Wednesday, July 28, 2010

Using Web 2.0 Technologies for Cost Effective Healthcare Interventions

Imagine taking your child to the doctor and getting an antibiotic prescription.  A few minutes later you get a text message on your I Phone or Blackberry:  “Important Message from Wellpoint about your child’s medication:”.  You click on it and a video pops up:  “Hi, I just wanted to remind you how important it is to make sure your child completes the full course of antibiotics prescribed to him.  This is because……”  Or you get an email entitled:  “Important Medication Information from United Healthcare", you click on the link and:  “Hi:  We’ve noticed that you haven’t refilled your Statin prescription.  Your Doctor prescribed this prescription because studies have shown that it reduces heart attacks by….percent.  But sometimes patients have difficulties with certain medications:  they have stomach aches or other side effects.  Usually your doctor can resolve this by modifying your dosage or therapy.  Would you like us to let him know you’re having problems?  Or would you like more information?  Or would you like to speak to someone about your medication?” 

These types of compliance interventions have historically been difficult to do.  They relied on telephoning patients at home in the evening and no one is happy to have their dinner interrupted to discuss their Gall Bladder medication.  The call center staffers were poorly paid so it was hard to deliver consistent, high quality messages.  And of course all interventions had to be three way conversations:  between the PBM and the patient to get agreement to seek intervention and between the PBM and the physician to get her approval.  Understandably, the cost per successful intervention was high, limiting the scope of communication.  Yet with all these drawbacks I saw the program succeed when I worked for the CEO of Eckerd.  We had a program like this that created so much value that we were able to sell a Design, Build, Operate decision support and intervention center to a leading managed care company for more than $100,000,000.

The good news is that with video enabled mobile devices, ubiquitous high speed networks and web services, the major operational drawbacks of intervention programs are mitigated.  Email and text messaging mean that messages can be sent and viewed at the member’s convenience.  The message is delivered once by highly skilled professionals via reusable video rather than poorly paid staff reading from a script.  Consumer responses can be done in real time and at the patient’s convenience and because it is video content, it can be reused and delivered at a cost per message far, far below that of traditional ‘live’ interventions.

Short 2 to 4 minute video messages can be driven by adjudication edits or retrospective utilization review results.  And the capability can be made available directly from providers, enabling them to deliver more, higher quality information to your customers about their diagnoses, treatments and required patient follow up at the point of delivery.  Member call centers can use them to support and enhance telephonic communications.

The real challenge is not in producing the interventional content.   We estimate that the ‘consumer’ relevant messaging for drug therapy and related topics probably equals roughly 1,000 topics.  This content, if supported by the right Medical Schools and Pharmacy Schools could be created in a reusable format, allowing different providers, insurers and physicians to utilize it and make it their own by using their own branding and introductions.  Here’s an example of what we’ve done with the concept in the Investment Advisor space.  We have developed a content configurator that allows common, clinically approved content to be branded and ‘owned’ by a wide range of institutions see here (it isn’t in HTML so it’s not pretty) PW: demo, Userid:  demo.  By creating this content once, Wellpoint and providers have the opportunity to dramatically improve the effectiveness of data driven interventions at a tiny fraction of the cost.

The real sources of competitive advantage are three-fold:
·         Intelligently tying the automated intervention content into execution and analytical systems so that the right message gets to the right patients in time for them to act upon it
·         Connecting this messaging in a consultative and professional manner to the involved healthcare professionals – primarily physicians and pharmacists
·         Pushing the toolset out into the provider community so that the right interventions and education are presented at the point of delivery

While this is relatively inexpensive when compared to other sources of healthcare innovation there will be investments:    A large library of ‘use cases’ that define which data events will trigger which innovations and interactive options  must be developed.  Tools must be created that will sit on top of adjudication and retrospective utilization engines.  Providers and insurance company staffers will need to be given tools and training that will allow them to easily and accurately convey this rich new communication medium to their constituents.

We’ve been working with the creator of the $100 Million first generation high speed retrospective DUR system described earlier and our collective experience tells us that direct to consumer wireless video intervention is a far, far bigger opportunity to deliver value, credibility and market differentiation than anything that has ever come before.  I urge anyone who funds or delivers healthcare services to seriously consider re-prioritizing their investments to deliver this type of solution sooner rather than later.  By doing so you may be able to save the lives of many people who are currently stranded out on the Openwater. 

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