PODCAST/TECH: Interview with David Blauer at Click4Care

Here’s the full transcript of the David Blauer podcast interview from December.

Matthew Holt: Well hello again. It’s Matthew Holt at THCB and it’s time for another podcast. This one is also about technology, somewhat different than some of the technology we’ve been talking about recently. We’re now back in the world of technology to help improve health and health management, in particular connecting with health plans. Today we have David Blauer who is the CEO of Click4Care. David, how are you?

David Blauer: I’m doing well, thanks. Thanks for having us.

Matthew: Great. Let’s start off with the basics. Click4Care has been around for a few years now and has been known to some of us on some sort of inside baseball view of the world in terms of what’s going on within health plans. It’s pretty fair to say you guys have been building out your product line and building out your client base without making a lot of marketing publicity splash. You coming on this show is part of changing that. Can you give me a quick background as to what the basic business problem is that Click4Care is helping to solve and how you’re solving it?

David: Sure. Our application is built on the premise that preventive healthcare is more effective than reactive healthcare. When we formed the business, we took a look at the industry. Like everybody else, I think, we noticed that if you look at any P&L for a health plan, 85% of the costs for that plan are being driven by medical costs rather than administrative costs. People had spent a lot of time, at that point, trying to refine and skinny down administrative costs as far as they can refine them. But people haven’t found technologies to address the 85% of the cost structure that comprised medical costs. When we looked further, we saw that the sickest 1% of an insured population was driving 40-50% of all those medical costs. The sickest 5% of any insured population was driving nearly 90% of those medical costs. If you continued to drill down, you found that the people responsible for those small percentages were typically moribund, chronically ill people. It became clear to us that there needs to be a technology platform that enables people to identify those risky people driving all the costs and automate the workflows throughout the supply chain to support those people who are driving all those costs in a preventative way that prevents them from incurring those costs by staying healthy.

That’s a great introduction to the problem. I think anybody who has
been reading the healthcare blog or anybody in the healthcare for a
while is finally getting the 80/20 problem. We talk about insurance and
coverage, but we know there are sick people. We know they can be better
managed. We know a lot of the care that is going on, or care that is or
isn’t going on, for those sick people at the moment is either
inappropriate or not evidence based. We know all the data from the
studies from the RAND studies and the IOM reports. You’re not the first
people to come up with this as a problem. What do you think is unique
about your approach?

Some of the things unique about our approach are really embedded in the
technology itself. The first thing philosophically is we believe that
healthcare is not purely clinically driven. We think that psychosocial
factors and other family factors have a lot to do with how well people
feel and, physically, how well they’re doing. We decided that, if we
were going to attack this problem, we had to have an application that
had interfaces and functionality for all of the people on a care team
throughout the supply chain. We’re not focused on just workflow
functionality for nurses and other people in the care organization.
We’re focused on building a platform that can enable a collaborative
team of patients, family members, friends, social servants, extended
family, providers, and health plan supporters, to all work together to
execute long-term preventative care plans that are not just clinical in
nature but psychosocial.

For example, if you’re a married person
who is supporting aging parents, you’re a baby boomer and you’re also
supporting children who are teenagers or even younger, and you’re also
at a point where your own health is starting to incur typical problems.
You’re in the sandwich where you have to watch out for yourself, your
spouse, oversee the health and well being of your children, and also
maybe join your siblings in supporting an aging family member that’s
far away. To do that, you have to have tools that enable you to
communicate with those people. You have to have educational resources
to understand and contribute to that person’s care plan. But you also
have to be aware of and able to manage things outside of the clinical
realm. For example, if your children aren’t doing well in school, your
job isn’t going well, you’re recently divorced, and there are lots of
other social factors that are driving your behavior in a way that
you’re not treating yourself well in a clinical sense. It’s hard to
separate those factors. You really have to have a supportive system to
deal with all of that. Our system is configurable enough that we can
build care plans that orchestrate lots of people executing a care plan
that’s as much psychosocial in addressing those social needs as it
clinical and evidence based in addressing clinical needs.

You’ve essentially set yourself an enormous challenge there. Let’s talk
a bit about what does this look like in practice. Your customers
currently are just health plans and some of this stuff are things that
you’d expect them to be involved in and others parts of that are care
plans that you mentioned that are things that health plans
traditionally haven’t been involved in. Give me sort of a sense of what
this actually looks like on a ground level. Who is building the tools?
Who is putting the care plans together? Who is using them? How does the
information and plans to get conveyed to various people up and down the
supply chain? How is this actually working on the ground?

