I am soooo behind on sharing everything that is going on around me related to healthcare, employers, consumerism, and the proposed government ‘public plan’ for healthcare [I get 2-3 phone calls a week from various system constituents and politicians posing questions, ideas, or plans around healthcare consumerism].  However, what causes me to perk up is when ‘front-line and in-the-trenches’ discussions surface across the blog-o-sphere such as the one taking place over on Dr. Jay Parkinson’s blog of HelloHealth [click here for the blog post].

Of most interest to me (selfishly) is an insightful comment made by the Orthopod:

…In one of the only examples of its kind, a true randomized placebo trial was published on this in NEJM and there was found to be no difference in outcome for knee scope in pts with joint space narrowing, yet the procedure continues to be done at a very high rate.  Why?  Because it pays $800-$1000.  And it takes 1/2 hour.  In fact there are studies showing that people who get scoped, go on to get a knee replacement sooner.   I don’t know if any committee is the solution.  Since patients don’t pay their own money, they are not incentivized to ask the right questions or be skeptical enough. And the CMS fixed pie system makes the PMD/ specialist war almost inevitable.  Sad.

PUH-LEAZ-EEEEE  go read the full post but MORE IMPORTANTLY read further down where the Orthopod adds a longer follow-up comment.  This frame of reference from the front-line is worth the 10min time it takes to read.

Nice, Jay. Simply Nice and Well framed.

Congratulations

Congratulations on your continued progress in gaining commitments from insurance companies to step away from the Ingenix Prevailing Healthcare Charges System (the database most health insurers use to determine “usual and customary rates” for out-of-network reimbursement rates). Most individuals inside and outside of the industry recognize the potential conflict of interest as well as the likelihood that what Ingenix defined as “reasonable” was probably less than reasonable by a significant margin.

And Then I Read…

My understanding of your settlement with each insurance Carrier (such as Wellpoint and Aetna) is based on the following excerpt::

…WellPoint will end use of the [Ingenix] database [to determine out-of-network reimbursements] and pay $10 million to help finance the development of a new independent database administered by a not-for-profit group. Cuomo, who reached similar agreements with five other health insurers earlier this year, said that his office hopes to have the new database operational in six months and estimated that the effort will cost about $100 million (Bray, Wall Street Journal, 2/19).

Without question, I applaud your efforts and commitment to create a not-for-profit entity that ensures objective, transparent and reasonable out-of-network insurance pricing. Spot on, sir. But an estimated cost of $100 million?! Good grief, I was caused to pause and try digest such a staggering expense for an informational tool that shouldn’t, nay, couldn’t cost that much.

A Drop In The Bucket

I then came across a New York Times article (2/18/09) entitled “For Uninsured Young Adults, Do-It-Yourself Health Care.  I contemplated the plight of New Yorkers but also people across the nation and noted that Gov. Paterson of New York proposed allowing parents to claim young adults as dependents for insurance purposes up to age 29. Unfortunately, this approach merely supports what I consider “a drop in the bucket“, as the article pointed out…

If Governor Paterson’s proposal is approved, an estimated 80,000 of the 775,000 uninsured young adults across New York State would be covered under their parents’ insurance plans. That would leave hundreds of thousands to continue relying on a scattershot network of improvised and often haphazard health care remedies.

And then the final straw smacked me in the face via yesterday’s (2/24/09) Washington (Associated Press) causing me to draw a deep breath while reading:

A new government report on medical costs paints a stark picture for President Barack Obama, who is expected to call for a health care overhaul in a speech Tuesday night to a joint session of Congress.

Even before lawmakers start debating how care is delivered to the American people, the report shows the economy is making the job of reform harder.

Health care costs will top $8,000 per person this year, consuming an ever-bigger slice of a shrinking economic pie, says the report by the Department of Health and Human Services, due out Tuesday.

As the recession cuts into tax receipts, Medicare’s giant hospital trust fund is running out of cash more rapidly, and could become insolvent as early as 2016, the report said. That’s three years sooner than previously forecast.

Based on current events and the state of our economy … The Offer

I would like to offer the LIVE and fully accessible healthcare consumerism change:healthcare platform, which currently is processing claims from multiple clients as a vastly less expensive, already HIPAA compliant and available TODAY for data connection to the carriers.

In fact, I would also be so bold as to say that we would offer our platform and Carrier integration for $3 million a year OR our annual operating/staff support cost (whichever is less) and we would immediately engage whichever University or not-for-profit entity you prefer for database auditing and oversight purposes.

