Aperion - Redefining Community

Aperion SMART Home on track with Online house calls that click with doctors

With insurers starting to cover them, virtual office visits for minor ailments, follow-ups gain popularity.

By Daniel Costello, Los Angeles Times Staff Writer
February 4, 2008

Consulting your family physician is finally moving into the 21st century and out of the doctor’s office.

Since the dawn of e-mail, patients have been pleading for more doctors to offer medical advice online. No traffic jams, no long waits, no germ-infested offices with outdated magazines and bad elevator music.

There was always one major roadblock: Most health insurers wouldn’t pay for it.

Until now.

In recent weeks, Aetna Inc., the nation’s largest insurer, and Cigna Corp. have agreed to reimburse doctors for online visits. Other large insurers are expected to follow, experts say.

These new online services, which typically cost the same as a regular office visit, are aimed primarily at those who already have a doctor.

The virtual visits are considered best for follow-up consultations and treatment for minor ailments such as colds and sore throats.

But some specialists, including cardiologists and gynecologists, also see these e-mail tete-a-tetes as ideal for periodic checkups that don’t require in-person visits.

"People can wait a long time to get in to see their primary-care doctor and longer for a specialist. . . . To have immediate access is huge," said Dr. Melissa Welch, Aetna’s Northern California medical director.

As more doctors move online, others are looking further ahead and adding webcams to their online arsenal, even if the video quality remains spotty.

Dr. Christy Calderon, a family physician at Kaiser Permanente’s Whittier office, conducts as many as half her appointments over the phone or online with a 3-inch camera affixed to her desktop. "It adds a more personal touch," she said.

Although actual doctor visits aren’t likely to disappear, the recent moves are evidence that long-delayed efforts to bring American medicine into the digital age may be gaining momentum, experts say.

"Paying doctors to do more patient care over the Internet is a small but important step in a good direction," said David Cutler, a Harvard University healthcare economist. "It increases patient access and could significantly improve their satisfaction."

If so, it comes at an auspicious time.

Doctor visits in the United States have surged 20% in the last five years to more than 1.2 billion visits annually, according to the Centers for Disease Control and Prevention. Even as the population ages, the number of doctors is falling across the country, and experts predict that office wait times will increase in the coming years.

Meanwhile, at-home devices that remotely check patients’ blood pressure and diabetics’ sugar levels are becoming cheaper, and tech leaders Google Inc. and Microsoft Corp. are expected to introduce products this year to simplify patient care and put medical records online, although neither company plans to assist in online physician appointments.

Some in the medical community envision a day when patients take their vital signs each morning and send the results to their doctor by computer.

But can a doctor really diagnose patients via pixels?

Critics, including many doctors, contend that online medical care carries risks. Some worry that mistakes are bound to happen and that the practice raises several hard-to-answer ethical questions.

"It’s perfectly appropriate that we use 21st century technology in the 21st century," said California Medical Assn. President Dr. Richard S. Frankenstein, an Orange County pulmonologist. "The concern I have is that [online visits] are simply not a substitute for an actual doctor."

And experts caution that this may not be a money saver. Healthcare costs could increase if the new technology leads more patients to seek care more often.

By the time San Francisco consultant Meg Young got to Boston on a chilly night last winter, she was running a 102-degree fever. She considered going to the emergency room. Instead, she went online in her hotel room.

The 40-year-old technology expert booked a visit with her primary-care doctor at Stanford University Hospital. After Young filled out a form and described her symptoms, he diagnosed a bacterial infection, prescribed an antibiotic from a drugstore near the hotel and suggested she get some rest.

"I couldn’t have been happier to not sit in some hospital for half the night," Young said.

Doctors and patients have many ways to communicate over the Internet. Some doctors and their office staffers already e-mail patients free of charge, especially when it involves minor questions or prescription refills.

Most of the new online consultations are far more structured than a simple e-mail. If insurance companies are expected to pay the bill, physicians need documentation of the event, including diagnosis and time spent.

As a result, companies have emerged to help doctors handle this. They typically arrange the online visits, maintain records and handle insurance reimbursements, patient co-payments and other payments.

To begin using these online services, patients visit a doctor’s website or go directly to one of the Internet companies that handle such services -- for example, RelayHealth Inc. or Medem Inc.

Doctors are typically encouraged to respond to patients within a day; they receive an e-mail reminder if they haven’t, with a phone call on the second day. Prices can vary from $25 to $125, which patients pay with a credit card at the end of the session.

Allison Holt, 47, of Santa Ana said she was "completely sold" on online healthcare and didn’t plan to visit her doctor in person anymore if she could help it.

