By JAMES MOELLER

Remote patient monitoring has emerged as the next significant challenge for virtual healthcare and that challenge is creating significant opportunities for many companies largely outside of the traditional healthcare technology marketplace. In particular, it is potentially setting up an opportunity for Big Tech companies like Apple, Google, and Amazon, to revolutionize telemedicine and healthcare similar to what those companies have accomplished in mobile phones, Internet search, and retail.

Next Generation Remote Health Monitoring

Next generation remote healthcare monitoring will likely look much different than anything done before. What is emerging today is the potential for the broad adoption of remote health monitoring devices and systems that leverage consumer wearables, smart home communication systems, and big data to produce holistic views specifically for healthcare providers. The pandemic has thrust telemedicine solutions forward by years if not a decade or more in the short span of three to six months. This is creating an opportunity for remote patient monitoring to provide even better visibility into patients beyond what can be accomplished with basic video conferencing.

But while telemedicine is now becoming more firmly established, remote monitoring seems to still have a long way to go. This is evident in a new report by KLAS Research (a healthcare industry research firm) published on August 27^th, where they interviewed 19 executives from 18 healthcare organizations regarding their challenges and solutions during the outbreak of the pandemic. Not surprisingly, telemedicine was the top challenge with 32% of the executives. Overall, though, 84% of the executives indicated that the telemedicine issues were already solved and the remining 16% indicated that the solutions were in progress. However, remote patient monitoring ranked as the second most significant challenge with 26% of the respondents. But furthermore, only 22% of the executives indicated the remote monitoring challenges were solved, with 33% saying it was in progress, and 45% indicating it was completely unsolved. So, a clear opportunity exists.

Big Tech’s Virtual Healthcare Market Leverage

For Big Tech, the leverage into virtual health comes from the ability to offer remote monitoring solutions across wearables, ambient sensors, and smart home communication devices, as well as the capability to apply big data, AI, and machine learning to the information from those devices. Big Tech is even combining these technology solutions with healthcare specific services like telemedicine, prescription drug delivery, and medical testing. Market evidence suggests that Big Tech is already putting these pieces together and using this leverage to expand into the broader healthcare market.

Wearables and Ambient Sensors

Wearables and ambient sensors, and particularly consumer-oriented versions of these products, are a key enabler of next generation remote healthcare monitoring by serving as the principle connection with the individual. Over just the last few years the overall market for wearables has increased significantly and the market demarcations are blurring between traditional medical wearables and consumer health and fitness wearables.

Apple leads the overall wearables market with its Watch, Beats, and AirPod products. Across those product lines the company shipped 29+ million units in Q2 2020 and holds an approximate 30% market share, which is nearly three times the size of its nearest competitor. In addition, the Apple Watch is aggressively pushing into classical medical applications with its ability to measure blood oxygenation levels, its electrocardiogram (ECG) capability, and its ability to detect atrial fibrillation (AFib) as well as other cardiovascular conditions. (5)

Fitbit, which is in the process of being acquired by Google, typically ranks 5^th in the wearables segment with a market share of approximately 3%. While Fitbit’s market share has been declining as of late, it would still position Google with an immediate unit shipment customer base (for Q2 of 2020) of approximately 2.5 million as well as its active user base of approximately 30 million.

Not to be left out, Amazon recently introduced its own wristband wearable device for health and fitness tracking called Halo. Its aiming to differentiate in the wearables market by offering capabilities to measure and track body fat, sleep temperature, and emotional state.

Smart Home Communication Devices

Smart home communication devices such as smart speakers and home control systems will also be a key component of next generation virtual healthcare. These systems can serve as communication access points to the Internet for lower power wearables and ambient sensors, and also enable intelligent personal assistant capabilities, such as reminders to take medications, and help in monitoring exercise and other behavioral health aspects.

Amazon is the dominant market leader in smart home communication devices with its Echo Alexa personal assistant, which has estimated 50%+ market share as of January 2020. Amazon was first-to-market with its smart speaker system and continues to augment its capabilities with an ever-expanding array of interactive skills. This includes skills to integrate Amazon’s Ring home security and control system, its portfolio of Alexa wearable devices, and numerous third-party products.

Google has the second position in the smart home communications device market with an approximate 30% market share for its Nest smart speaker products. (8) Recently the company make a $450 million investment in ADT, Inc. with the aim of growing its Nest deployments specifically in the home security market. Google also has a relationship with the Cleveland Clinic that has recently materialized into a capability for its Nest smart speakers that allow users to ask for Cleveland Clinic health tips. This is a perfect example of the virtual healthcare synergies that can be accomplished with smart home communication devices.

Apple is behind the competition in the smart home communications market. The company’s HomePod smart speaker is a distant 4th in market share at only 2.8%. So, while Apple’s Siri assistant has been an integral part of its iPhone for quite some time, the company has yet to make an impact in combining Siri and HomePod for the home market.

Big Data

The big data processing of medical information will become increasingly important as virtual healthcare remote monitoring grows. The ability to analyze the vast amounts of real-time, streaming data to produce trends, correlations, and medical diagnoses can potentially transform how healthcare is applied at both an individual and societal level. Big Tech is uniquely positioned with shear corporate size and technology assets to pursue remote monitoring big data. In addition, Big Tech is already pursuing healthcare data relationships with significant healthcare providers and can leverage those projects into new applications processing remote monitoring data.

In 2019 Google made waves in establishing relationships with both Ascension Health and the Mayo Clinic to partner on the development of digital tools that integrate healthcare data into new patient care models. While the Ascension deal, in particular, raised concerns about patient data privacy, the two relationships will provide Google valuable experience in processing healthcare data that can be leveraged into future remote monitoring data applications.

