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What’s Really Going On?
                                     or
     PHRs, Platforms, & Consumer
                Trends

             By: John Moore, Managing Director
                   John@ChilmarkResearch.com




1/12/09                                                           1
                        Copyright: Chilmark Research
                    For internal use only, not for distribution
Three Take-Aways

     What is State of
     PHR Market Today
     Advent of Health
     Clouds
            Implications
     Trajectory
            Drivers
            Challenges
            What to Watch




  1/12/09                                                                 2
                                Copyright: Chilmark Research
                            For internal use only, not for distribution
While Consumers Increasingly Go
Online for Health Info…




                                                           Source: Pew Research 2006
                                                           74% of all adults are online




  1/12/09                                                                           3
                 Copyright: Chilmark Research
             For internal use only, not for distribution
Few Manage Their Health Records
That Way




                                                               Source: Forrester Research Q2’08 Survey
                                                               n= 5,242




       Today, Meager 3.3% iManage PHI
  1/12/09                                                                                         4
                     Copyright: Chilmark Research
                 For internal use only, not for distribution
iPHR Adoption is Widely Dispersed
     Entity         Type       No. of                 PHR                               Features
                               Users                Platform
Kaiser-             Provider    2.5M                    MyChart                   EMR portal w/email &
                                                                                   transaction services
Permanente
                                                                                    Portability w/HealthVault

Veteran’s Admin     Provider    650K                RYO (VistA)                    EMR portal, Not portable

WebMD                 ISV       500K                    WebMD                  Client defined, claims-based
                                                                                HRA & alerts Rarely portable

Aetna                Payer     ~250K                ActiveHealth              Focus on HRA, DM, aggressive
                                                                               build-out Portability w/HealthVault

United Health Grp    Payer     ~200K                 HealthAtoZ                 Claims-based, part of new
                                                                                    OptumHealth Div.
                                                                                     Portability w/HealthVault

Cleveland Clinic    Provider    100K                    MyChart                         Similar to KP
                                                                                      Portability w/Google

BIDMC               Provider     40K                        RYO                    Aging portal w/email
                                                                                Portability w/Google & HealthVault

All Others            Mix         3M               Countless                   Highly variable, most 5  simple
       1/12/09                     Copyright: Chilmark Research
                                                                                  templates Little portability
                                For internal use only, not for distribution
iPHR Market has Moved to B2B Model

                                                             High Barriers to
                                                             Entry in Provider
                                                             Market
                                                               Entrenched EMR
                                                             Employer & Health
                                                             Plan Markets
                                                             Similar
                                                             Consumer Plays
                                                             Often Legacy
                                                               Not actively supported

   B2C is Road to Ruin for PHR Vendors
  1/12/09                                                                       6
                   Copyright: Chilmark Research
               For internal use only, not for distribution
Stand-Alone, Consumer PHI Apps:
Manage Health


                       nt
                     e
                   nt
                Co




  Attributes        Rating                                   Notes
 Data Source            NA       Self-entry, Fax, Cumbersome, Current/Trusted?
 Control             High        Owned & managed by consumer
 Interoperability   Medium       Standards adoption increasing (CCR dominant)
 Portability        Medium       Highly variable across vendors
 Tools              Modest       Highly variable across vendors
 Personalization        Low       Generic, simplistic solutions             dominate
  1/12/09                                                                              7
                                  Copyright: Chilmark Research
                              For internal use only, not for distribution
 Adoption               Low      Self-entry key detriment, Highly motivated only
Employer & Health Plan Sponsored
Platforms: Manage Risks, Lower Costs

                                                                              a
                          nt                                                at
                        te                                                sD
                       n
                     Co                                                  m
                                                                      lai
                                                                     C


                        s
                      ol                                                    A
                                                                          HR
                    To



  Attributes          Rating                                            Notes
 Data Source(s)             NA        Claims, PBM & HRA, Partial View
 Control                    Low       Sponsor controlled
 Interoperability     Medium          Potential there, more talk than action
 Portability                Low       Tethered to employer or insurer
 Tools                  Good          Significant activity, behavioral change
 Personalization        High          Copyright: Chilmark Research claims
                                       Leverage HRA &                           data
  1/12/09                                                                              8
                                  For internal use only, not for distribution
 Adoption             Medium          Trust, Incentives often required
Provider Sponsored Platforms:
Consumer Retention