The former human resources manager began using online appointments in May, after a long-simmering back problem flared up.

Holt has had two full check-ups since then and occasionally e-mails her doctor with minor questions or to request a prescription refill.

The visits cost $25 and are not covered by her insurance.

"When I used to call his office, the staff would take a message, wait for a reply and then call me back when they had time," she said. "Now I get an e-mail by the end of the day."

Even with major insurers signing on, it remains to be seen whether a large share of the public will embrace Internet medicine. Surveys show that many patients and doctors remain uncertain whether the technology is right for them. Also still on the sidelines is the federal Medicare agency, which pays about half the nation’s doctor bills.

Recently, some smaller insurers that began reimbursing for online consultations stopped doing so because few members used the service.

But Young, the San Francisco technology consultant, predicts that routine doctor visits will eventually go the way of the locomotive or buying CDs at the store.

"It can take me an hour and 15 minutes to drive to my doctor’s office, longer in rush hour," she said. "Why do I want to do that?"

daniel.costello@latimes.com

One-third Of US Adults Call For Completely Rebuilding Health Care System

ScienceDaily (Nov. 4, 2007) - At a time when the U.S. spends more than double what other countries spend for medical care - $6,697 per capita in 2005 - a new Commonwealth Fund seven-nation survey finds that U.S. patients are more likely to report experiencing medical errors, to go without care because of costs, and to say that the health care system needs to be rebuilt completely. U.S. patients, along with Canadians, are also the least likely to be able to get a same-day appointment with their physicians when sick and the most likely to seek care in emergency rooms as an alternative.

The study, published recently in the journal Health Affairs, finds that U.S. adults also have the highest out-of-pocket costs and greatest problems paying medical bills.

In the survey of 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States, one third of U.S. adults called for rebuilding the system, the highest rate in any country surveyed. The U.S. also ranked last in saying only minor changes are needed in the health system.

In addition to cost concerns, U.S. patients report more fragmented and inefficient care, including medical record and test delays, perceptions of waste and more time spent on paperwork, compared to patients in other countries.

“As policymakers and the public consider proposals for fundamental change, there are lessons to be learned from looking abroad. This survey shows that patients in the U.S. are frustrated by high costs and a complicated health care system,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article.

In terms of patient safety, adults in the U.S. report the highest rates of lab test errors and among the highest rates of medical or medication errors. Patient-reported errors were highest for those seeing multiple doctors or with multiple chronic illnesses. One-third of U.S. patients with chronic conditions reported a medical, medication, or test error in the past two years.

Despite assertions by some that universal insurance systems result in long waits for care or “rationing,” only Canada (22%) ranked behind the U.S. (30%) in the low percentage of patients saying they could get same-day appointments with their doctor when they are sick. In contrast, half or more of patients in Germany, the Netherlands, and New Zealand report rapid access to physicians. Notably, in the U.S and Canada, along with Australia, two-thirds or more reported difficulty getting care on nights, weekends, or holidays–the highest rates in the survey.

Easy access to elective surgery has also been cited as a benefit of the U.S. health care system. Yet, similar to the U.S., the majority of patients in Germany, New Zealand, and Australia waited less than a month for elective or non-emergency surgery and waits of 6 months or more were rare in these countries and the Netherlands. In Canada and the U.K., about 15 percent of patients reported waits of more than six months for elective or non-emergency surgery. In the U.K., waits dropped dramatically compared with the 2001 Commonwealth Fund International Health Policy Survey, when 28 percent reported waiting more than six months for elective surgery.

U.S. Patients Face Cost-Related Access Barriers

As in previous surveys, U.S. adults were most likely to have gone without care because of cost and to have high out-of-pocket costs. In the U.S., nearly two of five (37%) of all adults and 42% of those with chronic conditions had skipped medications, not seen a doctor when sick, or foregone recommended care in the past year because of costs–rates well above all other countries. In contrast to the U.S., patients in Canada, the Netherlands, and the U.K. rarely report having to forgo needed medical care because of costs.

In addition, one-fifth of U.S. adults report serious problems paying medical bills–more than double the rate in the next highest country. And nearly one third (30%) in the U.S. spent more than $1,000 in the past year out-of-pocket–a level rare in most of the other countries.

The U.S. also stands out for symptoms of more fragmented and inefficient care:

* One of four U.S. adults report coordination problems, either medical records not available during their doctor visit or duplication of tests–the highest rate of any country in the survey.
* One of five U.S adults report a time doctors recommended treatment the patient thought had little or no benefit; this rate was also high in Germany.
* Only the Netherlands (31%) topped the U.S. (24%) for the percentage of people who spent time on paperwork or disputes related to medical bills or insurance. In the other countries, fewer than 15 percent reported this concern.
* In the past two years, 36% of U.S. adults visited an emergency room; only Canada had a higher rate (39%). In both the U.S. and Canada, about 40 percent of those with an emergency room visit said the visit was for a condition that could have been treated by their regular doctor if available.