I am offering you and the carriers an immediately available, already proven and secure platform that is currently used by employers and their employees to save money (30%) on their healthcare expenses and make informed decisions.  I’d rather you and the Carriers leverage our platform at “cost” than to unnecessarily spend $100 million to build something that already exists.  We would be doing this for the public good, but that’s in line with our company values and founding principles!

Why do we care?

I have been holding back on this proposition for several months, but my blood was brought to a “I’ve got to do something now” boiling point due to the February 19th USA Today article by Julie Appleby regarding double-digit premium increases on the individual insurance market (est. at 17 million people):

At a time when more people are forced to buy their own health insurance because of job losses, costs for many individual policies are soaring…

Among this year’s large rate increases on the individual market:

• Anthem Blue Cross in California has notified about 80% of its 800,000 individual policyholders of double-digit increases, many above 30%. Spokesman Ben Singer says rising medical costs are prompting the increases.
• Blue Cross of Michigan is seeking state approval for a 56% increase in individual premiums. Spokesman Andy Hetzel says the company needs to offset losses stemming from state rules making it the sole insurer required to take all applicants.
• Regence Blue Cross Blue Shield of Oregon will raise rates for approximately 10,000 Washington state customers by 27.1% on March 1.

Another Washington insurer, LifeWise, raised rates 17.6% on Jan. 1, according to the Office of the Insurance Commissioner in Washington state…Some insurers say increases this year for individual policies aren’t out of the ordinary. Aetna, for example, says individual policy increases nationwide range from 8% to 22%.

…The average deductible, the amount paid before coverage begins, was nearly $2,000. Family coverage ranged from $219 to $494 a month with an average $2,600 deductible.

Insurers face shrinking enrollment in group plans because employers are shedding jobs. They also have deflated investment portfolios and higher costs as patients use more health services, says a report out last week from ratings agency A.M. Best. Those problems could lead to “higher rate increases than in the past,” says Sally Rosen, a managing senior financial analyst at Best.

Now it would be foolish of me to urge insurers to restrain premium increases. They are merely operating as businesses as any stock shareholder would expect (though I find a great deal of irony regarding these potential increases that will fall on the heels of the government’s COBRA subsidy plan for the recently unemployed). Yet, due to these decisions, there will be an immense welling of pressure on individuals to pay more for their premiums, swallow higher deductibles, and therefore urgently need help to understand and know where EVERY dollar is being spent and what their choices are.

As the tidal-wave of healthcare cost and utilization drowns individuals bearing the full weight of those costs, a dire need is raising it’s ugly head: The need for access to easily understandable negotiated prices for providers and the services they offer, allowing consumers to make informed decisions as well as save money that most of these people do not have. It’s rather simple, we need to enable a more transparent market for purchasing healthcare services. It’s not THE silver bullet, but rather one of many support mechanism that needs to be put into place.

Not a Perfect Solution, but it’s a start…

So there you have it. The wheels have begun rolling forward and what I am offering may seem trivial or naive but at least let us do something that would help you provide people with an easy to use tool at a fraction of the cost… in fact, at OUR cost.  I am offering our platform to support healthcare transparency combined with your choice of University or not-for-profit entity to ensure that out-of-network pricing remains independent and avoids (in your words) “manipulation”… all for $97 million dollars less than you anticipated. And yes, I really do stand behind this offer. Please feel free to contact me or my team to coordinate further discussions about our platform.

Sincerely,

christopher parks

CEO | co-founder
change:healthcare, Inc.

For the past week, this rather provoking nugget of insight has been floating around from a person (Robert Scoble) who has become a high visible and open person about his doings and daily experiences. What I find most interesting are the comments from various Health-thinkers, bloggers, and Tweeters.

I will be the first to admit that this group represent a small segment of the population, but the comments truly elicit self-evaluation and insight into just want does “Privacy” mean to individuals?  Are what people MOST concerned with “privacy” or more likely “control” of one’s personal information? There’s no answer in the conversation below, but it certainly sirs ideological positions.