Maybe the best way to respond to that is by describing how we do the
typical implementation and how the system works for a typical customer.

Matthew: Yes, that will help.

Indeed our customers, at the moment, tend to be large health plans. I
think collectively our system is used to address the needs of over 30
million people across a half a dozen or more relatively large
traditional health plans. In any one of those health plans, our
implementations work the following way. Our application is built in a
way that we can host it for people or, more typically, our application
can be installed on site at our customer and run via their
infrastructure. Once the application is installed, it likes to have
access to lots of different kinds of information. Typically information
is available to the application through real time integration of
external Legacy systems like claims systems, lab systems, product
systems, provider files, and those kinds of things. We also deliver the
application with a commercial quality data loading tool that enables
people to extract data from their Legacy systems and move that data
properly into our Oracle database.

Matthew: Which I would guess is non-trivial. [laughs]

Not trivial at all. In fact in a recent implementation of ours, we had
to execute 28 real-time integration points with things like –

Matthew: Just 28? [laughs]

Right. That’s because we integrate with things like call-center
systems, CRM systems, and lots of things outside of the realm of care
management. That’s because some of those disciplines have information
that contributes to decisions regarding care management. Once the
application is installed and connected to data in some way, the first
thing is that we have literally thousands of predictive and diagnostic
rules in our application that run against all that data. Those rules
try to make predictions about everybody in the population. They try to
predict how much each person might cost in the next 12 months. They try
to predict each persons probability of in-patient hospital stay in the
next 12 months. There are about 123 other predictive outputs from that
predictive model. In addition, our application tries to diagnose
everybody in the population, so if an insured population has someone in
it that is suffering out of control diabetes, diabetic retinography,
chronic skin ulcers, asthma, and depression at the same time, for
example, our system will recognize that and write those diagnostic
labels to that person’s record in the database. So once the population
is predicted and tagged according to various diagnoses and conditions,
the next thing that happens in our application is that we have this
very unusual tool that enables laypeople without any technical skills
to do very automated patient identification queries. And these queries
run in the background all the time constantly fishing through the
population to find great candidates for medical management.

Matthew: Right.

And people who build these queries can automate how the system
addresses those identified patients. For example, someone can, without
technical skills, teach the system to automatically activate customized
care plans for each person that those queries find. They can tell the
application to automatically build projects and route those projects to
nurses. They can trigger educational fulfillments and assessments and
all kinds of other workflows without any human intervention. So it is
an unusual way to trigger large population health management projects
without any human workflow, essentially.

And then, once the
application runs these queries and identifies candidates for medical
management, the next thing that happens in our systems is that it
contains an industrial strength routing engine that will take each
identified patient and try to match that patient to the nurse who is
optimally qualified to care for that human being. And the way it is
doing that is by matching that human’s conditions and diseases to the
nurse’s specialties. It does workload balancing and matches language
skills, it tries to minimize geography between the nurse and the
patient. And there are about 40 different routing parameters that it
uses to try to optimally route people to the right help. And then…

Let me interrupt you for a second, this would be for a call center type
nurse or disease management call center type nurse, that is what we are
talking about here?

It does not have to be, because the application is web-based and the
interface can be used anywhere that there is connectivity, and because
we can assign different user roles and assign people to different
places in an organization or supply chain. The system can grab patients
and route them all over the supply chain, it could be to an external
disease management vendor, it could be to an in-house nurse or call
center, or it could be to a social worker in the community, it is
unlimited in that way.

All right. Two differential questions come from that, ones on the input
and one on the output. Let me start with the input first, which is,
there is a lot of stuff, potentially, that can go into the system. You
talked about different types of claims and lab data and information
like that, you also talked about data coming in from CRM, I assume that
we now have at some point coming down the pipe these PHRs and patient
input data, you are presumably are starting to get some provider input
data, I don’t know whether that is coming yet to your systems, but
there is some of that coming out of some health plans. So, what are the
most important things to pick up to help the predictive modeling you
are doing? Is not the most important thing to figure out what is going
on in the medical claim system? What is really driving this?

