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Diving Deep with American Well by Craig Stoltz

American Well, an ambitious startup designed to provide virtual health/medical transactions between patients and doctors, has been invited to present its product overview in a thoroughgoing way–a deep dive, in Health 2.0 patois.

In this liveblog, I need to control the depth, of course. I’ll try to boil this into five (5) key points about American Well:

1. Unlike other industries, health so far hasn’t succeeded in doing transactions (Amazon, Expedia, eBay, etc.) on line. Imagine Expedia if, instead of buying a ticket, all you got was a picture of your plane. What’s missing? In health, it’s the real care transaction.

2. American Wellness is essentially a brokerage system for online wellness services–real services, not just information. Connecting consumers with providers and, as important, the money–which is to say insurance reimbursement systems. Patients, docs, money, all tied together.

3. Consumers can access specialists, from anywhere, for a fee. Their calls, e-mails, etc. are aggregated and distributed to the appropriate specialists in real time.

[The liveblogger anticipates the big question: How does this provide continuity of care?

And the answer comes immediately–the AW marketplace delivers only specialists, not a primary care doctor. The tradeoff of getting someone with whom there is no existing relationship to have immediate access to care. ]

4. What’s the transaction like? The demo shows a consumer’s entry into the system. [The interface is very clean–you can tell they usability tested this really well.] First, consumer looks for a doctor. [PowerPoint slide joke: Doctor profile that comes up is an OB whose name is given as Otto Matic.]

Doctors presented with bios, videos, etc. Ratings? Yes, but not clinical ratings. Just consumer satisfaction ratings. [Needless to say, this is one of many services attempting to aggregate patient evaluations of doctors.]

Part of summary is–price transparency! The cost of the anticipated consult is listed. Patients can fill in their health background to let docs understand the situation more fully. Then doctors, in real time, review request and decide if it’s appropriate that they take it on.

Then: When patient and doctor both agree to a clinical encounter online, an interactive console pops up –the interaction can be live video via webcam, live  audio or typing chat, on-screen notes and documents, etc. Lab information, with patient permission, can be added. While it’s a virtual interaction, it’s a rich-media virtual encounter.

5. And the consumer’s regular doctor? Patient can send doctor report of entire transaction.

[The liveblogger’s question: What will the patients’ internists have to say about this?]

Other point: Insurer AIG has developed a new malpractice insurance product–per transaction, not annual. It’s embedded in the service.

Will this save money in healthcare? AW argues that by providing some care in the home, and keeping some transactions at lower cost, insurers, payers and patients can save money. This can keep people out of the ER, maybe.

The AW plan–essentially disconnecting care from a physical location–raises all kinds of questions not dealt with, even in this deep dive: Privacy? Coordination of care? How to deliver service of real value without risking misdiagnosis, etc. How will insurers ultimately reimburse this care? How different/better/worse will this be compared to in-store retail clinics? What conditions or situations is this kind of virtual care best suited to?

And finally, when will this launch? In 2008, CEO Roy Schoenberg, MD assures us.

Liveblogging the Health 2.0 “Unconference” by Craig Stoltz

So Indu is on stage, introducing the Health 2.0 "Unconference"–user-led
discussions around tables, all happening at the same time. Whoever
submitted a topic gets to "hold court" at a table.

So you are reading The Health Care Blog’s liveblog of an Unconference. This is so front-edge, high-wire techno-virtual I think I may get a nosebleed. 

Enoch Choi, a very 2.0 physician and veteran leader of
unconferences, is leading the show. "Very reality TV"–if you’re bored,
pick up and go to a table that’s more interesting. Topics are being
submitted as we speak.

  • Enoch is giving out topics
  • Social media and pharma!
  • Genomics!
  • Extending patient-physician relationship!
  • The future of alternative sales channels in pharma!
  • Increasing patient engagement!

I’m using exclamation points, but we’ll see how exciting these topics
actually turn out to be. People are finding tables now. We’ll see how
many wind up bolting–and what precisely the I’m-leaving-your-table
etiquette is.

***********

The biggest crowd, curiously enough, is at the table discussing "information overload." David Sobel holds court. Interesting point: More information actually "disempowers" people due to confusion and excess. Information is not always power. It’s often annoyance, noise, even harmful.

*********Over at the table of the estimable Esther Dyson, there’s a hand-written sign "The Impact of Genomics Info." This is heady stuff: one discussant talks about the sensitivity of an individual’s genomic information, and that the system isn’t prepared for dealing with that.

"And doctors," it’s pointed out, "are not trained in genetic medicine."

Benjain Heyward of PatientsLikeMe seconds the motion: Doctors aren’t set up to deal with the information that patients often want about their genetic risks, etc.

******

BIG crowd over at the Pharma-and-social-networking table. Great point made: "What would pharma have to gain from trying to create and own their own social network?"

If you’re a patient with Crohn’s, it’s asked, where are you going to go to find support? A forum run by a drug company? Or one with more independence and credibility.

Something called GroupLoop is mentioned. It’s described as a network that has the ability to become a "cross between MySpace and health." We’ll have to check that one out.

TECH/HEALTH 2.0: Eliza & Silverlink, strategic healthcom 2.0

So the gang is all in San Diego getting ready for the Health 2.0 conference which starts Monday (gulp, that’s today!) Feverish last minute preparations are apace. 

