The Nexthealth Business Model(s) - Leave Your Preconceptions at the Door

At Medicine 2.0, Maarten and I decided to be true to our, ahem, unique communication styles.

We knew we'd need to shake people out of their comfort zones to spark hard-hitting dialogue on combustible issues like consumer-centric care evolution. We took a big risk with our particular brand of casual informality, but we think it paid off.

We did a lot of things differently. There is nothing in this list your organization cannot and should not be doing before presentations/demos.

A few examples:

1. We posted our presentation on Slideshare.net BEFORE our timeslot so potential attendees could decide if we'd interest them. Not interested? Don't attend. Luckily, plenty of people did.

2. We posted our ENTIRE research paper on Scribd for public review. Critique away. No copyright. Again, before our presentation.

3. We twittered the hell out of our upcoming session, as well as the rest of the conference, which let us make new friends and meet bloggers we'd only interacted with online. Of course we invited them all to attend.

4. We also posted qualitative aspects of the Nexthealth model/application up on our blogs, including our 'warm and fuzzy' elevator pitch.

When you do things differently, it generates comments you might never have expected.

Scott Shreeve left an interesting one on the Nexthealth Elevator Pitch post asking about our business model.

Scott says: "The only problem I see is that you are offering the service for free, you are giving away your technology, are not accepting ads, and you do not plan on using anonymized user information in any revenue generating way."

He's right on all counts.

"This leads to the big BM question (no, not that kind of BM) - how on earth do you plan to be around without any source of revenue. You either have a sugar daddy funding your every business whim or you will be out of business in short order. Would love to hear you describe the sustainable business model that will allow you to provide this valuable service."

It's such a good question I'll answer it here.

First Scott, if you find a sugar daddy (or sugar momma) please do send them our way. We'd love to talk.

It'd be a dream come true to develop a collaborative relationship like the one enjoyed (with great results) by Jay Parkinson and Myca. Probably no one else would be visionary enough (read: crazy enough) to take us on. But who knows. There are some amazing folks in healthcare, as we discovered this week.

Second - How do we expect to make money off the Nexthealth application?

By winning the lottery of course. Or gathering a few million via a VC round. Or being acquired.

Just kidding (at least about the first one), but I think far too many Health 2.0 firms have a similar bubble approach (relying on ad revenues in a rapidly morphing marketing world or charging only for premium services which are utilized by a small subset of users).

The short answer is that we don't. We're not trying to make money off the application, that's why we're throwing it out there as a public good.

Make no mistake, this isn't totally a selfless act of altruism. Many of the Nexthealth crew are more sinners than saints! Although we're social entrepreneurs working to spark change and global healthcare innovation, we realize the value of forging a new path with this sort of big splash.

After articulating our mission (connecting people online and offline to improve healthcare) and vision (people will be able to access healthcare goods and services, online and offline, at will), we decided very early on there would be things we wanted to build that should be set free "open source" style rather than siloed and privatized to death.

If you allow a company to put this kind of application to bed in a corporate stable you'll make a lot of money, yes, but you're not going to get the same relative neutrality and objectivity of which a completely NFP app is capable of doing.

Read: You will not be able to generate trust among digital health natives if you're selling off data on the back end with no opt-out a la Patients Like Me, especially once your users find out about it (and who wants a Health 2.0 version of Facebook's Beacon crisis?).

They may not know PLM is doing this yet, but when users (and potentially the media) uncover this I wonder if we'll see some of the first 'negative' HIT/Health 2.0 coverage - the nascent industry may still be too young for people to understand the implications and react in a critical manner.

This is why we won't gather your data and sell it at Nexthealth. However, you WILL have the option to make it available, open-source, to public health researchers (anonymized of course). We'll provide links and you can send it to them at will, or not.

That said, we have explored a few various ways to monetize use of the decision-support search app without sacrificing the relative neutrality and objectivity of the tool.

Some ideas include click-through plans, entering the Knight News Challenge and other similar unique open-source/NFP funding grant programs, etc., but more on those later.

And besides - we've got plenty of talents, skills, and plans that can be monetized. Call us foolish. Call us idealistic. Call us naive. Call us many other things. I'm sure that will happen. We are a new kind of 'business.' We will make many mistakes.