Traditionally, medical claims and other related administrative data
were the core predictive models and indeed for the longest time have
been dragging most of the members in the industry. And our system
relies on claims data to some extent. But increasingly, our system
relies on transactions and other types of activity in the system to
figure out who is at risk, rather than just the claims data. For
example, our system is constantly probing utilization management
activity, biometric inputs, assessment responses that are contributed
to the application by members who are taking bio-assessments
interactively, or by us pulling in assessment responses from
third-party vendors that carry out assessments.

So you are saying that most of the activity on these input is from
people who, once you figured out that they are diabetic or asthmatic or
whatever it is with modeled probabilities into the system, most of what
you are now doing is getting more information in various ways from them
and working on that? Is that a fair characterization?

David: That is a fair characterization, yes. 

Well, I was going to say that actually leads me to the next question
which is, so the output is that you need to get people into the system,
so for those folks in these managerial roles (I am thinking about the
HealthWays and Lifemasters type organizations, these phone-based
outreach to members or people), is also nontrivial and it is quite hard
to get people involved. It is also quite hard to get people to stay
involved, and not stop being involved. If you are the supporting
software for health plans or those kinds of functional things to help
their partners outsource it, how are you ensuring that you are getting
enough follow-through with the sick people that you can actually make a
difference with your care plans.

Once the application identifies people, most people are routed to care
managers or other people. The next thing in the application that occurs
is that our system evaluates each care management candidate and then it
will go into a library of very automated longitudinal care plans, and
it will pull from that library all the care plans that are related or
that are affiliated with all the different diseases that our candidate
patient suffers. And some of those diseases are not really diseases,
they can also be social situations like someone is divorced and
drinking too much, or someone lives in an apartment with lots of throw
rugs where they often risk having a bad fall, or someone lives rurally
and does not have a lot of communication with people.

So, our
application is constantly labeling and tagging people. And once the
application finds candidate for medical management, it goes into a
library of workflows related to all of that person’s conditions,
diseases, and social situations, and it grabs those work plans and
bundles them together into one big, comprehensive care plan for that
human being. And that care plan is smarter. Once you bundle lots of
work plans together, each one comprises lots of tasks. So you bundle
all of these different little nuggets or work or lego-pieces together
to build one comprehensive care plan for a human being. Well when you
do that, the system has to be smart enough to suppress redundant tasks,
and contraindicated tasks, and our system handles quite intelligently.

our system builds this extraordinarily comprehensive care plan for
people, and then that care plan gets activated, and from that point
forward our system uses that care plan to automatically deliver tasks
to the workforce of patients and their family members and friends and
social servants and providers and people in their care organization in
a very orchestrated fashion. Sometimes a care manager of a care
organization will not receive a task until three or four prerequisite
tasks are completed properly by external users of patient’s site or the
family’s site or the provider’s office, for example.

So these
are very sophisticated, complex workflows that automate how the system
behaves and how the system monitors for task completion, and when the
system sees any new information coming into it from claims data or
biometrics or lab values or assessment responses, the system takes that
data and can then in real time dynamically or automatically change that
person’s care plan; it will either suppress some of the tasks are
already in the care plan, or will add new little pathways in the care
plan to expand it to deal with either a long-term or transient
condition that it just noticed occurred. So the system is constantly
monitoring the patient and inputs regarding the patient, and is
dynamically changing the care plan all the time.

So, I get that part of it, that is how the software is working, and it
is obviously extremely complex. On the other hand you need those
inputs, and you need people to be doing things, and some of these
people are people that have not traditionally been involved in
connecting with the health plan or the software system. I include in
that the care giver, the patients themselves, the providers often have
not had much connection with this kind of a system, especially coming
from outside their own office. I mean maybe you do not regard this as
your job as a software company, but how are your clients dealing with
making sure that these things go into the system? You see, if you are
not getting these inputs into the system, I assume it is not that

David: You’re talking about the pathways and the contents of the workflows and such?

Well, I’m thinking not so much about what’s in the system already, but
you need to know — without being familiar with the system — where a
pathway needs a measurement of something, or a physician needs to do
something to the patient, do an assessment or whatever. And you said,
in some cases you may need to know information about what’s in the
home. So maybe the patient has to report where they have throw rugs and
maybe somebody has to go out there maybe a friend or a family member
has to do some input or report something back. So I’m wondering, the
system needs more inputs than just what it can scrape out of the claims
data or the lab data or the pharmacy data, I’m wondering how that level
of communication is happening.

