personalized public health campaigns
DESCRIPTION
An exploration of the wellness newsletter ecosystem and exploration of opportunities for variable data printing applicationsTRANSCRIPT
P l d P bl H l h Personalized Public Health Campaigns
October 2005Gi d B tt H S
p gExecutive SummaryGiordano Beretta, Henry SangPublishing Systems & Technologies DepartmentImaging Systems Laboratory, HP Labs
Basic problemBasic problem• Dependency of a family solely on their
d t tl i ffi i idoctor causes costly inefficiencies
• These gross inefficiencies can be reduced by timely and appropriate education in healthy life style habits and preventionhealthy life style habits and prevention
3 October 2005 2
goalgoal• To create a money-making venture around the
di l i d tmedical industry
3 October 2005 3
value proposition:help people help themselveshelp people help themselves• Leverage patient records
bli h lth it i f di− public health monitoring of diseases− on-going follow-up to medical problems− patient specific medical alerts (vaccinations, checkups,…)
• Leverage HP’s personalized publishing− Data mining and campaign optimization− variable content publishing capabilitiesvariable content publishing capabilities− automated workflow systems− high volume, high quality printing capabilities− existing partnersexisting partners
• Leverage the public’s demand for self-help− increased demand for accurate and timely information
d l h l h l d h f l
3 October 2005 4
− desire to pro-actively help themselves and their families
basic concept:high value & high volumehigh value & high volume• 392 printed health and fitness newsletters• currently more than 1 billion pages per year−potentially 115,904,641 housing units * 12 issues/year
* 8 /i 11 126 845 536 /* 8 pages/issue = 11,126,845,536 pages/year
• 2004 health insurance coverage (Census Bureau)245 3 million (84 3%) people have health insurance−245.3 million (84.3%) people have health insurance
−45.8 million do not have health insurance− number of people covered by government health p p y g
programs increased between 2003 and 2004 from 76.8M (26.6%) to 79.1M (27.2%)
i di t i
3 October 2005 5
• indirect savings
planned capital purchases over next 5 years (% CFOs responding) 5 years (% CFOs responding)
0 10 20 30 40 50 60 70 80
72
64
digital radiology systemscomputerized physician order entry 64
61
51
systemsmajor IT system
i ER i 51
50
increase ER capacity
increase OR capacity
36
25
convert semi-private rooms to private
add computer in patient rooms
3 October 2005 6
23new hospitalsource: Healthcare Financial Management Association, March 2004, p.8
funding sources for health services and supplies expendituresand supplies expenditures
private health insurance37%out-of-pocket payments14%other private funds 4%o e p va e u ds
state & local funds 13%
federal funds 32%
3 October 2005 7
Source: Centers for Medicare and Medicaid Services, 2004c
206 HMO medical centers with751 establishments751 establishments
45500+ employees
source: U.S. Census Bureau Statistics of U.S. Businesses: 2001. HMO medical centers United States
21
29
45
20 99 employees
100-499 employees
p y
15
21
5 9 l
10-19 employees
20-99 employees
53
18
1-4 employees
5-9 employees
25
0 100 200 300 400 500 600
no employees
3 October 2005 8
firms establishments
print: demographic data can be exploited for custom publishingexploited for custom publishing• newsletters are PR material or bait for demographic
datadata• control points: data modeling, publishing, VDP
productionproduction• integration: complex application yields
opportunities for C&I• managed services: small publishers lack IT skills• hosting: publishers may want not to deal with IT g p y
issues• utility data center: data mining and layout requires
large resources
3 October 2005 9
