Health Care Market Takes to the Web

In America, the market rules — except when it comes to health care choices. A Minnesota company named Carol is trying to change that with a new "care marketplace" website which allows free comparison shopping for health care services. "We want to let consumers define value," said Tony Miller, Carol's founder and chief executive officer. "We don't have care competition in the marketplace today."

While the ability to compare services, credentials and costs — with or without insurance — is a groundbreaking move, it must be noted that these comparisons can only be made amongst providers who are members of the network.

In an Associated Press article entitled "Minn. Web Site Creates Health Market," Elizabeth Dunbar explains the site's features:

Instead of going through a list of doctors or clinics, users tell the site what they're looking for by clicking on parts of the body.

For instance, if a consumer clicked on "entire body," then "annual exam," and chose a routine physical for women age 40-64, the results page would show six different options ranging from $207 to $335. After selecting a number of options, consumers can click "compare" and see exactly what each exam would entail. They can also read a description of the doctor or clinic's philosophy and link to ratings by MN Community Measurement, a nonprofit that measures health care performance in Minnesota.

The combination of provider ratings and the ability to calculate out of pocket expenses brings health care more in line with traditional markets. While this is cause for enthusiasm for many, the endeavor does have its critics, according to Dunbar:

The free site, which went live in January, generates revenue from health care providers who become "tenants" on the site. When a consumer sets up an appointment with a clinic or doctor on Carol.com, the provider pays the site a fee.

[...] Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said the site is nothing more than advertising, and he hoped it wouldn't catch on.

"Among physicians, there's a belief that health care is too critical ... to be left to the usual marketplace," he said.

[...] Elizabeth Boehm, an analyst with Forrester Research who studies the health care customer's experience [...] was skeptical of the site's prospects because many people's choices are limited by their HMO.

"(Price is) just not what drives people to make their health care choices," Boehm said. "The challenge for a site like this is that while conceptually it's good ... the reality is there are only a small group of customers looking for that."

While Boehm may have a point, there are many people in the United States for whom cost is what drives their health care decisions. There are 47 million Americans lacking health insurance, according to a National Coalition on Health Care report, many of them at or near the poverty line. It would seem that tools of this nature could make a significant difference for a large segment of our population.

Carol.com currently only serves the Twin Cities, but there are plans to expand into other markets during 2008.

SOURCE: "Minn. Web Site Creates Health Market" 02/10/08

FCC's New Telehealth Program Launches in North Carolina

With health care a subject on everyone's lips these days there are many organizations chiming in with their approaches to the subject. The Federal Communications Commission (FCC) joins those ranks as they launch their new "Telehealth" initiative, debuting today in western North Carolina.

Aliya Sternstein reports for the National Journal's Technology Daily supplement (accessed for this story via Government Executive):

The FCC's plan will fund dedicated broadband networks for telehealth activities, like videoconference consultations or second opinions from out-of-state specialists. Telemedicine is intended to cuts costs, travel time and medical errors, especially for people in remote or poverty-stricken regions of the country.

"With this pilot program, the commission will be taking a major step toward the goal of connecting healthcare facilities across the nation with one another through broadband telehealth networks for the benefit of patients," [FCC Chairman Kevin] Martin said.

The plan rests on leveraging existing telehealth networks to build new, more comprehensive systems. Rural providers, nonprofit facilities and county-run institutions that want to participate can obtain funding for up to 85 percent of design, construction and operational expenses.

For-profit entities also can join the new networks but will have to pay their fair share of the costs. The set-up allows larger urban trauma centers and teaching hospitals to serve as telemedicine hubs for smaller, rural hospitals and economically strained facilities.

According to Roy Mark over on E-Week the project is certainly not lacking in scope:

The Federal Communications Commission has allocated $417 million to help build 69 statewide or regional broadband telehealth networks across 42 states and three U.S. territories...

The funding will support the connection of more than 6,000 public and non-profit health care providers nationwide to broadband telehealth networks, which can be used to transmit health records and process transactions securely.

Telemedicine already has a proven track record with one of the groups administering the FCC funds for the West Virginia pilot program: the Eastern Band of Cherokee Indians. Jon Ostendorff of the Ashville Citizen Times reports:

Telemedicine is used in treating diabetes patients in Cherokee, said Dr. Ann Bullock, a physician with the tribal health care system. Doctors on the Cherokee Indian Reservation use the Internet to send images of retinal scans to a specialist in Asheville who then recommends treatment.

“So instead to of sending all those patients over to Asheville or taking his time to always have to come out here and do those screenings, we can do them in our diabetes clinic when our patients come, and he can take a look at those,” she said. “It saves a lot of resources and time.”

This is a major step toward more widespread use of EMRs (electronic medical records). According to E-Week's Roy Mark, those involved in this pilot program will need to "implement information technology standards as set forth by the U.S. Department of Health and Human Services wherever feasible." Are the days of data portability and transparency getting closer? It's too early to tell how far this will go, but access does seem to be improving!

SOURCE: "FCC announces creation of telehealth initiative"11/19/07
SOURCE: "FCC Launches Health Networks Initiative" 10/20/07
SOURCE: "Program brings top doctors to rural areas" 11/20/07
photo courtesy of J. Reed, used under this Creative Commons license

HealthVault: Holy Grail or Pandora's Box?

