During the 9th Annual Partners’ Connected Health Symposium, several speakers shared examples about how consumers are taking responsibility for their health by using online and mobile tools. Given the changes in health reform, Providers and Payers welcome patients taking on a more active role in both monitoring and managing their health.

 1. Trackers for Self Management: 

Susannah Fox presented findings from the latest research by the Pew Internet Project and the California HealthCare Foundation which focused on self-tracking. One interesting insight is the segment of adults who track a “health indicator or symptom”; “62% of adults living with two or more chronic conditions is self- tracking”.

The research also revealed that only one third of all self trackers shared this information with someone and half of those shared with a clinician and the other half with a member of the family, group or a friend.

2.  PHR with Mobile Capture of Observations of Daily Living (ODL):

Patricia Flatley Brennan, Professor, School of Nursing, University of Wisconsin, discussed the insights that can be gained by “listening in the moment”.  Patricia provided an overview of the Project HealthDesign’s five projects for this second round. I was particularly interested as she described how these projects capture the “words of the patient” about their observations of daily living.

Imagine the tremendous value in sharing the patient’s words not only to help the clinician communicate in a way that resonates with the patient but also to discuss the observation data patterns and their impact on the patient’s live.

After the conference, I reviewed the projects on the Project HealthDesign website to get a better understanding about the tools that were being used by patients. Several projects entail having the person enter the observations into their mobile phone; symptoms for Asthma, pain and energy levels for Crohn’s disease, caregiver stress for high risk babies and moods for Obesity. For the project focused on elders, I was interested to see sensors being used to collect information to monitor their cognitive decline.  

3. Online Patient Communities

Right from the beginning, I knew this panel was designed to be provocative- “Online Patient Communities are an effective way to Deliver Care”. Alex Drane, moderator and CVO at Eliza explained the panel's focus on peer to peer patient communities without clinicians. 

Shouldn’t this panel really have been titled “Online Patient Communities are an effective way to ‘support’ care”? So much has been written about the strong value that patients receive sharing their experiences.

Taking patient communities to the next level, it would be interesting to consider how one type of patient community differs from another.  Is there the same intensity of involvement for different types of conditions? Do patients participant in them mostly when they are diagnosed or do they stay on to give back? Are patients using the tracking tools and sharing with others in the community? Are there examples where clinicians are successfully participating in these patient communities?

Opportunities to Empower Patients with Data & Tools

Healthcare organizations have any opportunity to provide data and tools as resources to support consumer health management. Here are some areas that I am closely watching.

Connecting the Data Dots on Health: As a patient gathers information from the various tracking tools, how can this information be combined with other data about him to provide a more comprehensive picture to guide their collaborative care decisions? As Joseph Coughlin, Director MIT Age Lab asked during his Symposium keynote “Data, data everywhere but where are the drops of actionable knowledge?”

Interjecting Data into the Discussion: When can the patient discuss this information with their care team and get the needed guidance for behavior change? How can this information be incorporated in to a coaching session as the patient discusses the management of her chronic condition? During an intervention, how can this information support the decision discussion?

Measuring the Impact of the Tools: Each organization will need to think about measuring the elements that make the tool actionable. During her keynote on “e” is for Engagement, Susannah Fox shared a few key measures that they captured for the self trackers including the percent that said their data collection “affected a health decision”,  led them to “ask a doctor new question or seek a second opinion” and “changed their overall approach to health”. 

As organizations continue to evolve their business models and approaches, these data and tools become more important because they effectively engage patients in their own health. In recent discussions with leading organizations, I have heard about their increasing investments in connecting data and tools to bring more insight to the patient to better manage their health with the support of their care team. What is your organization doing to provide truly engaging online and mobile resources for your patients?

With the weak economy and strong pressure from healthcare reform, employers are investing in new approaches to lower healthcare costs and lift employee productivity. Increasingly employers are investing in strategies to engage employees in their own health and reward them to motivate needed behavior change.

According to the recent Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Healthcare, employers indicated that two of their top three healthcare strategies for 2012 are to “develop/expand healthy lifestyle activities” and “adopt/expand use of financial incentives.”

