Pondering Apple’s Healthcare Move

Outside Disruption

There have been a number of recent developments that involve impending moves from non-healthcare companies intending to venture into the healthcare space in some capacity. First, there was the joint announcement from Berkshire Hathaway, JP Morgan and Amazon that they intend to team up to “disrupt healthcare” by creating an independent healthcare company specifically for their collective employees. You have to take notice anytime you have three companies of that magnitude, led by Buffett, Bezos and Dimon, announcing an upcoming joint venture.

Not to be outdone, Apple released a very similar announcement last week stating that, “Apple is launching medical clinics to deliver the world’s best health care experience to its employees.” The new venture, AC Wellness, will start as two clinics near the new “spaceship” corporate office (the one where Apple employees keep walking into the glass walls). Here’s an example of what one of the AC Wellness job postings look like:

So in a matter of weeks, we have Amazon, Berkshire Hathaway, JP Morgan and now Apple, publicly announcing that they plan to create distinct healthcare offerings for their employees. I don’t know what the three-headed joint venture will ultimately look like, or if either of these two ventures will extend beyond their employees, but I think that there is a trail of crumbs to follow to try and discern what Apple might ultimately be aspiring for.

Using the Past to Predict the Future

If you go back and look at the timeline of some of Apple’s moves over the past four years, this potential move into healthcare seems less and less surprising. Let’s take a look at some of the software and hardware developments over the past few years, and how they might factor into Apple’s healthcare play:

The Software Developer Kits – The Roads and Repositories

The first major revelation that Apple might be planning something around healthcare was the introduction of the software development kit (SDK), HealthKit, back in 2014. HealthKit allows for third-party developers to gather data from various apps on users’ iPhones and then feed that health-based data into Apple’s Health app (a pre-loaded app that comes standard on all iPhones running iOS 8 and above). For example, if you use a third-party fitness app (i.e. Nike + Run) developers could feed data from said third-party app into Apple’s Health app, so that the user can see all of the data gathered in that app alongside any other health-related data that was gathered. In other words, Apple leveraged third party developers to make their Health app more robust.

When HealthKit debuted in 2014, it was a bit of a head-scratcher because the type of biometric data you can gather from your phone is very limited and non-accurate. Then Apple introduced its first wearable, the Apple Watch in 2015, and suddenly HealthKit made a lot more sense as the Apple Watch represented a much more accurate data collector. If your phone is in your pocket all day, you might be able to get a decent pedometer reading around how many steps you’ve taken, but if you’re wearing an Apple Watch, you’ll record much more precise and actionable data, such as your blood pressure and heart rate.

Apple followed up on this a year later with the introduction of a second SDK, ResearchKit. ResearchKit allowed for Apple users to opt into sharing their data with researchers for studies being conducted, providing a massive influx of new participants and data which in turn could yield more comprehensive research. For example, researchers studying asthma developed an app to help track Apple users suffering from asthma. 7,600 people enrolled through the app in a six-month program, which consisted of surveys around how they treated their asthma. Where things got really interesting was when researchers started looking at ancillary data from the devices, such as geo-location of each user, to identify any possible neighboring data such as the pollen and heat index to identify any correlations.

Then in 2016, Apple introduced a third SDK called CareKit. This new kit served as an extension to HealthKit that allowed developers to build medically focused apps that track and manage medical care. The framework provides distinct modules for developers to build off of around common features a patient would use to “care” for their health. For example, reminders around medication cadences, or objective measurements taken from the device, such as blood pressure readouts. Additionally, CareKit provides easy templates for sharing of data (i.e. primary care physician), which is what’s really important to note.

These SDK Kits served as tools to create roads and houses to transfer and store data. In the span of a few years, Apple has turned its Health app into a very robust data repository, while incrementally making it easier to deposit, consolidate, access, build-upon, and share health-specific data.

Apple’s Wearable Business – The Data Collectors

Along with the Apple Watch in 2015 and AirPods in 2016, Apple introduced a brand new, proprietary, wearable-specific computer chip used to power these devices called the W1 chip. For anyone that has used AirPods, the W1 chip is responsible for the automatic, super-fast pairing to your phone. The first two series of the Apple Watch and the current, first generation AirPods use the W1 chip, while the Apple Watch series 3 now uses an upgraded W2 chip. Apple claims that the W2 chip is 50% more power efficient and boosts speeds up to 85%.

Due to the size constraints of something as small as AirPods, chip improvements are crucial to the devices becoming more capable as it allows for engineers to allocate more space and power for other things, such as biometric sensors. In an article from Steve Taranovich from Planet Analog, Dr. Steven LeBoeuf, the president of biometric sensor manufacturer Valencell said, “the ear is the best place on the human body to measure all that is important because of its unique vascular structure to detect heart rate (HR) and respiration rate. Also, the tympanic membrane radiates body heat so that we are able to get accurate body temperature here.”

Apple seems to know this too, as they filed three patents (1, 2 and 3) in 2015 around adding biometric sensors to AirPods. If Apple can fit biometric sensors onto AirPods, then it’s feasible to think hearing aids can support biometric sensors as well. There are indicators that this is already becoming a reality, as Starkey announced an inertial sensor that will be embedded in its next line of hearing aids to detect falls. While the main method of logging biometric data currently resides with wearables, it’s very possible that our hearables will soon serve that role as they’re the optimal spot on the body to do such. A brand new use case for our ever-maturing ear computers.

AC Wellness & Nurse Siri

The timing for these AC Wellness clinics makes sense. Apple has had four years to build out the data-level aspect to their offering via the SDKs. They’ve made it both easy to access and share data between apps, while simultaneously making their own Health app more robust. At the same time, they now sell the most popular wearable and hearable, effectively owning the biometric data collection market. The Apple Watch is already beginning to yield the types of results we can expect when this all gets combined:

To add more fuel to the fire, here’s how the AC Wellness about page reads:

“AC Wellness Network believes that having trusting, accessible relationships with our patients, enabled by technology, promotes high-quality care and a unique patient experience.”

“Enabled by technology” sure seems to indicate that these clinics will draw heavily from all the groundwork that’s been laid. It’s possible that patients would log their data via the Apple Watch (and down the line maybe AirPods/MFi hearing aids) and then transfer said data to their doctor. The preventative health opportunities around this type of combination are staggering. Monitoring glucose levels for diabetes. EKG monitoring. Medication management for patients with depression. These are just scratching the surface of how these tools can be leveraged in conjunction. When you start looking at Apple’s wearable devices as biometric data recorders and you consider the software kits that Apple is enabling developers with, Apple’s potential venture into healthcare begins making sense.

The last piece of the puzzle, to me, is Siri. What patients really now need, with all of these other pieces in place, is for someone (or thing) to understand the data they’re looking at. The pulmonary embolism example above assumes that all users will be able to catch that irregularity. The more effective way would be to enlist an AI (Siri) to parse through your data, alert you to what you need to be alerted to, and coordinate with the appropriate doctor’s office to schedule time with a doctor. You’d then show up to the doctor, who can review the biometric data Siri sent over.  If Apple were to give Siri her due and dedicate significant resources, she could be the catalyst to making this all work. That to me, would be truly disruptive.

-Thanks for Reading-

Dave