Trickle Down Health or Health 2.0 Impressions

by | Sep 30, 2011

Another year, another Health 2.0 under the belt. This being the fourth time attending it is interesting to see how this event and its participants have evolved. Like many things in life, some things at Health 2.0 have changed, some have not, most for the better, but there remain some troubling aspects to this event that cannot be ignored.

When thinking back on the demos of countless vendors of years’ past, this year’s Health 2.0 had two distinguishing characteristics:

Demos are cleaner, with better user interfaces (UI). The companies demoing at Health 2.0 are spending a lot more time and resources on creating inviting, clean and engaging interfaces that are a welcome change from the cluttered messes of demos past. As with Mark Twain’s famous quote: “I would have written you a shorter letter if I had the time.” reducing an application to its core elements takes time. Clearly, the majority of Health 2.0 vendors this year have spent the time and resources necessary to create a simple and engaging environment for the end user.

Business models are more sophisticated. At the first Health 2.0 event, just about every single vendor there stated that their business model was going to be based on some mix of Freemium and advertising revenue. Needless to say, just about every Health 2.0 start-up from that conference has either gone out of business, is among the walking dead (takes a lot to completely kill a company – trust me, I’ve been there) or has changed their model to survive. This year, the business models presented are more creative and for some, likely to see success in the market.

The contributing factor to these two changes is the amount of money now flowing into the health IT sector. Investors smell opportunity and are placing some pretty big bets as represented by the investments in Castlight (~$80M), ZocDoc ($50M) and CareCloud, who announced a $20M round at the event. That’s some serious cash and with all the investors that were present at this event, quite sure there are more investments in the wings.

Snap-shot impressions of demos:

  • Mobile remains hot but no one seems to have figured out a way to rise above the noise.
  • Big data is the new hot phrase but few understand its implications. Most demos simply demonstrated even more fractionation of data into distinct silos with no clear path towards aggregation.
  • Many see the key to success as becoming the facebook of healthcare with a Zynga Farmville thrown in for good measure. By the end of two days, just about ready to strangle the next demo that started with some reference to facebook and/or gamification.
  • Pricing transparency is a big area of focus for many but seriously doubt most will get past their first round of angel funding as this is already a competitive market. Speaking of which, almost as frustrating as short vacuous demos is the lack of clear arguments by those giving these demos as to why they’ll succeed.
  • Demos never get into details, thus rarely instructive.
  • Many platform plays, ala PaaS, but like big data, few truly understand what that means and how to get there.

While Health 2.0 can get overwhelming with the number of rapid fire, albeit  shallow demos from the multitudes of vendors who are all trying to make their mark in a market that has experienced a significant amount of churn, the event is invigorating for the passion that is shown. Sure, everyone is hoping to make a living on their next greatest innovation, but unlike virtually any other health IT related conference, those at Health 2.0 have passion. They are on a mission. They want to truly change healthcare. They want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati.

Looking around at the Health 2.0 audience one sees a sea of almost exclusively upper, middle class professionals that are tapping away on their iPad, smartphone or laptop. When one sits back and thinks about the many demos seen, virtually all of them seem to be designed for this audience. Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system. And we need not go to that extreme, how about just having someone from a safety-net clinic talk about their needs? Sadly, no such representatives were to be found at Health 2.0.

It is this detachment that has Chilmark most concern with this passionate movement. Yes, virtually all Health 2.0 participants are passionate about helping all healthcare stakeholders but if we do not start talking to a broader cross-section of the populace, this movement may be much like the barricade scene in Les Miserables wherein the students leading the call for a revolution end up dead and with little to show for they had not engaged the populace-at-large. Some may argue that like this technology will indeed trickle down to the masses in much the same way that smartphones are now replacing feature phones in the mobile market. This “trickle-down theory may indeed come to pass but then again, we could just as easily end up with something very similar toPresident Reagan’s trickle-down theory for wealth distribution and we all know what the end result of that has been.




  1. Lisa Suennen

    John, I could not agree with you more. Too many of the Health 2.0-ish crowd are talking to only each other and not the majority of the world’s true consumers. It is a prescription for self-delusion and the conversation is often devoid of an understanding of what they payers want or need. Considering their role in reimbursement, that is a grave oversight. Lisa

    • nicolekidd

      Yes, I wholeheartedly agree with you both, Lisa and John: Those were also our observations during the Patient 2.0 gathering Sunday. The populations who command most of the health care dollars aren’t represented. It would be so great to invite the representatives of community health center leaders of large metropolitan areas, baby boomer groups and other reps of the biggest health care dollar consuming constituencies. The discussion would simply become more balanced and meaningful. My two cents.

