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Power to the People

April 1, 1998
by Charlene Marietti
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Healthcare consumers are taking charge. With the support of government, pharmaceutical companies, employers, health plans, and some healthcare organizations, consumers are taking responsibility for their own health and well-being under a new type of healthcare management termed population health management. This proactive approach includes all aspects of healthcare with particular focus on improving individual health levels as a claims cost-reduction strategy.

As a new age of accountability dawns, the spotlight on healthcare shifts from the provider and medical treatment delivery mechanisms to the individual. This transition brings an empowered patient into a working partnership with the healthcare provider.

New information technology systems and applications with innovative support mechanisms and educational opportunities are emerging in real and virtual healthcare communities. Also emerging are new ways to look at risk management and the individual. "It’s time to think about the moment of intervention at a different level," says Neal Sofian, VP of program and business development, Lexant, Seattle, a health risk management service organization.

Proof of purchase

Population risk management studies that link individual health styles with medical claims costs are building solid evidence for return on investment and fueling adoption of health promotion and personal behavior programs. Proof of savings, the increased understanding of behavior-based education and intervention methods and contemporary marketing practices are leveraging new and existing technology tools. Although a true multimedia program has not been consolidated into a solidified marketing approach for all members of the population, efforts are under way from various segments of the industry.

Healthcare organizations must pay attention to population health management for two reasons. Not only will it be necessary to rethink the healthcare delivery system in terms of managing wellness and chronic diseases for members in an increasingly competitive environment, but it will be important to consider the opportunities from the employer’s perspective. Many insurers, healthcare providers, health plans, employers, pharmaceutical companies and consumers are already actively investigating population health management’s potential to supplement the traditional care delivery system; hospital and integrated delivery system decision-makers must be ready.

The direct relationship between personal health and medical costs has long been considered a given, but not quantified. The outcomes measurements critical to cost benefit determinations have traditionally been a weak link in assessing the performance of a delivery system, mainly due to lack of communication among providers and among systems. Dee Edington, PhD, dean of the Department of Kinesiology at the University of Michigan Health Management Research Center, Ann Arbor, Mich., has been a leader in trend management and risk stratification studies linking health promotions with cost outcomes. His studies related to work-site health promotions and disease prevention highlight the financial benefits associated with personal health risk management and detail return on investments.

Edington centers his research on risk factors--those pointers that indicate less than optimal health outcomes. They are directly proportional to cost: As risks go up, costs go up. He estimates the economic value of assessing and changing one risk factor for one employee for one year can realize $300 in cost savings to the payor. To that end, he encourages increased use of health risk appraisal participation by individuals as a key cost saving strategy. In his trend management schema for optimal impact and health status, the individual’s risk level would be assessed, interventions assigned, resources allocated and outcomes measured to quantify the performance of the healthcare interventions.

A number of large employers are evaluating the economic potential of health promotion programs as a way of reining in healthcare expenditures and absenteeism costs. In one such example, New York-based Citibank, N.A., implemented a high-risk intervention program among employees to identify the validity of the strategy and to determine the cost benefits of such a program on health outcomes and costs. Jan Murnane, corporate director of health promotion and the employee assistance program, says that although the voluntary program was not randomized, follow-up financial analysis yielded a return-on-investment ratio that brought attention from management and a commitment to expand the program.

Tightly integrated with health management cost-benefits are quality-of-care issues. Service costs can point to intervention requirements, but they cannot prove cost-benefits, says Sofian. More studies showing positive returns on investment will drive payors to demand managed health strategy implementations before quality standards of care are addressed. Although managed care organizations will first respond to payor initiatives and cost-based strategies, attention will quickly transfer to quality-of-care issues, he says.

Reach out and touch some ’one’

"There are huge opportunities to use existing marketing techniques in healthcare," says Edington. New technologies that can automate the process of assessments and identification of risk factors, facilitate communication between providers and patients, and customize health programs to the individual are capable of changing the fundamental equation of population health management. Integration of new technologies with population health management programs has particular promise in bringing about behavioral changes that will result in reduced risk factors and better disease prevention and chronic disease management.

Tried, true and new marketing concepts are making inroads in healthcare. "There needs to be remote, but high-touch ways to form new bonds and new relationships between the organization and the patient," says Andrew Schorr, president of Schorr Communications, Seattle, producer of interactive, telephone-based information programs. Care providers must offer mechanisms that generate customer buy-in and allow patients to have ownership of the health process. In addition to access to reliable information, support for the emotional needs of patients seeking services is very important in establishing these new kinds of relationships, according to Schorr.

