“Our entire way of life has transformed in recent decades,” observes Glenn Dean, president and CEO of MeMD. Noting that technology — specifically the Internet — is at the heart of this transformation that has made it common practice for a person to use a mobile phone to order a ride or purchase groceries that are delivered to his front door, he says, “Technology has transformed healthcare, too, from breakthrough technologies that diagnose and treat diseases that could have otherwise gone undetected, to the way that medical care is accessed and delivered.”
One of the drivers in this is the millennial generation. Pointing out that millennials, a population of approximately 80 million, now outnumber the once-all-powerful baby boomers, Joel Barthelemy, founder and CEO of GlobalMed, says, “Already their impact on the healthcare landscape is being felt, as the ‘digital natives’ demand the same convenient, easy access to healthcare that they experience across other consumer-focused industries.” He cites the “Large Employers’ 2019 Healthcare Strategy and Plan Design Survey” (http://bit.ly/healthcare-strategy-survey) from the National Business Group on Health, released this past August, which confirmed that half of employers (51 percent) identified implementing more virtual care solutions as their top healthcare initiative in 2019.
Says Paige Rothermel, chief growth officer with Blue Cross Blue Shield of Arizona, “It’s exciting to see consumers being empowered to better manage their care and the care of their families. Ten years ago, the iPad didn’t exist. Now, patients meet their doctors face-to-face through a tablet without ever leaving their home.” Some examples are virtual doctor visits, trauma treatment from emergency rooms hundreds of miles away, and mobile apps that give patients the cost of an MRI before the scan. And she believes this is just the beginning of where technology is taking us in healthcare, each advancement sparking new expectations from consumers who want their healthcare experience to mirror their everyday retail experiences. “For insurers,” she notes, “that means giving consumers what they need, when they need it, wherever they are. Like never before, technology allows us to provide better solutions, upgrade the experience, and improve the quality of healthcare, all the while keeping costs in check.”
Dean points to telemedicine is a prime example — a well-established model for treating common injuries and illnesses as well as delivering care to patients in rural areas. And he says, “What you’re seeing now is the expansion into telehealth, which includes a more holistic approach to treating individuals.” He sees telebehavioral health — a service for treating emotional and mental health concerns over a computer or mobile device — as the next frontier. “It combats social stigmas related to seeking mental health treatment, addresses a national shortage of mental health providers and offers individuals a more affordable and convenient route to get help,” he says. “As the U.S. continues to make mental healthcare a priority, we expect telebehavioral health — which encompasses teletherapy and telepsychiatry — to gain serious momentum in the very near future.”
Allan Allford, president and CEO of Delta Dental of Arizona, points out that technological advances are also affecting how insurers deliver dental benefits. “Not only do clients want immediate access to their benefits, but they want their benefits delivered in new, innovative ways that reduce their time spent in the car or dental chair or that lowers the cost associated to maintaining good oral health,” he says. “In response to those demands from employers and enrollees, we’ve spent a lot of time introducing technological tools and programs that improve access to dental care and encourage regular dental visits.” These include a mobile app designed to make it easy for patients to access benefits information on-the-go or book an appointment with their dentist, and better tools to help employers dig through their claims data to understand their workforce’s dental health and implement programs for improving it. Recently introduced are on-site dental services to employers that have a younger workforce or express the desire to expand access to healthcare in a more convenient, expedient way. Says Allford, “It’s an unconventional and effective way to provide oral healthcare to people who normally don’t go to the dentist or take great care of their mouths.”
“Just as the financial services industry has brought to market easy account management such as mobile banking, online trades, and five-minute mortgage applications, we see that technology will help our customers with doctor visits, claims, prescriptions and even guiding wellness,” Rothermel says, noting also a shift in the ways hospitals, providers and insurers engage with consumers. “It’s now on the consumer’s terms.” An example of BCBSAZ’s increased adoption of digital technology is its BlueCare Anywhere telehealth solution, which allows group members to speak to a provider remotely, receive a diagnosis and have prescriptions placed electronically.
