How do we close the loop on patient education?

Depending on the condition, "rookies" in diabetes, hypertension or other common chronic conditions will fail to comply with doctor instructions anywhere from 29-71% of the time.

MedTera, a unit of a Connecticut-based graphics printing company, fights this with pamphlets, Web sites and even mobile apps. (Picture from the Mayo Clinic.)

It uses a sponsorship business model, president David Duplay explained to me yesterday.

Drug companies, insurers and trade groups all pay for MedTera to do its best for people, and Duplay has a case study called "Rookies at Risk" attesting to some success.

The problem is this is like having a relationship with a manufacturer that doesn't go through a retailer. How often do you fill in a warranty card and send it in? Even online compliance is limited.

What keeps MedTera from doing more? Privacy and business models, Duplay said.

"In theory prescribing this sounds nice. But I'm concerned about privacy, about who else might see that information, what firewalls there are, how secure is that data." So, "We don't call on the doctors." The pamphlets usually come into the office through drug company reps.

Besides, having a doctor in the relationship costs the doctor money.

"The doctor is going to ask if he's being compensated for the time spent on email. Will it reduce malpractice costs? Will third party payers reimburse? What's my liability?

"There are unanswered questions from the medical community, and since most physicians are small practitioners it is going to take a while" for change to happen.

This is the heart of the health reform dilemma, a question of business models.

Personal relationships aimed at coaching people in wellness may save tens of billions of dollars, as people who comply with medical advice are more likely to stay well. But it may also cost billions, and where will the money come from?

Lots of tech companies, including Google, have tried to solve this problem with technologies such as Personal Health Records (PHRs), which patients can create or download from hospital and insurance Web sites.

Other companies, ranging from Healthline to WebMD, have sought to add personalization and improve compliance. There are also social communities like DiabeticConnect, seeking to build coaching relationships between patients.

Some of these Web companies make money, but for most of us something like MedTera is state of the art. It's profitable because the margins on wellness are enormous.

Improving compliance, and wellness, might narrow those margins. But before that happens we need better wellness business models, and deeper relationships than those afforded by pamphlets and apps.

This post was originally published on Smartplanet.com