market insights for engaging consumers

©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential

Market Insights for Engaging Consumers

Created byCynthia Porter, President, andAllison Norfleet, VP, Business DevelopmentPorter Research

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The new book, “Engage!

Transforming Healthcare Through

Digital Patient Engagement” --

edited by Jan Oldenburg, Dave Chase,

Kate T. Christensen, MD, and

Brad Tritle, CIPP

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©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 3

68% of Physicians Refuse to E-mail their Patients That is a Problem, Topol Argues

“Nothing about me without me.”

That was the mantra of patient engagement and participation at HIMSS13

• Having access to data will change how patients behave

• Physicians need to change their mindset. The medical field needs to change

• Recognize each person as an individual. We now have the tools to do that.

• Doctors should be teachers, and they and their patients should be getting information together

Remote monitoring and telehealth

“SHOW ME THE DATA”

Dr. Eric Topol, MD

Keynote speaker

HIMSS May 2013


Market Insights into Engaging Consumers


Why It’s So Hard To Improve Consumer Engagement In Healthcare?

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Source:March 11, 2013 George Van Antwerp


Moving from fee-for-service to value-based care

Shift in payer/healthcare delivery organization relationships,

Innovations in healthcare IT

Role of employers

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Market Insights into Engaging Consumers


Market Background

*Care Management Industry includes more than software such as professional services, call center operations, outsourcing and care extenders** Wyatt Matas, Care Management Market Assessment, April 2012

► The Supreme Court ruling that upheld Obama Care (ARRA) has begun to provide greater certainty and legitimizes the movement in focus towards preventative care and enhanced management of chronic diseases in order to address the national cost conundrum.

► Accordingly, the Care Management industry and marketplace is undergoing rapid transformation – new vendors are emerging, new customers are appearing (both payers and providers) and the government is beginning to set formal direction resulting in a new model known as Care Cycle management.

► Care Management software market likely to expand rapidly and could approach $4B to $6B in annual spend by 2017 (of the total expected growth from $18B to $90B of the Broader Care Management Industry)*

► Healthcare industry leaders and policy makers have recognized that Care Management offers a positive return on investment for a specific segment of the population—those patients that represent 83 percent of total healthcare $1.5T expenditures (or the sickest 25 percent of patients treated across care venues).**

► While spending on the sickest 5 percent of the population accounts for 43 percent of total expenditures on chronic diseases… preventative care management practices are also needed for young adults and middle-aged healthy persons

©2013 Medecision – Proprietary and Confidential

“Regulatory” Market Trends Driving – Transformation of Care Management > Healthcare Consumerism

2012 2013 2014 2015 2016 2017

Meaningful Use Stage 1



> 30 Pioneer ACOs

~150 MSPP ACOs

~150 MSPP ACOs

Patient Protection & Affordable Care ActHealth Benefits Exchange

Medicaid ExpansionMandatory Coverage

ACA Implementation/OptimizationHIS Optimization

Health Information Exchange StabilizationUtilization of HIX/HBEs

ICD-10 HIPAA 6020

Chronic Disease Management

Health & Wellness

Care Management

Meaningful Use Penalties

VBH Performance Reporting

Window of Opportunity

ARRA


Consumer’s Role Within VBH – Moving from “Volume” to “Value”

Overwhelmingly, 75 percent of HC executives expressed support, but shared some level of reservation about the imminent transition to at least partial value-based health operating model.

Quietly, a number of providers foresee profits rising under value-based health, The rationale goes that hospitals will use value-based purchasing (VBP) to drive consolidation that in turn will enable them to dominate markers and set prices

Health insurers are beginning to implement value-based benefit design (VBBD), which involves customizing care to support needs of members to keep them as healthy as possible. Payers offer personalized benefits to incentivize particular behaviors for individual who have or are predisposed to certain chronic disease.

Consumer engagement, however, will be essential to building longer term, more intimate relationships needed through innovative programs, to align healthcare stakeholders and reduce costs, while respecting patient preferences and resource considerations.


Innovation in Health Care Delivery Models

Accountable care organizations and patient care medical homes are gaining traction as a new business model for healthcare deliver

• ↓ costs• ↑ quality care• ↑ patient experience

Constructing the new delivery model• Technology• Process • People• New Programs/Products

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Healthcare’s Movement to Consumerism

Why Embrace Consumerism/Repositioning of HC • costs• ↑ quality• service

Who is the Consumer• Physicians → “patients”• Health systems → “patients”• Health plans → “members”• Bio-pharma → “users”• Clinical trials → “subjects”

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Healthcare’s Movement to Consumerism

Who will need to Engage the Consumer• Providers• Health plans• Employers• Government

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Foundation Elements


Beneficiaries of Consumerism

Employers – (that support health benefits)

• Healthy, productive, stable workforce → company growth, viability

• Employees seek job security → HC benefits

Community • Physicians, hospitals, pharmacies, testing

facilities, home health…• Health plans• Community (lower per capita health costs)

Individuals and families – (purchase the services)• Access to “right” information via “right” tools• Benefit by “driving more value” within the provider health system


Consumers are interested in “innovative” health information technologies• Enable self-monitoring (i.e., blood sugar, blood pressure, etc.)• Facilitate information exchange and interchange with their care givers (i.e., videoconferencing)• Support treatment adherence (i.e., medication reminders, tracking towards goals, etc.)

