In 2008, Cisco launched their LifeConnection’s onsite health center which uses a Patient- Centered Medical Home model. Today, it supports over 42,000 employees and their families at Cisco’s corporate campus in San Jose, CA.

Cisco’s LifeConnections' Center offers primary and pediatric care integrated with care services including disease/condition management, health coaching, mental health, pharmacy, physical therapy and chiropractic as well as acupuncture services.

Cisco now has two physical LifeConnections' Health Centers, one at their headquarters and a second location at the Cisco Bangalore, India campus.  In addition, they operate a telehealth location in the Raleigh-Durham area of North Carolina.

Employees access LifeConnections’ services online for health management. “Within our Cisco LifeConnections' portal, our employees and their families can schedule appointments in real-time, view their medical records, communicate securely with their physicians and even send their doctor an attached document such as a food or exercise log”, explains Katelyn Johnson, Manager, Integrated Health at Cisco Systems. 

Cisco’s approach supports the findings from a recent Accenture Connected Health Pulse Survey which found that most patients (90%) want to use technology to self-manage which includes accessing their medical information, booking their doctor’s appointments and refilling their medications. The survey also revealed that patients do not want to give up the interaction with their doctor. 

Technology Transforms the Patient Experience

Working closely with employees and families, Cisco designed the LifeConnections’ Health Center to bring convenience, better care and transparency to the consumer.

Through ongoing interviews with patients, Cisco has heard feedback from consumers who:

     “Do not want to be burdened by the administration of healthcare”

     “Want technology to take away what I don’t like to do (i.e. clip board,

          discharge payment)”

     “Want to spend more time with my physician”

Cisco has used this insight to determine ways to leverage technology within the LifeConnections’ Health Center to increase patient satisfaction including:

Kiosk: Patients come into the Health Center and use a tablet to have a “paperless, self-service, check in” including verifying demographic information, paying co-pays and signing consent forms, taking less than five minutes of their time. 

Flat Screen Monitors in Care Suite: Within the patient-centric care suites, the patient and physician sit side by side to view and discuss health information projected on the flat screen such as the medical record with the latest vitals and lab results, x-rays and educational content about the patient’s condition. Cisco emphasizes the importance of providing transparency to the patient by showing them their medical record, in real time, during the visit. 

HealthPresence in Care Suite: Cisco has recently partnered with Stanford Hospital and Clinics to enable patients to access specialty care (tele-dermatology) through the use of Cisco’s own telemedicine solution called HealthPresence. A nurse assists the patient in the LifeConnections’ Health Center while the Dermatologist connects from the Stanford Outpatient center.  Cisco has found that connecting specialists with patients using this solution offers greater access to specialty care, reduces appointment wait times, and improves patient satisfaction. 

Matching Technology to the Employee Profile

Cisco has put healthcare technology in place to meet the needs and profile of their employees and families.

 “We are a high technology company and our many of our employees are engineers who literally live on-line.  Their average age is 42 years. Our employees expect our healthcare experience to mirror the way they work – which is surrounded by technology.  Specifically, they want technology to help enable care, remove access barriers and overall enhance their experience as a patient.” shares Sharon M. Gibson, Director Healthcare Business Transformation at Cisco.  “Not only do they want to see more information about their health status but they want to see trending data for themselves to better understand how their health stats change over time and how their behavior impacts those results.”

“Our employees are busy and always on the move.  They want to take care of their health in an efficient way.  Soon, we will also offer patients the option of e-visits with their doctors through WebEx, for example”, explains Sharon. “Online or e-visits would help engage employees in their health, whether from home or even remote sites, and bring the convenience that they demand”. 

ManyStrong Social Community SupportAs soon as he walked through the door at Starbucks, I knew something was terribly wrong. I have known Ben for more than ten years and he has never looked like this. Ben appeared extremely exhausted, had lost his smile and gained a few pounds since our last tea together.

After he dropped his keys on the small round table and sat down next to me, I asked Ben what was happening. His elderly mother had fallen again in her bathroom. Ben had been shlepping her from the hospital to her apartment, running to the pharmacy to change her medication for the third time this week and food shopping to make sure she had what she needed. As I listened to Ben, I wondered how his brother Rob or other family members were helping out. Just because Ben is the oldest child doesn’t mean that he needs to take on all of the responsibility. Caring for his mother day in and day out was taking a toll on my friend’s health.

When he stopped talking to take a breath, I started telling Ben about ManyStrong, the new social community initiative from UnitedHealth Group.  ManyStrong is a free new social tool that Ben can use to create an online community to support his mother, Evelyn.  When friends and family ask “how can help”, Ben can invite them to Evelyn’s private community which has tools for them to contribute in some way.

Over the past few years, I have worked with many different social communities but this one is different: 

Personalized Social Community On Demand: Ben can create a community for the specific purpose of supporting his mother.  Within the community, Ben can provide updates and request the help that he truly needs to care for his mother. Knowing Ben, it is easier for him to ask for help this way than it is to pick up the phone to call those who had offered help in the past.

Action Driven Support:  By following the link in Ben’s email invitation, friends and family can provide support in their own way. After all, some are a few miles away and others are across the country.

