HEALTH 2.0 INTERVIEW SERIES — Matthew Holt and Indu Subaiya discuss the companies to watch in 2008

Matthew Holt and Indu Subaiya are the chief organizers of the Health 2.0 Connecting Consumers and Providers conference, which will take place March 3-4 in San Diego. Matthew is a healthcare strategist and author of perhaps the industry’s most influential blog, The Health Care Blog. Indu is an MD and founder of Etude Scientific, which consults with healthcare and life science companies on new ventures. This is our fifth published interview in our series leading up to the event. So far, we’ve talked with Scott Shreeve of Crossover Health , Ed Silverman of Pharmalot, Fard Johnmar of HealthcareVox, and Jane Sarasohn-Kahn of Think-Health and the Health Populi blog.

Here’s our interview with Matthew and Indu:

Q: In our interview with Scott Shreeve, he offered an expansive definition of Health 2.0. Matthew, yours is a bit narrower. Can you explain the difference in how the two of you define the Health 2.0 movement, and why this is (or isn’t) important?

Matthew: You need to realize that Health 2.0 is at a very early stage and that outside of Silicon Valley few people have figured out Web 2.0 yet! So definitions are, by definition, fluid at this stage. I view the use of these new technologies for specific applications — search, communities & tools — in healthcare as the core of Health 2.0. Scott is talking more about the end of the progression when Health 2.0 tools are part and parcel of a significant change in relationships within the healthcare system. The initial phase of Health 2.0 is the use of these tools outside the current healthcare system — mostly patients talking to each other in a way they were not able to before. I view this as the start of the continuum. Scott’s definition starts closer to the end. But we have a great time arguing with each other about it.

Indu: What’s fascinating to me is how flexible and dynamic any definition of Health 2.0 needs to be. No matter what Matthew or Scott propose, there’s always some great new company from the midwest or Australia or India that dubs what they’re up to as Health 2.0 and for us, that’s great but it really shows that the phrase is out there and open to interpretation. I’m noticing that many of the Health 2.0 companies with traction are operating at multiple parts of Matthew’s continuum at the same time. That’s what makes it exciting. It’s not a purely linear progression at all.

Q: What are the four or five most exciting examples of Health 2.0 companies that are currently online, and why? Matthew: We are going to cheat, as there are two of us, and talk about more than four or five — after all in our two conferences so far we’ve had more than 40 companies show really innovative products, and we won’t showcase somebody if we don’t think they have something innovative to offer. But here goes our choices (and please don’t hate us if you’re a Health 2.0 sponsor who’s not on the list!)

• Patients Like Me – an easy choice– the best example of a combination of really useful community and tools making a significant difference in the lives of people with serious debilitating diseases. You can literally drill down and see people in exactly your situation, on your drugs and see what did or did not work for them.
• Sermo — you can’t argue with success; more than 30,000 physicians signed up on this social network and they talk in detail to each other about a lot of clinical and nonclinical issues. But what’s less well-known is that their survey and ratings tools are among the most advanced anywhere on the Web. I wish my blogging software had them!
• DoublecheckMD — disclosure–I’m totally biased. I love this product so much I bullied the company into letting me become an advisor. It uses natural language recognition to allow consumers to search medical texts and match symptoms with the drugs they’re on. This is incredibly important considering so many medical “conditions” are in fact side-effects of drug interactions. But more than that, it shows the potential for extracting information from the millions and millions of pages of medical text out there and presenting it back in a useful format.
• Vitals.com – a new site with one of the nicest interfaces I’ve seen. It uses reported empirical data, patient reviews, and even uses an algorithm extracted from physician reviews of their peers, to create a one-stop shop for information about physicians. The whole field of provider ratings is set to explode, and these guys have done a nice one-stop shop. Also well worth mentioning Xoova.com, another physician directory site which has done a great job with creating online appointments.
• Carol.com– so new it only launched [last] week but this is a swing for the fences. It’s creating a market in which consumers with health plans can buy discreet bundles of medical services. I don’t know if this is the start of the revolution, or whether they’re the Chinese guy facing down the tank outside Tiananmen Square, but if there is to be a rational market-driven change to the healthcare system somebody will have to come up with tools like these.