Role of Technology – Consumer Readiness

Deloitte 2012


Use of Health Plan and Doctor Websites & Portal

Use of “health plan websites” and “enrollee portals” currently more common than use of “doctors’ websites” and “patient portals”

Consumers say they value having access to “portals” and “websites” - access to

• Personal information about their health • Appointment scheduling

• Medical history • Prescription refill ordering

• Treatment plans

Source: Deloitte Center for Health Solutions Consumer Survey, 2012


Patients Should Be Able to Update EHR

82% of U.S. doctors want patients to actively

participate by updating their EHR.• Doctors want patients to add information.• Demographics (95%)• Family medical history (88%)• Medications (87%)• Allergies (85%)• Clinical updates to BP and glucose

(81%)

But only 31% want patients to have access to

their full record.

Nearly half (49%) think patient access to EHR

is crucial to effective care, yet only 21% allow

patients online access now.Source: Accenture Doctors Survey


Generational Consumer Interest

and Behaviors

Our “youngest generations” appear to be especially receptive to taking a more active role as health care consumers.

Source: Deloitte Center for Health Solutions

Consumer Survey, 2012


Consumer Engagement is a “Strategic Priority”

Providers and payers both ranked Consumer Engagement as a high priority initiative ; as expected payers as a group tend to rate this initiative as a higher priority than providers. This difference is reflective of who their customers are – employers and members.

(Source: Porter Research/Medecision VBH and Consumer Engagement Study 2012)


Innovations in Healthcare IT Driving More Coordinated, Consumer-Friendly and Value-Based Care

► So what is working?

► Has anyone found a technology, a business strategy or incentive that has led to truly successful consumer engagement when it comes to care management programs?

► Will providers and payers really have to resort to flyovers?

► Let’s take a look at these questions by breaking them down.

* Cartoon courtesy of Imprivata

http://www.imprivata.com/


Defining Consumer Engagement

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Providers Payers

“Not just a portal or other technology but actually having the patient participating in education and interventions on their health’.

“Having consumers engage in their health and when necessary medical treatment”.

“Simply put, including patients in their care both planning and participating”.

“Patient Relationship Management - Not necessarily consumer, but patient at this point”.

“Consumers accessing website for information about services we offer including finding a physician, health literacy and consumer education, personal health records, home monitoring and patient-clinician communication”.

“Consumers are actively involved in all aspects of their health care, compliant with their care plan, and optionally using the portal”.

“Engagement by the patient and family in care education designed for patients with specific health needs: onsite classes, focus groups, as well as engagement with navigators and case management for continued care needs and social workers for home/financial needs”.

“Efforts that change consumer behavior.” “Patient takes medicine, hits all quality goals and never

goes to the hospital and answers phone when we call”. “Any contact with the consumer I would assume”. “We struggle with this one -- clearly we all recognize that

the consumer needs to be engaged at some level for membership retention.

We all recognize however that ultimately it is the consumer's choices which drive health care outcomes.

Our evolving definition relates to the latter with the belief that a consumer who is engaged with our patient education, our provider network, and participates in our value incentives will ultimately be healthier with lower health care costs.”

Source: Porter Research/Medecision VBH and Consumer Engagement Study 2012

A wide array of definitions among our providers and payers all center around “changing consumer behavior” and “actively engaging” and the “patient participating” in their health management.


Defining Consumer Engagement

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Source: Porter Research/ Medecision VBH and Consumer Engagement Study 2012

A wide array of definitions among our providers and payers

Changing consumer behaviorActively engaging

Patient participating” in their health management.

“Not just a portal or other technology but actually having the patient participating in education, planning and interventions on their health’.

“We all recognize that ultimately it is the consumers’ choices that drive healthcare outcomes”

“We all recognize the consumer needs to be engaged at some level for membership retention,”


Challenges Encountered in Engaging Consumers

Challenge Providers Payers

Consumer Compliance/Engagement

“General lack of interest from consumers in this area”.

“Basically, they don't want to be engaged! By that I mean people basically trust their care team to provide quality and do their jobs. They make basic choices, but don't want to be bothered with some of the administrative details of their care (Medical records transport, etc.).

To provide true patient engagement, they need to PARTICIPATE in their care and make some of the decisions, not just trust the clinician. I'm not convinced clinicians are ready for this either”.

“Financially there are always challenges with patient being compliant, if they cannot afford their meds”.

