I’m just back from San Diego, where Matthew Holt’s second Health 2.0 conference finished up on Tuesday evening. Some of the things I found interesting about the conference:
- There weren’t many doctors there. There were a few — some of them, like a brilliant young visionary named Dr. Jay Parkinson, doing remarkable things. But he was one of a handful in attendance. (Erick and Linda from PharmaSurveyor wore some cool mad-scientist lab coats at Monday’s cocktail party — but they aren’t physicians.)
- There weren’t many big healthcare players there, either. Sure, Johnson & Johnson was a sponsor, but the vibe was a little like GM’s interest in the electric car; do they really want to help lead this movement — or just monitor and contain it? (A side note: A J&J official, addressing attendees at a cocktail party J&J sponsored, announced that alcohol is a social lubricant, “as opposed to KY, which is a different kind of lubricant.” A plug’s a plug, I guess.)
- Even some bloggers who consider themselves experts on medical technology weren’t at this conference and didn’t want to be.
And yet, despite the sneers and snubs, I now believe more strongly than ever that Health 2.0 is the disruptive innovation that is going to turn the U.S. healthcare system on its head — and ultimately, save it from itself.
Health 2.0 will give doctors more time with patients. Health 2.0 will give patients control over their own health records. Health 2.0 will eliminate those annoying clipboard moments at the doctor’s office. Health 2.0 will make sure we don’t mix the wrong drugs. Health 2.0 will give people access to “been-there buddies” who can provide the support they need during the darkest periods of their lives. And Health 2.0 can help people to save money on prescription drugs, too. What we’ve seen so far is just the beginning.
eDrugSearch.com is proud to have been a sponsor of this conference. And we’re gratified to have received some great feedback from attendees on our site’s new community features. We’re confident the best is yet to come.
Still, we should probably at least fire the guy who wrote the eDrugSearch.com Community launch press release, because the folks at MedGadget didn’t like it.
Oh wait — I wrote that release. Nevermind.
We’re delighted to be a sponsor and participant in Matthew Holt’s Health 2.0 conference in San Diego today and tomorrow.
Though I won’t be able to attend, Scott Baradell – a strategic advisor who has worked closely with me since our company’s founding — will represent eDrugSearch.com at the event. Scott will be introducing the panel “Health 2.0: The future user experience?” moderated by Jane Sarasohn-Kahn and featuring panelists including:
- Thomas Goetz, Wired
- Esther Dyson, EDventure
- David Kibbe, MD, AAFP
- Doug Solomon, IDEO
- Scott Shreeve, MD, Crossover Healthcare
- Amy Tenderich, Diabetes Mine
Scott has promised to blog about his experience when he gets back.
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.
In our interview series leading up to the Health 2.0 conference in March, we’ve talked with Scott Shreeve of Crossover Health , Ed Silverman of Pharmalot, and Fard Johnmar of HealthcareVox. Today we share our interview with Jane Sarasohn-Kahn, a health economist and management consultant who founded the Think-Health consultancy in 1992. She is author of the Health Populi blog and a member of the Health 2.0 conference advisory board.
Q: In our interview with Scott Shreeve, he offered an expansive definition of Health 2.0. Matthew Holt’s definition has been narrower. What’s your definition of “Health 2.0″?
A: The phrase “Health 2.0″ has become somewhat loaded with marketing hype, even since the San Francisco conference. When it comes to defining the phrase, I’m a strict constructionist based on O’Reilly’s concept of Web 2.0. In that context, Health 2.0 is the application of Web 2.0 tools to health. In this case, “health” is broadly defined and includes but is not limited to health ‘care.’ Thus, Health 2.0 is the convergence of social media and health, enabling people (whether we call them patients, consumers, caregivers), providers (clinicians and institutions), payers (people, plans, sponsors such as employers, government agencies) and suppliers (pharma, med device cos., financial services cos., etc.) to work together. Health 2.0 enables transparency.
My take is thus more aligned with Matthew’s, although I am a fan of Scott’s vision of a new model for health, health care, and health financing. Scott’s definition is for a new-and-improved, even disruptive, health delivery, financing and consumption model.
