Posts Tagged ‘consumer health’

WebMD announced first quarter earnings today that showed continued lackluster results for their “Private Portal” division, slipping roughly 5% year over year from $23M to $21.8M.

Now one could argue that the overall decline in employment due to the recession is to blame for the drop in clients from 134 to 131 in Q1-2010, but we see something else at play: high pricing for low value delivered.

Having spoken to a number of existing and former customers of WebMD, one gets the clear sense that the private portal business is no longer core to WebMD’s corporate strategy and frankly why should they as they reported overall growth of an impressive 20%.

Its pretty clear to us that the private portal business of WebMD is a business they intend to milk for all it’s worth. This may create opportunities for newer companies to capitalize on. The challenge for them will be to provide a full suite of solution capabilities as few employers or payers today are seeking niche solutions.

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8:15am, Intro done, Matthew, founder with Indu of the Health 2.0 conference announce all the countries and cross-section of companies represented. Quite amazing just how many people are here, nearly 900, considering the first Health 2.0 event was just over a year ago.

Some very very general comments from Matthew on what Health 2.0 is. What he has added to his famous bubble chart is transactions and data – basically how large data holders (e.g., Aetna or Kaiser-Permanente) are now getting into the Health 2.0 space with their massive data stores contributing to the continuing evolution in this market.

A spokesperson from PR firm, Edelman, also got up on stage to announce the release of their recent consumer study, The Health Engagement Barometer Dimitriy wrote a nice overview of the report.

9:30am, Clay Shirky keynote. He is on a book tour of sorts with his recent publication of Here Comes Everyody”, transposing his findings to the healthcare industry. Shirky states that there is already a NHIN, if not an international HIN being driven by consumers who are actively sharing and collaborating around health issues. Trust is not an aspect of technology, but one of a personal human nature. Where there is trust, information will flow. (Excellent point, so much effort is spent on the issue of privacy and security with vendors all seeking technological solutions to the problem. Unfortunately, they are putting their efforts into the wrong thing. Are you listening Microsoft, Google, payers and employers?)

Patients outnumber physicians 100:1, it will be patients that will be at the heart of healthcare change. Patient care is now beginning to occur among patients themselves rather than with physicians in small, focused organized groups around specific diseases.

What Shirky plans to follow in the future is how institutions (gave the example of orthopedic company, Zimmer) will try to thwart the growth in Health 2.0/patient communities due to perceived threat from consumers (whether real or imagine is another story). Shirky sees these efforts as quixotic.

9:00am, David Kibbe’s motorcycle tour video is now showing. Kibbe basically went across the country mostly interviewing Health 2.0 vendors beginning in my home town of Boston speaking to AmericanWell and PatientsLikeMe. Next stop was Dr. Jay Parkinson’s start-up, Hello Health with some discussion on the IT platform they are using with their customers. Adopted a facebook-type model, a doctor with 1000 friends, who happen to be his/her customers. Kibbe also dropped into a retail, Minute Clinic in TN. (Kibbe seems to ask all those he interviews: “Are you Health 2.0?” – getting a bit annoying). Not much from Minute Clinic. Road-trip stopped short when Kibbe’s motorcycle broke-down in TN. Flew to CA to interview Google Health, Healthline (Healthline CEO is lots of consolidation coming and big players jumping in). The Healthline CEO looked like the best interview, too bad it was cut so short.

10:15am Panel Session – Consumer Aggregators With the exception of Dossia, all the big boys are here: Aetna, Google, Microsoft, WebMD and surprise, Yahoo. Haven’t heard much from Yahoo in a couple of years as it pertains to health, will be interesting to get their comments. Aetna spokesperson announced the partnership with HealthVault for data portability. Microsoft spoke of their growing platform rattling off the statistics of number of devices, number of apps, etc., but no numbers as to how many users! Google talked about how they are focused on just making it easy for consumers to access and use their record data. Yahoo Healt spokesperson s brand new to the position and is now building a new team. Announced a partnership with Waterfront Media (content) and Healthgrades (physician search).

Demos by panelists:
WebMD used the Verizon HealthZone. Claims data driven PHR with HRA and risk factor analysis (what WebMD calls Health Quotient). WebMD providing structured health content and will even provide health coaching if client requests it. Phil Marshall, VP Product Development at WebMD did the demo.