“With the launch of the Apple smartphone in 2007, Americans have quickly adopted mobile connectivity as a primary means for obtaining information, performing daily tasks and becoming increasingly empowered consumers,” says Kristin Darby, chief information officer at Cancer Treatment Centers of America. She cites a report from Pew Research Center in 2015 that more than 62 percent of smartphone users have used their phone to look up information about a health condition. “The availability of telemedicine services has also increased, with most offerings being around urgent care and primary care services. Technology has empowered consumers to shop for the right medical care in a transparent manner that offers information on patient satisfaction ratings, immediate access or appointment availability, insurance coverage and the convenience of obtaining care where and when the patient wants.”
Darby notes the interaction of patients and physicians has also benefited from technology through the implementation of Electronic Health Records. “Relevant data is presented to physicians within the EHR, which includes treatment options, health risks and the capturing of data necessary to measure and understand treatment effectiveness. This has improved the accessibility of information available to physicians at the point of care, resulting in improved quality and efficiency in the delivery of care.” With the EHR, CTCA also makes a portal available to patients to access their medical record, with the ability to extract the information as needed.
CTCA’s recent opening of two outpatient care centers is part of its investment in technology to support a geographically dispersed footprint of care delivery locations. “Cancer Treatment Centers of America understands that, to have successful community care delivery, we must have interoperable systems that provide the right patient data in the appropriate electronic format to other providers within or outside our network. Efficient, secure communication improves patient safety with the reduction in errors and delays that are prevalent in paper-based transactions.”
From new tools and smartphone applications that assist individuals seeking quality and cost information to help make informed treatment decisions, to the ability to access personal healthcare data via electronic medical records for test results, to physician instructions or communication that includes online appointment scheduling and telemedicine care, “Technology plays an ever-increasing role in every facet of how patients access healthcare,” observes Kim Shepard, Cigna market president for Arizona.
Technology Advances in Patient Care
Similar to other healthcare specialties, dentistry is evolving along with scientific and technological breakthroughs, says Delta Dental’s Allford. “Dental professionals are able to offer better dental solutions and improve patient care with refinements in digital imaging, advances in 3-D printing and additional applications for laser dentistry. This often allows patients to identify oral health issues faster and provides options for less invasive treatment.” There has been an increasing focus on oral healthcare with the increasing knowledge of its connection to a person’s overall health.
“Technology continues to reshape how employers select and offer healthcare benefits to employees, putting access to information at our fingertips and creating a more seamless and interactive healthcare experience. At the same time, these advances may help improve health outcomes for employees and curb costs for employers,” says Dave Allazetta, CEO of Employer and Individual with UnitedHealthcare of Arizona and New Mexico.
Shepard notes that advancements in electronic medical records, alone, help improve patient care by enabling the sharing of critical patient history such as allergies, prescription history and other vital information with treating physicians — thereby avoiding issues that can arise when multiple physicians are involved in caring for a patient. “Patients and physicians also use new technology to jointly manage chronic conditions remotely, thus reducing the number of times a patient to needs to make a trip to the physician’s office to be monitored,” Shepard says. “Additionally, healthcare professionals have access to enormous amounts of data that can be used to research conditions and learn about new drugs and treatments to deliver the most timely-based information when treating patients.”
It’s a big deal that technology can help make sense of big data. Observing that “big data” is a buzzword now, Allazetta points out, “The applications are only meaningful if employers can make sense of that information.” UnitedHealthcare created its Health Plan Monitor as a resource to enable employers to more easily analyze health data, considering aggregate medical and prescription claims, demographics, and clinical and well-being information. “This can provide an analytics-driven roadmap that helps employers implement tailored clinical management and employee engagement programs, helping improve health outcomes, mitigate expenses, and help employees take charge of their health,” he says.
Pointing again to telemedicine as a rapidly growing method of care delivery, Darby says, “Consumers now have an option to access a provider at their convenience — virtually — for many common healthcare conditions.” It can be a struggle for physicians to piece together all of the care and supportive therapies or services that their patients need, but, she explains, when telemedicine options are combined with other medical services, it empowers a consumer-driven experience where an overall service offering can be personalized based on an individual patient’s requirements and the type of experience that patient values.
