Buoy Health AI triage botTrue to their mission “Making health care easier, so life can be better”, Banner Health has invested in digital health technologies to support their patient experience.

Banner Health, a large regional health care system headquartered in Phoenix, manages 28 acute hospitals across 6 western states, with 5,000+ Banner Health doctors and specialists and over 50 urgent care centers.

Given trends towards consumerism and digital health usage, Banner understands that many patients begin their care journey with internet searches, at a time when these patients feel sick and most vulnerable. Sorting through search responses, patients have the burden of finding trusted health information, interpreting what they need and figuring out where to go to address their latest health issue.  Unfortunately the default care setting for patients in the United States is the emergency room, which results in $32 billion in annual avoidable ED visits.  

Banner Health Triage Bot

When Banner’s Digital Business group looked for potential solutions, they wanted to understand the patient’s journey and explore digital solutions to complement their high touch hospital experience.

“Through research, we learned that our patients often do not know what is causing their symptoms or what to do about it. They do not know whether to go see their primary care doctor, visit an urgent care facility or go directly to the hospital ER”, explains Dr. Jeff Johnson, Banner Health’s Vice President of Innovation and Digital Business.

With their commitment to delivering both a superior patient experience and reduce unnecessary spending, Banner has tested the idea of empowering customers with a digital tool containing clinical content to engage and triage them to the right care setting.

During the fall of 2019, Banner Health evaluated different digital triage tools and selected Buoy Health’s AI assisted chat bot after both an internal clinical leadership evaluation and patient testing for value and desirability.

As part of their solution evaluation, Banner recruited patients who had gone to a doctor, ER or Urgent Care in the last 30 days and asked them to think about the symptoms that had driven their visit while testing several digital triaging tools.

“Our patients commented that the Buoy bot was ‘easy to use’ and they liked not having to log in to use it. Patients felt the bot interaction was also ‘easy to understand’ and was ‘credible’. These patients did not ‘second guess’ the information that they received in the bot exchange”, shares Johnson.

While preparing for the launch, Banner worked closely with their clinical team, informing them about the triage tool and how it works. If the patient mentions using the bot, Banner wanted clinicians to be aware of the digital tool, acknowledge that the patient had invested time into learning about her condition before arriving and recognize that it is part of the Banner patient experience.

In early January, Banner soft launched the Buoy Health bot across all 28-hospitals with a “Get Care Now” link on their website, giving customers the option of interacting with this tool or calling their Nurse on Call.

After clicking on the “Get Health Now” button, patients are asked questions about their profile (e.g. gender, age) and specific symptoms (e.g. which ones, how long, better/same/worse than before).  Banner likes that the bot gets smarter with each patient interaction. Since the Buoy digital tool is available to consumers on the internet and patients across different health care systems, this bot has over 3 million interactions per month.

To evaluate this digital tool, Banner gathers feedback from patients about their bot interaction. Specifically the “Buoy bot askes the patient at the end of an exchange to rate the experience and share what she plans to do next (e.g. wait and see, doctor, urgent care, ER).  So far we have received excellent star ratings for the tool, 4.7 out of 5”, adds Johnson.

“Working closely with Buoy, we have learned about the patient’s expectations for their experience with this type of digital tool. The bot exchange cannot be too short so that the patient doesn’t trust the responses. And the text exchange cannot be too long so that the patient feels the tool doesn’t know what it is doing”, Johnson comments.

Banner’s Digital Business team is looking closely at bot tool usage and feedback to guide further development.  The bot reporting will give them insight into which care setting patients were directed, what questions they asked and which symptoms and conditions were discussed in the exchange with the patient.

In the first 3 weeks after launch, the Buoy triage bot has had 1,200+ users. Moving beyond the soft launch, Banner plans to incorporate the triage bot in their mobile app and to promote it as an option when patients call the Ask the Nurse line. Banner is discussing developing a Triage Summary Report which captures the information that the patient has already provided to share with her doctor. Banner is also looking to expand care settings to include directing the patient to a virtual visit in the right situation.

Banner Health Emergency Department (ED) Bot

Lifelink ED chabot

Like many of the ER experiences across the country, Banner Health patients want more information and communication about what is happening and what will be happening next to adjust their expectations.

The Banner Health team brainstormed about how to help patients get the information that they need throughout their visit without having to trying to find their doctor, walk up to the nurses station or wait for the nurse to come to their room.

Johnson shares that “we found an interesting chatbot solution from a start- up, Lifelink. We started slowly by having patients use the bot on their smart phones while in the ED and we manually responded to their questions. This gave us tremendous insight into what patients wanted to know and when. Based on this insight, we designed the chatbot (available both in English and Spanish) to give the patient a status from the time her labs (or images) are ordered to the time they are ready and then reviewed by her doctor. We needed to set expectations that the lab will take 45 mins before it is done. In order to enable these real time updates on labs and images, we integrated the LifeLink bot into our EMR. We promote that the patient signs up to our patient portal to access all of the notes, labs and images from her ED visit”.

