readers weigh in on direct-to-consumer

By Brian Dolan

Brian Dolan, Editor, Contributing Editor Neil Versel really hit a nerve last week when writing about direct-to-consumer healthcare and the acquisition of Massive Health by fitness device maker Jawbone. (Be sure to read it now, if you haven't yet.) While his column made a number of provocative comments, I think this one really gets to the heart of his argument: "What those projects all have in common is that they never figured out some of the basic realities of healthcare. Fitness and healthcare are distinct markets. The vast majority of healthcare spending comes not from workout freaks and the worried well, but from chronic diseases and acute care. Sure, you can prevent a lot of future ailments by promoting active lifestyles today, but you might not see a return on investment for decades."

So many companies and startups working in mobile and digital health today are working to bridge the divide between "fitness" and "healthcare" and move more toward a healthcare system focused on preventive care. And yet, a number of readers agreed whole-heartedly with Neil's assessment. Here were some of my favorites:

Betsy Bennett, Ph.D: As a health psychologist with a lot of years in pharma and healthcare, I am continually frustrated with the hype that accompanies most "health apps". Not everyone enjoys computer games, not everyone wants to "share" the issues they're ashamed of with their "social network", not everyone is interested in being a "quantified self". This is not to say that digital health is futile or a bad idea. But if we took the time to understand why so many doctors hate EHRs and patients are not interested in paying to "manage their health information" (What does that mean, anyway?) we would come a long way towards finding digital interventions that people actually want to use.

D Zar: Neil, a belated thank you for saying in public what I've been saying to anyone who will listen. There is a secondary problem, however; with all of the hype and land-grab going on, millions of investment dollars are going into consumer apps and not into truly revolutionary, or at lest evolutionary, medical products in the "digital health" landscape. I'm involved with, and friends with many other, companies who are really trying to do some interesting things, but since we're not a consumer app to make people healthy, we get shut out of the funding. No matter that all are doing things with demonstrated clinical needs; since we sell to health professionals, we have a hard time convincing investors to give us a chance.

Civisisus: Love you, Versel, and good call on Massive Health's massive fail, but this: "Massive Health, Google Health, Revolution Health and Keas never came to grips with the fact that healthcare is unlike any other industry. In the case of Google and every other “untethered” personal health record out there, it didn’t fit physician workflow. That’s why I was disheartened to learn this week that one of the first two development partners for Walgreens’ new API for prescription refills is a PHR startup called Healthspek. I hate to say it, but that is bound to fail unless Walgreens finds a way to populate Healthspek records with pharmacy and Take Care Health System clinic data..."

Needs more work. First, there is no "healthcare industry". It's a thousand (several thousand?) industries under a handy if relatively useless label - much like "the" tech industry. To do something useful, no one needs to "come to grips" with either. Second, PHRs do not need to "fit physician workflow" to succeed. To succeed, they need to be useful for people. They are not "Physician" Health Records, they're PERSONAL Health Records. If anything, physicians need to provide data THEY trust TO PHRs, and PHRs should be ready to grapple with whatever output physician systems can manage (that they SHOULD be able to output - AND take in - useful data in practically any form, because there is no genuine technical barrier to doing so, we will save for another rant...).

There are already fairly practical personal health information resources functioning, if not flourishing, not far beyond the glare of the spotlights on clown shows like Massive Health. People need to develop basic information habits, and to have basic information expectations to which the traditional, conventional, backwards, legacy health care services providers must eventually succumb. Developing those habits takes time and the availability of handy examples, and working models. Healthspek may not be "it", but it might help move things closer to "it", if for no other reason than that in it, people have another "it" to draw comparisons with - favorable or unfavorable.

Anne DeGheest: Very nice article. Because of the "perceived" land grab, most of the new DTC startups are rushing into developing their product and getting it to the market quickly....and risk failure because they did not spend enough time defining the problems they are trying to solve and understanding the value proposition of ALL the players involved (including existing healthcare providers and payers)...therefore they encounter a value proposition and revenue model problem... in a very visible way.

Jim Bloedau: Neil, great piece. Who likes consuming healthcare? Nobody. How many providers have you heard say they wish they could spend more time in the office? Never. Because of this, the industry's growth has been predicated on the idea that somebody else will do it all for me - employers will provide insurance and pay for it, doctors will provide care. This is also the driver of the traditional business model for healthcare that many pundits label as a "dysfunctional healthcare system." Actually, the business of healthcare has been optimized as it has been designed - as a volume based business and is working very well. Your prospective fit this well and is not cynical, just experienced. Keep it up.

Cynical: Well written. This is one of the few columns (or rants) that actually understands the reality of healthcare and digital health (attending any health care conference will also highlight this divide). What I am finding is two fold:

1. The vast majority of these DTC products are created by people who have had success in other areas of "digital" - and therefore they build what they know - consumer facing apps / websites that just happen to be focused in health. They think that healthcare is huge ($$), broken, and therefore easily fixed using the same principals applied to music, banking, or finding a movie. But they have zero understanding of the "business of healthcare", and as a result have no ability to actually sell their products into the health care industry - one of the slowest moving, convoluted, and cumbersome industries in the world.

2. Almost none of these products have any clinical knowledge closely integrated -- many have a doctor (entrepreneur) on the "advisory board", but in most cases there are no actual practicing physicians involved (physician founders are often still in med school, only practiced for a limited time, or never at all). This results in two problems - one of which the author notes - no understanding of workflow; the other being no real clinical efficacy for the product -- meaning, they do not actually improve health, improve efficiency, or lower cost. Any physician will be able to lament the issues of self-reported data...

Instead of hanging out at gyms or restaurants building apps for diets or food I would recommend digital health entrepreneurs hang out in any casino in America around 1pm any day of the week - that is your audience. And until your product tests well with that group, you have no real shot.

Read on for a few reactions from Twitter:

The koolade is starting to sour. Great POV:Rewards for watching TV vs rewards for healthy behavior via @

— howard steinberg (@dLifest)

There is that "gamification" word again.Just gamify and everything will be good... — Kevin Harbauer (@KevinHarbauer)

Kudos to @ for a great read "Fitness and healthcare are distinct markets" Consumer HCIT doesnt work - yet

— Bijan Salehizadeh (@bijans)

@ @ @ This is THE Clash of the [Paradigm] Titans! Multiple paradigms have to shift before there's one answer. — VitalClip (@vitalclip)

@ @ (1/2) i do not disagree that from pure delivery (disease mgmt, care coordination) perspective b2c is tough...

— Charles Huang (@1CharlesH)

@ @ ( #2) but fitness=health. D2C tools @ @ @ @ = success bc reach, behavior change — Charles Huang (@1CharlesH)

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