                         nt
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                                                                       i
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                                                               C




   Attributes                 Rating                                                        Notes
  Data Source(s)                 NA             EMR, Gold Standard, Myopic
  Control                        Low            Portal to host EMR
  Interoperability               Low            Disparate systems, competitive pressures
  Portability                    Low            Tethered to EMR
  Tools                        Medium           Communication for engagement/retention
   Personalization            Low-Med.Copyright: Chilmark poor job, some exceptions
                                         Most do Research
  1/12/09                                                                                           9
                                       For internal use only, not for distribution
  Adoption                    Variable          Perceived value?
Utility Service Model for PHI:
Creating an Ecosystem




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                                            Secure
                                           Repository



   Attributes        Potential                                             Notes
  Data Source(s)        NA              Virtually any pertinent data source
  Control              High             Strong consumer control of data
  Interoperability     High             Adoption of Open Systems and standards
  Portability         Medium            Still under development
  Tools              Very Good          Multiple tools/widgets, communications???
  Personalization      High      Copyright: Chilmark Research the
                                          Farther down                     road
   1/12/09                                                                                        10
                             For internal use only, not for distribution
  Adoption             High             Perceived value?
Utility Service Model for PHI:
A Health Cloud Ecosystem




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   Attributes        Potential                                             Notes
  Data Source(s)        NA              Virtually any pertinent data source
  Control              High             Strong consumer control of data
  Interoperability     High             Adoption of Open Systems and standards
  Portability         Medium            Still under development
  Tools              Very Good          Multiple tools/widgets, communications???
  Personalization      High      Copyright: Chilmark Research the
                                          Farther down                     road
   1/12/09                                                                                        11
                             For internal use only, not for distribution
  Adoption             High             Perceived value?
Personal Health Platforms (PHP):
 Model & Attributes
               Business Model                                          (+)                           (-)
   PHP

Dossia          Lg. Employer Sponsors              Instantaneous user base of             Poor partner strategy =
                                                  over 8M+ employees                     ecosystem non-existent
                Initial joiners fee (founding
               mbrs, $1.5M ea.)                    Built on open, Indivo Health           Lack of traction, slow uptake
                                                  platform                               by employers
                Annual fee based on
               number of subscribing               Future biometrics, via Continua        Portability of records?
               employees                           Free to employees

Google           Attract more visitors to          Clean, easy to use interface           Limited to structured data
               Google properties                   Good consumer controlled               Limited to CCR standard
Health           Ubiquitous in all aspects of     process for data collection             Small internal development
               consumer’s life                     Reasonable ecosystem                  grp (commitment) to build out
                 Have not ruled out ads in                                               platform
                                                   Future biometrics, via Continua
               future                                                                     TBD - ability to attract
                                                   Free to consumer
                                                                                         consumers

Microsoft       Similar to Google’s                Largest & most complete                 Cumbersome, messy
                                                  ecosystem (>14,000 SDK                 interface
                 Become base for MSN
HealthVault                                       downloads)
               Health                                                                      Mish-mash of partner apps
                                                   Largest investment of
                Extend desktop OS to                                                       Ulterior motives? (no
                                                  resources
               health e.g., Connection                                                   support for Apple OS)
               Center                              Unique biometric capabilities           TBD - ability to attract
                Advertising revenue via            Free to consumer                      consumers
               health search


     1/12/09                                                                                                12
                                               Copyright: Chilmark Research
                                           For internal use only, not for distribution
Dossia’s Ecosystem: Where is It?

