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What's New in
Cybertalk?
by Jean Gora
February 1999
Note: CyberTalk is a
column that appears monthly in LOMA's Resource, the magazine for insurance and financial
services management. To see more contents of the magazine and to see how to subscribe,
click on
RESOURCE.
HMO, PPO, WWW: Managed Care Meets the Internet
Aetna U.S. Healthcare (AUSHC) and Kaiser Permanente have both made a massive commitment
to the Internet. Their activities show how important the Internet has become for the
managed care industry. The approaches of the two organizations differ, but each offers
valuable lessons for other managed care providers.
Aetna U.S. Healthcare operates two health-oriented Web sites–its own corporate Web
site and the InteliHealth site. InteliHealth is a joint venture between AUSHC and Johns
Hopkins University and Health System.
InteliHealth
The InteliHealth site offers massive health-related information (more than 2,000,000
pages worth) to the public on medical conditions of all sorts. It provides ordinary
individuals with access to medical information sources once solely to province of
physicians and researchers. InteliHealth has taken significant steps to position itself as
the leading health portal or aggregator on the Internet. It runs one Web site targeted at
consumers (http://www.intelihealth.com) and another (called the InteliHealth Professional
Network) targeted at health industry professionals (http://ipn.intelihealth.com). It also
has a presence on AltaVista, AOL, CBS.com, CompuServe, and PointCast. InteliHealth refers
to itself as a media company. The site accepts advertising; health-related products are
for sale on the site but are not endorsed by AUSHC or Johns Hopkins.
The quantity and quality of medical information available on this site are truly
impressive. The site provides access to:
The National Institutes of Health's databases. NIH is one of the leading biomedical
research institutions in the world.
Information provided by the National Health Council, a not-for-profit organization
composed of 108 separate health foundations such as the Alzheimer's Association and the
Leukemia Society of America.
Clinical Reference Systems, a publisher of patient education materials.
The National Library of Medicine (NLM), one of the world's largest medical research
libraries. NLM operates the MEDLINE database.
Johns Hopkins health library and encyclopedia.
United States Pharmacopeia, a not-for-profit organization that disseminates information
on the use of medicines.
The site also includes an "Ask-the-Doc" feature that enables Johns Hopkins'
doctors to answer health questions posed by users. The site does, however, include a
caveat, which reads, "All information is intended for your general knowledge only and
is not a substitute for medical advice or treatment for specific medical conditions. You
should seek prompt medical care for any specific health issues and consult your physician
before starting a new fitness regimen."
Thus, the InteliHealth site backs away from providing specific care recommendations to
individuals. Finally the site also includes online discussion groups on various health
topics of broad general interest.
Aetna U.S. Health Care has a very low profile on the InteliHealth site. It is
acknowledged as a co-owner of InteliHealth, but otherwise no reference to it appears.
Thus, despite all the alliances InteliHealth has with other Internet sites that generate
traffic for it, any benefit Aetna U.S. Healthcare gains from the site is somewhat
indirect.
The AUSHC Corporate Site
In contrast to the limited references to AUSHC on the InteliHealth site, the corporate
AUSHC site places significant emphasis on InteliHealth as a source of health information.
The Health Topics section of the AUSHC Web site has a major link to InteliHealth plus
additional links to parts of it that provide drug information, health information, and
online health search of an electronic medical library.
The Aetna U.S. Health Care site naturally includes descriptions of its major health
insurance, dental insurance, and group insurance programs. It also devotes significant
space to what it calls patient management programs and member health benefit programs.
Included in the patient management programs are programs on the management of asthma,
heart failure, diabetes, and low back pain. The member health benefit programs include
cancer screening; adult, adolescent, and pediatric immunizations; poison prevention; and
an on-call nursing service to answer employee health questions.
Members can use the site to enroll in an employer's program, request a new I.D. card,
and select or change a primary care physician. A section of the site targeted at providers
describes how AUSHC can file electronic referrals and claims, verify member eligibility,
and have instant access to member benefit and eligibility information. Another section of
the site describes programs specially targeted at employers. It offers an Internet file
upload utility that allows authorized plan sponsors to move data directly into Aetna's
systems.
In sum, the latest iteration of the Aetna U.S. Health Care site represents a mixture of
traditional brochureware and interactive functions. AUSHC makes it easy for people who
have come to the site in order to execute transactions to do so without having to read
through a lot of material to find them. That fact is one happy result of keeping most
health information off the AUSHC site and on the InteliHealth site.
However, the AUSHC site describes a number of functions without enabling users to
execute them. This gap probably exists because it is significantly more difficult to add
transaction capability to a site than to add additional information to it. Aetna has not
done all it would like to do with regard to transaction capability. Certainly the AUSHC
site has significantly more transaction capability now than it had two years ago.
