October 7, 1999
A PROTOTYPE FOR CLICKS AND MORTAR DISEASE MANAGEMENT
David Pottruck, the co-CEO of Charles
Schwab, recently coined the phrase "clicks and mortar" to describe
the formula for success in the new economy. An
article by Jonathan Weber in the Industry Standard
describes the essence of
this new catchphrase:
basic concept...is that the most successful businesses of this
remarkable era will combine the power of the Internet with the
ability to operate effectively in the offline world."
Pottruck uses the brokerage company Charles Schwab as his prime
example. Schwab initially launched its online service as a
separate operation. "It soon became clear that online customers
wanted the same level of service as Schwab's telephone and
retail customers, and offline customers wanted the low prices
online customers enjoyed. Despite the considerable short term
costs, the company decided last year to do away with the
online/offline distinction--and the results have been
focal point of clicks and mortar must be customer relationships.
Says Pottruck, "The true meaning of the word 'mortar'....is
people." The operative word in clicks and mortar is "AND".
Despite the ubiquity of the Internet (clicks), and the commonly
accepted adage that health care is a local business (mortar),
successful business and clinical models of care management will
need to provide the best of both worlds.
discussion of Ethan Allen's clicks and mortar initiative.
PROPOSITIONS OF "CLICKS" and of "MORTAR"
In health care there are traditional
"mortar" (bricks and mortar) organizations. This includes hospitals,
physicians and other care providers, and health plans. In most local
markets, these players have been combining to develop integrated
delivery systems (IDSs).
Then there are newer "clicks"
oriented organizations pursuing care management approaches. For
example, a number of companies are trying to establish themselves as
health information portals (e.g., allhealth.com, a division of
ivillage). Others include pure-play e-health companies, clinical
software developers, practice management software companies, etc.
(These companies are more difficult to peg; remember that the
distinguishing factor here is the primary reliance on Internet
The value proposition of traditional
"mortar" oriented organizations typically relates to INTEGRATION.
For example, a local IDS might articulate its value proposition as
"We coordinate care across the continuum and provide
one-stop-shopping in a defined geographic region, thereby lowering
costs and improving quality."
The value proposition of a "clicks"
company relates more to SPECIALIZATION. For example, an Internet
health information portal might articulate its value proposition as
"We provide specialized health information--the latest information,
from the most credible sources, written in a way that you can
understand. We use the Internet to reach a worldwide audience, and
that allows us to develop critical mass and scale to provide
information to you."
Other types of specialization could
include disease knowledge, information systems, technologies, etc..
Which value proposition--INTEGRATION or SPECIALIZATION--is more
important? The answer is--BOTH!
And that brings us to the essence of
clicks AND mortar-combining the value propositions of SPECIALIZATION
and INTEGRATION! We believe successful business models for chronic
care patients must combine specialization and integration. (This
hybrid model of care has also been referred to as a carve-in.
Describing carve-in and carve-out care management models is beyond
the scope of this e-newsletter. However, a framework for
understanding carve-out, carve-in, and IDS approaches to care
management is available on
CLICKS AND MORTAR DISEASE MANAGEMENT
Accordant Health Services is one company that has understood the
clicks and mortar concept for a long time. Accordant is a disease
management (DM) company with a special focus on individuals living
with high impact, complex chronic diseases. Its goals are to improve
clinical, functional, satisfaction, and cost of care outcomes.
Accordant focuses on 14 diseases, including lupus, hemophilia,
cystic fibrosis, myasthenia gravis, multiple sclerosis, and
Accordant's DM programs are based on
the premise that complex, chronic disorders are characterized by
catastrophic crises, co-morbidities and complications that are
preventable and manageable.
Accordant's services are typically
sponsored by health plans. The diseases covered by Accordant are
rare--only about 1/2 of 1% (.043%) of the population will have any
of them. However, these patients incur an average of $12,000 per
year in medical bills.
President Steven Schelhammer notes
that "Accordant has had a carve-in approach since it's inception. We
work with the patient's existing medical community. Accordant works
with the patient's physician to support the existing relationship
between the doctor and the patient."
ACCORDANT'S USE OF
SUPPORTING TECHNOLOGY TO DELIVER CLICKS AND MORTAR CARE
Accordant uses technology to further
its clicks and mortar approach. The key to Accordant's success is
providing patients and their physicians with information about a
patient's condition BEFORE that condition results in a high cost
emergency room visit or hospitalization. Both the patient and the
physician become empowered through technology and information.
About 40% of Accordant's patients
have Internet access and a majority of them choose to connect with
the company this way. This is a high level of connectivity, and it
shows how patients with complex diseases thirst for information and
are willing to be involved in their own care.
Accordant is developing tools using
Internet and computer telephony technologies to support its DM
A Patient Web Portal
as a destination for specialized health information
provides general health, disease, and pharmaceutical information
creates patient communities for many of Accordant's targeted
enables direct patient access to leading physicians and national
patient-requested chat rooms, bulletin boards, and other online
delivers online health assessment tools and electronic patient
facilitates online communication with Accordant nurses
provides links to additional resources and medical/physician
A 24-hour medical call center
number for easy patient access
based routing (calls are routed to the most qualified nurse
available to speak with a patient)
pop technologies to support caller ID and automated patient
center and Internet integration
decision-support system includes a longitudinal database and
customized software to support enrollment and ongoing patient care
management. It is also developing a corporate intranet to keep
clinical resources used by nurses organized and available
How do patients benefit? Accordant is
able to deliver both SPECIALIZATION and INTEGRATION. Accordant uses
technology to deliver specialized, up-to-date, research based
information to patients. This information is integrated into a care
plan that keeps the patient's doctor and local care team all on the
Accordant is pioneering combining the
best of the online and offline worlds--clicks and mortar disease
AN UPDATE ON
ASPs--TRIZETTO FILES S1 STATEMENT
20 issue of our e-newsletter featured an article on health care
application service providers (ASPs). The TriZetto Group is a health
care ASP that has recently filed and updated its prospectus (S1), a
document filed with the
Securities and Exchange Commission prior to going public.
In particular, the "Prospectus
Summary" (p.4) and the section describing the company's "Business"
(p.37) provide valuable insights into the market for health care
ASPs. TriZetto's initial applications relate to automating existing
transactions, with references to future availability of clinical
PRACTICES--IMPLEMENTING CLINICAL GUIDELINES
Truck Phenomenon described in a previous edition of our
e-newsletter? This refers to a weak link in the health care value
chain that occurs when health plans and physicians don't work
together to develop and implement clinical care guidelines. An
Modern Physician magazine describes how some health plans and
physicians are licking this problem.
CHAPTER, BEHAVIORAL DISEASE MANAGEMENT BOOK
Patrick Vega MS, is the editor of a
new book entitled Behavioral Disease Management (Manisses
Communications Group, 1999). You can
read about and order the book.
One chapter of the book, "Behavioral
Health Carve-Ins: The Next Generation of Specialized and Integrated
Care Care" is co-authored by Dave Johnson and Vince Kuraitis. Drop a
note to firstname.lastname@example.org if you'd like a complimentary copy (Adobe
.pdf format). Please put "BEHAVIORAL DM CHAPTER" in the subject
Manhattan Research is offering
free subscriptions to their Internet Update publication. The
September/October edition contains 89 pages of articles, statistics,
press releases, and more.
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
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management, and patient health information technologies.
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