What does the health care system of the future look like? That’s not an easy question to answer as companies such as IBM and Apple stake claims in health care, providers and insurers join forces, and coverage is increasingly sold directly to consumers. Health plan leaders and other stakeholders presented a mosaic of visions at the America’s Health Insurance Plans Ops/Tech Forum in Phoenix last month, but there was a common theme: The patient experience will shape tomorrow’s health plans and the entire health care system. And it’s clear that health insurance and episodes of acute care can be portals to a high-value health care experience that addresses a variety of patient needs over time. “There’s a massive amount of disruption out there, and actually that’s really great for the consumer,” said Natalie Schneider, who is vice president of strategic alignment with WellPoint. She argues innovation is key to connecting with consumers, but the real key to winning in a consumer-centric environment is nailing the core services of health insurance: providing health coverage in a way that helps people get the care they need. It can be tempting to get caught up in the innovation frenzy as technological advances come faster and faster, she said. “We must be very discriminating and specific about what problem we are trying to solve for the consumer.” A seamless health care system One clear problem is fragmentation of care and a system build around acute health problems, not wellness. The system must move from an episodic model to a continuous health engagement, argues David Schulte, vice president and managing director of Kaiser Permanente Ventures, and it needs to reach people where they live, work and play, he said. Terry Booker, vice president of corporate development and innovation with Independence Blue Cross, echoed those themes, emphasizing the importance of collaboration. That’s key in part, Booker said, because health plans “don’t control any one part of this ecosystem.” Health lives everywhere – the grocery store, work, social connections. That’s part of the thinking behind CVS Health’s Minute Clinic, which brings care to the corner drugstore. Dr. Tobias Barker, vice president of Minute Clinic’s medical operations, said half of Minute Clinic patients lack a primary care provider. In such cases, medical staff provide patients with resources to connect with a physician and develop a more continuous care relationship. Schneider and others see telemedicine (and its cousin remote monitoring) as another key tool for meeting people where they are. And interest is growing rapidly, said Dr. Henry DePhillips, chief medical officer of telehealth provider Teladoc, noting 46% of employers plan to have a telemedicine benefit by the end of next year. It’s an approach that pays off, averting $717 in spending per visit and resolving 94% of cases, according to Teladoc data. A study reported in Health Affairs that looked at Teladoc care found telemedicine care was associated with fewer follow-up visits than emergency or clinical care while potentially improving access to care. And DePhillips notes telemedicine can serve as an access point to more continuous health engagement, allowing insurers to follow up with patients who need a primary care provider or follow-up on issues identified via telemedicine care, filling additional care gaps. What does continuous health engagement look like? A few examples from talks at the conference:
- Linking drugstore clinics with more traditional health care providers to allow two-way data flow, facilitating follow-ups such as a recheck of a high blood pressure reading.
- Remote monitoring for patients with chronic conditions that are likely to progress, catching problems before they escalate.
- Adherence tracking designed to improve outcomes.
- Tracking of smartphone use patterns and aberrations that might signal mental health problems.
- Offering patients digital resources they can use anywhere, rather than a class, to learn how to manage their newly diagnosed diabetes.
Will consumers let health care stakeholders so far into their personal lives? Maybe, speakers said. “We’ve been pleasantly surprised,” Schulte said, noting consumers prefer to be “nudged” rather than “told” how to live healthier lives, and sometimes doctors have better luck than payers engaging consumers in digital health tools. However, Schneider noted that health plans will best position themselves to engage on a more personal level with consumers by nailing the basics of providing clear and affordable health insurance that meets consumer needs. “We have to earn the right to engage,” she said.