The Plot to Bring Down WebMD

MDNG Endocrinology, March 2007, Volume 9, Issue 4

Ten years ago, the first consumer health site, WebMD (www.webmd.com), was launched.

And with eight out of every 10 Internet users searching for health information--according to WebMD President and CEO Wayne Gattinella--the online portal has become "the most recognized and trusted source of health information today." In fact, Gattinella told MDNG that more than 35 million people visited the site each month in the fourth quarter of 2006. There's no questioning WebMD's popularity; we've highlighted resources found there dozens of times during OncNG's eight-plus years, you've probably seen their advertisements on television, and we bet more than one of your patients have come to the office with printouts of information they found at the site.

Although WebMD has carved out a prominent place on the Internet, recent trends have threatened to make the company's products and services less relevant to some health consumers. Most importantly, Americans are increasingly being exposed to and using content on blogs, wikis, online forums, and other forms of user-generated media. For example, according to an Envision Solutions study, 5% of people searching for information about the antidepressant Lexapro between mid-December 2006 and mid-January 2007 went to Crazymeds.org. This is a popular blog featuring insights on the safety and efficacy of psychiatric medications. Web 2.0 technologies like blogs are increasing the visibility of citizen medical experts, and consumers are increasingly relying on them for "straight talk" about health issues. People are also using these tools to share tips about treatment and caregiving. The Internet has also helped to fuel a more patient-focused model of healthcare delivery.

Armed with information from a variety of online and offline sources, consumers are asking physicians more questions about their care. In addition, baby boomers are taking steps to preserve their health and vitality in a bid to stave off the aging process. These changes in how people view their health have created a cadre of active patients who require more support and information than what WebMD has traditionally provided. Clearly, there is an opportunity to deliver new online services to consumers that combine peer-to-peer communication with financial, medical, and provider information. Recognizing this, a number of new companies are feverishly developing and launching products they think will satisfy consumers' needs, in the hopes of capturing a significant percentage of WebMD's audience.

The Contenders WebMD's new competitors include Revolution Health, US Preventive Medicine, Everyday Health, the HealthCentral Network, Organized Wisdom, and Daily Strength. Appearing in late December 2006 and with a planned full 2007, Revolution Health--backed by America Online (AOL) founder Steve Case, as well as Colin Powell, Carly Fiorina, Jim Barksdale, and Frank Raines--is WebMD's strongest competitor, currently offering at no services, disease information, articles, forums, more than 100 fun tools to help people and their families stay healthy--"why does healthcare always have to be so boring?" asks Case in his welcome letter--calculators, a physician finder, symptom checkers, and more.

"We believe that the transformation of healthcare entails three principles," Revolution Health Chief Medical Officer Jeffrey Gruen, MD, told MDNG. "The first is to make healthcare simpler, more consumer-friendly, easier to access, easier to use, and more comprehensive. The second is to build a strong bond between physicians and patients. We would like to help raise again the nobility of the profession of medicine in the public's eye and to help patients and physicians connect in new, more meaningful ways. We'd like to make it easier for patients to find physicians who they feel they'll be able to resonate with. We have tools to help them there. We also have tools to help physicians know more about their patients, including a tool called Know Your Number, which includes scientific data on risks for contracting certain diseases that we can provide to patients to then bring to their physicians."

Dr. Gruen said Revolution Health's third guiding principle is the belief that "an important part of health is for people to be connected, so we built powerful social networking capabilities. Having an illness can be very isolating, and we want to try to solve that by providing the support of the community. We also believe it's important for people to connect with the feeling of being healthy, so we're providing support online for people to choose healthier lifestyles. We're also revolutionizing that kind of support through a product we call Membership. This is really like AAA for health. It helps you with whatever breaks down in the system, including making positive lifestyle changes." Among Revolution Health's top features is "Revolution Ratings," which allows site visitors to rate the site's information and tools--licensed from Mayo Clinic, Cleveland Clinic, Harvard, and Healthwise--in the "Learn from Others" section. Visitors to this section of the site can also read or write about health experiences, post a question, or respond to others.

Revolution Health members can rate providers and facilities in the "Doctors and Hospitals" section, enabling consumers to browse information on nearby doctors, specialists, and hospitals and select the best provider based on what others have said. Visitors can rate treatments and medications in the "Conditions and Treatments" section, where patients will also find information about diagnoses, living with a vast number of conditions, from allergies to heart disease. "Isn't it crazy that we have ratings to help us pick movies, restaurants and hotels--but no comparable tools to help evaluate doctors, hospitals and treatments?" asks Case. "We aim to change that--and with your help, we will." Consumers who register with Revolution Health can create and maintain a personal health record that allows them to enter and update their health information and provide access permission to their physician or other healthcare provider as they see fit.

