From Patients to Partners

There was a time when the repository of all wisdom about your health was a physical chart. From cranium to metatarsal, this collection of facts on paper told a deep story of one patient and informed the diagnoses and treatments they received. When paper charts became digitized into electronic health records (EHR), that transformation kicked off a rolling revolution in healthcare data.

What was one north star of patient information has expanded to a constellation of health data from multiple sources, including from patients themselves in the form of wearables and other connected devices. Obviously, this explosion in health data has big implications for delivering better, more personalized care on the individual level. But once anonymized, supplemented with demographics, and aggregated into databases, big health data offers health plans insights into new ways of operating that are more effective, cost-efficient, and that leverage health plan member engagement as a lynchpin.

Big Possibilities from Big Data

We don’t use the term “explosion” in referring to the proliferation of health data lightly. A report from research firm IDC estimated “the volume of healthcare data at 153 Exabytes in 2013. At the projected growth rate, that figure will swell to 2,314 Exabytes by 2020.” To paint a picture, the authors of the report suggest storing all of that patient data on a stack of tablet computers.

“By the 2013 tally, that stack would reach nearly 5,500 miles high. Seven years later, that tower would grow to more than 82,000 miles high, bringing you more than a third of the way to the moon!”

In that same study, IDC notes that these sky-high numbers represent only an 80 percent penetration rate for EHRs today; they project that figure to vault to 95 percent in 2020.

The National Institute of Health recognizes the enormous potential in such a large dataset. Their $130 million Precision Medicine Initiative Cohort Program has a goal to enroll over one million Americans in a cohort by making their anonymized health data available to any interested researcher.

As described in an Information Week article, the NIH’s hope is to be able to answer questions such as, “What if we could… learn which individuals respond to certain types of drugs, are at risk for a certain disease, maintain health and fitness, age, and die?”

Beyond the Complete Blood Count

A million EHRs is certainly a start, but there is growing acceptance that clinical data alone doesn’t tell the whole story of health. A study from the NIH titled, Big data analytics in healthcare: promise and potential, defines big data in medicine as “the totality of data related to patient health care and well-being.” By that definition, we need to look more broadly at health information beyond blood tests and x-rays.

The University of Illinois at Chicago’s Health Informatics blog says providers and payers should look outside the traditional “chart” medical data for other factors that affect health outcomes, for instance, “patient health habits and behaviors, socio-economic factors like employment and education, and physical environment.”

An Insight report from Deloitte on the Health Plan of Tomorrow sees better personalization of health plan offerings being driven by a holistic view of the patient from multiple data sources:

At the center of all these sources is the patient. Health providers and payers are seeking ways to encourage more patient participation in their own health management. One promising strategy is using digital engagement channels and patient/member portals to provide consumers with the means to securely share data about their health and behavior.

Patient-generated Health Data (PGHD)

Technology is helping to transform health management from the once-a-year physical model to a continuous, interactive process where the patient plays a leading role in data collection.

The once ubiquitous watch is being replaced by a wearable device, and tech blog 3D Insider states that, “From 39.5 million back in 2015, the number of adults in the US who use some sort of wearable device has grown to 81.7 million in 2018.”

The blog points out that while smartwatches are the leading wearable now, the market is already growing for connected ear-worn devices, head-mounted VR devices, and smart clothing, all of which have the potential to collect health or behavioral data that can be of use in health management.

But wearables are just one option in gathering patient-generated health data. The Journal of the American Health Information Management Association points out that “digital health tools such as online questionnaires, personal health records, mobile apps, wearables, and connected medical devices —can help patients become more engaged in their own care or even take back their lives.”

Chronic disease management is one area where continuous, effortless health data collection and health plan member engagement can have a major impact. First, in helping patients identify that they may need medical intervention. Health data modeling company, Health Catalyst, points out that:

• Twenty-four percent of adults with diabetes don’t know they have it
• About 13 million adults with high blood pressure don’t know they have it
• One in five deaths is caused by cigarette smoking

After some initial skepticism about the validity and utility of such data, clinicians are now embracing PGHD. A report from HiMSS Media, sponsored by FitBit, found that, “according to one recent survey, hospitals and health systems are no longer questioning the value – or desire – for PGHD. In fact, they are demanding it.”

