Tremendous cost-cutting and patient care improvements await insurers and plans that can leverage the recent gains of computing to improve patient self-management of care.
The challenge is how to tap the big pools of data, and get “actionable” personalized results out to plan members so they can choose better, cheaper care and manage this care for better health — all through the prism of plan rules and incentives. These were important themes discussed in several sessions on March 23 at the World Health Care Congress + Exhibition in Washington, D.C.
Computing power has enabled rapid gains in:
- the collection of data sets on millions of claims, resulting in more price transparency;
- the ability to sort and sift through test results, enabling plans to steer patients toward preventive care instead of waiting until their health conditions become acute; and
- physician quality and outcome metrics, so plans can steer patients to providers that perform targeted elective procedures at lower cost and with better results.
Meanwhile, consumers are becoming accustomed to personalized instant-response digital experiences like Facebook, Twitter and the ride-sharing network Uber.
Data is available and being collected; the problems are: (1) interpreting the data; (2) data security and privacy; (3) who owns and controls the data; and (4) turning it into useful patient notifications and interventions after plugging in wellness incentives and plan design features, according to Victor Dzau, M.D., president of the Institute of Medicine.
One challenge is to tap “walled up” data and use it to tell patients as early as possible that they may have an incipient health problem and remind them not to neglect preventive care, such as flu shots and screening exams, added Bryce Williams, CEO of Healthmine — a company specializing in consumer engagement to strengthen wellness programs.
Insufficient interoperability among technology formats is another problem; for example, a dual paper-digital system is still requiring extra staff to transfer records from one format to another, Williams said.
The security of this data also should not be overlooked. As organizations empower consumers by giving them access to more health care data, they become susceptible to hackers — and need more stress testing to try to prevent hacks, Williams said.
Results of Better Communication
Customer experience is a key part of health plan value, due to the increase in consumerism. Customers expect more use of voice, click-to-chat and online forums and interactions with their providers and health plans, said Amit Shankardass, a marketing executive with Teleperformance. But health plans are not providing all of those points of access, he said.
One company says it is, however. Independence Blue Cross, whose territory includes Philadelphia and southeastern Pennsylvania, is using a service called Relay to improve the communication channels between patients and their health plans. As soon as members get their ID cards, and they call a toll-free number to activate the cards, they are invited to activate the Relay service. About 30 percent of IBX members have opted in.
The Relay service connects to plan members’ mobile phones, sending general reminders about care, like “Get a flu shot” or “Open enrollment’s about to close.” It also sends personalized reminders such as “We noticed you used a brand name for this medication. Did you know a generic is available?” and “Women your age are getting mammograms, and you’ve never had one.” Members also can directly contact a health coach for an instant messaging session at any time of the day.
Members who use the service showed doubled rates of mammograms and colorectal screens, resulting in improved patient health, IBX vice president Paula Sunshine told attendees.