Past e-Newsletter Issues
HomeAbout BHTServicese-NewsletterCare ManagementContact Us


Sign Up for Better Health Technologies, Free

Thank you!

E-CareManagement News 

September 2, 1999


There are two sides to being a pioneer.  Some pioneers come back with stories about lands of milk and honey.  Other pioneers come back with bullet holes in their hats, or they don't come back at all.

Health care organizations can learn from Internet pioneers in other fields. In this issue, we will take a look at two types of Internet financial services applications.


First, let's take a look at folks with holes in their hats.

The headline of an August 18 press release from Cyber Dialogue reads "Online Banking Growth Stagnates Due to User Churn" Here are a few highlights from their study:

While the absolute number of people banking online grew slightly to a total of 6.3 million in the past 12 months, 3.1 million U.S. adults have discontinued their use of online banking.
Approximately 1/3 of online bank customers discontinued their accounts during the past 12 months.  (The 20% disenrollment rate experienced by a typical health plan looks pretty good in comparison!)
"...more than 50% have discontinued use because they find the service too complicated or were dissatisfied with the level of customer service," said Michael Weiksner, Manager of Finance Strategies at Cyber Dialogue.
The study also found that only 35% of online bankers that discontinued their service were inclined to try it again.

You can read additional commentary about this study at The Standard.


Then there are pioneers who have found lands of milk and honey.

In contrast to online banking, only 3% of investment traders who are online have discontinued trading online and 85% of current traders are satisfied with their service.  As a result, the number
of online traders has grown 53% from 4.0 million in July 1998 to 6.1 million in July 1999.

"Online brokerages like E*Trade and Schwab have demonstrated real leadership by investing aggressively in marketing and customer service," says Mr. Weiksner. "Banks must react in Internet time or risk losing the banking relationships of their most valuable customers."


So what does all this have to do with health care and care management?

A lot.  The financial services pioneers bring back lessons for Internet consumer health information applications.

We use the term "Internet consumer health information" (ICHI) fairly broadly.  For example, ICHI applications include:

Disease management (e.g., Softwatch)
Personal medical records stored on the Internet (e.g., Personal
Medical information sites and/or health portals (e.g.,, Mediconsult)
Medical consultation (Cyberdocs)

If not developed and executed properly, ICHI applications could have even HIGHER annual churn rates than the 33% experienced with online banking!

The gist of it:  if a relatively straightforward Internet application like online banking is having difficulties taking root, how can ICHI applications be successful? ::::::scary music::::::

We believe ICHI applications will be among the most difficult, if not THE most difficult to execute.  ICHI applications have at least three major challenges:

1)  USER FRIENDLINESS of the transaction. "Did I find what I was looking for quickly and easily? Was the presentation pleasing and entertaining?  Could I understand what I read?"
2)  CUSTOMIZATION and PERSONALIZATION of the information obtained. "Did I get information about my specific health care condition? Did I get information that I can act on?"  For example, the distinction here relates to the difference between finding general information about diabetes and finding out whether to raise or lower dosages for MY shot of insulin for TODAY.
3)  CUSTOMER SERVICE.  How are questions handled?  How are clients handled when they have difficulties or when something goes wrong?

We will discuss each of these.

1) USER FRIENDLINESS challenges.  Internet health care applications can be far more complex than online banking:

There are many data points to capture in personal health and medical information.
Relevance of patient historical information (what if you had to enter all your checks for the past 10 years?).
Health and medical information has a higher level of interaction (e.g., comorbid chronic conditions affecting medical advice).
Medicine is an imperfect, evolving science.  Much is yet to be discovered about many diseases. Clinical guidelines and protocols differ.

The tradeoff:  the more complex the application, the more difficult it will be to design a user friendly web site.

2)  CUSTOMIZATION and PERSONALIZATION challenges.  While today people appreciate generalized medical information over the Internet, there is far more value in providing personalized information.

There is an inherent dilemma in ICHI applications.  The more customized the information that is provided over the Internet, the closer you come to "practicing medicine" (diagnosing and/or recommending a treatment).  Understandably, most ICHI applications avoid crossing this line (at the least so that the executives don't spend time in jail).

