So as we ratchet down, focus on, and refine our platform — Robert and team threw these questions out that may seem obvious on the surface but actually require some thought. I figured that I’d pass them along. It was interesting to see how I answered some questions vs. others on the team. I’d like to challenge some of the other Health2.0 gang to test these out on their offering. It was a good exercise for us and forced us to stand back and challenge some of our own individual assumptions:

1. What do people want?
2. Who is our audience?
3. Who is our target (is it the same as our audience)?
4. What do we want them to do?
5. How do we want them to do it?
6. How do they get/realize value from that?
7. How do we get/realize value from those willing (not willing) to pay for our service?
8. Where do our customers go (e.g. websites/stores/providers) for information?
9. Why do they want our product?
10. What will they pay for our product(s)?
11. Why won’t they sign-up? Why will they?
12. What draws them in?
13. What makes them stay?
14. What makes them come back?
15. What makes them stay away?
16. Where else do they get (or think they get) our info?
17. Do they want our info?
18. How do they know about us?
19. What do we do for them?
20. How do we make them better?
21. How do we carry thru on the initial wow?
22. Is there an initial wow and what is it (pick “the” main 1 wow)?
23. What do consumers care about?
24. What do consumers not care about?
25. Who pays for our services?
26. Who benefits the most from our service(s)? …Now who pays for our service(s)?
27. What is the ROI to the purchaser?
28. What is the ROI to the User?
29. Why do they want to be a part of us?
30. Why do they want to share info about their expenses/health issues?
31. Can we help them?
32. What matters most?
33. What do people understand about their healthcare? …Not understand?
34. Why do people care?
35. Why SHOULD they care?

Sheesh! Robert just “schooled” me on the 5 basic questions any person should ask themselves as they develop a marketing message. I’m a slow learner:

1. Who is the audience?
   
2. What is your target market?
3. What is the call-to-action?
4. What makes you unique?
5. What is the desired result?

He’s making me write this 500 times so I’ll remember it! jk

I guess MedBillManager is now “mainstream” to the millions of readers of Oprah’s O Magazine. The painful paperwork and confusion resulting from Consumers and Employees accessing the healthcare system has risen to loud roar.

Plus…we’re developing a case study about one of our employer client’s use of MedBillManager to address a significant employee benefit issue they faced [I'm very excited as this employer is a real industry thought-leader and has very progressive-thinking leadership].

As well as Matt and the dev team just showed us screens of the up-coming UI enhancements and new features for prescriptions/ health issues/ and providers – Wow! Nice work gang!

What a way to start 2008!

This just in (errr… for the government, “just in” means insight into data ending 2 years ago) via Theo Francis of the WSJ.com blog: Hospital charges are up 89% since 1997. Yawn.

Oh, wait-a-minute?! You mean the price that the working uninsured and (to some discounted degree) people paying for care out-of-pocket has shot up eighty-nine percent?!

YES.

Now of course there are all kinds of caveats and “buts” to the above statement such as “Nobody pays billed charges.” I would agree that nobody SHOULD pay billed charges (that’s like paying the MSRP when purchasing a car) and yet, the reality is that the majority of consumers use “billed charges minus some sort of discount” as their barometer of fairness since they historically have had NO FREAK’N IDEA what the avg reimbursed rates were for their given Provider for that particular admission. Therefore, when billed charges increase, so does the price paid when based on a discount off charges. Sadly, consumers have never had the right information to reasonably informed decisions [i know, i know, that is what change:healthcare is fixing as well as many other Health2.0 ventures].

Anyway, I thought that Theo did a good job summarizing AHRQ’s December 2007 data review…

The nation’s hospital bill has arrived, and it’s a doozy: $873 billion in 2005, up 89% since 1997, according to work by the Agency for Healthcare Research and Quality.The federal AHRQ study measured charges — the hospital equivalent of a car’s sticker price, which few actually pay in full. Still, the prices show the upward trend for hospital spending. The annual increase in hospital charges was 7% compared with 2004.

But the Health Blog was struck by some of the big-ticket conditions. (See the full report.)

The data from 2005, the most recent year available, show that pregnancy and delivery ranked No. 2 among line items, at $43.9 billion, while newborn infants came next at $35.3 billion. … (Coronary artery disease ranked No. 1, at $46 billion.)

… As a group, the top-20 conditions — which account for about half of all hospital charges — rose 67%.