            Date Sources                                      3rd Party Apps/Services




                Only WebMD “Live” Today
  1/12/09                                                                          13
                               Copyright: Chilmark Research
                           For internal use only, not for distribution
Google’s Ecosystem: Stalled
            Date Sources                                      3rd Party Apps/Services




 Slow Progress Recruiting Data Sources
  1/12/09                                                                          14
                               Copyright: Chilmark Research
                           For internal use only, not for distribution
HealthVault’s Ecosystem: Expanding
Date Sources                                                       3rd Party Apps/
                                                                          Services




            Excellent Partner Recruitment
  1/12/09                                                                    15
                         Copyright: Chilmark Research
                     For internal use only, not for distribution
Engaging the Consumer:
Google Health vs MS-HealthVault



            Consumer                                                 Consumer


                                                     ISV1                ISV3      ISV5
                                                                ISV2        ISV4

  ISV1         ISV3      ISV5
        ISV2      ISV4


  Models will Significantly Affect Adoption
  1/12/09                                                                                 16
                               Copyright: Chilmark Research
                           For internal use only, not for distribution
Listening-In:
Early Reports on PHPs
  Few Click-thrus from HealthVault
       But good enterprise visibility
       Connection Center gaining traction
            Over 20K users of AHA widget for BP monitoring
       Highly structured, significant resources, political
            Grumblings: “Where’s the marketing?”
  Significant Traffic from Google
       ~4k/day seen by partner ISV
       Loosely structured, few resources
            Are they serious about healthcare?
  Dossia Remains an Enigma
       Slow roll-out, only one ISV live, APIs to build ecosystem?
       No new members/employers
            Where’s the value?
  1/12/09                                                              17
                             Copyright: Chilmark Research
                         For internal use only, not for distribution
Looking to the Future for PHPs…
    HealthVault No Longer Standalone
    Property
            Embedded in MSNHealth
            Maintains strong clinical underpinnings
    Google Focuses on Wellness
            Healthy consumer centric
            Turns to ad-rev model for support
               Ads outside private domain
    Dossia Slowly Fades
            New members slow to appear
            Governance challenges
               Not an influencer in the market
    Fourth Entity Appears
            Many circling today


  1/12/09                                                                   18
                                  Copyright: Chilmark Research
                              For internal use only, not for distribution
Is the iPhone a Platform?
                                                           Leading Mobile
                                                           Web Platform
                                                              46% NA mkt
                                                              share
                                                              32% WW mkt
                                                              share
                                                           Tremendous
                                                           Momentum
                                                           Over 10K Apps
                                                              Over 450 in
                                                              Health &
                                                              Wellness
                                                           Technically, Not
                                                           a Cloud
                                                           Platform but…
                                                              Becoming de
                                                              facto platform

  1/12/09                                                             19
                 Copyright: Chilmark Research
             For internal use only, not for distribution
Evolution Accelerates PHR Adoption

                                                                                                   Adoption
                         High
User Value Proposition




                                                                                             Gen 4: Personal,
                                                                                                                    Users
                                                                                             Actionable, &
                                                                                                                  (Millions)
                                                                                             Connected


                                                                                                                 80
                                                                                   Gen 3: Data Aggregation
                                                                                   (Health Clouds Form)

                                              Gen 2: Online                                                      40

                                                                                                                 20
                                   Gen 1: Isolated
                         Low
                                                                                                                Time
                                           2000 2003
                             1992                                      2008              2011
                                          (Online)


                         1/12/09                                                                                      20
                                                         Copyright: Chilmark Research
                                                     For internal use only, not for distribution
Generation 4: “Convergence”
Personal, Actionable, Connected




 Value: About Me, By Me, With Me, For Me,
              Because of Me
  1/12/09                                                    21
                   Copyright: Chilmark Research
               For internal use only, not for distribution
Moving Ahead:
Adoption Challenges Remain
    Data Liquidity
      EMR adoption
      Standards Adoption
      Policies & Incentives
            Portability, Privacy, Liability
    Trust
       Health Plan, Employer, 3rd Party
    Consumer Apathy/Indifference
       Education
       Incentives
    Solution Capabilities
       Immature, Disparate


  1/12/09                                                                 22
                                Copyright: Chilmark Research
                            For internal use only, not for distribution
Drivers to Overcome Challenges

  Accelerating, Employer-led Initiatives
       Employee’s Financial Skin
  Accelerating IT Adoption Among Providers
       Incentives, e.g., eVisits, eRx
  Consumerism Entering Healthcare
       Visibility, Education
  New Consumer-centric Technologies & Tools
       Delivering Radically New Capabilities
  Disintermediation of Care
       Retail Clinics, Med Tourism, etc.
       Providers Becoming Consumer-Savvy


