Can Consumers and Health IT Find a Business Model?

by Jane Sarasohn-Kahn
Twitter: @healthpopuli

Two health conferences held on opposite coasts of the U.S. in June both addressed the role of consumers in health from two very different vantage points: the government’s Open Data Initiative vis-à-vis Silicon Valley’s opportunities for investing in consumer health.

Taken together, the discussions flowing from these two quite separate agendas drive toward one major question: Is there a business model for consumers in health IT? The answer lies in understanding how consumers frame the definition of “health” for themselves, the roles of trust and branding, and choice architectures that move people to do the right thing when it comes to personal health choices.

I had the opportunity to attend both of these events: the fourth annual Health Datapalooza, held in Washington DC on June 3-4 and, the second annual Consumer Health & Wellness Innovation Summit in San Francisco on June 11.

Consumer engagement: flavor of 2013.
At both meetings, consumer health engagement was a central theme. Setting a strategic context for consumers in health was an observation offered by Jordan Shlain at the Wellness meeting. Shlain wears many hats including physician, health care start-up adviser and founder of HealthLoop, a physician-patient engagement tool. During the panel on “Transforming and Diversifying Provider Organizations,” Shlain pointed out that “there are very few consumers in health care. No one wants to consume an illness, a pill or a disease. When you are healthy, you make decisions based on cost and convenience and ask Dr. Google. When you’re sick, you don’t want hyperlinks: you want humanity, someone to guide you through the process.”

This theme of a consumer’s need for a health sherpa or navigator came through both conferences. “Talk about things people really care about,” recommended Bryce Williams, vice president of Wellbeing at Blue Shield of California. “Health and wellness is the ultimate meritocracy. We can be field guides — that’s what I aspire to.”

Connecting dots for patients trying to navigate the fragmented health system was recommended by Erin Rech of Ridgeview Medical Center, who is also working with wellclicks, a heath engagement company. She pointed out that “health systems don’t want another non-integrated service.” Rech is working with providers and health plans to develop an integrated platform “to connect the customers back to local individualized resources to create a more holistic experience,” she told the attendees at the Wellness meeting.

Another organization trying to shepherd health consumers in local communities is Walgreens, represented at the Wellness symposium by Jay Rosan, senior vice president of Health Innovation at the pharmacy company. “Medicine is mediocre, which I hate to say as a physician,” Dr. Rosan admitted. He pointed out that medicine doesn’t understand consumer segmentation.

Because at least six million people enter a Walgreens store front every day, he said, the company has developed a platform to “add anything we want to drive healthier behavior.” The company launched its first loyalty program, Balance Rewards, in September 2012 and grew from zero members to 70 million members as of June.

“Imagine if we marry fitness self-tracking data to the pharmacy claims data in the cloud?” Rosan asked. He mentioned Walgreens’ Steps with Balance Rewards program where members earn points for sharing their fitness data (generated via BodyMedia, Fitbit, and Withings devices, which are currently used in the program). Launched in April, Steps with Balance had 150,000 members as of mid-June.

Importantly, Walgreens compares itself to consumer-facing brands like hotels and banks, not health care or medical companies.

As consumer-directed care takes on greater market share in America, consumers may look to branding to help them choose between health plans, prescription drugs requiring bigger co-payments and retail health services. But brands are still young in health care.

Malcolm Bohm of Liquid Grids analyzes online conversations about health. After examining more than one billion discussions about health care, the firm learned that only 2% of consumer conversations are about brand. They are, instead, “mostly about health experiences,” Bohm said. “From a brand’s perspective you have to appeal to what the dialogue is about: it’s not about brand, it’s about them,” the person/patient, Bohm concluded.

There are a handful of nationally embraced health brands, one of which is the Mayo Clinic. Jeff Cross of Mayo talked about his role for bolstering Mayo outside the Clinic focusing on consumers who aren’t affiliated with the Clinic as patients. His group is helping consumers with interactions with the health system — including how to stay away from it. Mayo Clinic is working with Better to streamline community-based service delivery via a mobile health app. Mayo has the “audacious goal” (according to Cross) of reaching 200 million lives by 2020. To do so will mean connecting in new ways with consumers through different means than currently used.

Cross’ objective of keeping health citizens outside of the Clinic — that is, well — means supporting people in the community before they need to access the health care system. For Blue Shield of California, Williams said, this means transforming into a new model that grabs people’s attention and acts behaviorally, designed on choice architectures. “Why do well-intentioned people cause negative choices to happen?” Cross asked.

The solution Martin Watson of SeeChange Health described bundling motivational rewards into health benefit design. The focus is to build systems based on behavioral economics, learning what triggers people to make good health decisions. Watson has learned that it’s not hard to attract people for a first engagement in a good health decision; it’s much trickier to get people to make good health decisions, incentivized, over time.

Both meetings were bullish on the role of health IT to drive the Triple Aim — to reduce costs, enhance customer experience and improve quality.

U.S. Chief Technology Officer Todd Park told Health Datapalooza-goers that “there has never been a better time to be an innovator at the intersection of health, data and IT.” Park called out several key reasons driving that opportunity.

  1. The emergence of a smarter health system focused on quality, not quantity of care — avoiding mistakes, driving patient health engagement, and promoting accountable and coordinated care that “rewards the stitch in time” that saves patients and improves quality of care, Park described.
  2. Historic increases in adoption and use of electronic health records — empowered by the HITECH Act. “At long last manila folders are turning into electrons,” Park said.
  3. A growing supply of government-created health information from charges and quality to regional health statistics and the latest science, available in computer readable downloadable form — especially important for entrepreneurs to corral and apply to innovation. This is emanating from CMS’ Office of Information Products and Data Analytics.
  4. The launch of health insurance exchanges, where Park says small businesses will have similar opportunities as big companies to access new health insurance plan models that use data to improve customers’ experiences.

To succeed, though, innovators will need to disrupt the siloes in health care that have grown up on incentives: especially, health care reimbursement.

Lisa Suennen of Psilos Ventures, who chaired the Wellness summit, said “the health care industry has been built on throughput, not personalization and people. We have system designed around financial incentives giving little credence to consumer desires.”

She noted that today, 25% of the Fortune 500 are “firmly” in the health industry and 50% have some health business, or are trying to grow in health, naming Apple, Verizon and Walmart among these companies. “These will be the ones to save the system,” Suennen predicted.

Successful consumer-facing health IT business models will bring together trusted branding and deep understanding of consumer segmentation — which is why incumbent health companies will need to partner with and learn from organizations from outside of health “care.”

This article was originally published on and is republished here with permission.