large resources
newsletter circulation datanewsletter circulation dataTufts University Health and Nutrition Letter 250,000PacifiCare HealthBeat 2,959,400
Harvard Health Letter 226,000
C C H l h M i 210 000
American Institute for Cancer Research Newsletter 1,600,000
M Cli i H l h L 750 000 Cancer Care Health Monitor 210,000
Harvard Heart Letter 115,000
Mayo Clinic Health Letter 750,000
Diabetes Health Monitor 528,717
Harvard Mental Health Letter 52,363
AIDS Clinical Care Newsletter 32 000
Arthritis Health Monitor 460,788
Johns Hopkins Medical Letter: 425 000 AIDS Clinical Care Newsletter 32,000
The Nation's Health 31,000
pHealth After 50 425,000
Harvard Women's Health Watch 400,000
3 October 2005 10
Fibromyalgia Network 20,000UCB Wellness Letter 350,000
newsletter pages per yearnewsletter pages per year
Mayo Clinic Health Letter 72,000,000 Harvard Health Letter 21,696,000
Johns Hopkins Medical Letter: Health After 50 40,800,000 Harvard Heart Letter 11,040,000
Harvard Women's Health Watch 38,400,000
Di b t H lth M it 38 067624
The Nation's Health 6,200,000
Harvard Mental Health 5 026 848Diabetes Health Monitor 38,067,624
Cancer Care Health Monitor 37,800,000
Letter 5,026,848
Fibromyalgia Network 4,800,000
UCB Wellness Letter 33,600,000 AIDS Clinical Care Newsletter 3,072,000
TOTAL
3 October 2005 11
Tufts Health and Nutrition Letter 24,000,000
TOTALthis table
336,502,472
newsletter subscription income/anewsletter subscription income/a
Diabetes Health Monitor $22,047,499 Harvard Mental Health Letter $3,770,136
Mayo Clinic Health Letter $20,250,000
Letter
Harvard Heart Letter $3,680,000
Harvard Women's Health Watch $12,800,000
Johns Hopkins Medical $10 200 000
AIDS Clinical Care Newsletter $3,488,000
Th N ti ' H lth $1 550 000J pLetter: Health After 50 $10,200,000
UCB Wellness Letter $9,800,000
The Nation's Health $1,550,000
Fibromyalgia Network $500,000
Tufts Health and Nutrition Letter $7,000,000
TOTALthis table
$101,413,635
3 October 2005 12
Harvard Health Letter $6,328,000
patient handoutspatient handouts• 500# gorilla: Krames
f−part of the international MediMedia conglomerate− sister company publishes Harvard newsletters− known more for breath than depthknown more for breath than depth−300,000 customers, 80% of US hospitals
• expensive ($2 each)expensive ($2 each)• has PoD solution Krames On-Demand
3 October 2005 13
Components of gross domestic product 2003 (total = $11 trillion)product, 2003 (total = $11 trillion)
Sources: Bureau of Economic Analysis, Medicare
OtherAuto 3.8%Defense 4.5%Food 9.7%Housing 10.9%Health 15 3%Health 15.3%
3 October 2005 14
Health is the largest sector of the U.S. economy
Economic health and burden of chronic disease in $ billion 2004chronic disease in $ billion, 2004
400
300
350
400
200
250
100
150
0
50
3 October 2005 15
diabetes cardio cancer tobacco obesity
Source: CDC
today’s systemtoday s system• what is counted?
f ff−publishers give free issues to medical offices
• make money by using feedback mechanisms and d t ti t t d hi d tdata aggregation to create demographic data− sell or rent address lists− targeted inserts in envelopestargeted inserts in envelopes−permission based mailing of adverts for pharmaceuticals
and medical servicesi t ti h ti t th f − campaigns targeting each patient over the course of a
disease, adapting the message to the disease’s course
• difficulty in assessing true market size in dollars
3 October 2005 16
• difficulty in assessing true market size in dollars
opportunitiesopportunities• main message: convert some of the health care
t i i timoney to savings via prevention− Fortmann data
li t f f i / l d h bi • list of sources of income/money pools and how big they aredirect money pools: subscription info pre op etc• direct money pools: subscription, info, pre-op, etc.