“Medical Homes” Improve Care Coordination and Patient Satisfaction
As medical care becomes more specialized and complex, adults in all seven countries said they place high value on having a relationship with a regular source of primary health care that is accessible and coordinates their care. To assess the extent to which such relationships exist, the study identified patients as having such a “medical home” if they had a regular source of care that knows their medical history, is easy to contact, and helps coordinate care received from other providers.

Across very different country health care systems, the study found that only 45 to 61 percent of adults described having a primary source of care with these key attributes of a medical home.

In all countries, patients with such medical home relationships reported significantly more positive experiences, including having more time with their doctors, more involvement in care decisions, and better coordination with specialists and hospitals.

Those with a medical home were also much less likely to report medical errors, receiving conflicting information from different doctors or to encounter coordination problems, such as diagnostic tests or medical records not being available at the time of care and duplicate tests.

In the U.S., uninsured adults were at high risk of being without such a connection to the health system: just 26 percent of uninsured compared to 53 percent insured adults under age 65 had a medical home.

“The lack of a link to care as well as insurance puts the uninsured at double jeopardy for both inefficient care and access barriers. Health systems designed to create medical homes could help improve patient safety, coordination of care and reduce reliance on emergency rooms, while also improving patient satisfaction,” said Commonwealth Fund President Karen Davis. “The potential gain has led to endorsement of the medical home concept among U.S. primary care physicians, including the American Academy of Family Physicians and the American Academy of Pediatrics.”

The authors conclude, “As countries confront the question of how best to organize care systems to achieve higher value, the study highlights the importance and potential of having a relationship with a primary care source with characteristics of a medical home.”

Survey Methodology

Harris Interactive, Inc. and country affiliates conducted the interviews by telephone with nationally representative cross-sections of adults ages 18 and older in seven countries between March 6 and May 7, 2007. The final study included 1,009 adults in Australia, 3,003 in Canada, 1,407 in Germany, 1,557 in the Netherlands, 1,000 in New Zealand, 1,434 in the United Kingdom, and 2,500 in the United States. The Commonwealth Fund funded the core study, partnered with the Health Council of Canada to expand the Canadian sample, and cofunded fieldwork in the Netherlands with the Dutch Ministry of Health, Welfare, and Sport and the Center for Quality of Care Research (WOK), Radboud University, Nijmegen.

The German Institute for Quality and Efficiency in Health Care funded the German sample. The interviews were conducted in German in Germany, Dutch in the Netherlands, and English in the five other countries, with an option for French in Canada and Spanish in the United States. The margin of sample error for country averages are approximately ±2 percent for the United States and Canada and ±3 percent for the other five countries at the 95 percent confidence level.

Aperion Teams with Microsoft To Improve Health Care

Home Buying As Way To Improve Health Care?
Community Developer, Microsoft Work Together To Deliver Next Generation Health Tools For Home Buyers

Expert Describes Strategic Relationship As A Pioneering Integration Of Real Estate, Health & Technology

OCTOBER 2, 2007. SCOTTSDALE, ARIZONA. Can buying a new home improve
your health? It can and will if Aperion Communities and Microsoft have anything to say about it.

Both companies have entered into a unique, strategic relationship to offer Microsoft’s HealthVault in Aperion’s new Inspiration communities, currently being developed in Texas and New Mexico.

Aperion Companies is a global land acquisition and development company which believes its Inspiration communities must respond directly to improve people’s daily lives from the first day residents move in.

HealthVault, just launched nationally by Microsoft, is an Internet-based consumer health platform that allows consumers to manage their own health and wellness through storage of personal health information, search and interaction with multiple applications, devices and services.

“Our company and HealthVault are about innovation to improve people’s lives. We are very pleased to be working with a forward-thinking company like Aperion to turn their pioneering community based health platform for Inspiration residents into reality,” said Microsoft’s Corporate Vice President Health Solutions Group Peter Neupert.

This new technology will be immediately installed at Inspiration Fort Worth’s prototype home. By 2009, Aperion’s community based health platform, which provides an integrated physical and social infrastructure that links health programs and medical data together will allow residents to relay secure information to an on-site primary health care facility and video conference with doctors on routine medical events from home. Inspiration schools and business are also integrated as part of the overall platform.

