Market Insights for Engaging Consumers
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Market Insights for Engaging Consumers

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The healthcare delivery model is being transformed and each stakeholder has an integral part to play in its much needed success. Healthcare delivery organizations, payers, and employers have typically ...

The healthcare delivery model is being transformed and each stakeholder has an integral part to play in its much needed success. Healthcare delivery organizations, payers, and employers have typically shouldered much of this responsibility, and now patients are being added to the mix as their consumer influence and purchasing power grows. Porter Research President Cynthia Porter will explore this evolution and the industry trends that have turned previously backseat patients into some of healthcare's most powerful drivers.

Presented in April 2012 at Breakthrough 2013 - the Medecision Client Forum

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    Market Insights for Engaging Consumers Market Insights for Engaging Consumers Presentation Transcript

    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialMarket Insights for EngagingConsumersCreated byCynthia Porter, President, andAllison Norfleet, VP, Business DevelopmentPorter Research1
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialThe new book, “Engage!Transforming Healthcare ThroughDigital Patient Engagement” -- editedby Jan Oldenburg, Dave Chase, KateT. Christensen, MD, andBrad Tritle, CIPP2
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 368% of Physicians Refuse to E-mail theirPatients 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 begetting information togetherRemote monitoring and telehealth“SHOW ME THE DATA”Dr. Eric Topol, MDKeynote speakerHIMSS May 2013
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 4MarketInsightsintoEngagingConsumers
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialWhy It’s So Hard To Improve ConsumerEngagement In Healthcare?5Source:March 11, 2013George VanAntwerp
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential Moving from fee-for-service to value-based care Shift in payer/healthcare delivery organization relationships, Innovations in healthcare IT Role of employers6Market Insights into Engaging Consumers
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 7Market Background*Care Management Industry includes more than software such as professionalservices, 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 andlegitimizes the movement in focus towards preventative care and enhanced management of chronicdiseases 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 governmentis 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 annualspend by 2017 (of the total expected growth from $18B to $90B of the Broader Care ManagementIndustry)*► Healthcare industry leaders and policy makers have recognized that Care Management offers a positivereturn on investment for a specific segment of the population—those patients that represent 83 percent oftotal 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 expenditureson chronic diseases… preventative care management practices are also needed for young adults andmiddle-aged healthy persons
    • ©2013 Medecision – Proprietary and Confidential“Regulatory” Market Trends Driving – Transformationof Care Management > Healthcare Consumerism2012 2013 2014 2015 2016 2017Meaningful UseStage 1Meaningful UseStage 2Meaningful UseStage 3> 30 Pioneer ACOs~150 MSPP ACOs~150 MSPP ACOsPatient Protection & Affordable Care ActHealth Benefits ExchangeMedicaid ExpansionMandatory CoverageACA Implementation/OptimizationHIS OptimizationHealth Information Exchange StabilizationUtilization of HIX/HBEsICD-10 HIPAA6020Chronic DiseaseManagementHealth & WellnessCare ManagementMeaningful UsePenaltiesVBH PerformanceReportingWindow ofOpportunityARRA
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 9Consumer’s Role Within VBH – Moving from “Volume” to “Value” Overwhelmingly, 75 percent of HC executives expressed support, but shared somelevel of reservation about the imminent transition to at least partial value-basedhealth 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 driveconsolidation 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 ashealthy as possible. Payers offer personalized benefits to incentivize particularbehaviors for individual who have or are predisposed to certain chronicdisease. Consumer engagement, however, will be essential to building longer term, moreintimate relationships needed through innovative programs, to align healthcarestakeholders and reduce costs, while respecting patient preferences andresource considerations.
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialInnovation in Health Care Delivery Models Accountable care organizations and patient care medical homes are gainingtraction as a new business model for healthcare deliver• ↓ costs• ↑ quality care• ↑ patient experience Constructing the new delivery model• Technology• Process• People• New Programs/Products10
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialHealthcare’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‖11
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialHealthcare’s Movement to Consumerism Who will need to Engage the Consumer• Providers• Health plans• Employers• Government12Sharing ofInformation atPOCEngagingConsumers(engagehealthybehavior)CoordinatingCare (acrosscare settings)Analytics(monitorproviders,systemsperformance)Foundation Elements
