This summarizes what I learned in sessions and one-on-one discussions at the recent Personal Health Information Workshop (www.release1-0.com/events/PHIindex.cfm) , held by Esther Dyson at the New School in New York, 9/30/05.
Health is a function of human behavior – the trick is identifying the right behaviors for each person and helping to motivate them to adopt and stay with those behaviors. The greatest opportunity in this space lies in providing better consumer outcomes, whether by helping to manage behaviors with human interaction (“skin-wrapped software” American Healthways, Canyon Ranch) or with the internet (RealAge, Fitlinxx).
Although it is far from complete, there is a great deal of patient health information today within the health systems, and there is value to be derived from mining this data to provide better outcomes (Aetna, Humana). Perhaps most interestingly, the government is highly motivated to find effective ways to control chronic disease costs and improve patient satisfaction before the baby boomer retirees swamp the Medicare system.
The key points of the day were:
1. There is a great deal of patient health information available today, but it is not being effectively aggregated across insurers, doctors, hospitals, pharmacies and patients.
2. The business opportunity lies in services that make use of existing patient information and activities to improve patient health or reduce costs.
3. The big money lies in reducing the cost of caring for patients with chronic diseases – in this space, it is possible to reduce costs while also improving outcomes!
Esther Dyson set tone by describing what she saw as challenges in this market: 1) shortage of visibility into the patient health information market – there are no marketers educating consumers, no “animal spirits” entrepreneurs attracting attention; 2) health information needs liquidity – lack of visibility into the data prevents more effective uses of the data to make better health decisions; 3) consumers are not given the opportunity to control their data, and so do not get to benefit from it. As an example, Esther cited the common practice of finding good doctors through personal connections because there is no reliable source of information on the web for quality doctors.
A number of the presenters helped make Esther’s point by focusing on technical capabilities and arcane medical issues rather than customer benefits. Only one of the presenters (from RealAge) had a successful, customer-oriented site with significant adoption (14m subscribers, 4m active users).
Rick Benci of Realage has had 14M people come to site (the site is based on the book, RealAge, and the authors have been on Oprah many times). RealAge subscribers take a test that associates lifestyle habits with effects on aging (your behavior-adjusted real age versus your chronological age). The site’s health risk assessment has 4M active subscribers, who stay with site on average 18 months and is supported by advertising.
Successful example of chronic health care
Everyone knows you need to eat right and exercise to stay healthy, but how do you personalize that knowledge for each individual’s particular needs, particularly for patients with chronic diseases like diabetes? Furthermore, how do you motivate them on a daily basis to stick with the optimal regime?
American Healthways is the most successful player in disease management, with over 2M customers covered. Their business model is to contract with insurer to lower the costs for managing patients with chronic conditions. Payment is on a per patient/per diagnosis basis (e.g., get X$ for patient with diabetes; X+Y for patient with diabetes + heart condition). They have 9 regional call centers, all staffed with registered nurses, who call customers on regular basis to assess health status, improve compliance.
Biggest competition for American Healthways is insurers taking this work in house. Biggest opportunity is doing this for CMS (Centers for Medicare and Medicaid Services). Currently, Medicare is running 8 pilots of 20K patients each, with a variety of partners. American Healthways is involved in 2 pilots, 1 of which they are doing solo.
To expand their capabilities beyond chronic care management, American Healthways bought HealthIQ to perform health risk assessments for broader patient populations. Test is part written + blood lab work to determine risk factors for each patient. As long as patient is improving risk factors, employer covers all/part of co-pay.
Behavior modification requires human element
David Crampton of Fitlinxx has web site that links to fitness clubs to help track exercise regime. Have created program with YMCA to get obese people excercising – very labor intensive – first three visits to gym, customer doesn’t even wear gym clothes. “Coach approach” take very small steps to modify behavior. Health Care Dimensions is a company that makes off-hours health club membership free to seniors (program called Silver Sneakers) – program is paid for by insurer.
