Birth Announcement: the Personal Health Information Network (PHIN)

Vince Kuraitis and David C. Kibbe, MD MBA 

The Internet and digital technologies have transformed many aspects of our lives over the past twenty years.  We can get cash at ATMs all over the world; we can book our own airline reservations; we can shop and get best prices over the Internet.

Why hasn’t this happened in health care?  Something is missing.

Recently, major global information and communication companies have announced their intention to bring their technologies and business models to health care.  While the creation of Google Health (GH), Microsoft HealthVault (HV), and Dossia (sponsors include Intel, Wal-Mart, AT&T) are important news items by themselves, what’s more important is what they represent collectively — a new Personal Health Information Network (PHIN). The PHIN and applications developed around the PHIN will fill in many missing pieces and bring health care into the Information Age.

For example, suppose you just found out you have high blood pressure – that’s not uncommon.  Suppose you could easily submit information about your condition using the Google Health platform to receive a service that does the following:

  • informs you whether there are clues in your medical history that point to a cause for your high blood pressure
  • explains why being overweight can be a contributing factor
  • tells you in easy-to understand language what the top number and the bottom number mean (“140 over 90”)
  • explains which laboratory tests are necessary
  • alerts you to the possibility that one of your prescription or over the counter  drugs could be making your high blood pressure worse
  • advises you about the usefulness of using non-drug approaches to treatment
  • tells you which treatment drugs have the greatest efficacy and safety for your specific circumstances
  • tells you if any of those generics high blood pressure drugs are available at Walgreens for $4 a month
  • offers to provide you a map with several Walgreens stores in your city that carry those $4 a month medications

…and many more possibilities we have not yet begun to imagine!

This essay:

  • Is the first in a series of articles we’ll be writing to describe the PHIN and why it’s important — expect about a dozen follow-up posts.
  • Is an overview of the basic idea — think executive summary or long abstract
  • Introduces some new concepts, which we’ll try to simplify and define.  We understand that some of this is not easy reading. ….so we suggest you refill your cup of coffee and settle in.

A First Comparison of Google Health and MS HealthVault

While details are thin, here’s a first pass at comparing and contrasting Google Health (GH) and Microsoft HealthVault (HV).  Overall, there are many common features, some differences, and many common challenges between these two platforms. 

A High Level Comparison

Google Health and Microsoft HealthVault Personal Health Information (PHI) Platforms

There’s still not much information available about the specifics of GH, although they did release sketchy information on the Official Google Blog.  I’ll comment on a few of the particulars.

HealthSpring “Gets” Physician Engagement.

I’ve written a lot recently about Medicare Health Support (MHS).  We are learning a lot from MHS about what DOESN’T work with the frail, elderly Medicare population.

 

But, what DOES work?

 

One key lesson emerging from MHS is the need to integrate and engage physicians and other local care providers…easier said than done.

 

MHS is just one of many experimental approaches being tried by Medicare.  Other approaches include the medical home model, Medicare Advantage plans, Special Needs Plans (SNPs), P4P, and a variety of other Medicare demos and pilot projects.  I’ve been critical of Medicare’s lack of transparency lately, but I applaud their innovation and experimentation.

 

While we definitely don’t have all the answers, I’d like to bring your attention one company that I believe has the right strategy and mindset: HealthSpring.  HealthSpring owns and operates Medicare Advantage plans in Alabama, Florida, Illinois, Mississippi, Tennessee and Texas and also offers a national stand-alone Medicare prescription drug plan. 

  

HealthSpring recently conducted an Investor Day meeting with financial analysts.  You can read the entire transcript of the meeting here — warning, it’s about 35 pages long.  I’ve culled through this presentation to dig out some best practices that HealthSpring is employing. 

$389 M of Healthways’ Market Value Vaporizes After CMS Announcement. What Happened?

Healthways stock price declined today by $10.52 (15.9%) after CMS “announcement” about ending Medicare Health Support (MHS) Phase 1.  This equates to a loss of $389 million in market capitalization…poof!  Gone. Healthways is one of the remaining five participants in the MHS program.

Without pointing fingers, it’s obvious that investors were surprised by the news.  What happened?

Connecting the Dots…Google Health Promises to Create AND Dominate Next Generation PHRs

Google Health (GH) could be the event of the decade in advancing health care reform — not just healthcare information technology (HIT) reform, but health care system reform. GH promises simultaneously to create AND dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.

While Google has not “officially” announced the details of GH, they’ve left a lot of clues. In this essay I’m going to play a combination of detective and tea leaf reader — deciphering existing clues and making some educated guesses about where GH is headed….it’s very exciting.

I get truly inspired when I see a business model that 1) is exceptionally powerful, and 2) offers dramatic benefits to humanity. Google Health is just such an animal.

Let me be clear. I am not speaking for Google; I don’t work for Google. This posting is my collection of inferences drawn from the clues provided about GH and from my general knowledge of health care and business. So when I write “GH will ______”, recognize that this is me putting together clues and applying my best judgment.

Here’s an overview:

  • The Current Market Structure for Personal Health Information (PHI)
  • GH’s Anticipated Technology Model
  • Three Leverage Points
  • GH Will Be Disruptive
  • Concluding Thoughts