In July 2011, Humana launched their HumanaVitality program, which is designed to both guide and reward the employee for participating in their health and making better lifestyle decisions. “Our members tell us that they are hooked as soon as they use the Vitality Age app to determine their age and learn about how their behaviors influence their health. And as they participate in the HumanaVitality program, members interact with the Vitality Age app to see how they are positively impacting their age,” explains Stuart Slutzky, chief, product innovation, HumanaVitality.

Although employee incentive programs around health are not new, Humana has incorporated several innovative strategies into their Vitality solution.

Personalized Program Design: “We are using information from the employee’s health assessment, claims information and online health behaviors to personalize their pathway,” describes Stuart. Each member sees a set of recommended activities and has the option to select any of over 30 activities to gain points.

In addition to an individualized approach, Humana has decided to test a segment strategy after determining that the pathway is similar for members that are moving through a life stage change. Humana has created a special pathway for expectant mothers, as their first target segment. This means that members who are pregnant view a special set of activities and programs that are relevant to remain healthy throughout their maternity.

Program Reward Structure: Humana has designed their program with different status levels for reward attainment. “Our members begin with a blue status and can move up four tiers to platinum over time as they collect enough Vitality Points™.  When climbing to a new status level, they unlock a larger discount in the rewards mall,” shares Stuart. “Humana is also working closely with small group employers in select states to offer a premium reduction based on the percent of employees that achieve silver or higher Vitality Status. Employers may choose to pass the premium reduction to employees reaching silver, gold or platinum Vitality Status."  This premium discount is in addition to rewards individual employees can redeem in the HumanaVitality Mall based on their own points earned.  

Humana has defined the mall to appeal to members that have different motivations. “Spenders” can get instant gratification by purchasing with their Vitality Bucks.  “Savers” can accumulate their bucks for larger prizes. Soon “Givers” will be able to donate their rewards to charity.

Through their “Jackpot Rewards,” Humana uses a gaming mechanic of randomness to select a program participant to win prizes, which are based on their status level. For example, blue status member can win movie tickets or yoga mat but a platinum status member can win a flat-screen television or iPad.

Program to Program Connection: “Our members get rewards points when they enroll in one of our health programs. We are working on rewarding the member with more points for ongoing participation in our health program such as Weight Management. In addition to tying rewards for coaching program usage, our coaches can see the member’s efforts and earnings to date and can promote different point opportunities during their interactions to motivate the member,” Stuart explains.

Consumer-Driven Program Development: The HumanaVitality team listens closely to members participating in the program. They have set up a process to gather feedback that members share through the email and call center channels, as well as Facebook and Twitter, and the team discusses these ideas and suggestions to define program enhancements. “Recently, we heard one of our members ask us to provide points when their kids participate in athletic events.  This was a great suggestion and is now another activity that we reward under the program.” 

Program Success Evaluation: One key program measure is participation. Humana has expanded the ways that members can participate to earn points including obtaining preventive screenings, exercising regularly, donating blood, getting CPR-certified and quitting smoking. The newest way for members to earn points is by playing their Ubisoft “Your Shape” fitness game on their Xbox.

HumanaVitality’s Future Direction for Engagement

The HumanaVitality team is working on developing a deeper personalized experience by looking at the member’s past behaviors and recommending healthy activities, which match her interests. This is similar to the way Netflix suggests movies based on past viewing behavior.

Humana is also gathering lots of data on how consumers are using their rewards program. “We are applying data analytics to evaluate program engagement beyond participation. We will look at status level movement and actions tied to behavior change,” explains Stuart.

“In the future we will continue to expand the program to ensure we’re providing support and optimizing outcomes for all members – from members with severe conditions to marathon runners,” added Stuart.  “New reward partnerships will ensure the program provides relevant and aspirational rewards that foster improved health.”

Regence Program Rewards Transformational Activities 

Regence started on a new path to consumer engagement back in 2005.

After seeing a recent presentation outlining their consumer engagement framework, I reached out to Torben Nielsen, VP, eBusiness Strategies and Services at Regence to learn more. Torben shared their past journey as well as their future direction with me.

Here are the 4 steps along their consumer engagement path. Regence is currently at Step 3 and has a conceptual view of their next step which will continue to evolve as the market landscape fills in around them.

