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Patient Engagement from a Payer Perspective

August 24, 2012
by Gabriel Perna
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Humana executes a diabetes patient engagement pilot

Widespread provider-led patient engagement platforms are becoming commonplace in the industry, especially with the requirements in the final rule of meaningful use Stage 2 of the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA/HITECH). However, payers are also getting on board with the patient engagement trend. According to a recent report from Chilmark Research, various health insurers have begun creating initiatives which use social media, mobile health (mHealth), and even games to support patient engagement.

One such payer is the Louisville, Ky.-based Humana. Recently, the nationwide provider of Medicare benefits rolled out a self-care program for Medicare Advantage diabetes patients in partnership with dLife Healthcare, the Westport, Ct.-based provider of diabetes management software. The platform, My Diabetes Path (MDP), has launched in pilot for more than 18,000 member participants, and provides multi-channel, multimedia interventions using dLife’s content, tools, and online community for diabetes self-management.

The results in the pilot have been positive, according to Humana. The payer saw a seven-percent improvement in LDL screening, nine-percent improvement in blood sugar screening, seven-percent improvement in eye exams, and a six-percent improvement in kidney disease monitoring.

Recently, Kathryn Creech, vice president of Medicare Services at Humana, spoke with Healthcare Informatics Associate Editor Gabriel Perna about the platform. Below are excerpts from the interview.

Describe the platform, how it’s used?

We describe it as a self-care program, our objective is to help Humana members better manage their condition, stay out of the hospital, have lower costs, and improve their well-being. We all know managed care companies are pretty good once they hit the hospital. We want to keep them from getting there. So we identify members in the Humana Medicare population who have gaps in care in terms of managing their diabetes. That could be, ‘I don’t have my a1c, I don’t know my blood pressure or cholesterol, I’m not taking medications.’ We reach out to those members, by phone and by mail, and we enroll them in My Diabetes Path.  The member has the option, depending on their learning style, of enrolling online or using a print booklet. So you can use online by itself, print by itself, or both.  We work with them over an eight-week course.

We look at it as a wakeup call. It’s an engagement. We’re trying to get your attention and help you understand what is possible with a few simple steps. Diabetes doesn’t go away, it’s a lifelong condition. It’s, ‘what can we give you that makes your life easier and better?’

How have you gotten patients to actually use it?

There’s no one magic bullet. Different things appeal to different people. You may work better with a message that says live better, feel better and I may need to be threatened with a message that says ‘if you don’t take care of yourself, you may be in trouble.’ What we try to do is test and experiment with different messages to different segments. The most prevalent way of attracting people is creating a picture of where their future can go if they manage their diabetes better. They can feel better, can be better, they can have a better of quality of life.

We also try to identify what the barriers may be and put them in an environment where they can be taken down. The barriers could be anything from ‘I don’t like going to the doctor’ to ‘I don’t know anyone else that is a diabetic.’ dLife is a huge asset in this regard, because it’s about the richness of the diabetic community there. So when we introduce our members to that community, they realize that others have done this and it is okay, they seen good results. So there is personalization, identifying barriers, and connecting to a community of people with similar concerns.

How many providers are partnering you with, to get this off the ground?

We’re in the process of doing that now. Our first wave of work was to go directly to the members to enroll. Our second wave is reaching out to providers, saying, ‘Here are your diabetic Humana members with gaps in care, and we’d like work with you to get them into this program.’ That’s been an interesting process, we find providers are often enthusiastic about being able to offer their patients a program that works for them and makes sense.

Backing up a little bit, what was behind the implementation of this program, from a payer’s perspective?

From a payer’s perspective, we want to improve the health of our members, keep them out of the hospital, help them feel better, and manage costs. When we look at our diabetic members, we try to identify opportunities for improvement, and one way to look at them is ‘Who has gaps in care?’ Who hasn’t had a Hemoglobin a1c in the last year, or lab work on their blood in the last year, or isn’t on an appropriate diabetic medicines? Can we reach out to those who aren’t yet acutely ill, and are not yet driving up costs, and get them engaged and taking care of themselves?

Where do you see the platform going? Could it be expanded to other diabetes Humana patients?  Could this type of platform work for other chronic diseases?

Both, other diabetics, commercial and Medicare, and other diseases that have a significant lifestyle component. In the elderly population with congestive heart failure (CHF), there is a long ramp up of multiple stages of that disease where lifestyle management– management of diet, physical activity, etc., just like with diabetes, makes a huge difference. We can see a very reasonable progression to other chronic conditions.

You have to really manage the entire disease stage from diagnosis to acute illness. I think we’re all pretty good at managing the acute illness phase, and where want to focus is the entire spectrum of the condition. It’s not just a nice linear progression, people go in and out of being able to manage their conditions effectively. We want to be there to help them manage it at the right point and time. It’s the use of data and analytics to understand the state of each member of the population is in and what the appropriate intervention would be, given the state.

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