Q: You have said that with Health 2.0, “consumers are turning the tables on old school health care, empowering themselves to bring greater balance to information asymmetry in health care.” Do you think most doctors, hospital systems, insurance companies, and pharmaceutical companies recognize that this is happening? How would you characterize their reaction to this consumer movement to this point?
A: Among the stakeholders you mention, health plans are ahead of the others. Look at The Health Care Scoop from Blue Cross and Blue Shield of Minnesota and Anthem’s alliance with Zagat. They recognize that social media are part of the consumer environment, and if they want to migrate toward consumer-directed health care, they need to provide greater transparency, information and tools that are consumer-manageable and -generated. Hospitals will be next to fall in line. Physicians tend to be resistant to consumer reviews and given the operating environment they’re in, this reaction is understandable. Still, there will be early adopters who may already be emailing with patients and are on the consumer-facing curve earlier than other doctors.
Finally, Big Pharma has been resistant due to what the industry perceives as regulatory and legal constraints: for example, liability for reporting adverse events to the FDA. But although many people don’t know this, many consumer-facing pharma brands have been monitoring social media for over two years to learn what’s being said about them, and bringing the learnings “home.” More will engage the way BCBS of Minn. is doing; for example, GSK is learning from its alli.com website for weight control. That is an OTC brand, but lessons will be learned across the business on the pharma side.
Q: What are the most exciting examples of Health 2.0 companies that are currently online, and why?
A: This is so fluid, and each week I find a couple of new entrants that are intriguing. I’ve already mentioned the “Scoop” which I see as a very brave and encouraging development by a health plan. Of course, health care is local and Minnesota isn’t necessarily Louisiana or Texas. But the Blues like to learn from each other, so I’m encouraged by the model.
Q:. How do you believe Health 2.0 will ultimately impact current issues in healthcare, such as the large number of uninsured, the inefficiencies of the current system, and the high cost of care?
A: Health 2.0 first enables transparency: sharing of opinions, information. This can impact quality by driving out, in the long run, poor providers based on consumers’ experiences. Similarly it can inform providers in a qualitative way how to improve their services. Transparency can also have an impact on the cost of care where consumers can shop around for services. We’ve seen this happen already with the advent of retail health clinics, which clearly post prices on their wall before services are rendered, and with medical tourism.
Health 2.0 in and of itself will not directly address the issue of access and the uninsured — but indirectly social media can impact these issues. Influentials online do gain attention for key issues, and health care is currently front-of-mind among consumers in this political year. If you look at the December Kaiser Health Tracking Poll, the #1 and #2 issues on voters’ collective minds are Iraq and health care. The economy, which had been a lower #3 issue, is increasing in concern based on the sub-prime mortgage crisis, the price of gas at the pump, and the negative impact on the stock market and Wall Street overall. Influential health bloggers, for example, raise the issue of access, which is then picked up by the mass media.
Q: Fard Johnmar has argued that Health 2.0 can’t really qualify as a “movement” until the various Health 2.0 startups begin cooperating in some formal structure, such as an advocacy group. Do you agree?
A: I’ve used the words “movement” and “Health 2.0″ in the same sentence. Fard is right insofar as to be a movement, there must be a confluence of early adopters to emerge in the adopter phase of Health 2.0. I’m not so certain we need to see a formal structure; that might go against the spirit of social media. I’m more concerned with adoption than what words we use to describe the phenomenon. It is what it is.
Q: What aspects of the Health 2.0 movement will have the biggest impact on the pharmaceutical industry, and specifically, the prices paid by consumers?
A: Transparency — I’m a broken record, but that is my bias as a health economist. There’s no flowing market with the flow of information, and when it comes to pharma, we’ve had lots of obscurity and opaqueness. But you don’t need social media to enable this; you need price lists which could be available in a 1.0 world. You can already cost-compare drug prices on Costco.com, and of course, Wal-Mart and others offer $4 generic scripts. So Health 2.0 isn’t necessary to drive down drug prices. Aggregation of purchasers is.
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? If so, how do you think the pharmaceutical industry might be able to overcome them in order to communicate more openly with consumers?