Microsoft had Kaiser-Permanente give the demo. KP showed how a KP MyHealthManager customer/user would move their records to HealthVault. Using HL7 CCD for transmitting the data between the two sites. KP has put together a fairly easy process (reminds me of the BIDMC/Google Health process) to move the records. Peter Neupert got up to give the HealthVault portion of the demo – he was unable to log-in to HealthVault to conduct the demo – OUCH!

Note: After reading this post, Sean Nolan, Chief Architect at HealthVault, put together a quick post on what Peter was trying to demo up there on stage.  Not quite the same as a real life demo, but Sean is able to show and describe the steps of importing records from the Kaiser system into HealthVault.

Next up was Aetna. Unlike Neupert, he quickly logged in to the Aetna PHR. Thy now have ten active health trackers in the PHR, online coaching and of course, the Care-Engine rules engine for alerting consumers on risks. They put out over 1 million alerts to PHR members/qtr. Healthline Looking at having all 17M covered members on the PHR by the end of 2009. Currently have 6M members on the PHR and forecast 7M by end of year.

10:50am, Here comes Google: Did a demo on downloading medications from a pharmacy into a consumers Google Health account. Geez, this is boring – retty basic, unimpressive demo. Hell, they had this capability when they first rolled out Google Health, would think they would actually show something new and interesting. Another demo glitch. Pharmacy partner doing the demo got hung-up had to go into the depths of the app to make it work, something no consumer would take on. Another poor demo.

Microsoft is given another chance, again demo fails. DOUBLE OUCH!

Last up, Yahoo Health. Kerry Hicks, CEO of HealthGrades is intro’ing the demo and Michael Yang of Yahoo is not so much giving a demo, but an overview of the interface/GUI of Yahoo Health. Complete redesign beginning with physician search (embedded HealthGrades app/service). Claims Yahoo is good at data mash-ups, particularly for rating and reviewing and will apply that expertise to Yahoo Health. Will also leverage Yahoo Groups, have gateways between the various groups and Yahoo Health.

Q&A with Panel:

Aetna spends $60M a year answering physician calls regarding member eligibility. They see big savings via th PHR for members that will alleviate, if not eliminate these calls. Microsoft is not worried about the trst issue, like us here at Chilmark Research, believes that what really needs to be done is create value. Yahoo has no intention of getting into the PHR market. See themselves as a possible “swing vote” to bring visibility to the concpet without any vested interests to support one PHR or platform or another. See themselves as providing a rich environment for widgets, and add-on services to these other consumer aggregators.

Couple of more data points from Aetna:

  • Each 1% of members that move to having their EOB delivered electronically vs. snail mail represents a savings of $500K/yr.
  • Each 1% of physicians that they can get to move to self-checking eligibility of customers online vs calling in saves Aetna $600k/yr.

No wonder they are investing heavily in eTools.

Kolodner, head of Dept of Health & Human Services ONC took the stage to provide his perspective on what was said by the consumer aggregators. Not sure if it is me or not, but why do so many govt. bureaucrats give such boring presentations. Kolodner did not use any slides, but oh it was hard to concentrate on what he was trying to say. In th end what I got out of it was, let’s not move to fast, let’s focus on interoperability, let’s insure that privacy and security are preserved. Looks to me like he was defending CCHIT and its consumer-facing initiatives.

1:00pm, Search in the Long Tail Panel Session: Matthew Holt has always been a big fan of health search tools for consumers and has brought together all the big, health-centric search companies, Healthline, Kosmix/RightHealth, Healia (which Meredith acquired), and Organized Wisdom. Not much new said in opening statements, typical positioning statements, boring.


Healthline began, really hard to see much here that would attract me to the site. Actually, would probably avoid as it presented a barrage of “stuff” and I always look for nice clean interfaces. Guess Google has spoiled me.

Healia demo, by founder Tom Eng talked about the communities feature they brought to market this past summer. Clearly looking to tap the growing disease community market. Partnering with American Diabetes Assoc for a diabetes centric community.

RightHealth (Kosmix) was next. One of the better demos and it appears that the broader public agrees as RightHealth claims to be the second most visited site after WebMD with 8.5M unique monthly visitors. Quick check shows something different. Yes, RightHealth has good presence, but in Sept. 08 it was only about 6M and WebMD is more than double that.

