Consumer Health Success – WebMD – 7/15/11

Happy Bastille Day everybody! For some reason it’s a date that sticks in my head from my high school European History class with Miss Murley. Anyway, if you like wine and cheese you should raise a glass tonight. If you like freedom fries and are offended, I’m sorry and in the spirit of transparency, I prefer wines from Australia and New Zealand, specifically Marlborough.

I got an email from my last post when I mentioned the story on “connected independence” telling me about Jitterbug, which I’m quite familiar with and I’ve posted about as GreatCall because that is the website name. “I enjoy reading your HISTalkMobile, and today’s post reminded me to let you in on a little secret called Jitterbug. It’s a mobile phone for older users – asks Yes/No questions only, so the confusion is eliminated. It even has a dial tone. The customer service is incredible, and the website allows care-facilitators (ie, family or others) to set up the phone book on the phone via a web site. But the real kicker is the added services that you can contract. They have services that will call to remind the user to take their meds, call to check in on them, use the phone as an emergency button (and not have to relay the signal through the user’s home land line), and others. Probably worth looking into and including in your posting about connected independence. I know for my 94 year old mother, it’s been wonderful.” Good point and they should at least be mentioned with Robert Bosch and Independa as currently in the “connected independence” space.

Continuing, or starting I guess as this is the first post that is actually about a consumer facing health offering, my series on Consumer Health Success, I thought I’d include what I think of and always hear about as the big success in consumer health, WebMD.

First, maybe everybody knew this but I had no idea that WebMD was much more than just the consumer facing, and ad-driven, website with health information. I was shocked to learn that they also operated several business other than the consumer site.

  • Medscape – an app I used in med school but decided I preferred Epocrates, as well as an email list and information source for info about providers and practices, including doc salaries. In fact, I still get med student emails from them a few times a week.
  • eMedicine – I’ve used this site for disease reference and have seen it used by lots of docs to quickly pull up information about symptoms, diseases, and treatments. It’s sort of like UpToDate without the trusted name but much cheaper.
  • Private Portals – these seem to be catering to employers and health plans.

Again, sorry if this is old news and I’m just uninformed. The company is public with a market cap of $2.7 billion on $558 million in revenue last year. I’m not sure what percent of that revenue or valuation is based on the consumer side of the business but, since that’s the title of the post, that is what I’m going to focus on.

According to WebMD: “WebMD has created an organization that we believe fulfills the promise of health information on the Internet. We provide credible information, supportive communities, and in-depth reference material about health subjects that matter to you. We are a source for original and timely health information as well as material from well known content providers.”

Timing over the last several years couldn’t be better for WebMD as more and more people turn to the Internet for health information. A recent Pew Internet survey found nearly 80% of Internet users, or 60% of all Americans, look for health information on the Internet. The same study found that the majority of those that looked for health information online used that information to make a decision about their health and to change the way they maintain their health or the health of someone they care for. Also, 39% said online information changed how they “cope” with a chronic condition or manage pain.

And where do people go for online health information? You guessed it, WebMD. WebMD gets almost 50% of all health related searches. Doing some math gives you about 30% of the US population that looks at WebMD for health information. That’s pretty staggering, especially considering the same survey found government sites to be the most credible. Maybe the governments needs to hire some search engine optimizers.

So who’s searching WebMD? According to Alexa, WebMD’s audience is disproportionately older (over 45 and all the way up), female, and without a graduate degree. That got me wondering if the graduate school group, underrepresented on WebMD, is bypassing WebMD and going direct to the more credible government sites. To test that theory, I checked Alexa for and found that graduate school users are disproportionately represented on while being underrepresented on WebMD. The NIH also has a higher proportion of over 65 year old users.

My excitement about my new discovery was short-lived as I discovered that the most popular search resulting in somebody visiting the NIH site is “pubmed”. It looks like the graduate users accessing NIH are likely researchers. Oh well.

So what are visitors that come to WebMD searching for to get there? According to Alexa, the most popular conditions people are searching for that direct them to WebMD are shingles, ticks, weight loss, symptom checker, ringworm, depression, and a few other common conditions. Most of these are acute and the most important one is probably weight loss, at least with the lens I’m using to look at the site, because obesity is a central problem and catalyst in most of the common health problems in the US – diabetes, high blood pressure, high fats and cholesterol, and eventually heart disease.

What do you get if you actually Google “weight loss”? You get directed to WebMD’s Healthy Eating and Diet page, it’s the top search result. It’s also the same place you get if you search WebMD for “weight loss”. The site provides all sorts of tips and guidance on dieting, cooking, calculators, shopping, exercising, and a list of forums.

It’s all great information and WebMD is the most popular place for most people looking online for health information but does it hold much hope of improving people’s health, especially the people in desperate need of help. As a passive source of information I can’t really imagine it changing individual behavior. But I guess that’s not what WebMD is all about. It’s just about access to information. My bet is that the first week of January and end of spring is when WebMD gets the highest amount of activity looking for diet and exercise info. Whatever lessons are learned are probably only transiently followed as people slip back to their previous behavior.

To WebMD’s credit, they’ve released several mobile apps that apparently have been downloaded over 5 million times, so they are at least trying to reach people where the are increasingly accessing information. But this is more about eye balls and revenue, not mobile tools to improve health. Realistically, without any incentive or motivation or social network integration or provider links, I don’t think you can meaningfully change behavior, especially with an unmotivated group of American consumers.

What are the big criticisms of WebMD? The WebMD ad-supported model is criticized and WebMD has been described as a “pill pushing” site that doesn’t do any good for consumers except play into their fears about their health. While I agree that sites created to provide evidence-based education and credible content ideally would be without advertisements, this is easier said than done. The NIH does it, but obviously has lost out to WebMD in terms of users and gaining back the upper hand on Google’s page rank is no easy task.

Mayo has just launched it’s online communities site and, as a deep-pocketed health system, it can provide it free without banner ads. But Mayo launched its site in 2011 and WebMD has been around for what seems like forever, having been founded as Healtheon by James Clark, the creator of Netscape. It was founded as a business, to make money, and has survived precisely because of this.

As the default source for health info in this country, all that web traffic creates good advertising revenue. At a $2.7 billion market cap, changing the business model to focus on individual outcomes doesn’t seem necessary or prudent. Besides, focusing on being the trusted source of health information is what brought WebMD out of the trough of the dot-com bubble. If there is anything to be learned from that story, it is that a business needs to prioritize and focus on the core value proposition of the business.

Consumers need to know, clearly and concisely and without searching, what you are offering and how it benefits them. Access to health information is enough for WebMD and it’s users, so why change?

Travis Good is an MD/MBA and is involved with health IT startups.

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