Dr. Facebook, I Presume

Reuters has reported that Facebook is planning to join the rush by tech giants (e.g., Apple, Google, Amazon, Samsung) to get into health.  I'm not sure if I "like" Facebook's rumored move but I'm sure going to comment on it.

As was true with the reports about Amazon, details are sketchy at best.  Reuters' sources suggest that Facebook is interested in "support communities" to connect users with specific conditions, and may possibly also offer some "preventive care" apps.  Earlier this year Facebook had bought activity diary app Moves, signaling its interest in health.

The support communities would be a logical brand extension, and are undoubtedly being done informally within friend circles to some extent already.  There are countless such online communities, the granddaddy of which is probably Patientslikeme.  Patientslikeme has successfully monetized its patient communities, allowing patients to let researchers to use their data via various collaboration tools, so Facebook may figure they can do even better.

Of course, just because Facebook may want to jump into a new field doesn't guarantee their success.  Anyone use the Facebook phone?  I thought not.

Partly because of Facebook members' concerns about protecting their privacy,  Facebook may release its first apps under a different name and/or allow members to use the service under aliases.  Facebook just unveiled its new ad platform that will gather data on what members do even on other sites, so I'd say the privacy concerns are legit.  Moves, for example, has already changed its privacy policy to allow it to share data with Facebook and Facebook companies.  Facebook will quickly find that privacy is even more paramount when it comes to health information.

Anyway, I think it's great that Facebook is interested in health.  Companies with expertise outside health can help bring new thinking into our rather in-bred health care system.  As I wrote in Getting Our Piece of the Pie, though, I worry that the tendency will be for them to be co-opted by the existing players rather than overthrowing them.  Health care may not be as easy to fix as it looks.

Since I'm still waiting for Amazon to call about my suggestions for their entry into health, I'm free if Facebook wants to pick my brain.  Here are a few ideas:

• Support communities: this actually is a good idea, but much lies in how it is done.  I'd suggest creating a second, pseudonym-version of a member's profile, which can join specific support communities.  Regular friends could -- at the member's option -- see any updates or comments the member said in those communities.  
• Updates: for years CarePages has allowed patients and their family to update their extended circle about a patient's condition and progress.  Many hospitals use CarePages as part of their digital strategy.  Frankly, I'm not sure how CarePages has survived in a Facebook world, but consciously adopting a similar strategy or even buying CarePages might be a smart move for Facebook.
• Advertising: OK, let's face it -- whatever Facebook does in health, they're going to find a way to advertise on it.  Maybe we should give in to the inevitable and focus on what that advertising is.  If it is simply selling health-related products that patients may or may not need, shame on them and on us if we fall for it.  If Facebook wants to be more strategic and, say, match up top-ranked providers with patients in need, then that would be progress.  I've proposed this kind of "provider exchange" before, especially for Amazon, but maybe Facebook can get there first.
• Provider messaging: Facebook has shown considerable interest in messaging, what with Messenger and WhatsApp.  They're even talking about using it for mobile payments.  Patient-provider messaging would be a very logical entry point for Facebook, competing with American Well and other current services.  

I want to loop back to privacy and to putting members' interests first.

The recent release of information (Open Payments) of financial ties between providers and drug/medical device companies is both eye-opening and instructive.  According to the CMS database, in just the final five months of 2013 some $3.5b was paid to providers.  This is with one-third of the data removed due to some provider matching problems.

Most providers didn't get very much money, but a number got well in excess of $100,000. The Wall Street Journal reported at least 2 physicians earned over $4 million in that five month period.  You can't tell me that level of payment has no influence.

True to form, the AMA issued a statement supporting transparency and opposing "inappropriate, unethical interactions," but cast doubt about this particular effort at this time.  They want to help CMS make improvements "to ensure the data is presented in an accurate and informative way to help patients understand and interpret the information correctly."

Yeah, thanks for that, but I think we get the picture already.

The size of these payments -- call it close to $10b on an annual basis -- is tiny in comparison to our overall health spending, but I look at them in the same way I look at political campaign contributions, which are small in comparison to government spending but which certainly seem to buy outsized influence.  Many voters have lost confidence in their elected officials, in no small part because of this lobbyist influence, and if health care providers aren't very careful the same will happen with patients.

The lesson in all this is that, whatever Facebook does in health, it absolutely needs to demonstrate that they are putting their members first, not just using them for its own monetary gain.  We don't need more players whose motives and financial motivations are unclear.

For years, Facebook's mantra was "move fast and break things," which, honestly, is exactly the attitude I think health care needs in order to innovate.  Their new mantra -- "move fast with stable infra[structure]" -- is not as catchy, but perhaps it is designed in part to assure the more staid health care community that patients and their data will be protected.  We can hope, anyway.

So if Facebook does enter the health space, what leading companies from outside health care would be left on the sidelines...and which will be next?