An exploration of the wellness newsletter ecosystem and exploration of opportunities for variable data printing applications

1. Personalized Public H l h
P l d P bl Health
Campaigns
pg
Executive Summary
October 2005
Giordano Beretta, Henry Sang
Gi d B tt H S
Publishing Systems & Technologies Department
Imaging Systems Laboratory, HP Labs

2. Basic problem
• Dependency
of a family solely on their
doctor
d t causes costly i ffi i
tl inefficiencies
i
• Thesegross inefficiencies can be reduced
by timely and appropriate education in
healthy life style habits and prevention
3 October 2005 2

3. goal
• To
create a money-making venture around the
medical i d t
di l industry
3 October 2005 3

4. value proposition:
help people help themselves
Leverage patient records
•
− public h lth monitoring of di
bli health it i f 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 capabilities
−
automated workflow systems
−
high volume, high quality printing capabilities
−
existing partners
−
Leverage the public’s demand for self-help
•
− increased demand for accurate and timely information
−ddesire to pro-actively h l themselves and their families
l help h l dh f l
3 October 2005 4

5. basic concept:
high 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 pages/issue = 11 126 845 536 pages/year
/i 11,126,845,536 /
• 2004 health insurance coverage (Census Bureau)
− 245 3 million (84.3%) people have health insurance
245.3 (84 3%)
− 45.8 million do not have health insurance
− number of people covered by g
pp y government health
programs increased between 2003 and 2004 from
76.8M (26.6%) to 79.1M (27.2%)
• i di
indirect
t savings
i
3 October 2005 5

6. planned capital purchases over next
5 years (% CFOs responding)
0 10 20 30 40 50 60 70 80
digital radiology systems 72
computerized physician order entry
64
systems
major IT system 61
increase ER capacity
i i 51
increase OR capacity 50
convert semi-private rooms to private 36
add computer in patient rooms 25
new hospital 23
source: Healthcare Financial Management Association, March 2004, p.8
3 October 2005 6

7. funding sources for health services
and supplies expenditures
private health insurance
37%
out-of-pocket payments
14%
o e p va e u ds
other private funds 4%
state & local funds 13%
federal funds 32%
Source: Centers for Medicare and Medicaid Services, 2004c
3 October 2005 7

8. 206 HMO medical centers with
751 establishments
source: U.S. Census Bureau Statistics of U.S. Businesses: 2001. HMO medical centers United States
500+ employees
py 45
100-499 employees 29
20-99
20 99 employees 21
10-19 employees 15
5-9
5 9 employees
l 18
1-4 employees 53
no employees 25
0 100 200 300 400 500 600
firms establishments
3 October 2005 8

9. print: demographic data can be
exploited for custom publishing
• newsletters are PR material or bait for demographic
data
• control points: data modeling, publishing, VDP
production
• integration: complex application yields
opportunities for C&I
• managed services: small publishers lack IT skills
• hosting: p
g publishers may want not to deal with IT
y
issues
• utility data center: data mining and layout requires
large resources
3 October 2005 9

10. newsletter circulation data
Tufts University Health and
PacifiCare HealthBeat 2,959,400 250,000
Nutrition Letter
American Institute for Cancer
1,600,000 Harvard Health Letter 226,000
Research Newsletter
Mayo Cli i H l h L
M Clinic Health Letter 750,000
750 000 Cancer Care Health Monitor
C C H lhM i 210,000
210 000
Diabetes Health Monitor 528,717 Harvard Heart Letter 115,000
Arthritis Health Monitor 460,788 Harvard Mental Health Letter 52,363
Johns Hopkins Medical Letter:
p
425,000
425 000 AIDS Clinical Care Newsletter 32,000
32 000
Health After 50
Harvard Women's Health
400,000 The Nation's Health 31,000
Watch
UCB Wellness Letter 350,000 Fibromyalgia Network 20,000
3 October 2005 10

11. newsletter pages per year
Mayo Clinic Health Letter 72,000,000 Harvard Health Letter 21,696,000
Johns Hopkins Medical
40,800,000 Harvard Heart Letter 11,040,000
Letter: Health After 50
Harvard Women's Health
38,400,000 The Nation's Health 6,200,000
Watch
Harvard Mental Health
Diabetes H lth Monitor
Di b t Health M it 38,067,624
38 067 624 5,026,848
5 026 848
Letter
Cancer Care Health Monitor 37,800,000 Fibromyalgia Network 4,800,000
AIDS Clinical Care
UCB Wellness Letter 33,600,000 3,072,000
Newsletter
TOTAL
Tufts Health and Nutrition
24,000,000 336,502,472
Letter this table
3 October 2005 11

