To explore what’s happening in healthcare, In Business Magazine asked those in the industry to give us the news from the inside. Technology and customer service continue to drive changes in the consumer experience. But increasing emphasis — as many of our contributors explain — is being placed on the engagement of an educated user..
Kishlay Anand
Founder, Akos MD
Healthcare Advances
Healthcare has certainly come a long way since its humble beginnings. For centuries, medicine in the United States was considered a family affair, with the burden of illness and injury falling primarily on the women in the household. In these early stages of medical care, doctors were far from easily accessible and often called in only for severe or life-threatening cases.
But this all changed starting in the early 1900s. Private health insurance gradually evolved into a “fee for service” system that was followed by the initiation of social programs like Medicaid and Medicare and, eventually, HMOs. The organization of healthcare in the United States endured a complete transformation. By the early 2000s, the fee-for-service system began to fade, and a new one began to take its place — one that placed greater emphasis on preventive medicine, consumer choice and being accountable for one’s own health.
Healthcare Goes Digital
For years, patients endured pain points such as access to care, increased financial support for the aging population, and high insurance premiums. But the rapid evolution of technology led to the creation of a new segment of healthcare known as concierge medicine.
Today, this segment — which includes telehealth, direct primary care, on-demand physician visits and virtual clinics — continues to grow at an astounding rate with no signs of slowing down anytime soon.
So, what can we expect for the future of healthcare?
Patients will continue to seek affordable, convenient and quality healthcare solutions. As a result, the telehealth market will continue to grow. In fact, recently published research by Harvard Medical School and the RAND Corporation shows that by 2025, the telehealth market alone is expected to grow to more than $113.1 billion.
With open enrollment around the corner, more businesses than ever will be considering integrating telehealth programs into their existing benefits packages as a means to save and meet consumer demand. It’s a good idea for human resource managers and business leadership to be proactive and research the benefits, platform features and plan options available, as no two telehealth programs are exactly the same. It’s equally important to educate one’s workforce about changes in advance so employees become informed advocates for themselves.
Making Healthier Consumers
A person who is sick wants to see a doctor as soon as possible, but that doesn’t usually happen. Appointment times never seem to be available when the ailing person needs them, and the long wait times at urgent care centers or emergency rooms certainly don’t help. Telemedicine, however, has made it possible to speak with a doctor almost immediately and, in many cases, from the comfort and convenience of home.
Using phone calls, video chatting and patient-centered data to help diagnose and treat patients remotely, telemedicine is reducing the cost and inconvenience of a traditional in-person visit. Now, everyone from homemakers to business travelers can address their healthcare needs anywhere, anytime, using their smartphone or tablet.
Every year, employee illness and injury cost employers $225.8 billion, according to the Centers for Disease Control and Prevention. The impact may be more pronounced on entrepreneurs and those who have their own business, as their income may depend directly on their own health as well as that of their employees. Not only could illness cause them to miss crucial business days, but productivity could also suffer on the days they try to work while feeling unwell. Telemedicine can provide on-demand treatment to help people get back to work and back to health as quickly as possible.
Between a career, family and life in general, it’s no surprise that our personal health often ends up taking a back seat. But it’s our responsibility to be proactive about monitoring our personal healthcare concerns and make sure we’re living a healthy and active lifestyle. And, as healthcare continues to evolve, it’s important to stay informed about healthcare plan options.
Akos is a pioneer in telemedicine, offering patient-centered, solutions that, in turn, benefit employers, physicians and healthcare centers. Its mobile interface lets users virtually consult with a board-certified provider anywhere anytime and care coordinators to ensure their needs are always being met.
Vishu Jhaveri, M.D., M.S.A.
Chief Medical Officer, Blue Cross Blue Shield of Arizona
Changing the Way Consumers Receive Healthcare
For most people, their primary care provider (PCP) is the point person for their healthcare, helping them stay as healthy as possible. When they’re not feeling well for any reason, their PCP is the person to whom they turn to tell them what is wrong and make recommendations or referrals.
But providing high-quality care is multifaceted and requires everyone in the healthcare field to think differently. Blue Cross Blue Shield Arizona’s (BCBSAZ) experience has shown that when health insurance companies, physicians and individuals work together, people are healthier and more engaged, and doctors are more productive and efficient.
The result is improved patient health that saves individuals time and money, and makes for a more positive healthcare experience.
