At Infosys, our focus on Healthcare is aimed at radical progress in affordability, wellness, and patient-centricity. We believe technology is a catalyst for game-changing healthcare solutions. In this blog, we discuss challenges, ideas, innovations, and solutions for the healthcare economy.

December 23, 2013

Take care along with coverage in the Health Insurance Exchanges

Affordable care is the goal for both enrollees and health plans participating in the exchanges. While exchanges will help health plans capture a larger market share, will they be able to reduce the overall healthcare costs?

Public exchanges bring in lots of tax benefits, premium subsidies, and models like defined contribution to provide low cost coverage to the uninsured population. However, with the provision to cover pre-existing conditions and increased competition, it will become more difficult for health plans to manage costs incurred to engage and service members.

Adverse selection, which increases the number of claims and associated costs, limits the ability of exchanges and participating health plans to contain the rising cost of care. Permanent Risk-Adjustments Mechanisms, introduced to address adverse selection, increase complexity and overheads for health plans and may not be very effective. Despite the costly and time consuming upgrades to core actuarial processes as advocated by the permanent risk adjustment mechanisms, health plans remain uncertain if the premiums setup will be sufficient to cover costs or not. This uncertainty increases premiums for specific plans. And, once the exchanges start supporting large employer groups, the cost control mechanisms would become more complex. Even if the risk adjustment mechanisms are made more effective to ensure stability of variable medical costs across uneven population, they will still remain a post-facto solution to curb costs. Is there a proactive solution then for cost containment?

Obama's reform vision of reduced costs and improved care requires a reformed care coordination process, harmonized with the health insurance exchanges. Providers, along with payers, need to take responsibility for cost containment. Care pricing models need to be reformed. Though exchanges have stringent plan certification process that focuses on provider cost and quality data, there is no mandate supporting the wellness programs and the value based care pricing models that are part of PCMH, ACO, and P4P programs. If preventive and proactive care initiatives such as these were associated with exchange plans then reform would encompass both cost and quality!

Provider payment reform and new reimbursement care delivery models need to be linked with exchange based plans. In addition, plan designs incorporating value based benefits can definitely incentivize patients to be compliant with the care process, enabling improved outcomes.

 Research suggests that one of the biggest lessons from Swiss insurance exchange is that care purchasing models are as important as network adequacy, cost, and quality data. The QHP approval process can take care of this. For high-risk populations attracted by the exchange, QHPs can be required to support wellness and care management programs (e.g., diet, life style and medication management) which would address the needs of the high risk population. At the same time, plan benefits can reward healthy behavior through seasonal initiatives or perks. Exchanges can encourage pricing negotiations between payers and providers and support innovative contracting models in QHPs.

ACOs and PCMH have already proven their models with millions of cost savings; why not apply them mandatorily in exchanges and make the exchanges efficient, sustainable, and capable of providing effective care along with coverage?

August 30, 2013

Social Media Adoption in Health Insurance Industry - Blog 5

In the previous blogs, we had discussed on the few key solution approaches to meet the challenges that are preventing the healthcare payors from a widespread adoption of social media. The list included the following.
• Adoption of Enterprise Social Media policy
• Right selection of tools or packages
• Implementation and Integration with existing capability
• Social Media Risk Management

I had elaborated on the importance and criticality of Evaluation and Selection of Social Media Tools in the previous blog (Social Media Adoption in Health Insurance Industry - Blog 4). I will continue the discussion in this blog and focus on Implementation and Integration Social Media tools with existing capability in a payor enterprise.

Integration of social media with the existing capability happens at multiple levels such as business process, technology and people.

Integration with Sales processes -  The payors collect and anlayse the sales leads generated by various advertisement channels such as surveys, webcasts, e-mails, paid search, website banner advertising for the group and individual members. The prospect information is then sent to brokers and Agencies who then contact the leads and covert into a deal.

Integration with Market and Product Research capability -  The payors aggregate, analyze and act upon member information derived from online surveys, call center records, Twitter, Facebook and blogs to design and manage the member experience on multiple channels while identifying future product and service needs.
Integration with Customer Relationship Management (CRM) system - The social media tools can be planned to be integrated with the legacy customer relationship management  systems, using tools which provides real-time , unified access to information across internal systems and external online or social media.
Integration with Social Data Enrichment Services - Payors will need to assess the potential value of emerging social data enrichment services, such as RapLeaf and Flowtown. These emerging data providers crawl the social web, integrate information about individuals, then sell the data and related insights to the Payors.
Integration with Electronic Health Record (EHR) system  - Social Media tools are now  integrated with EHR applications which will equip Payors and healthcare providers communicate better with the members and vice versa.  