It appears to be the most creative and aggressive effort yet by a real estate company to assist health care challenges. And it is impressing industry observers.

“The concept of bringing health care to the individual using both electronic and physical means is at the cutting edge of prevention and aggressive chronic disease management. This approach is certainly part of the solution to our national health challenge,” said Clifford Dacso, MD, Executive Director of the Abramson Center for the Future of Health in Houston.

In addition to developing pioneering ways to improve the health care of its residents, Aperion Communities will soon be making similar announcements about dramatic ways Inspiration residents will benefit from similar approaches to energy and transportation needs.

“We are building the next great communities not only for the 21st Century but the 22nd as well. We are talking quantum leaps forward in the way real estate development is done. We will use the best products and services available today to reduce the inefficiencies and lower the costs of daily life, while allowing for flexibility in the future. This has never been the approach or responsibility of developers in the past. We accept the challenge. For example, preventative health care is fundamental for everyone and needs to start in the home. We will enable this to happen now. Microsoft’s HealthVault is one cornerstone of Aperion’s overall community based health platform that broadens the opportunity for our residents, schools and businesses to take advantage of a wide variety of consumer driven health choices that can lower the cost of their family medical expenses and health insurance premiums. We plan to revolutionize both the health care delivery system and the home building industry at the same time,” Aperion Companies’ Vice President Rick Abelson said.

For more information on Aperion Communities please go to www.aperioncompanies.com.

For more information on Microsoft’s HealthVault please go to www.microsoft.com

Making health care work

How to continue providing quality medical care to all patients, including the uninsured, remains a challenge

Dallas Business Journal - May 25, 2007 by Jennifer Gordon, Staff Writer

The fever over health care continues to rise as political candidates and states debate how best to treat people.

In the Dallas-Fort Worth area, hospitals have been wrestling with health care costs, insurance changes, pressure from competitors and changing demographics since the first patient checked in.

Recently the Dallas Business Journal invited area hospital system CEOs to sit down and discuss the issues of the day, both in terms of providing care for D-FW residents and in running their own businesses. Participating were: Joel Allison, president and CEO of the Baylor Health Care System; Trevor Fetter, president and CEO of Tenet Healthcare Corp.; Doug Hawthorne, president and CEO of Texas Health Resources; and Stephen Mansfield, Ph.D., president and CEO of the Methodist Health System.

-----------------------------------------------------------

DBJ:What is the top issue facing hospitals today? Are there ways that you are addressing it and what are the top things that you are doing?

JOEL ALLISON: I think we are all concerned about the rising number of the uninsured that we are seeing. The Dallas-Fort Worth Metroplex and Texas have the highest uninsured numbers in the country, which is not a good statistic. I think we are concerned about access for the uninsured and how they can receive proper treatment in primary care and have a medical home, as opposed to perhaps waiting way too long and then having to access through an emergency department when they are very, very ill.

When we talk about the uninsured, I think it is also important that we recognize it is not just the indigent population. We are talking about people who are working and have incomes that are also uninsured because either their company doesn't offer it or they choose not to take it for a variety of reasons.

So, how do we find ways to get more people covered, and with that are some of the issues that we have around the children's health insurance program, and not having children have medical homes. (The top issues are) access to care for the uninsured, and how do we get the appropriate reimbursement (for services).

STEPHEN MANSFIELD: I agree. Over the past five years, fewer employers offered health insurance as a benefit to their employees and now we are down to only about 60% of employers offering health insurance. That means there are a lot of people who are not poor, but who cannot afford a visit to the hospital. And many employers who still do offer health plans, are beginning to offer consumer-driven plans, which have very high deductibles, and those can be catastrophic for many working families. The things that I see happening within our nation and our industry are all pushing a larger percentage of our population into that uninsured category with catastrophic effects for our society and for our hospitals and health systems.

DBJ: Is a solution out there ?

ALLISON: There is a lot of discussion. Obviously, every presidential candidate, so far declared, who said they have a plan says it is going to be a top issue for that election. The American Hospital Association and Texas Hospital Association have all been dealing with how do we really address the uninsured. There are some good discussions going on. I don't think there is one right solution at this point that has really been analyzed in detail.

FHN division to invest HSAs

Holders can park HSA money in mutual funds

Memphis Business Journal - May 4, 2007 - by Christopher Sheffield

Health savings account manager First Horizon Msaver, Inc., is now offering account holders the option to invest a portion of their funds in Goldman Sachs mutual fund products.

The funds include a money market fund, a bond fund, income fund and growth strategy fund. The investment option was started at the request of consumers, says Craig Keohan, president of First Horizon Msaver.

