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

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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

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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?

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− 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

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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