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 13Beneficiaries of Consumerism Employers – (that support health benefits)• Healthy, productive, stable workforce →company growth, viability• Employees seek job security → HCbenefits Community• Physicians, hospitals, pharmacies, testingfacilities, 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
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 14 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 ReadinessDeloitte 2012
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 15Use 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 plansSource: Deloitte Center for Health Solutions Consumer Survey, 2012
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 16Patients Should BeAble to Update EHR 82% of U.S. doctors want patients to activelyparticipate 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 totheir full record. Nearly half (49%) think patient access to EHRis crucial to effective care, yet only 21% allowpatients online access now.Source: Accenture Doctors Survey
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 17GenerationalConsumer Interestand Behaviors Our “youngestgenerations” appear tobe especially receptiveto taking a more activerole as health careconsumers.Source: Deloitte Center for Health SolutionsConsumer Survey, 2012
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 18Consumer Engagement is a “Strategic Priority” Providers and payers both ranked Consumer Engagement as a high priority initiative; as expected payers as agroup tend to rate this initiative as a higher priority than providers. This difference is reflective of who their customersare – employers and members.(Source: Porter Research/Medecision VBH and Consumer Engagement Study 2012)
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 19Innovations in Healthcare IT Driving More Coordinated,Consumer-Friendly and Value-Based Care► So what is working?► Has anyone found a technology, abusiness strategy or incentive that hasled to truly successful consumerengagement when it comes to caremanagement programs?► Will providers and payers really have toresort to flyovers?► Let’s take a look at these questions bybreaking them down.* Cartoon courtesy of Imprivata
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialDefining Consumer Engagement20Providers Payers ―Not just a portal or other technology but actually having the patientparticipating in education and interventions on their health‘. ―Having consumers engage in their health and when necessarymedical treatment”. ―Simply put, including patients in their care both planning andparticipating”. “Patient Relationship Management - Not necessarily consumer, butpatient at this point‖. ―Consumers accessing website for information about services weoffer including finding a physician, health literacy and consumereducation, personal health records, home monitoring andpatient-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 educationdesigned for patients with specific health needs: onsite classes, focusgroups, as well as engagement with navigators and casemanagement for continued care needs and social workers forhome/financial needs‖. ―Efforts that change consumer behavior.” ―Patient takes medicine, hits all quality goals and nevergoes 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 thatthe consumer needs to be engaged at some level formembership retention. We all recognize however that ultimately it is theconsumers choices which drive health care outcomes. Our evolving definition relates to the latter with the beliefthat a consumer who is engaged with our patienteducation, our provider network, and participates inour value incentives will ultimately be healthier withlower health care costs.”Source: Porter Research/Medecision VBHand Consumer Engagement Study 2012 A wide array of definitions among our providers and payers all center around “changing consumerbehavior” and “actively engaging” and the “patient participating” in their health management.
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialDefining Consumer Engagement21Source: Porter Research/ Medecision VBH and Consumer Engagement Study 2012A wide array of definitions among our providers and payersChanging consumer behaviorActively engagingPatient participating‖ in their health management.―Not just a portal or other technology but actually having the patientparticipating in education, planning and interventions on their health‘.―We all recognize that ultimately it is the consumers‘ choices that drivehealthcare outcomes‖―We all recognize the consumer needs to be engaged at some level formembership retention,‖