Indu: I second all of Matthew’s choices. Sermo wins the business model competition by a mile. They’re inventing whole new sets of market dynamics and really pushing the envelope (in a good way) of what you can monetize and how you can monetize it. It’s mind boggling in a way that Google’s Adsense created a whole new set of dynamics. I’d say Sermo is down that type of ground-breaking path. And lets just say with Marlene Beggleman of Enhanced Medical Decisions and Jamie and Ben Heywood down the block, Boston is becoming the brain trust of Health 2.0. I love Organized Wisdom, which I recently called the Wikipedia of healthcare. They demonstrate how you can be flexible in this space and still offer a highly credible/respected product. By allowing both experts and visitors to the site to organize information, they’re leveraging the best parts of the wisdom of the crowds concept. To win at this game, you’re not going to able to just be another diabetes content site or another patient community without bringing something else to the table. OW realizes that there will be so much innovation in the space, it’s smart to be the platform and the means of organization of this increasingly out of control amount of health information. And then the ones to watch: I’m intrigued by American Well and what they’re doing in the virtual visit space. Anything that allows doctors and consumers to behave rationally in an efficient economic marketplace is moving in the right direction for me. Also, little known but interesting, MyMedLab allows consumers to order and pay for many routine lab tests online and then just swing down to your local Quest or Labcorp site, get your blood drawn and get your results sent to you electronically. Why pay for a doctor’s office visit when you know what you need (say a cholesterol test) and can just go get it. Daily Strength just rolled out their “goals” feature. I like the idea of community sites pushing along the frontier of wellness management. If I’m more likely to stick with a goal, like exercising or eating right upon announcing this to my peers and then relying on them for support, then Daily Strength should be able to show some real effectiveness here.

Q: How do you believe Health 2.0 will ultimately impact the current hot-button issues in healthcare — the large number of uninsured, the inefficiencies of the current system, and the high cost of care?

Matthew: It’s unrealistic to expect Health 2.0 in its current incarnation to do anything about these problems. However, Health 2.0 is helping patients become more informed and is making the activities of those people who are making waste in the system become more exposed. This will add to the eventual pressure for significant reforms to solve the issues of the uninsured, and the widespread variation in care quality and quality. But don’t hold your breath, that’s a 20-year not a five-year process.

Indu: I think we’ll see small inroads into these giant issues being made sooner than we expect. Take cost of care — so much of that has to do with unnecessary visits to doctors or to the ER. If an online health advocate or wisdom-card guide like those coming from sites like Medhelp.org, Virgin and Organized Wisdom can answer a basic question, it might save you a visit to the doctor. And certainly companies like American Well are going straight at that issue. And some inefficiences in the system are already being taken on by sites like Xoova which will allow you to search for and make an appointment online with your doctor — so much for that month long waiting period to see a specialist. So it’s incremental progress, but progress none the less. And at some point there will be a tipping point.

Q: Tell us about the origin of the Health 2.0 conferences, and what attendees are gaining from them. To a cynic, a venue like this might seem like a meeting place for big healthcare companies and the consultants who are trying to get their business. Who actually attends (or should attend) — and why?

Matthew: Call us naive if you like, but we really felt that we were putting on a forum whereby a whole new type of healthcare technology company could get together. In fact, we put the conference on in response to requests from many of those companies. It was impossible not to feel the energy in the room last September, nor to be unimpressed by the innovation shown by the young companies on the podium. In fact, although several large healthcare organizations did send people to look-see, it’s clear that they are only beginning to consider the impact of these tools and technologies. We actually hope to see more involvement from large mainstream health care organizations, because we feel that understanding what’s going on Health 2.0 will improve their ability to better serve their customers.