3)  CUSTOMER SERVICE challenges.  In speaking personally with Mr. Weiksner of Cyber Dialogue, he emphasizes that this is the most important differentiating factor in the success of online brokerages and the difficulties experienced by online banks.  What kind of reputation do health care organizations have here?


We've learned about two types of financial services pioneers.  How can ICHI applications become more like online investment services than online banking services?

Execution, execution, execution.  Few health care companies will have the internal expertise or culture to support superb web applications.  Mr. Weiksner of Cyber Dialogue emphasizes that one of the key success factors of online investment services was that
they were able to develop their Internet applications autonomously (unlike online banks which have been an offshoot of their bricks and mortar parent companies).  Most health care organizations should outsource ICHI applications or develop partnerships.
Begin to integrate with local physicians TODAY!  Achieving optimal customization and personalization of patient information will require developing close ties to the patient's personal doctor.  If the concept of an Internet health portal can be successful, over time patients will expect not only the latest university research (content), but will expect a connection with THEIR doctor (scheduling, doctor/patient e-mail, test results,

Today, many Internet medical content companies appear far more focused on short term goals (increasing subscribers) at the expense of connecting with local health care providers.  We recognize that this  metric is driving financial valuations today, but it won't work in the long term.

Start in the shallow end of the pool.  Some organizations (e.g., health plans, hospitals, physician groups) will have a choice about where they begin Internet applications with their customers.  If possible, start with financial or administrative TRANSACTIONS-type web applications.  Diving into clinically or information oriented web applications can be like diving into the deep end of the pool.
For example, another study released August 25 by Cyber Dialogue showed that 78% of  Internet users covered by health insurance say that they are interested in managing their benefits through an insurance carrier's Web site
Measure the right statistics.  Today, the key metrics being quoted by Internet companies are imperfect.  Today's key metrics include:  number of page views, number of unique visitors, number of subscribers.  Over time, it will make a lot more sense to include metrics that measure the "stickiness" of the application, e.g., customer satisfaction with information received, % of repeat visitors, compliance with web based clinical protocols.
Choose your partners carefully. The August 23, 1999 issue of the Wall Street Journal reported that "...browsers in the e-marketplace of medical information will find that the quality is very diverse.  Some sites offer depth of data, with credentials to back them up.  Others display nice site design or easy access but have thin content."

We wish you the best in scouting new territories!


Thanks to Sharon Hultman of Gemini Graphics & Web Design for her patient and professional work on our new website.  If you missed earlier issues of our e-newsletter, you can now view them on the Past Issues page.


Researchers at Kaiser Family Foundation and the Harvard School of Public Health surveyed 1,053 doctors and 768 nurses.  Survey findings are available at their website.

Some highlights:


95% of doctors and 92% of nurses say it (managed care) has increased the amount of administrative paperwork.
83% of doctors and 85% of nurses say it has decreased time spent with patients.
80% of doctors and 68% of nurses say it has decreased the ability of patients to get the prescription drugs they need.
72% of doctors and 78% of nurses say it has decreased the quality of care for people who are sick.
Doctors say the biggest negative impact of managed care on their practices and patients is increased administrative paperwork; nurses say the biggest negative impact is decreased quality of care.

THE only UPSIDES related to care management initiatives:

68% of doctors and 51% of nurses say it has increased the use of practice guidelines and disease management protocols.
45% of doctors and 42% of nurses say it has increased the likelihood that patients will get preventive services.
Both doctors and nurses say the biggest positive impact of managed care on them and their patients is increased preventive services.


Pacificare just released its latest report cards on medical group and IPA performance.

The highest possible report card score is 100; best practice notations are awarded for physicians who scored in the 90th percentile on key clinical, service, and administrative performance measures. Physician groups whose grades are in the 90s will feel justifiably proud of their performance; those who scored a 2 (NOT a typo) are probably less delighted.

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 © 1999, Better Health Technologies, LLC. All rights reserved.

[Top of Page]  [Home]  [About Us]  [Services]  [E-Newsletter]  [Care Management]  [Contact]