• “Increased cost sharing has generated very little change in choosing providers -- which is very frustrating, since there is still a wide range in cost performance among providers. Consumers have responded to tiered Rx design, increasing their generic drug use.

• “Can't find them. They are not interested in engaging”.

• “Despite what we may think, many of our members view us just as their insurance company - as such they do not wish to become "engaged" to us. When we partner with our medical homes our uptake is much higher. Even with that we have been challenged with engaging patients around informed decision making”.

Both providers and payers rank “consumer engagement” as their greatest challenge – lack of compliance, interest, financial incentive.

Providers also cited – “technology and platform”, “portal adoption”, and “privacy/security concerns”.


Your Challenges of Consumer Adoption

Text to “XXXXXX”

Consumer Compliant Engagement send 1Technology send 2Portal Adoption send 3Privacy/Security send 4


Challenges Encountered in Engaging Consumers

Challenge Providers

Technology

Portal Adoption

Security/Privacy

“Our patient population, outside of employees, may have challenges with technology at some urban locations”.

“On our side resources has hindered further data sharing with patients only with EHR progress, which while advanced in not 100% complete”.

“Aging population that is rural and lacking in technology (computer access) and lacking in funds”.

“Not all providers in our area are using the same platform, although the bulk of providers are on Epic. Those that are not have a harder time reaching consumers”.

“The portal has been well received”.

“We have had a very high success rate with patient portal. Issue is to create the stickiness that keeps bringing them back to communicate without flooding them with information”.

“There is some concern about the security of the information”.

“Some are very interested - some see it more as an invasion of privacy”.


How Do Provider & Health Plans Engage Consumers Today?

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Providers Payers

• Patient Portal – scheduling, lab results, payments, medication refills, etc.

• Consumer portal – content to engage as consumers or patients

• Surveys (pre and post service) • One on one with provider• Classes, events, education material• Discharge call planning• Transition of care managers (navigators)• Health coaches (limited)• Secure Messaging• Patient focus groups for various diseases• TV and radio infomercials

• Letters, emails, outbound calls• Care Management focused on educating

members – benefits, treatment options, drug formulary options

• Website• Wellness program incentives (employer

biometric testing)• No voice response system (person picks up

the phone)• Phone apps to help find doctors, exercise



Technologies to Implement to Engage Consumers - Future

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Providers Payers

• Patient portals • Physiological monitoring/remote

monitoring • Medication management • PHR • Social media • Education materials• E-visits, e-consults• Website content• Outreach software for care coordinators• Online appointments• Physician contact tools• Smart phone mobile apps

• More web based functions• Smart Phone apps• Self health management• Home visits (electronic visits)• Online HRAs (mobile)• Social media• E-notifications



Lines blurring between traditional health insurance companies and healthcare providers.

Providers and payers are coming together via partnerships, alliances or outright mergers and acquisitions to better position themselves for this new world of value-based care.

Aetna has been doing some very innovative things when it comes to consumer engagement and business models.

“Bridging the Divides” – Emerging ModelsWhat it means to consumer engagement initiatives?


Role of Employers-Health & Wellness Gatekeepers for Newly Insured


Role of Employers-Health & Wellness Gatekeepers for Newly Insured

Jenn slide


“Bridging the Divides” Care Model

Christiana Care Health System partners with ColdLight Solutions and Medecision Designed to harness IT to transcend the gaps that currently exist within health care.

ColdLight Solutions delivers Neuron™ which taps into all available sources of data One of which will be Medecision’s Aerial solution “Aerial” platform will power the information sharing and care coordination to the

Christiana Care community and consumers Neruon will use the information gathered to ensure patients can safely transition

from acute care settings to their homes for follow up care – predictive analytics Christiana will leverage the information being provided by both firms with its clinical

expertise.

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Totally Engaged Consumer of the Future

Wearable Electronics

With chips shrinking and

sensors becoming cheaper,

personal computing is

moving from that

smartphone in your pocket

to your arm, your wrist, right

out to your fingertips.

Google GlassComing soon: Eyeglasses that take photos and video that you can immediately share online, all with a few taps of your finger or the sound of your voice.

Medical BandsStrap one on your arm and measure your heart rate and cholesterol.

Accessorize for AccessJewelry, belts and bracelets will monitor your caloric intake, connecting you to the cloud.

WristbandsWith the Nike™ Fuel Band, your gym workout just got more productive.

Glove that Calls HomeSpeaker on the thumb, microphone on the pinkie; ‘Nuff said.

iWatchApple’s much-rumored gadget could turn your wrist into an outpost for your iPhone.

Wardrobe Change on the GoClothes can light up, advertise, change colors or become transparent.

High-Tech FabricItems such as knee socks from Uniqlo convert evaporating moisture on your body to heat.


Questions?

Cynthia Porter, [email protected]

Phone: 678-282-1033

Allison Norfleet, VP, [email protected]

Phone: 678-282-1034

www.PorterResearch.com

market insights for engaging consumers

Health & Medicine