Last was Organized Wisdom. A lot of buzz, but leaves me wondering, Where’s the Beef? Of what I heard so far from these search providers, this company is probably in the most precarious position going forward. They did announce that they will be offering a physician rating/search service within Organized Wisdom. Now why do that instead of partner?

Healthline will also be looking to provide a physician search service. RightHealth will not, they will look to other, best-in-breed companies, to provide this service. Healia as no intention at this time to go down the physician search and rating path.

1:45pm Social Communities: Great line-up here with the CEO of Sermo, CEO of MedHelp, GM of HealthCentral and CEO of PatientsLikeMe (PLM). Sermo last year was at 40K physicians, they are now at 90K physicians. PLM is seeing very strong growth for their most recently introduced communities to address mood disorders (We had concerns as to whether or not PLM would scale effectively and mood disorders would be a real test, if not one of the hardest. Mood disorders are terribly challenging and terribly personal and there is a social stigma. PLM’s ability to overcome these challenges is true testament to the value they are delivering.) PLM is focused on addressing what treatments work in the real world for real consumers. See themselves becoming a key arbitrator of future pricing based on real efficacy.

Comments from HealthCentral and MedHelp have been pretty simplistic in comparison to comments by PLM and Sermo.


Sermo leads off showing the power of community intelligence. Big question that they had to face was will physicians trust the site. Time and agin they have been able to demonstrate that the system does work. This is contributing to the viral-like growth of Sermo. Which makes me wonder, just how many of those docs on their site are from the US vs rest of world? With some 600-700K physicians just in the US, a lot of upside community growht for Sermo. BTW, that demo, nothing special but the site does look clean and easy to navigate.

Ben of PLM was next presenting data from the ALS community at PLM looking at efficacy of lithium. Was prompted by a research study in Italy that p[ointed to some possible positive impact. In the past nine months, 300 PLM ALS community members have been using lithium (this is not some sort of formal clinical trial, it’s just happening) and the data is showing no measurable imporvement. Ben went on to say that the US is getting ready to launch mulit-million $$$ clinical trials program to look at lithium for ALS. His argument is that PLM already has the data, now, totally circumventing the clinical trial process. Could this story force us to rethink how some clinical trials should be performed in the future?

MedHelp gave a demo/story of a Victoria Secrets’ bra. Seems that VS introduced a new bra and within a month, MedHelp community members began posting about a rash they were getting from wearing the bra. Problem eventually traced to a new manufacturer in China using material that would cause an allergic reaction for some. Led to VS changing the manufacturing process and sure enough, posts on MedHelp began to subside.

HealthCentral is now up. Gave several demonstrations/page views of different communities at HealthCentral. Nothing terribly new here that I have not seen on any number of health communities. But taking a look at traffic numbers, does appear that HealthCentral is doing ok and is growing in number of uniques. Took a quick drive-by of the site, much different than the other three on the panel, coming across more as a competitor to WebMD or Waterfront Media.

4:30pm Due to low battery have not been able to provide update. But coming back now for wrap-up.

Some quick impressions so far:

  • Nothing terribly new being presented. Good event for those new to this market space, but for someone such as myself, well…
  • Great networking event. While content of presentations may be thin, the audience is top notch. Lots of great contacts being made.
  • One of the big contributors to the size of the event is all the new players. This is becoming a VERY BIG DEAL. Plenty of representatives from the healthcare sector old guard (e.g., payers, pharmaceutical companies and some of the very large providers). Lot of large institutional entities here looking more closely at this market sector.

Has Health 2.0 hit the mainstream?

Sure is beginning to look like it. Then again, we’ll have to see what unfolds over the next 6-12 months as there is a tremendous amount of overlap in solutions being shown here today. Clearly, not all will make it. Actually, most won’t. Challenge for investors is figuring out which one(s) have a truly distinctive product and a good model/strategy to take it to market. Not that much different from any other investment evaluation, with the “minor” exception that one must factor in a financial crisis.

And that financial crisis will put a major crimp in any Health 2.0 company looking to go direct to consumer with a subscription model. This was a challenge before the financial crisis, now it is simply untenable.

Same goes for those looking at an ad-supported model. Online advertising is starting to see some contraction and the healthcare sector will not be immune. And those companies looking to offer their sponsors some type of completely new advertising approach, don’t count on a receptive audience. When the purse strings start to be pulled, new (i.e., risky) ideas are pulled.