  1/12/09                                                              23
                             Copyright: Chilmark Research
                         For internal use only, not for distribution
What to Watch
   Traction of Platform Plays
      Data Sources (agreements)
            E.g., Cleveland-Google, KP-MS
        Consumer Adoption
            Which sub-groups adopt
        Developer Adoption
            What are popular apps/services
   Market Consolidation
     Rationalization & Acquisitions
            New players entering
   Employer Successes
      Demonstrable ROI
   All Things mHealth
        Smartphones App Ecosystems
            Biometrics + Smartphone

  1/12/09                                                               24
                              Copyright: Chilmark Research
                          For internal use only, not for distribution
Final Thoughts…

 Privacy is a Ruse
      Value is the Metric
            Most PHRs are Garbage

 Time to Kill PHR Term
      Dated, confusing, and not reflective of consumer needs
 Govt. Sponsored RHIOs & NHIN are Folly
      Self-forming Clouds rain on parade
 HIT Stimulus may be Wet Cement
      Difficult to chip-out later



  1/12/09                                                              25
                             Copyright: Chilmark Research
                         For internal use only, not for distribution
www.ChilmarkResearch.com
             5 JFK St., Suite 404
            Cambridge, MA 02138



1/12/09                                                       26
                    Copyright: Chilmark Research
                For internal use only, not for distribution

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PHRs, Platforms & Consumer Trends

