Why WebMD Is History: The Next Generation of Web-Based Medicine

3/19/12Follow @SkipFleshman

The healthcare industry has been waiting a long time for its “2.0″ moment. As social networks like Facebook and LinkedIn exploded in the late 2000s, so did e-commerce, enterprise SaaS, and cloud services. Business models, features and strategies have all dramatically evolved in the past decade and the valuations of many IT companies have taken off. But the Health 2.0 transformation is finally here, and it’s going to be profound—dramatically changing the way patients obtain health and wellness information, track their progress, and interact with providers and physicians. It’s going to be an exciting time in Silicon Valley as next-generation information startups address the multi-trillion dollar healthcare market.

The first generation of Web-based health information tools emerged during the dot-com boom. Organizations like WebMD, Wikipedia, health.com, and Mayo Clinic began to give patients much more information than they ever had access to before. But these sites are like dinosaurs in today’s age. Even beyond look and feel, users just are not getting the information they want. In a 2010 Pew Study, over 50 percent of adults reported that the health information they found online was of “no help” at all. No help at all online? That’s an amazing opportunity for startups.

So what needs to happen? The status quo is that users go online and search or navigate their way through sites that provide medical content. It’s static and one-way. Health 2.0 web applications will become more personalized and interactive. They will begin to use individualized quantified data and patient history to give very specific feedback to users. Service models will evolve to the point that physicians are integrated into the online experience.

The first critical component for any new online medical information product is to establish trust. Patients want to believe that the information they are getting is accurate, and they want any information they provide to remain private and secure. Sites like Wikipedia suffer because it’s hard to know if their information is accurate or not. Sites like WebMD and Health.com lose a tremendous amount of credibility because their visitors are immediately inundated with advertising. How does one trust a site’s content when its entire model is predicated on attaining advertisement dollars?

Mayo Clinic establishes credibility based on its brand, but another way to do this is to have doctors validate the information. Patients trust their doctors, and getting physicians involved in the Web experience can be a huge boost in establishing this incredibly important validation. In addition, integrating physicians into the Web experience can help make the experience more interactive, sticky and valuable. Companies like WellnessFX and HealthTap—in which my compay, Asset Management Ventures, is an investor—are on the right track here.

Patients should certainly be able to get curated and timely information. The medical profession is filled with scientific studies, confusing names for therapeutics, jargon, and Latin words. When everyday users seek information about a medical problem, they need to get back information that is easy to understand and digest in simple, everyday English. Latency has no place here either—the expectation for any interaction with the web is that feedback is immediate. This means that companies need to be developing on Android, iOS, and HTML5 so that their applications can be accessed anytime, anywhere.

Personalization will be another critical component in improving a patient’s online experience. One factor driving this is the emergence of the quantified-self sector. There are currently hundreds of young companies offering connected devices to collect and analyze personal data pertaining to blood pressure, weight, pulse, activity level, sleep patterns and mood. Patients ought to be offered personalized medical information based on the readings from such devices. Partnerships will play a key role and companies will need to figure out whether they are platforms, data collectors, or data analyzers and where they sit in the value chain.

There are currently no dominant platforms, and this may be a hard area for startups to move into. It’s difficult for platform companies to generate scale without some compelling application or service that inherently solves a problem and attracts a critical mass of users. Of course, existing enterprise applications or electronic health record systems used by large medical providers could solve this problem, but I would still keep my eye on smaller companies like WellnessFX (advanced lab testing) , AirStrip (FDA approved patient monitoring), and Avado (patient relationship management), which sit between patient and physician and could evolve into interesting platforms that collect consumer-generated data and integrate it with the providers and their electronic health records and then run analytics on these data.

In order to be long-term, sustainable businesses companies will, of course, need to have a viable monetization model. As previously mentioned, advertising can present problems when people are looking for credible, unbiased information. Advertising also doesn’t bring in much money on mobile devices. Would traditional healthcare payers get involved? Perhaps, but it’s unlikely that there will be direct reimbursement for health care information any time soon. It’s not unfathomable to imagine insurance companies offering reduced co-payments or deductibles for patients who find the answers to their questions on the Web, thus avoiding costly doctor visits. What about charging the end consumer? Patients already assume basic, public health care information should be free, but what they may pay for is quick access to certified physicians. I feel that most consumers would be willing to pay some money (perhaps up to their co-pay amount) for a home-use, mobile-phone-compatible diagnostic tool that would help them to avoid having to drive their sick child to the hospital.

