Uber Hits Speed Bump

Uber Japan is shutting down after being cited as being illegal.  44 Cab companies in Philadelphia, PA are seeking an injunction against Uber.  New York City has lost nearly $500 million in Taxi cab medallion revenue as a result of Ubers success in the city.  Uber has been halted in Portland Or and Anchorage AK.

Ubers business model is essentially a 20% split on all revenues relating to moving passengers from point A to Point B.  Uber has clearly created a better “taxi” service.  But how long will the taxi industry keep its meter running?

Uber has clearly invested in Big Data and predictive analysis to enhance the service and customer experience.  A quick review of Uber’s patent filings demonstrates the deep knowledge that Uber has invested in enhancing service.

1	20150012341	SYSTEM AND METHOD FOR SPLITTING A FEE FOR AN ON-DEMAND SERVICE
2	20140279011	GENERATING PROMOTIONS FOR A SERVICE USING A MAP INTERFACE
3	20140278838	DETERMINING AN AMOUNT FOR A TOLL BASED ON LOCATION DATA POINTS PROVIDED BY A COMPUTING DEVICE
4	20140129951	PROVIDING ON-DEMAND SERVICES THROUGH USE OF PORTABLE COMPUTING DEVICES
5	20140129302	PROVIDING A CONFIRMATION INTERFACE FOR ON-DEMAND SERVICES THROUGH USE OF PORTABLE COMPUTING DEVICES
6	20140129135	DYNAMICALLY PROVIDING POSITION INFORMATION OF A TRANSIT OBJECT TO A COMPUTING DEVICE
7	20140011522	SYSTEM AND METHOD FOR PROVIDING DYNAMIC SUPPLY POSITIONING FOR ON-DEMAND SERVICES
8	20130246301	PROVIDING USER FEEDBACK FOR TRANSPORT SERVICES THROUGH USE OF MOBILE DEVICES
9	20130246207	SYSTEM AND METHOD FOR DYNAMICALLY ADJUSTING PRICES FOR SERVICES
10	20130132887	TRANSITIONING USER INTERFACE FEATURES FOR ON-DEMAND SERVICES THROUGH USE OF PORTABLE COMPUTING DEVICES
11	20130132246	PROVIDING A SUMMARY OR RECEIPT FOR ON-DEMAND SERVICES THROUGH USE OF PORTABLE COMPUTING DEVICES
12	20130132140	DETERMINING A LOCATION RELATED TO ON-DEMAND SERVICES THROUGH USE OF PORTABLE COMPUTING DEVICES

There is a focus on calculation of on demand pricing and an excellent method for splitting fares oinvolved in a ride sharing or “car pool” trip.

In addition to grass roots litigation and outright bans of the Uber service in cities around the world, Uber is facing harsh criticism over passenger safety.  There have been a string of sexual assaults by ride-share drivers in San Francisco, Chicago, Boston, Los Angeles and Washington, D.C.  The US Congress is now looking into Uber’s practices regarding background checks

 Uber has clearly made the riding experience better.  The company generated nearly $500 million in gross revenues (including driver receipts)in San Francisco alone.  Given the scale of these numbers it may not be long until Uber faces real competition.

@ebukstel

The Healthcare No One Cares About

Posted on February 26, 2015

Digital Health and Mobile Patient Engagement Applications have made tremendous strides in the past 2 years. Vendors are quick to announce an agreement or partnership with Stanford, The Mayo Clinic, and Brigham Women’s Hospital and attract headlines in industry blogs, magazines, and journals. Investors become excited and the process continues.

The US Healthcare System is only as strong as its weakest link. Today, that link includes over 50 million Medicare and Medicaid beneficiaries that will not being using a Smart Watch and never used Google Glass. It is not tech sexy to issue a Press Release about solving problems in the trenches of Healthcare Delivery for at risk populations.

In addition to Medicare and Medicaid disbursements, it is estimated that nearly $500 billion worth of free care is provided annually by family and friends of elderly, disabled, and chronically ill patients. There is a significant amount of data that could be collected during home care of patients that could impact the overall quality and cost of care. The provision of Home Health services to patients is the fastest growing job title in the US Healthcare System.

There are nearly 1 million Personal Care Assistants (PCAs ) providing over 1 billion hours of care to Medicare and Medicaid Patients, annually. The care provided by PCAs has come under scrutiny at Federal and State levels due to the high level of fraud involved in this home health occupation. Ohio Governor John Kasich has introduced a budget that envisions a phase out of over 13,000 Medicaid providers over 4 years. The Centers for Medicare and Medicaid have submitted a 2016 budget that will trim fraud by over $400 billion over 10 years.

As a group PCAs provide more hours of patient care and contact than all physicians in the US. While it may not make headlines, the impact that PCAs have on the health of elderly, disabled, and chronically ill patients can no longer be overlooked.

Half a Trillion in Healthcare not Paid by Medicare or Medicaid

In 2009, about 42.1 million family caregivers in the United States provided care to an adult with limitations in daily activities at any given point in time. The estimated economic value of their unpaid contributions was approximately $450 billion.  Caregivers want to use connectivity tools to keep track of loved ones—data, connectivity, sharing—even from a distance.  So healthcare will be personal, but also easier for the people who love you.  This family and friend care is not paid by Medicare or Medicaid.

Interesting insights regarding the Uber Model and Healthcare

Healthcare Apps Everywhere

If you’re in Healthcare and you’re not working on an App or using an App you may be looked at as being from 1999. All types of entities are providing Apps to “someone,” and sometimes, to anyone without using the appropriate market demographics to identify if the app works!  This applies to all stakeholders, including:

• Physician
• Hospital
• Insurance Company
• Clinical Laboratory
• Pharmacy
• Home Health Company
• Pharmaceutical Company
• Health Information Technology Company
• Healthcare IT Vendors
• Patients / Consumer

The usual stake holders are listed above.  Sometimes even physicians and patients use the Apps and there questions concerning discernible real world benefits.  It’s too early for most applications to show real benefits and outcomes for the vast majority of apps and their respective stake holders, especially patients.