Government is getting involved in chronic care
60% of health care costs are paid by government (Medicare, Medicaid, US Govt employees). Government chronic care improvement projects. Medicare has 240K seniors in program focused on more holistic wellness approach. Medicaed/Pfizer teamed to take care of 150K indigent patients. Technology is cool but 1 800 number with good navigation system is better. Have to save 5% net of program fees, show improved clinical metrics as well as customer satisfaction improvement.
Giovanni Colella of RelayHealth was one of the best speakers of the conference. He made an eloquent argument that the best way to create a personal health record is as a side effect of interactions with the doctor – setting up appointments, online consults, prescribing medications. Had to come up with a model where the health plan saved enough to pay the doctor to use the service.
It is hard to get health plans to pay for things out of the ordinary – need a compelling ROI. To do this, RelayHealth did a clinical study with Blue Shield of CA showed savings of $1.50-$3 per patient per month for patients who use internet to interact with their doctors, mostly in saved trips to ER. The only way to make this work is to pay doctors for interacting with patients online. Aetna is now launching this in 6 regions with 7K drs.
Customers not asking for PHR
People don’t see how a personal health record helps them – this is where marketing/education is required. PHR something like a credit report – people don’t like it, but they need to know about it, understand it. PHR issues: how do you make $, who pays for this, how do consumers get immediate and ongoing value from this, how to keep information current/dynamic, key is active relationship between individual and dr/ins/hospital/pharmacy. Have to respect the consumer – what is the benefit for them? One target market, people with chronic disease, who are very motivated and who are currently using spreadsheets/home grown approaches (but doesn’t American Healthways have a better approach here?)
One challenge is that US govt insures all the really sick people (>65, poor), so insurers don’t have as much to gain from wholistic approaches to health.
Value is in decision support tools on top of PHR.
Paul Sheils of Aetna, feels health plans are sleeping giants. Tremendous data in health plans already – claims, medications, procedures. Challenge now is to mine that data, provide applications on top of the data that add value. Difference between Electronic Health Record (maintained by large hospitals etc), Personal Health Records. For example, can run rule base against claims to identify anomalies – over treatment, sham diagnoses, treatment not consistent with medical standards.
Patients must control/pay for their PHR.
William Yasnoff of NHII believes that doctors have to be paid to keep PHR up to date. Plans to charge $50/year to create trusted e-health repository, get patient to sign HIPPAA request which allows repository to get info from all providers. Repository is paid for and controlled by patient. Under HIPAA you request data, provider has 30 days to respond, hopefully electronically.
PHRs can create communities
Carol McCall of Humana discussed a desire to use PHR to create communities – “I want to find my twin.” What are people like me doing for their conditions, how do they communicate their illnesses to their children, how do they care for their aging parents. What works for them, what have they tried?
Clinical trial data doesn’t work for real people – need to customize care with PHRs
Earl Steinberg, Resolution Health stated that most clinical trials work with very narrow band of patients (e.g. only one condition) that does not mirror real-world poplutions. Real need to mine PHR to find out how people like me react to a particular therapy approach. Provide personalized decision support for people making important medical decisions. Science is way ahead of clinical practice. Need to provide better decision support data at the “moment of truth.”
Mark Liponis of Canyon Ranch pointed out that patients who are paying for their own health care are do much better at following directions. Motivation is a huge driver of successful outcome – if they pay for advice, they are more likely to feel that they should use it. Canyon Ranch designing a web-based system to stay in touch with 35,000 guests who visit each year, improve their ability to stay on the program.
Health care is really sick care – real value is in preventing people from getting sick. How can we get consumer to drive adoption of technology to help their well being? Men tend to be in denial about health – most important decisions made by woman for their family and also for their elderly parents.
How are aging baby boomers going to affect health care? These people are likely to be more demanding, less tolerant, live longer!
Quit worrying about your health. It'll go away. - Robert Orben