So what kind of world could this be? Well, imagine you start by having a DNA test. You also use a daily monitor that measures activity and mood. When working out you track your pulse and exercise intensity. At night you track your sleep. You regularly measure your blood pressure, weight, and body mass index, and, perhaps annually, get advanced blood work done. When feeling ill, you can run basic diagnostics from home using your mobile phone and attachments. All of these data are seamlessly transmitted to the cloud and combined with your medical history. Sophisticated algorithms can correlate data and give you periodic reports on your health and also highlight when you may have problems (this is an area where IBM’s Watson project may shine).

If you don’t feel well, then you first go online to a site where you enter your symptoms. This information, combined with data related to your history and statistics, will give you a first attempt at a diagnosis. Or perhaps a reply will ask you more questions to hone in on an answer. If you need to speak with a medical professional, you first do this online with e-mail, chat, or a video feed. This integration of quantified data, online content, medical history and online physician input could serve as an early triage system that would save everyone time, improve patient outcomes, and save the healthcare industry billions of dollars. Companies are now developing the building blocks for all of this; it won’t be long before it’s all brought together.

Skip Fleshman is a Managing Partner at Asset Management Ventures, which has invested in Health 2.0 companies such as CardioDx, HealthTap, Lark, Proteus Biomedical, and Maverix. Follow @SkipFleshman

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  • http://mHealthInsight.com David Doherty

    Hi Skip,

    Nice article.

    “Companies are now developing the building blocks for all of this; it won’t be long before it’s all brought together”

    At my company we’ve been doing this since 2006 in the UK and Ireland and we’ll be launching in US in 2012.

    “If you don’t feel well, then you first go online to a site”

    http://3gdoctor.com (only currently available for patients in the UK or Republic of Ireland)

    “where you enter your symptoms. This information, combined with data related to your history and statistics, will give you a first attempt at a diagnosis. Or perhaps a reply will ask you more questions to hone in on an answer”

    To achieve this we use the worlds most advanced patient history taking questionnaire that was developed in the USA. This helps patients prepare for a consultation, provide their history and ensure Doctors are given this information in a standardised format before consulting with their patient. More on this can be found a Mayo Clinic Proceedings paper that is introduced in the following video by it’s author Prof John Bachman MD, Mayo Clinic:

    http://www.youtube.com/watch?v=RKv49X_63Vw

    “If you need to speak with a medical professional, you first do this online with e-mail, chat, or a video feed”

    We decided to make this available via a 3G mobile video call or Facetime. This has several advantages over fixed line/PC based systems eg. it’s more private (you’re not stuck in the living room of the home etc), patients you easily take a mobile to bed while awaiting the Doctor to read their report and call them, etc

    • drjchandler

      But, how are you profitable?

  • Mike

    Skip, very interesting piece; good market analysis. Regarding this point you made: “There are currently no dominant platforms, and this may be a hard area for startups to move into.” There are numerous new players in the game but one to watch carefully is Jeff Arnold’s new venture, Sharecare. They’ve made tremendous progress in their first year of operations and have a sophisticated, 2.0 model that can scale across the consumer and professional sectors.

  • http://www.wellness-layers.com Robert Hallock

    Thanks, Skip, for your thoughtful article. We at Wellness Layers have been providing what you suggest for 15 years–we intertwine relevant content with personalized tools and community. The sum total of these three elements provides patients with a unique personalized and powerful experience, and they love it (and therefore are more inclined to stick with behavioral change programs).

    • drjchandler

      How do you get the word out without marketing?

  • http://www.senstore.com Antony Evans

    Skip,

    This is exactly the kind of solution my startup is developing. We are part of Rock Health’s latest batch, working towards demo day on June 13th.

    Would love to run our ideas/prototype past you and get your input. Feel free to email me at my first name at Senstore.com

    Regards,
    Antony

  • http://www.linkedin.com/groups?about=&gid=2181454&trk=anet_ug_grppro Paul Sonnier

    A plausible view of the very near future of consumer-empowered health and medicine!

  • FredO

    You guys are kidding yourselves. Doctors won’t get involved with this for the same reason that so few do email with patients–they don’t get paid and they expose themselves to legal risk.

