CareFirst BCBS Medical Home SDM Tool

Over two years ago, I led a panel on patient decision support tools for a large interested crowd in Boston, despite the very snowy day.

Since then, I have noticed a few key changes. Physicians are now prescribing information to patients, using the EMR to send emails with links to health resources. And innovative health plans are playing a role in bringing shared decision making tools to engage and empower their members. Health Plans have a big cost saving incentive when these tools educate their members about less invasive and less expensive options.

3 Key Engagement Drivers With Shared Decision Making Tools

While evaluating technologies for my panel on “Evolving Web & Mobile Tools to Engage Consumers in the Shared Decision Process”, I identified how three key drivers of consumer engagement are being utilized:

1. Education

These tools show the consumer what the treatment entails and share patient stories which tell them what to expect.  This education reduces anxiety by putting the consumer in control to understand their health issues and presenting options to address them.

2. Evaluation

Shared Decision Making tools are ideally designed for “preference sensitive conditions” where there are multiple clinical options (For information about target conditions, see the recent report on the Dartmouth Atlas Project which was developed with The Foundation for Informed Medical Decision Making). The most effective tools offer alternatives, capture preferences and guide the consumer through the process while documenting their decisions. This helps set expectations for their experience and supports the discussion with their doctor or care coach. 

3. Collaboration

As the patient and clinician/coach review the SDM summary document together, they can discuss questions, concerns and comments to make the best decision.

Health Plans Leverage Shared Decision Tools

During the panel, health plans described using Shared Decision Making tools to engage members in two key areas:

• Medical Home

Panelist Zev Lavon, PHD, Director Solution Architecture, CareFirst BCBS emphasized “the story of the patient is not their last doc visit or lab test”.  CareFirst launched their Primary Care Medical Home initiative across a panel of physicians deploying communication tools to push information to patients to support the management of their chronic conditions.

•   Wellness Coaching

According to Mark L. Robitaille, MBA, Head of Care Management Support & Engagement, Aetna puts these tools into the hands of their health coaches to send emails with resources links to members or use the tools to look up information for the members without internet access.

Independent Health panelist, James J. Mis, MBA, Communications Manager, Health Care Services, described their interactive voice response campaign to inform members about viewing a shared decision making video (from Emmi Solutions) selected for their specific health interest.

Emerging Mobile SDM Tools 

With a high penetration of smart phones and strong usage across minorities, health care organizations are realizing the tremendous opportunity to deploy mobile applications to engage consumers. To date, most health mobile health applications have been focused on wellness with educational information and tracking.

Panelist Changrong Ji, Senior Solutions Architect, CareFirst BCBS described the opportunity for mobile shared decision making tools. In the future, she envisions that sensors will capture the context of the consumer’s daily life, database analytics will identify patterns and machine learning will be used to help identify relevant mobile messages to send back to the consumer.

Healthwise’s View on Patient Response

During the Shared Decision Making Summit, the chairperson, Don Kemper, Healthwise’s CEO discussed the opportunity for shared decision making tools to give a “voice to the patient”.  After the physician prescribes health information, the tool gathers patient’s preferences to document them in the medical record. I strongly agree with Don as he explains “there is no better way to engage the patient than to assure them that their voice will be heard in treatment and care plan decisions”.

Shared Decision Making Tools for Your Consumers

What are you doing to bring Shared Decision Making Tools to your consumers to motivate engagement in their health and wellness?  I can help guide you through the process of identifing, evaluating and piloting these technologies to deliver better outcomes and a better experience for your consumers. 

My wish list grew as I researched how companies were using mobile to generate engagement in consumer- driven industries such as financial services, retail, travel and entertainment.

As I prepared for my Mobile Workshop at World Congress’s Product Innovation Conference, I identified, evaluated and selected mobile applications to inspire the workshop participants with their mobile health strategies.  Each mobile application was chosen because it cleverly incorporated key engagement capabilities.  Some mobile examples were designed to engage short term while others were intended to sustain engagement over the long run.

