Register for Better Health Technologies, free email updates Thank you!	E-CareManagement News January 4, 2000 WILL THE INTERNET CONNECT -- OR DISCONNECT -- PATIENTS AND PHYSICIANS? It's hardly news these days, but there's another entrant into the Internet health portal race. However, this one brings some unique twists. Medem has opportunities to employ both push and pull strategies to promote its web site and to improve the patient-physician relationship. WALL STREET AND MAIN STREET HEALTH CARE At the new millennium, U.S. health care is living in two different worlds. The world of Wall Street recognizes the huge opportunities in bringing the Internet to health care. In 1999, market capitalization levels of new e-health companies reached multi-billion dollar heights practically overnight. The world of Main Street is one where physicians are seeing patients one at a time, just as they have for years. Most physician practices are still largely paper based and barely touched by computerization, never mind by the Internet. And...caught in the middle? The patient. Patients have access to 15,000 web sites that provide health information. Their challenge occurs when they take information from the Internet back to their physician and try to apply it to their personal care. Will Wall Street and Main Street coalesce or collide? Will physicians accept and reinforce information patients receive on the web? Or will patients live in two worlds of care -- one found on the Internet, and one received from their physician? Will physicians be defensive and reactive to changes brought by the Internet, or will they be proactive in looking for new and better ways to serve their patients? WHAT'S MEDEM? In February 2000, the Medem web site will go live. "What's Medem, and why should I care?" you ask. The American Medical Association and six other medical societies have joined to create Medem, an Internet health care portal. Physicians and patients will be able to access information through the Medem site or through their physician's web site. Medem will include secure physician-patient messaging and other online utilities. Additional information about Medem can be found at its web site or in commentaries found in the Industry Standard and American Medical News.  During the past year the field of health portals has become crowded. Other health portals include adam.com, Medscape, OnHealth, Mediconsult.com, WebMD, DrKoop.com, HealthCentral, and AmericasDoctor.com -- just to name a few. So what's the big deal about one more? These health portals have been dependent upon a "pull" strategy. They work on getting the patient to their web site first, with the hope that the patient will encourage their physician's involvement in utilizing information from the portal. In contrast, a "push" strategy will target physicians directly, encourage them to become involved with the health portal, and get the physician to direct the patient to the health portal web site. Medem has GREAT POTENTIAL to use BOTH push and pull strategies to unite patients and doctors. Its model emphasizes using the Internet to enhance patient-physician connectivity and communication, rather than the information/e-commerce approach emphasized by many other health portals. Medem could become the hybrid, clicks-and-mortar model of care that INTEGRATES Wall Street and Main Street health care. Why? 1) ACCEPTANCE BY PHYSICIANS -- Doctors Trust Their Specialty Societies and the Internet. A recent survey of physicians asked the following question: "Who has helped or hurt physicians' ability to provide quality patient care?"   HELPED HURT Medical specialty societies 47% 7% The Internet 41% 8% Pharmaceutical companies 40% 22% Medical device manufacturers 36% 10% Hospitals 33% 27% Patient advocacy groups 26% 16% Group purchasing organizations 21% 20% Government 9% 65% Physician management companies 8% 30% Managed care plans 6% 77% Medicare managed care 5% 58% (Source: Strategic Health Perspectives 1999, Proprietary Study, Harris Interactive. Thanks to Ian Morrison for sharing this data.) Medem is attempting to leverage BOTH of the two most favorable responses shown in this survey -- medical specialty societies (Medem's founders and investors), and the Internet. The Medem web site notes that over 10% of physicians attending recent medical society meetings signed up for the service immediately.

2) ACCEPTANCE BY PATIENTS -- Patients Want to Receive Health Information from Their Physician.

A 1998 FIND/SVP study found that 77 percent of patients surveyed would prefer to receive online healthcare information directly from their own physician. This suggests that patients have a high level of trust in their doctor and prefer to receive information that is customized for their personal care.

Medem also leverages patient preferences for receiving health information. Physicians will have the option of referring patients to the doctor's own web site to receive Medem's information. Physicians also will be able to tailor web site information for their own patients. (Medem is not the only health portal using this approach.)

COMMENTARY

Medem has recognized the importance of building a health portal that directly connects patients and physicians. In many other sectors of the emerging Internet economy, hybrid clicks-and-mortar approaches are winning against pure-play Internet companies or traditional bricks and mortar companies.