The way that the system adjusts itself to ensure that it’s driving work
appropriate work flow like you described, is that rather that just
relying on administrative data, it’s constantly monitoring all kinds of
data regarding a patient because our data model is purely consumer
centric. So our system, there are queries unique to each member or
patient that are running in the background figuratively all the time to
look for changes in not just claims and administrative data, but in a
way people are executing their tasks in the care plan, in the way
people are responding to assessments, in biometrics and lab values in
very structured notes that the nurses are making in the system as they
execute transactions and research over time in the system regarding a
patient. The system’s responding to grievances regarding a provider,
for example…I don’t know how to answer your question properly.

Well, a lot of the issue is that we have, in general in health care, a
scarcity of good usable data from a lot of useful areas. We don’t know
traditionally what was going to the patient’s home and we traditionally
don’t have regular biometric data from patients, they may go visit the
physician and have a lab test every so many weeks or months, but we
don’t have consistent information coming back. Some of the things you
mentioned like whether there are too many rugs in the house which might
trip up an elderly person,  is data that I’m sure is generally never
collected. So, I’m just wondering how that information is actually
collected and how you’re getting information from a physician’s office
that may be some of the assessments in the notes from a physician’s
office are still taken on paper and not entered into a particular
electronic medical record that’s not on the claims form. I’m just
wondering how that information actually shows up so you can make these
adjustments to the plans.

In the part of the care plans — a component of the care plans — is a
group of tasks that occur intermittently that drive nurses and patients
to respond to assessments, and providers as well and family members. So
lets say you have a two year health care pathway to support a certain
kind of condition of disease, along that care pathway at various times,
the system will prompt someone to interactively take an assessment from
the patient’s website or from the patient’s family member’s website or
from the provider’s website, and sometimes it will prompt a care
manager in a cubicle to pick up the phone and call a number and
interactively take that assessment on behalf of the member who’s on the
phone with a nurse. And as those assessment responses occur, those
responses automatically drive additions or withdrawals from a care
pathway, so that’s one..

I see. So a lot of this is based on essentially somebody completing
some kind of health risk assessment or other assessment or
questionnaire type information with either directly the patient, the
patient’s care giver doing it online, or a nurse doing a check of the
patient or the care giver and saying, "Hey, what’s up with this kind of
information? What’s going on with these following six or seven or 20

That’s right, that’s part of it. We’ve also made the application sort
of a multi-channeled application. In other words, our application
includes and email server, a fax server, and lots of other channels for
communication so patients can receive tasks directly and contribute
information not just by answering assessments. But we have partnerships
with Health Hero for example and Imetricus so if people are using
biometric devices, they can contribute biometrics directly through
those devices, and…

That’s actually pretty interesting. Those are two companies that I know
pretty well. With customers you’re working with is the uptake of that
anywhere close to being worth noticing yet or is it still sort of very
much in the early stages?

It’s still truly very much early stage. I don’t know if it’s the cost
of the infrastructure necessary to carry out that model or if health
plans in particular are not quite ready to turn on that level of
functionality for members because it implies a lot of customer support
and a very different kind of customer support once you open up that
kind of functionality to people who are maybe novices with the
technology or with the web in general. But so far we haven’t seen our
customers really take up member interfacing devices and tools like
that. So…

Matthew: So you’re ready but they’re not?

That’s right, everybody seems to have a member portal but it’s sort of
a member portal that includes sort of a vanilla personal health record
and that’s about it.

Right, right. Well, actually, I have some stuff to say off line, and
I’ll talk about personal health records in a moment because I think
they’re pretty important in regards to all this. But let’s touch base
in one area which is something that, in my recent interview with Lonny
Reisman of Active Health Management was something that he was of pains
to point out was pretty important, which was communication with
providers. It’s all very well to say that we’re doing all this great
stuff from the health standpoint, but as you know, most providers in
this country believe that health insurers are these evil bastards who
strip 20 percent of the dollars off and refuse to pay them back their
justifiable claims and they don’t know anything about health care or
medicine and they have a clerk on the phone that didn’t go to medical
school maybe didn’t go to high school [laughter], and there’s that
attitude you have to overcome. How have you communicated, and what type
of approaches in terms of actually communication now are you using, to
get providers involved in doing their part within the care programs,
because I assume if they don’t get involved, it’s less useful.

