By Jackie Kimmell, Senior Analyst

In a recent interview with Mad Money's Jim Cramer, Apple CEO Tim Cook posed a rhetorical question about the future of his company: "If you zoomed out into the future, and you look back, and you ask the question, 'What was Apple's greatest contribution to mankind?'"

After a moment, Cook answered his own question: "It will be about health."

It's a bold claim, but it's not just talk. In the past year, Apple has hired dozens of doctors to expand its digital health products, grown its employee's health and wellness clinics, and rolled out a long-anticipated Apple Watch equipped with an electrocardiogram (ECG).

Perhaps because of the sheer breadth of Apple's ambitions, it can be tough to pin down exactly what Apple wants to do in the health care space. To help, we've distilled all the confusing and sometimes-contradictory reporting into the five concrete ways Apple is seeking to transform the health care industry.

Want to learn about other forces shaping the health IT industry in 2019? Join our experts for a webconference on Thursday, January 24th at 1 pm ET to discover how providers can respond to IT innovation and prepare for digital disruption.

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What Apple has done in health care so far

Cheat sheet: What you need to know about wearables

Apple's biggest venture into health care so far is its Health app, which it launched in 2014 and now comes preinstalled on every iPhone. The app includes features such as activity tracking, sleep monitoring, and mindfulness support.

But those built-in features are only the starting point. Apple has also created three "kits" that help developers build health-related apps for the iPhone and Apple Watch:

• HealthKit, which allows developers to feed information to and from the app and provides a framework for connecting new apps;
• ResearchKit, through which developers can create apps for medical research or clinical trials; and
• CareKit, aimed at connecting patients with providers.

5 visions for Apple's ambitions in health care

So what's next? Given Apple's notorious penchant for secrecy, it's hard to say for sure, but here's what analysts and experts say are the company's likeliest next steps.  

1. Apple wants to let patients connect their iPhones directly to their providers' EHRs

   Last January, Apple rolled out a feature in its Health app that allows users to download, store, and share parts of their medical records—and in turn, participating providers can send lab test results, medication regimens, and other data directly to a patient's iPhone. More than 39 providers have already come on board, including Cedars-Sinai, Geisinger Health System, Dignity Health, and Johns Hopkins Medicine. At the same time, Apple also announced it was teaming up with several EHR vendors—including athenahealth, Cerner and Epic—to help users view their personal health records on iPhones.

   Clearly, Apple isn't the first company to try bringing health records to mobile devices: Google, Microsoft, and others have tried and, so far, have failed. But Apple has unique advantages. Its Health app is already installed on the phones of 140 million Americans. It has a strong reputation with consumers for safeguarding the privacy of its users' sensitive data—a commitment perhaps best summed up in its recent billboard at the CES show in Las Vegas: "What happens on your iPhone stays on your iPhone."

   And importantly, Apple's high-profile status as America's consumer technology leader means that industry-leading health systems are beating down its door to partner up.

2. Apple wants to help providers monitor their patients' health in new ways

   Soon after Apple released HealthKit, it announced that partners including Duke University School of Medicine and Stanford University Hospital already were using the technology to allow chronically ill patients to remotely track and manage their symptoms. Those high-profile partnerships soon led to high-profile endorsements: Ricky Bloomfeld, the director of mobile technology strategy at Duke's hospital, said the platform "worked as seamlessly as we'd hoped."

   Apple's future ambitions may be much grander. Through CareKit, it is offering providers the tools needed to connect with patients throughout the care pathway—potentially supporting population health interventions aimed at promoting large-scale behavioral changes, such as improving medication adherence and diet.

3. Apple wants to help researchers recruit hundreds of thousands of study participants—in a snap

   Because so many Apple users already use the Health app, the company can recruit patients rapidly and at a large scale for proposed medical studies—dramatically lowering costs for providers, pharmaceutical companies, and medical device manufacturers.

   One of the first examples is the Apple Heart Study, currently being conducted in partnership with Stanford Medicine, which compares Apple Watch's ability to detect to atrial fibrillation to standard detection methods. The study recruited more than 400,000 participants via their iPhones. As Alan Yeung, medical director for Stanford Cardiovascular Health, explained, "To get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers around the country."