• indirect / leverage: reduce health cost
3 October 2005 17
newsletter players todaynewsletter players today• in the US there are two distinct ecosystems served
b th t f bli hi iby the same set of publishing companies:−wellness newsletters
• no medical liabilityno medical liability• leveraged on the supplement industry• gather demographics via round-tripping• heavy content reuseheavy content reuse• shake-out in industry
−patient information• l t t • leverages on same content corpus• clinician bears full responsibility• clinician generally unhappy with what they have
3 October 2005 18
wellness newsletter ecosystemwellness newsletter ecosystemgovernment
agency
h it lmedical group
governmentagency commercial
customershospital
Medicareinsurance
…
content providers
non-profit …
governmentagency
f i lschool of
di i
partnersconsulting
data center
expertsprofessional
societymedicine
internationalorganizationself-help
organization…
HP business
call center …
production
print serviceprovider data center
suppliers
3 October 2005 19
call center …
role will become supplier/partner, not competitor
best ecosystem for HPbest ecosystem for HP• redo in terms of new slide “today’s system” above• build up for strategy, i.e., move money and capture 20%• wellness newsletters are printed in high volume on light
paperpaper− it is hard to compete on price with gravure and offset on large runs
• patient informationp− can benefit from print-on-demand− clinicians are unhappy with current state− pages have high valuep g g
• business challenge: the same group of people owns the content
h b d l
3 October 2005 20
• opportunity: hybrid newsletters
leverageleverage• what HPL technologies can we leverage on?−optimized production processes− campaign management−document analysis and automatic layoutdocument analysis and automatic layout−print optimization−general digital publishing know-how
3 October 2005 21
complexity highlow
divisional customersdivisional customers• opportunity for IPG to enter
the digital press application the digital press application market
• opportunity for C&I to enter
data center,hosting
pp ythe health care vertical market
• contributes to the goal of
printers, supplies
• contributes to the goal of achieving estimated 10 billion Indigo pages/year
C&I integration,domaincomsulting
managedservices(propritery
3 October 2005 22
(propritery,S/W, systems,associated
pilotpilot• want reference customer, marketing tool, and shake
our the productour the product• hospitals and large HMOs in need of branding
t t b i d i ti t i f ti• partner must be experienced in patient information−what works and what does not?−what is ethical?−HIPAA
• must also partner with a content creator i i− content is expensive
• need also funding− insurance company?
3 October 2005 23
− insurance company?
special customersspecial customers• Department of Veterans Affairs
f f−mandate to providing federal benefits to veterans and their families
−about a quarter of the nation's population, approximately about a quarter of the nation s population, approximately 63 million people, are potentially eligible for VA benefits and services
−2004 spending was $63 5 billion2004 spending was $63.5 billion
• Kaiser Permanente−Nation's largest HMO 8 2 million members in 2003Nation s largest HMO, 8.2 million members in 2003−Kaiser Foundation Health Plans and Hospitals,
Permanente Medical Group
3 October 2005 24
• both may be able to self-fund
a win-win propositiona win-win proposition• patients get guidance towards a healthier life• insurance companies save money when their
members need less services• medical services grow because−patients are happier and recommend it
li th fi d i th t f i− can live on the fixed income they get from insurances
• HP makes a step towardsth l f hi i 10 billi I di /− the goal of achieving 10 billion Indigo pages/year
− enters a new vertical in which it has no presence−does good for society
3 October 2005 25
g y
a win-win proposition ALTERNATEa win-win proposition ALTERNATE• Win for HP customers in health care industry
Hi h l i th t h ld i ll f th i ti t− High value services that should increase wellness of their patients− Potentially reduce health costs owing to early intervention
• Win for patientsp− More informed health information allowing self help− Mechanism to seek additional information
• Win for industry• Win for industry− New services and printing opportunities
• Win for HP− New product and services opportunity for HP in digital publishing− High value, high volume opportunity for Indigo division for printing
and supplies
3 October 2005 26
pp− Leverages on HP’s core competencies
next stepnext step• recommendations on how to go forward
f− need help from a business development specialist− find an interested divisional partner−work with a sales or C&I person (we are interacting work with a sales or C&I person (we are interacting
directly with customers, but do not yet make a sale)−get a second meeting with Palo Alto Medical Foundation
d VA P l Alt H lth C S tand VA Palo Alto Health Care System− form a team of technology providers
3 October 2005 27
go/no go decisiongo/no go decision• should it live or die?
