Empowering the Patient

Q: What is LifeMasters?

A: We provide health care plans with technologies that allow chronically ill patients to self-manage their disease. LifeMasters was founded on the principle that healthcare as a service business has not kept up with the rest of industry in using technology to be customer centric. The financial services industry had ATM machines even before online banking was available. Technologies like interactive voice response gave customers control over their finances by allowing them to access their accounts and complete their own transactions.

Healthcare service is one of the last bastions of industry where the consumer doesn't have control. So we wanted to inject customer-based technologies into the healthcare system for people with chronic diseases in a way that not only improves the quality of care but saves money as well.

Q: Why did you choose the area of chronic disease management?

A: Ninety percent of the time the consumer--or patient--is responsible for managing his or her own care. Patients with heart disease or diabetes take their own drugs, adjust their diet, monitor their vital signs and decide when they need a physician's attention.

Q: How long has LifeMasters been around?

A: The company was founded in 1994. We spent the first three years building the platform, doing pilot studies and building the databases and the protocols used to drive and build the content in our educational programs. In 1996 we started marketing to our customer base, which is health plans, HMOs, PPOs, medical groups and hospital groups that have responsibility for the cost of healthcare. But the philosophy really was to provide a vehicle for people to track their symptoms and to teach them in turn the appropriate skills they need to self-manage. And if you can do that cost-effectively, you can manage huge numbers of patients.

Q: Why did you decide to develop your e-business channel?

A: We've always been known as the technology-based disease management company. In 1994 the Internet was not widely used, so we started with more common technologies like pagers, fax machines, telephones and interactive voice response. In 1998 Intel invested in our company and funded a study comparing the use of the telephone and the computer as technologies and measuring the outcome. That proved that computers are more effective than other technologies even among the elderly.

Suddenly everyone was saying that healthcare would work on the Internet. So to maintain our competitive advantage we needed a Web-based solution with value-added information on asthma, congestive heart failure, coronary artery disease, diabetes, etc. We marketed it by offering companies a private label to put on their corporate Web site. It was a compelling business proposition.

Q You developed the back end internally and hired Genex to develop the front end.

A: Yes. Genex usually develops the front and the back ends, but because we evolved from using non-Internet tools to using the Web, our back end was already very fleshed out, very sophisticated. But our front end needed work.

Most of our users are in their 70s so we did a lot of testing with seniors. As part of the Intel study we actually gave computers to seniors with congestive heart failure who had never used computers before, and trained them. This was before we had engaged Genex to do the front end. We learned a lot about what works and what doesn't work, like which fonts they liked and the fact that they don't like scrolling. And we found that the people who used the Web interface are actually healthier than the people using our telephonic interface. An added benefit was that these tools help physicians to be more efficient in their practice. Rather than having all patients come in for office visits on a regular basis to be monitored, physicians can see patients on an exception basis, when something's wrong.

Q: Conventional wisdom says that the Web is generally best employed in an industry or market where the consumer is very Web savvy. Most 70-somethings are not computer users.

A: We manage about 34,000 patients right now and only 10 to 12 percent of them use the Web. But as our generation ages we will get these chronic diseases and we are Web savvy. So we're building a means for all of us, as we start going down that path, to participate in Web-based disease management.

We found was that if you give an older person the opportunity and a good reason to use a computer, they use it. The computer helps them get healthy and alerts their doctors when they need help. It gives them a way to communicate with a nurse. And even more importantly, it allows them to communicate with other people who have the same condition. They very quickly become engaged. People who had never touched a computer before are surfing online for 45 to 50 minutes a day almost immediately. And when you think about how isolated elderly people are--especially those with chronic diseases--the computer gives them a window on the world they've never had before.

Q: Are the patients using the Web for other services and activities as well?

A: Absolutely. They only need to be on our site for five minutes a day to answer the seven or eight questions that we need to monitor them. And then we have a lot of related content for them to go through. They spend other 45 or 50 minutes with e-mail or playing bridge online or in chat rooms with other people. It was amazing how quickly they see all the things they do on the Web.

Q: Do you give them all computers?

A: No. We did for the Intel study because they were interested in doing market research with us. But if we give everybody an electronic scale and an electronic blood-pressure cuff and other tools, it's certainly feasible that in the future as prices drop we could provide people with other devices.

We guarantee the HMOs and the health plans that we will reduce healthcare costs by a certain percentage or your money back. So we have a real incentive to do whatever it takes to engage the patient. If, as it seems we've proven, the computer results in greater savings, we are vested in the idea of patients being able to access computers.

Q: Could you give me a thumbnail sketch of the solution's back-end?

A: The database is the system's foundation. It is really a big database management project, based on medical data. We get the data from several sources including an interactive voice-response system where the patient dials an 800 number and answers relevant questions. Or the data can come from a Web site or a device.

The health plans we contract with provide us with historical claims information on their patients including hospitalizations, prescriptions etc., which we compile into patient profiles. These databases then drive the interactions. We have staff nurses with assigned patients who can access that information. Each nurse might have a hundred patients or 200 patients, depending on the disease, directly assigned to them, and they can access all of this information on our system. It's all NT, SQL server, very open architecture.

That database then drives scripts that the nurses use when they interact with patients on the phone. Right now the only interaction our patients have with nurses over the Web is through e-mail. Because we don't have that many patients on the Web as a percentage, we've chosen not to build out as much as we could. We've talked to Genex about further enhancing our service to do more live online interaction with nurses, but right now that's not a huge priority.

Today the nurses talk to the patients on the phone. If a patient enters data that hits a clinical threshold--for example, a rise in blood pressure, the system alerts the nurse who calls Mr. Jones with a specific set of database-driven questions. The answers determine whether the condition is the result of something that Mr. Jones did--maybe he ate a high sodium meal the night before--or maybe the nurse can't determine what caused it and alerts the doctor.

In the first case, the nurse will coach the patient, saying, "Here's hard proof that if you eat a high-sodium diet your blood pressure will go up. So let's talk about ways that you can change your diet." All of that information is in our system.

The content that we then share with the patient is accessed from a Web feature called Menu Builders, which we created with Genex. If you need a low-sodium diet, the system helps you build your own diet and generates a shopping list.

If we determine that the problem is not behavioral--that there's a true deterioration in the patient's condition--our system automatically compiles what we call an exception report, which is based on two weeks of vital data plotted on a graph plus a summary of the nurse's notes from the phone session. Then the report is automatically faxed or e-mailed to the doctor.

Then we worked with Genex to take that information and make it available to the patient on the Web site so they'll have all of the same kinds of educational materials available to them that the nurses use in their coaching.

Q: Why Genex?

A: They had the capacity to handle our account, which was a big factor in our decision making process. Also their Los Angeles-area location was comforting to us. We're based in California with offices in San Francisco and Orange County. We had looked at a lot of their work and it was excellent. But I think everybody on my team would agree that before we actually made the decision, Genex really made an effort to learn our business. Their proposal really showed that they understood what we were trying to do.

Many e-health companies have gone by the wayside in the last six months because they didn't understand healthcare, which is a very complex, fragmented industry with a lot of different customers and payment methodologies that are totally Byzantine. We were trying to accomplish a whole new way of delivering a service that we were already delivering successfully. They showed a real willingness to get in there and understand the space. That really impressed us.