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 22ChallengesEncounteredin EngagingConsumersChallenge Providers PayersConsumerCompliance/Engagement ―General lack of interest fromconsumers in this area‖. ―Basically, they dont want to beengaged! By that I mean peoplebasically trust their care team toprovide quality and do theirjobs. They make basic choices, butdont want to be bothered with someof the administrative details of theircare (Medical records transport,etc.). To provide true patientengagement, they need toPARTICIPATE in their care andmake some of the decisions, not justtrust the clinician. Im not convincedclinicians are ready for this either‖. ―Financially there are alwayschallenges with patient beingcompliant, if they cannot afford theirmeds‖.• “Increased cost sharing hasgenerated very little change inchoosing providers -- which isvery frustrating, since there is still awide range in cost performanceamong providers. Consumershave responded to tiered Rxdesign, increasing their genericdrug use.• ―Cant find them. They are notinterested in engaging”.• ―Despite what we may think, manyof our members view us just astheir insurance company - as suchthey do not wish to become"engaged" to us. When we partnerwith our medical homes ouruptake is much higher. Even withthat we have been challenged withengaging patients aroundinformed decision making”. Both providersand payers rank“consumerengagement” astheir greatestchallenge – lack ofcompliance,interest, financialincentive. Providers alsocited –“technology andplatform”, “portaladoption”, and“privacy/securityconcerns”.
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 23Your Challenges of Consumer AdoptionText to “XXXXXX”Consumer Compliant Engagement send 1Technology send 2Portal Adoption send 3Privacy/Security send 4
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 24ChallengesEncounteredin EngagingConsumersChallenge ProvidersTechnologyPortalAdoptionSecurity/Privacy ―Our patient population, outside of employees, mayhave challenges with technology at some urban locations‖. ―On our side resources has hindered further data sharing with patientsonly with EHR progress, which while advanced in not 100% complete”. ―Aging population that is rural and lacking in technology (computeraccess) and lacking in funds”. ―Not all providers in our area are using the same platform, although thebulk of providers are on Epic. Those that are not have a harder timereaching consumers‖. ―The portal has been well received”. ―We have had a very high success rate with patient portal. Issue is tocreate the stickiness that keeps bringing them back to communicatewithout 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”.
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialHow Do Provider & Health Plans Engage Consumers Today?25Providers Payers• Patient Portal – scheduling, lab results,payments, medication refills, etc.• Consumer portal – content to engage asconsumers 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 educatingmembers – benefits, treatment options, drugformulary options• Website• Wellness program incentives (employerbiometric testing)• No voice response system (person picks upthe phone)• Phone apps to help find doctors, exercise(Source: Porter Research/Medecision VBH and Consumer Engagement Study 2012)
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and ConfidentialTechnologies to Implement to Engage Consumers - Future26Providers Payers• Patient portals• Physiological monitoring/remotemonitoring• 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(Source: Porter Research/Medecision VBH and Consumer Engagement Study 2012)
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 27 Lines blurring between traditional health insurancecompanies and healthcare providers. Providers and payers are coming together viapartnerships, alliances or outright mergers andacquisitions to better position themselves for this newworld of value-based care. Aetna has been doing some very innovative things when itcomes to consumer engagement and business models.“Bridging the Divides” – Emerging ModelsWhat it means to consumer engagement initiatives?
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 28Role of Employers-Health & Wellness Gatekeepers for Newly Insured
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 29
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 30Role of Employers-Health & Wellness Gatekeepers for Newly InsuredJenn slide
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential“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 theChristiana Care community and consumers Neruon will use the information gathered to ensure patients can safely transitionfrom acute care settings to their homes for follow up care – predictive analytics Christiana will leverage the information being provided by both firms with its clinicalexpertise.31
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 32Totally EngagedConsumerof the FutureWearable ElectronicsWith chips shrinking andsensors becoming cheaper,personal computing ismoving from thatsmartphone in your pocketto your arm, your wrist, rightout to your fingertips.Google GlassComing soon: Eyeglasses that takephotos and video that you can immediatelyshare online, all with a few taps of yourfinger or the sound of your voice.Medical BandsStrap one on your arm and measureyour heart rate and cholesterol.Accessorize for AccessJewelry, belts and bracelets willmonitor your caloric intake,connecting you to the cloud.WristbandsWith the Nike™ Fuel Band,your gym workout just gotmore productive.Glove that Calls HomeSpeaker on the thumb, microphone on thepinkie; ‗Nuff said.iWatchApple‘s much-rumored gadget could turnyour wrist into an outpost for your iPhone.Wardrobe Change on the GoClothes can light up, advertise, changecolors or become transparent.High-Tech FabricItems such as knee socks fromUniqlo convert evaporatingmoisture on your body to heat.
    • ©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 33Questions?Cynthia Porter,PresidentCynthia@PorterResearch.comPhone: 678-282-1033Allison Norfleet,VP, BusinessDevelopmentAllison.Norfleet@PorterResearch.comPhone: 678-282-1034www.PorterResearch.com