Market Insights for Engaging Consumers

©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential
Market Insights for Engaging
Consumers
Created by
Cynthia Porter, President, and
Allison Norfleet, VP, Business Development
Porter Research
1

©2013 Medecision – Proprietary and Confidential
The new book, “Engage!
Transforming Healthcare Through
Digital Patient Engagement” -- edited
by Jan Oldenburg, Dave Chase, Kate
T. Christensen, MD, and
Brad Tritle, CIPP
2

©2013 Medecision – Proprietary and Confidential 3
68% of Physicians Refuse to E-mail their
Patients 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 be
getting information together
Remote monitoring and telehealth
“SHOW ME THE DATA”
Dr. Eric Topol, MD
Keynote speaker
HIMSS May 2013

Market
Insights
into
Engaging
Consumers

Why It’s So Hard To Improve Consumer
Engagement In Healthcare?
5
Source:
March 11, 2013
George Van
Antwerp

 Moving from fee-for-service to value-based care
 Shift in payer/healthcare delivery organization relationships,
 Innovations in healthcare IT
 Role of employers
6
Market Insights into Engaging Consumers

Market Background
*Care Management Industry includes more than software such as professional
services, 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 and
legitimizes the movement in focus towards preventative care and enhanced management of chronic
diseases 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 government
is 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 annual
spend by 2017 (of the total expected growth from $18B to $90B of the Broader Care Management
Industry)*
► Healthcare industry leaders and policy makers have recognized that Care Management offers a positive
return on investment for a specific segment of the population—those patients that represent 83 percent of
total 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 expenditures
on chronic diseases… preventative care management practices are also needed for young adults and
middle-aged healthy persons

“Regulatory” Market Trends Driving – Transformation
of Care Management > Healthcare Consumerism
2012 2013 2014 2015 2016 2017
Meaningful Use
Stage 1
Meaningful Use
Stage 2
Meaningful Use
Stage 3
> 30 Pioneer ACOs
~150 MSPP ACOs
~150 MSPP ACOs
Patient Protection & Affordable Care Act
Health Benefits Exchange
Medicaid Expansion
Mandatory Coverage
ACA Implementation/Optimization
HIS Optimization
Health Information Exchange Stabilization
Utilization of HIX/HBEs
ICD-10 HIPAA
6020
Chronic Disease
Management
Health & Wellness
Care Management
Meaningful Use
Penalties
VBH Performance
Reporting
Window of
Opportunity
ARRA

Consumer’s Role Within VBH – Moving from “Volume” to “Value”
 Overwhelmingly, 75 percent of HC executives expressed support, but shared some
level of reservation about the imminent transition to at least partial value-based
health 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 drive
consolidation 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 as
healthy as possible. Payers offer personalized benefits to incentivize particular
behaviors for individual who have or are predisposed to certain chronic
disease.
 Consumer engagement, however, will be essential to building longer term, more
intimate relationships needed through innovative programs, to align healthcare
stakeholders and reduce costs, while respecting patient preferences and
resource considerations.

Innovation in Health Care Delivery Models
 Accountable care organizations and patient care medical homes are gaining
traction as a new business model for healthcare deliver
• ↓ costs
• ↑ quality care
• ↑ patient experience
 Constructing the new delivery model
• Technology
• Process
• People
• New Programs/Products
10

Healthcare’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

Healthcare’s Movement to Consumerism
 Who will need to Engage the Consumer
• Providers
• Health plans
• Employers
• Government
12
Sharing of
Information at
POC
Engaging
Consumers
(engage
healthy
behavior)
Coordinating
Care (across
care settings)
Analytics
(monitor
providers,
systems
performance)
Foundation Elements

Beneficiaries of Consumerism
 Employers – (that support health benefits)
• Healthy, productive, stable workforce →
company growth, viability
• Employees seek job security → HC
benefits
 Community
• Physicians, hospitals, pharmacies, testing
facilities, 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

 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 Readiness
Deloitte 2012

Use 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 plans
Source: Deloitte Center for Health Solutions Consumer Survey, 2012