  • 1. What’s Really Going On? or PHRs, Platforms, & Consumer Trends By: John Moore, Managing Director John@ChilmarkResearch.com 1/12/09 1 Copyright: Chilmark Research For internal use only, not for distribution
  • 2. Three Take-Aways What is State of PHR Market Today Advent of Health Clouds Implications Trajectory Drivers Challenges What to Watch 1/12/09 2 Copyright: Chilmark Research For internal use only, not for distribution
  • 3. While Consumers Increasingly Go Online for Health Info… Source: Pew Research 2006 74% of all adults are online 1/12/09 3 Copyright: Chilmark Research For internal use only, not for distribution
  • 4. Few Manage Their Health Records That Way Source: Forrester Research Q2’08 Survey n= 5,242 Today, Meager 3.3% iManage PHI 1/12/09 4 Copyright: Chilmark Research For internal use only, not for distribution
  • 5. iPHR Adoption is Widely Dispersed Entity Type No. of PHR Features Users Platform Kaiser- Provider 2.5M MyChart EMR portal w/email & transaction services Permanente Portability w/HealthVault Veteran’s Admin Provider 650K RYO (VistA) EMR portal, Not portable WebMD ISV 500K WebMD Client defined, claims-based HRA & alerts Rarely portable Aetna Payer ~250K ActiveHealth Focus on HRA, DM, aggressive build-out Portability w/HealthVault United Health Grp Payer ~200K HealthAtoZ Claims-based, part of new OptumHealth Div. Portability w/HealthVault Cleveland Clinic Provider 100K MyChart Similar to KP Portability w/Google BIDMC Provider 40K RYO Aging portal w/email Portability w/Google & HealthVault All Others Mix 3M Countless Highly variable, most 5 simple 1/12/09 Copyright: Chilmark Research templates Little portability For internal use only, not for distribution
  • 6. iPHR Market has Moved to B2B Model High Barriers to Entry in Provider Market Entrenched EMR Employer & Health Plan Markets Similar Consumer Plays Often Legacy Not actively supported B2C is Road to Ruin for PHR Vendors 1/12/09 6 Copyright: Chilmark Research For internal use only, not for distribution
  • 7. Stand-Alone, Consumer PHI Apps: Manage Health nt e nt Co Attributes Rating Notes Data Source NA Self-entry, Fax, Cumbersome, Current/Trusted? Control High Owned & managed by consumer Interoperability Medium Standards adoption increasing (CCR dominant) Portability Medium Highly variable across vendors Tools Modest Highly variable across vendors Personalization Low Generic, simplistic solutions dominate 1/12/09 7 Copyright: Chilmark Research For internal use only, not for distribution Adoption Low Self-entry key detriment, Highly motivated only
  • 8. Employer & Health Plan Sponsored Platforms: Manage Risks, Lower Costs a nt at te sD n Co m lai C s ol A HR To Attributes Rating Notes Data Source(s) NA Claims, PBM & HRA, Partial View Control Low Sponsor controlled Interoperability Medium Potential there, more talk than action Portability Low Tethered to employer or insurer Tools Good Significant activity, behavioral change Personalization High Copyright: Chilmark Research claims Leverage HRA & data 1/12/09 8 For internal use only, not for distribution Adoption Medium Trust, Incentives often required
  • 9. Provider Sponsored Platforms: Consumer Retention nt e ta nt a Co lD ca i lin C Attributes Rating Notes Data Source(s) NA EMR, Gold Standard, Myopic Control Low Portal to host EMR Interoperability Low Disparate systems, competitive pressures Portability Low Tethered to EMR Tools Medium Communication for engagement/retention Personalization Low-Med.Copyright: Chilmark poor job, some exceptions Most do Research 1/12/09 9 For internal use only, not for distribution Adoption Variable Perceived value?
  • 10. Utility Service Model for PHI: Creating an Ecosystem ns s ce io ur at So ic pl ta Ap Da Secure Repository Attributes Potential Notes Data Source(s) NA Virtually any pertinent data source Control High Strong consumer control of data Interoperability High Adoption of Open Systems and standards Portability Medium Still under development Tools Very Good Multiple tools/widgets, communications??? Personalization High Copyright: Chilmark Research the Farther down road 1/12/09 10 For internal use only, not for distribution Adoption High Perceived value?
  • 11. Utility Service Model for PHI: A Health Cloud Ecosystem ns s ce io ur at So ic pl ta Ap Da Secure Repository Attributes Potential Notes Data Source(s) NA Virtually any pertinent data source Control High Strong consumer control of data Interoperability High Adoption of Open Systems and standards Portability Medium Still under development Tools Very Good Multiple tools/widgets, communications??? Personalization High Copyright: Chilmark Research the Farther down road 1/12/09 11 For internal use only, not for distribution Adoption High Perceived value?