The original string of thought can be found at FriendFeed (a conversation aggregation tool that I love) for Robert Scoble http://friendfeed.com/e/08954685-00fe-4e55-b28f-4b99f83bfb0d/Health-privacy-is-dead-Here-s-why/ PLEASE, please, puh-leeeazee add to the conversation and perspective.  Below are some samplings of the discussion:

“Health privacy is dead. Here’s why:”

January 20 at 10:25 pm

1. By disclosing your weird diseases other people help you out and get you more information than your own doctor can. – Robert Scoble

2. By disclosing your weird diseases, other people give you ideas you would never have thought of. (This happened to me tonight). – Robert Scoble

3. By disclosing your weird diseases you feel better just by telling other people what’s going on in your life. – Robert Scoble

4. By disclosing your weird diseases other people can make sure you don’t “cheat” on your treatment plan. – Robert Scoble

Absolutely. We got lots of great information from blogs & forums when my husband was diagnosed with liver cancer. It was through social media that we learned the transplant programs in Shanghai probably used condemned political prisoners as donors. Also, doctors sometimes won’t tell you things for fear of malpractice or being wrong. – Robyn McIntyre

It’s not a violation of privacy if you chose to disclose your health issues. Privacy is violated when others access or profit from your record without your express consent. – David McCallie

I always love it when Scoble tells why something is dead, especially when it’s alive. – genieyclo is legal

Your disclosure is your business and always has been. It’s others disclosures when you don’t want it to be that’s the issues I would think. – John Rubier

The interaction also provides a feedback loop into the medical community – esp in areas like Oncology where all sorts of mixed/weird treatments are being tried. Many docs are also experimenting with holostic approaches, incl diet and drugs. And the Genetics Testing whirlwind is about to hit – further stretching what we don’t know and pushing people to seek out others with same genetic predispositions. – texaszman

5. By disclosing your weird disease, you don’t get that job you applied for because they saw you have [insert weird disease here] – John Rubier

John: our ideas of privacy have totally changed. 20 years ago I would NEVER have told my community my weird diseases. Today? There’s HUGE benefits to doing so. And, if you are on a medical treatment plan you should put your medications into an online database which can warn you about problems before your doctor will even know about problems. – Robert Scoble

The real issue is what happens when privacy is lost. Currently, you’d probably lose the ability to get insurance, or perhaps to retain or get a new job. We need to fix the laws to protect us from inadvertent (or willful) disclosure of personal health data. The GINA laws are a step in the right direction, but they only apply to “genetic” information (as if there is any health information that isn’t at some level “genetic!”) – David McCallie

For the majority of people there is very little value for someone to gain from finding out you are having an invasive procedure such as a colonoscopy, have a health problem or have a funny rash. There are much larger health benefits to be gained by allowing your healthcare provider to openly share you information between providers/organizations. There is also much social value in having information open for research. – Robert D. Fraser

Mathew: the thing is, the insurance world now knows about my condition. So, if they are going to discriminate against me, they already have that info. In the meantime, by keeping it quiet I don’t get the other benefits. – Robert Scoble

Robert: the example I mentioned was someone with a back injury from ‘work’ who was receiving compensation benefits and posted something on their facebook about getting injured in a football game that same week. – Mathew Packer

Robert Fraser: I disagree. My wife recently shared her funny rash (her doctor thought she had an infection and was trying to treat it with anti biotics. One of her Facebook friends said “looks like you have Shingles.” Turns out the doctor was wrong and the Facebook friend was right. – Robert Scoble

re: health privacy – are people just not getting what scoble means here? if the advantages to being open about these health issues are great enough (and the advantages are becoming greater due to social networks for instance) then health privacy will die because nobody really will want to keep these things private …. nothing to do with the doctor/hospital side of things – Chris Heath

Chris: exactly. We are in a weird place where insurance companies can use this data against you (if they don’t have it already, which in my case isn’t true). There are other cases where diseases are socially negative, like sexually-transmitted diseases. But people will see that for 98% of the health problems they’ll have there’s a benefit to talking it through online. – Robert Scoble

Certain parts of our medical history have been for sale for a long time, insurance companies, the MIB, been writing about this for 2 years, it’s really almost who writes the best algorithms, I post more breaches about government systems than private industry, DOD 2 weeks ago – Barbara Duck

Don’t you owe us 20 more reasons? I became a big believer in sharing when the Internet helped me find others having the same reaction to a new MS drug & discover what other drug we all had in common Happened in 1995! Company was stunned, but soon shared “possible interaction” on warning list – mcwflint

More importantly, there are billions of dollars traded arcross the globe daily and people are still unsure if they want to have an electronic health record, why is this? – Robert D. Fraser