    • John

      Thanks for the feedback Lisa. There are times when I write these things, going out on the limb, you wonder, will those who were there as well as those who were not understand the meanings of the post without being offended. As you know, I strongly believe that the healthcare system we have today is in need of some shock therapy and these innovators may just have the cattle prod to do it with but if they do not do a better job of understanding the broader market and addressing their needs, then as you so rightly put it, it is nothing but self-delusion that will lead to failure.

  2. andrew tessier (@andrewtessier)

    I agree. We need a brave CEO @ a CDO to put more of the power in these software purchasing decisions in the hands of Providers and Patients.

    If they do I don’t think you will see too many Patients voting to spend two years of profit on Epic when there are a bunch of other places that money could be put to use directly in care delivery.

  3. Dave Chase (@chasedave)

    Hard to argue with your points, John but curious if you saw any good counterpoints to your observation “Demos never get into details, thus rarely instructive.” I believe virtually all of the demos were limited to 3.5 minutes. I’ve yet to crack that nut short of talking like one of those fast-talkers in a TV ad. Have you seen any good examples of this? It seems like an oxymoron to go into detail in a 3.5 minute demo. Even the King of Demos (Steve Jobs) probably takes more than 3.5 minutes. Would love to know of some great examples to study them.

  4. Dan Munro (@danmunro)

    Dave’s point is spot-on. 210 secs is almost impossible – and most of the demos I saw were heavily tilted to features & benefits.

    There was a certain amount of “Kumbaya” to the event – but I prefer that over the canned, heavily entrenched vendor-speak at HIMSS. That always feels like a Bataan death-march to me. I think GE had an elevator actually in their booth at Orlando – or was that McKesson?

  5. pnerger (@pnerger)


    I agree with you and your assessment but the issue with Demo’s is not the issue of the vendor. I gave a demo during one of the sessions and the format of the organizers was such that I had 3 minutes. I only had time to describe the very tip of the iceberg of what we are doing and the value we provide to our Hospital customers. It’s a tradeoff in that kind of format.

    Paul Nerger
    CTO Happtique

    • John

      Paul and all others that commented on the short time-slot you had to do a demo, yes, I realize the constraints you were put under that you had no control over. I’m not of the Ted/Health 2.0 technorati crowd and thus not a fan of these short demos, at least not for most of an event. Maybe one or two sessions, then let’s move to deeper dives where we truly have an opportunity to understand what a company wants to do, wants to be and how they plan to get there. Guess it’s just the analyst in me.

  6. Gregg Masters (@2healthguru)

    Agree John, the ‘gene pool’ can get a little thin at Health 2.0. I was one of those middle aged white guys tapping on both an iPad and MacBook. When the ‘quant family’ clip came on, I had exactly the same reaction.

    Yet, a positive innovation vibe is essential for the shift we so desperately need.

    As usual my friend, you spare no punches but stick to the knitting of an independent voice. Bravo!

  7. Bill Prenovitz

    Curious whether you saw anyone at Health 2.0 who understood they needed to provide real value to real consumers, where the real consumers are the ones who will use and need their services?

    • John

      Bill, there was plenty of talk, many a grand idea, and some of these grand ideas may actually see adoption by the average US consumer. But a slick piece of technology is only one small piece of the puzzle. There are several other factors that must also come into play for an innovation to see success. Companies/innovators that have a full understanding of this are few and far between.

  8. Bijan Salehizadeh (@bijans)


    Great story. As a student of this space going back to the days of EhealthcareWorld 1997 – 2000, I must say I’m concerned.

    There are surely some great and exciting companies in the space. But I just feel like the whole thing is overfunded or about to be so.

    When tech investors rush into healthcare, it usually ends badly.

    When biotech VCs invest in HCIT, it usually ends badly.

    When internet health conferences are overcrowded with those types of VCs and the conference organizers are the only ones that seem to be profitable, it usually ends badly.

    Both of those things are happening now. Just check the roster of attendees at H2.0 and DCtoVC.

    Healthcare IT is actually more cyclical than biotech. The good times are good and the bad times are very very bad. I’d be trying to sell everything that isn’t nailed down right now. Not sure it’s a great time to be a net buyer.

    History repeats itself – or at least it “rhymes”.

    In this case, there are too many consumer-oriented, gamified, apps that appeal to the 280 and 101 crowd and not enough that actually have a business model that ever has a chance at working.

    It reminds alot of another era not that long ago when all of the same dynamics were at play. Surely WebMD, ePocrates, and a couple of others came out of that era – but many many others flamed out and killed the space for 6 or 7 years afterwards.

    You and and a couple of others such as Neil Versel are providing some of the best and most intellectually honest commentary on the space. Neil’s piece is worth reading too:

    Everyone else seems to be getting sucked into the vortex of BS that seems to pervade this space every 10 to 12 years.

