Attendance seemed sparse (~100)  to the disappointment of exhibitors and reflected in a listless Twitter stream.  However, it did include a robust group of payers and, from that standpoint, the networking was good and a welcome contrast to the Health 2.0 conferences where payers are far out-numbered.  The Health 2.0 conferences differ in scope (larger) and focus (more technology and desire for more profound change), though, and remain a better bet for staying current on HIT innovation.

Overall, there was clear support for the idea that HIT, ACOs, and PCMHs, would increase quality and drive down costs, and many examples of payers and providers taking concrete steps to develop new collaboration models and advancing their technological capabilities to do so.  Highlights:

• Todd Park kickstarted the conference with his high-energy speech that “right now is the greatest opportunity in our lifetime” to successfully transform the healthcare system.  He spoke about how HHS is encouraging the two “megatrends” driving this change:

1. New incentives i.e. new payment models
2.  “Data Liberacion” i.e. greater data liquidity enables innovation

• Premera Blue Cross and Blue Cross Blue Shield of Michigan both presented innovative plan designs they have launched into their respective markets.  In addition to financial “carrots and sticks”, both plans use smart personalization to engage members and to find the health program that best fits them.  Neil Sofian presented from Premera and Cindy Bjorkquist presented from BCBSM, and both were compelling and clearly dedicated to finding new ways to help members.  I recommend learning more about their efforts or catching them at future events.

• Zachary Myer, Blue Cross Blue Shield of Minnesota, nicely outlined four strategies to drive engagement:

1. Integrated solutions and information, delivered seamlessly to members whenever and wherever they want them (ex: no triple data entry)

1. Messaging has to be personalized (engaging, cultured, relevant, and timely)

2. Motivation: incentives, gaming, social media

3. Sense of community

• Anadeep Parhar, CIO of Blue Cross Blue Shield of Minnesota presented how he is re-focusing and re-organizing his entire IS organization to support their new contracting model.

• Karthik Shyam, from the American Institute of Research, has been researching the most engaging uses of cost and quality information, and identified the following five guidelines:

1. Always report cost with quality information
2. Report cost data that are meaningful (e.g. members’ out-of-pocket costs)
3. Use language to describe or frame the cost info and explain why and how to use it
4. Follow best practices for labeling and displaying info for ease of use
5. Align with a trusted source to develop, report and disseminate cost and quality information (e.g. independent, non-profit community health organizations)

Please feel free to comment on your perspective from the conference or post questions about its content.

There was a consensus that organizations currently emphasize technology at the expense of solving real-world problems for their users.  The service providers in particular, spoke of the “disposable apps” they are asked to build: don’t involve IT, too much focus on iOs vs. web, built to check a box and not as part of a longer-term strategy.  Both panels also warned of trying to simply replicate your existing website on mobile; David Nguyen, VP mobile strategy at Putnam Investments compared it to the brochureware approach to websites in the web’s early days.  But identifying the features which really need to be mobile optimized is challenging: Nguyen had the line of the night when he advised that “fitting 20% of a website into your mobile version is easy, getting it down to 5% is hard.”

Mobile applications should not only be sub-sets of the full websites; mobility creates opportunities to deliver unique features.  Panel members urged the audience to find low-tech processes which can be improved.  For example, Putnam salespeople now use an application with real-time data instead of paper presentations of old data. Alex Bratton, CEO of LexTech Global Services described an application his firm built with a solution identified by the client’s truck drivers. Matt Foell, senior analyst at PNC Bank stated an agile approach is needed and that, as a result of this methodology, users are PNC’s best source of ideas for new features.

Both panels also called for automated test solutions, pointing out that device and OS fragmentation renders non-automated testing unscalable.  Security will remain a challenge, particularly with Android. Both Joe Ferra, chief wireless officer at Fidelity and Eric Weinberg, VP business development at DeviceAnywhere emphasized that mobile web capabilities are quite robust, though Jonathan Stark, VP architecture at Mobiquity noted that “HTML5 is not a silver bullet”. Stark also noted that integrating with legacy applications remains a challenge in building mobile applications in the enterprise, while Ferra later noted that consumers expect this challenge to be overcome in order to present a consistent experience across across mobile and desktop applications.

