April 1, 2000
AN eDM SCORECARD:
WHO'S SUITING UP TO PLAY IN THE GAME?
A host of different organizations --
some old, some new -- are emerging from the wings to provide
disease/care management services and tools utilizing the Internet!
...and they are approaching the Internet disease management (eDM)
opportunity from very different angles.
Let's categorize organizations
scrutinizing eDM into four broad groupings:
1) Traditional Health Organizations
2) E-Health Companies: Business-to-Consumer (B2C)
3) E-Health Companies: Business-to-Business (B2B)
4) Other Technology Companies
How might each of these groups view
the eDM opportunity?
Traditional health organizations that
have shown interest in eDM include DM outsourcing companies,
hospitals, physician groups, health plans, pharmaceutical
manufacturers, pharmacy benefit management companies, and others.
Traditional health organizations are
more likely to view DM (and eDM) as their bread and butter. "It's
what we do for a living. We help take care of patients and their
diseases." These organizations are more likely to view DM as an END
in and of itself -- a core part of health care service delivery, and
often a direct service for which fees are charged.
COMPANIES: BUSINESS-TO-CONSUMER (B2C)
The e-health companies that are most
likely to show interest in eDM fall into two subcategories: health
portals (Drkoop.com, Mediconsult, Medscape, etc. ) and personal
health record companies (see
Informatics-Review for a listing of 17 of these companies).
Most of these companies are
start-ups, early stage ventures or recent initial public offerings (IPOs).
Many have roots more in "new media" or "e-commerce" than in health
These companies might well view eDM
as a MEANS, rather than an END.
A means to what? They are likely to view eDM as a STICKY APPLICATION
that will attract visitors to their web sites more often and for
longer visits. Wall Street is using metrics such as number of unique
users, total page views, page views per visitor, and similar
measures to evaluate and compare these companies. These companies
are more likely to be giving away free eDM tools as a way of
Why do they view eDM as a sticky
application? The very nature of DM refers to patients with CHRONIC
conditions. They will have ongoing needs for information, services,
drugs, etc. ....and their demographics and psychographics will be
viewed as highly desirable: 45+, computer literate, high levels of
discretionary income, more likely to be taking control of their own
COMPANIES: BUSINESS-TO-BUSINESS (B2B)
Companies in the B2B arena will view
eDM as a task in using the Internet to move VAST amounts of patient
information across multiple participants in the health care delivery
Some subcategories include:
Many other technology companies are
watching the eDM game from the sidelines...ready to jump in when
opportunities present. This includes a wide variety of other
companies -- software, computer hardware, Internet, communications,
We are aware that many large
companies whose roots are based in technology (software, networking,
communications, devices) have established e-health related divisions
or initiatives. These include Intel, Cisco, IBM, Bell Atlantic,
Motorola, Hewlett Packard, Kodak, Sprint, Microsoft, Lucent, Nortel,
Sun, and Oracle. (Who are we missing?)
These companies find the world of local health care delivery as both
opportunistic and daunting. It's opportunistic because health care
is the largest fragmented, cottage industry left to be
revolutionized by the Internet. It's daunting because of their
unfamiliarity with the local nature of health care delivery, the
politics, the culture, and the irrational economics of the health
These large organizations will also
view eDM as a MEANS, but for different reasons. For them, eDM
promises to be an application that holds great potential to leverage
computer and communications technologies. In plain old English, eDM
promises to be an application that can help sell a lot of computer
chips, software, web enabled phones and devices, data bases, and the
Is all this confusing? If your answer
is "Yes", then you've begun to appreciate the complexity of the eDM
opportunity. In summary, there are a wide variety of organizations
poised to be involved in eDM for a wide variety of reasons.
REMINDERS CAN IMPROVE PREVENTIVE CARE DELIVERY
A study in the
Archives of Internal Medicine assesses the impact of prompting
physicians about preventive measures for patients. The study
concludes that prompting can significantly increase preventive care
performance by 13.1%.
"Vigorous application of this simple
and effective information intervention could save thousands of lives
annually. Health care organizations could effectively use prompts,
alerts, or reminders to provide information to clinicians when
patient care decisions are made."