But we're trying not to make the mistake of disguising selflessness for selfishness - an integrated "do not cull out" approach to altruism and a healthy attitude towards capitalistic profit guide our decisions in kind. If a good would cause more momentum in the public domain, we'll drop it there. If a good can be privatized, yet still work in concert with our goals, we'll do it for a paycheck.

This isn't the last application Nexthealth will produce - it's the first of many.

We're thinking ahead to sustainability for the collaborative and other projects already in the design life cycle (including others that will generate revenue). We've got multiple other plans in the works. In fact, Martijn Hulst and Jacqueline Fackeldey present some additional ideas and concepts this week in Holland. Break a leg both!

At Nexthealth, we generate a different business model, with different principals 'shepherding' the project, for each product.

You'll be seeing both more 'public' and 'private' goods developed by the Nexthealth team, sometimes in relative 'isolation' and sometimes in cooperation with other organizations.

This application is the getting-to-know you handshake from our group. It's the best business card in the world - showing we're capable of producing with limited resources and extreme creative prejudice. Consider it our proof of concept, the ultimate whitepaper.

In order to understand why we'd be crazy enough to do research, detail a new model, nearly kill ourselves trying to design/build an app, and then be totally committed to giving it away for free without 'commercial bias' or interference, you have to know a bit more about the group nuts enough to try this.

The short version: Maarten and I are social entrepreneurs who are part of a health innovation COLLABORATIVE (Nexthealth) with a page here. The model/application we described at Medicine 2.0 is just ONE of the projects we have in the works. The collaborative produces both 'public' NFP goods, and 'private' FP goods, and we don't separate the two in our daily business activities.

So, about Nexthealth (the group):

NOTE: I'm taking a stab here at putting 'how we work' into terms many readers can follow...some of my Nexthealth Dutch buddies may have other descriptions (Jacqueline, I know you'd die before using the "PM" acronym for instance:).

1. We are a hive collaborative nonprofit founded in April in the Netherlands (following the first Health 2.0 Unconference NL) with two 'arms': NL and the US. I'm mostly US, the others are mostly Holland, although there's some definite flux.

2. Nexthealth has a core group of 6, but our initiatives almost always involve others recruited from the hives of our personal and professional networks.

A basic snapshot of how our current workflow looks:

• Someone's radar picks up a project they're interested in doing. Sometimes we find it, sometimes it finds us. They bring the idea back to the group (6) - usually first via email, Twitter, Skype, and other social web tools.
  

• Much discussion ensues. Normally the person (or persons - Maarten and I often work as a team) who introduce the idea becomes a 'Project initiator' or internal PM (except many of us call ourselves 'firestarters' - that's just the way we roll).
  

• Sometimes the discussion is kicked offline in one of our famous meetups, but often we get rolling without having seen each other in person (ROPE and ROWE), and have multiple projects and initiatives on the whiteboard (literally) during our next face-to-face.
  

• Sometimes the person who introduces a project just throws it out for discussion and another core member becomes the initiator.
  

• IMPORTANT NOTE: The initiator isn't static. If a project reaches a stage where the initiator loses interest and/or doesn't have the skills/time to continue (most common), someone else picks up the ball and runs with it. We find this change happens, oh, less than 25% of the time (estimate) as we each tend to introduce things about which we're invidividually passionate.

• We decide, kind of individually and collectively, if the project has anything in common with our goal and 'ideal' healthcare system: first, does it connect people, online and offline, interested in improving healthcare? Second, does it work towards semantic interoperability of health - "consumers will be able to access healthcare goods and services, online and offline, at will?" If the answer to one or both of those is yes, chances are we'll take it somewhere.

• Kickoff! The project initiators (and other core members) recruit/recommend resources (human and otherwise) to complete the project. The initiator largely directs the initiative and keeps the group updated on progress via the social web.

• The Payola: Sometime we get paid (for profit, "private" goods) and sometimes we don't (NFP, "public" goods). If we get paid as a group, the revenue will be split according to prearranged terms based on who works on the project. Obviously we aren't making much money yet - the group is bootstrapped for now, and each of us have other gigs outside of Nexthealth (all in healthcare).
  

Also Scott, let me apologize for leading you and other readers on a bit over the last few days.

Maarten and I have been working on the research/model just since the latter half of April. Things have been moving so fast we haven't provided substantive information (operations, people, etc.) about the Nexthealth group itself as quickly as we should have.

