by Susan Solomon

Most of us go shopping for books online. Some of us even shop for houses and cars. So, why not use your computer to shop for health care?

That’s the basic premise of Carol, The Care Marketplace (www.carol.com). Carol is an online mall where consumers can browse, compare, and select health care services, view base prices (including estimated in-network and out-of-pocket costs), and search clinic locations – similar to the way they shop online for other items in their lives.

Carol launched in January of this year and focuses on providers in Minnesota’s Twin Cities market. Marcia Miller, Carol’s chief marketing officer, says that the company is looking into expanding to other major markets, but Minnesota was a logical place to start. She points to the state’s laws, which enforce transparency in health care pricing – and make posting actual prices for services much easier than in other states.

Carol was conceived out of a passion for consumer-driven health care, took about a year to launch, and was funded with $35 million in venture capital. The organization’s president, Tom Valdivia, is a physician, futurist, and e-commerce enthusiast who has spent several years exploring the Web’s ability to empower consumers. Carol’s CEO, Tony Miller, was formerly CEO of Definity Health, a Minneapolis-based company involved in the early stages of health savings accounts and other consumer-driven health benefit products, which has since been sold to UnitedHealth Group. Miller states that fixing the complex, confusing state of today’s health care delivery “is a calling.”

Why the name Carol? Marcia Miller explains that the name was chosen to represent a trusted female family member, friend, or associate. “We didn’t want to sound like every other health care company,” she says. “Carol is a woman because most of us usually ask a woman for a health care referral.” She adds that Carol, a typical name from the 1950s, infers the woman is “a bit more experienced.” “We all have a Carol in our lives,” she states.

Carol staff members admit that changing consumer behavior has been challenging. Right now, the site gets about 1,000 visitors per day, and Marcia Miller reports staff members are “impressed” by the number of health care service purchasers, although she did not provide the actual number of transactions. Currently, Carol drives traffic to the site through radio and other direct-to-consumer marketing, as well as relying on referrals from the health care community and current users.

Another issue has been getting providers to participate. Providers with services that are traditionally marketed directly to consumers have been most responsive to the Carol concept. “Obviously, cosmetic surgery, dentistry, and LASIK surgery are more easily bundled and marketed online,” says Marcia Miller. “When we start talking about cancer and heart care it’s often more difficult, although interest is growing.”

Other areas where Carol sees potential are in medical education, elective procedures, and tests and medical tourism packages. Mayo Clinic uses Carol to market its “virtual” packages for pregnancy counseling. Carol is also currently in discussion with a service for genetic testing.

Care packages
One of Carol’s unique offerings is the care package, a bundle of related health care services. Packages are currently offered for chronic and minor conditions, routine examinations, and hospital-based services. For example, there’s a package for neck pain evaluation and treatment. Carol works closely with physicians and health care providers to develop and bundle their care packages. Providers set a base price (i.e., the amount a cash-paying consumer would put down) for each of their care packages. The entire cost of care is provided on the site, and there is a calculator to figure out-of-pocket costs for various insurance plans. For those insurance providers not yet represented on Carol.com, the site offers estimates for out-of-pocket expenses so consumers have a truer sense of the amount they are responsible for when selecting a care package.

In some cases, consumers can compare specific care packages from various health care providers in a side-by-side view where they can see the service offering breadth, the estimated cost (both base and out-of-pocket) of each package, package features, the provider’s quality measures, location of clinics, appointment availability and duration, and related therapies and diagnostic services. Some packages also include supplemental health education literature on the health care concern being treated. Carol staff members say that posting prices hasn’t exactly started a bidding war among health providers. They contend that with so much information readily available, price is just one factor in the health care decision.

A bit like Travelocity.com
Once a consumer has selected a care package, specific scheduling directions are provided. Although most appointments are scheduled via phone, some of Carol’s providers have online scheduling capabilities. Carol then notifies the health care provider about what care package the consumer has selected, using a secure fax to comply with HIPAA privacy guidelines. When patients arrive for their appointment, they either present a printed copy of the care package receipt or their care package reference number. Patients then see the care provider and receive the care outlined in the care package, just like any other doctor appointment. And, of course, they know what the price will be ahead of time, so there’s no “sticker shock” at the end of the session. Marcia Miller compares the experience to buying a plane ticket on Travelocity.com – consumers know what they’re getting and how much it will cost.