 - Financial Support: They can donate money which will be placed on a cash card or purchase a gift card for Evelyn.  

- Motivational Support: Her loved ones can leave care messaging to encourage Evelyn on a daily basis, motivating her to get stronger.  

- Story Telling For Support: Ben and others in Evelyn’s community can upload  pictures and videos to share. Seeing a photo of Evelyn walking after her fall may bring  relief to her loved ones. Ben can enter comments that “mom has her dancing shoes  ready” which may bring a smile to their faces, easing their anxiety for a moment.

- Physical Support: When Ben adds new requests for help within the ManyStrong  community, friends and family can take on the responsibility to make a meal, run an errand to the store, spend time with Evelyn or simply check- in on her. The  calendaring feature automatically tracks the need and the person taking on that need for all to see  in the community. 

ManyStrong Back Story

“We created ManyStrong simply to help people more easily help each other.  When people we know get sick, or go through a sudden medical emergency or other serious health event, we naturally want to help them.  They are our friends, our families, people we care about.  It’s tough to know how to help. And with everything that person is dealing with, it’s hard to find out what you can do to help without putting additional stress on them and their family.  That’s where ManyStrong comes in”, explains Kunjorn Chambundabongse (KC), VP Innovation and R&D, UnitedHealth Group.

When serious health issues arise, people turn to online communities for support. Many communities are designed for the individual with the health problem but not necessarily to support the caregiver.  In their February 2011 Peer- to -Peer Healthcare research, Pew found 59% turn to family, friends and fellow patients when needing “emotional support in dealing with a health issue”.

How is UnitedHealth providing a unique social community solution?  KC clarifies ManyStrong’s differentiation. “Yes there are many communities out there doing pieces of this.  Some sites focus on the medical and clinical related side, allowing people to connect with others going through similar illnesses and share treatment data.  Other sites focus on the non-clinical side, such as fundraising or keeping people informed through journaling/blogging.  And you have many people using the big sites like Facebook, but privacy and security are huge problems with something as serious as health.  ManyStrong brings all these tools into one place in a private and secure way, and allows the caregiver community manager to create a safe spot for people to rally together to support a person or family they care about.”

The ManyStrong social community solution can be used to support many different situations such as for a child with the long term illness, a senior aging at home or a co-worker battling a disease. Sometimes companies cannot envision the use cases before launching their offering into the marketplace.  KC has thought about the various situations and shares ”we don’t know exactly how people will use Many Strong but we make it our mission to learn from them. When we look at users or potential users of Many Strong, we ask if there is any way that we can make the product better for that family, that community, for the people they’re supporting based on how they’re using it.  One community could have hundreds or even thousands of supporters, or it could have a handful of very close supporters.”  

What does success look like? KC explains “success to us is about celebrating the actions of people helping one another.  Millions of messages of encouragement, millions in donations to families, and millions of hours of volunteered time… so many beautiful and meaningful actions.  Success to us is seeing all these actions across our country and across the world, one community at a time.”

During their initial beta phase, UnitedHealth is offering the entire community site for free and is even covering the transaction fee on the donated money.  KC describes their evolving business model for the ManyStrong Community. “Eventually we will need to charge small fees to cover bank transaction processing costs. We are also exploring integration with other service providers such as meal delivery, professional in-home care, and other features to provide even more options for people to give. We may earn referral fees from these merchant partners over time. While the site may earn some revenue, our mission is to give back profits to charitable organizations that will further benefit users of ManyStrong.”

Note: December 2013, UnitedHealth discontinued their ManyStrong website. 

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.”

In early 2011, Group Health set out to find ways to use mobile to help members manage their health and make better decisions about where, how and when to get care. “We view mobile as another channel of delivering patient care which is important to us given our mission of serving the greatest number of people”, explains Colby Voorhees, Senior Product Manager at Group Health. 

Group Health launched their award winning mobile application with key capabilities such as care management with “My Care”, care guidance with “Consulting Nurse” and care planning with “Wait Times” for Pharmacy and Laboratory services.

Group Health’s app moves beyond the mobile capabilities enabled by other health plans which let consumers look up health information, check symptoms or find urgent care.

“We’ve received very positive feedback from members on our version 1.0 app but were surprised that members expected our mobile application to have more capabilities out of the gate such as refilling a prescription or accessing information on the entire family”, Colby reports.

     “Love the new app but am frustrated that I have to go to the full site to reorder meds. Will this be available on the new app soon?”

     “Please provide a Parental Access feature in the next update, soon.  I have to take my kids in much more than I go in so most of the time I end up using a web version on my phone (not fun)  instead of the app.”

Last summer, Group Health released their 1.5 version with prescription refill and parental access capabilities. Their mobile app now has over 36K downloads (iPhone 25+K) and Android 11+K) by 14% of their web access users and 5% of their total members.

The two most used mobile app features are “My Care” (37%) and “Wait Times” (36%) followed by “Symptom Checker” a distant third (10%).