UPDATED:

ohhhhh man, I just had to come back include these interesting comments made by WSJ readers…

America needs to wake up and realize that heart disease is still its biggest health problem. The country should be very angry that while our system happily pays for nearly each and every hospitalization/procedure, it invests almost nothing in prevention of heart disease and so far has been unwilling to pay for good prevention. Instead, we bitch and moan loudly about the cost of our statin or ACE inhibitor going up a few $$ a month, but we’re silent when the insurer pays a $30,000 bill for the heart attack we just had. The fact remains that drugs account for about 10-12% of overall healthcare costs, and hospitalization accounts for over 60% of total healthcare costs. Time to turn the system on its ear and actually pay more system-wide for prevention so that we can decrease hospitalizations costs in 1-2 years.
Comment by Dr. Remulac – December 14, 2007 at 9:12 am

Ask any hospital administrator why costs are so high and the answer is the same: Bad debt/charity care for the millions of uninsured and underinsured (WHO do you think is taking care of the app 13 MILLION illegal immigrants and their children?) and ever-increasing staffing costs (heaven forbid a union moves into your hospital). And yes, nothing annoys health care providers more than lazy, excuse-making patients that expect the physicians to fix all their problems, all the time and accept no personal responsiblity at all. There is a bill before Congress to improve health care literacy starting in elementary, secondary, high schools, vocational schools, community centers and houses of worship. This would be helpful to getting people to become more efficient users of the health care system and about health insurance generally. At the end of the day, health insurance is insurance like car, home, life, etc. It is there for emergencies only- not prevention.
Comment by First Anonymous – December 14, 2007 at 10:36 am

I’m just getting caught up on emails and i came across the following article that made me ponder the latest health+web efforts here in Nashville. Considering that the majority of for-profit healthcare companies (sans Tenet) are headquartered here in Nashville — is the Country Music City becoming the Silicon Valley of Health2.0 [e.g. Peerclip, connectivhealth, and change:healthcare] Also, do local entrepreneurs have the fortitude to launch their web tools with a “long-view” approach?

Granted, internet phenoms like Twitter are not models that people look to when it comes to healthcare, but i think that many of the same human needs (e.g. Twitter’s notion of instant communication) do align with a person’s healthcare needs and decision-making desires as more and more responsibility gets pushed on to the employee and avg consumer’s shoulders. Think about.

Back to twitter…

What of the business model. I guess in this day and age, put the product out first and go with the flow. I agree that ideas that are not executed are doomed to stay on that ever winding road that leads you back to where you started. I call that “living in square one, round hole optional” syndrome. While popular business thought says to write a business plan, make a half dozen matrix’s, and crunch all those numbers; in today’s world – that just doesn’t work if you plan to succeed. Why? Because as Jason was saying in his post “We all live in Brooklyn (and need to get out) and need to get to the Valley.”

It’s almost like a band. Unless you get out there and just do it, it never gets done. Believe me, all the bands I was in didn’t have a business model. It never prevented us from reaching a level of success. The only thing that stopped us was the personnel factor or personal issues within the band. As far as a business, any of the bands I have been in could have survived and been a successful business. They were all the same, original music done the old fashioned way. Now would a business model have helped much? Yes and no.

Just in the case of twitter, the idea was the foremost item necessary. Just like a band, the players that wanted to play music and write new tunes were needed, so is twitter. An idea that was based on a basic need for instant communication, done in a Web 2.0 way. Nothing really scientific about it. Nothing really ground breaking on what they are doing. They kept it simple, just like rock n’ roll.

Back to twitter again – why do I like twitter? Well of course I use it to help promote my work, as well as keep in touch with people that I like to chat with. It’s almost like that big water cooler of the cubicle days. I think that twitter has a big future in 2008 as it grabs more mainstream recognition. I also believe that now there are local STL news sites on twitter, it has reached that level of acceptance. For me though, it is like the chatter of the cubicle environment where I use to have a job at.

It’s ridiculous! Medicare had attempted to push Providers to adopt a NPI (National Provider Identifier) which is intended to replace the moderately utilized UPIN for Medicare. I can only imagine the complexity, frustration, and inconsistent data pools that exist between federal and state agencies as all parties begin the migration to NPI utilization as well as attempting to spread consistent adoption and broad agency data synchronization.

Unfortunately, as we began aggregating providers there has been a serious lack of consistent and timely data about Providers. From the Provider’s perspective, I often wonder if they’re sick and tired of the continual flood of code and documentation redundant requests and lack of intra-system communication. As a consumer, it seems that the ONLY broad and accurate source of Provider information is the phone book. Why? Because it is a referral mechanism. Providers WANT to maintain correct contact information so patients and other Providers can contact them.