Were you at the event, too, and have anything to add to these notes?

Lately, I have been neglecting to do so because I have been spending less time on Twitter.  So I wanted to find a simple way to get back into the practice.  My solution was to create a draft on Monday, schedule it for Friday delivery, and then add users during the week who shared valuable links. (I use HootSuite, but many other tools, such as TweetDeck, allow you to schedule your tweets)

It was quick to edit the tweet during the week, and then I didn’t have any additional work on Friday.  In fact, my Friday ended up busy and I would have missed the opportunity entirely.

Another time saver is forgetting about creating a new, unique list every week.  Too much cranium time for what should be a time-effective task, and no one’s keeping track.  If I end up repeating users often, it’s because I like their feeds that much.

Do you have any tips that help you stay engaged?

• Clean and simple user interface
• Clear plan selections to help members identify which doctors are in their plan. Even simpler, members can use their member portal login to automatically select their plan.
• In-depth comparisons
• Broad array of criteria for members to narrow search results to those doctors who best fit their personal needs
• Directories which can be emailed or faxed

Many of the upgraded features reflect how our products have evolved in recent years; specifically the wide variety we offer and the membership growth of deductible plans and tiered plans, where members’ cost-share can differ by doctor.  It was important to provide more robust features to help members best use their plans.

We partnered with Prism Services Group to develop the website, and we could not be more happy with them.  Their team was thoughtful and creative every step of the way, and I think it’s reflected in a great website.

From a personal standpoint, I learned a lot during this project and that will be the subject of another post.  (One side effect of this project has been a paucity of posts here) For now, any feedback you have about our new Find A Doctor website would be highly appreciated.  If you can take a minute or two, visit http://tuftshealthplan.prismisp.com and shoot me a note at grossad (at) yahoo (dot) com or post a comment below or on Twitter to @AdamGross.

Another advantage according to a photography buff friend is that photos are much better.

I would like to connect the items I share via Google Reader with Google Plus.  If I could stream my shares into consummable posts like Twitter, I might not need Twitter.  I love connecting with new people on Twitter, something I would never do on Facebook. However, I may do that on GooglePlus because of Circles.

But do connections want every type of content from all of their “friends”? Circles should work in reverse, too: I may want text posts from my co-workers, but not their personal posts. Likewise, I like hearing from my nieces, but don’t need the latest YouTube videos of cats, Bieber, or cats dancing to Bieber. (One of my nieces, however, just quoted Rush on Facebook and I am so proud.)

Life is never as orderly as we like, but increasing signal-to-noice reduces the chaos.

+1 is a version both of Facebook’s Like and Twitter’s re-tweet: a way to share content you like.  But at first glance, +1 falls short in two areas.

Like vs. Re-Tweet vs. +1

The first shortcoming is how to use it on Google itself.  A search engine is by definition designed to help you find content and go. In order to click +1 on Google, you need to return to the search results and click +1.  That’s unnatural. Especially when good sharing options are readily available on the content page itself (i.e. Like, Tweet, and every other social network under the sun).  Adoption of +1 will depend on publishers adding +1 buttons to their content en masse, which they admittedly are inclined to do (after all, it won’t cost too much real estate, and the opportunity to influence Google search results is irresistible).

The second more serious shortcoming is defining exactly what rewards a user reaps by using +1.  Sharing links on your Google profile page by itself certainly won’t float anyone’s boat.  And, at this time, there’s no conversations or networking generated by +1.  While there’s an obvious connection to Buzz that could be built, Buzz has its own issues.

So, Google remains as it was before: owning very nice discrete pieces, but without a clear compelling connection between them.  The potential remains, though, and that will continue to get us excited for each announcement.