Medem also offers opportunities to involve physicians and patients in collaborative care management. Here's a quick scenario for the future:

A patient is newly diagnosed with diabetes -- a lifelong chronic condition. The physician verbally provides basic information to the patient and tells the patient that the same information can be viewed later at the doctor's web site. The patient is told to e-mail questions to the doctors office, many of which can be answered by the physician's nurse. The physician enrolls the patient in a web based disease management program, which allows the patient to enter and view routine glucose levels and participate in monitoring his own care. All this information becomes part of the patient's ongoing digital medical record and is accessible at the doctor's web site.

Will Medem be successful? It's far too soon to predict success. Medem still has a number of steep hurdles to overcome, including being very late in the game, raising capital, overcoming physician politics, and of course, executing its game plan.

Can Wall Street and Main Street work together to harness the power of the Internet? Medem's approach is worth keeping an eye on.

EXECUTIVES WITH WHITE COATS -- THE WORK AND WORLD VIEW OF MANAGED-CARE MEDICAL DIRECTORS

Medical Directors in health plans and provider organizations are key decision makers in care/disease management program decisions. They usually approve WHETHER care/disease management programs are offered, WHICH programs get offered, to WHOM they are offered, and WHICH VENDORS or PARTNERS are selected.

A two-part article in the New England Journal of Medicine poses several questions about Medical Directors: By which routes did they come to their jobs? What do they do when they arrive at work each day? What are their beliefs? Part I, Part II 

Some interesting findings:

There are no clear guidelines regarding the skills and knowledge that medical directors should possess.

High-level medical directors spend from 5 to 20 percent of their time on individual case reviews.

Top-level medical directors spend a substantial proportion of their time on quality improvement....Virtually all medical directors agree that preparing for NCQA accreditation and improving HEDIS scores are two of their top priorities.

Medical Directors were found to share the following set of beliefs:

First, there is great geographic variation in the practice patterns of physicians, and some practice patterns are better than others....Managed care should eliminate or at least reduce this variation.

Second, there is no fundamental conflict between the needs of patients in managed-care organizations and the financial concerns of the organization, because high-quality care generally costs less than low-quality care.

Third, in the areas of preventive care and management of chronic diseases, under treatment is common, and physicians should be encouraged to improve their practices.

Fourth, if physicians are made aware of how their practices compare with those of their peers, care can be improved.

INTERNET SHOWN TO BE EFFECTIVE IN IMPROVING DRUG COMPLIANCE!

A recent press release from Cyberdialogue documents how the Internet can be effective in improving patients' compliance to drug treatment schedules.

One-third of chronic disease sufferers who seek disease information online report taking their medications more regularly following a visit to a disease-specific web site.

54 Percent of chronic disease sufferers who seek disease information online reported asking their doctor about a particular treatment after learning about it online. This suggests that the Internet may be a more powerful method of motivating patients than traditional media.

IS IT ETHICAL FOR PHYSICIANS NOT TO FOLLOW GUIDELINES?

An article in American Medical News raises this provocative question:
"Practice guidelines are supposed to embody the best in medical practice, presumably resulting in better outcomes for patients. Yet evidence suggests they are frequently ignored in clinical practice. Does this behavior violate medical ethics?"

THE BUSINESS OF TECHNOLOGY: RED HERRING IDENTIFIES 10 TRENDS FOR 2000

The Red Herring magazine annually identifies 10 trends that will be the most important influences in the business of technology in the coming year. Trends identified for 2000 are:

1) Brick-and-Mortar and Online Retailers Come Together
2) Business-to-Business Exchanges Take Off
3) The Web Gets Personal
4) Open-Source Hackers Go Pro
5) The Human Genome Project Bears Commercial Fruit
6) Politicians Court the Industry, But Tech is Still a Fringe Issue
7) The Cost of Internet Access Drops to Zero
8) Venture Funding is Reinvented
9) Europe Imports Internet Euphoria
10) Enterprise Software Becomes a Service

Previous issues of E-Care Management News touched on several of these themes and discussed implications for care management. (Trend #1 -- October 7; Trend #2 -- December 8; Trend #10 -- September 20). We welcome your comments and thoughts as to how other technology trends will impact care management - write us at info@bhtinfo.com.

SEVEN ALTERNATIVES TO EVIDENCE BASED MEDICINE

Read this article in the British Medical Journal for a strong dose of dry humor.

E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC (http://www.bhtinfo.com).  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

You may copy, reprint or forward this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2000, Better Health Technologies, LLC. All rights reserved.