   Duke University Health, meanwhile, recently completed a study using the iPhone's facial recognition technology to screen young children for autism and other neurodevelopmental disorders. The app was downloaded more than 10,000 times, and usable data was collected on 88% of the videos that parents uploaded.

   But Apple's not just partnering with providers for clinical research. Just last week, they announced a multi-year partnership with Johnson & Johnson (J&J) to run a randomized control trial testing if the combination of the Apple Watch's ECG function with J&J's patient engagement app can help detect and diagnose atrial fibrillation earlier in patients over 65. Advisory Board's Brandi Greenberg, managing director of life sciences research, said that this partnership shows that life science firms may not only benefit from improved patient recruitment through working with Apple, but could gain access to "treasure troves of real world health and behavior data." Greenberg added, "When coupled with other clinical and cost information, these new sources of evidence can help firms accelerate diagnoses, enable more precise treatment planning, and support manufacturer's claims of differentiable value."

   Interestingly, it's not yet clear how—or if—the company will earn money from recruiting study participants. As Tim Cook told Fortune, "We put out ResearchKit and made it a source so that people could run enormous-sized studies. ... Honestly, we don't make any money on that. But it was something that we thought would be good for society, and so we did it."

4. Apple wants more users to monitor their health via Apple devices (and it's convincing health insurers to foot the bill)

   The iPhone and Apple Watch are already sophisticated medical tools, offering features ranging from ECGs to fall detection—creating an opening for providers to use the devices to involve their patients in monitoring and improving their health.

    

   
   Get started with Patient Generated Health Data (PGHD) for patient monitoring

    

   Toward that end, Apple has aggressively pitched its consumer technologies to industry stakeholders. It's reportedly in talks with at least three Medicare Advantages plans about providing subsidized Apple Watches to the plans' patients in hopes of detecting atrial fibrillation early. It also signed deals with Aetna and UnitedHealthcare to provide discounted watches to health plan beneficiaries who walk at least 10,000 steps a day.

   (The Daily Briefing is published by Advisory Board Research, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group. UnitedHealth Group separately owns UnitedHealthcare).

   These partnerships are a win-win for Apple. Not only does the company sell its products, but it also gains consumers among an older, generally less affluent population among whom it currently has less market penetration.

   As the iPhone and Apple Watch grow increasingly sophisticated, these partnerships could grow even bigger. The company already has provided Apple Watches for studies examining the device's ability to monitor migraines, blood pressure, adherence in psychiatric care, and even as a virtual therapist for arm recovery in stroke patients. And Apple has filed patents suggesting that future versions of its devices might let users measure their blood pressure, body fat, and heart rate simply by pressing their finger on the screen.

5. Apple wants to pioneer a wellness-based approach to employee health care

6. Last year, Apple took its first big step into the direct provision of health care by launching its own primary care group, AC Wellness, to provide care to Apple employees. Currently, the company only has has clinics in the area of Santa Clara County, California, but it's aggressively ramping up. Recent hires include Sambul Desai, formerly chief of Stanford's Center for Digital Health, and M. Osman Ahktar, former COO of Fairview Health.

   Apple isn't alone in venturing into employee health care; the much-ballyhooed Amazon-Berkshire Hathaway-JPMorganChase venture may also be exploring primary care offerings. Apple's venture is, in fact, so similar that Cramer, CNBC's Mad Money host, recently joked that Apple should join the famous partnership itself.

   But Apple may be unique in its emphasis on overall wellness. According to CNBC, many of the doctors that the company has hired have a background in alternative management or wellness. They've also hired at least a half-dozen non-MD "care navigators" who can direct patients to the most appropriate care, as well as dozens of nutritionists.

   If Apple's approach is successful, it may inspire other large companies to adopt a clinic-based wellness approach. Plus, the clinics could provide Apple with an excellent venue to test, pilot, and iterate on its own pre-market health care products.

What other players could transform the health care industry in 2019?

To learn more about disruptive forces in the health IT industry in 2019—including updates on players such as Amazon, IBM, and Google— join our experts for a webconference on Thursday, Jan. 24, at 1 pm ET. Don't miss the chance to discover how providers should best respond to new IT innovation and prepare for digital disruption.

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