A: The pharma companies say this and live in a litigious environment. In all of the layoffs occurring in Big Pharma right now, there is still a full-employment act for lawyers and outside legal counsel. But as I’ve said, brand managers are tip-toeing into the world of social media and doing small experiments. This is the culture of pharma — it’s conservative, but teachable. And a new generation of leadership is about to supplant the Old School pharma executives at the C-level, and they are Blackberry-carrying, web-surfing people. So while pharma may be a late entrant, they can be fast followers.
So far in our interview series leading up to the March Health 2.0 conference, we have talked with Scott Shreeve of Crossover Health and Ed Silverman of Pharmalot. Today we share our discussion with Fard Johnmar, founder of Envision Solutions and author of HealthcareVox.
Q: When you write about the Health 2.0 movement, you tend to put “movement” in quotation marks — as if Health 2.0 WANTS to be a movement, but really isn’t one yet. Why not?
A: Let me clarify my intent. First, the term “Health 2.0″ is one that has generated come controversy, mainly because some wonder what “Health 1.0″ is and whether appending “2.0″ to health has any significance. I’ve spoken with Matthew Holt about this. Based on our conversations, I think he uses the term Health 2.0 as a type of shorthand observers can use to illustrate how technology is playing a greater role in health.
In my mind, a movement is a grassroots effort being driven by a group of people seeking to change an entrenched system from without. In a few respects, the Health 2.0 community certainly qualifies. Some entrepreneurs in this space are hoping that technology can solve the many problems health systems around the world face. And, they are actively working toward this goal. However, others, for various financial and personal interests, are less interested in this agenda. This is part of the reason that I put the word “movement” in quotation marks, because it does not yet qualify. However, I would also note that I’m not sure people in the Health 2.0 community want to change it into a movement. Rather, they are interested in finding ways to leverage new technologies to meet their various objectives.
Q: You argue that Health 2.0 companies are too fragmented to have a policy impact, and that they need to begin working together. How might this cooperation take form, and what do you think it can realistically achieve? (Can you provide a couple of specific examples?)
A: I’m not the only one who has suggested that the players in the Health 2.0 world come together around a common purpose. I’ve mentioned the ideas of Marty Tenenbaum, creator of CommerceNet previously. He has suggested that businesses in the Health 2.0 space come together to form a network that would have the intellectual, human and financial power to generate real change in the U.S. healthcare system. Now, there are certain problems that are best left to policymakers, such as improving access to quality care. However, there are a host of other issues, including increasing the public’s ability to understand (and influence) healthcare costs, that Health 2.0 advocates could come together around.
The health industry is filled with examples of coalitions and public-private partnerships that have achieved great good. We don’t have the time to go into many of them here. But, what I would say is that the best partnerships are organized to achieve specific, tangible goals. I think the first step would be for the folks who are driving Health 2.0 to decide what it is they want to change. Once that happens, the rest is simply strategy and tactics.
Q: Even if Health 2.0 entrepreneurs come together to form a network or advocacy group, isn’t the likelihood that the promising startups will just get bought up by large healthcare companies anyway? Would such acquisitions hurt or help the “movement” as it’s currently envisioned?
A: I think the goal of many startups is to be bought out by large companies (inside and outside of the health industry). However, if Health 2.0′s proponents decide to achieve universal objectives, personnel/businesses may shift, but others will take up the charge.
Q: What are the four or five most exciting examples of Health 2.0 companies or Web sites that are currently online, and why?
A: Well, I’ve talked quite a bit over the past few years about companies I think are doing exciting and interesting work. This may continue. However, recently I’ve been focusing on some overall issues that are important in health, that go way beyond individual firms — although some have greater or lesser influence on them. They are:
- Patient privacy
- Healthcare information control
- Health behavior change
Based on my reading of articles, blog posts and other media over the past year, I think there is a conflict brewing between established health companies, Internet startups, government agencies and managed care organizations around who will be able to effectively address each of these issues and how they will do it. For example, one important question is who can we trust to protect our privacy? This is critical because new companies (especially in the area of genetics) are starting to gather data about individuals in unprecedented ways. What are their responsibilities?
