There Is No Such Thing As A Health Care Consumer

Google announced last week that it is shutting down personal health record service Google Health. The underlying cause: the people who use Google Health aren't the people making health care decisions.


The Internet has been a boon for consumers who want to learn more about their medical symptoms and conditions. According to the Pew Internet and American Life Project, 80% of the American adults who use the Internet report that they regularly go online for access to health information. But so far, the Internet has not helped drive the adoption of health records created and maintained by consumers. That's why Google announced last week that it is shutting down Google Health, a personal health record service that allows individuals to centrally store and manage their health information online.

The theoretical appeal of such a service is that people can make better decisions about health care when they have all of their health information readily available. After a very successful pilot test with 1,600 patients of the Cleveland Clinic, Google Health launched a little over three years ago. It joined similar consumer-driven offerings from Microsoft, Dossia and Indivo. While none of these other services have outright failed, they cannot be considered home-run successes. Why not? Why hasn’t the Internet empowered consumers to manage their personal health information the same way it has better informed them about medical conditions?

There are three reasons. But the underlying cause is that there is no such thing as a consumer in the American health care system today. A consumer is someone who uses personal dollars to buy goods and services for his or her own use. In our health care system, the users of medical services are, of course, individuals. But users don’t pay the largest share of costs for these services. Employers, the government, and health insurance companies do. So while people may be highly concerned about quality medical care, most are not motivated to manage costs. With that fundamental understanding, it’s easy to see why Google Health failed.

First, people are not really interested in entering information at a website unless they get value in return. And gathering personal health information from many different sources and entering it in an online database can be time-consuming and tedious. Dossia works with employers to pre-populate their employees’ health records with information from their group health plans. This saves people time, and also has the effect of making the employer a partner with employees in taking control of health information.

One can imagine how this has an effect similar to that of 401(k) employer matching. An employee puts in some amount of money and the employer matches it, with the total automatically invested in mutual or exchange-traded funds chosen by the employee. There are now dozens of studies that show that when employers match the 401(k) contributions of their employees, the number of accounts skyrockets. And what if employers took it a step further? After helping to create personal health records for their employees, what if employers engaged them to "manage" their health care more efficiently in return for a lower annual deductible? That would go a long way toward motivating employees and save millions of dollars for both employers and themselves.

Second, Google Health failed because Google did not offer tools that allowed people to put their health information to good use. One of the greatest needs is for comparative pricing tools for purchasing medical services.

For example, my son was ill last year and needed to have some blood tests done. I called our local laboratory and got some basic price information. However, it turned out that the lab was closed on the weekend we needed the tests done. So we went to a lab owned and run by the same company, but situated across the street in the basement of the large tertiary hospital in our town. The prices we were quoted were five times more expensive for exactly the same tests. What if Google Health had a tool that could allow me to "shop" for other labs in the area open on the weekend—but independent from the expensive ecosystem of a large hospital?

Third, Internet consumers expect connected interactions that create real economic value. If Google Health offered such interactions, more people would have found a way to use the service—even if it meant arduously pre-populating an online record. For example, what if Google Health had a tool that allowed individuals to compare their own medical bills to those of others with health records stored on Google Health (anonymously, of course)? Or what if Google Health had a tool that searched for better deals from medical providers based on the aggregated experiences and claims of other health care consumers in the same geographic area?

These types of comparative Internet tools are commonly available to consumers in other markets. I’m surprised that innovative companies have not launched them for health care yet, but I’m sure they will soon. It just seems like Google will be missing the opportunity.

[Image: Flickr user zerok]

Bryce Williams is the President and CEO of Extend Health. Mr. Williams holds a J.D. degree from George Washington University and a B.A. from Baylor University.

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  • Dan Munro

    Bryce - great insight - and post.  I would agree that GOOG was premature in their decision - but I think they could actually return.  I also think that as the Government effectively moves the system from volume to value based - the consumer will engage much more directly - for two simple reason:

    1) As the out-of-pocket consumer costs continue to escalate - we'll all be looking for more tools to help us determine alternative cost/value.
    2) As providers are increasingly measured (and paid) on outcomes (accountable care), they too will need a much more engaged consumer.

    We're not there today - but I can see a day when an Rx or therapy program includes self-monitoring and electronic reporting (with privacy and security of course).  Some of that is already taking hold quickly in the whole Home Health movement.

    John Moore (Chilmark Research) has it right when he says what we need is a "Collaborative Health Record" - not necessarily a Personal one.  That's somewhat the theory around the HIX's - but I don't think spinning up new hub-and-spoke networks will (ultimately) be all that effective - or cheap.  

    The types of comparative tools you reference are already on their way.  Don't know if you've seen Castlight Health - but they have been building a compelling solution for quite some time - and there are others too.  