By the way, +1 has not been rolled out to everyone.  You can to opt-in to use it at http://www.google.com/experimental/

I’ve signed up, and am admittedly over-excited to distribute my new QR code.  I’ve inserted my shiny new toy in the right-hand column here and also in my email signature (we use Lotus Notes, and it took me a hack or two to get it right).  Despite a few kinks to work out in the contact form, I recommend you check it out.

It has me thinking about services LinkedIn should be offering – maybe more on that in a future post.

In other social media news related to me, Posterous, which has been at the bottom of my toy box since the spring, is being discarded and de-linked.  I have accepted the fact that I am simply a fan from afar.

Why did I stop using it? Its utility as a blog for me waned because I ultimately wanted something more robust, which is why I came to WordPress.   After I moved my blogging here, I was occasionally using Posterous to post a photo and brief commentary, but Facebook and Foursquare both fulfill that need.  Oh well.  You can’t be everything to everybody.

"It's me. My fault. But we're still breaking up."

Behavior change, rising costs, and patient advocacy were three topics in the spotlight at the Health 2.0 2010 conference October 7 and 8.  The semi-annual event showcases innovative companies who are creating new ways to provide patients with greater control over their care, generate better outcomes, elevate our medical literacy, promote evidence-based medicine, enable greater provider cost and quality transparency, and to encourage us to eat more, not fewer vegetables.  It was an impressive collection of innovative thinkers who are as committed and creative as Wallace, but luckily not so hare-brained.

A main theme of the show was the increasing sophistication in how health data, such as user-generated content, medical knowledgebases, industry sources, or government databases, is being utilized.  One driver of these advancements is the increased quantity of health data available to us today, such as personal data from biometric devices or crowdsourced research from online communities.  Another is more advanced cloud computing and web services, which allows greater ability for applications to access these data. A few examples:

• Provider Search: Multiple websites are integrating user reviews, cost and quality data, and other patient-provider communication tools. For example, Castlight Health is hoping to be the “kayak.com of healthcare” and announced they have raised $81 million. Vitals.com is another; they announced integrations with an online-appointment application and with a point-of-care eprescribing system.
• Health & Wellness: TweetWhatYouEat is an online diet management tool, which leverages crowdsourced nutrition information.  To participate, you do exactly what the name implies.  Users’ accountability to a larger community encourages healthy behavior; this is one of many companies using social media for this purpose.  Zamzee.com is a rewards systems for kids to combat childhood obesity. Kids wear a biometric device that records their physical activity.  Zamzee announced a pilot which had produced a 30% increase in moderate to vigorous physical activity. However the gain persisted only for 12 weeks. MedGift.com is a medical gift registry, on which patients in need can create profiles findable by consumers who can contribute to their care. Qpid.me is a text messaging service aimed at combating STDs. Users are able to text a person’s name and receive back their STD test results (HIV, gonorrhea, syphilis, chlamydia) and date of test.
• Business Solutions: CyPak enables lab results and tests to be directly read by mobile and diagnostic devices. Razoron Health Innovations creates barcodes (aka QR codes) containing patient and procedure information that can be read by mobile devices.

The lineup of speakers was impressive, too. Aneesh Chopra, Todd Park, Esther Dyson, Susannah Fox, Thomas Goetz, and Elizabeth Cohen were just a few who added starpower to the panels. The main achievement of the show, though, was to pack the two days with as many creative companies, mostly start-ups, as humanly possible..

As exciting and potentially disruptive as some of these companies may end up being, it is important to remember that much is unproven.  In fact, despite significant innovation, it is unclear whether adoption is growing beyond the segments of the population already engaged in healthy behavior. Other observations:

• Infrastructure (e.g. cloud, identity, permissions, security) is evolving, but many barriers remain for greater data exchange. However, data liquidity appears to be inexorably advancing, if slowly.
• Healthcare social media has significantly evolved beyond community support and patient literacy, and is now being deployed to attack costs and behavior.
• Likewise, mobile devices are driving innovation across the entire spectrum of applications.

