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When disease-specific support groups started leaving church basements and turning to the Internet, members found a few sympathetic ears could grow into national or international communities several thousand strong. More members meant more power. And, ultimately, more power meant more action.

Over the past decade, online patient groups have evolved from large communities of people sharing a common disease to even larger communities sharing a common goal: to help spread awareness and support for the treatment and cure of their respective conditions.

The evolution of the Assn. of Cancer Online Resources has become a typical example of this trend.

ACOR was founded in 1995 by Gilles Frydman after his wife, Monica, was diagnosed with the ductal carcinoma in situ type of breast cancer, shortly after recovering from a rare heart disorder.

Not satisfied with the answers his wife's doctor was giving them, Frydman turned to Internet groups for information. The groups he found convinced him that his wife needed a second opinion and also helped him find a new doctor. But, he found that navigating the boards was difficult and cumbersome. The idea of ACOR was to provide one-stop shopping for every type of cancer support group.

Now, due to its amplitude, ACOR has evolved from a patient resource to a source for researchers looking for clinical trial subjects; a directory of specialists, complete with firsthand critiques; and a large collection of cancer information and research. The group is now moving into fundraising.

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UnitedHealthcare is going ahead with plans to release its physician rankings for the New York area, despite a threat of legal action from the state's attorney general, a United spokesman said.

However, the company is delaying implementation of the rankings system for a few months so physicians can get more familiar with it -- a move United says has nothing to do with the attorney general's threat.

United will roll out its Premium program -- a physician evaluation system based on cost and quality-of-care data -- in the New York area, including New Jersey and Connecticut, at the end of the year, said United spokesman Tyler Mason. The health plan already uses the program in 100 other markets, he said.

A July 13 letter from the attorney general's office said the ranking system would influence patients to use physicians who are cheaper but not necessarily better. The letter told United it would face legal action if it released the rankings as planned at the end of July.

Mason said United will release the rankings at the end of the year, and added that the delay is not because of the letter, but because the plan had already decided to give physicians more time for input and review.

"It's a national trend," Mason said. "All health plans are engaged in this type of activity. The need for consumers to have information as they pick up a larger share of their health care costs is here. So to the degree [the state is] contending [the rankings] could cause confusion, we obviously disagree with that."

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Moselle Brotman, DO, a Riverside, Ill., ob-gyn, played her fair share of video games while growing up in the 1980s. She still likes electronic games, although her busy schedule doesn't allow for much more than an occasional -- but spirited -- Pac-Man challenge.

Like many other physicians, Dr. Brotman has, for the most part, kept her gaming and doctoring worlds separate. But she started to see how gaming and medicine could meet when she recently played "Trauma Center: Second Opinion" with her 8-year-old son, Ben, and his 9-year-old friend, Matt.

The game requires players to perform surgery, from repairing shattered bones to fixing perforated lungs or failing hearts. The game is produced for the Nintendo Wii gaming system, which has remote devices that require the surgery be done by a player moving his or her hands and arms, rather than using a controller, making the surgery seem more realistic, even when players acquire such unrealistic tools as a magic "healing touch."

"The game is a lot of fun. And I could see how the boys were actually learning some very basic surgical concepts," says Dr. Brotman, who works with her partner, ob-gyn Vybert Greene, MD, in a private practice that serves patients at Michael Reese Hospital in Chicago.

While there has been plenty of attention and discussion on the negative impact of video games, from their potentially addictive qualities to their effect on the obesity rate, a growing number of gaming advocates within the profession are trying to figure out what good things games have to offer physicians and patients. The effort is growing stronger in part because the latest generation of physicians grew up with video games, and many of their patients are comfortable with them.

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Google, the Internet search giant, has convened a committee of health care leaders, in the company's words, to "help us better understand the problems consumers and providers face every day and offer feedback on product ideas and development."

The move, announced June 27 on the company's blog (www.googleblog.blogspot.com) has fueled speculation that Google, which has advocated personal health records, is on the verge of developing and marketing its own PHR, among other health ventures. The company has not specified any specific plans for new products, nor a specific role for its advisory committee in developing them.

Still, there have been hints about a Google PHR since the company earlier this year publicly began endorsing the Continuity of Care Record standards for electronic and personal health records. Idaho-based health technology consultant Vince Kuraitis is one of many experts and health bloggers who see Google's health advisory council as the company's first step to a PHR that could dominate its market. He also is one of many who sees Google's health ventures having a dominant impact on the health system itself, given the company's size (No. 241 on the Fortune 500 and rising quickly), Web power (not just search engines, but numerous other Web-based software ventures) and cultural significance ("googling" has become a generic team for Internet searching).

"Google Health ... could be the event of the decade in advancing health care reform -- not just health care information technology ... reform, but health care system reform," Kuraitis wrote on his blog e-caremanagement.com/. "GH promises simultaneously to create AND dominate the market for next generation personal health records. There is nothing else in our solar system or in the entire universe like it."

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A Minnesota health plan is adding another component to its high-deductible plans -- the use of blood pressure, body mass index, cholesterol levels and other wellness indicators to determine out-of-pocket payments.

PreferredOne, which in January 2004 became one of the first plans to offer health savings accounts, has begun marketing plans that offer clients the option of using "biomarkers" to reward healthier employees with lower deductibles.

Low blood pressure, target BMI and other positive indicators can slash deductibles by up to 20%, said Eugene Sako, PreferredOne's manager of product development.

"A lot of our clients have moved from a co-pay plan to a high-deductible plan. They had to give the employee something to bridge that leap from a $10 office co-pay to a $1,000 deductible. In the past it was a health reimbursement arrangement or a health savings account," Sako said. "This is allowing them to say, 'I'm not just going to give you the [money], I'm going to give it to you only if you're healthy.' Instead of just giving a kid an allowance, it's making him work for it."

Sako said 180,000 members will be eligible for incentives. The firm sells to mostly small- and medium-sized businesses. Experts say other plans have begun looking into biomarkers but that PreferredOne is among the first to use them widely in setting rates.

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