EHRs are an important part of this. Emphasizing the need for the medical history to be complete, Darby explains the benefit is multi-factor: They allow patient medical history to be transferred between different physician offices so the patient does not need to provide this detail again or complete any unnecessary paperwork, and they enable the physician to leverage this data when making care decisions, with the potential to eliminate unnecessary duplicative testing and improve coordination of care among different physicians where the patient may be receiving care.
“I fully expect to see the utilization of home monitoring devices and telemedicine offerings to grow as patients understand and become comfortable with a comprehensive patient examination being delivered virtually,” Darby says.
And there’s the growing phenomenon of wearable wellness devices. Says Allazetta, “An estimated 35 percent of employers now integrate wearable devices into their well-being programs, helping employees more accurately understand their daily activity levels. As these programs become more common, there are opportunities for cost-savings for companies and their workforces.” One such program is UnitedHealthcare Motion®, which enables people to earn more than $1,000 per year by meeting certain daily walking goals, while employers can achieve premium renewal discounts based on the aggregate walking results of their employees.
This is part of the Internet of Things, which has come a long way in recent years and is well integrated within the healthcare space, among multiple other industries. According to GlobalData, a leading data and analytics company, the continuous implementation of IoT within healthcare will expedite productivity and analysis of data, which will, in turn, improve patient outcomes. The IoT network of physical devices uses connectivity to enable the exchange of data and streamline processes to complete tasks in a timely manner.
Says Atif Nawaz, medical devices analyst at GlobalData, “IoT in healthcare facilitates mundane albeit important tasks to improve patient outcomes, and also takes some of the burden off health practitioners. Tasks such as remote patient monitoring, treatment progress observation and the housing of vaccines are all capabilities of medical devices with integrated IoT.” Not only are the IoT devices themselves important, the aspect of analyzing data is a secondary benefit they offer, GlobalData recently reported, naming Kaa (KaaIoT Technologies), MindSphere (Siemens), and Azure (Microsoft) as among IoT data analysis platforms that allow data to be collated from IoT devices to draw meaningful actionable trends.
Patients are also increasingly using technology to comparison shop. Thirty-six percent of Americans say they 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 survey by UnitedHealthcare, which also makes information available on market averages and prices of services. Employers can encourage employees to participate in this trend by offering financial incentives — such as $25 or $50 gift cards — to employees for using healthcare transparency resources. “Healthcare quality and cost varies widely within a city or neighborhood, so encouraging the use of transparency resources can yield savings for employers and employees,” Allazetta says.
Says CTCA’s Darby, “I believe the future will present an even more consumer-centric care delivery model that provides cost and quality transparency combined with an empowered patient.” She predicts an increase of healthcare delivery through mobile devices and telemedicine; more monitoring of chronic conditions through mobile apps in which the patient provides information on their mobile device, such as a glucose or blood pressure monitor; and pro-active interventions from care management to enable patient outreach when potential issues are detected. Additionally, she says, “Artificial intelligence will also begin to be used to improve the overall patient experience and handle many low-acuity encounters, which will contribute to reducing cost of delivery.”
Technology Impact on Employers’ Benefits Programs
“Benefits directors are harnessing technologies like telehealth to provide employees with high-value, cost-effective options for accessing care,” says MeMD’s Dean. “What’s more, self-insured companies reap an immediate return on the investment through direct cost savings, and all employers experience increased productivity and decreased absenteeism. It’s a win-win for businesses and their employees.”
And, as Allazetta notes, “The intelligent use of data can help employers develop and implement more customized clinical management and wellness programs.” Analyzing and applying that information can lead to significant cost savings for the employer.
“Employers’ benefit programs must continue to evolve to keep up with changes from many perspectives,” says Shepard. While the technological advances will likely enhance the patient experience and outcomes, she does not expect them to require significant changes to benefit programs. “However,” she says — and cites telemedicine as an example — “employers will need to continue to monitor their programs to ensure employees have the ability and encouragement to take advantage of new advancements.”