Then it hit me like a ton of bricks. Isn’t the web supposed to support the notion of semantic data exchange? How is it that across a multitude of email and web applications every consumer and Joe Schmoe can easily and simply export or share their contact information in a basic format found in Microsoft Outlook (aka a vCard or .vcf). One entity implemented a standard that became a widely adopted and pseudo-semantic standard.

It’s simple and obvious

I’m sick and tired of everyone building non-open systems and proprietary standards. What a freak’n waste! If consumers use a vCard to exchange contact information, why isn’t there a doctor vCard? A dCard, if you will… What if a web company found several other open and like-minded provider entities who all adopted the same dCard standard so that Providers could easily and simply move, exchange, and maintain their contact and credentialing information seamlessly across the Internet. No. Not via some expensive nor closed system. Just a simple data format/standard.

What if this standard was applied across 900,000+ practicing Providers and included contact and summary credential data as well as obvious consumer-centric data elements like “Office Days and Hours” (Duh?!) and “Accepting New Patients”. That’s right! Not 1,000. Not 10,000. But almost a million Providers.

The dCard

Is it possible that several national and leading organizations could agree upon such a simple standard? Yes they can. Though, there will be some “old school” entities that will desire to perpetuate their own proprietary forms and closed data systems that require Providers to repetitively send/enter/maintain multiple versions of their contact information.

Yes this standard has been established! It will be made an open standard and ANYONE will be able to adopt, share, and implement making it SIGNIFICANTLY less cumbersome for Providers to choose to easily provide and exchange information – as well as web services that support providers and consumers.

Finally, the easiest and most obvious question of “Are we talking about the same Dr. Jones?” can finally be addressed [no pun intended].

More to be announced soon.

Dad passed away Dec 3^rd and Mom a year later on Dec 23^rd. I miss them both. Tremendously.

When asked why i started change:healthcare, why i give a damn about healthcare consumerism, why it is important to make a difference – it’s because i told them and myself that i would do something. Something honest, sincere, and significant.

From my Father I learned the meaning of compassion, honesty, a sense of humor and the value of a warm smile and a firm handshake.

From my Mother I learned that nothing is impossible, loyalty, integrity, hard work always pays off (just sometimes not in the way you thought it might) and that there is good in everyone though sometimes you’ve gotta look really really hard.

Your son and grandchildren miss you. In loving memory.

– christopher

Two things:

First, I wanted to say thanks for the latest mention by Bob Coffield over at the Healthcare Law Blog.

Bob is one of those individuals whom, when you meet, you just know that he is an all-around good guy. Go on over and read some of his latest posts. Good stuff… Speaking of which…

Secondly, Bob includes a rather telling example of social media influence used by a physician to coach his patients who have obesity behavior modification issues:

…example comes from Dr. Parkinson’s new (old) approach to providing care through technology and house calls. A while ago he mentioned in a post (Food Photography) his approach to helping a patient with weight and obesity problems. This recent Chicago Tribune article again mentions his simple but effective approach to monitoring his patients food intake using Flickr. In the Q/A Dr. Parkinson explains his approach:

Q. How do you treat obesity?
A. I use the Internet as much as possible. I use Web sites like sparkpeople.com or weightwatchers.com to help patients understand how much they eat. I encourage them to start a flickr account to post photos of what and how much they eat. I can comment on portion size, fat content, etc. Having a visual record of all of the food you eat is quite powerful. I calculate how many calories they should take in to lose weight by a certain date. I do frequent follow-ups via IM or e-mail to see how they are doing and to let them know that there is one other person in the world who cares and supports them. My role is that of informative coach.

I’m telling ya, ch-change is a coming and social influence is a powerful tool [note that i did not indicated whether is was good or bad].

I rest my FREAK’N case! Well, actually, i’m not that smart and certainly this is a loose stretch to use the term “validate” but it is nice to have the New England Journal of Medicine validate my notion of social influence as noted below in today’s post:

An interesting and somewhat shocking study published in The New England Journal of Medicine shows that the chance of becoming obese increased by 57% if a person had a friend who became obese in a given period!

Similar with other vices like smoking and drinking, we are easily influenced by the people around us. Social networking is just a new medium but the psychology behind peer influence is still same.

To make matters worse, obesity spreads up to 3 degrees of separation. According to Nicholas Christakis, a physician and Harvard University professor who headed the study:

We know that people are influenced by their friends. But what was innovative about our study is the fact that people tend to be influenced by friends of friends of friends.

This is on top of the sedentary lifestyle of many active members of social networking sites.