During the workshop, I presented more than a dozen selected examples which I organized into four groups based on how they engage consumers. Let me share one example from each group with you.

1)     Life Management

Companies are creating mobile applications that help consumers get things done while on the go.

Example: Omnego launched a “Go Travel Wallet” application which enables consumers to load and access their travel documents including digital pictures of their passport and insurance documents. Consumers plan their travel by using all of their travel information such as rewards programs, credit cards and travel providers. They save money with the merchant coupons that are placed in their mobile wallet from social media, QR codes (scanned), emails and texts.

2)     Information Access

By placing QR codes on their promotional materials, companies are grabbing the attention of their customers and offering them access to special content in return.

Example: For an upcoming movie, Fox Spotlight has splashed QR codes across their marketing materials distributed or placed (posters) around the community, all ready to be scanned to access exclusive content.

3)     Social Community & Commerce

Businesses are realizing the power of using mobile to tap into the social networks of their customers.

Example: Amazon’s Back to School mobile application is targeted to the student segment. Students can buy and sell text books, access exclusive deals and share their “finds” with their social network.

4)     Social Gaming

While playing a social game through a mobile application, consumers interact virtually with the company’s brand and are driven into the business’s physical locations.

Example: New Balance gets their customers moving in the community collecting “virtual batons” which can be redeemed in their stores for rewards, These batons appear on the consumer’s mobile phone by using GPS and maps. Consumers are motivated to visit the store quickly since the virtual baton can be stolen by others playing the game.

Mobile Insight & Guidance

During our workshop, my colleague Ahmed Albaiti, CEO of Medullan shared technology and consumer demand trends. After sharing a framework and guidelines for the interactive game, we split our workshop participants into teams.

Ahmed and I worked closely with our team as they defined their target users, thought through their needs and current resources to support them and then conceptualized a mobile application.  

As I observed my group, I noticed that it was easy for them to suggest mobile capabilities from health applications already on the market but I had to continuously challenge them to incorporate innovative ideas from other consumer industries. My role was to help my team see how these innovative examples can be applied to healthcare to meet their business objectives.

It was exciting to watch the teams describe their wish for a mobile application designed for their target consumers.

Imagine a mobile workshop for your company, where all of your internal stakeholders are focusing on the users, identifying their own wish list and defining capabilities to truly engage these consumers.

At the recent World Congress mHealth Summit, I led a panel called “Personalizing the Mobile Experience to Drive Consumer Engagement”.

Why is mobile so important and why does it need to be incorporated into all consumer health & wellness engagement strategies?

Pew Research’s May report found that “83% of US adults have a cell phone, and 42% of them own a smart phone”.  As mobile phone ownership grows so does the consumers’ expectations about using this device to plan, manage and monitor their personal lives. Consumer- driven companies across financial services, retail, media and entertainment are designing creative ways to engage the consumer through a valuable mobile experience.

Within healthcare, mobile is a cost effective and efficient way to not only generate but also sustain consumer engagement.

Here are several strategic considerations that I presented while introducing the panel topic.

1. Segmentation & Customization. Once a company moves beyond enabling mobile access for all target users, they must think carefully about the varying needs and mobile usage profiles of their different consumer segments. Consider consumer segments which have high mobile technology usage.

Pew Research found that over 87% of minorities such as African Americans and Hispanics have mobile phones and they are more likely than whites to send/receive text messages, use the internet on their mobile phones and have smart phones. What about a mobile texting program educating them about their health condition or motivating them to engage in preventative care?

Frequent business travelers stay connected to their company, customers and family through their mobile phones and tablets. A recent Columbia University study showed the association of business travel and cardiovascular disease. According to the study, this may be caused by their poor diet, lack of exercise and sleep as well as stress. Imagine how mobile can be used to help these travelers manage their health issues and make better decisions while on the road.

