Medsite has built a steadily growing revenue stream and customer base, primarily through online sales of books and medical supplies. It also leverages those e-commerce offerings to provide pharmaceutical and other product companies with a means of promoting themselves to physicians by using incentives, such as discounted books or supplies. With further growth in mind, the company filed a $100 million IPO earlier this year--only to withdraw it a few months later when the bottom fell out of the e-health public markets. Facing a suddenly hostile financing environment, Medsite's management re-engineered their business plan, with the goal of accelerating the company's drive to profitability by emphasizing the higher-margin end of its business that derives income from promotional deals with product companies. A key element of this effort is an ambitious package of customizable Internet tools for physician practices that is intended to bring in lucrative sponsorship contracts from product companies. In entering this arena, Medsite will find itself up against some major players with significantly greater resources. And to fund their ambitious new initiative, Medsite will have to convince a wary investment community that, in an industry apparently headed for domination by a few billion-dollar companies, they will be one of the survivors. But Medsite's management expresses confidence that its higher-profile competition has yet to make any deep inroads into the physician market, which they argue remains quite open. The task now is to persuade investors, product companies, and physicians that they can succeed---where others have largely failed--in getting doctors to make the Internet an integral part of their practices.

e-Health IPOs have been among the hottest IPOs available recently, fueled not only by Internet stock mania, but a genuine belief among experts that e-commerce will have a lasting impact on the health care industry. In this column, we examine the impressive valuation jumps made by recent Internet-related health care IPOs.

Recently, the PPM industry seems to have collapsed under the weight of the perhaps inherently contradictory nature of PPMs: how can a health care maintenance organization contain costs when it is made up of the very individuals who feel obligated to make treatment decisions without regard to expense? Start-Up looks at recent PPM IPOs.