The economics of the healthcare industry have changed dramatically since the introduction of the Affordable Care Act (ACA) in 2010. Although there are other factors impacting healthcare today, the ACA has had perhaps the strongest influence on the current trend toward value-based care. Achieving the Triple Aim – improving access, creating better outcomes and lowering costs – requires an activated member base for payers and engaged patients for providers. Healthcare consumers, on the other hand, have much more autonomy when it comes to choosing their healthcare plan, finding providers, and budgeting dollars for healthcare.
As we move toward value-based care with its balanced focus on illness and wellness, payers and providers have begun focusing on sophisticated engagement techniques that encourage healthier behaviors among the populations they support. That includes influencing not only individual actions, but also non-clinical social determinants of health – the social factors and physical conditions of the environment in which we are born, live, learn, play, work, and age. A focus on wellness also requires a holistic view of health that considers the whole person and the person’s preferences when it comes to healthcare. For that reason, we believe we must stop talking about “member engagement,” “patient engagement” or even “health engagement.” Instead we need to discuss how best to engage people no matter where they may be in the continuum of health, from a young athlete headed for college, to an elderly person entering hospice.
It’s important to remember that engagement takes many forms depending on the interaction, and the goals of that interaction. Sometimes it might involve a reminder for an annual skin screening appointment. Or it might involve something much more serious, such as a patient seeking a second opinion after a cancer diagnosis. When engagement is successful, the individual actively participates in their health, whether the purpose is to maintain wellness or to treat an acute illness.
Engagement requires getting past buzzwords and industry acronyms, and instead focusing on empowering people to take the right action when it comes to their health. To achieve that goal, we must overcome a set of obstacles that include, among other things, regulatory dynamics, data management challenges, and even human nature itself. We do not believe there is a 100% technology-driven silver bullet to overcome all barriers standing in the way of more personalized and impactful engagement strategies. Specifically, for certain complex populations, in-person interactions may be required to drive a level of trust and personalization that technology, though advancing rapidly, is unable to provide. That said, through a better understanding of these barriers, stakeholders are better positioned to develop effective enterprise engagement strategies that leverage both digital and analog solutions to maximize desired outcomes.
Despite messaging to the contrary, most providers, payers, and other healthcare experts still view regulations such as HIPAA, the HITECH ACT and Protected Health Information (PHI), as barriers to the interoperability necessary for creating a holistic, shared view of an individual’s health history. Adding to this challenge is the fact that each state has applied its own set of privacy standards. The result is that individual health histories are comprised of fragmented views housed and owned disparate different stakeholders in the ecosystem. These realities make it particularly challenging to integrate disparate information and create a holistic view of an individual’s lifestyle and health.
Data Management Challenges
A fragmented view comes from different EHR systems, various office visits, preventative screenings, insurance information and a host of other sources, creating significant barriers to gathering information into one central location. These barriers are not technical in nature but rooted in the often-contentious relationship between payers and providers established by virtue of our legacy fee-for-service system. According to KLAS
, a Utah-based health informatics research firm, the rise of ACO’s and new risk-sharing arrangements has breathed new life into the “payvider” model
, or provider-owned health plans. As this model becomes more prevalent, sharing of clinical and claims data will become standard. Integrated delivery networks and anti-data blocking regulations both support a future where information flows more freely throughout the healthcare ecosystem. These forces represent progress from where the industry has been, but we remain far away from a world where a 360-degree view of a person is available by combining clinical, claims, social, and other personal information. As we advance toward that future, there are important questions to answer around security, including which entities are positioned in a place of trust to house such voluminous and sensitive information on individuals, particularly considering recent privacy controversies in the social media space.
Even if we can get to a place where 360-degree “whole health” views of individuals are possible through strong, shared data management, the fact remains that it’s still enormously challenging. Engagement alone is nothing without activation. Activation is the critical step in which an individual becomes compelled to complete a desired activity, change their behavior, or become more intentional in their own healthcare. Here in the United States, we’re excellent at delivering “sick” care (i.e., intervening after a condition presents). By contrast, our track record is less than average at activating people for preventative care, or staying healthy once acute care ends.
CMS and the ACA have created a stronger emphasis on actions to encourage wellness. Yet connecting regulatory carrots and sticks for payers and providers to drive these activities down to the individual level and create better long-term outcomes is still an emerging influence. In addition, the individual’s experience with healthcare is far behind the common consumer experience in banking, financial, and ecommerce, transactions that typically utilize much more sophisticated IVRs, payment apps and portals. The fact that healthcare often feels a decade behind, with its less advanced and less user-friendly methods, lessens the effectiveness of many engagement programs.
A New Definition of Engagement
We believe that, as an industry, our approach to health engagement is nearly as isolated as the data itself. We must stop thinking of engagement as something that happens between a member and a health plan, or a patient and provider. Instead of defining it as member
engagement, we need to think of it as people
engagement. Understanding a person’s entire health history, along with their individual preferences, will provide more effective engagement and support those individuals acting in the best interests of their own health.
The role of technology in this new view of engagement is not as an answer, but rather an enabler. Other industries in the financial, retail and insurance sectors have proven that the technology exists to create this holistic individual view of health. Steps must be taken to leverage new technologies to inform all of the partners involved in an individual’s health history, as well as provide that information to the individual themselves. The convergence of health data then occurs at the individual level, not with the payer or provider.
Technologies like blockchain and AI will help the industry leverage the mountains of data created every day and help it become smarter in a much more secure way. Digital health capabilities, like telehealth and wearables, are also encouraging a focus on wellness; at the same time, they are providing invaluable data to the wearer, and possibly plans and providers. New engagement techniques based on data-driven practices, similar to those we see in the retail industry, are moving the needle in the right direction.
The Future is Personal
It’s still unclear whether this new vision of people engagement and a holistic view of health will evolve slowly over the next decade, or if a major player will create a massive disruption. Companies like Apple, Google, and Amazon are making moves today to lay the seeds for elements of this disruption, though their prospects for success remain uncertain.
Across the TripleTree platform, our firm has been exposed to some interesting companies that clearly point toward a different way of doing things. GoodRx
has given consumers the ability to find the lowest cost prescription possible within a geographic area. VigiLanz
helps bring clinical and business data together to help identify meaningful opportunities for patient intervention, while Clarity Software Solutions
is enabling health plans and other payers to more efficiently manage the numerous administrative touchpoints across a member’s lifecycle and leverage these interactions for more targeted member engagement. Revel
delivers a unique, data-driven, and personalized approach to engagement through a next-generation technology platform that communicates with healthcare consumers according to their own preferences. (NOTE: Revel is a TT Capital Partners portfolio company.)
As the health tech market moves forward, we will continue to see new ventures seeking to provide the platform that will ultimately become one, single source of truth for informing healthcare decisions. Before that happens, however, we will need to see technology enabling people to make strong, data driven decisions concerning their health. Providers, plans, and any hybrid type of healthcare entity will need to use technology to capture and leverage each individual’s preferences, so that engagement becomes stronger and more meaningful to the individual healthcare consumer.
TripleTree is a proud sponsor of the upcoming 2018 KLAS Digital Health Investment Symposium
where patient engagement will be a topic of discussion. Click here for a different perspective on patient engagement from KLAS