Over 75% of teens have a mobile phone and more than half are texting every day based on Pew research. Can you send mobile messages to teens to educate them about staying fit or informing them about ways to manage their diabetes? There is also opportunity on the mobile apps front.  I recently participated on a project envisioning mobile solutions to support the mental health of (college) students to avoid depression.

How is Highmark approaching segmentation? Highmark utilizes Forrester’s Technograph Segmentation to prioritize their mobile initiatives. Panelist Lisa Fitting, Director Client Engagement mentioned that when Highmark conducted segmentation research across their member base, two key segments emerged-- “Connectors who use their mobile phone for work and are productivity- oriented” and “Communicators who regularly use SMS” and often use other digital communications. Highmark is using this insight to define mobile initiatives based on these preferences. They also plan to come out with mobile applications targeting specific needs such as “fitness, weight management, diabetes, medication”.

2. Multi-Channel Experience. As consumers move about their daily life, they move from channel to channel. Teens put down their mobile phones when they pull out their laptop computers. When they are through interacting via their computer, it is important that their next mobile interaction reflect their latest online activities.

Humana conducts user experience research to better understand how different types of users interact with their Humana Fit application through their mobile phones and computers. Panelist Tony Tomazic, Director of Consumer Innovation at Humana explains “we understand the strengths of mobile. Through research, we have learned how consumers want to use their mobile phone for tracking and communications regarding personal health and fitness (e.g. saving episodes of activity, receiving reminders and alerts), whereas consumers prefer to use their computers to manage more complex and visual planning of their goals and gather information from their other external devices.”

3. Personalization in Context. While carrying their mobile devices, consumers can use them to receive reminders, review educational messages, track information (e.g. mood, pain levels, fitness and nutrition) as well as search for information to make decisions while on the go.

"Healthline brings both personalization and contextualization to the consumer", explains panelist Ryan Tarzy, VP Business Development. “Aetna members view search results that are both contextual to the issue they are researching (e.g. diabetes), but also personalized based upon their personal health record, location, and covered benefits”.

As you develop your mobile health and wellness strategy, think about the needs of your various consumer segments and their mobile technology profiles. Consider their multi-channel experience of which mobile is only a part. And determine how you can design a mobile strategy which brings new value to the consumer through personalization within the context of their current health, plan coverage and location.

Have you read the Seven Mobile Health Engagers?

“My participation in online communities (within BHive) provides me with a platform to engage & converse with my peers and build camaraderie based on shared interests. Through ‘Tastebuds’, our online community for foodies within Brocade, I have engaged like-minded individuals to discuss recipes, exchange restaurant reviews and promote healthy eating, resulting in a sense of belonging centered around a common interest.”

BHive is a private online employee social community. BHive is leveraged to help promote many wellness initiatives which helped make Brocade one of the top 100 companies to work for, making Fortune’s 2011 & 2010 list.

Within BHive, employees friend and follow each other as well as earn points for posting and answering questions and contributing to discussions. The most popular topics that Brocadians are discussing online are WellFit (includes ViveCoach challenges, Sports Groups), WIN (Women in Networking), BInvolved (volunteerism & community involvement) and San Jose Campus (employees posting photos from various work events like the annual Chili Cookoff). Brocade uses BHive to gather information from employees through polls and discussions and generate engagement in offline company and community events. During May, employees worldwide participated in “Bike to Work” and posted their photos online. 

With the ViveCoach platform, Brocade engages employees through their mobile phones. During social challenges, employees receive mobile messages about additional challenge points needed by their team, team work-out reminders, healthy nutrition or fitness tips, reminders (“drink lots of water” or “take the stairs”), team banter and leader board status.  Brocade had a team of remote employees join a recent challenge and they are planning a competition that includes spouses and family members. “We believe that it is important to include employee’s family members so these lifestyle changes become more sustainable”, explains Lisa McGill, VP, Worldwide Human Resources at Brocade.

