BUSINESSES, INCLUDING HEALTHCARE businesses, look to the Internet to increase efficiencies and lower costs. What online consumers want is often not lower costs, but better service, more in-depth information, and communities of like-minded people freely sharing ideas and empowering each other in an ethical, safe online environment. This is especially true in healthcare where consumer costs are not controlled by market forces like competition, consumer choice, and so forth. Consequently, the need of e-healthcare business to lower costs of healthcare delivery is at odds with the need of healthcare consumers to control their own healthcare, become more knowledgeable about their medical condition, and seek solace and support from a community of their peers. Complicating the picture further are the needs of physicians, which are often at odds with managed care organizations and patients. Unless the needs of all these constituencies be met in a single e-health business plan and implemented in a trusted, secure, and ethical manner, then the type of virtual managed care organization (VMCO) envisioned by Alemi will not materialize or flourish. The problem is not the technology, as Dr. Alemi rightly points in his article, but the management of healthcare business and, specifically, the vision of management and its commitment to changing the way healthcare business is run. The solution to the problem will not come from the top down, it will come from the bottom up. Management must understand what the health consumer really wants from the Internet and adapt their businesses to meet these demands. While consumers might expect that web-enabled computers will improve the quality of services, reducing costs is probably not high on their list of desires. This is borne in other e-businesses that are learning that consumers will pay more for added service, product knowledge, and convenience. No longer are e-commerce sites competing on price. They now must compete for the hearts and minds of their customers. ON-LINE SUPPORT GROUPS Alemi points a few areas where the needs of healthcare consumers and healthcare businesses mesh well. One is the use of electronic support groups, which can lead to drastic reductions in the cost of care. Online support groups are perfect vehicles for patients to become more knowledgeable about their medical conditions and to seek advice from other patients who have experience dealing with complications, therapy regimens, life-style management, and so forth. Today health-related e-mail listserves as well as web-based chats and discussion forums are widespread. Many of the major health portals feature chats and forums. Even health plan sites like KP Online provide forums for members. Interactive patient discussions are important factors that bolster a site's stickiness (how long visitors stay on the site), return visit rate, and page views (each message posted counts as a page viewed). THE ROLE OF THE PHYSICIAN The conclusion could be made that because patients go to online support groups to get many questions answered by their peers, they have less need to visit their doctors and hence the cost of care is reduced. It is unfortunate, however, that the reduction in costs are, as Alemi reports, a result of less interaction between patients and physicians. The Internet gives consumers the invincible feeling that they learn what they need to know from sources other than their own physi- cians, who are feeling increasingly out of the loop. Physicians-and othersrightly worry about the quality of the information consumers are getting from the Internet and each other as well as the integrity of commercial health web sites sponsored by advertising and pharmaceutical companies. As DeLuca and Enmark point out, managed care and other health organizations step in at this critical juncture and make a difference through innovative Internet programs. …