The show would have done better if it gave voice to more opposing viewpoints.  While there were cautionary notes on the pace of change in healthcare, the conference erred too much on the side of trying to be inspirational rather than sober.

And though Alexandra Drane, president of Eliza, convincingly described how issues such as marital life, job stress and financial concerns impact our health, there still wasn’t enough discussion of the role mental health plays in our overall health.

Half the fun of Wallace & Gromit is seeing them find new ways to solve problems, and that same spirit was evident at Health 2.0.  I’m looking forward to watching how their agenda evolves. Please ping me if you’d like to compare notes or discuss.

(Photo courtesy of wallaceandgromit.com)

Similarly, the firms under the Health 2.0 banner, such as PatientsLikeMe, AmericanWell, and Sermo allow members to leverage communities and technologies to either be more-informed patients or to serve more patients.  Just like RelayRides, which allows members to rent out their own cars when they’re not driving them, thereby creating value from an untapped asset, a medical community allows its members to find people with a similar condition, for example, and tap their knowledge.  It’s collaborative consumption of knowledge “purchased” from the health care system.

I was thinking about whether collaborative consumption could be applied not just to patient empowerment, but to health insurance.  Individuals would need to have enough control over the product to allow a market to develop where they could trade health risk based on its economic value or they could gain purchasing power by joining a community.  I think there’s potential for “personal underwriting” if increased processing power accessible at a personal level brings the mathematics behind actuarial science and underwriting to the individual level.  In doing so, we also create an adverse-selection problem.

Let’s say both my neighbor Joe and I understand our risks, and had the ability to understand what effects they had on our health plan premiums.  Perhaps he is a smoker and has a family history of diabetes, while I am lucky enough to have healthier genes and don’t engage in avoidable health risks.  We wouldn’t even need a thorough understanding of each other’s personal health if we could communicate standardized scores, derived by a neutral third-party. If the two of us were to form a “micro-group” in this simplistic example, my premiums would rise and his would be lowered.  Personal finance applications would help us understand and track each of our impacts on “group” premiums.  Perhaps, even after paying for the increase in my premiums, the arrangement is worth $500 per year to Joe.

So what would we do now? And how do we blunt the ensuing adverse selection if we enable consumers to form micro-groups?  We would need liquid markets that would allow health risk to be traded like an asset:

1. Cash. Joe pays me $500 or less. If  the transaction is simply cash-neutral for both parties, there needs to be another incentive.  What if my insurance company offered me a bounty for bringing in a new customer?
2. Barter. We barter for $500 of services.  Perhaps he’s a general contractor building an extra room on my house.  To take this a step further, forget Joe and his smoker’s teeth.  Maybe I’ve found a tax accountant in another state, and he joins my plan in exchange for his services at tax time.
3. Bundling. Combine different types of insurance. Maybe John has risk to spare on his hazard insurance which we could swap.

There are certainly many obstacles and issues to be considered, in addition to the task itself of inventing the technology. But there is precedent. Consider Kiva, where individuals band together to loan capital to far-away entrepreneurs.  This is a case where technology brought risk-based finance from the back rooms of banks to the personal computer.

To learn more about collaborative consumption, and if you are in the Boston area this week, Bentley is hosting a fairly high-powered “Collaborative Consumption Summit” this Thursday September 30 with Swap.com CEO Jeff Bennett and author Rachel Botsman.  Definitely worth checking out.

First, let’s review why they may be toast.  As Michael Ansaldo neatly summarized in PC World:

Once Facebook Places incorporates enough Foursquare-like features — and it will — Foursquare users will start abandoning the service in droves to take advantage of the expansive network they’ve already built on Facebook

The heart of the problem Foursquare and Gowalla face is that neither their social networks nor their business programs have any unique value yet.  Both services are only good for keeping track of check-ins and statuses and broadcasting them on Facebook and Twitter.  Though David Berkowitz argues that there’s value broadcasting only to your Foursquare network to avoid over-sharing, Facebook could also launch a feature allowing members to check-in, collect points, but not broadcast to their network.  So what does being friends with someone on Foursquare’s social network get me?  Nothing unique.  And users can not yet redeem the points they’ve earned for their check-ins for significant real-world rewards.  Facebook is more likely to establish a vibrant rewards programs than small start-ups like Foursquare and Gowalla, thanks to its scale and resources.