"We have a lot of trust that consumers can be a lot more effective than they are now; they just need the tools," says Dr. Gruen. "We're providing good tools, because consumers are being asked more and more to help take care of themselves and manage their healthcare. Physicians are also being held more responsible for patient outcomes, so patients--to achieve good outcomes--need to be motivated. And one of the motivations is to see your values over time and see how they change. Also, when patients show up in a physician's office, it's very important for the physician to know reliably what the patient's history is. Oftentimes, patients can't keep it all in their head. Wouldn't it be great for a physician next time a patient shows up to be able to look at all the past medical files right there online?"

Dr. Gruen notes that Revolution Health offers many tools and resources that none of its competitors currently offer. One is an insurance marketplace that "helps consumers really understand what they're getting when they buy insurance. The marketplace brings consumers a wide variety of insurance options, as well as tools and information to help in making the right health insurance provider and plan choices."

When Revolution Health's online resources aren't enough, or when a consumer needs someone to talk to regarding a diagnosis, finding a doctor, or navigating the complex healthcare system, the membership program steps in, allowing anyone who joins by April to make a call 24 hours a day, free of charge (an annual subscription price of less than $100 will begin thereafter). Revolution Health says they'll intervene and handle the situation, whatever it may be, on the consumer's behalf.

Everyday Health

According to a January 23 article in the Washington Post, EverydayHealth.com has received 5 million unique visitors per month since its October 2006 launch as a no-cost site designed to provide simplified health information. Everyday Health plans to revamp this year to offer more personalized services. The site was developed after its founders asked the public what it wanted in a health site and learned that consumers are looking for credible information from unimpeachable, trustworthy sources; practical information for managing a condition on a day-to-day basis; easy-to-use, customization features; and support from people in similar situations. Using this information, the Everyday Health site currently offers detailed information from Harvard Health on diagnosis, management, and prevention of hundreds of diseases and conditions, question and answers from board-certified medical specialists from top institutions across the country, more than 10 thriving condition- and health topic-specific message boards for patients and caregivers and the "3-Minute Health Check," an online exam that helps consumers evaluate the everyday habits that affect their health, analyze their habits, and tells them the "3 Things [They] Can Do Today" to improve their health. The Health Check also serves as a springboard into the personalized information available based on consumers" answers to questions asked within.

An expansive video library, condition-specific recipes, and an impressive and robust drug library round out the site's content. The HealthCentral Network This collection of condition-specific sites--founded in the late 1990s and recently revitalized after being acquired by a team of blue-chip investors--receives 7 million unique visitors every month, according to the same Washington Post article referenced above, and provides "timely, indepth, trusted medical information, personalized tools and resources, and connections to a vast community of leading experts and patients for people seeking to manage and improve their health."

Under the categories of "Mind," "Body," "General Health," and "Our Affiliates," the HealthCentral Network provides more than 40 sites that combine "medically-reviewed original content from doctors, researchers and expert patients, as well as news, information, video and other multi-media content from leading authorities such as A.D.A.M, HealthDay News, and Ivanhoe. "The sites under the "Mind" and "Body" categories have a similar layout and design. Visitors can find answers to common health-related questions, symptom information, and other resources in the "Find" sub-section. The "Manage" sub-section offers support and advice that can help patients take action, achieve goals, and resolve health problems.

Under "Connect," visitors will find support, advice, and the opportunity to share opinions, serving the Network's goals of fostering "a rich community of patients and experts who share their experiences, "real-world" learning and support as they manage their day-to-day lives and their health" and capturing "the rich knowledge base these people have absorbed through their own experiences to be shared and expanded upon by others." Patients and caregivers can also create their own personalized website for keeping in touch, offering support, and staying informed by linking from most of the Network's sites to the CareCentral Tool.

Organized Wisdom

Launched in October 2006, the Organized Wisdom website provides access to HealthWise content. Organized WisdomCards' uniqueness lies in the ability for consumers who have registered with the site for free to easily create and post "," which tell the consumer's story about how they handled a specific health issue and provide recommendations on where patients can find information, treatment, and advice, thus helping others learn from their experience. The "health-focused, social-networking site" also "enables consumers, physicians, healthcare professionals, and health organizations to collaborate on more than 6,500 health topics" and provides free access to doctor-reviewed information covering these topics. More than 1.3 million people visited the site in January, a portion of whom were rerouted from 35 condition-specific sites.

DailyStrength Based on the premise that most people face "a serious personal challenge themselves or [have] someone close to them who does," DailyStrength hosts "a collection of safe, anonymous, online support groups focused on more than 500 specific challenges to help people overcome their personal challenge or support a loved one through theirs." After signing up for a free account that allows for as much anonymity as desired, consumers start a "Wellness Journal" that allows them to share their story with others, invite their friends and family to participate, join one of the hundreds of communities to instantly meet others who share their challenges, make online friends with other members and stay up-todate with each other's progress, send private messages, and receive e-mail updates regarding recent community progress. When community members are having difficulty meeting their health challenges and are in need of support, DailyStrength will alert fellow members of the community so that they can take action.