Going forward, Health 2.0 companies will need these large institutional entities for sponsorship via adopting their solutions. Therefore, Health 2.0 companies will need to go back to the drawing board and look more closely at the value proposition they can provide these sponsors. As you go back to those drawing boards, think one of two things:

1. How can I save them money?

2. How can I make them money?

Word to the wise: Number 1 is always a much harder sell than number 2.

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I’ll be attending the World Health Care Congress (WHCC) here in Washington DC getting my fill of all things healthcare and most likely an overdose on policy – after all, this is Washington.

The people who put on the WHCC have put together quite an impressive agenda with so many different and what look to be interesting tracks, the biggest challenge for me was just deciding which ones to attend.  In the end have chosen to focus on those tracks focused on consumer health including transparency, successful models for engagement, empowerment and the like.  Over the course of the next couple of days, I’ll provide a couple posts outlining some of the most critical issues raised and lessons learned from the various presenters and participants.  So stay tuned.

As an aside, had two interesting experiences yesterday, here in DC hainvg arrived a day early.  The first was meeting a man on the DC Metro who had flown in to attend a training session.  We got to talking and he asked me what I did for a living.  Told him healthcare and he immediately opened up with: “Healthcare costs and gas prices are going to drive us into the ground.”  As we continued talking he related his own, most recent experiences with the healthcare system.

He receives good coverage from his employer, though complained about his share of costs continuing to rise.  He has had a heart condition ever since he was a child.  Recently, he changed primary care physicians.  Despite a long record of a heart condition, his new doctor ordered a battery of tests that he estimates cost between $30-40,000.  Though he readily admitted that his costs were a few hundred dollars, he knew that in the end, we all will be paying higher prices to support such practices, that for him seemed at a sham.  He also found the multiple Explanation of Benefits (EOBs) forms that he received from the insurer during this whole process as to appear as though they were written in Greek – simply incomprehensible.

Now, I am not a doctor and certainly not one to judge whether or not these tests were unnecessary.  What this story does point out though are two important points:

  1. Might this consumer, if he had control of his records that were safe-guarded in one of the online data repositories like HealthVault, or Google Health, or even Dossia (if his employer was a member), be able to provide a complete longitudinal health record, maybe the physician would have decided not to order these tests.
  2. With all the talk from insurers about transparency, consumer empowerment and all the wonderful online tools that they want to provide to enable such, from this story it looks like they are getting a little ahead of themselves.  Rather than looking to the Internet and IT as the magic elixir to make all this happen, maybe insurers might want to start with something as simple and basic as making EOBs understandable.   Granted, not novel, nor sexy, but it may deliver better results.

The second little musing is that while heading over to the Hirshhorn Museum (my favorite here in DC, great sculpture garden and fabulous modern art) coming out of the Metro and what should I see plastered on the walls – at least 8 small billboard posters with that big smiling face of Magic Johnson saying something to the affect of “Together we will better manage our health.”

These are part of Aetna’s consumer advertising campaign to encourage greater consumer involvement in managing their health.  Really like this advertising campaign (seen full page ads in the WSJ as well).  As far as I can tell, they are the only major insurer being proactive on educating the consumer.  Now if we could just get the other big insurers (are you listening WellPoint, Cigna, UnitedHealth, etc.) to ramp-up their own consumer advertising to focus on a similar message, we may indeed begin to see consumers take a more proactive role.

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Recently CMS announced that they were expanding the capabilities of their hospital rating site.

Just demo’d the site and it works pretty well.  Easy to navigate, a number of various search options to choose from, and an ability to look at raw numbers (using percentage metrics) and even chart them to compare up to three hospitals a once – nothing new on that front.  Beyond the quality type metrics that HHS has been measuring and reporting on for some time such as providing a heart attack patient aspirin upon admittance, HHS is now including soft measures like bedside manners of caregivers, cleanliness, noise, etc.   This adds but another site to the list of those that are measuring soft metrics related to patient care.

Now, if we could only get CMS to report on some of the more touchy subjects like infection rates.