Since the ED bot was rolled out across all 28 Banner Hospitals, there are over 100,000 patient users, one million plus conversations with an average of 5-10 conversations with the bot per person. 

“We have seen our patient satisfaction score for our EDs increase by up to 35%. This ED bot is such a satisfier”, Johnson explains. “Here are some patient comments about the value of using our ED bot”:

“It was nice to be given updates instead of just sitting in a chair and waiting for someone to get to me.”

“It gave me updates on my progress without bothering the nurses.”

“Very informative, relieved my husband’s worries by 90%”

In the near future, Banner Health is planning to “connect the dots” and engage the patient from the moment of interest and throughout their care journey. “We are looking to begin at the first part of the journey when the patient goes online to let us know that they are coming to the ED. Our ED bot will let the patient know that ‘we will be waiting for her’, provide map, picture of the entrance and parking directions. We also want to have the ED bot support the patient post discharge, reminding her to fill her medication, the date of her follow up visit, signs of what to look for and where to go if there is a relapse”, Johnson explains.

Later in this year, Banner Health is planning to extend the bot to inpatient care, with the goals of helping the patient get the highest outcomes and reducing their length of stay. This inpatient bot project is part of a bigger ‘patient flow’ initiative. Banner wants to get patient’s engaged at the beginning of their stay for a successful discharge. The bot will give guidance and recommendations so that the patient improves her eating, walking and bowel movement activities. Banner is also exploring ways to engage the family/care network to ensure an optimal recovery.  

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.”

Health care companies today are following in the footsteps of the retail-oriented, information based financial services industry.

What financial services companies have discovered is that in order to build their business, they must build a personal relationship with the consumer.  They accomplished this by creating a consumer-centric database, monitoring shopping behavior through reporting and analytics, motivating activity through multi-channel communications and launching a loyalty program to reward consumer spending,

I was part of this customer-centric transformation as the Director of Database Marketing at GE Capital, which provides private label credit card programs for Disney and Apple, to name a few marquee brands. My cross- functional team started with the consumer in mind. We envisioned the experience that our retailer customers needed to deliver to their consumer card holders to differentiate themselves in the marketplace and capture a larger mind share and business share.

This is the same path that health care companies are marching down to get ready for new customers.

Consumers Are Coming!  Health Care Companies Invest in Retail Strategies 

In their report on “The Era of the Health care Consumer,”  Accenture describes the shift in responsibility from the employers to the consumers and the resulting health care company investment changes from BTB to BTC. Accenture cites the opportunity to learn from the retail sector, especially the segmentation, profiling, loyalty and cross channel communications.

A few health care organizations are making the needed investments to move closer to the consumer in order to better understand their needs for information and tools to support health management.  Aetna, for example, has partnered with Best Buy to sell wellness programs to consumers within the retail store and deliver their wellness coaching program online. In addition to store fronts, Florida Blue (previously BCBS Florida) has invested in their Guidewell online initiative to build a relationship with consumers beyond their member base.

Most health care companies, however, are still trying to figure out where to begin.

Barriers for Data-Driven Retail Health Care

There are several key barriers that Health care companies must overcome in order to effectively engage these retail consumers. 

• Knowledge about the New Consumer: Health care companies have limited or no information about their newest customer that is either considering their health product/service or has just come onboard. As a result, the interaction can feel less satisfying.  Using best practices from the financial industry, health care organizations can utilize segmentation and profiling to deliver a more personalized experience while gathering knowledge about the consumer through each touch. 

• Knowledge about Consumers' Data Needs: During their recent research, IDC Health Insights learned that “despite large investments meant to extend the organizations’ consumer-centric model, health plans know little about how consumers want to consume information…”.  Financial Services companies remain aligned with their customers by inviting them to participate in their own private branded online research community. The company captures consumer input and feedback on their product road map and new marketing initiatives.

• Knowledge about Proactive & Personalized Communications: Many health care organizations wait for consumers to come to their online marketing destinations including their website and social media and then wait for them to return. Although these companies maybe have tools in place to capture the contact information of interested consumers, they tend to send out the same information to everyone. Financial Services companies segment these target consumers and stream content of interest across their preferred communication channels to bring them back and engage. 

• Knowledge about Developing a Personalized Incentive Program: One way that health care companies can differentiate themselves is with an incentive program that rewards a consumer for healthy lifestyle behaviors that fit her profile. One of the reasons that some credit card loyalty programs (e.g. American Express) are so effective is that they target personalized offers based on each consumer’s spending behavior profile.  

Health care companies can learn from the leaders in the Financial Services industry about how to leverage technology to build a retail consumer relationship through ongoing personalized communications and programs which are aligned with the consumer’s ongoing data needs. 

Since returning from the Healthcare Unbound Conference in San Diego earlier this week, I have been asked  what has changed in the past year.

In his opening remarks, my colleague Vince Kuraitis, Principal of Better Health Technologies talked about the progress we’ve made with the technologies and experimenting with different business models, but the focus now is on the “value network”.

Steps Along the “Value” Brick Road

During the conference, one clear theme was that value is determined by the recipient and can be used to attract and engage consumers.