What is the secret for being on the leading edge of employee engagement?  In June 2010, Brocade launched their WellFit Council with 15 representatives from all departments and geographies. These employee advisory Council members are divided into four work teams (Health & Wellness, Fitness, Education & Communities) and meet once per month to provide input and guidance on wellness related events, education, communication channels/content and metrics to motivate and measure engagement at Brocade. Each employee member leverages their own employee network to bring additional ideas and feedback to the Council meetings and into the dedicated online WellFit Council discussion area within BHive. “Being part of the Council has been a great experience and for me it has really affected how I manage my health, wellbeing and work-life balance.  Some of the ideas are even rubbing off on my husband”, shares one WellFit Council member.

Learn more about Brocade’s successful initiatives to drive employee engagement at the Healthcare Unbound conference panel, "New Directions in Employee Engagement: Competition, Coaching, Community and Compensation".

"I do not want to disengage with my life to engage with my health…you want me, find a way to weave it into my life.“ ~ Quote from 2010 Health 2.0 Conference

As I viewed an in-depth demo of Aetna’s new social solution, I immediately noticed the unique approach they are taking with the Mindbloom platform.

My Tree

Mindbloom uses a tree metaphor to represent the different areas or branches of a person’s life. Let me share my thinking as I envision “My Tree”.

I am empowered to design my tree with branches that are important to me; health, relationships, lifestyle, leisure, finances, spirituality, creativity and career.

As I identify and complete an action of my choice, a new green leaf appears on the related branch. For my health, I may decide to add my own action to “complete my dance class this week”.  When I overlook an area of my life, over time my leaves turn brown on that branch.

There are other trees from friends and family that I have invited to join my forest. I control what each of them sees. My closest friends and family view each leaf and can comment to acknowledge my accomplishments and support me when there are setbacks.

As I grow my tree, I strive for balance. I begin with a few branches and get them strong before adding others. In time, I envision having a vibrant tree.

When completing actions, I receive rewards that unlock new features including the option to select a new forest background or the ability to upload my own photos for inspiration. 

Through my mobile phone, I can update my actions, journal my progress, view my friends' progress and send messages for encouragement. This lets me “grow on the go”.  Beyond the existing mobile web capabilities, Mindbloom will be launching a much more robust native iPhone application in the fall timeframe. 

“People will not track every day” explains Kyra Bobinet, Medical Director eHealth & Wellness at Aetna. “This tool is a repository where they will come in and out. We will give consumers reasons and stimuli to continue their journey for a healthy balance”.

Elements of Engagement

Although I have seen many health related games, this one is customized, comprehensive and compelling.

Here are five elements to drive consumer engagement:

1) Personal. My tree looks different than yours. It has specific branches and leaves that are important to me.

2) Holistic. I extend my tree with branches from different aspects of my life beyond health. In fact, the growth of one branch influences another. When my health branch is under stress, my relationship branch is impacted.

3) Social. My forest has trees representing my friends and family. We are all there to support and strengthen each other. This forest is changing all the time and I am drawn back to take a look.

4) Rewarding.  As I reach new milestones or succeed in maintaining a healthy balance, I am rewarded in many ways. In addition to feeling better, I receive points as well as recognition through my private forest and public social communities (e.g. Facebook). And I am also rewarded seeing my “Tree Summary” displaying my accomplishments.

5) Fun. Like any interactive game that keeps my attention, this one is full of surprises. My points take me to new levels which reveal new opportunities for growth.

Engagement By Design

Before designing this solution, Aetna conducted extensive research with consumers. They learned that consumers want Aetna to make it “more fun”, “easier” and “rewarding”.

I am most interested in seeing how engagement grows and which segments of consumers are motivated to develop and nurture a balanced tree of life.

Disclosure: I worked with the Aetna team on concepts before the Mindbloom partnership.