With this welcoming attitude from the medical side, the government’s Office of the National Coordinator for Health Information Technology believes that, “PGHD can provide a more holistic view of a patient’s health and quality of life over time, increase visibility into a patient’s adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode.”

The American College of Cardiology (ACC) endorsed this approach: “In contrast to viewing the position of patients as ‘end-users’ of healthcare delivery and services, engaging patients as ‘partners,’ with a role that is facilitated by increased access, can provide a key accelerant for healthcare transformation.”

Putting Out the Digital Welcome Mat

Patients are eager to take on this role as “partners” on their own health management. Cognizant surveyed health plan members in 2018 and found that “Compared with 2016, digital adoption has increased across all channels and all ages, and members want still more digital capabilities from payers.”

But payers are still playing catch-up in health plan member engagement and the “if you build it, they will come” theory of member portals has not yet proven true. As a survey by consulting firm HealthMine found, despite nearly all health plans offering member portals, “45 percent of MA beneficiaries were unsure (of how to access) and 18 percent had no access.”

Plans may need to take additional steps to make these digital portals more welcoming and member-centric to encourage broad adoption and convince members to participate. For example, by making efforts to align member communications with their stated preferences (in delivery method, language, etc.) Managed Care Magazine recommends,

“Many plans possess member data that can provide a wealth of information about how that member prefers to receive communications. Some prefer an email or a phone call. Others respond better to a traditional mailing. Knowing the communication preferences of members is akin to speaking to them in a language they understand and can be crucial to making a genuine connection and facilitating the desired clinical outcome.”

Understanding how best to communicate with members is valuable information that can inform member health strategies like chronic disease management. Medicare enrollees in particular want more frequent, personalized, and relevant information from their plans. The HealthMine 2018-2019 Medicare Advantage Report survey of Medicare Advantage beneficiaries found that, “Few think their plan knows them well, with spotty personal communication about their chronic condition. The lack of perceived help in managing a chronic condition could present a huge opportunity for plans based on beneficiaries’ needs and required CMS metrics and incentives.”

Seen as part of the constellation of data about a patient, nearly every element of patient/member care and engagement can be more effectively delivered when aligned with the member’s communication preferences.

What Comes After 1 and 0

While it seems to be universally agreed that having access to Exabytes of health data from a myriad of sources is a good thing, being able to put it to use is an Exabyte-sized challenge. That’s where analytics come in.

The University of Illinois at Chicago’s Health Informatics blog is encouraging: “Cutting-edge data analytics, if used properly, improves patient care in the health care system. With the change in health care toward outcome and value-based payment initiatives, analyzing available data to discover which practices are most effective helps cut costs and improves the health of the populations served by health care institutions.”

From a survey of healthcare IT executives in 2018, Deloitte found that “More executives—84 percent—say that analytics will be extremely important for their organization’s strategies in three years, compared to 36 percent who say analytics are extremely important today.”

From that same survey, Deloitte learned that healthcare organizations are increasingly building analytics and business intelligence capabilities into their enterprises:

For health plans in particular, there is real opportunity in applying data and analytics to business strategy. According to Managed Care Magazine, “These increasingly robust data sets make it possible for health plans to segment their member populations and tailor care plans based on such factors as demographics, clinical history, and consumer preferences. This type of data-driven, personalized plan design has all kinds of positive effects—on utilization, on outcomes, on patient satisfaction.”

Deloitte’s view is that the influx of data, and the insights that come from it, are the engines of the Health Plans of Tomorrow: “Business model transformation will speed up as health plans shift to focus on improving wellness and care using multidimensional data. Products will balance traditional population-level risk with being hyper-personal and easy to understand, based on consumer need. Moreover, health plans will have learned how to engage and influence consumers toward better health through a high-touch experience with digital devices.”