Although the funds are no-load funds, meaning no upfront costs, Msaver does charge $2.50 per month for the service.

The set-up, enrollment and management can be done through the Msaver Web site and can be reallocated on a daily basis if needed, Keohan says.

"It's really taken the guesswork out of 'where do I put my investment dollars,' " he says.

Msaver, purchased by Memphis-based First Horizon National Corp., in 2005, currently has about 23,500 account holders. Nationally, Keohan says about 4.5 million consumers qualify for HSAs.

HSAs are consumer-directed plans approved by Congress in 2004 to allow individuals and their employers to contribute to a savings account that goes toward covering medical expenses.

To qualify for a HSA, the employee must choose a high-deductible plan, typically $1,100-$3,000 for an individual and $2,200-$6,000 for family coverage.

To begin the investment option, account holders must have a minimum of $1,000 in their account. Keohan says the average Msaver account size is $1,700. That's small, but he notes that 65% of the HSAs are less than 12 months old. And with 23,500 accounts, that's a pool of about $40 million.

Jim Gandolfo leads the HSA initiative for PFPC, Inc., the financial processing arm of PNC Financial Services Group. PFPC provides the technology behind the Goldman Sachs/Msaver arrangement.

"What Msaver has done is they have selected a group of mutual funds that can really round out a customer's portfolio," Gandolfo says.

While there will always be a need for customer education, the merging of health care and financial services is a long-overdue solution to controlling medical costs, Gandolfo says.

First Horizon Msaver, Inc.

Health savings account manager
HQ: Overland Park, Kan.
President: E. Craig Keohan
Phone: (888) 367-6727
Web site: www.firsthorizonmsaver.com

Health savings accounts flourish

Kansas City Business Journal - April 27, 2007 - by Rob Roberts

Lower-premium, high-deductible plans offered in conjunction with health savings accounts (HSAs) are growing by leaps and bounds.

America's Health Insurance Plans, a national trade organization representing health insurers, reported this month that the number of Americans covered by the tax-favored HSA plans rose 43 percent last year -- from 3.2 million to 4.5 million.

The AHIP report does not explain the rise. But local sources said the reasons include legislative changes, improved plan designs and a trend among employers fed up with steep increases in insurance costs.

Many such employers aren't offering any health plan choice besides an HSA or other high-deductible plan.

The no-choice choice

The consulting firm Watson Wyatt Worldwide reported in March that 9 percent of employers in a nationwide poll planned to offer only one option, a high-deductible plan, next year.

If you work for such a company, said Dennis Triplett, president of UMB Financial Corp.'s health care services unit, "you're going to be forced to learn what an HSA or HRA (health reimbursement arrangement) is" -- depending on which type of tax-favored savings account the plan offers.

But in companies that also offer traditional HMO (health maintenance organization) and/or PPO (preferred provider organization) plans, ignorance remains an obstacle to greater HSA and HRA plan adoption. According to a 2005 Watson Wyatt survey of 1,000 individuals with health insurance, 63 percent had never heard of HSAs, and of those who had, only 33 percent had a good idea how they work.

Since that survey, the public has become more educated about HSAs, said Triplett, whose Kansas City-based unit was a pioneer in HSA banking. That's evidenced by the fact that UMB doubled its HSA deposits to $75 million last year through its partnerships with insurers, third-party administrators and technology companies that offer HSA plans.

"But I still see education as the biggest adoption hurdle," he said. "Having a consumer-directed high-deductible plan is a huge change for consumers, who previously had no incentive to manage their health care spending and little understanding of medical costs."

In traditional employer-sponsored plans, Triplett said, low copayments tend to give workers the impression that a doctor's visit is as cheap as a haircut. They rarely factor in the amount the employer pays or even how much they, the employees, pay through their share of monthly premiums.

That has contributed to soaring health insurance costs, which in turn gave rise to HRA and HSA plans -- the so-called consumerism plans.

Consumerism 101

Federal legislation creating HRAs was enacted in 2002. And HSAs were created when President Bush signed the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

Humana Inc. is set to launch new SmartResults program

San Antonio Business Journal - April 20, 2007 - by W. Scott Bailey

The quest by health care insurers to roll out programs that can capture the fancy of employers and their employees by reducing costs and improving health has not escaped Humana Inc.

The company, which operates a regional office in San Antonio covering much of South Texas, is launching SmartResults, a new administrative program that will become effective July 1.

Human South Texas spokesman Ross McLerran defines SmartResults as a bold new solution that features a three-year partnered approach between the insurer, insurance brokers, employers and their employees. The program is being offered to self-funded employers with 300 or more workers as a complement to new or existing Humana benefit programs.