AUSHC Site Integration
The Aetna U.S. Health Care site and the InteliHealth site are not well integrated in
one respect: Physicians connected with Johns Hopkins University accept health questions
through the InteliHealth site; the physicians listed in the AUSHC site do not.
If participants in AUSHC plans want medical questions answered, they have to go to the
InteliHealth site and have Johns Hopkins University doctors answer them. AUSHC plan
participants might prefer to direct these questions to their own doctors or to groups in
which those doctors participate. There are several reasons for this disconnect.
First, because many of AUSHC's group health insurance plans are not HMOs, Aetna does
not employ many physicians directly. The physicians that it deals with through contractual
arrangements may not be receptive to providing medical advice through an AUSHC Internet
service.
Second, operating a site as massive as that of InteliHealth is expensive. By allying
with Johns Hopkins University and by having InteliHealth enter a host of commercial
alliances, AUSHC has chosen to try to use the site to generate revenue. It has found a way
to make providing health information pay. InteliHealth would not have its present broad
appeal if its focus were on providing medical advice only to participants in AUSHC's
health plans.
Kaiser Permanente
Kaiser Permanente (www.kaiserpermanente.org), a leading health maintenance organization
(HMO), has gone significantly farther than AUSHC in integrating health information with
its own health care delivery systems. It uses its own medical staff to supply medical
advice to participants in its health plan. Although the full functions of the site will be
available only to plan members, Kaiser has made a demo of these functions available on its
Web site.
Kaiser's members only site has three sections:
Learn about health.
Communicate with others.
Explore Kaiser Permanente.
In the "learn about health" section of the site, users can fill out a health
questionnaire and receive personalized information about their health risks. They can also
access a health encyclopedia and a drug encyclopedia. The health encyclopedia provides the
kind of consumer-oriented health information provided by InteliHealth but not
InteliHealth's in-depth medical research.
The consumer-oriented health information is organized by medical condition. For each
condition, there is a section devoted to assessment and one devoted to treatment. Under
assessment section, the following headings appear: description, cause, symptoms, course,
risk factors, when to call, exams/tests, and visit preparation. The treatment section has
headings on prevention, home treatment, when to call, consumer resources, drug treatment,
surgery, and other treatment. The information is extremely well-presented. It is also
practical. For example, a discussion of risk factors notes factors the individual cannot
change and those he/she can change.
The treatment section of the demo (devoted to asthma) shows how this site might reduce
Kaiser's medical costs. Everyone with asthma receives a treatment plan. A key element of
the treatment plan is the asthma control plan. This plan encourages the asthma sufferer to
treat asthma symptoms early, "possibly preventing severe asthma episodes that can
lead to hospitalization." The asthma control plan includes self-monitoring (checking
lung function), avoiding allergens and other triggers, identifying and treating symptoms,
getting regular exercise, taking asthma or other similar medications, and decreasing
stress. Clearly, the goal is to have the individual understand his/her condition and
treatment plan well enough to manage his/her own care with minimal use of medical
resources.
In addition to providing detailed information about overall treatment, the demo also
presents extensive information on prescription drugs usually prescribed for the particular
condition. This information includes details about using the medication correctly and
about potential side effects.
As noted above, the site also includes an online health risk profile questionnaire that
poses about 40 questions. The answers are used to generate a personalized health risk
profile. The profile is not designed to diagnose disease, but rather to provide broad
recommendations and resources to help someone reduce health risk.
One of the most interesting aspects of the site is the feature that makes it possible
to send a non-urgent online question to a Kaiser Permanente advice nurse or pharmacist and
receive back an answer within 24 hours. These services are provided with the following
warning: "Important: If you are experiencing a medical emergency, call 911
immediately! Do not attempt to access Emergency Medical Care through this option!"
The site also allows participants to schedule non-urgent appointments. The
appointment-scheduling feature also includes a warning similar to the one noted above.
The site varies by geographic location. Thus, individuals who are served by a
particular Kaiser medical center ask questions of and make appointments with the staff of
that medical center. For this reason, Kaiser's Internet service is only available in a few
locations at this time. Like the InteliHealth site, Kaiser's site also includes online
discussion groups about various medical conditions.
Affecting Health Care
The activities of Aetna U.S. Health Care and Kaiser Permanente on the Internet show the
profound role the Internet can have in the management, delivery, and financing of health
care.
The Internet excels in the presentation of complex information. It is beginning to
excel in transaction execution. Health issues are complex; and health management,
delivery, and financing are transaction-intensive. The future is likely to see greater
Internet use by the managed care industry.
See
previous issues of CyberTalk in the CyberTalk Archives.
For more information, E-mail research@loma.org
To register / order, call 1-800 ASK-LOMA
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