Jane Sarasohn-Kahn: “Transparency can drive out poor providers”

In our interview series leading up to the Health 2.0 conference in March, we’ve talked with Scott Shreeve of Crossover Health , Ed Silverman of Pharmalot, and Fard Johnmar of HealthcareVox. Today we share our interview with Jane Sarasohn-Kahn, a health economist and management consultant who founded the Think-Health consultancy in 1992. She is author of the Health Populi blog and a member of the Health 2.0 conference advisory board.

Q: In our interview with Scott Shreeve, he offered an expansive definition of Health 2.0. Matthew Holt’s definition has been narrower. What’s your definition of “Health 2.0”?

A: The phrase “Health 2.0” has become somewhat loaded with marketing hype, even since the San Francisco conference. When it comes to defining the phrase, I’m a strict constructionist based on O’Reilly’s concept of Web 2.0. In that context, Health 2.0 is the application of Web 2.0 tools to health. In this case, “health” is broadly defined and includes but is not limited to health ‘care.’ Thus, Health 2.0 is the convergence of social media and health, enabling people (whether we call them patients, consumers, caregivers), providers (clinicians and institutions), payers (people, plans, sponsors such as employers, government agencies) and suppliers (pharma, med device cos., financial services cos., etc.) to work together. Health 2.0 enables transparency.

My take is thus more aligned with Matthew’s, although I am a fan of Scott’s vision of a new model for health, health care, and health financing. Scott’s definition is for a new-and-improved, even disruptive, health delivery, financing and consumption model.

Q: You have said that with Health 2.0, “consumers are turning the tables on old school health care, empowering themselves to bring greater balance to information asymmetry in health care.” Do you think most doctors, hospital systems, insurance companies, and pharmaceutical companies recognize that this is happening? How would you characterize their reaction to this consumer movement to this point?

A: Among the stakeholders you mention, health plans are ahead of the others. Look at The Health Care Scoop from Blue Cross and Blue Shield of Minnesota and Anthem’s alliance with Zagat. They recognize that social media are part of the consumer environment, and if they want to migrate toward consumer-directed health care, they need to provide greater transparency, information and tools that are consumer-manageable and -generated. Hospitals will be next to fall in line. Physicians tend to be resistant to consumer reviews and given the operating environment they’re in, this reaction is understandable. Still, there will be early adopters who may already be emailing with patients and are on the consumer-facing curve earlier than other doctors.

Finally, Big Pharma has been resistant due to what the industry perceives as regulatory and legal constraints: for example, liability for reporting adverse events to the FDA. But although many people don’t know this, many consumer-facing pharma brands have been monitoring social media for over two years to learn what’s being said about them, and bringing the learnings “home.” More will engage the way BCBS of Minn. is doing; for example, GSK is learning from its alli.com website for weight control. That is an OTC brand, but lessons will be learned across the business on the pharma side.

Q: What are the most exciting examples of Health 2.0 companies that are currently online, and why?

A: This is so fluid, and each week I find a couple of new entrants that are intriguing. I’ve already mentioned the “Scoop” which I see as a very brave and encouraging development by a health plan. Of course, health care is local and Minnesota isn’t necessarily Louisiana or Texas. But the Blues like to learn from each other, so I’m encouraged by the model.

Q:. How do you believe Health 2.0 will ultimately impact current issues in healthcare, such as the large number of uninsured, the inefficiencies of the current system, and the high cost of care?

A: Health 2.0 first enables transparency: sharing of opinions, information. This can impact quality by driving out, in the long run, poor providers based on consumers’ experiences. Similarly it can inform providers in a qualitative way how to improve their services. Transparency can also have an impact on the cost of care where consumers can shop around for services. We’ve seen this happen already with the advent of retail health clinics, which clearly post prices on their wall before services are rendered, and with medical tourism.

Health 2.0 in and of itself will not directly address the issue of access and the uninsured — but indirectly social media can impact these issues. Influentials online do gain attention for key issues, and health care is currently front-of-mind among consumers in this political year. If you look at the December Kaiser Health Tracking Poll, the #1 and #2 issues on voters’ collective minds are Iraq and health care. The economy, which had been a lower #3 issue, is increasing in concern based on the sub-prime mortgage crisis, the price of gas at the pump, and the negative impact on the stock market and Wall Street overall. Influential health bloggers, for example, raise the issue of access, which is then picked up by the mass media.

Q: Fard Johnmar has argued that Health 2.0 can’t really qualify as a “movement” until the various Health 2.0 startups begin cooperating in some formal structure, such as an advocacy group. Do you agree?

A: I’ve used the words “movement” and “Health 2.0” in the same sentence. Fard is right insofar as to be a movement, there must be a confluence of early adopters to emerge in the adopter phase of Health 2.0. I’m not so certain we need to see a formal structure; that might go against the spirit of social media. I’m more concerned with adoption than what words we use to describe the phenomenon. It is what it is.

Q: What aspects of the Health 2.0 movement will have the biggest impact on the pharmaceutical industry, and specifically, the prices paid by consumers?

A: Transparency — I’m a broken record, but that is my bias as a health economist. There’s no flowing market with the flow of information, and when it comes to pharma, we’ve had lots of obscurity and opaqueness. But you don’t need social media to enable this; you need price lists which could be available in a 1.0 world. You can already cost-compare drug prices on Costco.com, and of course, Wal-Mart and others offer $4 generic scripts. So Health 2.0 isn’t necessary to drive down drug prices. Aggregation of purchasers is.

Q: According to Ed Silverman, pharmaceutical companies say they can’t be more transparent (and thus fully take part in the Health 2.0 movement) because of “regulatory oversight, trade secrets and fear of litigation.” Do you think these barriers to transparency are real? If so, how do you think the pharmaceutical industry might be able to overcome them in order to communicate more openly with consumers?

A: The pharma companies say this and live in a litigious environment. In all of the layoffs occurring in Big Pharma right now, there is still a full-employment act for lawyers and outside legal counsel. But as I’ve said, brand managers are tip-toeing into the world of social media and doing small experiments. This is the culture of pharma — it’s conservative, but teachable. And a new generation of leadership is about to supplant the Old School pharma executives at the C-level, and they are Blackberry-carrying, web-surfing people. So while pharma may be a late entrant, they can be fast followers.

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Comments (4)

My views on medical tourism and it’s health risks are rather mixed. I had one friend who received heart surgery in India with no complaints. Another friend had plastic surgery in Thailand and didn’t enjoy it.

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