Trends in such patient-focused approaches ensure that physicians have access to data and research allowing for deeper patient insights and enabling them to tailor treatment plans to the individual. The outcome of all this is reducing the likelihood a person will need to visit the ER or be hospitalized.
Doctors committed to this approach often offer longer physician office hours, which can be helpful when a person gets sick or hurt late in the day, so they don’t have to go to urgent care. It also means more convenient appointment times, so people are more likely to make it to their check-ups.
In addition, patients have multiple ways to communicate with their PCP: phone, email or online.
BCBSAZ implemented its Patient Centered Medical Home (PCMH) program several years ago. The PCMH program incentivizes physicians for improving health outcomes, not for the number of patients they treat. This means patients have the support from their PCP, the pharmacy and a BCBSAZ case manager to help ensure they can get in to see the doctor quickly, are completing their follow-up appointments, taking medication properly and have a better understanding of their care path and management plan.
After two years of monitoring the program, BCBSAZ has found that, compared with non-PCMH patients, PCMH patients have 25 percent fewer ER visits and 12 percent fewer hospitalizations. There have been 31 percent fewer hospital admissions from issues that can be avoided or managed by getting a quick appointment with their PCP, such as a simple pneumonia, urinary tract infections, etc.; a 23 percent reduction in ER visits due to better education in self-management of conditions; and doctors in the program have prescribed generic drugs 8 percent more than other doctors, helping people save money on prescriptions. That’s why BCBSAZ works closely with PCPs and their teams to shape what the future of healthcare looks like.
Blue Cross Blue Shield of Arizona is committed to helping Arizonans get healthier faster and stay healthier longer. With a focus on connecting people with the care they need, the not-for-profit company offers health insurance and related services to nearly 1.5 million customers.
Doug Adelberg
Senior Vice President, Lovitt & Touché
Empowering Employees, Shifting Health Benefit Mindsets Saves Employers Money, Time
With open enrollment around the corner, businesses are feverishly cobbling together benefits packages to meet their workforce’s diverse needs. After all, the vast majority of employees consider health coverage to be one of the most important employee benefits.
While balancing deductibles, coverage, reimbursements and restrictions with costs and competitiveness, few employers take time to realize the fundamentally crucial components of a health benefit plan. Contrary to popular belief, it’s not sharing the nuances between option A and B. Much simpler, it’s about educating — and empowering — employees to be better consumers of healthcare.
There is a difference between healthcare and insurance. Individuals utilize healthcare and insurance pays for a portion of the expenses related to healthcare. Making employees and their families better consumers of healthcare and educating them on all the insurance options available leads to lower costs for the employer.
Empower Employees
The average Amazon customer spends approximately 40 hours online researching products that add up to $2,500 annually. How much time do they really spend understanding their benefits? What do they spend? And, how do they consume healthcare?
Empowering employees to look at where they’re spending their money, how much they’re spending and what they could save is vital. For instance, prescription costs differ vastly from one pharmacy to the next. Comparison shopping at mainstream chains, big-box retailers and even warehouse clubs, where memberships are not required for prescriptions, can add up in hundreds or thousands of dollars in savings.
Speak Beyond the Building
Employers go to great pains explaining benefits to their employees. But many times, the decision maker and the utilizer of healthcare is not the employee but the spouse. Incorporating the spouse into the healthcare decision is a key step in making the participants in the employer plan better consumers of healthcare.
For example, has the employee conveyed that there’s a telemedicine option, which can be a more efficient and cost-effective option for young families? Any parent will agree that calling a nurse 24/7/365 from his or her home is a better option than waiting for hours at a doctor’s office with a sick child.
To bridge this information gap, employers should expand communications beyond the board room. Informative, easy-to-understand mailings and hosted information sessions targeting family decision makers have both been immeasurably successful.
Consider Alternatives
Putting together benefits options can be an albatross for the most seasoned HR professionals. Despite their best efforts to build a plan they think will meet the greatest needs, it’s an educated-guess effort because every employee has unique circumstances. This is why private exchanges are rising in popularity.
Employees can navigate a menu of options, choosing those that best suit their circumstances. It saves money by providing what the employee truly needs, and giving greater control creates both trust and appreciation.
At the end of the day, an employer’s efforts should enhance employees’ lives. And since benefits are key to that end, arming them with the tools they need to make smart choices will ultimately create better consumers and provide greater value for both them and their company.
Arizona-based Lovitt & Touché, one of the largest insurance brokerages in the nation, offers property and casualty insurance, specialty insurance, risk solutions for business, personal insurance, bonds and surety, and comprehensive employee benefits solutions.
