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An Apple A Day - The Ultimate Customer Loyalty Program
What if the latest feature from Apple wasn’t a larger screen, better design or a longer-lasting battery? What if it was a longer, healthier life?
We’re entering an age of innovation that will transform everyday health and add decades to our lives. Human health is being disrupted by Apple.
Five hundred years ago, despite incalculable wealth, the world’s richest man had access to the same medicine as everyone else. Herbal remedies, rudimentary surgery, bed rest, and prayers. Sure, he had the best beds, finest herbs and hundreds of praying servants, but it was just more of the same.
As we move further into the 21st century, health tech is returning us to parity. The best monitoring, testing, diagnosing and prescribing will be performed by devices and algorithms. Every tech-enabled doctor, even those with less-than-average skills, will deliver a far superior standard of care than the best of the best do now.
Health tech is being commoditised and health services are about to be democratised.
The Apple Health Bundle
"...if you zoom out into the future, and you look back, and you ask the question, “What was Apple’s greatest contribution to mankind,” it will be about health."
- Apple CEO, Tim Cook
Apple revolutionised the mobile phone, mobile applications and the way we spend a big chunk of our lives. It's less than five years since the Apple Watch debuted, and it already outsells the entire Swiss watch industry. Now there’s rumours that Apple Glasses may be released in 2021. Another industry disruptor, this time with a heavy emphasis on health.
When you add in Apple’s core competency of data management, its proven commitment to privacy, and the successful debut of EHRs (Electronic Health Records), you have the ultimate Apple Health Bundle.
[Phone + Watch + Glasses] + [EHR + Data & Algorithms] = Apple Health Bundle
But what can this super bundle actually do?
The combo of [Phone + Watch + Glasses] will play the role of 24/7 medical advisor. They'll track a staggering list of personal health markers, screen them against global norms, and reference the latest medicine to design your bespoke health regimen.
The iPhone Health app is the central repository for everything you can measure. The Watch already tracks sleep, heart rate, heart rhythm, blood oxygen levels, hand washing, menstrual cycle, exercise, vO2 max, noise exposure, air quality, and fall detection. Apple Glasses will watch every breath you take, scan every inch of your body for abnormalities, and track your brainwaves.
With this bundle, Apple has created the operating system for health. Vendors are queueing up to plug into the system and start measuring anything and everything. Samples of saliva, urine, blood, stool. Vision and hearing tests. Temperature, blood pressure, blood glucose. The long tail of the measured life will be endless.
Apple will own the essentials we rely on 24/7 - phone, watch and glasses.
In addition, Apple has created a trusted EHR (Electronic Health Record). Google and Microsoft both tried to push into that space, but only Apple has earned the trust of the health providers - and us. Apple’s Health Records give authorised medical staff access to a full history of medical information that they need to inform their task.
Imagine not having to remember answers to questions like, When was your last flu shot? Your last tetanus shot? Last time you had the flu? Any hospital visits over the last 10 years?
The Apple Health Bundle is a medical advisor that never sleeps. Never gets bored. Never makes a mistake. Never keeps you waiting.
Interestingly, the first big gains won’t rely on any wild new tech. For example, did you know that most people don’t take the prescribed dose of medication? Medication adherence sits at around 50% (it should be at 80%) for people with chronic conditions! Simply connecting doctors, calendar reminders and compliance tracking will have a profound effect.
If we received notifications that people nearby have the flu, we could put on a mask and use social distancing to avoid it.
Automated scheduling for vaccinations would also make a difference. “Smith's Pharmacy is 100 metres from your current location and has an immediate opening for a flu vaccination. Would you like to accept this appointment?”
Wearing a Watch-Glass combo could monitor hand-washing, mask wearing and transmission tracing. That could be useful.
Why disrupt health?
If you’ve read even one technology article over the past decade, you’ve likely encountered the theory of Moore’s Law: every two years, computer speeds and capabilities will double, and the costs will halve (due to reduced size of transistors).
You may have even come across Eroom’s Law: every nine years, the cost of developing a new drug doubles and the process slows further.
In a world where every new drug costs more than the last, and tech solutions keep getting better and cheaper, you have to expect disruption.
The disruption: Tech-enabled prevention will displace medication-centric reaction.
Apple only gets involved in industries where the reward is big enough to warrant the pain of starting a disruption war. Mobile phones ($409B), watches ($116B), payments ($1T), glasses ($139B).
Consuming 3.2% of all government spend each year, the health industry offers a reward worth fight for.
Flipping the health model
Have you ever had a health issue come up and needed to go straight to the doctor or (gulp!) a hospital waiting room? You struggle to get an appointment. Forget seeing your preferred doctor. Surrender to spending hours in a waiting room. When you finally see the doctor, it’s over in minutes and you leave with a prescription for any one of the most frequently prescribed medicines.
The reason it’s hard to see your favourite doctor is that, on a typical day, physicians spend 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work.
With those stats, I imagine doctors are crying out for a disruption too. Who amongst them studied a large part of their life away only to spend 50% of their work life doing admin?
Tech-enabled health will position the physician as a proactive partner rather than a reactive triage clerk. Right now, the doctor is time-restrained, admin-heavy and most of their advice comes as responsive guesswork. It will be far better for everyone to engage them as proactive, informed, life-long health coaches.
Clay Christensen's Disruptive Innovation theory says that “when one layer commoditises, another layer grows”. Case in point, while music sales revenues decreased over the past two decades, live performance revenues grew by 4x.
In the new health paradigm, responsive treatment and prescriptions for chronic medications may decrease, but the complement - proactive health management - will grow exponentially.
Physician will have super powers when their patients use the Apple Health Bundle. Constant tracking, consistent health markers, compliance monitoring. They’ll be able to experiment with natural preventions, like diet changes, sleep variations, and exercise programs.
The standard approach will be personalised health plans, dynamically monitored and adjusted to optimise results. It’s a nirvana where everyone will be happy. Well, almost everyone.
Can anything stop this juggernaut?
I’m not equipped to comment on the motivations and machinations of Big Pharma. But I do wonder if they will allow the shift from high-profit long-term medication to low-cost tech-enabled health. Apple has wrestled with monolithic competitors before, but I imagine this will be something else entirely.
In his essay, On the folly of rewarding A will hoping for B, Steven Kerr points out that we must be mindful we don't accidentally reward the wrong behaviour. The classic example is The Great Hanoi Rat Massacre of 1902. French colonists wanted to rid the town of rats, so they offered to pay for every tail delivered as evidence of a dead rat. Instead of capturing and killing every rat, the workers started breeding rats so that they would have more and more tails to deliver for reward.
Government has an important role to play here, but we must avoid another rat massacre. Incentives that encourage old-school players to squeeze themselves into the new model will do more damage than good. The challenge will be to develop policies that reward Big Pharma for not blocking the transition to preventative health.
At the same time, it may be cheaper for government to provide tech-enabled health support than medicare-funded reactive treatment. Many of the world’s most prevalent diseases can be prevented with lifestyle changes. Obesity, diabetes, and coronary heart disease kill too many people and cost $trillions to treat.
I wonder which [Scandinavian] country will be first to go all-in and equip every citizen with the full Apple Health Bundle.
Bottom line
“A healthy man wants a thousand things, a sick man only wants one.”- Confucius
Good health is the ultimate wealth. If Tim Cook has his way, Apple’s legacy will be an endless supply of true wealth, distributed it to everyone. Now that’s a customer loyalty program I’ll sign up for.
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