Health 2.0: Observations

(Note that this is a follow-up post to my summary of the conference.)

First, I have to say that I feel old. At Monday night’s reception, someone guessed that I was late 40’s (not that there’s anything wrong with that but it’s a decade off). For years, I wanted to be older (as a young consultant). Now, I am happy to slow that process down. Then, I had dinner last night with people in their 40’s and 50’s that are talking about Twittering and online music services and blogging for years. I felt like I was a parent listening to their teenagers talk even though I consider myself pretty technology savvy.

Second, I think it was a great conference although the next step has to include the involvement of the establishment.

Third, as I heard several people say, this is very different than your typical healthcare conference. No suits. Lots of sharing across seemly competitive companies. Fairly pointed. Patients involved.

Finally, here are a few of the thoughts / comments:

  • How can we create data that stays with the individual (i.e., portability)? As patients build content and networks and document their disease online, what happens with the logical consolidation and shakeout in the space? Do they lose their records as companies eventually go out of business?
  • Are we inevitably going toward a two tier system of healthcare for the health literate and/or wealthy and all others?
  • Where are the VCs? There were a few here. Even if they don’t buy that there is a model yet. I would think they could get great market data from attending and listening to companies.
  • Can we avoid the dotcom issue of creating things that are important to us but not scalable? Given the lack of a mechanism for systemically engaging patients in product design, this myopic view is a risk.
  • There is a definite funding question here. Do you make these DTC (direct-to-consumer) models where they pay? Do you go to the payors and ask them to fund it for their members on some PMPM basis? Or, do you take advertising dollars? And, if you take pharma advertising (for example), does that change people’s trust in the site?
  • There was a brief discussion which I think is really important. Do consumers trust a site that is “anti-establishment” and less slick or are they okay with a more “corporate” feel to a site that gives them better functionality and a better user interface?
  • Corporate blogs and personal blogs seemed to be the norm. A lot of these are companies built by passionate people that are either patients or caregivers driven into the Health 2.0 space by some event in their life. They actively use blogging and other social media to engage with a community. I mentioned the blog a few times and felt like … “of course…who doesn’t have a blog.”
  • I brought it up over lunch and heard someone else bring it up over dinner, but there was not a lot of discussion around lifecycle / phase. Patients move from newly diagnosed to ongoing care and eventually into a late stage. The solutions and their needs are different.
  • There has been talk about the hospitality industry (i.e., hotels) using employees, family members, etc. to pump up their ratings. Not sure how you control this, but is this an issue for MD ranking sites?
  • I heard very little about how to address the unengaged. Most of these solutions are on those active patients that care about their health, know they have a disease, and are willing to spend the time and effort to manage it. Just like with prescription non-compliance, the biggest issue is not managing those who don’t refill but identifying those that should be getting a prescription based on medical claims (or eventually genetic markers). This is clearly where the establishment can help. Managed care companies could use medical claims to identify people that would be benefit from these solutions and drive them use them. Assuming an ROI based on less hospital visits or some other criteria, it should pay for itself.
  • There was some discussion about mandated care for the uninsured and whether that was just a gimmee for the existing infrastructure. So, is the government rewarding those that haven’t fixed the system so far? It’s interesting. It made me draw an analogy to the auto industry. Certainly, we could fix the industry by limiting public transportation, developing a low cost car option (e.g., SmartCar), and having the government require every family to purchase a car.
  • There was a little discussion around what I would consider a typical business IT issue. Should the best-of-breed survive or is it better to settle for some lowest common denominator but provide one, integrated solution to patients. Right now, you have to use lots of sites to get different things done.
  • I thought about that Robin Williams movie about Patch Adams several times. Is our model changing to be less about administrative efficiency and more about care? [Not that I believe for a minute that we are efficient in healthcare.]
  • It made me realize that I need to think through the “Patient 2020” about what they will look like in 12 years. Transparent access to data. Integrated online tools. EMR. PHR. Community and care network tools. It won’t look anything like what we are trying to solve today.
  • Not enough talk about wellness and prevention. Some. It came up at the end around the fact that technology is typically focused on end stage solutions that are very expensive and can’t scale. Most of what was talked about here is focused on early stages and is very scalable. Clearly, this space faces the same issues as disease management. It’s logical. It seems to work in many cases, but clearly proving ROI on comparative populations while avoiding regression to the mean is difficult.
  • I think it was a person from Digitas that brought it up, but there was a comment about whether Beta is okay in healthcare. I think as long as the Beta (i.e., unfinished product) is about the UI (user interface) and not the clinical content then it should be fine.
  • iMetrikus brought up the idea of “activity based plan design” which conceptually I like.
  • Some of the models presented seemed focused on the payors as customers but would get traction with individuals that would pay. It would be interesting to see a model focused on the payors but with a DTC option which was completely automated for sales and payment in order to make it scalable.

It is important to find more patients than those that were there to be involved and help shape the future solution. It’s like HealthCentral “kick-starting” their communities by finding and recruiting (and possibly paying) 100 patients to be their super-users. As long as they are actual patients with the disease, I don’t mind.

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