Mike Bechtol
Director of Care Logistics. Redirect Health
Self-Funded Healthcare: An Innovative, Cost-Effective Approach to Employee Benefits
Despite ongoing political discourse about improving our nation’s healthcare system, all signs indicate health insurance costs will continue to skyrocket. For business owners who have experienced rate increases year after year, it’s a tough pill to swallow. Some are forced to pass the expenses on to their employees in the form of high deductibles, copays or coinsurance. Others slim down their benefits packages to protect profitability. It’s a lose-lose situation.
But a new solution is emerging — and it’s proving to be the silver bullet for employers who want to provide quality healthcare but can’t afford the annual rate hikes of traditional insurance.
Self-Funded Healthcare: A Better Way
With self-funding, employers create their own benefit plan and pay health claims directly or through a third-party administrator. Businesses can choose from a wide variety of plan designs, and may offer benefits that include medical, dental, vision, prescription medications and workers’ compensation.
For employees, the health plan may look and operate the same. For business owners, a smart self-insurance plan will drastically reduce costs while providing better benefits.
Improving Efficiency through Self-Funded Healthcare
Simplifying access, understanding the factors that impact costs and helping employees navigate the healthcare system are key to building an efficient, innovative self-funded plan.
Free Routine Care: Most traditional plans include deductibles and copayments, creating a barrier to care. Low-wage earners, especially, may choose to not seek treatment because they’re concerned about the money. This may result in extra sick days or reduced productivity. In some cases, health issues left untreated may become worse — and much more costly.
A smart self-funded plan offers routine health services at no cost to employees. Treatment of common conditions like sinusitis, flu, colds and minor injuries is inexpensive for the business but highly valuable for employees.
Stop-Loss Insurance: Companies that self-fund often purchase stop-loss insurance to cover claims that exceed a certain dollar amount. For example, claims costs may increase significantly for an employee who receives a complex medical diagnosis. This insurance ensures the employee receives the necessary healthcare while protecting the business from an unexpected financial loss.
Factors that Impact Costs: The average cost of a hospital MRI is $4,000. The same MRI costs $300 at an offsite imaging center. There is no difference in quality. The same is true of X-rays, blood and urine tests, and other common procedures. Hospitals generally charge five to 20 times more than independent labs or doctor offices. This happens at the pharmacy, too. A simple antibiotic may cost $40 at a corner store pharmacy but just $10 at a supermarket pharmacy. When people understand the factors impacting cost, they make smarter decisions about their healthcare:
Care coordination: Most companies that self-fund hire a TPA to administer the plan. To realize the full benefit of self-insurance, businesses may also consider partnering with a third-party organization to help employees navigate the healthcare system and get the care they need at the most appropriate site of service.
Redirect Health, a national leader in healthcare delivery based in Scottsdale, specializes in building healthcare solutions that are easy and affordable.
David Allazetta
Chief Executive Officer, UnitedHealthcare of Arizona
Healthcare Transparency Helps Improve Outcomes
As our nation seeks solutions to help improve health outcomes and make healthcare more affordable, there are a variety of resources available to help Arizonans comparison shop for healthcare based on quality and cost.
Giving consumers, healthcare professionals and other stakeholders access to information on healthcare prices could reduce U.S. healthcare spending by more than $100 billion during the next decade, according to a 2014 report by the Gary and Mary West Health Policy Center.
That is in part because there are significant price variations for healthcare services and procedures at hospitals and doctors’ offices nationwide, yet a study by Families U.S.A. concluded that higher-priced care providers do not necessarily deliver higher-quality care or better health outcomes. For example, in Phoenix, a knee MRI can cost from $390 to $1,635, and back surgery (lumbar fusion) can range from $42,820 to $91,345.
There are many new online and mobile resources that provide people access to healthcare quality and cost information, enabling them to comparison shop for healthcare as they would with other consumer products and services. And people are starting to take action: Nearly one-third of Americans have used the Internet or mobile apps during the last year to comparison shop for healthcare, up from 14 percent in 2012, according to a recent UnitedHealthcare survey.
ar more accurate and useful than those of past generations, and, in some cases, provide people with estimates based on actual contracted rates with physicians and hospitals, including likely out-of-pocket costs based on their current health plan benefits. Some resources also include quality information about specific physicians, as determined by independent standards.