The most popular communities currently focus on asthma, breast cancer, celiac disease, chronic pain, depression, divorce, grief, and parenting issues. Site users will also find community-provided recommendations for doctors and healthcare facilities, and even restaurants and parenting advice. Those with a challenge who can't find a community that serves their needs can contact DailyStrength, and they'll create one for the individual.

US Preventive Medicine

Although the sites and organizations described above all provide, to some degree, information on preventive care and how to decrease the risk of acquiring certain diseases and conditions, US Preventive Medicine has found its niche in providing "consistent services and methodologies, strong brand recognition, and a turnkey business model that will make the "prevention experience" a winning proposition for healthcare providers and consumers" by creating a "comprehensive prevention ecosystem." US Preventive Medicine believes that "proactive, preventive health management is a necessary and imminent revolution in medical care" and that "economic necessity and medical evidence are driving the transformation of health care from a legacy of treatment to a culture of prevention." The site's most useful consumer information and resources include a newsletter focused on preventive medicine and how to protect oneself from preventable disease, a virtual library, and a medical glossary.

The highlight of the site is by far the virtual library, which asks site visitors to mouse over a virtual body part--much like the symptom checker offered by WebMD--or choose from a "list of conditions, tests, procedures and anatomical descriptions" of the body. Instead of providing detailed text information, like WebMD's symptom checker, the US Preventive Medicine virtual library offers slides, brief text, and illustrated videos with audio for every one of the dozens of featured topics, including angioplasty, bronchitis, skin cancer, and thyroid scan, allowing for a more inviting, interesting experience than reading the straight text found at more robust sites.

Fighting the Good Fight

WebMD is not sitting back and letting its competitors capture its marketshare by providing peer-to-peer networking tools, more relevant online searches, and other services. "Just yesterday [February 21], we launched our new, next-generation consumer portal," Gatinella explains. "The objective for the new WebMD consumer portal was to bring a new level of personalization to the user experience in order to create an even more personalized view to people�s health question." WebMD's most recognizable tool is probably the symptom checker, advertised on television for years, which was revamped for the launch of the new site and features "a fully interactive graphical interface that allows people to click on the area of the body that their physical symptom might be related to," explains Gatinella, "and from that we then present the most targeted and appropriate content related to the condition, its potential treatment, and other related information."

Extending the personalized feel of the site, the "new WebMD health search product is designed to deliver a new level of search results when looking on a related health term, and even personalizes those results based on a symptom related to the term or its diagnosis, treatment and care, prevention, and other types of things," adds Gatinella. "Another exciting part of the new site is our collection of new community centers. This is where we're really taking advantage of peer-to-peer capability, where people can benefit from the experience of others with similar health needs. We have more than 140 peer-to-peer health ports.

The new site also includes expert blogs lead by some of the nation's top health experts in their respective fields, and 60 new health and wellness and lifestyle centers to help guide users through all the relevant information in their area of inquiry. These centers provide access to "new WebMD videos on each of those topics that create a more engaging experience by combining sights, sounds, and motion to enhance health information," notes Gatinella. The new WebMD consumer health portal also gives consumers the ability to build, for free, their own personal health record for securely storing and maintaining their health history. They can also take advantage of an assessment tool that lets users learn their "personal health score," which they can use to help in devising plans to take a more active role in managing their health.

"The best way to get people involved in the topic of health--other than 'I have a question, give me an answer'--is to get them truly involved in health management programs that can improve their health," explains Gatinella. "The best way to do that is to start by asking consumers questions about their personal health history, and that's what we call our personal health assessment. We store that information, and give users access to it; it's their information, so the individual determines who else, if anyone, should have access to it. And if you so choose in the future, you have the ability to take your personal health information, based on self-reported data and other medical information that you update your record with, and communicate that to others. How many times can a person sit in a waiting room in a doctor's office and be handed the clipboard and be asked to fill out this information? It really becomes a test of memory, instead of a test of a person's real health history."

WebMD personal health records are password-protected, and the site's developers are working on secure e-mail communications and the capability of integrating them into physicians" electronic medical records. "Those enhancements are evolving and will be occurring later this year," explains Gatinella.

Clearly, WebMD isn't going to be pushed around. If anything, it has become stronger due to the recently added competition. "We've been able to build the largest audience online," concludes Gatinella. "The WebMD brand has become the most recognized and trusted brand of health information out there today. And the continued investment we're making in our business--both with delivering a new consumer health portal and with continuing to drive innovation in the marketplace--we think is something that will help us maintain our leadership in this market as it continues to grow in the future."

Thanks to Fard Johnmar, founder of Envision Solutions, LLC for his help with this article.