By Spitz (@SpitzStrategy)

Bad Hair Day

I met Seth Godin at ePatient Connections 2011 in Philly, where he sat forlornly at a table after his keynote and peddled his latest book, “Poke the Box.” Sadly Seth wasn’t getting many real world pokes, most folks too distracted with the other presenters and event buzz to bond with the world’s most popular blogger; I was also too busy prepping for my presentation on social listening with @Radian6 to do more than shake the media maverick’s hand, ironic proof of his own point that mindshare can be more generous in the digital world than in flesh, blood, and three spatial dimensions.

But I’ve since made it up to Seth by avidly following his blog, daily intuitive nuggets of irreverent insights fitting for our digital age. Even if you don’t always agree with him, his pithy, Nietzschean style of using aphorisms to pack plenty of punch into at most a few hundred words caters perfectly to our 140 character limit social and mobile consumption habits. He compels us despite our continuous distractions to take a few contemplative moments and stop, think, and sometimes even change the way we connect with each other, understand the world, and come to redefine ourselves.

Web Wars

What I like best about Seth is that he’s the consummate disruptor, deconstructing the most banal and taken-for-granted aspects of our everyday digital lives and often coming up with simple yet still startling solutions. One of his recent posts gave me such an “Aha!” moment, sparking a reassessment of pay-to-play models for content, social, and mobile platforms. People have been speculating about paid models for years, but the pressure point has never been this acute, or more urgent‚îespecially for the most relevant yet problematic platforms for us as digital healthcare communicators, such as building and managing patient and HCP online communities.

Some quick back story first: The Web can be understood as a “brand” of sorts, following many of the same marketing rules, such as competition for limited mindshare, the importance of reputation and loyalty, and obeisance to good old fashioned human habit. Since the first websites went live in the early 90s, content has been expected to be instantly accessible, public domain, and free‚îlargely because nobody at first took the Internet seriously, and hardly anyone foresaw the extent to which the “World Wide Web” would transform media, advertising, entertainment, publishing, music, and virtually every aspect of our lives as consumers. As such, any notion that content should be paid for has met continuous and often relentless resistance, along the way redefining and often wrecking proprietary content creators and content distributors.

Fast forward to 2012 and the war between “attention and cash” as Seth puts it continues. Major battles throughout this brief but frenetic history have helped shape the uneasy balance between public domain, paid, and earned media, ones where Napster has been replaced by iTunes, iJournalism flourishes amid “premier” magazine and newspaper subscriptions, and discounted eBooks explode in popularity on mobile readers while traditional hardcopy publishing languishes but stubbornly refuses to die. Media fragmentation has also shifted content distribution into increasingly targeted channels, giving rise to a new era of syndication and mobile ads. The result is a hybridized digital universe where most content remains free, micro-billing has become the norm, and consumers are constantly choosing between open and closed platforms based on immediacy, convenience, quality, peer pressure, style, and cost.

Who Would Ever Pay for Social Media?

From Friendster to MySpace to Facebook, social media has‚îand will remain‚îfree, right? Don’t think so: If the stuttering Facebook IPO is any indication, Wall Street and advertisers have become increasingly skeptical not only about Zuckerberg’s fiefdom, but peer-to-peer channels in general. Twitter remains yet another example of strong engagement metrics combined with relatively low monetization potential, a complicated, frustrating business problem that harkens back to those earliest days of the Web where everything was free and nobody made any money except geeky html programmers and smarmy affiliate networks. Change user habits, and watch the tech change along with it.

As Seth writes, Twitter could successfully monetize overnight with a subscription-based model, providing “premier” features and functionality (metrics, zero ads, preferred tweets, Tweetdeck Pro, what have you) to a core set of loyal users, perhaps tens of millions strong. Even if “only” 25 million users join at $10/month the platform could become instantly profitable and eminently more viable. Would you pay? I would, especially if the now level playing field changes into a two or three-tiered network where not all tweets would be tweeted equally.

Digital fascism you say? Why? In the competition between attention and cash advertisers and platforms are losing, while consumers are winning‚îuntil the model implodes and the social media bubble bursts. Somewhere, someone must pay for those disks to keep spinning, those networks to stay connected, that bandwidth to keep flowing. Contextual ads work in search because people seek content, not connectivity, generating billions in the process; Google tried to combine search and social and has not surprisingly so far failed, if only because the mind set remains different, the “Google” brand identity inexorably connected to search as “Facebook” is to social. “Google Plus”? What is that supposed to be? “Android”‚îwell, that’s got nothing to do with Google/search, and therefore gave itself ample room to become a game-changing mobile operating system. What’s in a name, a brand? Everything.

But does paid social media sound too radical? In concept, it shouldn’t. In practice, it’ll take an exercise in REBRANDING what we mean by “social media” to make it work, in the same way 7-Up defined the “Uncola” and Google penetrated the mobile market by simply changing the name of the division and disassociating the effort from its core competency. The good news is that as platforms evolve they take entrenched user behaviors with them, mutating them, feeding back off of and through them, the eventual shift from a free to a payer model likely less disruptive than movement from individual Facebook pages to community newsfeeds to branded Timelines. So much change has already happened in digital: Why not this?

The Dawn of Paid Healthcare Social Media

All this got me to thinking about online healthcare communities, up to now so brimming with potential user benefits‚îand seemingly intractably weighed-down by privacy, reputation management, adverse event reporting, conflict of interest, clinical fact checking concerns, and management resourcing, among a slew of other roadblocks. For example, on the physician side WorldOne buys SERMO and folks instantly become suspicious of a data mining and marketing company monetizing a clinical peer-to-peer professional forum; on the patient side pundits pontificate endlessly about the need for online communities for particular conditions and disease states without realistically addressing their feasibility and management, especially if pharma and medical device companies become even remotely involved‚¶

Enter the social media paid business model‚îfor healthcare: Considering how much physicians already pay for journal articles and other sources of clinical data, would it be too much to ask them to contribute $50/month or what have you for engagement within a protected, safe, objective, and unsolicited social network where they could unabashedly discuss diagnostics, treatment, and other daily challenges? And considering how much patients and their families already contribute for copays and healthcare in general, would it be too much to ask them to pay a few extra dollars per month to participate in a safe, secure, unbiased, specialized healthcare social network where they can openly share their questions, concerns, hopes, and stories with others going through the same experiences, and perhaps even communicate directly with mentors and even healthcare professionals capable of providing effective solutions?

The Time is Now

For years healthcare marketers have been dancing around social media, acknowledging the channel’s incredible potential yet unable to implement much of anything outside faux attempts at social functionality that don’t allow true user-generated content or connectivity between end-users. The pressure is already near the bursting point for the gargantuan networks like Facebook and Twitter to capitalize on their enormous free base and evolve to paid business models. In my opinion healthcare social media designers should therefore go right ahead and create closed yet popular, proprietary yet flexible, powerful yet secure subscription-based, password protected online communities where patients, caregivers, and professionals can finally engage with their peers with impunity. Why wait?

I’m eager to hear your thoughts and feedback!




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