1. Evolving PHR Market
Analysis & Trends
Presented for HHS, AHIC Consumer Empowerment Workgroup
June 17, 2008
By: John Moore, Managing Director
Chilmark Research
John@ChilmarkResearch.com
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

2. Three Take-Aways
What is Market
Structure Today
How will Market
Evolve
4 Generations
Trajectory
Drivers
Challenges
What to Watch
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

3. PHR Market has Re-ignited
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

4. Who is Engaging a PHR
Total Adoption Today:
~5-7%
Consumer Profile:
Mid to Upper Class
Middle Aged
Working Mothers with
Medical Proxy
Chronic Care & Web-
savvy
Source: Intuit Survey 2005
Little Adoption Among
Healthy
Financial “Skin in the Game”
will Play a Large Role
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

5. Market has Moved to B2B Model
Primary Market Secondary Market
High Barriers to Entry in Provider Market
Employer & Health Plan Markets Similar
Consumer Plays are Often Legacy
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

6. PHR Sponsors
Sponsor Motivation(s) (+) (-)
Employer Lower HC costs Health & wellness Trust
Increase productivity Integrated to HR Incentives required
Support CDHP package Most are tethered
Can be comprehensive
Health Lower medical losses Claims & meds Trust
Plan Behavioral change HRA & PBM Claims data not clinical
Differentiator - CDHP Domain expertise Most are tethered
Provider info
Provider Customer retention Clinical & lab data Not comprehensive
Workflow Online consultations, Not interactive
Lower Readmissions scheduling, Rx refill Most are tethered
Trust
Consumer Chronic disease Motivated Disconnected - self
mgmt Personal control entry
Care mgmt Portable Low adoption
CDHP mgmt Privacy & security
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

7. PHR Market is Highly Fragmented
*
*iPHRs: Internet-based PHR
Extremely Difficult to Choose Viable Solution
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

8. 1st Generation: Isolated
Target: End Consumer
Most 3rd Party PHRs
e nt Stuck Here
nt
Co 85% of those
interviewed
Adoption Remains Low
Generic
Little personalization
Self-entry
Only for VERY
motivated
Value: Track & Manage Care
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

9. 2nd Generation: Online with Some Data
Target: Businesses
r Insurers, Employers,
s o ata Providers
m D
lai cal
C i
Land Rush by Insurers &
in Employers
n t Cl Manage/Lower Risks
nte HRAs, Behaviors, CDHP
Co Provider Market
Dominated by EMR Vendors
Customer Retention
Communication
Adoption Highly Variable
Trust, Perceived Value
Incentives often req’d
Some self-entry required
Portability?
Value: Facilitate Interaction, Promote Healthy Behavior
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

10. 3rd Generation: Highly Networked Utility
Target: Consumers
Data Exception - Dossia
s
Three Dominant Players
ce
vi
Dossia, Google, HealthVault
De
Utility Service Model
ps
Perform Heavy Lifting
Ap
Data Repository
Multiple sources
Identification Mgmt
Security/Privacy
Data Market Contraction
Accelerate Demise of Weak
Adoption Unknown
Not a PHR, but a Platform: Can They Get the Data?
Personal Health System (PHS) Can They Build an Ecosystem?
Trust, Value
Value: Richer Data = Richer Experience
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

11. Dossia’s Utility Model
PHA PHA PHA Dossia Ecosystem
PHA PHA Dossia Logo Prog.
Dossia Open API Dossia SIG
Dossia Data Framework Dossia.Org
Built on INDIVOHEALTH
Dossia Data Services
Dossia Data Provider Network
EMR
Meds Claims Labs Images Dossia Certification Prog.
Provider
Google Health & HealthVault have Similar Models
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

12. Successful (PHSs) Will Evolve Into
Ecosystems
Providers
If Successful…
PHAs Data Consolidation
Researchers (PHRs)
Data liquidity
Unmatched
PHS
(e.g., Dossia) Richness
Insurers
Game Changing
Consumer
Devices
Empowering
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

13. 4th Generation: Personal, Actionable, Connected
Target: All Markets
Leverage Utility Services
Now that we have the data…
Market Fragmentation
Proliferation of Apps & Widgets
Serve highly individual needs
Enable personalized medicine
Seamless Integration
“SPIME”
Always on
Adoption Predicated On…
Liquid Data
Success of ecosystems
Consumer Value
Value: About Me, By Me, With Me, For Me
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

14. PHR Evolution Accelerates Adoption
Adoption
Value
Gen 4: Personal,
Users
Actionable, &
(Millions)
Connected
80
Gen 3: Data Aggregation
(Rise of PHS)
Gen 2: Online 40
20
Gen 1: Isolated
1992 2000 2003 2008 2011 Time
(Online)
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

15. Moving Ahead:
Adoption Challenges Remain
Data Liquidity
EMR adoption
Standards Adoption
Policies & Incentives
Portability
Trust
Health Plan, Employer, 3rd Party
Consumer Apathy/Indifference
Education
Incentives
Solution Capabilities
Immature, Disparate
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

16. Drivers to Overcome Challenges
Accelerating, Employer-led Initiatives
Financial Skin
Consumerism Entering Healthcare
Visibility, Education
Accelerating IT Adoption
Among Providers
E-Consultations
New Consumer-centric
Technologies & Tools
Delivering Radically New Capabilities
Disintermediation of Care
Retail Clinics, Med Tourism, etc.
Will Consumer Drive Needed Change?
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

17. What to Watch
Traction of Platform Plays
Data Sources (agreements)
E.g., Cleveland-Google, KP-MS
Consumer Adoption
Sub-group types
Developer Adoption
Popular apps/services
Market Consolidation
Rationalization
Acquisitions
Employer Successes
Demonstrable ROI
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution

18. The world is moving so fast these
days that the one who says it can’t
be done is generally interrupted by
someone doing it.
- Harry Emerson Fosdick
June 13, 2008 Copyright: Chilmark Research
For internal use only, not for distribution