Although consumers cannot choose services a la carte within a care package, Carol plans to gather feedback on what consumers want to see in future care packages, ultimately allowing consumers to “design” packages that meet their care needs. Carol does provide “add ons” to each care package that, according to the company, “can make a package feel customized.”

Consumers participating in the “Carol community” are encouraged to leave feedback about their experiences. To date, however, most of the comments are questions to the Carol team about services available and basic “how does it work?” inquiries.

Some 30 mall ‘tenants’
Currently, some 30 health care providers participate in Carol (they’re called “tenants” because they occupy space in the health care mall). These primarily Twin Cities organizations include: Northwest Eye Clinic, Southdale Pediatric Associates, Twin Cities Orthopedics, Park Nicollet Clinic, HealthPartners, Ridgeview Medical Center, and Metropolitan Obstetrics and Gynecology. Several individual physicians are also listed, along with a diagnostic imaging center, a group of family physicians, and a medical testing lab.

Although Carol’s services are free for consumers, the site’s tenants pay a monthly “lease.” Each individual tenant contract is unique, and the rate is based on the number of locations, care packages, and level of programming and development required by Carol. The Carol team says rates can be as low as $400 to $500 per month for a single provider with a single location. Larger providers’ monthly leases can run several thousand dollars. There are also click fees associated with actual delivery of care; the provider is charged a small click fee only after the service is scheduled and completed.

So far, Carol’s “tenants” have been positive about the site, particularly because it seems to be well positioned with the concept of consumer-driven health care. “Carol is a cutting-edge development in health care and a new way of bringing value to consumers,” says Mary Brainerd, president and CEO of HealthPartners. “People need to know how much health care costs and what they are getting for their money. Carol does that by creating care packages that are relevant to consumers and help people know what to expect and how much it will cost before they receive care. That’s something that hasn’t been available to individuals before, which makes Carol a great opportunity for HealthPartners and others to change health care.”

Marti Crosby, manager of product development and new offerings at Park Nicollet Clinic in Minneapolis, says her organization signed on with Carol because Park Nicollet has “a history of being an early adopter.” In March 2007, Park Nicollet became one of Carol’s first tenants.

“We were attracted to the concept of being more transparent and giving consumers the opportunity to shop and compare,” says Crosby.

Park Nicollet has been involved with Carol for more than a year, helping with much of the initial planning and the early creation of care packages. “Carol approached us early on to talk about the type of services that could be available. Lots of wonderful ideas came about and we helped [Carol] conceptualize the care packages,” says Crosby.

Presently, Park Nicollet offers 50 care packages through Carol, including primary care, women’s heart screening, early pregnancy, and baby care. Crosby says that the “health coaching” package is the most popular. The package includes a seven-week program for addressing key lifestyle changes – stress reduction, nutrition, and weight loss. Eventually, according to Crosby, Park Nicollet hopes to address more specific preventive care with its packages, such as offering a year’s worth of health advice and coaching for those prone to diabetes.

Although not all of the staff physicians at Park Nicollet were initially on board with the Carol concept, they have found that those patients choosing the care packages are both informed and more engaged. “The patients bring their printouts with them, and they’re very excited. For the doctors, this is also very beneficial because patients are more engaged on the front end of care,” says Crosby.

Crosby notes that she has spent considerable time fielding phone calls from other health care marketers wanting to know about the benefits of signing on with Carol. For Crosby and Park Nicollet, it’s an indication that the Carol concept will catch on soon.

“We believe that this company is headed in the [direction] of health care’s big changes,” says Crosby. “With higher deductibles, people want higher control. They want more information and more transparency. We only wish we could do more and have more services available through this service.”

Susan Solomon has worked in health care marketing and public relations for more than 20 years. You can reach her at Sussol@gmail.com.