Google changes health search rules

Given that one in 20 Google searches is for health-related information, Google, Inc. recently decided to try something new. In February, the global technology firm, in partnership with Mayo Clinic, launched a Web health-search product that it says is giving U.S. consumers “a better place to start” in finding reliable, vetted online information on health conditions such as concussion and measles.

Industry experts assert that Google’s still-evolving product, while perhaps a “useful first pass,” won’t replace nurse advice lines or other information tools used by managed care organizations (MCOs) for members. Some MCOs, including Cigna Corp., also tout their own online information sources as offering increasingly sophisticated information on local provider costs and quality directly related to members’ coverage and geography. But such efforts, even for national MCOs, are by their nature more limited than massive Google’s efforts--and may come later in the information-seeking process.

Conservatively, Google, which posted $66 billion in revenue for 2014, gets several billion hits a month from consumers seeking health information--even before they approach their physicians or other providers in their insurers’ networks. Studies by Pew Research Center and others indicate that about eight in 10 consumers seeking health-related information begin with a search engine.

“A thread that runs through all this is consumer trust,” says Harry Greenspun, MD, director of the Deloitte Center for Health Solutions in Washington, D.C., the consulting firm’s research arm whose scope of work includes regular consumer surveys. “...It’s very common for people to do Web searches for information, but they bring the information to someone they trust more.”

NEXT: What it means for health plans

Among consumers seeking health information, there is “real skepticism once you [look beyond] government agencies and organizations that are specifically aligned around a particular disease,” Greenspun says. Payers, pharma and employers--those entities trying to send the most information to consumers--actually rank at the lowest level of trust, especially amid privacy concerns, he says.

Against this backdrop, he says the jury is still out on consumer information partnerships among technology firms, healthcare companies and other businesses, viewed with varying levels of trust. “Just because you create this, doesn’t mean consumers are going to use it....Mayo already has this data on its website,” Greenspun says.

Consumers’ “needs haven’t changed much,” he says, but their expectations have risen considerably. “Millenials in particular want to get information the way they want to get it,” Greenspun says. “If someone has a question, they’ll want it answered on the device, in the moment....So the question will be whether health plans are serving consumers in the ways they want to be served.”

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The bottom line for health plans? “Plans need to understand what their consumers want,” Greenspun says. “Consumers may or may not use this kind of thing [i.e., the Google/Mayo search product]. If they don’t trust this information, they may just do what they’d do anyway--and call a nurse advice line [or another source]...But it could be important because the first call that you make will often determine your ultimate outcome and the cost.” A person with neck pain, for example, might call a primary care physician, a neurosurgeon, an orthopedist, a chiropractor or a massage therapist, he says.

“The real lesson here for plans is that disruptions are everywhere, and there are lots and lots of traditional and nontraditional players [partnering with each other]--and they’re jumping into healthcare and challenging traditional business practices,” Greenspun tells Managed Healthcare Executive. “In an era where consumers are becoming more powerful, organizations that can meet consumers’ needs better are likely going to erode existing business models...disruption is the new norm now.”

NEXT: Not trying to replace medical advice

Not trying to replace medical advice

 In its new health-search venture, Google is using Knowledge Graph, a Google app that provides more than a list of Web pages related to a search. Included next to page links is boxed information on typical symptoms and treatments, details on how common the condition is, who it affects, whether it is contagious, and so on, sometimes accompanied by medical illustrations.

Google’s Prem Ramaswami, the product manager directing the health initiative, told Managed Healthcare Executive in an exclusive interview that Google has been interested in health searches since its inception. Google wants to help users by “providing an introductory framework from which you can have a really useful conversation” with your physician, he says.

In general, Google wanted to better understand the health space, according to Ramaswami, and to build a database of health-related information similar to what it has done in other fields. He says the effort evolved from the idea of looking at a condition’s basic symptoms to consideration of other matters, such as its prevalence, in order to “take users down a safe path.”

Ramaswami explains that Google “crowd-sourced information,” paying more than 150 medical doctors across the U.S. to review materials and to give Google “prevalence ratings,” such as whether asthma always presents with a cough. Google also has medical doctors on staff who review information, he says, explaining Google is aware that “getting health information wrong can have really bad impacts.

“We are in uncharted territory...so we hired a medical director on staff to implement the process,” he says, adding that the information-vetting process with 150 doctors is ongoing. He explains the idea is to present “the medical gestalt,” and not the latest information on cutting-edge research. For example, doctors vetting information on Ebola determined that a rapid test for Ebola, while FDA-approved, is not yet commonly used, so this test isn’t included in Google’s “knowledge graph.”

NEXT: Mayo Clinic "an excellent partner"

Google thought about who provides accurate health information and is a well-known brand, then asked Mayo Clinic to be a partner, Ramaswami says. Google approached Mayo on the new health-search product, he says, “but Mayo has also approached us for years about how to be a partner.”

According to Ramaswami, Google presents health information to Mayo-- “Here’s a condition and here are all the facts and prevalence”--and asks Mayo to tell Google if it is “missing anything along the way.” He says there are space constraints for information since Google’s app is designed for a mobile phone; but even though the source line is listed as “Mayo and others,” with a hyperlink to Mayo’s website, he says other resources are listed under “Learn more.”

