As I mentioned previously, the hype of personalized medicine is breeding a new industry-direct to consumer (DTC) Genetic Testing. These companies offer to test, analyze and store your genetic information for you. Navigenics entered this arena in April’08, with some stellar credentials in terms of team, funding (KPCB, Sequoia among others) and collaborations (Mayo, Partners, Duke, Scripps, MedScape, etc.).

Here is a simple overview of their offering: pay $500 to be tested for 10 common conditions or upgrade to $2,500 for all conditions (28 currently). The upgraded package has perks of genetic counseling, personalized updates and educational content for a year.  Beyond  that you pay $250/year to keep it going. What sets Navigenics apart (as I understand) is that they only tell you your results from the perspective of these 28 (and growing) conditions whereas others (deCODEme, 23andMe) let you ‘explore’ your results for every trait/condition they are continuously covering.

Regardless of what company it is, the question remains that how much can you learn from you genetic profile? If you are at 64% risk for Diabetes type 2 and 47% risk for macular degeneration, what can you do about it?  Well, the advice would mostly include one or more of- exercise,  dont smoke, eat healthy, avoid alcohol, sleep well, vitamins, lookout for warning signs etc. So why get the test; you should be doing all that anyways. I’m not knocking down genetic testing per se, just trying to find utility for it in a DTC model.

The future of healtcare is more personalized, for sure. I’m happy that the commercial foundation for it is being laid down right now. But personally, I wouldnt invest in these services till we firmly and clearly establish an end-to-end causal linkage between genes, diasease, and therapy. We havent even agreed on how important is the role of enviornment and habits (is it only genes that determine a disease outcome?) Heck, who said it’s genes- what about proteomics?

Consumerism is on the rise in healthcare, and MyMedLab brings that trend to the Lab testing space. With their service users can self-order wellness lab exams online and walk-in to the lab nearest to their zip code. Note that this doesn’t include all possible lab tests, but only the subset that don’t require direct physician order.

The price they charge includes collection fee for sample draw, ordering physician fee (i.e. lab order approval, result review, consultation) and a Personal Health Record (where you can view and store the results, among other things). Users pay upfront for the tests and have the option to receive a receipt to submit for reimbursement from an insurance company or a health savings account.

There are several other players in this direct-to-consumer lab testing, like DirectLabs, HealthCheckUSA, MedLabUSA. The benefits of these services are tangible- lower cost (specially for the uninsured, who don’t want to pay for the visit to the doctor), convenience, speed and privacy.

But not everything is that straight-forward. Most insurance companies will not reimburse patients for tests that were not ordered by a physician, so the target market is restricted to people who are health-conscious and rich enough to pay for self-initiated disease monitoring. Jury is still out on many aspects- who approves these tests medically? Who carries the legal burden? Is it okay to let patients self-diagnose themselves? what about misinterpretation of results? IMHO, there is a market and advantage for direct-to-consumer lab testing, even if the healthcare system doesnt recognize or reimburse for it yet. Also, these services would look pretty good as applications on PHR platforms like Google Health.

Simply put, icyou is the Youtube of health-related videos. It launched around September 2007 by BenefitFocus, a Charleston (SC) based healthcare benefits software provider. The name icyou stands for ‘Intensive Content for Your Health’…a twist on the actual ICUs (Intensive Care Units).

Basic idea is for icyou to be the exchange hub for patients, providers and caregivers to share their stories and experiences with the world. Some social networking add-ons like profile page, blogs are included too. The company seems to be well-funded and seriously engaged, given their onsite studio and mainstream press coverage.

I’m not a big optimist when it comes to online video space, but icyou does point to an important trend: massive information sharing platforms like online videos are prone to be more successful (as businesses) when adapted to a niche.  Healthcare is a great example of such a niche. But I’m not convinced if anyone has mastered a straight forward revenue model. Icyou doesn’t mention how they intend to monetize their content either. They don’t have ads running, but even if they did, advertising can’t really pay the bills for such a bandwidth-heavy service.

Good ideas are always simple. I’m really optimistic about the emerging simple tools that let consumers manage, monitor or understand their health issues better. ZeaLOG is a simple tracker that lets you measure anything, and report off it. The service seems pretty new and driven by a team of one, so there are some rough edges here and there. Most of the ZeaLOGs started are around profound topics like ‘Number of Simpsons Episodes Watched’ or ‘TV Dinners Eaten’, but there are some borderline-serious ones too (exercise, diet related).

It’s not focused on healthcare issues, but I see potential for something like this in chronic conditions that affect an individual’s lifestyle. A good example is migraines. Those who have these terrible headaches would benefit from knowing exactly how many did they have this month vs. past 6 months and what were they doing when it started. So If one could log the onset/end of a migraine attack and the preceding activity conveniently, it’d be easy to spot a pattern (e.g. higher chance of migraine after cold shower).

Why not keep a simple diary bedside? or spreadsheet? Yeah, you can. But how many people do? And how many diaries can remind you to enter latest information in them and chart/graph your progress? It’d be a good idea to add some social networking features to ZeaLOG- finding comparative stats or just connecting with others in the same state as you are powerful motivators for using such tools (for example- Qwitter). ZeaLOG has twitter integration, but it’d be neat to have a mobile app too, especially one that syncs up intelligently with online data.