Indu: I like to think we started Health 2.0 as an antidote to more mainstream healthcare conferences. You’re in the crowd if you’re interested in change and you believe that elegant technology in the hands of engaged consumers and creative providers will make a difference. But it’s a little like TiVo. Once you’ve tried it, you get what the fuss is all about, but just listening from the outside it can seem like what’s the big deal, my VCR works just fine.

Q: Can you preview the March conference for us? What sessions might be of particular interest for those of us who follow (or are part of) the pharmaceutical industry? Matthew: In March we are going to focus on the user experience as patients/consumers/citizens use these tools to connect with each other, their providers and large healthcare organizations. We are currently researching and documenting this activity for some videos we will show at the conference, and will be featuring a whole new set of innovative Health 2.0 companies … as well as some leading edge patients and physicians who are using these tools in their everyday lives.

Indu: The panel on Connecting Consumers and Providers is structured in a cool way. We’ll be taking people through the entire process of care and showing innovative technologies and how they fit in at each step. We’ll start with searching for a doctor, making an appointment, purchasing care. Then we’ll go into the office visit. What’s making that experience better? We’ll look at technologies that help you stay in touch with your doctor between visits and also “visit” with your doctor virtually.

Q: What aspects of the Health 2.0 movement will have the biggest impact on the pharmaceutical industry, and on drug consumers?

Matthew: The biggest impact will be the much wider discussion about the impact of drugs on particular conditions for particular types of patients. Sites like Daily Strength are already rating patients’ experiences on different medications; this as a whole new method for how pharma companies need to both market to and listen to their customers.

Indu: And I’d say Doublecheckmd and Pharmasurveyor are putting tools in the hands of consumers to check drug-drug interactions and adverse events and that’s going to shake things up. Also on Sermo, doctors are openly discussing drugs and drug companies are listening very hard.

Q: Can the Health 2.0 movement help bring down prescription drug prices for U.S. consumers? If so, how?

Matthew: Prices? No. Even if we could get totally transparent pricing on world markets, there’s not enough supply from outside the U.S. to significantly change pricing internally without major government intervention. Health 2.0 can certainly change how patients use drugs, hopefully for the better.

Indu: Hmm, I’d say Health 2.0 can bring drug prices down. I have a friend who is starting a different kind of Pharmacy Benefit Management (PBM) company (Web-enabled technology with evidence-based medical information sent to physicians) that will make drug prices a lot more transparent to employers and allow them to give their employees choices about where to fill their prescriptions to get the best price. So not immediately, but over time, this will empower stakeholders to negotiate and drug companies will have to respond and the fat middlemen in between will hopefully be squeezed.

Q: According to Ed Silverman, pharmaceutical companies say they can’t be more transparent (and thus fully take part in the Health 2.0 movement) because of “regulatory oversight, trade secrets and fear of litigation.” Do you think these barriers to transparency are real? Matthew: I think the drug industry is very comfortable doing what it has done for many years, and that it’s a very brave (foolhardy?!) CEO who would significantly change the balance of his marketing strategy from the things that work now — physician detailing and TV-based advertising. That to me is a bigger barrier to pharma diving into Health 2.0 than the regulatory oversight, etc. But pharma is just like the rest of the healthcare industry in that it could use a huge shock of transparency into both the data that it is sitting on, the totality of data from clinical trials it has and the way that it behaves — especially in its relationship with physicians. It’s just hard to be the first over the top, when profit margins are still pretty damn healthy. But I remain hopeful that a more transparent, ethical and innovative pharma industry is possible without completely blowing up the current model.

Indu: That’s a funny statement. Pharma companies will be forced into transparency whether they like it or not. It’s not their decision to make. So on Sermo when 40,000 doctors are online comparing early reports of adverse events that then go back to the FDA or when new types of PBMs expose wide and irrational ranges in pricing the information will force a conversation. They can hang out on the sidelines as long as they want, but the rest of the world is already in their business.