Mayo Clinic has been “an excellent partner so far,” Ramaswami says, but he stresses that Google is working with others on reviewing health information. Each of the facts in the knowledge graphs has been reviewed, on average, “by 11.1” medical doctors, he says. He describes it as a rigorous process: “We really spent a lot of time to make sure a lot of eyes are on these graphs.”

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Ramaswami says the health product partnership “makes good sense” for both parties, and that Google is keeping its options open with respect to future initiatives. “We view this as an initial foray into health, and there’s a lot more we want to do over time,” he says. For example, Google may do more with its information for people doing searches on prescription drugs, expanding on materials it compiled on Lipitor and other drugs a couple of years ago, he says.

NEXT: A 'first pass'

Thus far, Google has completed information for about 400 health conditions, and wants “to add more conditions and make the graph more applicable,” Ramaswami says. Google wants to make this health information available globally over time, he adds, noting that medical care isn’t as accessible in some parts of the world as it is in the U.S., and some conditions are rare in the U.S. but not elsewhere. 

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Ramaswami says Google, through its constant monitoring of Web searches, “knows what people are looking for on a daily basis,” and its completed information on 400 conditions represents a significant portion of what is being searched for. “Google has tried to build prevalence information...and just because it’s rare doesn’t mean people aren’t looking for it a lot,” he says, citing Ebola as an example.

Just prior to Google’s launch of information on measles, vaccination was in the news because of a recent outbreak in the U.S., he says. To “disseminate good health,” he says Google’s measles description is: “A viral infection that’s serious for small children but is easily preventable by a vaccine.”

Overall, Google is getting good feedback on its new health-search product from users, Ramaswami says. He notes this is the first time that Google is building user graphs using experts, and some physicians are telling the company that they want to be able to print out the materials for patients.

A ‘first pass’

Broadly speaking, some healthcare industry insiders say Google’s new product, as an effort at promoting more transparency in healthcare, is welcome. But others voice concerns.

Morris“I think a lot remains to be seen,” says Caitlin Morris, health system transformation program director at Families USA, a healthcare consumer advocacy group.

In general, Morris says that, while she isn’t sure the Google/Mayo initiative will prove to be of great benefit to consumers, “any sort of effort to direct consumers to more validated, more useful information is a good one.” Such direct access to validated information reduces problems associated with finding less credible information, she says. But she notes that Google and Mayo are businesses, so their venture “can be perceived as an ad--which doesn’t mean it’s not a credible service.”

Moreover, Morris says the way in which health information is presented can bias consumers--and “what it selects to display can have real consequences for folks,” especially with respect to treatments. Thus, she says, people must understand the Google health search “is very superficial and a first pass at information, and not a replacement for a conversation with a doctor.”

As for whether Google’s product could replace other consumer health-information tools, Morris says: “I wouldn’t see it as a credible replacement for tools that health plans provide to support consumers outside of the doctor’s office, like nurse help lines...which respond to individual needs.”

NEXT: Cigna's health info tool

Cigna’s health info tool

MondyCigna spokesman Joe Mondy says Google’s venture into improving health searches could be helpful. “As a principle, we think all forms of transparency are important,” he says. “When Google says they want to provide tools, we say, ‘Come on in.’”

But Mondy notes that Google has “been in the game in fits and starts with various partners,” whereas Cigna has spent the past 15 years steadily improving its information tool in its role as a health-service provider for millions of customers.

Cigna offers its own online information tool--myCigna.com--to 14 million-plus consumers, including members and their families, he says. It has evolved from a network provider directory and now offers in-depth quality and cost information on network physicians; pharmacy drug-cost comparisons; information on MRIs and other procedures, including hospital charges and pricing ranges; and other data for comparison shopping. Data are updated in batch work on a weekly basis, he says, and quality measures are vetted with network physicians before approaching consumers with the tool.

Cigna also uses Google maps and color-coded pins to show doctors’ ratings and locations, he notes.

The insurer has “virtually 100% saturation” of medical members registering to use myCigna, he says, “and the number of visits is dramatically rising, particularly on the app side.”

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In 2014, Cigna had 28 million customer visits to its professional search engine, Mondy says. While the plan offers cost and quality information on 110 medical and dental procedures comprising almost all of its claims (up from 80 procedures in 2014), he says, about 8 million hits were related to three procedures: colonoscopy, MRI and mammography. Cigna also offers pricing information on 60,000 pharmacies.

Cigna added the capability to perform cost analysis to its mobile app in 2014 and had 3 million app visits last year, says Mondy. It may begin “anticipatory computing” (monitoring what members are looking at and anticipating what else they might be interested in) in the next few years, he adds.

“You could start there [i.e., with a Google search], then go to myCigna to see what doctors and hospitals specifically charge according to your plan, determine how much money is available in your Health Savings Account, get real-time information on where you are with your deductible and your co-insurance,” Mondy says. “[Ours] is a very precise tool that does the math for you.”

“We want to make consumers more proactive and better partners in their care,” Mondy concludes, echoing Google’s Ramaswami.

Judy Packer-Tursman is a freelance writer in Washington, D.C.