Patients Should Be
Able to Update EHR
 82% of U.S. doctors want patients to actively
participate 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 to
their full record.
 Nearly half (49%) think patient access to EHR
is crucial to effective care, yet only 21% allow
patients online access now.
Source: Accenture Doctors Survey

Generational
Consumer Interest
and Behaviors
 Our “youngest
generations” appear to
be especially receptive
to taking a more active
role as health care
consumers.
Source: Deloitte Center for Health Solutions
Consumer Survey, 2012

Consumer Engagement is a “Strategic Priority”
 Providers and payers both ranked Consumer Engagement as a high priority initiative; as expected payers as a
group tend to rate this initiative as a higher priority than providers. This difference is reflective of who their customers
are – employers and members.
(Source: Porter Research/Medecision VBH and Consumer Engagement Study 2012)

Innovations in Healthcare IT Driving More Coordinated,
Consumer-Friendly and Value-Based Care
► So what is working?
► Has anyone found a technology, a
business strategy or incentive that has
led to truly successful consumer
engagement when it comes to care
management programs?
► Will providers and payers really have to
resort to flyovers?
► Let’s take a look at these questions by
breaking them down.
* Cartoon courtesy of Imprivata

Defining Consumer Engagement
20
Providers Payers
 ―Not just a portal or other technology but actually having the patient
participating in education and interventions on their health‘.
 ―Having consumers engage in their health and when necessary
medical treatment”.
 ―Simply put, including patients in their care both planning and
participating”.
 “Patient Relationship Management - Not necessarily consumer, but
patient at this point‖.
 ―Consumers accessing website for information about services we
offer including finding a physician, health literacy and consumer
education, personal health records, home monitoring and
patient-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 education
designed for patients with specific health needs: onsite classes, focus
groups, as well as engagement with navigators and case
management for continued care needs and social workers for
home/financial needs‖.
 ―Efforts that change consumer behavior.”
 ―Patient takes medicine, hits all quality goals and never
goes 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 that
the consumer needs to be engaged at some level for
membership retention.
 We all recognize however that ultimately it is the
consumer's choices which drive health care outcomes.
 Our evolving definition relates to the latter with the belief
that a consumer who is engaged with our patient
education, our provider network, and participates in
our value incentives will ultimately be healthier with
lower health care costs.”
Source: Porter Research/Medecision VBH
and Consumer Engagement Study 2012
 A wide array of definitions among our providers and payers all center around “changing consumer
behavior” and “actively engaging” and the “patient participating” in their health management.

Defining Consumer Engagement
21
Source: Porter Research/ Medecision VBH and Consumer Engagement Study 2012
A wide array of definitions among our providers and payers
Changing consumer behavior
Actively engaging
Patient participating‖ in their health management.
―Not just a portal or other technology but actually having the patient
participating in education, planning and interventions on their health‘.
―We all recognize that ultimately it is the consumers‘ choices that drive
healthcare outcomes‖
―We all recognize the consumer needs to be engaged at some level for
membership retention,‖

©2013 Medecision – Proprietary and Confidential©2013 Medecision – Proprietary and Confidential 22
Challenges
Encountered
in Engaging
Consumers
Challenge Providers Payers
Consumer
Compliance/
Engagement
 ―General lack of interest from
consumers in this area‖.
 ―Basically, they don't want to be
engaged! By that I mean people
basically trust their care team to
provide quality and do their
jobs. They make basic choices, but
don't want to be bothered with some
of the administrative details of their
care (Medical records transport,
etc.).
 To provide true patient
engagement, they need to
PARTICIPATE in their care and
make some of the decisions, not just
trust the clinician. I'm not convinced
clinicians are ready for this either‖.
 ―Financially there are always
challenges with patient being
compliant, if they cannot afford their
meds‖.
• “Increased cost sharing has
generated very little change in
choosing providers -- which is
very frustrating, since there is still a
wide range in cost performance
among providers. Consumers
have responded to tiered Rx
design, increasing their generic
drug use.
• ―Can't find them. They are not
interested in engaging”.
• ―Despite what we may think, many
of our members view us just as
their insurance company - as such
they do not wish to become
"engaged" to us. When we partner
with our medical homes our
uptake is much higher. Even with
that we have been challenged with
engaging patients around
informed decision making”.
 Both providers
and payers rank
“consumer
engagement” as
their greatest
challenge – lack of
compliance,
interest, financial
incentive.
 Providers also
cited –
“technology and
platform”, “portal
adoption”, and
“privacy/security
concerns”.

