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What is next for healthcare IT provider American Well, whose innovative Online Care technology allows physicians to deliver care to patients online in real time? Using American Well's platform, patients with non-emergency health concerns can communicate with physicians online or by phone and receive advice or even a diagnosis without having to visit the physician's office. American Well's co-founders, Ido Schoenberg and Roy Schoenberg, believe this platform will reduce the cost of care delivery; create new revenue-earning opportunities for providers; and contribute to a more efficient, convenient healthcare delivery system. While the platform could benefit insurers, providers, employers, and patients alike, the company has only marketed to a few health insurance companies to date. In November 2009, 3 insurers have adopted the technology, and American Well expects several more to do so over the next 12 months. As the company plans to accelerate adoption by health insurers, it is also considering other growth options. Is it too early to commit resources to developing and marketing American Well's second-generation product, which facilitates real-time connectivity between primary care physicians and specialists? Should American Well pursue new markets in the U.S., such as hospitals, chains of clinics, and pharmacies, or even expand internationally? In a broader sense, American Well's technology solves the economic obstacle of time and place by connecting excess supply (of physician capacity) with excess demand (for patient care). Could this model be adapted to other industries, such as legal and accounting services? Alternatively, should American Well continue to focus solely on its primary product and on becoming the leader in the Online Care Industry?

Consumer-directed healthcare promises to reduce costs and increase quality by expanding provider choice for prospective patients. High-deductible insurance, employer- or government-subsidized health savings accounts, transparent pricing, and accurate information on clinical performance help generate millions of patients shopping for healthcare. As in any other well-behaved market, when patients shop, there is a link between financial reward and value for the individual patient. Absence of price competition, agency problems, and high barriers to entry in local markets are market failures that currently break this link in U.S. healthcare. Consumer-directed health plans are already popular among many employers and have established a momentum that indirectly shapes discussion of reform by the Obama administration. Complexity of reporting clinical results, dependence of treatment success on at-home patient behavior, and scientific ignorance among consumers threaten delivery of results promised by theory. Successful implementation requires regulator attention to sophisticated data reporting that adjusts for clinical risk, avoidance of patient-focused marketing that leads to over-consumption, and adequate subsidy of health savings accounts. In the end, implementation shifts the locus of healthcare system control from cost-shifting negotiations between employers, providers, and payers to new-found purchasing power of prospective patients.

Anticipating the expiration of its Prozac patent, Eli Lilly has to make tough decisions regarding the development of its next-generation antidepressant drug. In particular, the company needs to decide whether to first establish that once-a-day dosing for Cymbalta (Duloxetine) is effective in treating major depressive disorder and only after launch get FDA approval for treating painful physical symptoms, or to first establish efficacy in treating pain and later get FDA approval for once-a-day dosing. The decision needs to take into account how Cymbalta can be differentiated in the marketplace vis-a-vis other antidepressants and the marketing challenges to getting adoption that the new drug will face. Lilly's new antidepressant team making this decision has several market research inputs on physicians and patients at its disposal.

Reviews the role of corporate venture capital and its history at Eli Lilly. Also presents a challenging venture investment opportunity.