    You really expect people to type in generic symptoms ? Do you have any idea of the content of a medical encounter, how highly specific it is and how dependent it is on actually examining a patient ?

    Do you understand why personal health records have been such a flop ? How exactly do you expect to make money on health “2.0″ ?

  • http://www.smokefreelife.co.uk Karen

    Timely article. Hmmm…But they are not dead yet. Companies like WebMD have other products and services that target various populations and provide valuable services I think. Enough so where people still seem interested in paying for their services.
    So, if a company is not aligned with a pharma company for advertising or some other type of revenue, how will these start-ups secure revenue other than from investment money? Health plans? Employers? Physicians? Consumers? The government? It would be very interesting to read their business plans. Thank you for the article, Skip.

  • civisisus

    The power law distribution of spending on health care in the US practically guarantees there will not ever be a profitable mass-use (5 million plus genuine – not “facebook accounting” – users) health application. As long as you’re disabused of the notion of a big score, you might well come up with a nice niche health info business or two that actually makes some money.

    Dave Doherty’s 3Gdoctor is a more apt model than Jeff Arnold’s latest attempt to make up for all the dough he gave up to Marty Wygod.

    As for RockHealth’s tribe of fresh-scrubbed kids, or StartUp Health’s hyperidealistic missionaries? Well, it’s never too late to learn that a snazzy logo and a dormful of caffeinated code-doids won’t cure bupkis.

    But least clueful of all? FredO, naturally….

  • FredO

    Sorry, but you guys are the clueless ones. You sound like the guys trying to dot-com every possible vertical circa 1999–pet food, janitorial supplies, etc. (?urinalpuck.com). You think that putting “2.0″ or “social media” or “cloud” on your business plan will disguise the fact that there’s no there there.

    Do you have any idea how medicine is practiced ? What doctors and patients actually do together ? Tell me, how profitable is WebMD, if your glorious new startup is going to replace it as king of consumer health IT ?

  • BrianA

    Skip some great insights but have you ever worked in healthcare? Understand the reimbursement models? What services patients are willing to pay for (medical spas are hot) vs those they expect to be provided by insurance?

    HealthTap sadly will never have any brand trust based on the founders reputation he earned with his prior company WellSphere. The model there was to get other’s to create the content and he resold it. Not the most trust-worthy model but it might appeal to the healthy wealthy or cyber-chondriacs.

    Patients trust their “own” doctors not doctors who they don’t know and most are bright enough to realize that top notch doc’s aren’t spending their time online answering random questions without any information about the person asking the question. Given the average visit time of 8 minutes and less than 500 words asked by the patient it doesn’ make sense to think you will have more time to bring in outside research.

    Outside of the IT world the quantified self is only about 10% or less of the population (where is my fitbit ?).

  • http://www.healthper.com David Lenihan

    Good observations Skip. Wellness in general is the next very big evolution in healthcare. It will require a technology base to bring together the content (Mayo, WebMD, HMI etc) with programs (weight loss, smoking cessation etc)and integrate to health benefit plan design (discounts for non smokers, employees with BMI under 25 etc)and be fun and easy to use (gaming, points, mobile etc). It turned out that Consumer Directed Health was a big deal (now over 35% of insureds in some form of account based plan design)and it required the technology platform to make this happen (CareGain et al). Technology advances and enablement will drive the new world of wellness as well.

  • http://content-science.com Colleen Jones

    Hi Skip,

    Thanks for the insightful post. I agree with you about the importance of trust and credible content for health 2.0. I see it as so vital to the future of digital healthcare (as well as finance and travel) that I’m having my firm study it. In fact, we just completed the first phase and released our first report. (More about the study here: http://content-science.com/the-study)

    We find brand does go a long way toward credibility. For example, we actually had people view samples of health content from a variety of sources and rate their credibility. WebMD was by far the winner.

    Startup health brands are going to have a tough time forming credibility compared to Mayo, WebMD, and established players. That doesn’t mean it isn’t possible, but don’t underestimate the power of brand and everything that goes with it–a consistent voice, an appropriate tone, a familiar presence, a trusted point of view. These strengths of an established content brand aren’t overcome with a little more personalization or some additional verification from doctors.

    Also, an interesting startup in this space is Sharecare. Sharecare brings together curated, credible content and social features.

    Colleen