Your Challenges of Consumer Adoption
Text to “XXXXXX”
Consumer Compliant Engagement send 1
Technology send 2
Portal Adoption send 3
Privacy/Security send 4

Challenges
Encountered
in Engaging
Consumers
Challenge Providers
Technology
Portal
Adoption
Security/
Privacy
 ―Our patient population, outside of employees, may
have challenges with technology at some urban locations‖.
 ―On our side resources has hindered further data sharing with patients
only with EHR progress, which while advanced in not 100% complete”.
 ―Aging population that is rural and lacking in technology (computer
access) and lacking in funds”.
 ―Not all providers in our area are using the same platform, although the
bulk of providers are on Epic. Those that are not have a harder time
reaching consumers‖.
 ―The portal has been well received”.
 ―We have had a very high success rate with patient portal. Issue is to
create the stickiness that keeps bringing them back to communicate
without 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”.

How Do Provider & Health Plans Engage Consumers Today?
25
Providers Payers
• Patient Portal – scheduling, lab results,
payments, medication refills, etc.
• Consumer portal – content to engage as
consumers 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 educating
members – benefits, treatment options, drug
formulary options
• Website
• Wellness program incentives (employer
biometric testing)
• No voice response system (person picks up
the phone)
• Phone apps to help find doctors, exercise

Technologies to Implement to Engage Consumers - Future
26
Providers Payers
• Patient portals
• Physiological monitoring/remote
monitoring
• 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

 Lines blurring between traditional health insurance
companies and healthcare providers.
 Providers and payers are coming together via
partnerships, alliances or outright mergers and
acquisitions to better position themselves for this new
world of value-based care.
 Aetna has been doing some very innovative things when it
comes to consumer engagement and business models.
“Bridging the Divides” – Emerging Models
What it means to consumer engagement initiatives?

Role of Employers-Health & Wellness Gatekeepers for Newly Insured

Role of Employers-Health & Wellness Gatekeepers for Newly Insured
Jenn slide

“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 the
Christiana Care community and consumers
 Neruon will use the information gathered to ensure patients can safely transition
from acute care settings to their homes for follow up care – predictive analytics
 Christiana will leverage the information being provided by both firms with its clinical
expertise.
31

Totally Engaged
Consumer
of the Future
Wearable Electronics
With chips shrinking and
sensors becoming cheaper,
personal computing is
moving from that
smartphone in your pocket
to your arm, your wrist, right
out to your fingertips.
Google Glass
Coming soon: Eyeglasses that take
photos and video that you can immediately
share online, all with a few taps of your
finger or the sound of your voice.
Medical Bands
Strap one on your arm and measure
your heart rate and cholesterol.
Accessorize for Access
Jewelry, belts and bracelets will
monitor your caloric intake,
connecting you to the cloud.
Wristbands
With the Nike™ Fuel Band,
your gym workout just got
more productive.
Glove that Calls Home
Speaker on the thumb, microphone on the
pinkie; ‗Nuff said.
iWatch
Apple‘s much-rumored gadget could turn
your wrist into an outpost for your iPhone.
Wardrobe Change on the Go
Clothes can light up, advertise, change
colors or become transparent.
High-Tech Fabric
Items such as knee socks from
Uniqlo convert evaporating
moisture on your body to heat.

Questions?
Cynthia Porter,
President
Cynthia@PorterResearch.com
Phone: 678-282-1033
Allison Norfleet,
VP, Business
Development
Allison.Norfleet@PorterResearch.com
Phone: 678-282-1034
www.PorterResearch.com

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