Monday, February 19, 2001

Battle for the Hearts and Minds of ‘Cyberchondriacs’

Latest Harris Interactive health care research data show that well over 100 million adult Americans have gone online at least once to look for health or medical information. Humphrey Taylor, chairman of The Harris Poll at Harris Interactive, coined the term "Cyberchondriacs" which describes these individuals. The online activities of Cyberchondriacs have captured the attention of physicians, and pharmaceutical and health insurance companies, who have now started to battle for the hearts and minds of these online health care consumers.

Explosive growth of Internet usage will surely transform the doctor-patient relationship

Before long, most doctors and their patients will be using the Internet to fix appointments, to refill prescriptions, to read about the latest medical research, to ask for and provide information and advice, and (such is the Internet) to do many things we have not yet thought of. But physicians are not the only people who will use the Internet to build relations with health care consumers. The large corporate battalions also want to build their own online relationships with patients.

The Internet is, by a wide margin, the fastest growing technology in history. It is a revolution that has only just begun, and nobody knows where it will take us. Initially, like all new technologies, it is being used to do old things better, faster or cheaper. Increasingly however, it is being used to do completely new things that people could not do at all, or could not afford to do, previously. Nobody knows, with any certainty, how all of this will transform the health care marketplace in the long run. But whatever they are, the effects will be huge.

The Pharmaceutical Industry
Right now, pharmaceutical companies are investing huge sums of money in what they call ‘relationship marketing,’ ‘direct to patient marketing’ or ‘database marketing.’ This is different than direct-to-consumer (DTC) advertising that uses traditional TV and print media, because it involves building databases of e-mail addresses of patients who have particular medical conditions. These are patients with whom they can develop one-on-one relationships through the Internet. For example, drug companies are building email databases of people with hypertension, diabetes, arthritis and allergies. If they succeed, this will forever change the doctor-patient relationship in that patients, in effect, will be receiving medical advice (including "compliance management") from someone other than their doctors.

The Health Insurance and Managed Care
The health insurance and managed care industries have started building email databases of their own plan members so that they can build closer relationships with them. They want to bond with their members and (the general unpopularity of managed care notwithstanding) they probably will succeed to some extent. Most people are still reasonably satisfied with their own health plans even if they think managed care, in general, stinks.

According to recent reports by Ernst and Young and other sources, some health plans are already beginning to use the Internet to communicate with their members or potential members about:

- claims status reports
- online prescription drug ordering
- enrollment applications
- replacement ID cards
- benefit details
- customer feedback reports
- ability to change account information online
- report cards on medical groups, physicians and - - hospitals
- health club membership
- customer service e-mail
- health assessment
- referral information

One reason why "direct-to-patient" online marketing will grow very quickly is that the Internet makes it possible to send highly personalized messages, tailored to the specific needs and interests of millions of individual patients, at a ridiculously small cost. And patients can reply from their homes at no cost to themselves. This is as big a communications revolution as Guttenberg’s printing press.

Managed care and insurance companies want to build relationships with their members for demand management (getting people to seek and receive medical care when, and only when, appropriate), case management, and member retention. The drug companies want to build relationships with patients so that they will ask questions about their drugs, use their drugs appropriately and refill their prescriptions when necessary. None of this is inherently bad for physicians or patients – and much of it is good. However, the risk to physicians is that their patients may come to rely more on advice from drug companies and insurers and become less dependent on advice from their doctors, weakening the doctor-patient relationship.

Physicians, Patients and the Internet
Physicians enter with a huge advantage; they have earned the trust and respect of their patients to an extent that pharmaceutical companies, let alone insurance companies, have not, and never will. But the health care industry has enormous financial resources and will invest very heavily in building one-on-one Internet-based relationships with the public. If physicians do nothing much, they will lose this battle by default.

Until now, only about three percent of adult Americans have either contacted or received communications from their physicians online. Four major issues need to be addressed before this can become

commonplace:

1) Doctor-patient communications must be secure to protect patient privacy.
2) Physicians must know how to protect themselves from unreasonable malpractice claims.
3) Physicians need to be compensated appropriately for providing care online.
4) Physicians must be able to connect their patients to a good online "library" of relevant medical information.

All of these issues are now being addressed and, we believe, will soon be resolved.

Our latest data show almost 49% of Americans are online from home, and over 63% of adults are online from home, work, school, university or the library. In a few years, almost everyone will be using the Internet as well and as much as the 10% of the public who use it most effectively now. The battle to determine who controls patients – or at least who most influences them – has only just begun.

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