I spent some time on Saturday morning talking to two people at the forefront of the communications revolution on the telephone. Alex Drane, President of Eliza, and Stan Nowak, CEO of Silverlink.  We had a fascinating
interview. See if you can spot the moment when Stan invented a new term which Alex trademarked before he’d finished speaking. (Hey at least the lawyers are making money!)

TECH: Drugs & technology–Allscripts and SafeMed

To finish off the last but not least of my HIMSS interviews, here are two companies that both announced being part of the Google ecosystem on the Thursday of HIMSS. One is well known and a leader in ePrescribing and EHRs (even though it’s had a tough year on Wall Street and won the HISSIE for most likely to be acquired!) That’s Allscripts of course, and I was able to grab a quick chat with head marketing honcho Dan Michelson and Jamie Stick, IS Director from one of their star clients, Central Utah Clinic in Provo, Utah.

They also have a very cool video called Paper Free health care (I spot some inspiration from the Health 2.0 video!)

I also got the chance to meet a much smaller company called SafeMed. Rich Nossfinger & Ahmed Ghouri hasve built a very very sophisticated rules and processing engine which can interpret drug data and embed that decision support into patient specific indications. Very intriguing stuff and you can learn more by listening to this interview (although they weren’t allowed to let me tell the world in advance that they are one of the first partners in the Google ecosystem. Here’s the SafeMed interview.

TECH: Location tracking, RadarFind’s view

I’m still hot on location tracking. The idea is that if you can locate devices like pumps and wheelchairs and eventually staff and patients, hospitals should become much more operationally efficient.

But this market which is now 4–5 years old has yet to take off. Part of the reason is that WiFi based systems don’t seem to work as well as advertised, and infra red or others that need new networks are too expensive. Stephen Jackson is CTO of RadarFind, which has a new system which plugs into the electrical system and uses that to move its tracking data around. It seems cheap, easy and effective. Too good to be true? Let Stephen convince you in this podcast.

TECH/PODCAST: Microsoft speaks health care

Microsoft has made some big strides in health this past year. You can easily argue that a) its search has outpaced Google (following the acquisition of Medstory), b) that it’s making strides in the provider market with the renamed Amalga (although that’s leading to a strategic question about whether they’re really going to be a serious player on the inpatient EMR side there) and c) finally that HealthVault legitimizes the whole PHR market. Microsoft will be at pains to tell you that HealthVault is not, though, a PHR. What is it? Ad what about the rest of those questions?

Listen to my interview with Chris Sullivan (US Provider Solutions) and Grad Conn (HealthVault) to find out…

TECH: Interview with Newt Gingrich

The controversial and not-shy-with-his-opinions former speaker of the House Newt Gingrich has been very active in recent years promoting the automation of health records and EMRs. But he’s never been a great pains to stress how that would get done from a policy perspective.

I was glad to get a few minute with him because I was able to get straight to that question. And on that topic it appears that Newt has become a fan of government mandates and directed government spending. I think you’ll find this podcast fascinating, although it’s short.

TECH: Finishing up HIMSS!

HIMSS was an intense experience this year. Not only did I present on Health 2.0 at CHIME and at the Cisco Community for Connected Health, but I met lots of old friends and made some new ones at the ICW, HISTalk, Allscripts and Google parties, as well as seeing an almost complete reunion of the old i-Beacon gang. (Bringing back memories of the famous 2001 New Orleans HIMSS beigner 2am powdered sugar fight!)

I also got up very early to attend a breakfast organized by the good people at Allscripts for Newt Gingrich and 50 of his closet friends, and was lucky enough to get 5 minutes to talk with him…..and those of you who think I’m an un-repenting Marxist will be amazed that I agree with him on the issue of mandating and payment for ePrescribing and EMRs! (Although I suspect several of my free market friends do not!)

Unfortunately my experience getting home from HIMSS was way less fun, and I arrived home way later than expected (although I narrowly avoided spending the night on the floor of the Miami airport and actually had a nice room in a rather trendy airport hotel called the Preston in Nashville). And of course by the time I got home I as deeply underwater in Health 2.0 Conference related activities.

So I’m playing catch up and the next several posts will be the remaining podcasts from HIMSS. They’re well well worth listening to.

What’s wrong with individual health insurance mandates by Claudia Chaufan

Individual health insurance mandates have lately been hailed as the solution to the health care crisis in America. Mandates to buy health insurance have been included in legislative proposals at the state level – for instance, by Gov. Schwarzenegger and Speaker Nunez, in their “Health Care Security and Cost Reduction Act”, or at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Can mandates achieve universal access to health care and control rising costs of medical care? This article explains why they can’t.

Lately, legislation including a universal mandate – a legal obligation that everybody purchase a health insurance policy – has been hailed as the solution to the health care crisis in America. At the state level, mandates have been included, for instance, in Gov. Schwarzenegger and Speaker Nunez’s “Health Care Security and Cost Reduction Act”, and at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Yet many of us remain skeptical. Why? After all, if everybody is forced to buy a health insurance plan – maybe with a subsidy if you are “poor enough” – would this not resolve the problem of uninsurance? Maybe so. But the real question is: would mandating universal health insurance guarantee universal access to medical care? And the short answer is no. 

Continue reading…

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