At Medicine 2.0 there was so much conversation about the model (and where healthcare is going in general) that we didn't get around to specifics of business models for the group and the application.

That's no excuse, however.

I've tried to remedy that oversight here.

In addition to doing completely new research in Health 2.0 (and trying to act as a bridge between 'commercial' and 'entrepreneurial' Health 2.0 types and 'research' and 'academic' Medicine 2.0 types), we're operating under a new type of business model, a hive collaborative, with our current 'alpha' workflow process detailed above.

Also keep in mind that this is an organization just learning to hold its head up....we're in the infancy of Nexthealth. Our birthmonth is April 2008.

We recognize the org. structure is liable to morph and go through various refinements as the 6 original principal founders (myself, Maarten den Braber, Martijn Hulst, Jacqueline Fackeldey, Niels Schuddeboom, and Jeroen Kuipers) determine what's next for each of us individually as well as for the collective.

Some will stay, some will go. We'll add new members, new strategies, and new revenue streams as we learn to crawl.

But with this sort of commitment to sparking global healthcare innovation, skinned knees and elbows are inevitable. It's how we react to the stumbles that'll show whether or not we're one of the groups to be running at the front looking for what's next.

Nexthealth Elevator Pitch

This is where healthcare is going, the gold standard of semantic interoperabilty.

Consumers WILL be able to access healthcare goods and services online and offline at will.

This means consumers will have many choices to make in healthcare - how? where? when to access? which sources are credible? which providers protect my privacy? which hospitals provide services online and offline?

At Nexthealth, we use a database and graphic UI to organize knowledge so users can organize their health choices.

Nexthealth is literally the launch pad and the landing site for healthcare decision making.

It's a neutral, free interactive process for anyone who needs to make a healthcare decision - consumer or producer.

You won't see ads on our site. We don't charge subscription fees and are organized as a nonprofit. We're a credible, trusted, 'helpful' partner in consumers' time of need.

When your health is on the line, a lot of emotion and subjectivity is involved.

This model supports rapid decision making in very stressful situations. We provide a logical, rational, clear scaffolding that guides you through making tough choices in tough times. But we're not making diagnoses, we're not a 'recommendation' engine. Think of Nexthealth as an objective exoskeleton, providing the framework to break healthcare decisions down into manageable bits and pieces.

We start directly with the consumer searching for health decision support. Througout the process we facilitate navigation to other resources with health-related information we do not provide ourselves, but rely on trusted Health 2.0 partners to architect. We refer users to these partners.

Armed with that information patients go about the next step in the decision process, which is further defining what's important for their decision. The end of a user's interaction with the model is when they subjectively determine that they have made their decision ("Click the button").

Let's take a closer look at the experience of being a patient. With a devastating diagnosis, a consumer is suddenly required to evaluate options for treatment based on personal life goals. Most of us don't know we have choices in healthcare until that terrible moment arrives.

Suddenly, you need to be able to decipher a stunning array of options - which hospital is the 'best' for this condition? Which doctor is rated highly by patients and has a low malpractice rate? Where can I talk with other people who have lived through something like this?

Say you go to Google. Good luck sifting through search result for ones that mean alot to you. Current search engine optimization techniques sell the consumer short - we value search based on keywords, terminology, rather than the meaning each word has, the impact a diagnosis has on our daily lives. We can't search for healthcare resources based on the decision we need to make - right now we can only search based on the phrase someone else determines has meaning and relevance.

Who or what is there to help consumers make these decisions in an objective way? Right now? No one. Nothing. But Nexthealth fills the gap between current services, content and community online, and how consumers move towards action, the do/buy decisions required to go forward.

At Nexthealth we don't judge your decision. We don't put any limits on the process. Bring your baggage. Have a seat. Use the tool for as long as it takes. As many times as it takes. We walk you through four specific, concrete steps to arrive at a decision. When to start, stop, communicate, or abandon the process is entirely up to you. Like decision-making in the real world - maybe you're not ready to take the next step. Don't worry, no pressure.

Bring a box of tissues, your anger and confusion. We'll help you bring simple, welcome clarity to the process of determining where you are now, and provide the support system that helps you create a roadmap to where you're going next.