This reminds me of Citrix and Microsoft in the mid-’90s.  At the time, Citrix was a start-up with a very cool remote access product called WinFrame. The product’s existence, and therefore Citrix’s, was made possible only by Windows.  This was when Microsoft was the biggest, baddest 500 pound gorilla around.  And sure enough, Microsoft was on the verge of building its own remote access directly into Windows. Citrix, of course, is still around today and quite successful.  They survived by cutting a deal with Microsoft allowing them to power Window’s remote access features, but limiting other products they Citrix could sell.  Not only did they survive, but Citrix has innovated, diversified, and grown.

Perhaps Facebook will build certain features, but partner with the independents to round-out a more robust experience.  Indeed, Facebook launched a Places API and announced Foursquare, Gowalla, and Yelp were “launch partners”.

It’s also instructive to examine threats from emerging niche players.  While Foursquare and Gowalla provide the same experience no matter where you check-in, others are creating new engagement models.  For example, SCVNGR has created a check-in game customized for particular locations.  Other startups are trying to crack the entertainment check-in experience.

This where Foursquare, Gowalla, and Yelp may have opportunities.  There are dimensions which could be added to the currently quite broad check-in experience:

• Do you need advice?
• Are you having a good experience?
• Do you need to find another store?
• Are you late or early and need to adjust your schedule and inform people of this change?
• Did you just arrive or are leaving?
• Are you actually going somewhere and want to let others know where you’ll be? You’ll confirm the check-in once you get there.

When you check-in, your app could ask you these and other questions.  Then, it could offer you discussion opportunities and web content.

For example, let’s say I go to the Home Depot. As is often the case, I’m not exactly sure what I need, let alone how to use it.  So, when I check-into Home Depot, it asks me what I’m looking for.  I type in “porch screening” and returns links, including how-to discussions from across the web.  It also finds a Facebook friend who checked into Home Depot recently who I might ask for a recommendation.  At any time, I could opt to simply comment and submit.  The app asks me whether I have been helped and, if not, whether it should send a tweet for help.  It then calculates the distance between the Home Depot and my next location, which I’ve pre checked-into, and asks me if I want to inform anyone that I’ll be late.  It also checks my Google Calendar, where subsequent appointments are recorded, and asks if I want to inform the friends on that appointment that I’m running late.  It offers me to post a review directly to Yelp.  And, of course, it offers me a coupon because I just seized the mayor badge from some other, less-hapless homeowner .

One area in which Foursquare, Gowalla, and Yelp may have an advantage over Facebook in creating new engagement models is agnosticism.  For example, does Facebook really want to encourage discussions in other communities and not on Facebook?  The flaw in this argument is the Places API they’ve already launched.  But the purpose of the API may be more to demonstrate it can play nice for the time being.

The other advantage the independents may have is focus.  Check-in usage remains relatively low compared to other social features, and, despite how innovative Facebook is, they may not want to invest as heavily in this area until the return is more clear.  The independents will be forced to innovate as quickly as possible.

Trust is another bugaboo for Facebook, since they keep stumbling over privacy.  Managing to whom your check-ins are visible will be complicated on Facebook, and that alone could scare off potential new users.

I use Foursquare, but am not a heavy user.  I broadcast almost all check-ins to Facebook, but not to Twitter (see my earlier post about why I stopped broadcasting to Twitter).  It’s simply a Facebook posting service for me, and if Facebook Places proves quicker, I will abandon Foursquare.  This is why I rarely use Posterous anymore; I can quickly and easily post the same thoughts and photos to Facebook, a bigger network in which I’ve already invested my time.  Hopefully, though, Foursquare and the others can innovate successfully and provide a unique service.

What do you think of their odds?