  • John Smith

    I'd like to point out THEidahopotayto that "this is the internet" and if you want to go write three paragraph pretentious comments that nobody will read go ahead and start up a blog. But thanks for rehashing the article in a "I-know-more-than-you" manner. Next time please include even more obvious examples you "fool."

  • BigRedTruck

    Another reason that Google failed--like most others that have thrown their hat into the personal health record arena--is that the healthcare industry has failed to adopt an interoperability standard.  The consequence to consumers is that even if every provider adopted some means to share records with patients, the variances in those means make it a hassle--or untenable--for consumers to manage the information and for vendors like Google to support meaningful use of the medical history.  This is the same problem that the healthcare industry itself faces.  While adoption of electronic health records is becoming the norm, the industry has yet to adopt a standard by which Provider X can easily access and import the records of Provider Y.

    I wholeheartedly disagree with the assertion that there is no healthcare consumer.  Has the author noted the increasing prevalence of employer-sponsored or individual market HRAs, HSAs, and high deductable health plans that mandate more consumer skin in the game?  As costs are shifted to consumers, it cerrtainly does create a healthcare consumer.  The problem is that without means to compare providers and absent cost transparency in the medical industry, consumers have little opportunity to make meaningful choices.

  • THEidahopotayto

    I'd also like to point out that the reason "consumers" participate this way is because they do not view health insurance as insurance.  Rather, they view insurance as a way to get somebody else to pay for their health care costs.  This is not the purpose of insurance.  Take home fire insurance as an example: the reason people purchase fire insurance is that they are scared that a fire may occur at their home, and in order to protect themselves they pay somebody else (a monthly premium) to shoulder some of the risk of financial burden should a fire occur.  The purpose of the insurance is to protect their property should something catastrophic happen to their home.  People do not utilize health insurance in the same manner.  Rather than use it only when their costs are extremely high, consumers expect to use health insurance plans for all medical costs, regardless of price, because they know the bill will be paid (regardless of who pays it).  To me, this is the equivalent of a person purposely igniting a lint ball in their dryer because they know their insurance will pay for a new one when the old one is consumed in flames. 

  • THEidahopotayto

    I think the article brings up good points, although it is poorly written and some of the suggestions for change are left wanting (they seem unrealistic and are generally skeletal, as if they were included only because the author knew they needed to be for the article to seem credible).  Regardless, he is right - we cannot really call the "consumers" of today's health care market "consumers" because they are not consumers in the denotative sense of the word.  Rather, they are "members" of a health insurance plan, and they do not take the time actively participate in a market in the economic sense.  As the author has pointed out, the crux of the issue is financial responsibility: "consumers" don't feel the need to shop for health care because they are not the ones footing the bill.  Of course, this whole issue could be remedied by putting the responsibility (financially or otherwise) on the consumers to manage their own health care expenses, which is where we see a lot of health insurance companies moving towards today. 

    I also want to point out that kpa and Michael Carr are fools.  This is the internet.  You don't need expensive marketing campaigns to make something successful (and even if you did, don't you think Google would know better than you?).  To use possibly the most cliche example in online history, look at Facebook: when was the last time you saw a TV commercial or internet add for Facebook?  Never; because they don't need it.  People found out about Facebook because it was a useful tool for socialization, and it spread virally like any popular internet site.  Similarly, people would have found out about Google Health if it were a useful tool for health care management.  Although my logic isn't sound, I think it follows that one reason that Google Health failed is that it wasn't a useful tool (although, I concede, marketing could have been an issue - but by no means is it necessarily the sole factor!). 

  • Andrew Krause

    Forget expensive - this is the first I've ever heard of Google health, and I had a hand in developing an EMR system for a regional healthcare provider so I should know about this. I think it's a fair point to make that Google could have lifted a finger to support this.

  • Reed Smith

    I actually don't think it had to do with Marketing (this of course wouldn't hurt), but more to do with data being on an island.

    You make really good points about who the healthcare consumer actually is, but even those who used the tool I would guess were not very active with it.

    The problem is Health IT as a whole and all these tools, Google Health or not, do not talk to each other rendering them useless.

    So until we have tools that interface with our primary care physician, the hospital, and our insurance provider this will never work.

    This was basically a digital medical ID card...which no one needs...

  • Warnner

    any actual or potential recipient of health care, such as a patient in a hospital, a client in a community mental health center, or a member of a prepaid health maintenance organization.Tank Top

  • kpa

    you got it partially right but your arguments don't make sense.  Google Health failed because it didn't market and it wasn't the right product fit.  NOt because of the cost related user issue you described and not because of the missing medical services comparitive tools.  

  • Michael Carr

    I guess not only the records were anonymous...the service itself was more under the radar than most "code-word" operations in the Pentagon (even WikiLeaks is silent on the subject of Google Health).

    If you're going to spend millions of dollars to build and maintain a revolutionary healthcare service, consider telling some people about it.