September 2, 1999
CARE MANAGEMENT ON
THE INTERNET: IF WE BUILD IT, WILL THEY COME?
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.
BANKING--NOT A FIELD OF DREAMS
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:
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
"...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.
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
RIGHT--ONLINE INVESTMENT SERVICES
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
CARE APPLICATIONS: IF WE BUILD IT, WILL THEY COME?
So what does all this have to do with health care and care
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:
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:
are many data points to capture in personal health and medical
Relevance of patient historical information (what if you had to
enter all your checks for the past 10 years?).
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
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
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
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.
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
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
TECHNOLOGIES HAS A NEW WEB SITE!
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
SURPRISE--SURVEY FINDS DOCTORS AND NURSES DON'T LOVE HMOS
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
doctors and 92% of nurses say it (managed care) has increased
the amount of administrative paperwork.
doctors and 85% of nurses say it has decreased time spent with
80% of doctors and 68% of nurses say it has decreased the
ability of patients to get the prescription drugs they need.
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
UPSIDES related to care management initiatives:
doctors and 51% of nurses say it has increased the use of
practice guidelines and disease management protocols.
doctors and 42% of nurses say it has increased the likelihood
that patients will get preventive services.
doctors and nurses say the biggest positive impact of managed
care on them and their patients is increased preventive
PHYSICIAN REPORT CARDS - WOULD MARCUS WELBY APPLAUD OR JEER?
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 (http://www.bhtinfo.com). BHT provides consulting and
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management, and patient health information technologies.
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