12. newsletter subscription income/a
Harvard Mental Health
Diabetes Health Monitor $22,047,499 $3,770,136
Letter
Mayo Clinic Health Letter $20,250,000 Harvard Heart Letter $3,680,000
Harvard Women's Health AIDS Clinical Care
$12,800,000 $3,488,000
Watch Newsletter
J
Johns Hopkins Medical
p
$10,200,000
$10 200 000 The N ti ' Health
Th Nation's H lth $1,550,000
$1 550 000
Letter: Health After 50
UCB Wellness Letter $9,800,000 Fibromyalgia Network $500,000
TOTAL
Tufts Health and Nutrition
$101,413,635
$7,000,000
Letter this table
Harvard Health Letter $6,328,000
3 October 2005 12

13. patient handouts
• 500# gorilla: Krames
− part of the international MediMedia conglomerate
f
− sister company publishes Harvard newsletters
− known more for breath than depth
− 300,000 customers, 80% of US hospitals
• expensive ($2 each)
• has PoD solution Krames On-Demand
3 October 2005 13

14. Components of gross domestic
product,
product 2003 (total = $11 trillion)
Sources: Bureau of Economic Analysis, Medicare
Other
Auto 3.8%
Defense 4.5%
Food 9.7%
Housing 10.9%
Health 15 3%
15.3%
Health is the largest sector of the U.S. economy
3 October 2005 14

15. Economic health and burden of
chronic disease in $ billion, 2004
billion
400
350
300
250
200
150
100
50
0
diabetes cardio cancer tobacco obesity
Source: CDC
3 October 2005 15

16. today s
today’s system
• what is counted?
− publishers give f
free issues to medical offices
ff
• makemoney by using feedback mechanisms and
data
d t aggregation t create d
ti to t demographic d t
hi data
− sell or rent address lists
− targeted inserts in envelopes
− permission based mailing of adverts for pharmaceuticals
and medical services
− campaigns t
i targeting each patient over th course of a
ti h ti t the f
disease, adapting the message to the disease’s course
• difficulty in assessing true market size in dollars
3 October 2005 16

17. opportunities
• mainmessage: convert some of the health care
money t savings via prevention
to i i ti
− Fortmann data
• li t
list
of sources of i
f f income/money pools and how bi
/ l dh big
they are
• direct money pools: subscription, info, pre-op, etc
subscription info pre op etc.
• indirect / leverage: reduce health cost
3 October 2005 17

18. newsletter players today
• in
the US there are two distinct ecosystems served
by the
b th same set of publishing companies:
t f bli hi i
− wellness newsletters
• no medical liability
• leveraged on the supplement industry
• gather demographics via round-tripping
• heavy content reuse
• shake-out in industry
− patient information
•lleverages on same content corpus
tt
• clinician bears full responsibility
• clinician generally unhappy with what they have
3 October 2005 18

19. wellness newsletter ecosystem
government
agency government
medical group agency
commercial
hospital
h it l
customers content providers
Medicare
insurance
non-profit
… …
partners
government
consulting
agency
school of data center
professional
fi l medicine
di i
HP business
society
experts international
self-help organization
call center
organization …
…
print service
provider
data center
suppliers
production
call center
…
role will become supplier/partner, not competitor
3 October 2005 19

20. best 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
•
paper
− it is hard to compete on price with gravure and offset on large runs
p
patient information
•
− can benefit from print-on-demand
− clinicians are unhappy with current state
− pages have high value
pg g
business challenge: the same group of people owns the
•
content
opportunity: h b d newsletters
hybrid l
•
3 October 2005 20

21. leverage
• what HPL technologies can we leverage on?
− optimized production processes
− campaign management
− document analysis and automatic layout
− print optimization
− general digital publishing know-how
complexity
low high
3 October 2005 21

22. divisional customers
opportunity for IPG to enter
•
the digital press application data center,
market hosting
opportunity for C&I to enter
pp y
•
the health care vertical printers, supplies
market
contributes to the goal of
•
achieving estimated 10 C&I integration,
billion Indigo pages/year domain
comsulting
managed
services
(propritery,
(propritery
S/W, systems,
associated
3 October 2005 22

23. pilot
• want reference customer, marketing tool, and shake
our the product
• hospitals and large HMOs in need of branding
• partner must b experienced i patient i f
t t be i d in ti t information
ti
− what works and what does not?
− what is ethical?
− HIPAA
• must also partner with a content creator
− content i expensive
is i
• need also funding
− insurance company?
3 October 2005 23

