Health Road – Patient Engagement Series Part 2: Opportunities (Payers)

 In Healthcare Services

Blog by Vishnu Saxena, VP & Business Head – Diaspark Healthcare
Last month, I was at AHIP annual conference in Nashville, TN. I was amazed to see how the face of AHIP has changed. My initial observation was the diversity and inclusiveness to many new stakeholders and vendors from Population Health, Telehealth, Patient Engagement, Data and Analytics. Unlike a 100% payer dominated event in the past, this new face of AHIP, is a reflection that payers are evolving fast. A great example of this could be the 2 historical acquisitions that happened in the last 2 weeks – Anthem’s acquisition of Cigna and Aetna’s move to Humana.

Payers are in fact moving from not only providing payment transactions after care is received, to monitoring patient care at the consumer and wellness levels. How come this happened..? Payers, faced with multiple payer modalities, have been challenged with designing care management programs that promote universal coverage and facilitate value based care delivery under increasing levels of consumerism. They are moving towards new risk sharing arrangements with providers, preparing to manage consumer care, and engaging constituents at every level to address chronic health conditions to keep the healthy, healthy.

The real wake-up call came by healthcare reform. This action “forced” payers to create a transparent model which provides consumers a complete view into their benefits, and provides the freedom to choose the plans that are better suited to individual needs. This is in stark contrast to traditional public and private insurance models that adopt a one-size-fits-all approach to manage patients enrolled into the health program. The focus on healthcare payer transparency towards consumers has led to a gradual shift in healthcare payment burdens, from payers to consumers. Further, payers are facing immense pressures to attract the consumers towards a well balanced and well-crafted healthcare plan, that goes beyond a transactional approach managing patient wellness. The need to impact consumers favorably has been more of a concern among private healthcare payers. With the decline of the transaction-based payment formulas, payers are seeking alternative business strategies to meet revenue goals. Engaging patients and trying every effort to enable, “Health Ownership,” is a new strategy that is fast growing among payers. Payers are getting extremely creative in adopting the patient engagement philosophy, which is driven by health IT initiatives across Analytics, mHealth, Telehealth and Remote Monitoring. Let’s have a quick look where payers have an opportunity for Patient Engagement success:

Wellness Management , Medication Adherence and Personalized Plan Design:
The most crucial and winning proposition for healthcare payers to engage with the healthcare consumer today, is to play strong in the patient wellness space. Keeping healthy, healthy is the only way payers can survive in this environment and continue to be solvent. To that end, health plans are increasingly leveraging health IT and mobile platforms with a high usage of mobile health apps that range from providing medication reminders, to vital sign monitoring. Patients review their medical records and engage with doctors based on location and specialty, who may be best suited to treat them. Payers working with providers are also leveraging wearable devices and Telehealth solutions that greatly help consumers engage their personal fitness and wellness levels and remain engaged with their care provider anytime they need. With the core focus increasing around personalized, preventive, and evidence based medicine, payer organizations are taking new initiatives to incentivize patients towards engaging in good health practices and motivating them through proactive health management in order to reduce their overall healthcare costs.

Data and Analytics to Drive Next Generation Patient Engagement:
Payers have a treasure trove of information. Larger payers – serving tens of millions of members – process enormous volumes of information, which gives them a particularly unique opportunity to leverage Data and Analytics in ways that segments Patient population. This in turn, allows them to create consumer specific custom health plans and drive consumer specific Patient Engagement strategy? The application of Analytics to identify behavioral patterns of consumers based on historical claims data helps health plans segment the addressable populations based on disease risk, dietary focus, and health goals of the consumers. This vital information helps payers drive a real-time, and effective patient engagement actions.
Payer organizations today are surrounded by a wealth of structured and unstructured data. Not only is their data specific toward areas such as health claims data, but now they are sourcing consumer purchase data across a host of categories such as clothing, entertainment, and groceries, apart from patient communications across social media sites. Analytics on this data can help determine factors such as disease risk, patient compliance to medications and scheduled versus unscheduled visits to emergency rooms. Further, payers can engage a mix of consumer behavior marketing tools coupled with analytic modeling tools that can help determine key aspects such as – lifestyle patterns of individuals, their dietary patterns, and their weight management habits. The objective here is to improve insight about a consumer’s current situation that will devise an effective Patient Engagement strategy for that consumer.
An interesting example is – where certain institutions have begun monitoring individual apparel shopping behavior as an indicator of changes in body weight. Wherein, purchases of clothing in increasing sizes, could signal that the consumer is tending towards obesity. Some are monitoring dietary preferences based on the frequency of visits to restaurants. This data / insight further enables health plan organizations to develop an effective and tailored Patient Engagement strategy.

Medical Concierge:
With concepts such as connected medical home, mobile health, and telemedicine gaining acceptance, healthcare payer organizations are looking to bring medical services to the patient’s doorstep as a part of new Patient Engagement strategy. Healthcare payer organizations have leveraged mHealth solutions to serve as a bridge between providers and patients by creating reminder applications that facilitate scheduling of medical appointments and medication compliance. In an effort to reduce hospitalization costs, payers are increasingly connecting patients to global specialists by way of payer backed patient engagement portals, Telehealth platforms that facilitate real-time communication between the doctor and patient. In facilitating a patient centric care approach, healthcare payers have transformed themselves as medical concierges that are focused on maximizing health benefits for patients through treatment decision support tools. This allows nurses to communicate treatment options to patients, analytics tools such as cost estimators that indicate to patients the cost savings across various healthcare provider services in minute details that extend to the cost of specific medical procedures. This is indeed engaging.

Patient Engagement is a cultural shift and presents strategic opportunities for providers, payers, and life science organizations to collaborate and engage with the patient community with single objective, which is to provide value based care and keep the overall care delivery cost low. Patient engagement’s philosophy in my opinion can only be realized to its full potential solely through the effective integration of digital health technology, government policy, best practices in medical sciences, and care management.

This was the last blog of the Patient Engagement series that previously covered challenges and the opportunities in Patient Engagement across three key stakeholders- Pharmaceuticals, Providers and Payers.

Start typing and press Enter to search