The Internet has become a major force in the consumption of health care services.  Statistics vary, but surveys indicate that over 114 million Americans searched for health-related information online in 2006.  This equates to more than 80% of Internet users and roughly half of all adults.  While a variety of health-related interfaces have been built to accommodate the demand for health information online, the vast majority of these users continue to use a search engine rather than a specialized site.

While specialized sites offer medical information, very few of them effectively communicate financial information that helps people manage the costs associated with medical care.  Several have tried, but none has been able to find an effective way of addressing this need.  HHS Secretary Mike Leavitt has called for a “health care ‘Travelocity’” and vendors have attempted to respond, so far without much success.

Online health interfaces have the potential to address the uncovered portion of health care costs in the following ways:

1. By providing financial information about providers that will allow people to choose on the basis of cost as well as other factors
2. By providing information about the efficacy of various providers (success rates, outcomes, etc.) that will help people make decisions that reduce future costs.
3. By integrating financial information about a person’s health coverage with information about health providers, thereby helping them make decisions that result in less out-of-pocket costs.
4. By providing wellness and disease management functionality that helps people manage their own health and reduce the need for future costly interventions.

The potential to deliver these services has been largely unmet, but there are promising initiatives and the potential for future developments that could help reduce the uncovered portion of health care costs.

Revolution Health was founded by AOL head Steve Case as a full-service, consumer-oriented website.  It contains general health information for consumers, information on specific conditions, a provider search engine, and spaces for peer-to-peer reviews of doctors, hospitals, and other health providers.  In addition, it has cosponsored personalized wellness seminars called “O You” with Oprah Winfrey.

Steve Case’s personal blog states that, according to independent ranking organization comScore, the site “generated 256 million page views in January, enabling it to pass WebMD to become #1 in terms of consumer engagement.”

WebMD has historically been the largest online portal for health information.  It serves doctors and other health professionals, as well as consumers.  It owns Medscape, the largest online source of health information for healthcare professionals.  WebMD’s consumer functionality resembles Revolution’s, with the addition of a new function that allows users to create and maintain a secure, personalized health record.

$335 million in revenue for 2007; stock price is currently down on comScore report and other news.  They reported 863 million page views in the third quarter of 2007.

Medstory is a customized search engine for health information that allows users to search both general information and research papers.  Medstory presents search results in a graphically friendly way according to subcategories that were designed with physician input.  Medstory was acquired by Microsoft last year, creating the potential for major investment in growth and R&D.

ReliefInsite was designed to address the growing issue of chronic pain management, which is driving health care costs up while only partially addressing the problem of ongoing human suffering.  ReliefInsite allows people to monitor their own pain levels while creating a “pain diary,” which allows them to keep a record of treatments, medications, and other factors which influence their pain problem positively or negatively.  In effect, ReliefInsite creates a ‘feedback loop’ that should allow people to better monitor and alleviate their pain.

ReliefInsite is also providing online disease management services targeted to employers and other payers.

Patients Like Me provides a peer-to-peer environment for the exchange of information on medical conditions, symptoms, prognosis, treatment, providers, and life issues for people who share a common medical complaint.

Hospital Pricecheck provides Minnesota residents with hospital pricing for the 50 most common inpatient stays and the 25 most common outpatient procedures.  It is sponsored by the Minnesota Hospital Association and is based on full charges, which hospitals don’t typically receive.  It does not provide information that correlates to insurance plan copays and deductibles.

The California Hospital Fair Pricing Initiative was created to provide uninsured Californians with information on hospital charges, and to enforce, coordinate, and publish information on charity care and other financial support tools for low-income and uninsured patients.

The Fair Pricing Initiative combines information access with negotiation on behalf of low-income/uninsured patients.

Carol.com is an attempt at meeting the HHS challenge to provide a “healthcare Travelocity.”  Providers have to pay in order to have their prices included.  Like the Minnesota initiative, Carol.com lists the prices providers want to receive, not historical information on the rates they will accept.

It features a well-designed user interface, but is limited in usefulness due to the absence of a negotiation function or a link to personal coverage data.

The Federal government’s Center for Medicare and Medicaid Services (CMS) publishes information on costs for common procedures in the following categories:  Hospital inpatient, hospital outpatient, ambulatory surgery centers, and physician services.  The purpose of providing this information online is “to make cost and quality data available to all Americans.”

The CMS system is not very user-friendly.  It requires users to download Excel and pdf files and manipulate the information they contain, if they want to answer questions that consumers would be expected to ask (e.g. which hospitals in my area charge the least for the procedure I’ve been told I need.)

Vimo is designed to help individuals and small businesses “navigate the health insurance maze” by providing information on different plan options, access to insurance agents (who appear to be a Vimo constituency), provider directories, and other data.  While it provides medical information, Vimo appears to differ from other initiatives (e.g. Carol.com, Trusera) in that its emphasis is primarily on insurance decision-making for consumers and small-business owners.

Each of these initiatives is based on the following assumptions:

• Consumers are seeking medical information online
• Properly designed medical information will alter behavior
• Common search engines are not an appropriate interface for the consumption of health-related information
• A better-designed interface will attract viewership.

Speaks to multiple leverage points.

• Transparency
• A well-designed interface has the potential to provide needed information to health consumers
• This information can change behavior in a way that reduces overall out-of-pocket costs
• Anticipation of Out-of-Pocket Expenses
• Online interfaces can provide the financial information needed to anticipate out-of-pocket expenses and plan accordingly
• Visible gaps
• Online decision-making tools (e.g. Vimo, or something like it) could help people make insurance purchasing decisions that more closely reflect their needs and habits
• New Alliances
• New alliances may be able to publish information in order to serve their constituents – example:  an organization could negotiate prices on behalf of the uninsured and make that information available online