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<center><h3>BillionHealth<sup><small><small><small>TM</small></small></small></sup> Network Pitch Survey </h3></center>
This brief survey asks for your comments about the BillionHealth<sup><small><small><small>TM</small></small></small></sup> Network pitch, which will help guide us in building a powerful business plan and market strategy. Please include your name and phone number, so we may contact you to discuss your comments.
<br><br>
When done, click the "Submit" button at the bottom of the form.
<br><br>
Thank you,
<br>
Steve Beller
<hr><br>
Your Name:
<input type="text" name="name"
value="" size="20">
<br>
Phone Number:
<input type="text" name="phone"
value="" size="20"> (where you can be reached during the day):
<hr><br>
1. Is the value proposition clear and easy to understand?
Yes<input type="radio" name="1.1_Y" value="Yes">
No<input type="radio" name="1.1_N" value="No">
<br><br>
How can it be improved?<br>
<textarea name="1.1_C" rows=6 cols=80 ></textarea>
<hr><br>
2. In your own words, what would you say is the overall value (or value-add) of our products and services (e.g., one-stop shopping for whole-person health management and consultation):
<textarea name="1.2" rows=6 cols=80 ></textarea>
<hr><br>
3. If you would want a service or product not offered by BillionHealth, what would it be:
<textarea name="1.3" rows=6 cols=80 ></textarea>
<hr><br>
4. Please rate the following BillionHealth services and products in terms of their value and importance to you. <br>
Click the boxes in the "Value" and "Importance" columns next to each product or service, <br>
and select a number from 1 to 5, with <b>1 = the Least</b> value/importance and <b>5 = the Most</b>.<br><br>
<table border="1" cellspacing="1" cellpadding="5">
<tr>
<center>
<td><i>Personalized Guidance Professionals (PGPs)</i> [per hour, per incident or flat fee]</td>
<td><i>Value</i></td>
<td><i>Importance</i></td>
</center>
</tr>
<tr>
<td><b>Intermediary Doctor (iDR)</b> who provides whole-person care professionals -- by phone, email or in-person -- for health related issues such as:
<ul><li>Rebuilding your health using a holistic approach that focuses on fixing the causes, not just treating the symptoms</li>
<li>Spending the time to make sure you understand your health problems and care options</li>
<li>Coordinating your care when multiple clinicians are treating you</li>
<li>Assisting you with developing a durable power of attorney for healthcare and make informed decision about care for their elderly and infirmed loved ones</li>
<li>Evaluating your medications for potential problems and finding lower cost generics alternatives to brand-name prescriptions.</li> </ul>
</td>
<td>
<center><select name="1.4.01_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.4.01_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b>Wellness Trainer (Coach) </b>who offers personalized health counseling by presenting concrete, understandable action steps for dealing with physical problems and psychological stressors and for achieving peek performance.
</td>
<td>
<center><select name="1.4.02_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.4.02_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td>
<b>Care Advocate </b>acts as a �surveillance system� at a hospitalized patient�s bedside that supplies more-constant monitoring than overworked staff nurses can readily provide in order to make sure they notice if vital signs are going downhill, to ensure the right medication is given at the right time, etc. otherwise known in days of old as a �private duty nurse.�
</td>
<td>
<center><select name="1.4.03_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.4.03_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b>Health Plan Expert </b>assists you in understanding and choosing the best insurers for you, and helps answer questions about your healthcare bills.
</td>
<td>
<center><select name="1.4.04_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.4.04_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b>Life Coach </b>supports you in examining major financial and health-related issues and in making sound decisions that affect your quality of life now and in the future.
</td>
<td>
<center><select name="1.4.05_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.4.05_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<center>
<td><i>BillionHealth Programs</i> [per hour, per incident or flat fee]</td>
<td><i>Value</i></td>
<td><i>Importance</i></td>
</center>
</tr>
<tr>
<td><b> Personalized Information Program (PIP).</b> Gives you ongoing access to comprehensive health information you need when you need it, to assist you and your healthcare providers in making sound decisions. This program includes:
<ul>
<li>Personal health assessment tools that aid in understanding your health status and risks, troubling trends, and current needs.</li>
<li>Decision-support and problem-solving self-help tools that help you deal with physical and psychological issues, and manage you health proactively.</li>
<li>A secure, encrypted Portable Personal Health Record containing your complete health information. It enables you and the authorized people you name (i.e., your �trusted partners�) to access the particular information designated by your instructions, no matter which doctor�s office or hospital you visit, insurance you have, or place you travel.</li>
<li>Evidence-based information (aka �Information Therapy�) � delivered via pamphlets, e-mail, phone calls, etc. � prepares you for your doctor�s visit and, once you have received a diagnosis and treatment, you get a summary of the results along with clear-cut how-to instructions about recovery and maintaining good health.</li>
</ul>
</td>
<td>
<center><select name="1.5.01_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.5.01_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b> Personalized Healthinfo Program (PHP).</b> You have ongoing access to comprehensive health assessment tools, which aid in understanding your health status and risks, troubling trends, and current needs. It also includes decision-support and problem-solving tools that help you deal with physical and psychological issues, and manage you health proactively. In addition, you receive a secure, encrypted <i>Portable Personal Health Record</i> containing your complete health information. It enables you and the authorized people you name (i.e., your �trusted partners�) to access the particular information designated by your instructions, no matter which doctor�s office or hospital you visit, insurance you have, or place you travel. </td>
<td>
<center><select name="1.5.02_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.5.02_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b>Peer Support Program (PSP).</b> You no longer have to feel isolated from peers having similar health problems since we enable you to contact and collaborate with them to discuss experiences, ask questions and share knowledge, while keeping your identity private as per your preferences. </td>
<td>
<center><select name="1.5.03_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.5.03_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b>Personalized Awareness Program (PAP).</b> We will help you be more aware and responsive by giving you reminders, alerts and warnings, e.g., when a doctor�s appointment is upcoming, when medications should be taken, when there�s a potential adverse drug interaction, when blood glucose testing should be done, when there are significant emotional stress indicators, etc. </td>
<td>
<center><select name="1.5.04_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.5.04_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
<tr>
<td><b>Research Contribution.</b> You will be able to contribute your health information to a research database with complete privacy, which will be used to improve the quality and efficiency of care delivery for yourself and others. It will not contain your name, address, or any other information that can identify you. [No charge]
</td>
<td>
<center><select name="1.5.05_V" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
<td>
<center><select name="1.5.05_I" size=1>
<option value="0">-</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select></center>
</td>
</tr>
</table>
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<input type="submit" value="Submit">
<input type="reset" value="Reset">
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