When i posted about the tangible influence of peers and behavior modification, i was merely pulling from my anecdotal experience. But now i feel even more strongly that where change:healthcare is headed will provide a DRAMATIC means for employers to engage and enable their employees to become better healthcare consumers and reducing the need to force nor apply top-down pressure but rather by giving people the objective, portable tools that they have been asking to access. People can make smarter, more informed decisions when given the tools, relationships, and platform to influence each other. Remember that a company’s best communication and influence tool has been and will continue to be the infamous “office grapevine” and “water-cooler conversations.” Which i would propose is the precursor to Facebook and Linkedin.

Heh… I’m just a mess-o-conflicting analogies these days. Of course nothing is ever as black and white as we might want them to be. But the NEJM study certainly does point to some rather compelling data and outcomes…

Christakis said the perception change can be either conscious or unconscious.

Beggs said the “tide of information” a person receives about acceptable behaviors usually has to be backed by a support frame to have a significant impact.

“In order not to exhibit certain behaviors, you have to be able to go against the tide of information,” Beggs said.

Just noticed that Adam Bosworth posted a nice summary of the Aspen Institute conference — which had a multitude of intriguing panel summaries such as:

“Cracking the Code: Life and Wellness in the Genomic Age,” “The Emerging Science of Mood,” and “The Hospital of the Future.” Other sessions will explore health reform and the presidential campaigns, international models of science funding, personal stories of scientific discovery, the rise of medical tourism, and what Americans expect from their medical research and healthcare as evidenced by a new national poll slated for release at the Forum.

I found several of Adam’s comments interesting, especially since i too met Dr. Frist while traveling [of course, it was here in the Nashville airport as i was on my way to Mayo Clinic in MN].

I’m sure that Bill wouldn’t remember meeting me nor my son’s heart issues that we discussed while waiting in line together at the snack bar. What i thought would be a passing “hello” turned into a 10 minute conversation.

Alas, i digress. I wanted to follow-up on some of Adam’s well documented summary. More specifically, I wished that i could have been there when the conversation focused on:

But there was a thoughtful discussion about how this, all by itself, isn’t a solution, and we need to alter the system to actually reward people for good overall care and wellness of patients and good outcomes rather than paying doctors for procedures. It short we need the system to help keep people well rather than only treat them (at best) when they are sick.

Preventative care and the notion of rewarding/incentivizing wellness care and behaviors is definitely the “right” thing to strive for, but that will require centuries of emotional de-programming. Humans hate change and are unwilling to do work nor expend effort unless forced to. This can be validated/evidenced by the multitude of stereotypical american towns full of obese and de-motivated citizens (yes, Nashville was voted as the FATEST city in the U.S… sigh) who are all answering get rich quick ads in newspapers and calling the 800 # for those “no money down” real-estate investment infomercials [this is my poor attempt at sarcasm]. As one of my old employers used to say, “People don’t do what you expect, they only do what you inspect.” How ever sad a statement that is, it has proven itself to ring true in my experience time and time again.

Enough with the “nay-sayer-isms” though. Having been in healthcare for quite some time and leaving my jaded perspective at the door – what i do know from experience is that patients and individuals are most influenced to change a behavior (a la behavior modification) and stick to aforementioned change when patients are perpetually communicating and connected to other individuals who are dealing with the same issue and hold each other either directly or informally accountable.

Whew! So all of that gobbly-gook can be translated into the following analogy…

Obesity is a social epidemic. If you are obese and have obese friends, then there is a much higher likelihood of remaining obese. If you are obese, but interact, surround yourself with friends and activities that are activity/exercise related [healthy lifestyle-focused], then there is a higher likelihood of you undertaking a weight-loss program and sticking to it.

Patients and individuals want to be – nay – need to be connected. I suspect that innate human need is why social-networks, blogs, and other forms of 2–way communication (the oldest being the infamous water-cooler conversation). We depend on neighbors and friends to help us with our decisions. We use linkedin, and facebook, and over-the-fence conversations to figure which doctor to see, what to do about that brown spot on your tummy, and whether so-and-so’s friend had a good experience at Hospital X down the street. I would also propose that when it comes to healthcare and healthcare decision making that the use of social-network applications would provide tremendous benefit when coupled with an employer-based disease management effort.

I am not suggesting that a health-focused social network alone is a silver bullet solution. Instead, i believe that a social network platform used as a communication/dialogue platform and coupled with web-based educational tools and call center-based disease management services group would make a VERY powerful behavior change management approach and would most like provide the BEST return on investment for a self-insured employer.

Though in the above described uber approach – there is one core element that would be required to make it effective – price and quality transparency.

Fortunately, we’re about to address that issue in a significant way. Change for the better is coming.