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Amazon, Fitbit, and Apple are launching new wearables. Does it really matter?

Over the past few weeks, a number of large companies have made big announcements about wearables they're developing, from Amazon's Halo, to Fitbit's newest device, to the latest Apple Watch update. In this episode of Radio Advisory, host Rachel Woods sits down with Advisory Board expert partner Andrew Rebhan to discuss what you need to know about all the latest news on wearables, and what impact these announcements will have on the health industry.

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Read an edited excerpt of the interview below and download the episode for the full conversation.

Rachel Woods: If I'm tracking correctly, there's been at least three big announcements that have happened in the wearable space recently. Remind our audience and me what actually is the big news here?

Andrew Rebhan: We're tracking a couple of different moves here. First there was Fitbit, which came out with a whole new line of wearables, including a smartwatch that—in addition to doing the things you'd expect, like physical tracking, heart rate, sleep patterns—also enabled users to actually manage  stress by looking at this activity center that's already embedded there alongside a mobile app. It also had a lot of other features, like being able to search for signs of atrial fibrillation, tracking people's skin temperature for signs of fever, and trying to really expand beyond its fitness-tracking roots.

The thing is, though, Apple's really eaten up this market share of smartwatches, so if you go back a little bit further into the case around why Google would want to acquire Fitbit, this should be a win-win, right? Google's getting a bit of a stronger foothold in the wearable space, it's leveraging Fitbit's brand, and it's getting access to consumer data from millions of users—information that Google can pair with its machine learning capabilities, its predictive analytics, its strong cloud platform network. So the potential here is pretty great as far as what Google can do with this data, but of course it's just sharing that common competitor with Apple and its Healthkit platform and trying to build out this data and device ecosystem.

Woods: But Google with Fitbit is going beyond Apple, right? Apple to my knowledge isn't monitoring stress—which, in this moment, is something everyone is experiencing, or at least challenges with mental and behavioral health—and Amazon has also tried to get into new spaces that Apple had not gotten into.

Rebhan: Right. So, this is something where, if you start to look at the different wearables out there, they're not dramatically different. At this point, they're each trying to add one new feature, just something else that might differentiate them. Now, Covid-19 definitely did influence this idea of tracking people's mental health and behavioral wellness, and so with Amazon's Halo device, there's this feature called Tone, which is a microphone that can analyze users' voice patterns, either on demand or periodically throughout the day, and provides feedback based on that sample about whether they are stressed, or are speaking with tension in their voice, or whatever that may be.

It can feel a little Big Brother for people, it can feel a little weird, and there's even some probably skeptics who are saying, "I don't need a wearable to tell me I'm upset, I know if I'm upset or I know if I'm mad." But there are other applications here.

There are algorithms out there that can analyze video feeds, they can look at your facial expressions, the way that you kind of have a twitch in your eyebrow or a stutter in the way that you speak, they can analyze physical gestures. So think about a clinician having a telehealth visit with someone, having just the video feed of them and the audio and hearing their voice, seeing their face, and picking up these subtle cues through AI that say, "This patient stuttered a certain way or they have a certain expression that indicates underlying anxiety or potential depression or the onset of dementia."

These are things that patients don't always bring up to their clinician, but it's actually something that could be pulled out on the backend through these algorithms. So the fact that Amazon, such a large scale commercial entity, is implementing something like Tone, is actually kind of bringing emotional intelligence out into the mainstream, which I think is really notable.

Woods: Of course, Google and Amazon are just two examples, tell me about the big one, what's the news with Apple?

Rebhan: Apple released their latest iteration of its watch, with a new feature that enables the watch to measure blood oxygen levels. Now, Apple's kicking this off as it's kind of the new big feature, but Fitbit has already done this in at least one of its products, so it's not the first time we've ever seen something like this.

On the other hand, it's also likely another feature that is supported by the influence of Covid-19, like we saw with the other devices as far as stress management and Tone analysis. This blood oxygen measurement is something that's used to help predict other symptoms of the virus, or at least it could be, so that's one angle to that.

But Apple has actually launched about three different research efforts to show how this sensor could be used elsewhere, so it's most notable in the sense that Apple not only brings out this new feature, but also the three research efforts to establish some validity to it—Apple isn't just putting it out there for consumers and hoping they accept it.

Woods: And beyond just improving what kinds of metrics can be tracked via these devices, Apple also announced a new partnership with CVS.

Rebhan: Right, Apple, as a first for its smartwatch, has introduced a fitness subscription service, called Fitness+. And again, this is something we've seen before, both with Fitbit and the premium service offered in its new smartwatch, as well as Amazon's Labs services, where a user gets access to personalized workouts, digital trainers, wellness goals that they can track, and try to reach from different third-party apps.

Woods: Very traditional fitness wearable stuff.

Rebhan: Yes, and it's a service that is new for Apple but again, we've seen it from other providers, I think Halo just beat Apple to the punch with it. So this is a service that launches later this year, and CVS said that it was actually going to be offering a one-year subscription to the new Fitness+ service to Aetna commercial and CVS Caremark members, and it also said its employees would get short-term free access to the program as well.

That is notable in the sense that Apple would pair up with CVS, but I think that there's actually a more simple explanation here, which is that CVS bought Aetna two years ago, and Aetna actually had a preexisting arrangement with Apple back from 2016, heavily subsidizing Apple watches for members as a part of its wellness programs. So that's essentially a preexisting relationship that I think CVS is looking to build upon with this new Fitness+ service.

And this really plays into CVS' focus around being a community partner, its focus around social determinants of health. It is tapping into the digital health space to gather patient generated data, social determinants data, and it's building out its HealthHub model to focus in on primary care services on site. So we're talking about again, just having hands in lots of different spaces and really building out a pretty robust effort to redo how they're placed in this health care ecosystem.

Woods: What do you want executives to focus on when it comes to wearables right now?

Rebhan: I would say wearables are going to have a play as far as advancing population health management, they're going to help to build out your consumers and strategies, but you shouldn't look at wearables as a standalone technology. It's got to be part of a multi-dimensional clinical program for wellness. So if you think about wearables as far as them being just one source of patient-generated data, you've got to compile that with mobile apps and home monitoring equipment and virtual assistance and patient portals, and then have those appropriate wraparounds, that are actually typically nontech in nature, for your care managers, your social networks and communities, your health navigators, your coaches, because those are people who are actually going to keep patients accountable, because patients will not often act in their own self-interest.

So, you have to make this technology—from either the consumer or clinician side—completely seamless, totally effortless for everyone. Or you just have to incentivize them to use it.

There's lots of potential and lots of barriers. We are fair about acknowledging that it's a mixed bag, but I'm generally optimistic about the use of wearables in health care.

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