How can your organization create and lead with value? Here are the key steps which begin by identifying…

Step 1)     Who?

Consider how much your organization deeply understands the needs and behaviors of your target audience (Notice that I did not say understands the consumer’s feedback on your offering). This perspective is essential before you can define, develop and deliver value which is compelling to your target consumers.

Many companies use segmentation to focus in different groups of consumers and understand what each group values.

Several speakers mentioned segmenting the senior market. After all, the active 68 year old male is not the same as the 78 year old male trying to manage his health and the health of his 98 year old mother who happens to live three states away.

Within the corporate wellness market, we heard that employees have different motivations. Some employees are eager to participate in a company- wide competition tracking their activity weekdays and weekends, while others are interested in socializing at lunch time with their Walking Group. Employers have an opportunity to offer a set of programs with online tools to meet the needs of these different employee segments.

Step 2)  What?

After understanding the different segments of your target audience, it is important to think about ways you can bring value to each of them.

Liz Boehm, Principal Analyst at Forrester Research, discussed the “Four Pillars of Aging in Place” which included health, safety, connectivity (e.g. friends. family and community) and contribution (e.g. meaning/purpose).

Most companies in the senior market focus on health and safety, which happens to be the “stuff that people wish they did not have to think about”. Through research, Forrester has learned that the other two areas, to be connected and to contribute, are actually the “stuff that people want”.  These are two areas can be used to engage seniors in a way that is meaningful to them. Is this the consumer’s desire for “meaningful use”?

Step 3)  How?

Gordon Norman, Chief Innovation Officer at Alere challenged us with “Now that the we’ve unbound healthcare, who will put it back together?”

Think about the value network and the role that your company can play.

You may choose to partner to meet all of the needs of your target audience. With technology standards in place, you can design your product to connect in with a larger solution.  

Or you can lead the way and take on the “aggregator” role, building a hub to service the consumer/member/employee/patient. By becoming the aggregator, your company has an opportunity to deliver more value through data and analytics. Consider the holistic view that you can share, enabling your users to make better decisions.

I will leave you with two questions to consider. Where is your company on the “value” brick road? How far are you willing to go?

Over the weekend I had dinner with close friends who told me about their teenage daughter and her sleepover with few girl friends. “All three of the girls had their cell phones lined up and plugged in a charging side by side on the night table”.  Even when they are sleeping, teens keep their cell phones close by.  While awake, these “digital natives” are continuously connected which provides opportunities for reaching and engaging teens in their health. 

Strong Statistics on Teen Mobile Usage

In Pew’s latest study of 12- 17 years old teens, there are interesting insights about teen's use of mobile technologies:

- Teens Have Mobile Phones. “Three-quarters (75%) of teens now have a cell phone”.

- Teens Texting for Connection. “Fully 72% of all teens – or 88% of teen cell phone users — are text-messages. That is a sharp rise from the 51% of teens who were texters in 2006.” 

- Teens Texting Daily. Each day, 54% of teens text compared with 25% using social networking sites.

- Girls Texting Much More. Teenage girls tend to send and receive more texts each day, 80 compared with 30 for boys.

- Minority Teens Use Mobile for Internet Access. “44% of black teens and 35% of Hispanic teens use their cell phones to go online, compared with 21% of white teens”.

Influencing the Health of Mobile Teens

Organizations have been researching and piloting programs to learn how to impact the teen’s health behaviors for better outcomes.

After a successful pilot, the Murdoch Children’s Research Institute (MCRI) with the Telstra Foundation rolled out a program for teens (and young adults) that uses mobile to monitor their mental health including stress levels, coping strategies, dietary and fitness factors.

The NY Times reports that Mount Sinai Hospital has researched and learned that sending text messages to young liver transplant patients can improve their medication adherence and “avoid life-threatening complications”.

Partner’s Center for Connected Health recently ran a pilot with pregnant teens with the goal of using mobile for outreach. OB Case management sent SMS text messages about proper pre-natal care and regiments. These messages were educational and prompted the teens to take an action such as attend an office visit. “We learned that the texting strengthened the relationship- 83% reported feeling more supported by the health center case manager”, explains Alex Pelletier, Team Lead, Program and Product Development at Partners. More about this pilot from Alex on my upcoming World Congress panel, Generating Mobile Engagement Through Consumer Segmentation, Crowd Sourcing and Personalization. 

Future Mobile Teen Projects:

The Robert Wood Johnson Foundation recently granted $2.4M to mobile health project including one from the San Francisco State University – San Francisco, California targeting teens from low-income backgrounds who experience much higher rates of obesity. To help these teens manage their obesity and depression, the University will evaluate the capturing of observations of daily living (ODLs) through smart phones and sharing of the data with their care team for planning and care management.

Teens are dealing with many different health issues while on the go managing their busy lives. Their health concerns span their physical and mental health which may include juvenile diabetes, obesity, asthma, sexual health problems and even autism.

How is your organization targeting this segment of “digital natives” around health? How are you leveraging mobile technologies to reach, influence and impact them to have healthier bodies and minds?