What’s Apple Been Up To?

Apple’s goal is still largely aspirational in the orthopedic healthcare space, despite public announcements such as CEO Tim Cook’s prediction that health will ultimately be the company’s “greatest contribution to mankind.”¹ Apple is building its bench through relationships with orthopedic companies like Zimmer Biomet and its teams of physicians and engineers creating software and hardware targeting the healthcare market. Will the new digital health innovations such as Zimmer Biomet’s mymobility transform the joint replacement standard of care?

Why This Is Important
Apple, Microsoft, Google, Amazon—they all want to be in the healthcare space, and the scale of their businesses provides them resources much greater than what’s seen in traditional medtech. Zimmer Biomet recognizes this and has started a remote care management system with new mymobility features on the Apple Watch.²

This is an expansion of a first-ever remote care management system in orthopedics with a goal to transform the pre- and post-operative joint replacement experience. These features expand the existing software between Apple and Zimmer Biomet from the first generation mymobility care management system, launched in October 2018.

The second generation of mobility metrics will measure gait quality to provide healthcare professionals with more real-time patient information to augment the clinical decision-making process. Patients get an improved connected and customizable experience during their episode of care.

Gait quality metrics leverage the capabilities of Apple’s network through sensors in the Apple Watch and iPhone to store walking speeds and double-support time (defined as the amount of time where both feet touch the ground) when walking on flat level surfaces. No GPS is used. Gait quality metrics will be available to hip and knee joint replacement patients that opt in, as well as their healthcare professionals. Zimmer Biomet expects the mymobility app will be a new and effective way to mitigate patient issues while enhancing the patient experience, obviating the need for additional physician office visits.

mymobility’s gait quality metrics from Apple Watch allow clinicians to compare patient progress to a database to improve management of post-op care. The gait tracking feature can assist identification of patients not recuperating at the expected pace. These metrics will also be entered into the company’s OrthoIntel Orthopedic Intelligence Platform—a solution that collects pre-, intra-, and post-op data to identify new clinical insights for physicians and their care teams.

What Has Apple Done So Far?
Apple is not the worldwide smartphone market leader (Table 1). In the U.S., the sales of iPhones as compared to Android are shrinking. iPhone sales dropped from 38.1 percent in 3Q18 to 36.1 percent in 3Q19, a drop of 2 percent. Android increased by 1.8 percent from 61.8 percent in 2018 to 63.6 percent in 2019.⁴

In China, the dogs in the fight are not limited to Apple and Android leaders like Samsung. Local Chinese brands account for 79.3 percent of sales in the Chinese market. Huawei and Honor combined have a 46.8 percent market share, easing the impact from the U.S.-China trade dispute.⁴

Apple has successfully targeted the Big-Five European markets against Android (Table 2), leveraging the strengths of the iPhone 11 and 11 Pro. In the latest smartphone study5 for 3Q19, the iPhone accounts for 19 percent of all smartphone sales across Germany, France, U.K., Spain, and Italy. Android’s market share across the five markets remained dominant, even though they lost a slight amount of market share (down 1.5 percent in the quarter). Other operating system usage declined from 0.7 percent market share to 0.2 percent. Lower unit market shares for the iPhone contrast sharply with Android revenues, due to the immense price difference between the two smartphones.


Outside of orthopedics, Apple is grabbing the healthcare flag and running with it via an exciting new portfolio of products and services in healthcare.

First and foremost is the Apple Watch. Apple positions health as a use case and as a brand. The Apple Watch provides heart rate monitoring, with an ECG to detect heart rhythm irregularities, activity tracking, integration with third-party wellness apps, fall detection alerts, and more.

In addition, Apple is trying to get patients to incorporate lab results and medical history into their iPhones.⁶ Apple Health Records is another electronic medical record (EMR) that still has some software usability issues to work out. The largest EMRs have built firewalls around access to patient records and are bare-knuckle fighting over market share. Currently, patients using Apple Health Records must remember which doctors and hospitals they have seen and log into those portals to capture the data.

For the COVID-19 pandemic, Apple has teamed with Google to create contact tracing technology for smartphones. These will allow public health experts to build apps to track patients who have been exposed to the coronavirus.

A Double-Edged Sword
It’s no surprise physicians are of two minds regarding the use of patient health devices. Some doctors are pro-use, citing increased patient attention to personal health, while others feel analyzing patient-generated information is overwhelming and something they aren’t reimbursed for. Many doctors are uncertain about the accuracy of wearables when tracking patient health data. In addition, to make patient-generated data usable, it must integrate better with an EMR dashboard so the care team can see trends in a structured way.

A Finger in Every Pie
Apple is increasing its healthcare revenues by partnering with insurers like Aetna to market and sell more of its devices. In some programs, patients can pay down the price of a device like the Apple Watch while demonstrating healthy behavior.⁷ Apple has also reportedly begun discussions with private Medicare plans about subsidizing Apple Watch costs for seniors.

There is a longer game here. In the future, Apple could own a body of clinical evidence to get into the business of population health risk management. If Apple can improve the quality of care and reduce costs, it will reach the holy grail that supports AI in healthcare.

Preventive health will expand the Apple Watch’s market opportunity. Expect more game-changers if Apple can introduce non-invasive glucose or blood-pressure monitoring sensors. With sensors like these, the market for a home-use device on a smartphone increases dramatically. At that point, Apple’s iPhone could reach a much bigger market. It is estimated 60 percent of Americans have one or more co-morbidities8 and one out of every three Americans are at high risk for Type 2 diabetes (Table 3).⁹


The Medi-Vantage Perspective
We have several early-stage clients utilizing the strengths of the big four (Google, Apple, Microsoft, and Samsung) to harness their investment in healthcare. Also, is your device compatible with the iPhone to collect the data? If your device utilizes the cloud in any way, consider leveraging a smartphone, especially if you are targeting patients. The cost of HIPAA compliance is an issue, but the price for this certification will be coming down. 

References

1. bit.ly/odt200701
2. bit.ly/odt200702
3. bit.ly/odt200703
4. bit.ly/odt200704
5. bit.ly/odt200705
6. bit.ly/odt200706
7. bit.ly/odt200707
8. bit.ly/odt200708
9. bit.ly/odt200709

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Maria Shepherd has more than 20 years of leadership experience in medical device/life science marketing. After her industry career, including her role as VP of marketing for Oridion Medical, where she boosted the company valuation prior to a Medtronic acquisition, and director of marketing for Philips Medical, she founded Medi-Vantage. Medi-Vantage provides marketing and business strategy and innovation research for the medical device industry. Visit her website at www.medi-vantage.com.