  • 12. Personal Health Platforms (PHP): Model & Attributes Business Model (+) (-) PHP Dossia Lg. Employer Sponsors Instantaneous user base of Poor partner strategy = over 8M+ employees ecosystem non-existent Initial joiners fee (founding mbrs, $1.5M ea.) Built on open, Indivo Health Lack of traction, slow uptake platform by employers Annual fee based on number of subscribing Future biometrics, via Continua Portability of records? employees Free to employees Google Attract more visitors to Clean, easy to use interface Limited to structured data Google properties Good consumer controlled Limited to CCR standard Health Ubiquitous in all aspects of process for data collection Small internal development consumer’s life Reasonable ecosystem grp (commitment) to build out Have not ruled out ads in platform Future biometrics, via Continua future TBD - ability to attract Free to consumer consumers Microsoft Similar to Google’s Largest & most complete Cumbersome, messy ecosystem (>14,000 SDK interface Become base for MSN HealthVault downloads) Health Mish-mash of partner apps Largest investment of Extend desktop OS to Ulterior motives? (no resources health e.g., Connection support for Apple OS) Center Unique biometric capabilities TBD - ability to attract Advertising revenue via Free to consumer consumers health search 1/12/09 12 Copyright: Chilmark Research For internal use only, not for distribution
  • 13. Dossia’s Ecosystem: Where is It? Date Sources 3rd Party Apps/Services Only WebMD “Live” Today 1/12/09 13 Copyright: Chilmark Research For internal use only, not for distribution
  • 14. Google’s Ecosystem: Stalled Date Sources 3rd Party Apps/Services Slow Progress Recruiting Data Sources 1/12/09 14 Copyright: Chilmark Research For internal use only, not for distribution
  • 15. HealthVault’s Ecosystem: Expanding Date Sources 3rd Party Apps/ Services Excellent Partner Recruitment 1/12/09 15 Copyright: Chilmark Research For internal use only, not for distribution
  • 16. Engaging the Consumer: Google Health vs MS-HealthVault Consumer Consumer ISV1 ISV3 ISV5 ISV2 ISV4 ISV1 ISV3 ISV5 ISV2 ISV4 Models will Significantly Affect Adoption 1/12/09 16 Copyright: Chilmark Research For internal use only, not for distribution
  • 17. Listening-In: Early Reports on PHPs Few Click-thrus from HealthVault But good enterprise visibility Connection Center gaining traction Over 20K users of AHA widget for BP monitoring Highly structured, significant resources, political Grumblings: “Where’s the marketing?” Significant Traffic from Google ~4k/day seen by partner ISV Loosely structured, few resources Are they serious about healthcare? Dossia Remains an Enigma Slow roll-out, only one ISV live, APIs to build ecosystem? No new members/employers Where’s the value? 1/12/09 17 Copyright: Chilmark Research For internal use only, not for distribution
  • 18. Looking to the Future for PHPs… HealthVault No Longer Standalone Property Embedded in MSNHealth Maintains strong clinical underpinnings Google Focuses on Wellness Healthy consumer centric Turns to ad-rev model for support Ads outside private domain Dossia Slowly Fades New members slow to appear Governance challenges Not an influencer in the market Fourth Entity Appears Many circling today 1/12/09 18 Copyright: Chilmark Research For internal use only, not for distribution
  • 19. Is the iPhone a Platform? Leading Mobile Web Platform 46% NA mkt share 32% WW mkt share Tremendous Momentum Over 10K Apps Over 450 in Health & Wellness Technically, Not a Cloud Platform but… Becoming de facto platform 1/12/09 19 Copyright: Chilmark Research For internal use only, not for distribution
  • 20. Evolution Accelerates PHR Adoption Adoption High User Value Proposition Gen 4: Personal, Users Actionable, & (Millions) Connected 80 Gen 3: Data Aggregation (Health Clouds Form) Gen 2: Online 40 20 Gen 1: Isolated Low Time 2000 2003 1992 2008 2011 (Online) 1/12/09 20 Copyright: Chilmark Research For internal use only, not for distribution
  • 21. Generation 4: “Convergence” Personal, Actionable, Connected Value: About Me, By Me, With Me, For Me, Because of Me 1/12/09 21 Copyright: Chilmark Research For internal use only, not for distribution
  • 22. Moving Ahead: Adoption Challenges Remain Data Liquidity EMR adoption Standards Adoption Policies & Incentives Portability, Privacy, Liability Trust Health Plan, Employer, 3rd Party Consumer Apathy/Indifference Education Incentives Solution Capabilities Immature, Disparate 1/12/09 22 Copyright: Chilmark Research For internal use only, not for distribution
  • 23. Drivers to Overcome Challenges Accelerating, Employer-led Initiatives Employee’s Financial Skin Accelerating IT Adoption Among Providers Incentives, e.g., eVisits, eRx Consumerism Entering Healthcare Visibility, Education New Consumer-centric Technologies & Tools Delivering Radically New Capabilities Disintermediation of Care Retail Clinics, Med Tourism, etc. Providers Becoming Consumer-Savvy 1/12/09 23 Copyright: Chilmark Research For internal use only, not for distribution
  • 24. What to Watch Traction of Platform Plays Data Sources (agreements) E.g., Cleveland-Google, KP-MS Consumer Adoption Which sub-groups adopt Developer Adoption What are popular apps/services Market Consolidation Rationalization & Acquisitions New players entering Employer Successes Demonstrable ROI All Things mHealth Smartphones App Ecosystems Biometrics + Smartphone 1/12/09 24 Copyright: Chilmark Research For internal use only, not for distribution
  • 25. Final Thoughts… Privacy is a Ruse Value is the Metric Most PHRs are Garbage Time to Kill PHR Term Dated, confusing, and not reflective of consumer needs Govt. Sponsored RHIOs & NHIN are Folly Self-forming Clouds rain on parade HIT Stimulus may be Wet Cement Difficult to chip-out later 1/12/09 25 Copyright: Chilmark Research For internal use only, not for distribution
  • 26. www.ChilmarkResearch.com 5 JFK St., Suite 404 Cambridge, MA 02138 1/12/09 26 Copyright: Chilmark Research For internal use only, not for distribution