I’m starting to look at companies within this context. Firms that are operating at a high level (no matter their size or niche) that appear to have the most influence in these domains are the ones poised to make the most impact on the health industry. I’ll be focusing on this topic a great deal on my blog HealthcareVox this year.
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?
A: I’m not sure if Health 2.0 can impact access issues because that is something policymakers will have the most influence over. However, I do believe that technology can reduce inefficiencies and help consumers and others exert pressure on prices. This is because as pricing information becomes more widely available (and understandable), people (who will likely be asked to manage their own healthcare dollars) will gravitate toward the providers and services that provide the most benefit. This will take years, perhaps decades, but Health 2.0 technologies can certainly influence this process.
Q: What aspects of the Health 2.0 movement will have the biggest impact on the pharmaceutical industry, and on drug consumers? Can the Health 2.0 movement help bring down prescription drug prices for U.S. consumers?
A: Overall, prescription drug prices are out of the control of the individual consumer. The US regulatory/legislative structure has more influence on drug prices than technology and consumers ever will. In addition, with the flood of generic medications that will hit the market in a few years, drug prices have no where to go but down.
That being said, we are slowly moving to a system where drug companies are being asked to illustrate the benefit of their products in more profound ways. Technology will provide third party payers and consumers with detailed knowledge about the effectiveness of prescription drugs. I firmly believe that social media will help drive this trend because it will provide us — almost in real time — with information about drug side effects and real-world efficacy that is hard to get today. As more information becomes available, certain drugs will win while others will lose. I can’t predict how this will influence drug prices, but I’m sure it will have some impact.
Q: According to Ed Silverman at Pharmalot, 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? If so, how do you think the pharmaceutical industry might be able to overcome them in order to communicate more openly with consumers?
A: I certainly believe that the issues Ed mentions are very, very real. In many cases, it is much safer (and prudent) for organizations to remain silent about certain issues because of legal, ethical and regulatory concerns. However, there are a host of issues pharmaceutical companies can address that are pretty safe — especially at the corporate level. Given that the industry’s reputation is still poor (although some industry-backed surveys indicate it is improving) drug firms need to do a lot more to communicate about how and why they make decisions and be much more proactive and candid when communicating with the public. Social media can help.
In anticipation of the Health 2.0 “Connecting Consumers and Providers” conference in March, we are excited to announce that we are conducting a series of interviews with some of the top figures in the Health 2.0 movement (as well as some skeptics and other industry observers) for publication on the eDrugSearch Blog. Our intent is to run one interview per week between now and the end of February, for a total of 12 interviews.
Our goal is to extend awareness and discussion of Health 2.0 to a new audience — those who visit the eDrugSearch Blog either as prescription-drug consumers, Healthcare 100 bloggers, or others who may not to this point have gotten directly involved in the Health 2.0 conversation.
For our first interview, we talk with Scott Shreeve, MD, of Crossover Health and Lemhi Ventures. Scott, an avid blogger and co-founder of Medsphere (which he later left), has been a leading advocate of Health 2.0 as a key to addressing many of the frustrations of the current healthcare system.
Here’s our discussion with Scott:
Q: How do you define Health 2.0?
A: The definition I still favor is:
New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.
Even this core definition (January 24, 2007) of the term is not inclusive of another aspect of the term — it is encompassing of both the enabling technology PLUS the attendant healthcare reforms which must take place.
Health 2.0 is most appropriately described as an underlying movement within healthcare. So we not only need technology tools that make pricing transparency possible, but we need legislation that mandates this information be available to consumers. The technology informs us of what is possible, legislation defines how to make it happen, and the market ultimately determines what happens. It is the synergistic give and take which gives the movement momentum.
Q: On the Health 2.0 wiki, you argue for a more expansive definition of Health 2.0 than some others, such as Matthew Holt. Holt describes it as the application of Web 2.0 innovations to healthcare, whereas you argue that the term should represent something more — a movement to overhaul the way healthcare is delivered. Are these differences in definition important?