How many aspects of your life do you handle online? Do you buy books from Amazon? Do you bid or sell on eBay? Do you check your bank balance in a browser? How about your investments? Do you communicate by email more often than you write physical letters? Most modern Americans do at least one or two of these things on a regular basis. Now consider this, when was the last times you looked at your prescriptions, X-Rays, or health records online?

The advantages and cost savings of EMRs are consistently touted, both on this blog and in many other places. The recent unveiling of Microsoft's HealthVault makes it seem a viable EMR option is looming on the horizon. While at first glance this is a good thing there are many who seem uneasy about it. Robert Langreth, Senior Editor for Forbes, is one of them:

Microsoft, the company whose personal computer software is regularly attacked by hackers, the company reprimanded by governments for its aggressive monopolistic behavior?

While the aknowledged leader in the field of computing, Microsoft's history does lend itself to some unsease when considering privacy concerns (Win XP, Service Pack 2 anyone?). Langreth's interview with Peter Neupert, Microsoft VP in charge of development for their health group, is an interesting one as Langreth tries to counter that perception.

Microsoft argues that HealthVault can avoid the countless security problems that have afflicted its operating systems. "It's an apples and oranges comparison," he [Langreth] asserts. "It's a lot easier for us to manage a service for reliability, security and privacy than it is to manage hundreds of millions of distributed personal computers." Microsoft is working with two hacker organizations to test the security of its system.

Although HealthVault will be free for consumers, this is no philanthropic effort. Microsoft hopes HealthVault will translate into more search revenues through targeted health-related ads. The site includes an improved online search that uses a machine-learning algorithm to help consumers search through articles on health issues by breaking broad topics into concrete subcategories.

"By providing a great health search experience, we will actually improve the search loyalty of Microsoft overall," says Sean Nolan, the Microsoft programmer who designed the site. He admits though that moving into the medical record arena "is a huge crazy challenge." Among other issues, Microsoft will have to tiptoe the line between assuring people their information is private -- and serving up advertisements relevant to the health problems they have.

Walking that line might be easier than suspected. The success of numerous social networking sites, as well as online products such as the Google suite of applications show that while this is a concern it seems a rapidly diminishing one. People everywhere are getting used to seeing keyed text ads in the margins of their Gmail / Hotmail / Yahoo mail, getting reccommendations from eBay and Amazon when shopping, and generally having their data not only stored on the net but also implemented for promotional means.

Is this good? Is this bad? Will the public embrace or revile it? Only time will tell.

It is, after all, "a huge crazy challenge."

SOURCE: "Who Are You Going To Trust?" 10/08/07
Photo courtesy of: Library of Congress via pingnews.

Healthy Voices Across The Nation

From the halls and meeting rooms of Capitol Hill to the offices and press conferences of governors around the country, proposals and ideas for reforming our health care system are being announced and argued. A vast array of approaches and plans are being put forth as people on both sides of the partisan fence attempt to find an equitable and implementable solution to the current state of affairs.

Across the nation, citizens are being consulted on the subject as the politicians evaluate possible support for their various plans.

East Coast: In Vermont, the state Legislature's Health Care Reform Commission is consulting its constituency for input. According to the announcement in the Rutland Herald, some questions the Commission put forth in their open hearing were:

What do you believe the next steps should be in health care reform?

What specific suggestions do you have for expanding the state's new Catamount health insurance program for people without coverage?

In addition to expanding affordable coverage, which of the options being considered by the commission are most important to successful health care reform?

Midwest: In Iowa, the consultation with the voting public continues, as reported by The Journal. Their article focuses on Kay Ciha, a resident who has had constant issues with the Medicare system since her husband suffered an accident:

Ciha was one of about 20 county residents from all walks of life - seniors, businesspeople, physicians - that took part in a forum for the Legislative Commission on Affordable Health Care Plans for Small Businesses and Families, a bipartisan group of legislators working to provide a cost-effective health care to Iowans. Sen. Becky Schmitz and a representative for U.S. Congressman Dave Loebsack attended the meeting to hear the wish lists of people who were present.

West Coast: eMax Health reports, the findings of CaliforniaSpeaks, a 3,500 person statewide conversation that took place simultaneously across Sacramento, San Diego, Humboldt County, Fresno, Los Angeles, San Luis Obispo, Oakland and Riverside on August 11:

The eight sites were linked by satellite, so that participants could see and hear what other attendees said across the state. Skilled facilitators led face-to-face discussions at each location while ideas were recorded, considered and voted upon throughout the day with personal voting keypads. To ensure that attendees spanned all different ages, ethnicities, and socio-economic backgrounds, CaliforniaSpeaks used a random selection process to invite most of the participants to take part in the conversation.

While there is a diversity of opinions on the subject, concern over the issue seems nearly universal.

SOURCE: "Public Input Sought on Health Care Reform" 08/29/07
SOURCE: "Citizens Voice Concerns on Health Care" 08/30/07
SOURCE: "How Californians View Current Health Care Reform Proposals" 08/30/07
IMAGE SOURCE : public domain map