I must say that we haven’t focused on the provider interfaces as much
as we have the other interfaces. We’ve paid a lot of attention to the
payer’s side of the functionality and we have very deep functionality
for patients and their extended families who tend to probably care more
about the patient’s well being than maybe the patient as… But, I
guess philosophically, most of the care happens in between provider
visits and I think we’d recognize everything that you just stated, that
providers in general, they business model is pressed by a lot of
external factors and don’t necessarily have time to entertain an
application that’s supported by one versus another health plan since
they on average see patients that are covered by a multitude of
different health plans.

Well, on the other hand, things that providers do obviously matter
dramatically in the care plan, so let’s just make up, if you have a
patient who’s on a certain number of drugs or whatever else and there’s
something in your care plan that says they need to change the
therapeutic category they’re in, or whatever it happens to be. There’s
something going on which involves changing a provider’s decision. How
does that show up in practical terms? Does a physician get a phone call
or a fax saying "We suggest that for this particular patient there may
be some issues you need to look into these or this information, or

We have — as we do for the patient and their family members — we have
a browser based interfaced directly for the provider and providers
administrators so our application will deliver tasks and alerts and
notices directly to the providers web based interface, and on that
interface a provider can see her patients’ care plans, and all of the
different tasks that have been allocated to the different people on the
care team, they can execute formal processes like utilization
management requests and appeals and re-determinations. They can also
receive educational materials and communicate directly with anybody on
the care team through our application. So they have this very full
functioning browser based portal, if you will, through which they
interact with our system, but our system also has a fax server so
providers can fax things to the system, and the system will attach
those faxes to the relevant patient’s record, and our application can
fax things directly to providers office. And also our system can
deliver tasks via email as well. We have not yet integrated with an
outbound calling system like Eliza and Par 3. Certainly that is
something on the horizon.

And is this a…I am kind of reading between the lines here…It sounds
to me, I may be putting word in to your mouth here, that in the degree
of integration of this care management program, you put this technology
in place so that the providers can get these messages. Reading between
the lines it seems to me as though most of what you are doing, is
leaving the degree of integration and introduction of these programs
with providers up to your clients, to health plans. So the medical
director of the health plan can now announce, or not announce, to the
provider network they are working with, that they are going to be
putting the sick or more chronically ill members on this plan. And they
are going to be giving suggestions, and it going to be coming from the
plan rather than the software company. Is that a fair assessment?

Yeah, that is a fair assessment, without being too cryptic. That is
currently the case because of our business model. I think that the
structure of the supply chain sort of warrants a payer is the
underwriter of these services and indeed supports this kind of
functionality to their affiliate providers, but very quickly now we are
trying to move that responsibility and authorization to consumer him or

Matthew: Right, and that again maybe
something that is going to obviously be a big change in how consumers
deal with providers. My suspicion would be that the majority of the
change will be lead probably by the baby boomers, sort of mid forties,
thirty five to forty five year old female with elderly parents and kids
still in school, but you talked about, rather then by the most,
chronically ill people themselves, and I think that as that change goes
on, this type of support is going to be something that you could
imagine almost being a consumer product.

Having said that basically there are only a few people in position
to put all this data together. So with that, we just had yesterday
blues, AHIP and The Blues announced that they are now going to have
interruptible patient records, health records. Last week we had a big
announcement, J.D. Kleinke’s group that is, up your way (Oregon), that
a bunch of employers will get together, and put together personal
health records. Speaking from somebody who tried to sell these things
five years ago, and went bankrupt doing it…[laughter]  Where do you
think they fit in? Do you guys have an active personal health record
product that you are going to bring to market?

David: We feel that our data model
has probably the most complete longitudinal personal health record
program out there. And because of how easy it is to integrate with our
system, I think it might be the most viable one. We believe that
ultimately carrying out that personal health record and exposing it or
unveiling it to the masses actually may involve partnership with
someone entirely outside the health care industry. We are not sure
that, obviously, the data available in the longitudinal personal health
record belongs to the patient herself. But the person who manages the
personal health record and makes it available for use by the supply
chain, we think is outside the health care supply chain. We were
looking at a lot of different brands in the financial institutions
market, and others. We actually feel that someone who’s independent of
health care may step up and be most logical candidate for sponsoring
personal health records, I don’t know if you follow that or not?