Consumer Engagement Step 1: Know Me

Regence’s first step focused on the passive cardholder, giving them value as they logged in. The cardholder saw all of their claims, benefits and provider information. This was back in 2005. Prior to that “it was not a good experience” since the member only saw some of their claims information and the list of providers “did not even indicate whether each one was inside or outside their network”.

Consumer Engagement Step 2: Engage Me

Beginning in 2008, Regence decided that they needed to get to know their members in order to effectively engage them.

Instead of linking the member over to their health or wellness program vendor’s website, Regence decided to keep the member within their portal to capture their online behavior.

Around that time, Regence launched their Rewards Program which awarded points to members for “tranformational activities”. These activities were rewarded because they “informed, empowered and educated the consumer”, including looking up content around a health issue or participating in a wellness program. Regence decided not to reward members for “transactional activities” such as looking up a claim or searching for a provider.  Regence really needed to keep the member on their portal to track their online behavior in order to reward them.

Next Regence started their email program, sending out relevant electronic communications to bring members back to the site. Although many health plans have an interest in emailing members, I hear all the time that they do not have their email addresses. Regence collects the member’s email address during their site registration process. “We can’t engage with out email. It would be a missed opportunity to get in front of the member”, Torben emphasizes.

In addition to generating additional portal traffic, health plan communications can also strengthen their member’s satisfaction scores, which is more important now than ever with the increased market  competition.

Consumer Engagement Step 3: Connect Me

Over the past two to three years, Regence has been moving faster down the path with consumers.

“Connect Me” goes beyond the “member to health plan” relationship. According to Regence, this also includes strengthening the “member to member” bond through social community and the "member to their care team" bond through ACO efforts.

One important way for Regence to strengthen the “member to member” relationship is by getting consumers to contribute more content online through conversations, ratings/reviews and suggesting local events in their geography.

Another aspect of “Connect Me” addresses the cross communication channel experience since members are increasingly accessing and engaging through their mobile devices. “We’re connecting the data that we’re sitting on to provide a more personalized experience for our members”, explains Torben.

Consumers are engaging with Regence!

• 67,000+ patient reviews have been submitted by members, of which 90% are favorable (i.e. the member  would recommend the physician/facility).
• 63,000+ posts in the Community section of myRegence.com, written by more than 6,000 unique content creators.
• 346,000+ have opted- in for member electronic communications (e.g. updates and alerts, account information, etc)
• 260,000+ subscribers signed up to receive the bi-weekly myRegence.com email newsletter

Consumer Engagement Step 4: Partner with Me

As they look down their Consumer Engagement path,  Regence has determined where they want to be directionally. Regence wants to be relevant to the consumer’s every day life. Something consumers need to check as part of their daily routine. Their starting place to look for information to meet all of their health needs.

Although it is challenging to know exactly where the market is going, Regence will remain in touch with their users to help guide the way.

In fact, Regence has over 400 users that help advise them by providing ongoing feedback to potential directions. [Note: Innovative companies have consumer advisory boards as a best practice. Increasingly, these consumer advisory boards are managed in a private online area and the insight captured is used to guide product and marketing decisions.]

Regence is co-creating with this growing group of consumers to define and refine online capabilities. When Regence asked for feedback about “patient reviews”, members felt they needed to see more than the reviewer’s screen name. Users wanted “the ability to connect with their peers in order to get advice when selecting a provider”.  In the latest patient review experience, the screen name is linked to the reviewer’s Community profile page, where to learn more about who they are, where they’re from, what they do for a living and members have an the opportunity to make a friend request.

Regence’s Results Realized

Due in large part to Regence’s consumer engagement strategies, myRegence.com experienced the following results in 2011 over 2010:

• 30% increase in the cumulative number of content creators (i.e. those who have left a patient review, posted in Community or both).
• 88%  jump in the number of $25 gift card redemptions through the Rewards program 
• 76% increase in the Consumer Engagement Index (CEI) which measures the user adoption of transformational features
• 26% open rate for targeted email campaigns, nearly 2x the industry benchmark of 14%

Regence has also noticed that their segmentation efforts for email have been effective in engaging consumers. For example, by sending a Patient Review email to previous reviewers, Regence realized a 38% open rate.

As Regence moves onto step 4 in Consumer Engagement, they are conceptualizing new ways to reach out to their members with relevant information from their plan, community and care team. And they will be innovating with and listening to their users throughout their journey.