A: Words absolutely matter. My entire blog is dedicated to defining, redefining, or refining specific aspects of the health care delivery system. I start every blog with a definition, not only as a signature uniqueness to my blog, but also as an indicator that words (definitions) actually matter. I am surprised that Matthew, a solid policy thinker, would artifically limit the reach of Health 2.0 by saying,
Health 2.0 is a just a term that groups together the healthcare use of Web 2.0, which is in itself just a term for easy (& cheap!) to create and easy to use software that encompasses search, wikis, blogs, video, online communities, mash-ups and all the other stuff …it’s just a description of recognizable technologies that are an advance on the first generation of web tools. This has nothing to do with ‘outcomes’, ‘quality’, and ‘health reform’ and I guarantee you that Michael Porter (he had heard of it) hasn’t even heard the term.
While I am good personal friends with Matthew, he is dead wrong on this artificial definitional limitation. Health 2.0 will have everything to do with outcomes, quality, and health reform because it is the enabling and underlying technology that will make it possible. See a followup article on Health 2.0 by two other policy thinkers — Sarahson-Kahn and Klepper for validation.
Q: Who do you think will ultimately win this argument over the definition of Health 2.0, and why?
A: My open source background taught me alot about how arguments like this are won — they are won in the marketplace as people choose to adopt or not to adopt things based on the value (intrinsic, extrinsic, etc) that the item brings to them. So I am Darwinistic about this — let the best, most comprehensive, appropriate, real, and functional definition win. I believe if you asked Matthew now, he would have to admit that Health 2.0 is being adopted faster, is much bigger, and the appetite for more types of these innovations is more intense than he ever imagined (as demonstrated by the high powered Health 2.0 conference held in San Francisco; they increased the hotel conference size three times ). As a result, I believe you have to argue for a more expansive definition, and move away from “its just web technology applied in health” myopia.
Q: Do the major corporate players in the current healthcare system — insurance companies, pharmaceutical companies, and hospital systems — have more to gain or to fear from the Health 2.0 movement as you define it?
A:Healthcare is broken — talk to anyone. Everyone is throwing their hat in the mix to fix it — presidential candidates, large multinational companies, non-traditional health care players, infrastructure companies, and your grandma who is buying her pills over the internet. The major entities you mention — payers, players, and providers — have a lot to gain but also some things to lose in the new paradigm.
- First, the future of healthcare is centered in value (outcomes / price) and payors are going to have toe a completely new line around transparency, healthcare value they provide to their members, and the administrative / financial systems that drive care have to improve dramatically. Payers who can’t/won’t adapt will be undercut by nimble Health Plan 2.0 companies who will erode their market share.
- Secondly, pharma should benefit tremendously in its ability to have access to providers and patients in totally unpredicted ways. They will become the new voyeurs — paying for permission to observe large social networking sites of physicians, patients, and other providers settings. But they will have to also be much more transparent on their reporting of clinical trials, their pricing mechanisms, and their involvement in the medical-industrial complex.
- Finally, hospital systems are going to be exposed in ways that will initially be painful but ulimately will be their key differentiation — cost, quality, and access. Everything from straight pricing information, to quality reporting, to customer service, to outcomes data will be posted online and immediately accessible to anyone. There will be some pain, as the vaunted practice variation sees the light of day.
I believe the collective experience will be one of “some pain, prior to the gain”. Overall, however,transparency will prove transformative.
Q: Healthcare has been a major issue in this year’s presidential election, and yet I can’t recall any candidate discussing Health 2.0 technologies and how they may change the debate. What are your thoughts about the government’s role in healthcare?
A: I am not worried about any specific reference to Health 2.0 by the candidates as they are several cycles behind the curve on the latest innovations. However, I believe they have talked abundantly about the reform side of Health 2.0 which must include universal coverage, new models of healthcare financing, and the drive to improve quality, cost, and access. The government will continue to be a tremendous influence, hopefully not a driver, of healthcare in the future.
I believe the government’s proper role is to set the regulatory and perhaps even some of the financial framework for how care is delivered and how it is provided. Then, in my opinion, they need to get out of the way. The initial problem with capitalism is that the invisible hand of the market is often perceived as steady and capricious, but over time it typically bears out to be the best model of delivering every type of good. As an economist, I believe in this principle of free markets.