Matthew: This is something I follow
very closely, which is why I brought it up, you see if you look at the
employer initiative announced, the Walmart, Intel thing announced with
J.D. Kleinke’s group, with OmniMedex and that is basically where they
have gone. They say you need an independent non-profit. And so what you
are saying is that you put together the data structure behind that,
that can go into whoever ends up being the front end, but you
yourselves are not gong to be the front end.

I presume that,of your clients, United has already made this
announcement about going with Intuit, I do not know the rest of your
client lists, but I see several of them who are going to be working
with WebMD or whomever else, to be that front end. It obviously it
remains to be seen, as to this health plan announcement made yesterday,
about how real the "Interoperability" of data or portability of data to
be between different plans, between different systems. Because, let’s
say data that is collected by your system  for one health plan, and the
member goes to join another health plan which is using one of your
competitors systems or something different. How this data is going to
move around is still open to question.

Exactly form what I see, that is a big selling point for why some big
company like Wells Fargo or Bank of America or someone else may be the
more logical place as a home for these kind of records. Simply because
It may be more appealing to employers and others to not have to cause
people to carry that information from one system to another, or from
job to job.

Yeah that makes, it’s the same rational as to why we should actually
have either individual health plans, or a non employer based health
insurance system, but that is what we have got right? [laughter] Its
going back to the old system, you looked at the health care system as a
whole you would have never design it this way to begin with…

David: Right…

That is very true, So tell me a bit about, I think we have covered a
lot of ground here in the last couple of minutes, tell me a bit about,
sort of a ball park on Click4Care as a company. Where you are client
wise, anything you can tell me about revenue wise and any of your
future plans for rolling this thing out?

We have been around for about eight years now, and most people have not
heard of us yet, because we have been heads down just building our
application. Our application was built in a very disciplined way, and
it has become an enormous application. It is the result of about
500,000 man-hours at this point. We probably have about five million
lines of quite pristine code. We built the application strictly
according to a process called the rational unified process which caused
us to spend literally two years doing nothing but examining and writing
very specific use cases for the functionality before we started to code
the software we really tried to refrain from being out there marketing
vaporware. So we decided to not really focus on selling our software
until it was really ready for prime time.

At this point we now
have a platform that’s amazingly configurable, extremely performant and
supports and sort of intermingles all of the disciplines of medical
management. Utilization management, case management, care management,
population health management, even family management if you will. About
a year ago we started to heavily market ourselves and participate in
RFPs and since then we’ve been surprised by how much success we’ve had.
No one anticipated where we’d be today but in the first year we’ve
signed signed seven customers. By far our largest customer is United
Health Group.

We recently won a closed deal with a three to four
million member health plan by which we will be the sole platform for
supporting their case utilization and disease management programs as
well as their long term and short term disability products and their
employee assistance program products. And our application will start to
provide some of their CRM functionality. So in total we have seven
customers, collectively they cover a little over 30 million health plan

A few of them are not health plans. One of our
customers is a company called SummaCare, which is a health system in
Ohio that has it’s own captive, smallish health plan. We also have one
of our customers is CVS. Their specialty pharmacy subsidiary, which is
called Pharmacare, is a customer of ours that uses our application to
provide care management for people using specialty drugs for diseases
like hemophilia, multiple sclerosis, hepatitis C and that sort of
thing. We also have customers in the disease management space. One of
our customers is a publicly traded disease management company for
example. So that’s where we are in terms of our customer base and where
we came from in terms of building the software.

Where we’re
going? We have to jump on the bandwagon. Whether you believe that HSAs
are the vehicle for the future or consumer-directed health plans are
the vehicle for the future, we think it’s irrefutable that something,
regardless of the vehicle, something is going to continually shift the
cost and the risk of health care to the consumer because external
drivers like demographics and economics just simply won’t let it go any
other way. Regardless of what that vehicle is that means that consumers
need tools, decision support tools and workflow automation tools, to
manage their own risk. So our application is quickly moving into the
consumer realm.