There are many resources people can consider when shopping for healthcare. In addition to online and mobile resources, people can call their health plan to discuss quality and cost-transparency information, as well as talk with their healthcare professional about alternative treatment settings such as urgent care and telehealth options. Public websites, such as www.uhc.com/transparency and www.guroo.com, also provide access to market-average prices for hundreds of medical services in cities nationwide, including Phoenix.
These resources can help people save money and select healthcare professionals based on objective quality and cost information. A UnitedHealthcare analysis showed that people who use online or mobile transparency resources are more likely to select healthcare providers rated on quality and cost-efficiency across all specialties, including for primary care (7 percent more likely) and orthopedics (9 percent more likely). The analysis also found that people who use the transparency resources before receiving healthcare services pay 36 percent less than non-users.
As people take greater responsibility for their healthcare decisions, transparency resources are becoming important tools to help consumers access quality care while avoiding surprise medical bills.
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the healthcare experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers, military service members, retirees and their families.
AI Isn’t SciFi
by Artel Petakov
When it comes to healthcare innovation, Artificial Intelligence is frequently discussed in the future tense: “Here’s what will happen in a few short years.”
It’s important to imagine how healthcare might cure diseases in the future, but let’s take a closer look at how artificial intelligence is helping real people get healthier today.
In the past six months, 44-year-old Andrea Egan — a mother of four — lost just over 40 pounds. She didn’t lose the weight from any crash diet. She lost it with the help of real human coaches combined with artificial intelligence from Noom.
If you talk to Egan, she’ll tell you her human coach seemed to know just what to say when. When she was depressed, Egan says Noom Coach would send her inspirational quotes or articles, lifting her mood. When she wanted to indulge in food, she says her Noom Coach would pop up a message reminding her to visit her group for support. Egan says that approach helped retrain the way she looks at food.
So how does artificial intelligence work behind the scenes to know what to prompt, for whom and when?
In Egan’s situation, Noom’s AI was able to leverage more than 4 billion coaching data points that Noom has collected in the past about how other past participants responded to certain situations and prompts: when was the read-thru-rate (finishing the content) highest, for which people, and so forth. The AI then found the most similar cluster of past situations, extrapolated a bit and matched it with Egan, then repeated the action that got the best result (such as messaging her about visiting the group for support).
IBM Watson and Artificial Intelligence in Healthcare
In 2011, IBM Watson made headlines when the AI machine went on “Jeopardy” and beat its two best champions at trivia. At the time, everyone predicted it was only a matter of time before Watson would beat cancer.
Unfortunately, six years later, the medical community and scientists are beginning to accept the prediction for ending diseases is unlikely to happen in the near future. That’s not because of any flaw in Watson’s machine learning or inferencing abilities; those have developed well since.
It’s because Watson doesn’t have nearly enough quality data; and the data it does have is correlational, not causal. Watson has the capability to draw complex inferences from a lot of data (like it did for “Jeopardy”), but it doesn’t have enough “training” data to learn what to suggest in each case. Instead of just seeing how a patient’s health develops over time, it would need to have records of what the doctor said and prescribed at each moment, and what local effect each intervention has. Such data is just not available and, because cancer is relatively rare, is heavily regulated and siloed across many EMRs.
For artificial intelligence to revolutionize healthcare, it must have quality data in large amounts. The data can’t be biased, or it risks making flawed assumptions based on bad data. Noom’s strategy has been to focus on lower acuity conditions, like obesity, where data is more plentiful and intervention is less regulated and risky. By learning there first, the AI can take the needed steps that would then allow it to step up to more acute conditions.
To date, Noom has 4 billion data points of coaching data. Because all that is collected in Noom’s own programs, it can collect very rich data. That means it has information on what a coach told a person to do, what the person did in response and what the long-term effects were. This is precisely the type of data that AI systems like Watson need to learn. It’s the largest coaching data set in the world, helping us understand, predict and change behavior patterns. As that data set grows to 10 times the size over the next few years, AI will be able to get significantly better than humans can ever imagine.
Noom Coach is used in literally every country in the world, and, since the data is entered by real people, it provides deep insight into how people behave. More than 100,000 people have used this AI and human combination to get healthier.
While Noom has currently focused on obesity, it shares lifestyle factors of exercise and diet with diseases that cause 50 percent of deaths worldwide, according to the World Health Organization. And yes, that includes many forms of cancer.
Perhaps then, one day soon, Noom will help Watson figure out that cure.
Artel Petakov is co-founder and president of Noom Inc., who began coding at the age of nine and holds a B.A. in Computer Science from Princeton University.
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