cost savings of more than $500 per patient, per year. We are now enrolling patients with diabetes and obesity, and will expand to CHF, COPD, asthma, depression, and others by the end of the quarter.