Humana officials say the new program will help employers control insurance costs by helping them better manage their employees' health.

Linda Comeaux, a regional consumerism consultant for Humana, says SmartResults will incorporate health assessments and wellness programs, as well as clinical programs and other consultation into employers' overall benefits strategies.

"It's not a product," Comeaux says. "It's a partnership."

Humana, according to Comeaux, will provide employers access to its experts and physicians, who will meet multiple times each year with the employers to assess the performance of the program.

Between 2002 and 2006, according to Humana, Americans' annualized health insurance premiums increased, on average, 11 percent. Humana officials say the new SmartResults program will help employers better control those rising costs.

"We're confident that the agent/broker community will embrace this approach, because many large employers are looking to Humana -- and their brokers -- to provide innovative thinking and guidance that helps these employers get their health care costs under control," says Rick Remmers, large group segment vice president for Humana.

Andrew Grove, director of large group sales for Humana South Texas, says there are some 160-plus employers in San Antonio that qualify for the program based on the number of people they employ.

AOL Founder Hopes to Build New Giant Among a Bevy of Health Care Web Sites

Published: April 16, 2007 - New York Times

Stephen M. Case wants to be America’s doctor, courtesy of the Web.

This week he plans to unveil his new company’s Web site for consumers, RevolutionHealth.com, which has built a growing audience since a test version went online in January.

The site, to be officially introduced on Thursday, is part of Mr. Case’s Revolution Health Group, a company he has bankrolled with a group of others who — like him — are famous for what they used to do for a living, including Carleton S. Fiorina and Colin L. Powell.

Revolution Health’s other medical ventures include a stake in the growing RediClinic chain of retail health clinics operating in some Wal-Marts, Walgreen’s and other stores around the country.

Mr. Case, the America Online founder who oversaw an ill-fated merger with Time Warner before he left in 2003, set up Revolution Health two years later. He says the time is ripe for a dominant health care brand — one that could be as powerful as Starbucks in latte or Nike in fitness. So far he has devoted more than $100 million of his money toward that goal with the RevolutionHealth.com Web site.

“There is a big opportunity to create the most trusted brand in health,” Mr. Case said in a phone interview late last week.

It is such a potentially big opportunity, in fact, that one of RevolutionHealth.com’s main challenges could be making itself visible in a market increasingly crowded with competitors elbowing for the consumer-patient’s attention.

The biggest in the pack by far is WebMD Health, a stock market favorite of late, which has more than 40 million unique users a month visiting its network of consumer sites, including the flagship, WebMD.com. Other leaders, as measured by Web traffic, include NIH.gov, from the National Institutes of Health; Yahoo Health; Mayoclinic.com; and About.com Health, which is owned by The New York Times Company.

Meanwhile, Google, without announcing any big health effort, has been quietly drawing more health information seekers into its gravitational pull with various new patient-friendly features. By typing a search term like “sore throat,” for example, a Google user is led to relevant information about potential causes and risks, treatments and tests, and alternative medicines.

Google is also reportedly at work on various links to consumer health information that users will be able to personalize to their own specifications.

Mr. Case, though, dismisses search-engine approaches like Google’s as “not particularly helpful.” And while he acknowledges that WebMD “does have a lead and does a good job,” he says he hopes to make RevolutionHealth.com into a site visitors will use frequently “to manage their lives.”

Wes Richel, a health care analyst with the research company Gartner, said that even if Mr. Case could succeed in the health information arena, establishing a new brand would take at least several years. Meanwhile, he said, “Google is a known brand. Mayo is a known brand.”

Mr. Case said he hoped to achieve brand awareness within five years, but he declined to predict when his Web site would become profitable.

Since the test site went up in late January, RevolutionHealth.com has assembled an audience of 486,000 unique visitors in March, according to the research firm comScore Media Metrix.

The revamped version of the site will be aimed primarily at women, who tend to be the bigger portion of the Web health audience.

A Mom Central page is intended for a busy mother who, according to Revolution Health’s executive vice president, Ron Klain, is “trying to juggle her health, her children’s health and perhaps her elderly parents’ health, all at the same time.”

There will also be 1,500 medical conditions that can be sorted by the ailment or treatment, with related comments from experts and from other users of the site. And like other health Web sites, it will provide a directory of doctors by specialty and location, along with short reviews by patients.

There will also be information from the Mayo Clinic, Cleveland Clinic and Harvard Medical School, which also have their own popular Web sites.

Users will also be able to create their own pages within RevolutionHealth.com for collecting personal and general information, which they can keep private or share as they choose, Mr. Case said.

