In anticipation of the Health 2.0 “Connecting Consumers and Providers” conference in March, we are excited to announce that we are conducting a series of interviews with some of the top figures in the Health 2.0 movement (as well as some skeptics and other industry observers) for publication on the eDrugSearch Blog. Our intent is to run one interview per week between now and the end of February, for a total of 12 interviews.
Our goal is to extend awareness and discussion of Health 2.0 to a new audience — those who visit the eDrugSearch Blog either as prescription-drug consumers, Healthcare 100 bloggers, or others who may not to this point have gotten directly involved in the Health 2.0 conversation.
For our first interview, we talk with Scott Shreeve, MD, of Crossover Health and Lemhi Ventures. Scott, an avid blogger and co-founder of Medsphere (which he later left), has been a leading advocate of Health 2.0 as a key to addressing many of the frustrations of the current healthcare system.
Here’s our discussion with Scott:
Q: How do you define Health 2.0?
A: The definition I still favor is:
New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.
Even this core definition (January 24, 2007) of the term is not inclusive of another aspect of the term — it is encompassing of both the enabling technology PLUS the attendant healthcare reforms which must take place.
Health 2.0 is most appropriately described as an underlying movement within healthcare. So we not only need technology tools that make pricing transparency possible, but we need legislation that mandates this information be available to consumers. The technology informs us of what is possible, legislation defines how to make it happen, and the market ultimately determines what happens. It is the synergistic give and take which gives the movement momentum.
Q: On the Health 2.0 wiki, you argue for a more expansive definition of Health 2.0 than some others, such as Matthew Holt. Holt describes it as the application of Web 2.0 innovations to healthcare, whereas you argue that the term should represent something more — a movement to overhaul the way healthcare is delivered. Are these differences in definition important?
A: Words absolutely matter. My entire blog is dedicated to defining, redefining, or refining specific aspects of the health care delivery system. I start every blog with a definition, not only as a signature uniqueness to my blog, but also as an indicator that words (definitions) actually matter. I am surprised that Matthew, a solid policy thinker, would artifically limit the reach of Health 2.0 by saying,
Health 2.0 is a just a term that groups together the healthcare use of Web 2.0, which is in itself just a term for easy (& cheap!) to create and easy to use software that encompasses search, wikis, blogs, video, online communities, mash-ups and all the other stuff …it’s just a description of recognizable technologies that are an advance on the first generation of web tools. This has nothing to do with ‘outcomes’, ‘quality’, and ‘health reform’ and I guarantee you that Michael Porter (he had heard of it) hasn’t even heard the term.
While I am good personal friends with Matthew, he is dead wrong on this artificial definitional limitation. Health 2.0 will have everything to do with outcomes, quality, and health reform because it is the enabling and underlying technology that will make it possible. See a followup article on Health 2.0 by two other policy thinkers — Sarahson-Kahn and Klepper for validation.
Q: Who do you think will ultimately win this argument over the definition of Health 2.0, and why?
A: My open source background taught me alot about how arguments like this are won — they are won in the marketplace as people choose to adopt or not to adopt things based on the value (intrinsic, extrinsic, etc) that the item brings to them. So I am Darwinistic about this — let the best, most comprehensive, appropriate, real, and functional definition win. I believe if you asked Matthew now, he would have to admit that Health 2.0 is being adopted faster, is much bigger, and the appetite for more types of these innovations is more intense than he ever imagined (as demonstrated by the high powered Health 2.0 conference held in San Francisco; they increased the hotel conference size three times ). As a result, I believe you have to argue for a more expansive definition, and move away from “its just web technology applied in health” myopia.
Q: Do the major corporate players in the current healthcare system — insurance companies, pharmaceutical companies, and hospital systems — have more to gain or to fear from the Health 2.0 movement as you define it?
A:Healthcare is broken — talk to anyone. Everyone is throwing their hat in the mix to fix it — presidential candidates, large multinational companies, non-traditional health care players, infrastructure companies, and your grandma who is buying her pills over the internet. The major entities you mention — payers, players, and providers — have a lot to gain but also some things to lose in the new paradigm.
- First, the future of healthcare is centered in value (outcomes / price) and payors are going to have toe a completely new line around transparency, healthcare value they provide to their members, and the administrative / financial systems that drive care have to improve dramatically. Payers who can’t/won’t adapt will be undercut by nimble Health Plan 2.0 companies who will erode their market share.
- Secondly, pharma should benefit tremendously in its ability to have access to providers and patients in totally unpredicted ways. They will become the new voyeurs — paying for permission to observe large social networking sites of physicians, patients, and other providers settings. But they will have to also be much more transparent on their reporting of clinical trials, their pricing mechanisms, and their involvement in the medical-industrial complex.
- Finally, hospital systems are going to be exposed in ways that will initially be painful but ulimately will be their key differentiation — cost, quality, and access. Everything from straight pricing information, to quality reporting, to customer service, to outcomes data will be posted online and immediately accessible to anyone. There will be some pain, as the vaunted practice variation sees the light of day.