There is a paid service idea in this concept somewhere. I’m sure we’ll see one soon in healthcare.

Medpedia is an attempt to apply crowdsourcing concept to medical knowledge, just like Wikipedia. It launched in beta mid-February this year, with some big names backing it (Harvard, Stanford, NHS, AHA, ACP to name a few). The idea is to create a collaborative body of knowledge using physicians and Ph.Ds as gatekeepers.

Anyone can contribute- physicians/Ph.Ds become directors editors (after approval) and others can give suggestions that queue up for editorial review. The site has modest traction but not enough to differentiate it from other wiki-like approaches in healthcare like Ganfyd.org, wikiDoc.org, WikiMD, AskDrWiki and many others (see David Rothman’s extensive list of medical wiki’s here)

There is potential in the wiki-approach, but I’m not holding my breath. Wikipedia may have reached a size and popularity threshold that it remains useful with the community self-policing content effectively, but it was a long an painful journey to that point. Right now the medical wiki space is too fragmented to be impactful.

Polka’s mission is to make your up-to-date basic health information available to you all the time, on the web or your iPhone. They claim that their ’secure aggregation and collaboration service’ can help users manage their health. Here is what they offer:

• My Health – An application to store your basic health information (allergies, meds, diagnosis, emergency contacts, and a twitter-ish 140 char Health Log). Available as a 99¢ iPhone app or a free online dashboard.
• If Found+ – A 99¢ iPhone app that can display a short message and contact info on the wallpaper of a locked iPhone.
• My Emergency Info – Another 99¢ app that essentially does the same this as If Found+ but instead of a short message, you can show ’summary health info’. (So how is this different if I choose to write health info as the message in If Found+? I’m not sure.)
• Close Call – A free iPhone app that apparently does the same thing as If Found+ and My Emergency Info. It displays important emergency contact info as a part of wallpaper on a locked iPhone. Don’t know how that is different from the other two 99¢ apps.

Polka is the first funded company created at the Lab2Market progam at UCSD Rady School of Management and they started around mid-2008. I think they are certainly on the right track since the fast-growing, 24X7 access mobile platform is ripe for healthcare information storage and communication.  Except that I’m lost at the product differentiation and pricing level. In terms of competition, there are other In-Case-of-Emergency category apps available for the iPhone like Easy I.C.E for 99¢, EMT ICE for $1.99, Health n Me Pro for $2.99. None of them do any better job at it, though.

There are rough edges to what Polka offers today (tried their online dashboard.. not particularly impressive) but that may be understandable given that they are relatively new startup. iPhone apps are fine, but I think online dashboard may be a stretch unless there is a really ground-breaking, never-before feature that they can offer. Why not integrate with Google Health/Healthvault for the online PHR-like functionality right out of the box?

Primary care is a frustrating experience for most patients as well as physicians. Patients find the experience inconvenient, borderline impersonal and hardly get access to any of their resulting information from the visit. Physicians are hard-pressed for time since they are mostly drowned in paperwork. Considering the rise in HSA, high-deductibles, and no-insurance it’s logical that out-of-pocket payments for primary healthcare will keep increasing.

Myca plans to ride that wave. It’s an outpatient EMR and Practice Management system built with a social networking perspective. Its core emphasis is on enhancing the physician-patient communication and provide a shared ‘dashboard’ that both can utilize. As a patient, one can schedule appointments (or cancel) online, pay with credit card, setup email/video consults, access your record, etc. The service is based on a $35 monthly fee with physician charging $100-$200 depending on the complexity of complaint (see breakdown here).

Using Myca platform, any PCP can setup a subscription-based, consumer-oriented primary care practice. The first such practice is called HelloHealth, located in couple of neighborhoods of New York city. HelloHealth is co-founded by Myca’s Chief Concept Officer (?) Jay Parkinson who attained fame with his unconventional anti-establishment practice approach couple of years back.

I like the concept. It empowers PCPs to get off the hamster wheel of insurance and invest time in patients. Given enough competition and market acceptance, tools like these can make the old ‘Boutique Medicine’ concept more affordable and efficient. If nothing else, its a sign of service innovation in an orthodox industry.

I found out about SeniorEducators during a trip to the bay area last year. They are a startup trying to help seniors make the most out of their medicare benefits.

Quick Medicare tutorial: It consists of Part A, B, C and D. None pays for all of a covered person’s medical costs. The program contains premiums, deductibles and coinsurance, which the covered individual must pay out-of-pocket. After 1997, beneficiaries were given the option to receive benefits through private health insurance plans, instead of original Medicare plan (Parts A and B). That’s why today Medicare insurance market is a complex landscape, filled with lots of insurance companies offering thousands of plan options.

It’s hard to understand it all, let alone find one that fits your health need as well as budget. There is competition, for sure-small (ehealthinsurance, healthinsurancefinders, medigap ) and big (United, Aetna, Cigna..). But I didn’t find many that were only focused on Medicare- most seemed like one-stop shops for all health insurance needs, trying to target everyone.

Notably, this consumer segment is predictably technology-averse with significant communication need. Which is probably why all SeniorEducator online content is in simple language with easy navigation, and they use toll-free numbers to connect with the customers. It’s a good strategy, and it’ll be interesting to see how much traction they can get in a mature market with big entrenched players.