Parents of autistic children, for example, may decide to gather experiences and knowledge in digital scrapbooks and transfer all or part of the material to public sites.

Like WebMD.com and many insurers, including Aetna, RevolutionHealth.com will also promote personal health records, giving consumers a place to assemble their medical information, prescription records and insurance payment claims, for example.

But Mr. Richel, the Gartner analyst, said there were high barriers to the concept’s catching on.

“One of the most hyped terms in the country is the personal health record,” he said. “Only a tiny fraction, less than 1 percent, of those who have access to their information in all of the health plans together actually look at it.”

The complications, he said, include the technology issues involved in linking such records to the doctors, hospitals and other health care providers that might be in a position to use them to improve a patient’s treatment. And consumers may have trouble compiling the data from various health care providers into a single record, he said.

“The real issue is that the providers don’t want to give up that data,” Mr. Richel said.

RevolutionHealth.com plans to announce several advertisers on Thursday. But Mr. Case said he would be conservative in pursuing and displaying ads, to avoid any perception that a drug manufacturer, for example, might influence the information.

Drug industry money is one of the big lures for the Web health publishers.

Martin J. Wygod, the chairman of WebMD Health, said the pharmaceutical companies were spending about $455 million on marketing to patients and doctors online this year. But that is only about 3.5 percent of the $13 billion the drug industry spends on advertising, he said.

“Our major competition is television,” Mr. Wygod said. But he noted that drug ad spending, online and off, is growing as the drug companies cut costs by using fewer sales representatives who call on doctors.

With advertising as the main revenue model, RevolutionHealth.com is promoting itself as entirely free to users. The site does plan eventually to sell services like helping patients sort out disputes with health insurers, Mr. Case said. But in a departure from an earlier intention to sell such offerings to consumers, Mr. Case now sees employers as the buyers.

A group of private investors who have joined Mr. Case in putting a total of about $130 million into Revolution Health Group are helping bankroll the Web venture. They include some former corporate chief executives who were handsomely rewarded amid corporate controversies on the way to retirement. They include the Revolution Health board members Ms. Fiorina, late of Hewlett-Packard; Franklin D. Raines, the former chief of Fannie Mae; and Stephen F. Wiggins, founder and former chief of Oxford Health Plans.

Perhaps the best-known and least controversial board member is Mr. Powell, the former secretary of state, who spreads the word about Revolution Health in his frequent speaking engagements.

Those big backers, Mr. Case said, will give RevolutionHealth.com its edge.

“We plan to invest significantly,” he said. “We can afford to take the time to build the brand and build the trust.”

Correction: April 18, 2007

An article in Business Day on Monday about a new health information Web site, RevolutionHealth.com, misstated the contribution of various investors in Revolution Health Group, which operates the site. The business’s founder and chairman, Stephen M. Case, has put $100 million of his own money into Revolution Health Group, and his other board members have invested about $30 million. Mr. Case and the investors have not contributed $500 million to Revolution Health Group. (Mr. Case has put about $500 million of his own money into the various business ventures, including the health group, that operate under his holding company Revolution L.L.C.)

Banks, others marketing health credit cards

San Francisco Business Times - April 13, 2007 by Marie-Anne Hogarth

Banks and health insurers are rushing to offer credit to help patients pay for health care.

• Insurer Aetna Inc. paired with Bank of America Corp. to offer a credit card late last year. Aetna is among the first to offer a general-purpose card with incentives to encourage health-care spending.
• Other insurers, such as UnitedHealth Group, which chartered Exante Bank in 2002, look to give consumers lines of credit to be used toward paying medical costs.
• Blue Cross Blue Shield Association offers a line of credit to health savings account (HSA) holders at Blue Healthcare Bank through a third-party vendor.
• Kaiser Permanente has piloted a credit card in Hawaii and Colorado.
• Health Net Inc. is considering offering a line of credit on its card.

"The credit card companies, the banks and the insurance companies are all rushing into this business (HSAs) because they all see a huge business in the next five to 10 years," said James Unland, president of the Health Capital Group in Chicago. "There is a perceived gold rush."

Consumer advocates worry about the push for consumers to put health care on credit. Medical bills are a leading cause of consumer bankruptcies, a fact often cited by Gov. Schwarzenegger in his push for health care reform.

"Because of credit cards and lending products, it may seem that patients are absorbing the costs," said Cindy Zeldin, federal affairs coordinator with the public policy research and advocacy group Demos. "But they are actually ending up in debt, and that medical debt is being moved over to this other category of consumer debt."

She has concerns about the poor, who may be discouraged from seeking information about charity care programs when paying at the point of service. Additionally, people who are sick, even though they might normally be on top of their finances, may have trouble keeping up with credit card payments.