The number of downloads is one “metric” used by vendors, healthcare providers, and other entities to measure success.  Downloads say nothing about the “meaningful use” or success of a product offering or App.  The ubiquitous stethoscope app is just one example of the weirdness surrounding the “real” functionality of an app.   Three Million Doctors Download iPhone Stethoscope App is a link to a company that suggests a large number of downloads by “physicians.”  There are only, as of 2010, 850,085 practicing physicians in the United States.   There are many stethoscope apps in the Apple Store and the Android store.  The number of app downloads is not a function of actual use in the healthcare industry.

The download numbers are an example of a healthcare “App” industry that is looking at the wrong metrics for success in healthcare.    There is a more fundamental number which is not being factored into many business plans in cloud based medical application development focused on consumers.   There is a wrong assumption that is found in many venture capital and investment presentations made by App developers.  Healthcare application developers routinely assume there will always be a smartphone in the hands of an end user with the costliest diseases such as, Diabetes, COPD, Hypertension, and Cardiac Diagnoses.

Patients with the  costliest diagnoses are usually older and it cannot be assumed that this population has a smartphone or even knows what to do with a smartphone or iPhone.  Pew Research (chart below) conducted a survey in January 2014 which found results that should be strongly considered for elderly patients and their use of smartphones.  The Pew study found that smartphone market penetration for people aged 50-64 is approximately 49%, while smartphone use among people over 65 is only 19%.

These numbers are staggering consider the massive venture and angel investment in technologies that are dependent on smartphone penetration in markets that are most likely to have the costliest diagnoses and complicated conditions.New mobile health vendors and astute investors should consider the basic facts about the real meaning in download numbers.  But, it is even more significant to know the market penetration of smartphones in the universe of users with the costliest diagnosis codes.
The healthcare industry, particularly vendors and investors that have App excitement needs to focus on the fundamental business demographics which are not based in number of downloads.  Furthermore, the patient focused medical App development vendors must acknowledge how there will be market penetration in demographic groups that do not have access to smartphones (iPhone and Android).

Hospital Data does NOT Equal Community Health

The Becker Hospital Report is a misleading "population health" study that incorrectly projects community health with hospital payment data.  About 15 tears ago I worked at HCIA.  HCIA found Albany Hospital was the worst in the country for cardiac care.  The following year Albany Hospital was one of the best in the US by changing admissions requirements.  Hospital data does not reflect the health of a community.  Below are the "healthiest cities" according to the Becker Report. 

1. Washington D.C. 

2. Minneapolis-St. Paul, Minn.

3. Charlotte, N.C.

4. Virginia Beach, Va.

5. Portland, Ore.

6. Boston

7. Chicago

8. Philadelphia

9. Grand Rapids, Wyo.

10. Atlanta

Uber to fire 100,000 drivers over next 10 years

Uber is developing a self driving car in a partnership with Carnegie Mellon University.   This development points to a long term strategy where there will be no need for drivers.  Over 100,000 Uber drivers could be fired over the next decade.  

Billions wasted by Big Data Healthcare Contractors in a Texas Sized Medicaid Fraud

Over the past 20 years, Texas has privatized computer systems and call centers for its Medicaid program to contractors, including IBM, Accenture (formerly Andersen), Electronic Data Systems, (currently HP), and Xerox.   Accenture’s contract alone was for $899 million.  In 2006, IBM received a $869 million contract in 2006.  In 2008 IBM’s servers crashed which compromised Medicaid fraud investigations.  The private contracts have been a disaster for residents of Texas that receive benefits.  Delays, misinformation, and denial of coverage are just the tip of the proverbial iceberg.

While many influential people are heralding the potential of Big Data in solutions across multiple industries including healthcare, lack of domain expertise and oversight will destroy any big data deployment.  Many of the bungled Texas Medicaid contracting disasters could have been prevented with competent checks and balances.

Surprisingly, after IBM’s server debacle in 2008 Texas paid the majority of IBM’s contract and transferred the contract to Capgemini and Xerox.  Xerox was fired by the Texas Health and Human Services Commission charging that Xerox paid hundreds of millions of dollars in rubber stamped Dental Claims.

Headlines are made across the country documenting prison sentences for Medicare and Medicaid providers and recipients that defraud the State and Federal healthcare programs.  Doctors, dentists, chiropractors, and home health administrators are found guilty of Medicare and Medicaid fraud on a daily basis.   Very rarely do you find contractors going to prison for fraudulent activities in the deployment and operation of State Medicaid contracts.

Existing technologies and data sets can keep tabs on contractor performance in Medicaid and Medicare contracts.  These systems can prevent fraud and increase the quality of care in Medicaid and Medicare services.

Texas attempted to rein in Medicaid fraud and recently hired a small technology firm, 21CT.  The no-bid contract worth $110 million was a project utilizing big data to visualize healthcare fraud.  The company utilized healthcare claims databases to identify potential Medicaid fraud.    Rampant fraud at the company hired to identify fraud has been alleged by Texas Health and Human Services and an FBI investigation is reportedly under way.

The data gathered by mobile health technologies including patient monitoring and sensors provide a means of increasing quality of care and identifying healthcare fraud.   Incremental inclusion of mobile health data sets into big data analysis will be a benefit to patients and prevent Texas sized healthcare frauds committed by vendors and contractors.