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On Target:
The Internet-Enabled Disease Management Revolution
Will Not Be Televised

Remember when the Internet was going to change the world, make everyone rich, and be the driving force behind a new renaissance of individual and communal expression? That was ages ago, of course, back in early '99. Now the hype-o-meter has swung from dot-great to dot-sucks, sweeping all the good away with the truly useless in sine-wave sync with the previous wave that lifted all those boats so high.

But despite the rapid deflation of those wild-eyed visions of the Internet empowering a new socio-economic order, the 'Net is in fact helping to truly revolutionize certain areas of human endeavor. And certain economic sectors such as healthcare are ripe for revolution.

The bottom line is pretty clear in this case: Healthcare, especially in the U.S., is expensive. And one of the most expensive areas in healthcare is the treatment of chronic illnesses such as asthma, diabetes, and most heart conditions. Some 90 million people in the U.S. alone suffer from such chronic medical conditions, and these illnesses account for nearly 75% of total healthcare costs in the United States. And asthma and diabetes, for example, are particularly 'modern' diseases, responsible for rapidly increasing patient populations worldwide, especially in industrialized countries.

A chronic illness is one that, left untreated, can easily become life-threatening. Managed properly, a chronic illness can be controlled enough so that the patient stays out of danger and out of the ER. The illness is never cured-at least not yet-just controlled, through adherence to a drug and/or diet regimen, exercise, and similar measures. But if the condition is not carefully treated on an ongoing basis-if the condition is not properly 'managed'-the patient can soon wind up in a hospital bed. And that's dangerous for the patient and expensive for everyone involved.

Enter chronic disease management (CDM), a more comprehensive attempt to help patients manage their chronic illnesses to keep themselves healthy and out of the hospital. Already, outcomes assessment data from various CDM programs that have been running for the last few years indicates the programs are effective in meeting both those goals. In addition to appearing to be the best course of treatment for the patient, the programs get the blessing of today's healthcare industry as 'managed care' becomes the norm.

Managed care is more than just the HMO you or your spouse belong to and its network of care providers and referral requirements: Fundamentally, it's a philosophical-economic shift from catastrophic care and health crisis intervention to longitudinal health care management across a person's lifespan. Emerging gene treatments that focus on pre-natal intervention further accelerate this fundamental shift in the delivery and driving philosophy of care.

If it's hard to envision this somewhat 'holistic' attitude towards care delivery being important to a large company such as one of today's major health insurers, then just consider how important it is to the rest of the healthcare world, where care is socialized. Such care is truly cradle to grave- longitudinal management of patient populations is the only option. CDM provides the best of both worlds: Effective CDM programs benefit patients as well as the bottom line, particularly since most CDM programs are based on more self-care in disease management, home healthcare, and an overall decrease in the average length of hospital stays.

The Internet, which has clearly emerged as the single most popular communication, transaction, and education channel for almost every link in the healthcare chain from patient to provider, has also emerged as the platform of choice for recent CDM initiatives. Health Hero Network and LifeMasters are the leaders in Web-based disease management programs.These services use the Internet to deliver personalized support to chronically ill patients on an ongoing basis and receive up-to-date information on those patients so healthcare providers can better monitor patients and intervene before potential problems escalate into expensive, life-threatening emergencies.

Health Hero provides program participants with an Internet appliance, the "Health Buddy", which the patient uses at home to receive and respond to daily queries via any standard phone connection. LifeMasters allows patients to enter their vital signs or other monitoring information and interact with the LifeMasters system by either telephone or Web site. Both services offer provider-patient "dialogues" that can be customized for different disease populations and personalized for individual patients, as well as proactive alerting of the patient and provider if data received from the patient indicate a potential problem, before that problem escalates into a potentially life-threatening emergency.

Both operations show preliminary success in the market: Health Hero has signed numerous large payors to cover enrollment in the program and has teamed with large, respected provider networks such as Catholic Healthcare West to roll it out. LifeMasters is a once-media darling backed by Intel and has a wealth of clinical trial and other research materials showing the effectiveness of the program.

Faced by continuing pressures to cut costs and truly "manage" the care and service utilization of patients and patient populations, healthcare organizations from providers to payors, as well as socialized healthcare systems, will likely continue to work with patients to adopt such disease-management programs as they prove their ability to beneficially impact patient outcomes while also benefiting the bottom line.

While HealthHero and LifeMasters are the big players in this game, healthcare is one of those areas that supports a lot of players in various forms. The next wave of CDM development will likely consist of individual provider networks and healthcare organizations migrating their IVR- (phone-) based systems to the Internet, once they've addressed HIPAA-mandated security and privacy regulations with the proper use of SSL-encryption of any sensitive data traffic with the patient and secure storage of that information. Also keep a look out for incentive-based CDM programs, in which the patient receives points for successfully managing their illness that can be redeemed for products, services, or financial instruments. Such incentive-based health programs are clearly applicable to the management of the general health of specific patient populations as well.

The revolution is happening as healthcare continues to focus on helping patients better manage their illnesses and long-term health and well-being, empowering them to stay out of the hospital and out of danger. And while the media and day-traders berate all things Internet, it's important to remember that some of the true Internet revolution(s), such as the new Internet-enabled approach to chronic disease management, are already underway…

--WebGunForHire, 2/01

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