What works for me is posting health woes in a semi-private place like Facebook. I had no idea that several of my friends had thyroid and/or adrenal issues, and we wound up having really helpful discussions. With 225+ friends, I’m guessing there will always be someone who can give advice without worrying about insurance companies finding out. (Although I’m on a high deductible self-employed plan…and barely make a dent in said deductible, so I personally am not worried about this…) – Carolyn

Last week was a big success for the US Attorney’s office in shutting down a company called Ingenix that sold your medication data for $15.00 a pop to any insurer and the were using it to deny claims and coverage, and it was owned by United Health care, so not only is privacy gone but we are for sale too! There’s still one more company out there doing it and hopefully they will be next, Ingenix made 1.3 billion last year. Wash Post story: http://www.washingtonpost.com/… – Barbara Duck

Anyone out there know anyone that had nerve/groin pain after suburethral sling surgery? My latest, weird surgical complication… in an otherwise totally healthy and uncomplicated gal. It is being addressed by my great doctors, but just curious if there is anyone out there that went through this and had a great outcome. I would like a place to find this stuff quickly and simply online…. but don’t really want to discuss it with Facebook friends or Twitter… Something more annonymous would be good. – Colleen

The whole health privacy argument is a ruse. If you think your records are private, think again folks. Most IT depts in hospitals have extremely poor security practices, health insurers, well they like to do all sorts of things with your data and for most cyber-criminals, about the only thing interesting in your record is your SS#. The privacy ruse is simply put out there by various parties to insure that he who own the data, owns the customer relationship. – John Moore

Not for pharmacies it’s not. HIPAA scares the hell out of us. – Jim Shireman

Privacy is your right to withhold that info if you wish. If you’re sharing it then good for you, but others don’t have to if they don’t want to. I think a lot of people don’t understand privacy and so they’re willing to call it dead. I have spoken about my epilepsy because I wanted to. I’m also aware that you don’t trust everything you read on the net – many people are misdiagnosing themselves because of other peoples conversations causing a strain on healthcare as they turn up whenever they feel off. – alphaxion

HIPAA d/n apply when a patient discloses their health records.GoogHealth & MSFT HealthVault don’t comply with HIPAA b/c patients, not healthcare providers, disclose personal data. Ever tried to read your (probably mostly paper) medical records? Expect chaos, confusion, scary/confounding notes & references to family history, family members, maybe mental health. Be careful before disclosing. Relying solely on wisdom of non-medical professional crowds for diagnosis or advice has considerable downside risk. – Tom Stitt

the communities that deal with health issues always show users anonymous nicknames – not their real names. – Alensa

Caution is name of game here… Recognize analogy that is happening FOR REAL with college applications officers. One of the 1st things they do circa 2009 when processing prospective students is to Search FB & MSpace. As adults we have to lead our youth and help to present a respectful outward image. *** Per Health Care, I agree that support groups and the like will yield (and have done so in case of my personal family) COUNTLESS new insights where your GP or Specialist may not be fully up to speed. – Jeff Ploetz

focused support groups / chat rooms such as www.BrainTrust.org were a God Send to me as I grasped for ways to learn, 1st hand, what to expect and how to assist my bro-in-law who is 300+ miles to the west.  – Jeff Ploetz

Recent Updates on change:healthcare

In an effort to make the system easier to use and more effective, we are continually making changes. Yep, there will be a whole new User-Interface coming, but in the meantime because of User feedback we’ve implemented the following:

COMMUNICATIONS

A huge benefit of using the site is being able to connect with people experiencing like health issues, using the same physician, or taking the same prescription. Up to this point, reading comments has been the extent of that connection.

Well, that’s changing big time!

With the new enhancements, users can mark comments as helpful and the writer will be notified when one of their comments is marked as helpful (securely…we’re not sharing your email address). You can also reply to a comment. The original author will receive an email and the reply comment will appear indented. In the example below, Goofball replied to the MattTest comment and MattTest received an email letting him know that someone had replied to his comment.
NOTE: The count for helpful comments is not associated to replies. In this example, two other users found MattTest’s comment to be helpful.

In your profile, you can elect to accept or decline private messages from other users. If you have accepted this option, your profile bar will include a link to compose a message.

If you have received a message, you will be notified in the status bar (found on every page of the application if you are logged in). You can retrieve your message by clicking the message link or from your dashboard.