Behavior-based interventions, closely tied to underlying emotional as well as intellectual needs of the individual, are in favor among the marketing cognoscenti. Making a person feel unique and special through technology is on the upswing.

Emerging technologies enabling program administrators to customize multimedia interventions are allowing healthcare organizations and patients to form new kinds of relationships that are a step away from the traditional physician-patient personal encounter. Personalized mailings, online interactive learning programs, telephone coaching and counseling and interactive voice responses systems supplement traditional printed newsletters, educational materials and self-help guides. Messages can be structured to the individual or to a population segment in multiple media presentation styles. Customized interventions are based on learning styles, motivational factors, and readiness to change, as well as on the patient’s state of wellness or chronic condition.

"We believe in building one-on-one relationships one million at a time," quips David Bulger, chairman and CEO, MicroMass Communications, Inc., Raleigh, N.C., who sees tremendous marketing opportunities in healthcare for content-based tailored messaging. His company combines customer-specific information and generic, content-based information to create a customized message for each person. Core information is stored in separate data warehouses and moved to data marts for real-time data compilation into multiple media messages.

Internet technology has already fostered the virtual community; it will also serve as a solid foundation for the virtual integrated health delivery network. Accompanied by increased ownership of Internet-accessible devices, increases in bandwidths, and improvements in Internet telephony quality, consumer access to health-related issues is expected to soar. "Entertainment will drive the Internet into the home; we can piggyback it from there," says Edward "Skip" Walters, president of Personal Health Connections Inc., Seattle, developers of personalized healthcare applications using Internet technology. At present, most health information accessible on the Web is generic. That will change, he says. It will play a key role in increasing population health program participation rates, both on its own and in combination with other media. Web-based health programs are adaptable--they can be targeted and personalized to an individual or to a group.

Offering the advantages of immediacy, interaction, convenience and timeliness, the Internet can support access to millions--one at a time and all at once. "The Internet brings the notion of instant actualization," Walters continues. Access is on-demand and, in addition to generic information access, can be in real-time. Interventions can appear in real-audio, real-video, dynamic interactions or on Web boards. There will be virtual classrooms with a facilitator--or virtual treatment rooms. Messages and interventions will be transformed to a different context every time the member touches the system. Add the element of personalization and, using tailored scripts, Web pages can bring a sense of intimacy to the computer environment--for an individual or a population segment.

New ways of tapping plain old telephone service can bring access to healthcare information and support that is often free to the patient. Schorr Communications has extended the traditional audio-health library concept to create interactive voice response systems for radio-style talk shows over the telephone. Its HealthTalk Interactive system uses voice segments recorded during live shows hosted by physicians and health experts. The program even has a talk-back feature where patients can leave questions for experts; answers are incorporated into the program. The Health Care Financing Administration (HCFA) is currently evaluating it for use with Medicare patients nationwide as a cost-effective alternative to traditional physician-centric medical care.

Some organizations have set up outbound call programs for medication management, support and positive intervention to extend telephone-based counseling. Using standard call center technology, calls can be scheduled to send program participants tailored messages, in the patient’s counselor’s voice if desired. The better the data integration, the more opportunities for data analysis to select at-risk patients and determine the most beneficial time of intervention. But it is not necessary to integrate vast amounts of data for such behavioral interventions, says Sofian. A few key data elements can pinpoint the optimal times and types of intervention required.

Embracing the consumer

Programs ideally combine multiple technologies to market effectively to the needs of each individual. Schorr, for example, is loading HealthTalk Interactive information onto its Web page where patients with mainstreaming technology can access and retrieve the information both visually and audibly. A personalized disease management program, under development by the American Heart Association, will include stage-based kits, tailored quarterly newsletters and an interactive extranet environment to provide program participants with ongoing, personalized education and support.

The multiple facets of health management can provide the support, the education and the ownership. But the delivery is still fragmented and lacks a unified approach that incorporates complementary technology strategies. Outcomes measurements, critical to cost-benefit determinations, have traditionally been a weak link in assessing the performance of the delivery system, mainly due to lack of communication among providers and among systems. A comprehensive suite of approaches that will embrace the consumer will be ideal, says Schorr. All approaches--personal Web pages, personal phone calls, interactive voice response resources, videos, workbooks, classes and email--must be incorporated into a full-service package to be most effective. "The example for tying it all together does not exist," he says, "but business forces, based on financial impact, will make it happen."


Charlene Marietti is senior technology writer at Healthcare Informatics.



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