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This week, Angie’s List, an online rating service by and for consumers, announced it will now allow consumers to rate doctors.  Similar in some respects to the WellPoint/Zagat rating service in that it rates such things as cleanliness, bedside manners, etc. the service will cover 55 practice types from dentists, to docs, to insurers hospitals and everything in between.   Like a schoolmarm,  consumers will be able to rate healthcare services from an excellent A to a failing F.

Already there are some in the medical establishment bemoaning this latest move with statements to the effect of, we are unique, we can’t be simply rated like this, and on and on.  These same tired arguments that the medical establishment  has been using to thwart just about any initiative that changes the equation from a doctor-patient relationship, which often turns into a parent-child relationship to one of a doctor-consumer relationship, which is much more of a peer to peer relationship.

Get a clue.

Consumers increasingly want a greater say in any number of services that they will procure, including healthcare, and consumers want to share their experiences to assist others.  This is something that the AMA and virtually any other organization of its ilk needs to understand.  And it is not just the AMA as I find this view pervasive throughout all corners of this industry sector.

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This week, the “Live Free or Die” state of New Hampshire’s House voted down House Bill 1587, a bill that would have strengthened the privacy rights of consumers.

The biggest objections to this bill came from the medical establishment itself claiming that passage of the bill would stall adoption of healthcare IT (HIT) systems. In one of the more bizarre statements Kathleen Bizarro (I’m not making that name up), EVP of the NH Hospital Association stated the bill would “essentially put a halt to the development of electronic medical records.” The medical establishment went on to state that the bill was too onerous, would restrict a physicians ability to provide good care, and that it would exceed existing federal laws (HIPAA).

All of these are pretty empty statements for the following reasons:

  • The bill was designed to simply provide the consumer more control over who gets to see their records. That it not a major burden for providers.  In fact, if a consumer requested an audit trail, the provider/hospital could charge the consumer a fee for providing such a report.
  • Adoption of HIT is not struggling due to privacy/record access issues, nor will it be in the future. HIT is struggling simply because for most physicians, the value proposition is not there.
  • In many states, laws have been passed to strengthen privacy above and beyond HIPAA as HIPAA certainly has its fair share of weaknesses. Unfortunately, most do not know this and hold up HIPAA as the be all to end all for privacy requirements.

Clearly there were other factors at play here as to why these organizations were against the bill. I have not read the bill itself and there may very well be some good reasons to oppose it, but based on the aforementioned arguments that were used, I have the feeling that this was a good bill and that special interests who have a vested interest in keeping firm control of consumers’ health records were at work here.

In a little touch of irony, legislators were granted privacy on this vote as they were able to cast their votes anonymously thereby not showing the public what side of the issue they were on. And it was a close one, defeated 166 to 150. The measure has gone back to committee for revision.

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This week, consulting firm Deloitte release their report: 2008 Survey of Health Care Consumers.  While I only learned of this report earlier today, via Jane’s website, Health Populi, and have made only a cursory review, it appears to be a well done.

Lots of metrics and charts in the report that many a small consumer centric healthcare company would be wise to review for their internal strategic planning.  And for those seeking funding or looking at where to invest, the final report provides some interesting trends, identifies sub-markets, unmet needs and willingness to pay. All good info for building/supporting a business plan or evaluating one.

Don’t be too surprised when you start seeing this report, and the graphics therein, show-up in numerous  presentations, business plans and the like through-out the year.

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This morning’s newscast of Morning Edition on National Public Radio (NPR) had a brief story (~ 4min, you can listen to it here) on the growing use of IT in a medical practice.  The story quickly focuses in on the potential of Personal Health Records (PHRs) with interview comments from a doctor on how useful he would find PHRs for providing more complete and accurate care for his patients.  Mentions are made of Google’s planned PHR and Microsoft HealthVault’s own software architect, Sean Nolan gets a few sound bites in.  Unfortunately, the reporter fails to differentiate HealthVault, as it is NOT a PHR, but a personal health platform (PHP) from PHRs, which this story focuses on.  Probably would have made the story to complex to attempt that separation.

Story closes with a brief discussion on the issue of privacy, something I’ve commented on in the past.  This is a HUGE issue for the PHR market and one that has been poorly addressed to date by legislators and the vast majority of PHR vendors in the market today.

Good to see a major news organization such as NPR pick-up on this story.  Maybe in the near future we’ll get a special edition of Frontline to delve deeper into healthcare IT issues as four minutes barely scratches the surface.

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