After you retrieve your message the status will change to read and move to the bottom.

SEARCH

Medical terms are difficult to understand and even more difficult to spell! The search functionality has been expanded to include a “Did you mean” suggestion to expedite your search process. This functionality is available as shown with health issues, but is also available for services, insurances, providers and prescriptions.

If you have any questions or need further clarification about these changes or any other issues on the site, please feel free to contact us at 800-655-0732 ext. 1 or email us at info@changehealthcare.com.

Be on the lookout for other changes in about 30 days! An inside source leads me to believe that activity feeds will look very different!

Just passing along that I’ll be speaking at Wharton on Feb 13th about healthcare, entrepreneurship, and a plethora of other things that come to mind (anyone who has seen me speak knows can be both comical and unnerving to a facilitator).  Please feel free to join us and participate!

The Healthcare Panel for the Wharton Entrepreneurship Conference on February 13th, 2009 in Philadelphia, PA – www.wec2009.com

From Read Write Web, a post AND application  that shoud cause a lot of excitement in healthcare and Health2.0 for possibilities in our vertical:

What Twitchboard does is tie together different services on the social web and automates their interactions. Specifically, Twitchboard watches your Twitter stream and notices when you post a URL. It then automatically sends that link to your del.icio.us account. And, according to the company’s homepage, they’re working on connections to many other services for the future.

Blogger Chris Arkenberg says Twitchboard is a part of the “emerging class of cloud agents.” These cloud agents, as he describes them, will help us sort and search the massive volumes of data we interact with regularly. He envisions that soon we’ll have many of these cloud agents, swarming around us, working on our behalf, helping to parse the data flowing in and providing us with the information that we need, separated from the noise.

If that’s true, then we seriously can’t wait. We hope that in 2009, we’ll start seeing more of these smart cloud agents and less of those “yet another”apps. Developers, start your engines, it’s time to build some real tools.

full article is here

Flickr @ jimfrazier

The “Last Mile“

It’s an expression that has been running through my mind for quite some time over the past year.  I think that I first heard it used to describe the frustrating gap of getting everyday consumers/households connected to high-speed internet svc with the belief that if only our Parents and the guy that works at the bowling alley could surf the internet at high-speed for a reasonable price, then people would flock to (nay… DEMAND) rich media experiences such as music, videos, pictures, etc.

There existed an ever growing fat pipe of rich content just sitting… waiting… to entertain and engage people on the internet backbone and trunk-lines that ran into the cities and across the country – If only people had faster internet than their old 56k dial-up modem via home telephone lines in order to connect at blindingly faster speeds across that figurative last mile gap of connectivity from a person’s home to the internet-backbone connection point in the community . Of course, much more expensive internet access was available but only eager techies and early adopters were willing to pay the much higher costs to access this pipe of richer information. I’m sure that i’ve botched the exact specifics, but hopefully I’ve jogged your memory enough to understand the issue of the time – that palatable yet intangible Last Mile of connectivity, of rich and engaging User experience.

Healthcare Consumerism

So what the heck does that Last Mile stuff have to do with American healthcare?  Well, i’ve begun to feel a growing sense of Deva Vu.  There has been an ever increasing explosion of healthcare technology and web-based services that was first aimed at payors, then TPAs, then employers, and now the burgeoning and highly befuddled individual consumer. And as more emphasis and focus has been placed on individuals becoming both financially and personally accountable for their health and all related costs – I am left with a seriously nagging question: As the arsenal of tools and information available to consumers grows…what is the Last Mile of healthcare consumerism?

Unfortunately, I don’t have a clear ‘answer’. I’m just not that smart. But as I think about it, I thought that I’d lob some characteristics of the Last Mile of Healthcare Consumerism out to the blog-o-sphere to ponder and see what you guys throw back:

The 6 Things Needed to Shorten the Last Mile of Healthcare Consumerism

(e.g. the ingredients needed to cause Joe Average to actually care about and desire to get the best value for the his dollar spent on healthcare services received)

