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E-CareManagement News

April 1, 2000


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.


The e-health companies that are most likely to show interest in eDM fall into two subcategories: health portals (, 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 care delivery.

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 attracting viewers.

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 health.


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 system.
Some subcategories include:

  • DM Enablers (e.g., Health Hero  or Alere)
  • Clinical Work Flow Automation Software companies (e.g., Confer or Care Tools)
  • Electronic Medical Record (EMR) companies (e.g., MedicaLogic)
  • Application Service Providers (e.g., Trizetto)

    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, etc

    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 system.

    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 like.

    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.


    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."


    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.


    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?"

                                                                                        PERCENT "YES"
    a. Information about how to treat a disease                                 62%
    you or a family member has

    b. Information about a health care provider, such                         27%
    as doctor or a hospital

    c. Information about medicines or prescription drugs                    57%

    d. Information about ways to prevent illnesses                             52%

    f. Information about sexual health issues such                            17%
    as birth control, HIV, AIDS, or STD's

    g. Some other kind of health information                                     30%


    "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 structured.
  • 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.

    A recent feature article in Business 2.0 examines the 10 driving principles of the new economy:

    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 opportunity.
    9) Transactions - it's a one-on-one game.
    10) Impulse - every product is available everywhere.


    Pragmatic futurist Jeff Goldsmith examines this topic in his recent article in Health Affairs


    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 (  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

    You may copy, reprint or forward this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2000, Better Health Technologies, LLC. All rights reserved.

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