f− financial data is OK− interest is strong
h t i i l d f th il t?• what is involved for the pilot?− need help from business development specialist− need to develop connections within HPneed to develop connections within HP− line up resources to provide the technology
• this proposal exploits the insurance vectorthis proposal exploits the insurance vector− it is a financial business and that organization is probably
the best partner
3 October 2005 28
technological impacttechnological impact• technology requirements
f− high performance custom printing on digital press and laser printer (for point of contact handouts)
−optimized production processesoptimized production processes− campaign management−document analysis and automatic layout−print optimization
• potential research vectors:i l i h DFE−automatic layout in the DFE
− new digital publishing paradigms− new campaign management strategies
3 October 2005 30
new campaign management strategies
data to datedata to date• not being a player in the health vertical made it
ti l l h d t t d t b ld t particularly hard to get data, because we could not get introductionsh did it• how we did it− searching on the Web− scouting patient librariesscouting patient libraries− interviewing health sector decision makers for patient
informationi t i i t t id− interviewing content providers
− lots of cold calls, with great help from the HP library
3 October 2005 31
Importance of brandingImportance of brandingDo you think the certification and/or accreditation of medical Web sites may reduce the issues listed above?
YesNNoUndecided
3 October 2005 32
Source: 8th HON Survey, Health On the Net Foundation, May-June 2002
Internet is not trustedInternet is not trustedIn your opinion, what is the most critical issue facing the Internet and especially the medical Internet?
Accuracy of infoTrustworthnessFinding info /NavigationAvailabilityJunkSpamSubscriptionPornographyPrivacyEqual accessEqual accessCostAdvertisingBandwidthRegulationSecurityAccessibilityCopyrightsCensorshipLegalityNo response
3 October 2005 33
Source: 8th HON Survey, Health On the Net Foundation, May-June 2002
Wellness newsletter cost exampleWellness newsletter cost example• Assumptions:
4 − 4 pages− 1,000 identical copies− Prepared by M.D. and staff
Research, writing & editing text $500Layout, design & graphics $400P i ti & f ldi $450Printing, paper & folding $450Envelopes $100Postage $350Postage $350Addressing, inserting, sealing & affixing postage $250
Total $2,040
3 October 2005 34
,Source: Patient News Publishing, Niagara Falls
Traditional workflowTraditional workflowacademic
paper
conference
medical writereditorial
wellnessnewsletter
online content
patient
press release
WHO/CDCbulletin
medical writermedical writer
medical writereditor
editorialboard
patientinformation
news article
online content
board prestige salary subscriberwellness vs.medical info$:
UC B k l B l i M di h lthM dli Pl
3 October 2005 35
UC BerkeleyHarvard
Belvoir MediaUniversity Health
healthyvs. sick
Medline Plusvs. Medlineexample:
Clear return on investmentClear return on investment• Claims by contents provider Healthwise−One client reported saving $34.5 million in 30 months
with Healthwise information−23% of respondents reported avoiding an unnecessary 23% of respondents reported avoiding an unnecessary
visit to the doctor−15% avoided an unnecessary visit to the emergency
roomroom−Another survey showed 87% of the respondents were
more satisfied with their health plan as a result of ti i ti i H lth i participating in a Healthwise program
3 October 2005 36
source: http://www.healthwise.org/mhb_employers.aspx
Alternate usesAlternate usesPuerto Rico health card
wellness
trainingmaterials
clinic
medical group
wellnessnewsletter
staff bios
content
publisher
medical grouppost visit info sheet
institution infocontent
repository
insurancein-depth info
admission info
hospital
Medicare/Medicaid
clinician’supdate
i f
3 October 2005 37
self-help grouptherapy info
surgery info