In no particular order, make ‘it’…

1. Relevant – People just don’t care about information or services unless it relates to them directly and to the specific issues that they face NOW.  A 30yr old male doesn’t care about and becomes miffed when he gets a flurry of emails reminding people of the importance of mammograms. Actually, I think that Relevance AND Specificity go hand-in-hand.  One big challenge of keeping communication and tools relevant to individuals is that something that IS relevant now, may not be relevant 3 months from now. Just as something that isn’t relevant now, may be relevant 2 months from now.  Yep, us healthcare consumers are a fickle lot.
2. Timely – It seems like people have a loosely defined horizon of what conversations and information are ‘timely’.  Any communication beyond two weeks of when I needed it just seems worthless. And printed materials that are more than a month old, seem out-dated and irrelevant.  Timeliness, fortunately, is a dimension of communication that falls into the ‘perception is reality’.  It’s not that the information or communication has to be newly created but rather that it is presented within close proximity to when the person needed it.
3. Simple – Yep, often the hardest thing to do is make complex things simpler and less confusing. I like the adage of ‘Keep It Simple Stupid’  and yet healthcare consumers are overwhelmed by the complexity of rules, plans, choices, communications and multitude of various entities involved in a basic healthcare service transactions. It’s sad when an insurance company has to create for its members an Explanation of its Explanation of Benefits.
4. Easy – Just because something is Simple… doesn’t mean that it is Easy (as in nearly effortless or without much thought).  Just as people can use Mint.com to gain insight into their finances and GoodRec.com to review/find what people say about local restaurants – the tools available and services accessed should require minimal effort to get started with. As a general rule of thumb, the more effort or interest that is exerted, then the derived insight and resulting value should dramatically increase. Honestly, this is one aspect that we (change:healthcare) continued to struggle with but are making some significant strides (and announcements) in the coming months to overcome this barrier. Healthcare data has been historically locked up in separate or proprietary silos but soon, we’ll be breaking it free!  Viva Consumers!
5. Trustworthy – Without trust, consumerism will stall and wither.  I know that many of you have thoughts about where, when and how a trusting relationship is established and perpetuated… but i’ll summarize it as my Dad did once for me, “Trust is earned, often fragile, and hard as hell to earn back once lost.”  What are the qualities of sites/Brands that you trust with your healthcare information, transactions, and tools?
6. Controllable – I’d argue that when it comes to healthcare data and information, that people are actually LESS concerned about being secretative or isolated BUT RATHER care more about controlling who or what other parties has access to or sees their healthcare issues and related data. In fact, my guess is that the more control individuals are given over their own data, the likely people will begin to share and exchange personal information that can help others… aka healthcare transparency of choices made, perceived quality and experiences, and the costs thereof.

Final Questions

We are sooooooooo excited!  Chris McIntyre (of Podcast Alley, PodShow.. aka Mevio fame) is joining the change:healthcare team as Director of Product Management and Making Stuff Useful.

If any of you listen to podcasts or work in San Francisco, then you know Chris’ work and understand why we are so freak’n thrilled to add his integrity, experience, focus, insight, and personality to the team — He’s an A+ rock-star who understands development, community engagement, and building products and services that are intuitive, collaborative, support millions of Users and scales to meet demand. Most importantly, Chris knows how to listen to Users, respond, and get stuff done!

Please welcome Chris (sometimes referred to as ferf, theFerf or cmac), his wife Amy (who has a fitness book and video podcast), and their 100lb. golden retriever ‘Cason’ to the change:healthcare family and Nashville.

The change:healthcare team is growing and preparing for some more significant announcements that will DRAMATICALLY shift and improve how everyday people try to deal with the healthcare system as consumers.

More to come, but we thought you might want to know about Chris.

[Alert - this post is openly brown-nosing a friend's new venture launch. And I'm glad to do it!]

Super nice and authentic guy Dr. Jay Parkinson, whom i count as a personal friend and all-around good man, is officially opening Hello Health’s first store-front office this evening.  I sincerely wish that Nashville wasn’t so far away from NYC as I’d really like to be there to personally support and congratulate him.

Hello Health is located in NYC area or more specifically: Williamsburg at 105 Berry and North 8th Street. Members pay a $25 monthly fee, and an additional $75-100 per visit depending on condition.

His idea: target those who are uninsured, and offer them doctor services on a pay-per-visit basis, with the option to text, IM or email when you have questions or concerns. In a new development, Parkinson has decided to franchise his operations (which he now describes as "Geek Squad as doctors with a Netflix-type subscription fee") and is opening his first brick-and-mortar storefront.

I am neither in NYC nor uninsured. But, dang , I wish that someone in Nashville would get "ballsy enough" to open here in Nashville – as I would be one of the first people to sign up.