We are focused on marketing ourselves to payers
and we find that very valuable but we’re coming out with versions of
the application that, in a very unusual way, will support consumers
becoming their own care managers to an extent.

Well I think that there’s a tremendous amount of interest in the whole
issue of how people are going to interact with the many different ways
that the medical care system and that the whole notion of that there
isn’t really such a thing as a easy health advocacy system that you can
plug yourself into and as you get sick you have to navigate around by
feel or trial and error at the moment is a problem.

So I think
that that’s very exciting and I think you pointed out that nobody
really has a clue what it means yet but I think that there are people
from all aspects of health care and outside of health care sniffing
around trying to figure out how do you improve the consumer experience.
Because one thing we do know is that the consumer experience with the
medical care system is, at the moment, not a good one.

You mentioned the word experience, I think that it’s time that people
start to think about employing other verticals, paradigms on the health
care industry. You know one of the things that discourages sometimes is
that we see people in their thinking are thinking about using big,
extraordinary platforms to do nothing more than send mailers to people
or do sort of mundane things, cold-calling to recruit patients in the
medical management programs. But this is the point of one speaking but
perhaps some specific percentage of those mailers go right into the
trash and we started this business to have a profound effect on the
direction of people’s lives and we don’t think you can do that by just
doing mailers and cold-calling and working from a cubicle.

when I talk about an extraordinary consumer experience, I’m talking
about our next version of the application, leveraging a lot of the
tools and ideas of the entertainment industry and lots of other
industries to try to motivate people to change themselves because
everybody is motivated by something different. Some people you can pay
them enough to get them to change their behavior. Other people can be
shamed into changing their behavior. Other people can be guilted into
changing their behavior because maybe they’re guilty if they’re not
taking care of themselves for their four-year-old son or daughter, for

So we intended to use lots of different means of
communication and entertainment and lots of other devices to really
intervene with people at magical moments throughout the day, through
lots of different kinds of devices to get them to change themselves in
a very sort of emotional way not just by sending mailers to people.

Well you know that’s really interesting because you got currently this
kind of explosion online, for want of a better word, the Health 2.0
movement of people communicating with each other online and trying to
figure out how to get information that’s more personal to them and
store it and manage it. There are a lot of active health consumers,
trying to kind of put together different versions of their sort of
health care management process and really fumbling around—but there is
a lot of activity going on.

There’s a huge appetite for, as you
know, Internet search around health care and all that kind of good
stuff and you really got a health care industry both on the payers’
side—well, the payers have made some movement but not as much as some
of us would have liked and even less on the providers’ side—that has
been slow to  start delivering some information to the patients. It’s
kind of slow and then you’ve got these champions like Don Kemper and
others on the information therapy side who have, suggesting that
exactly what you said, you need to motivate people in a number of
different ways and we should be stealing techniques from other
industries to do that.

So I think what you’re talking about is
under-laying this, putting a software platform that under-lays a huge
part of that but your organization is going to be the dominant player
in that but there’s a huge opportunity there if we can just figure out
how to connect that demand with the supply side. So I think it’s very

Right. It gets to be down and dirty but what I’m saying is that we’re
trying to figure out how to intervene with that person at any time
during the day, when someone has to make a decision about gobbling down
an incredibly unhealthy cheeseburger they’re doing something very
detrimental to their health without aggravating or annoying that person
and you can’t do that with a static website where people look up
information and maybe log their personal health record. We think we
have the answer, so hopefully in about 18 months we’ll unveil the next
version of our product that will address that.

Matthew: That’s great. So that’s going to send me an electric shock at 5:45 and tell me to get off the Internet and go to the gym.

David: Yes, if electric shocks work for you that’s what we’ll do.

That’s great. Well I’m not sure whether I’m looking forward to that but
we’ll talk about that later. That’s a shocking place to end the
interview. [laughter] Great. So I want to thank Dave Blauer for going
through the last 45 minutes with us on The Health Care Blog podcast and
telling us about Click4Care and their vision for the future. An
exciting company to watch and it’s a space that there’s clearly a lot
of activity going on in the future and we’ll keep tabs on it. And when
that new version comes out we’re going to have you back on the blog and
you can tell us about that.

David: That sounds great. Thanks for having me, Matt. I appreciate it.

Matthew: OK, well it’s been a pleasure thanks so much and we’ll see you next time.

David: You bet.

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