However, I realize that our current construct does not work and that American values dictate that healthcare should be a right. If this, in fact, is the will of the American people then we need to quit kidding ourselves and just put in a system where healthcare is a right and that if you are able to afford additional services, you should get additional benefits. This creates a two-tiered system, which I believe is unavoidable when healthcare is treated as a right (which I believe most people agree with until they have to pay the bill for someone else through taxes, subsidies, or rationing). The government will continue to be heavily involved, which then colors the entire healthcare reform debate with the darkest hues of red and blue.
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 high prices for treatment and prescription drugs?
A: I will try to take those one at a time:
- Uninsured. I am don’t believe that Health 2.0 is going to impact this issue — this is a policy decision. Once the policy has been set, then Health 2.0 can be applied to this agenda.
- Inefficiencies. Health 2.0 will be a major player here to create a much more inclusive “system” (in quotes because we really don’t have a system but a bunch of uncoordinated stops along the way). Health 2.0 engages people who have been disenfranchised (patients), disconnected (providers/patients), and discombobulated (payers/regulators). It is all about information, all about sharing, and all about connecting.
- High Drug Costs. Health 2.0 will help streamline the approval process, the clinical trials process, and the self reporting process. Also, evidence based medicine can be more quickly and widely applied through the dissemination of information that Health 2.0 can quickly achieve through blogs, wikis, email blasts, and other forms of electronic informational blitzkrieg. Drugs do cost alot of money to create, but there are efficiencies in multiple areas that can be gained through the smart application of Health 2.0 technology.
Q: What aspects of Health 2.0 should be of particular interest to the pharmaceutical industry today?
A: Big Pharma is drooling at the mouth regarding Health 2.0. Picking up on one aspect, would be the previously mentioned opportunity to voyeuristically peer into large social networked sites of physicians, patients, and other providers to see how they are responding, reacting, and ruminating on different drugs, prescribing patterns, side effects etc.
One of the coolest companies I have seen in this area is Patients Like Me which has developed essentially a real time reporting engine whereby all these patients (1,500+ and counting), are reporting their off label use of the medication, different dosing regimens, and all the associated symptomology in a way that would cost drug companies tens of millions to get — now they can have access to this information at a fraction of original cost. There are dozens of other examples.
Q: What aspects of Health 2.0 should be of particular interest to prescription drug consumers?
A: Health 2.0 is all about empowerment, about information sharing, and about helping people make informed decisions based on having information. One of my favorite prescription drug examples is how transparency eliminates disparities. I mean — seven miles from each other the pricing difference is astounding. Guess what happens when you start comparing medical procedures in this way. What about looking beyond pricing, and comparing quality of medical services in this way? What about comparing outcomes in this way? Again, the power of information in the hands of the consumers is an unbelievable force for change within the new Health 2.0 paradigm.
Q: Do you still practice as an emergency physician? If not, do you miss it?
A: Unfortunately, the demands of starting Medsphere and now my current roles have precluded me from continuing to practice traditional medicine in my chosen specialty of emergency medicine. However, I have also seen my profession as a platform for my chosen profession — igniting a revolution in the delivery of healthcare.
I do miss some very satisifying aspects of my practice (great interactions with patients, ability to solve problem, knowing that your individual skills can save lives, and the great teamwork of the other healthcare providers), but I certainly do not miss other aspects (bad interactions with patients, inability to solve problems, knowing that my skills were not enough to save lives, the challenges of working within a broken system, the liability environment, etc). I have been able to reconcile my decision by the passion I feel for resolving one of the largest problems we face as a nation. I also believe my very unique background has provided me with a vista, a vision, and a verve to go after fixing these problems.
Here’s an interview with the CEO, Steven Krein of Organized Wisdom, from Matthew Holt’s recent Health 2.0 conference. The company’s not in our space, but has an interesting business model. (We like ours a little better, though.)
This is actually a second attempt at getting off the ground for the startup, according to Fard Johnmar. Here’s his take.
Subscribe in a reader