john konczyk and emma lagreze | health data management | 28 july 2016
America’s Health Insurance Plans (AHIP), the national trade association representing the health insurance community, recently held its annual Institute & Expo event in Las Vegas, Nevada. While the conference covered comprehensive tracks, such as customer experience, data analytics, prevention & wellness and business solutions, there were three central themes intertwined into all of the sessions: Digital Health Impacts, Consumer Engagement Trends, and Business & Care Transformation.
Below is a closer look at what each theme means from an industry perspective, the overall messages that were delivered on each theme throughout the conference, as well some potential challenges ahead that the industry should keep an eye on going forward.
Digital Health Impacts
Digital Health is an all-encompassing term for the intersection of healthcare and technology. This phrase now pervades all areas of the industry—from social media, mobile technology, analytics to wearables and embedded devices—and supports the goal of a more integrated and connected delivery approach to healthcare. Yet, even as technology-based tools have enabled health plans, providers and businesses such as pharmacies to offer more attractive care options, consumers have embraced the ongoing use of these tools with varying levels of adoption.
One noteworthy case study example focused on new chronic-disease or condition-specific apps. It is important that they be designed to ‘mature’ with consumer requirements, and expand to meet transitioning needs after serving an initial purpose by delivering on a well-developed series of use cases. For example, one panel discussion highlighted an app that provides pregnancy monitoring and later offers pediatric care support for new mothers.
App developers are collaborating closely with providers and payers to understand how to offer sustained value through technology and through integration. Gone are the days of pedometers for the sole purpose of knowing your step count—consumers are now demanding a holistic approach to their healthcare to understand how to take action based on their activity, eating and sleeping habits, posture and more.
The key to being a successful player in this market is the understanding that these technologies actually fulfill their claims. Apps that do not live up to their marketing messages erode consumer confidence and, ultimately, the user base which extends well beyond the assumed millennial audience. The point was made in several sessions that it is not only the millennial generation with technology expectations. In fact, some even noted that it’s naïve to generalize the millennial generation as the population segment that is most interested in advancements in technology and is expecting highly integrated, more on-demand healthcare. However, that’s the majority of all consumers.
The next challenge is understanding how to engage these consumers. Many companies are looking to gain perspectives outside of the healthcare industry and outside of their own organization to catch up to the standards consumers are expecting.
Experts in healthcare are relying heavily on behavioral economics to understand the decisions their customers make and how to better engage them. Something that has long been done in other industries is now front and center in healthcare, as both payers and providers stress the importance of aligning themselves to their customer’s incentives. Sharing the same end goals of improving outcomes, reducing cost and delivering value is a step in the right direction.
The health industry has tried to engage and educate consumers via patient portals, health apps, educational videos and more. However, as a result of this proliferation of data, consumers are experiencing information overload, which is not culminating in the behavioral changes that some were anticipating. Similarly, customized health insurance may sound appealing, but too many options in the healthcare marketplace or employer packages can overwhelm consumers who struggle with decisions on what coverage, doctors or prescription plans to elect.
Throughout the conference, the point was made that with fewer options and clear, concise descriptions, consumers, both young and old, can make informed choices. The ability to customize your purchase is only useful when one can understand the industry and the products. The healthcare literacy rate in the United States is only 14% by most estimations, thus it is safe to say that simplification is key. By employing the method of “nudging” to offer subconscious guides to consumers, healthcare companies can make it easier to participate and engage in an environment with so many choices to make.
As speakers repeated the topic of consumer engagement, an obvious challenge that was also reiterated time and time again was how to implement the methods above while navigating a transitioning environment to a value-based payment model. Our recent experience helping a major US-based payer create a digital engagement strategy enabled us to us identify an emerging trend we expect to become more evident as consumer engagement is operationalized. As the customer centric payer market takes root, there will be a migration of engagement responsibility from primary and secondary care physicians to payers and payer employed Health Care Professionals operating at the maximum of their licensure.
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Business and Care Transformation
Many companies are focusing on how technology will help with this transition and the ways in which data analytics can provide insight into actionable quality improvements that can be made. What is key - and a theme that was highlighted throughout AHIP Institute - is emphasizing people and process changes prior to system augmentations in order to make it stick and realize the intended value.
As one speaker pointed out, implementing new technologies is not a solution – empowering staff and management to employ a culture of continuous improvement and using technology to assist these processes is when business transformation is successful. With a focus on cost reduction, this is important to keep in mind in order to avoid jumping to the ‘quick-win’ solution of buying a system. In short, cost savings can be realized without the introduction of any new technology.
By aligning incentives of the business and the industry to the consumers we are servicing within healthcare, it is easier to focus on care transformation, which can be used to drive business decisions. A challenge with this is satisfying the oxymoron of creating ‘scalable personalization’—how do you use cookie cutter systems to provide individualized care?
The answer to this is agility and it is what those in the healthcare industry will need engrained in their business and culture to quickly adapt to the changes that are already happening and those that are on the horizon.
While ‘scalable personalization’ and ‘business optimization’ seem to be opposing goals at first glance, the central themes presented throughout the sessions at AHIP Institute point to a common understanding that aligning incentives towards the consumer goes far beyond just one solution. It is the solution to maximize the integration of care and develop offerings that allow consumers to easily engage with an adaptive and complex healthcare ecosystem.
As we have seen, change is the only real constant in the US healthcare system, and consumers are the current crux of this change. As consumers of healthcare, each of us play an important role in helping the industry transform and evolve into a delivery system that is more personalized, and one that delivers high quality care how, when and where we need it.
John Konczyk and Emma Lagreze are healthcare experts at PA Consulting Group