The Veterans Administration is one employer that has kept an eye on new advancements. Barthelemy relates it was an early adopter of telehealth, and now offers 55 service lines “all via virtual care powered by GlobalMed” that range from tele-allergy to tele-physical therapy to tele-surgical/transplant.
Telehealth is also helping employers enhance mental health benefits. Says Dean, “Employers are increasingly aware of the importance of mental health in the workplace; they understand that depression, anxiety, interpersonal problems and other behavioral and emotional challenges can wreak havoc on productivity, morale, and may lead to higher medical costs down the line. With teletherapy and telepsychiatry, businesses can help employees with mental health concerns access the care they need — cost-effectively, conveniently and confidentially.”
Allazetta reports that integrating medical and ancillary benefits, such as vision and dental coverage, is another trend. “While some people may overlook these plans, offering this coverage as part of an employee’s menu of benefits options may maximize the effectiveness of a company’s healthcare dollars, provide families with added peace of mind and help build a culture of health,” he says, explaining that combining medical and ancillary benefits under a single health plan may enable the integrated analysis of a wide range of data that can facilitate proactive outreach and clinical support for employees. “For instance, for a diabetic with both UnitedHealthcare medical and dental coverage, we are able to crosscheck dental and medical health data to determine if that person has missed recommended periodontal treatments or cleanings. Our team then proactively follows up with the member to help schedule the recommended dental treatment or cleaning, which have been shown to reduce inflammation and improve the management of diabetes.”
Observing, “Keeping a workforce engaged and healthy is a top priority for employers,” Rothermel notes that larger employers have more advanced analytic tools to understand the health of their employee population and know which programs and services are proven to improve the health of their workers. With data that reveals utilization, healthcare trends and cost drivers, employers can tailor their benefit and incentive programs to more closely match what works for their employees. And, she says, “A strong benefits program can increase care options, incent the use of meaningful healthcare tools and make the overall experience easier.”
Engagement and the Bottom Line
“Employee healthcare is a hot-button issue right now. Research continually shows the link between a quality benefits package and an engaged, loyal workforce. In fact, it’s critical to attracting and retaining talent,” Dean says. Telehealth, in general, helps employers provide robust benefits “without killing the bottom line”; even more so with regard to mental health. “Most health plans include some mental healthcare, but accessing these benefits is another story altogether. A shortfall of mental health providers combined with extremely narrow provider networks make it extremely difficult for people to access care through their health plan,” he explains. “Telebehavioral health fills the gap, giving employees the option to speak with a therapist quickly, privately and conveniently. In addition, research has shown time and again that, when people receive effective treatment for emotional or behavioral health challenges, medical and disability costs come down. Moreover, the vast majority of employees who seek care report improved engagement, productivity and satisfaction in the workplace.”
While acknowledging that technology has produced many innovations in healthcare over the past decade, Barthelemy breaks down the impact it is having on healthcare costs. “In a study reported in the U.S. National Library of Medicine of the average costs of telemedicine in a variety of settings, telehealth episodes of care were $36, $153, $162 and $1,735 less expensive, respectively, than retail health clinics, urgent care centers, primary care offices and emergency departments.”
Observing that increasing numbers of employers are offering onsite or shared site corporate health or wellness/well-being clinics as part of their efforts to simplify and lower healthcare costs, Barthelemy says, “Experts project that 65 percent of large employers will operate them by 2020. A majority of these clinics offer virtual care.” He adds, “Technological innovations such as virtual care help employers strengthen the opportunity for cost savings, improved outcomes, greater worker productivity and stronger employee retention.”
Toward that goal of helping design a more efficient and easier-to-navigate health system that will encourage employee engagement in their health and help curb healthcare costs for employers, UnitedHealthcare annually invests more than $3 billion in data, technology and innovation, according to Allazetta.
“Today, employers are engaging and communicating with employees through easily accessed mobile and online activities and incentives, all with the goal of helping employees make vastly better healthcare decisions for themselves and their families,” Rothermel says. “Be it through educational resources, transparency tools or greater access to care, technology is changing the healthcare industry, changing the workplace, and changing the way employers are supporting their employees.”