Tuesday, December 09, 2014

Commoditizing patients

This report on BetaBoston made me uneasy.  I'm almost reluctant to comment because my colleagues in the industry may see it as a part of a pattern to criticize a certain health system, but I would say the same thing regardless of what company might be involved in this venture.  See what you think.  Here are key excerpts from the article:

The Center for Connected Health at Partners HealthCare has created a secure survey tool to help medical product makers and investors get feedback from patients and customers. The new mobile app and Web-based survey tool called cHealth Compass will charge companies for the service and pay survey takers for their time.

New enrollees get a flat $50 when they register and $110 per year to take monthly surveys. Other opportunities from individual vendors could pull in between $20 to $50 per survey.

“We currently have several hundred people, and are actively enrolling more,” said Jethwani. The goal is to enroll 2,000 patients from Massachusetts by summer 2015, and then expand to include residents from other parts of the United States.

Client companies will pay a fee for the service, depending on how many questions are included in their surveys and how many patients they intend to reach.

My first reaction is that the health system has just found a new way to commoditize patients.

My second reaction is that this effort is designed only to help companies. It is not designed at all to help patients.  The press release doesn't even pretend that it is otherwise.

My third reaction concerns the potential for bias that is created when responders are paid.

If there were a way for patients to find value by participating in surveys, outside of money--like in this case--that approach might lead me to a different set of conclusions.


beverly said...

My first reaction was like yours. But my second thought was, well, maybe this is a standardized way for companies to ask patients what they think of products in development so they can be improved before production begins. Companies often don't know the right questions to ask of patients, and presumably the CCH's experience in that realm could help.
I am also ambivalent about the payment but, having been asked to participate in surveys by at least 5 vendors lately and having the thought, 'what's in it for me when you are using up my time', maybe it's not a bad idea.

Anonymous said...

I agree with your post, Paul. It sounds like a business independent of Partners in that they want to sign up all kinds of patients and be a trusted fancy Harvard-branded broker with HIPAA protection. But by not saying that, they implicitly suggest that they're going to help people survey Partners patients.

Weird all around. And underscores the commoditization happening in healthcare. Fascinating and uncomfortable.

Really, though, this is nothing more than https://truvio.com/ with a Partners sticker on it.

Anonymous said...

Basically, they have turned the tried-and-true focus group approach into an app. Great, they have 2000 patients signed up, but most of those patients are likely not appropriate for any given survey. They will answer it anyway to get the $. (For example, when I have been solicited for a focus group, they ask specific questions, e.g. they look for patients with diabetes, or parents of children with asthma, or women between 25-40 taking antidepressants, etc.)

It's pretty standard to pay those participants for their time, though, so that probably shouldn't influence their answers. So my take is that the company has invented a way to take business from the established companies who do market research, charging more and providing less meaningful data. (They could call it "UNfocused Group Research.")

Oh, and they will advertise that their market research is better because it comes from MGH.

Anonymous said...

Patient here. There is just no end to others making money from my sickness. Healthcare i nothing about health and there's very little care. Just one more example.

Barry Carol said...

Over the course of my career I participated in numerous financial focus groups for which I was usually paid between $100 to as much as $300 for one to two hours of my time. During pre-screening, sometimes I found that I didn’t have the particular expertise they were looking for and I always told them so because I didn’t think it would be fair to their client to take their money and not be able to make a meaningful contribution.

I don’t have any problem with what Partners is doing assuming they are able to segment the data in a way that ensures participating companies are getting reasonable value for the fees they are paying. My son is a brand manager for a consumer products company and they use focus groups all the time. It’s standard practice to compensate people to participate.

e-Patient Dave said...

In this case I see it entirely differently from you, Paul. I often point out that medicine typically designs things without patients involved in the process, while other industries not only seek out their customers' wants, they PAY for it. In this case I see the company not only seeking patient feedback but paying for it - exactly as other industries do.

I imagine it's possible to see evil anywhere money changes hands, but in this case what I see is ordinary business sense finally coming to medicine.

(In case it matters to other, I have occasionally met with some people at this Center, but not much, and it was usually to ASK for advice, not give it, and I'm in no way involved with them, nor with this project.)

e-Patient Dave said...

Re compensating people for their time: a couple of years ago I was randomly selected to be in a focus group for Southwest Airlines. The pay? A free round trip to anywhere in their system. THAT's something.

(They didn't do the focus group according to best practices, btw - the VP who was the consultant's client was in the room, and occasionally *argued* with what we guinea pigs said, which is precisely how you throw off the accuracy of the final report. But that's a separate issue.)

Richard said...

I too am very disturbed by this.

To me it clearly crosses the line of patient ethics and confidentiality and is supporting the device industry at the potential expense of the patient. Is the patient being given a clear and unbiased choice? I doubt it.

nonlocal MD said...

It appears we need more information. Perhaps an explanatory comment could be requested from the Center.

e-Patient Dave said...


> Is the patient being given a clear and unbiased choice? I doubt it.

I have to ask, what on earth are you talking about? (I mean, specifically.) As I said above, I have no stake in this; not only that, I've ranted at length on my blog about cases where patients are neither listened to nor supported in their participation.

What specifically makes you say you doubt these patients (who are being paid for their time) are being given a clear and unbiased choice? Have you perhaps seen what information they're given?

Again, I emphasize that I agree the issue at hand is important - I just have no idea what specifically you're talking about. Is it just a belief that anything any company does is probably evil?

nonlocal MD said...

Dave, I think you've hit on an important point about the "belief that anything any company does is probably evil." Unfortunately with the monied interests now attracted to the $$ available in medicine, 'let the buyer beware' is taking on new significance. But I agree that it is not clear a ripoff is taking place here and it may actually be a good thing instead; we just need a fuller explanation of what they are doing.

Matthew Katz said...

Provocative topic.

Dave, I see your point. I agree patients should be included and valued. However, there is controversy about the ethics of paying patients/research subjects that would raise questions.

If this were a study rather than a business model it would require IRB review to ensure patient protections.

In reading the press release, it does seem more the announcement of a new business line than a patient service. I'm sure there's more to it, but the article's focus doesn't sound patient-centric.

So here are some questions I have:

Should a pilot project like this require IRB review when conducted by academic medical centers - or its corporate entity?

What assurance/safeguards has Partners put in place to ensure that no harm occurs to patients, intentionally or otherwise, while companies pay a nonprofit hospital to access patients?

Is this kind of business appropriate in a non-profit hospital? It sounds more like a startup internet company.

Joseph Kvedar's input would be welcome to clarify these issues. I think more questions will likely need to be answered.

Anonymous said...

Some obvious conflict of interest issues - at the very least there should be full transparency (i.e. Partners openly declaring the funding model to the public and mention how patient data might be used for their and other corporate profit)