Thursday, March 17, 2011

#whchpi Innovative tools and customer centric techniques to deal with Health Care Reform @doctortarzy

More from the Health Plan Innovations Conference in Orlando.
Innovative Tools and Customer-Centric Techniques to Respond to Health Care Reform: Personalized, Contextual Member Communications – Optimizing Touch Points to Maximize Engagement and Reduce Costs
Learn through case study presentations new strategies for delivering information to beneficiaries that maximizes engagement and loyalty, while reducing costs.
  • Importance of the consumer experience in the new health care marketplace
  • Concrete techniques to reduce medical cost ratio
  • Improved transparency to meet new regulations
  • Case studies: Evaluating successes at Aetna and Regence
Ryan Tarzy 
Vice President of Business Development
Healthline Networks, Inc. 

 View Biography

Healthline is the 5th fastest growing internet company. Provides health information to 100M users each month across many major sites including Yahoo Health, Regence, Aetna and many more.

- Lower Medical Loss Ratio and Reduce costs
- Improve member engagements
- Tools for decision support.

Integrated Decision Support Tools
Smart Messaging
Transparency Tools

Aetna uses Healthwise Knowledgebase, Provider Directory, Drug Database. Cost of Care calculators.

How do customers navigate.

2008 Aetna launched SmartSource with HealthLine.

Healthline provides a semantic search technology.

[Ed: Consumers expect a search box that works - that is a BIG challenge for many health plans with their plethora of siloed information solutions.]

Healthline Smart Source matches semantic search with member information. 

Consider Health data as "In house Ads" - Use Search and Ad technology to deliver contextually relevant information to members.

Smart messaging:
Drive personalized information from a member PHR or claims data.

SmartMessaging Admin Dashboard is a simple Excel-like GEMs Editor interface.

Allows message segmentation, dates to start and stop display.

The next step will be to deliver smart messaging via email with link to secure web page. Process complies with HIPAA with opt-in/outs etc.
Message can appear to come from the doctor rather than the health plan.

On the horizon: Online Text Care Alerts. Adding Mobile Apps to alert members to savings opportunities. Care Gap alerts. Alerts may currently go to care management staff. This can extend to members and their doctor.

Cost benefits: 
- Convert phone calls to digital
- Convert paper to digital


Administrative messages move to clinical messaging (therefore part of MLR not admin cost) Add Patient Education messages to eligibility checks - makes it a clinical rather than admin transaction. 

e.g. Send links to health information and directory of relevant local docs for treatment.

Cost savings from member behavior change. 

Members are used to going to web to find information but find information to hard to find on payer sites.

- Convert Claims codes to consumer friendly names (Regence uses this capability)
-  Link from claim to relevant content 
- Enhance understanding of the EOB
- Leverage Provider Directory Search as a "teachable moment" (most used tool on health plan web sites)
-- Provide related content
-- Related Drugs
-- Cost and Quality information
-- Links to Social media and relevant discussion groups (e.g Regence My Blue Community).

Same tools can be applied to the online EOB. Deliver relevant information based upon claims data.  Add Smart Messaging as part of EOB.

Dealing with HIPAA regulations to manage member email/contact preferences. Healthline has solutions as part of Smart Messaging.

Tools provide Segmentation as well as personalization.

Decision Support Tools: Clinical decision - symptom, treatment searches. Doctor search. Can integrate third party or in house tools. The key is to deliver contextually relevant information at the right time.

Plans are looking to leverage Social Media to reach members.

Benefits come from linking information silos with relevant info from other silos. e.g Community forum links to clinical decision support tools.

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