Ironically, as more employees begin to realize that they are getting more financial responsibility shiffted on to their own shoulders, an obvious unintended shift is/will happen — people are natural consumers and will want [nay, expect ] a better healthcare consumer experience when they spend their own dollar.

Yes, I would expect to hear about more and more people willing to pay for a Hello Health in their city.

While visiting with a potential partner company that happened to be both an employer and healthcare system, I realized that they were emotionally trapped by the theory of "negative doctor reviews by patients lead to lost referrals."

Yes, there were sites like MDratings.com that tend to be clusters of individuals dealing with Anger Management [i jest]. There are also several other websites that mesh doctor and hospital reviews in with restaurants and retailers – such as Yelp.com (which i actually like and use).  Regardless of the site or the quality and depth of the reviewing/rating tools – one inalienable fact remains… Doctors and hospitals, in general, suck at dealing with negative reviews/ratings by patients.

The irony of this to me is that these patients/caregivers who are upset, angry or dissatisfied still exist regardless of whether there is a public forum on the internet to vent their case. In fact, these individuals actually leverage an even more insidious forum to express their poor experiences: around their office water cooler and over the backyard fence! Gasp!

Recognizing that most of the internet review sites lack the tools for the "reviewed" Provider to participate in the conversation about them in a constructive manner – so I wondered IF there was mechanism, would Providers actually and willingly participate?  Just like any other business or human experience, NOBODY is 100% satisfied . It’s just not a realistic expectation.

Upon accepting the notion that not every patient will have a perfect experience and then embracing and participating in a public dialog to acknowledge negative patient experiences, Providers will likely experience a social principal of “reciprocity” that is at the core of most social interaction online, especially things like customer reviews and recommendations. When people read patient reviews from other people, they feel like returning the favor and write reviews of their own.

I have become a fan of Joshua Porter who recently published a great book on social design and recently blogged the following :

I received a question from someone … who claimed to be skeptical of reviews…that in his mind he thought that people would go out of their way to write negative reviews but not positive ones. In other words, a site would get a disproportional amount of negative reviews, even if the general sentiment for the product was positive. … This is a typical example of the fear that I was talking about. It’s easy to imagine the damage done by people who write negative reviews. As someone else in the audience mentioned, they were afraid that if someone went to a site and saw a negative review first then they would leave and be lost forever.

But here are a few points to keep in mind.

1. Most of the time, negative reviews are genuine. Many products are bad. If someone truly has a negative experience with a product, they will write a review not just to get it off their chest, but because they actually want to help others avoid the same fate as they had. Most people write negative reviews to be helpful.
2. Negative reviews are an opportunity. If you treat negative reviews as input into your design process, then you can actually use them as research to improve your offering. This is a tough pill to swallow, however, as it’s not easy to admit shortcomings.
3. People seek out negative reviews. As someone in the audience mentioned, they almost always zero-in on the negative reviews. Why? Because they’re already interested in the product, they know the positive aspects of it. What they’re looking for are the negative aspects, that crucial information that the manufacturer or the site will never tell you. People know that products are never as good as they’re advertised to be, and seek out the balancing information so they can make a smart decision.
4. People write positive reviews to balance out the negative ones. This is often overlooked when people think about reviews, they imagine that negative reviews simply beget more negative reviews. But if a product has a bad rating and people have had an opposite experience with the product, they’ll be more likely to write a review to balance out the message. People vote for the underdog, and generally want others to know the truth.

In addition, there are several designers can do to make reviews more valuable.

• Good sites average reviews and show distribution. This dampens the ability for any single review to unfairly upset the pot. If people can clearly see that there are both positive and negative reviews for a product, they’ll be more likely to investigate and see why people are having such different experiences
• Let people rate the reviews. On Amazon you can rate the review, which helps to moderate rants and overly-biased negative reviews. This allows the site to display the reviews in helpfulness-order, which means that people see the most helpful (positive or negative) reviews first. This also helps to remove the worry that a single unfair review will upset the pot.

Here are two arguments for using product reviews, tailored to the situation:

For product managers: Negative reviews exist whether or not they’re published. By stopping them from being published, you’re not stopping negative sentiment, you’re just slowing down the spread of it. But in the long term, ignoring that negative sentiment will kill you just as thoroughly as if it were fast-acting. Why not embrace the speed of feedback to improve your offering?

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In general, people are coming to expect customer reviews as part of the shopping process . If you don’t have them, then they’ll go … somewhere else to find them.