24. special customers
• Department of Veterans Affairs
− mandate to providing f federal benefits to veterans and
f
their families
− about a quarter of the nation s population, approximately
nation's
63 million people, are potentially eligible for VA benefits
and services
− 2004 spending was $63.5 billion
$63 5
• Kaiser Permanente
− Nation's largest HMO 8 2 million members in 2003
Nation s HMO, 8.2
− Kaiser Foundation Health Plans and Hospitals,
Permanente Medical Group
• both may be able to self-fund
3 October 2005 24

25. a 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
− can live on the fi d i
li th fixed income th get f
they t from i
insurances
• HP makes a step towards
− th goal of achieving 10 billi I di pages/year
the l f hi i billion Indigo /
− enters a new vertical in which it has no presence
− does good for society
g y
3 October 2005 25

26. a win-win proposition ALTERNATE
Win for HP customers in health care industry
•
− Hi h value services th t should i
High l i that h ld increase wellness of th i patients
ll f their ti t
− Potentially reduce health costs owing to early intervention
Win for patients
p
•
− More informed health information allowing self help
− Mechanism to seek additional information
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
pp
− Leverages on HP’s core competencies
3 October 2005 26

27. next step
• recommendations on how to go forward
− need help f from a business development specialist
− find an interested divisional partner
− 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
and VA Palo Alto Health Care S t
d P l Alt H lth C System
− form a team of technology providers
3 October 2005 27

28. go/no go decision
• should it live or die?
−ffinancial data is OK
− interest is strong
• what
ht is involved f th pilot?
ii l d for the il t?
− need help from business development specialist
− need to develop connections within HP
− line up resources to provide the technology
• this proposal exploits the insurance vector
− it is a financial business and that organization is probably
the best partner
3 October 2005 28

30. technological impact
• technology requirements
− high performance custom printing on digital press and
f
laser printer (for point of contact handouts)
− optimized production processes
− campaign management
− document analysis and automatic layout
− print optimization
• potential research vectors:
− automatic l
i layout i the DFE
in h
− new digital publishing paradigms
− new campaign management strategies
3 October 2005 30

31. data to date
• notbeing a player in the health vertical made it
particularly h d to get d t b
ti l l hard t t data, because we could not
ld t
get introductions
•h
how we did it
− searching on the Web
− scouting patient libraries
− interviewing health sector decision makers for patient
information
− i t i i content providers
interviewing tt id
− lots of cold calls, with great help from the HP library
3 October 2005 31

32. Importance of branding
Do you think the certification and/or accreditation of medical Web sites may reduce the issues listed above?
Yes
No
Undecided
Source: 8th HON Survey, Health On the Net Foundation, May-June 2002
3 October 2005 32

33. Internet is not trusted
In your opinion, what is the most critical issue facing the Internet and especially the medical Internet?
A ccuracy o f info
Trustwo rthness
Finding info /Navigatio n
A vailability
Junk
Spam
Subscriptio n
P o rno graphy
P rivacy
Equal access
Co st
A dvertising
B andwidth
Regulatio n
Security
A ccessibility
Co pyrights
Censo rship
Legality
No respo nse
Source: 8th HON Survey, Health On the Net Foundation, May-June 2002
3 October 2005 33

34. Wellness newsletter cost example
Assumptions:
•
− 4 pages
− 1,000 identical copies
− Prepared by M.D. and staff
Research, writing & editing text $500
Layout, design & graphics $400
Printing, paper & f ldi
P i ti folding $450
Envelopes $100
Postage $350
Addressing, inserting, sealing & affixing postage $250
Total $2,040
,
Source: Patient News Publishing, Niagara Falls
3 October 2005 34

35. Traditional workflow
academic
paper
online content
conference
wellness
newsletter
medical writer
editorial
WHO/CDC board medical writer patient
bulletin editor
medical writer
patient
information
press release
online content
news article
wellness vs.
$: board prestige salary subscriber
medical info
UC B k l
Berkeley Belvoir M di
B l i Media Medline Plus
M dli Pl healthy
h lth
example:
Harvard University Health vs. Medline vs. sick
3 October 2005 35

36. Clear 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
visit to the doctor
− 15% avoided an unnecessary visit to the emergency
room
− Another survey showed 87% of the respondents were
more satisfied with their health plan as a result of
participating i a H lth i program
ti i ti in Healthwise
source: http://www.healthwise.org/mhb_employers.aspx
3 October 2005 36

37. Alternate uses
training Puerto Rico health card
materials
wellness
newsletter clinic
staff bios
medical group
post visit
info sheet
publisher
institution info
content
repository
in-depth info
insurance
admission info
Medicare/Medicaid
clinician’s
update
hospital
surgery i f
info
therapy info self-help group
3 October 2005 37