Apple is leveraging its iPhone and wearables products in its health data initiatives. In 2018 the company introduced a health records app for the iPhone where Apple partners with healthcare providers to deliver a patient’s records to their mobile phone. In addition, Apple has established a variety of research relationships with organization such as Harvard’s T.H. Chan School of Public Health, Brigham and Women’s Hospital, University of Michigan, and others, that focus on cardiovascular projects related to the Apple Watch and hearing projects related to the AirPod earbuds.

Amazon’s principle relationship for health data is with Cerner Corporation, which has an approximate 25% share for electronic health records systems across the entire healthcare marketplace. In 2019, Cerner chose Amazon Web Services as its preferred cloud provider for its healthcare patient data. More recently the companies announced a further collaboration where consumers using Amazon’s Halo wearable can opt-in to share their activity and health data and allow that information to be stored in their patient record in Cerner’s systems. The patient’s healthcare provider can then access and evaluate that information directly in the patient’s records. This is another example of virtual health synergies accomplished via the integrated capabilities of a consumer wearable, health data systems, and a patient’s healthcare provider.

Healthcare Services

As the most straight-forward initiatives toward revolutionize healthcare, Big Tech is also directly entering the healthcare provider and services market, which at a minimum provides a convenient platform to leverage its healthcare technology and data solutions.

In 2018 Apple launched a group of health clinics called AC Wellness for its employees and their families. These clinics are generally focusing on providing primary care but have extended that to also included on-site lab testing and wellness care such as exercise and dietary programs.

Last September Amazon introduced its pilot telemedicine program, Amazon Care, for its employees in Seattle. This service includes virtual primary care as well as home consultations and prescription drug services via Amazon’s PillPack division, a virtual pharmacy Amazon acquired in 2018.

Google’s most recent activity takes a different approach where on August 24^th it announced it was investing $100 million in telemedicine provider Amwell. The synergies mentioned in the deal specifically focused on Google’s cloud computing services, but the intersection extends into its data processing and machine learning expertise and can potentially tap into its home personal assistant products for remote monitoring capabilities.

Challenges and Opportunities Ahead

When Big Tech pursues business growth, the companies must think big and look for markets that are ripe to be thoroughly transformed. With the global healthcare market size at more than $8 trillion and new technologies poised to transform how healthcare is executed, a prime opportunity exists. But significant questions remain in terms of the technological solutions, the market competitive and relationship dynamics, and of course, concerns about regulatory and information privacy.

Despite the market positions of Big Tech in wearables, smart home communications, and big data, there continues to be significant venture capital and start-up activity in the technological areas of virtual health that tend to focus on opportunities that Big Tech hasn’t yet pursued. The companies that achieve some degree of success will likely experience a very attractive market to be acquired by not only Big Tech competitors like Apple, Amazon, and Google, but also the leading telemedicine companies like Teladoc Health, Amwell, MDLIve, and SOC Telemed as well as technology-oriented insurers like UnitedHealth Group. From a Big Tech product portfolio perspective, two of the more significant gaps pertain to Apple’s position in smart home communications and Amazon’s position in wearables. In the smart speaker market, Apple’s 4^th place position behind Sonos Inc. has led to speculation that Apple might buy Sonos purely to increase its market share. This is very unlikely to happen given Apple’s reluctance to large M&A deals and, more importantly, its recent announcement that it is will stop selling Sonos products in the Apple Store. So, for the moment, Apple looks to be preparing to grow its market share on its own. For Amazon in the wearables market, the situation is similar. There doesn’t look to be any wearable or smartwatch companies that help Amazon’s market position. Even if Amazon were to acquire a company like Garmin, it would only improve its market share by a few percentage points.

The competitive and relationship dynamics of the virtual healthcare market will continue to be very active as broad industry solutions come together. Ultimately, this market is a non-trivial combination of technology, information systems, and healthcare providers. Big Tech has significant positions in many key markets, but lacks considerable exposure to others, most notably in the healthcare provider area. The first six months of the Covid-19 pandemic has thrust telemedicine providers like Teladoc Health, Amwell, MDLive, and SOC Telemed to the forefront and positions them as key parts of future virtual health solutions. Teladoc just recently announced an $18.5 billion deal to acquire Livongo, a company focused on remote monitoring and virtual health services for diabetes and related health issues. Amwell, MDLive, and SOC Telemed are all accessing the public markets to shore up access to capital and the ability to leverage stock as an acquisition currency. So, watch for all these companies to be active acquirers. But for Big Tech there are many more private telemedicine companies that could be acquisition targets to improve Big Tech’s connection to the healthcare provider market. These include companies such as Doctor on Demand, Crossover Health, 98point6, and HealthTap. In fact, Amazon just recently announced a partnership with Crossover Health to provide health services to its employees and health centers near its fulfillment and operations facilities. This could potentially be a precursor to a more significant acquisition opportunity.

Last, but certainly not least, are the concerns over regulatory issues and information privacy. For Big Tech, under the current environment, any initiatives to capture significant portions of the next generation virtual healthcare market are likely to attract even more scrutiny regarding antitrust issues and the companies’ abilities to keep patient information private. But even these challenges are unlikely to deter Big Tech’s pursuit of healthcare. The market opportunity is just too attractive.

Jim Moeller provides business intelligence data analytics consulting services including reports, strategic planning, competitive analysis, technology assessment, and intellectual property research.