In “My Care”, consumers can now see their personalized list of care reminders for preventive and chronic conditions (if applicable), communicate with their clinicians (e.g. primary care and specialists), review their ‘after visit summary’, refill a prescription and access care information for children under twelve such as immunization timing. Members can also use the scheduling feature to check available appointments and book them with their PCPs. “It’s like picking a seat on the plane that you want instead of having someone else select it for you”, exclaims Colby.

Within “My Care”, the top three features used are Reading Messages (32%), Viewing Lab Results (25%) and Making Future Appointments (16%).

Group Health’s Mobile Motivation

The product team at Group Health remains focused on taking complex tasks that the consumer is trying to do and making them simple. Group Health collaborates with consumers to get input on mobile concepts and works closely with them through usability research to make sure the capabilities meet expectations and the interface is intuitive. 

While Colby discussed their mobile research, I heard members voice their desire for increased convenience and an improved customer experience.

“If they had an app that made it that easy to interact with healthcare, I would choose Group Health.”

"My spouse would absolutely download that app to take care of his health since he can use it while commuting to work on the bus or while he is waiting in line.”

“I absolutely appreciate the forward thinking technological advances that Group Health has. Something seemingly as simple as an iPhone app to access my health records, completely changes and improves my experience in a way that other knuckle dragging change adverse medical providers just can't comprehend. Thank you.”

What is next for Group Health on the mobile front? Colby reminded me that they are only on their 1.5 mobile app version and there are opportunities ahead such pushing communications to consumers instead of relying on them to access their My Care dashboard.

As an integrated care system, Group Health has the advantage of leveraging their common platform for patients and providers to support care collaboration and self- management. Consumers can use mobile to access a single source for their care communication and transactional needs.

“We are thinking about the continuity of the care interaction with the clinician. There is a big divide between phone calls and in person visits. We already have secure messaging and can see where video might be the opportunity to bridge the gap in a low cost and high convenience way for patients and providers” shares Colby. 

Within healthcare, the consumer demand for mobile services is quickly outpacing the apps being supplied by organizations. Consumers want all the features available on their specific mobile device, which poses a big challenge to organizations that don’t have the resources to fund all of the mobile platforms. The key will be to identify, prioritize and deliver the most meaningful features which will enhance the member experience, enable care collaboration and empower consumers to simply engage in their health. 

Health Plans are finding new ways to bring value to consumers by empowering them with tools and guidance to manage their health while on the go.

At many conferences, health plans present their newest mobile application or texting campaign to engage consumers.

UnitedHealth Group announced their latest move at the recent Consumer Electronics Show to integrate several mobile health applications into their OptumizeMe solution, through partnerships with CareSpeak Communications, FitNow and FitBit. UnitedHealth is integrating content and tools to bring new capabilities to both consumers and caregivers.

Through the CareSpeak Communications’ partnership, consumers sign up to receive two-way texts to help them manage their medication and condition. UnitedHealth delivers CareSpeak’s personalized messaging to provide relevant content to each consumer segment ( e.g. asthma, diabetes, cancer, etc). A patient with diabetes opts in to receive customized education and reminder messages and can give a caregiver permission to monitor her health. The patient’s clinician is also kept in the loop with medication and condition management data to discuss during patient interactions. Patients are further engaged by receiving text based educational quizzes and viewing online reporting showing their effectiveness in managing their medication and condition over time.

With the integration of FitNow’s Lose It! mobile app, consumers can better manage their weight through fitness and food tracking tools, educational nutrition information, motivational reminders and social peer support.

From the FitBit integration, consumers automatically track their physical activity instead of having to key it in. Since this activity data is no longer self reported, UnitedHealth Group can use validated information to drive their rewards program. The FitBit app also tracks the consumer’s sleeping behavior for a more complete view of their health.

Integration Delivers Insight

UnitedHealth Group has invested in this set of mobile technologies to capture and connect multiple sources of data for a holistic view covering the consumer’s physical activity, dietary behavior, medication adherence, biometric and mood information.

“With these partnerships in place, we are connecting all the pieces of data across our platform for a common view for the consumer to self manage and share with their coach while creating a personalized experience”, explains Nick Martin, VP Innovation and R&D, UnitedHealth Group.

This supports the trend for “integrated end to end health to care solutions” where technology connects with care management platforms and programs, as noted by IDC Health Insights’ analyst Janice Young.

Coach/CareGiver & Consumer Collaboration

Nick Martin describes how the OptumizeMe application is being used by the consumer with their coach.  “Let’s say you are trying to lose weight. Your coach can push messages to your mobile which are educational and supportive. And if you give your coach permission, she can see your tracked physical activity”.  Think about how much more motivated and accountable the consumer will feel when her coach is monitoring and responding to her daily progress.  On the health side, the asthma patient can give access to her caregiver to monitor and address medication compliance issues. Her caregiver can also send encouraging and educational messages between visits.

UnitedHealth’s partnerships deliver new capabilities to their OptumizeMe mobile app giving consumers a new way to remain in close contact with their coach and to self manage with the social support from caregivers. With the power of the personalized information pushed and pulled from the consumer’s mobile phone, UnitedHealth Group can successfully generate both stronger consumer engagement and better health outcomes.