EXAMINES HEALTH PLAN PROGRESS IN USE OF WEB SITES
First Consulting Group (FCG) recently
published a study entitled "Health Plans on the Road to E-Health".
Their press release is available at
FCG; a link near
the bottom allows you to access the study.
This excellent analysis develops a
five stage model to examine the state-of-the-art in health plan
usage of web sites:
Stage One - Publish. Build Web
awareness by publishing information, e.g. company profile, news etc.
Stage Two - Interact. Engage
community by enabling interaction, e.g. online provider directory,
search formulary, interact with member services.
Stage Three - Transact. Self-service
capabilities and online transactions, e.g. online enrollment, online
referral processing, claims submission.
Stage Four - Integrate. Integrate
automation of many transactions to automate entire business
functions, e.g. online medical management.
Stage Five - Transform. Transform
entire enterprise, seamlessly integrating all processes, end-to-end
web-based interactions with customer and business partners.
The study concludes that most health
plans are in early Stage Two. Those in Stage Three are doing so as a
pilot or early rollout.
OF AMERICANS ON TECHNOLOGY"
The "National Survey of
Americans on Technology" is a random survey of adults and
children on their use of technology (i.e., computers, the Internet,
e-mail, faxes etc.). The survey is part of an ongoing project of
National Public Radio, the Kaiser Family Foundation and Harvard
University's Kennedy School of Government.
One question in the survey
specifically related to medical/health uses:
Question 27A (Asked of respondents
who have a computer at home to get health or medical information)
"Do you use a computer at home to get the following types of health
information, or not?"
a. Information about how to treat a disease
you or a family member has
b. Information about a health care
as doctor or a hospital
c. Information about medicines or
d. Information about ways to prevent
f. Information about sexual health
as birth control, HIV, AIDS, or STD's
g. Some other kind of health
REPORT ABOUT THE INTERNET'S EFFECTS
"e-volve: dot-com and beyond" is a
comprehensive 339-page report from
Bear Stearns. It assesses
the impact of the rise of the Internet on various industries. (click
on the "e-volve" icon on the left to access the table of contents or
to download the report).
Themes relating to health care:
On-line-based automation of
back-office functions (such as claims handling and payment tasks)
and increased use of procurement services could lead to
significant cost savings.
The improved connectivity that the
Internet brings could help alleviate problems that have plagued
the health care industry, such as imperfect pricing dynamics and
poor inventory and storage systems.
The advent of on-line disease
management programs will also lead to better cost controls.
Health care will become more
consumer-driven as 1) fees for health insurance products fall
(partially owing to more pricing transparency among managed care
plans); 2) more medical information is available via the Web; and
3) improved communication between doctor, patient, and pharmacist
helps consumers gain more control over how their health care is
The rise of the Internet could
lead to more standardized medicine, owing to improved
communication and more efficient data warehousing.
Drug sales are unlikely to rise
appreciably as a result of the expansion of the Internet, mostly
because of the continuing importance of the doctor and state and
federal restrictions when it comes to issuing prescriptions.
THE 10 DRIVING
PRINCIPLES OF THE NEW ECONOMY
A recent feature article in
Business 2.0 examines the 10 driving principles of the new
1) Matter - it matters less.
2) Space - distance has vanished.
3) Time - it's collapsing.
4) People - they're the crown jewels....and they know it.
5) Growth - it's accelerated by the network.
6) Value - it rises exponentially with market share.
7) Efficiency - the middleman lives.
8) Markets - buyers are gaining dramatic new power, and sellers new
9) Transactions - it's a one-on-one game.
10) Impulse - every product is available everywhere.
HOW WILL THE
INTERNET CHANGE OUR HEALTH SYSTEM?
Pragmatic futurist Jeff Goldsmith
examines this topic in his recent article in
PRACTICES ADOPT CASE MANAGEMENT TO CUT COSTS, IMPROVE CARE
An article in
Between Rounds discusses how even some small medical practices
have hired case managers to cut costs and improve patient care.
E-CareManagement News is an
e-newsletter that tracks a major change in health care and managed
care—the paradigm shift from “managing cost” to “managing care”.
This e-newsletter is brought to you by Better Health Technologies,
LLC (http://www.bhtinfo.com). BHT provides consulting and
business development services relating to disease management, demand
management, and patient health information technologies.
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