    • John

      I was there for the last massive tech blow-up, heck I may have been a part of it with my talks about all supply chain transactions moving to large, industry specific e-procurement sites. Needless to say, hype was way ahead of reality and hopefully I learned a thing or two in the process. That is why, like you, I take a very wary and cautious view of the Health 2.0 market. Hype in this space is far ahead of reality and unfortunately, the passion expressed at such events has little to do with what actually occurs in the field, in th actual delivery of care to the broad x-section of the American populace.

      That being said, I do admire the passion of many of these innovators and wish them well on their path to helping consumers. patients and doctors better manage health, wellness and when one does get sick, end up in the hospital, go under the knife, etc., that the quality of that care is improved through the use of such technology. After all, that is the whole reason I started Chilmark Research.

  9. Gerry Higgins, Ph.D.


    I did not attend the event. However, I am not as “bullish” about mHealth for use in healthcare as others seem to be.

    I think the recent article in Technology Review says it well: “How the Health-Care System Slows Mobile Medical Technology” -Under a fee-for-service structure, doctors aren’t motivated to embrace innovation. See:

    Also, the notion of “Big Data” is certainly not a contrived idea, but rather a significant challenge (see the upcoming report from the NIH director), as academic medical centers and now hospitals are dealing with exabytes of genomic sequence (short read archive) and other storage and management issues.


  10. Jim Bloedau

    I also find the passion in Health 2.0 inspiring. However, I’m also a survivor of the clinical setting and Health 1.0, a recovering Luddite, and agree with the few that it sounds like we may be coming to the end of this hype cycle. So, maybe we should stop and consider, what are the realities that will make the “Consumer Miracle” hoped for by most presenting and the curious come true? Let me start a list.

    • Other than a CVS heart transplant researcher I knew, I’ve never heard a professional healthcare provider whishing for real time mega-data monitoring streaming into their offices.
    • I’ve never heard a low income sixty-eight year old with multiple chronic health issues clamoring for the latest tablet, smart phone or more bandwidth.
    • I’ve never heard a doctor or nurse wishing they could spend more time in the office.
    • I’ve never heard a family caregiver, “alpha daughter” or employer looking forward to taking half a day off work to take Mom, Dad or Granny in for a few more tests.
    • I’ve never heard a consumer/patient say they would trust a Health 2.0 vendor over their doctor’s or nurse’s recommendations.
    • I’ve never heard a CEO of a large provider enterprise say they are more interested in the latest Health 2.0 tech than P&L and keeping their referral base happy.

    Obviously, my orientation is toward the pain points of the current delivery of healthcare, the place where the money is spent. Let’s hope that the rumored Health 3.0 movement takes a sober look at these questions…they might find a more viable business model. Any more?

    PS: I’m ready for that online drink anytime you are.

  11. e-Patient Dave

    John, I’m late to the party on this post. Not to be a broken record but yeah you nail the issues as I see them.

    Pragmatically, having attended 100 events in the past year, I see that a conference needs to keep itself in business. Matthew’s Orwellian “deep dive” sessions (12 minutes shorter than a TED talk!) has always amused me, but clearly that’s always been his format, for better or worse, and he sure keeps selling tickets. I respect that, even though, just as clearly, it’s no way to get a deep understanding of anything.

    (Did they master wifi this year??)

    Seems to me that Health 2.0 is what it is. I for one am pleased that this event had a BIG pre-day, “Patients 2.0,” one of the most substantial efforts I’ve seen to bring patients into the conversation. Again, to take time off from other things and attend, one needed to be relatively well off – not the obese very-sick family you described, which is indeed a big deal. But I doubt we’ll see those people at a conference, ever – the conferences will always be talking *about* them.

    Given your orientation and aptitudes, and what Health 2.0 is, I’m a little surprised you’d go – except that as a know-everything :-), you kinda need to!

    (I wasn’t there because (a) there are enough e-patient things happening now that we can’t all be everywhere – I was in Holland, at event with some other e-patient members, and (b) there are enough of us that there was no shortage of patients to be there instead of me. And that’s as it should be.

  12. Pamela Landis

    John – Great thoughts on Health 2.0. Your observation about who we are talking as these companies and solutions are built is spot on. I would wonder how many of these strategic thinkers at these start ups have actually sat in a waiting room of a family medicine doc in Des Moines, Detroit or Denver? The patients who are requiring the most time, the most effort, the most money aren’t the worried well. They are the chronically ill.



  1. Week of 9/26/11 – Roundup | - [...] Chilmark Research: Trickle Down Health 2.0 Impressions [...]
  2. Reflections on Health 2.0 San Francisco 2011 | NewHealthRock - [...] finished reading a particularly good recap of the Health 2.0 conference written by Chilmark Research’s managing director John Moore…
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