Need help making the decision? At every step of the way, Nexthealth gives you the option of connecting with Health 2.0 content and community sites that support your decision process. We've done the due diligence and provide partners without commercial bias.

We don't charge you anything to use the Nexthealth tool. Ever. And we don't sell, rent, or give away your information. We firmly believe the tools to make better, more informed healthcare decisions should be open-source, in the public domain, available at no cost.

The only thing we're selling is the barn-burning concept that you have choices to make in healthcare. Who's in the driver's seat? You are. We're the wheel, the brakes, the chassis. How fast you need to travel is up to you.

Are you ready to map your next steps? 3.2.1. Liftoff.

It's your health - what's next?

Nexthealth Model on The Way...

After hours of feverish coding, emails, phone calls, and international Skype chats, we saw the first Flash animation elements and very rough mockup of our Nexthealth model.

I will tell you that after 3 hours of sleep, with a team of 3 calling in from an office in Baltimore, MD, a family vacation on the Potomac in southern Maryland, and a library in Amsterdam, what we're doing seems even more incredible.

Try using Skype video chat, holding up a graph mockup of the website you've just drawn, showing it to a partner in Holland, while also talking on the land line to your web design partner in Baltimore, who's also walking you through an online mockup of the application.

This is the way thought moves to action in tomorrow's healthcare innovation teams.

Even more amazing than the multi-channel method of communication we've adopted is the way this thing is being built.

Nexthealth co-founder Maarten and I met online at Tony Chen's Hospital Impact Ning site last year before I moved to Holland, and we met a sum and total of once in person before kicking off the Health 2.0 Unconference NL in Amsterdam last April.

We drew the graph we're turning into an interactive roadmap to consumer-centric care on a small whiteboard in his apartment the first time we met for dinner to discuss the Unconference. He drew an x-axis, I drew a y, and we were off.

We've been drawing and refining this &^% graph on cocktail napkins, flipcharts, and available forearms ever since.

Talk about collaboration - it gets even crazier.

I recruited Brad Sugar, our web guru extraordinaire, after being left high and dry via a recommendation from a friend who flaked. Oh yeah. And I found Brad (or he found us) on Craigslist. LAST THURSDAY.

The very rough teaser: We're building an interactive, 'free range' decision support model that lets healthcare users create a roadmap to consumer-centric care.

Health 2.0 sites give us content. They give us community. But consumers still have to find ways to integrate that information and social networking in a way that supports the choices they have to make about what's next for their own health.

It goes beyond needing to verify credible sources or incentivize behavior - first we have to give consumers tools to help them make choices that are relevant to their needs, wants, and lifestyle.

Who or what currently helps a patient answer the question: Which hospital do I choose for my knee replacement surgery - hospital A or hospital B?

Who or what currently helps a physician answer the question: How competitive am I with other docs in my practice area and local environment?

The Nexthealth model walks users through the process of making these decisions in a non-intimidating way.

This baby is the first of its kind. Free to use. You won't see any ads on the site. You won't have to pay to play.

You'll be able to test it anonymously, sign up by yourself or with a strategic planning team. Send someone plotted points. Maybe even connect to other Health 2.0 firms using a search function, but that'd be phase II.

We're building the site, graph, database, and animations in (deep breath) just under 2 weeks. We hope. To say this is one of the most intense work periods of my professional life would be the understatement of the century.

This is an incredible commitment of time, energy, and brainpower by three people who believe in the 'holy grail' of semantic interoperability for health: Consumers will be able to access healthcare goods and services, online and offline, at will.

We also believe this needs to go free-range rather than be kept in a consulting firm's closet somewhere, to be parceled out hospital by hospital, physician group by physician group.

We're talking about providing something real, concrete, to help accelerate our system's evolution to consumer-centric care.

Maarten den Braber and I will present research on the evolution of consumer-centric care at Medicine 2.0.

If you'll be in the Toronto area September 4-5th, please join us.

To the friend who told me at the last Health 2.0 show that I was ready to get something started - You were right. More than ready. I was afraid of failure, and it was holding me back.

And maybe the worst will happen - we fail. Maybe the graph doesn't work, or maybe only our friends and family use the tool to make us feel warm and fuzzy.

But it's time to stop talking about how to bring consumer-centric care to the fore and try something new. If we fail, we'll keep trying. Building other decision-support applications.

Nexthealth is on the way. And it's just the first step.