I believe the collective experience will be one of “some pain, prior to the gain”. Overall, however,transparency will prove transformative.
Q: Healthcare has been a major issue in this year’s presidential election, and yet I can’t recall any candidate discussing Health 2.0 technologies and how they may change the debate. What are your thoughts about the government’s role in healthcare?
A: I am not worried about any specific reference to Health 2.0 by the candidates as they are several cycles behind the curve on the latest innovations. However, I believe they have talked abundantly about the reform side of Health 2.0 which must include universal coverage, new models of healthcare financing, and the drive to improve quality, cost, and access. The government will continue to be a tremendous influence, hopefully not a driver, of healthcare in the future.
I believe the government’s proper role is to set the regulatory and perhaps even some of the financial framework for how care is delivered and how it is provided. Then, in my opinion, they need to get out of the way. The initial problem with capitalism is that the invisible hand of the market is often perceived as steady and capricious, but over time it typically bears out to be the best model of delivering every type of good. As an economist, I believe in this principle of free markets.
However, I realize that our current construct does not work and that American values dictate that healthcare should be a right. If this, in fact, is the will of the American people then we need to quit kidding ourselves and just put in a system where healthcare is a right and that if you are able to afford additional services, you should get additional benefits. This creates a two-tiered system, which I believe is unavoidable when healthcare is treated as a right (which I believe most people agree with until they have to pay the bill for someone else through taxes, subsidies, or rationing). The government will continue to be heavily involved, which then colors the entire healthcare reform debate with the darkest hues of red and blue.
Q: How do you believe Health 2.0 will ultimately impact the current hot-button issues in healthcare — the large number of uninsured, the inefficiencies of the current system, and high prices for treatment and prescription drugs?
A: I will try to take those one at a time:
- Uninsured. I am don’t believe that Health 2.0 is going to impact this issue — this is a policy decision. Once the policy has been set, then Health 2.0 can be applied to this agenda.
- Inefficiencies. Health 2.0 will be a major player here to create a much more inclusive “system” (in quotes because we really don’t have a system but a bunch of uncoordinated stops along the way). Health 2.0 engages people who have been disenfranchised (patients), disconnected (providers/patients), and discombobulated (payers/regulators). It is all about information, all about sharing, and all about connecting.
- High Drug Costs. Health 2.0 will help streamline the approval process, the clinical trials process, and the self reporting process. Also, evidence based medicine can be more quickly and widely applied through the dissemination of information that Health 2.0 can quickly achieve through blogs, wikis, email blasts, and other forms of electronic informational blitzkrieg. Drugs do cost alot of money to create, but there are efficiencies in multiple areas that can be gained through the smart application of Health 2.0 technology.
Q: What aspects of Health 2.0 should be of particular interest to the pharmaceutical industry today?
A: Big Pharma is drooling at the mouth regarding Health 2.0. Picking up on one aspect, would be the previously mentioned opportunity to voyeuristically peer into large social networked sites of physicians, patients, and other providers to see how they are responding, reacting, and ruminating on different drugs, prescribing patterns, side effects etc.
One of the coolest companies I have seen in this area is Patients Like Me which has developed essentially a real time reporting engine whereby all these patients (1,500+ and counting), are reporting their off label use of the medication, different dosing regimens, and all the associated symptomology in a way that would cost drug companies tens of millions to get — now they can have access to this information at a fraction of original cost. There are dozens of other examples.
Q: What aspects of Health 2.0 should be of particular interest to prescription drug consumers?
A: Health 2.0 is all about empowerment, about information sharing, and about helping people make informed decisions based on having information. One of my favorite prescription drug examples is how transparency eliminates disparities. I mean — seven miles from each other the pricing difference is astounding. Guess what happens when you start comparing medical procedures in this way. What about looking beyond pricing, and comparing quality of medical services in this way? What about comparing outcomes in this way? Again, the power of information in the hands of the consumers is an unbelievable force for change within the new Health 2.0 paradigm.
Q: Do you still practice as an emergency physician? If not, do you miss it?
A: Unfortunately, the demands of starting Medsphere and now my current roles have precluded me from continuing to practice traditional medicine in my chosen specialty of emergency medicine. However, I have also seen my profession as a platform for my chosen profession — igniting a revolution in the delivery of healthcare.
I do miss some very satisifying aspects of my practice (great interactions with patients, ability to solve problem, knowing that your individual skills can save lives, and the great teamwork of the other healthcare providers), but I certainly do not miss other aspects (bad interactions with patients, inability to solve problems, knowing that my skills were not enough to save lives, the challenges of working within a broken system, the liability environment, etc). I have been able to reconcile my decision by the passion I feel for resolving one of the largest problems we face as a nation. I also believe my very unique background has provided me with a vista, a vision, and a verve to go after fixing these problems.