"If you have ongoing health costs, perhaps you are going to have people who are paying interest instead of having comprehensive insurance," said Zeldin. "It depends how it plays out."

Insurers with banks are competing with bankers for health savings account deposits. The insurers argue they can serve patients better than banks can.

They say the cards don't charge exorbitant interest rates. And they say people would need to apply for the credit card or line, so that consumers wouldn't be getting access to credit for which they aren't normally eligible.

Aetna's Healthy Living card, offered through Visa, has a 0 percent introductory annual percentage rate for the first 12 billing cycles, after which the standard APR financing rate is 9.9 percent for Platinum accounts and 15.99 percent for Preferred accounts. For late payments, the rate is 29.99 percent.

A card from Citibank, without the involvement of an insurer, offers consumers no-interest payment plans when they purchase services from certain dental, vision, hearing and veterinary providers.

State examining how, when universal coverage will be in place

New Mexico Business Weekly - April 13, 2007 by Pamela Hyde Guest Columnist

We are reaching a critical juncture in New Mexico. No longer is the health coverage discussion about whether or not we should provide universal coverage, but rather how and when is universal coverage going to be implemented?

Over the past four years, under the direction of Governor Bill Richardson, Lieutenant Governor Diane Denish and the state Legislature, New Mexico has taken several incremental steps to provide more coverage for New Mexico's uninsured.

For example, unmarried dependents up to age 25 are now allowed to stay on their parents' plan. The State Coverage Insurance program is helping small employers cover their employees and now insures almost 6,000 previously uninsured adults.

New Mexico children and pregnant women now have an opportunity for health care coverage through the Premium Assistance for Kids and Maternity programs, even if they don't qualify for Medicaid due to income. We also have made the Health Insurance Alliance (HIA) premiums more affordable and small employers can offer both HIA and public/private programs as options for their employees.

Recently, the governor signed the Fiscal Year 2008 budget that expands Medicaid to cover adults up to 100 percent of the Federal Poverty Level, which he had called for in his executive budget recommendations, noting it was "a major step in closing the uninsured gap in New Mexico."

A single adult will now qualify for one of New Mexico's Medicaid programs if he or she has an annual income below $10,200. The Human Services Department will receive $10.9 million in the fiscal year beginning July 1, 2007 to cover up to 18,000 more adults by the end of FY 2008. Previously, only adults earning less than $4,000 qualified. In addition, the department will receive $750,000 to hire 44 new staff members to handle the increased enrollment, including positions for American Indian outreach workers. A disproportionately lower number of American Indian children are enrolled in Medicaid, compared to other populations.

From a public sector viewpoint, this administration has made enormous strides to provide publicly financed health care coverage for the lowest income New Mexicans. This is significant because it also helps to close another gap -- uncompensated care that is provided every day across the state by hospitals and health care providers of all types. But soon, the governor and Legislature will be calling on all of us -- individuals, businesses, nonprofits, and the commercial insurance market -- to do even more. These recommendations will be brought forward to the next legislative session in January 2008.

It is now time to move from incremental steps made towards health insurance reform to a comprehensive approach to universal coverage, and the work has already begun. The Health Coverage for New Mexicans Committee has spent the past nine months identifying different health coverage models that would provide a solution for New Mexico to achieve universal coverage. Appointed by the governor and legislative leadership, the 23-member Health Coverage for New Mexicans Committee selected three models that are being analyzed to determine the cost and economic impact of each model.

Over the next few months, the financial analysis of the models will be complete and the public debate will shift to the pros and cons of adopting one of these models or a variation of these models. The Committee encourages the people of New Mexico to participate in the debate because it is the public process that will move the political will of the state to come to the right solution for New Mexicans.

New Mexico, and the nation, for some time now has accepted the fact that car insurance is a fact of life. The owner realizes the cost of owning a vehicle includes the cost of insuring the vehicle.

New Mexico needs to take that same approach with health care coverage. Being healthy and raising healthy children comes with a cost -- the cost of health care coverage. For those people too sick, low-income or middle-income to afford the cost of this coverage, we as a state need to help with those costs.

Incremental steps have helped thousands of uninsured New Mexicans get the health care coverage they need. For those still without coverage, there is most likely a plan that will help them through the Insure New Mexico! Solutions Center at (866) 901-4538. But incremental steps can only take us so far. It is time to take the BIG step to universal coverage and make sure health coverage for New Mexicans becomes a reality!

PAMELA HYDE is the Secretary of the New Mexico Human Services Department. She can be reached at (505) 827-7750.