August 14, 2013

Care Management: Innovations and Trends - Empowered Member

Care Management programs are designed and executed to enhance care co-ordination, reduce cost while improving the quality of care. Howsoever well these programs are implemented; the changing market dynamics imposes new challenges, which needs continuous evaluation and innovative ways to increase the effectiveness of care management programs.  Let's explore some of the recent innovations and trends in care management.

Continue reading "Care Management: Innovations and Trends - Empowered Member" »

August 8, 2013

ACOs - Why they could fail?

Accountable Care Organizations (ACO) are healthcare organizations which are accountable for quality and cost of healthcare services. These are group of physicians, hospitals & other healthcare provider who provide coordinated high quality care to patients. ACOs would share financial responsibility with government and private healthcare insurers. Their payment models are quality-based, which differ from traditional quantity-based models. ACOs have the potential to reduce healthcare expenditure and improve quality of care. However, they face certain challenges which they need to overcome and avoid failure.

Continue reading "ACOs - Why they could fail?" »

July 31, 2013

Social Media Adoption in Health Insurance Industry - Blog 4

In the previous blog (Social Media Adoption in Health Insurance Industry - Blog 3), I had mentioned a few of the key solution approaches to meet the challenges that are preventing the healthcare payors from a widespread adoption of social media. The list included the following.
• Adoption of Enterprise Social Media policy
• Right selection of tools or packages
• Implementation and Integration with existing capability
• Social Media Risk Management

I had elaborated on the importance and criticality of an enterprise social media policy in the previous blog. In this blog, I will focus on Evaluation and Selection of Social Media Tools.

Evaluation and Selection of Social Media Tools
A wide variety of social media tools are available in the market and the list is continually being updated with the new additions to it. The Payors need to evaluate and select the right combination of social media tools in order to meet their both tactical and strategic goals. There are methodologies available to evaluate the tools. One of the popular methods is Balanced Scorecard Method
Balanced Scorecard Method - The measurement in balanced scorecard method is based on four categories.
• Financial - In this category, the cost benefit analysis for the strategy of deploying a social media tool is done and ROI is determined.
• Value add to Organization - This category addresses the value add to the Payor's internal staff (includes employees and agents) by the deployment of a social media strategy. The value add is in terms of enhancing the awareness on the usage and technical knowledge.
• Members or Subscribers - This category assesses the effect on the members especially engaging them in spreading awareness and the success of the Payor's marketing strategies.
• Internal Processes - This category assesses the contribution of the adoption of social media strategy on the maturity of Payor's various business processes such as sales & new business, underwriting etc.


June 28, 2013

Social Media Adoption in Health Insurance Industry - Blog 3

In the previous blog (Social Media Adoption in Health Insurance Industry - Blog 2), we had discussed the various challenges that are preventing the payors from a widespread adoption of social media.
In this current blog, we will focus on how to address those challenges. Following are few of the key solution approaches that can be thought of.
• Adoption of Enterprise Social Media policy
• Right selection of tools or packages
• Implementation and Integration with existing capability
• Social Media Risk Management
We will elaborate, to start with the discussion, on the importance and criticality of an enterprise social media policy in this blog.

Framing the enterprise social media policy -

It is critical to establish policies, structures and ownership at the organizational level to manage usage of social media more effectively.  At some point after the organization starts using social media, the required team can be established to develop policies, guidelines, standards for the organization.
The laws (such as HIPAA) published by the regulatory authorities in healthcare industries will provide crtitical inputs to the creation  of the corporate social media policy of an organization. We will need to involve the various stakeholders in the healthcare value chain who will have specific view points and will form important parts of the the policy.

Sales  and New Business - The enterprise social media policy dictates what can be advertised as far as the Insurance Organization's product and plans are concerned.

Underwriting - The insurers need to come up with a clear policy guideline restricting/enabling underwriters /agents capture the member data  in the social netwroking sites as appropriate.

Claims Investigation - Insurers need to be cautious in coming up with an ethical approach in accessing the data present in the public domain for claims investigation.

Customer Service - The customer service department uses social media (such as facebook) and encourages the members to narrate the good service experiences. The corporate social media policy dictates who can represent the organizations and how to respond to replies from the members. 

Marketing - The policy establishes a formal review process before any publication in the social media. Social media is one of key marketing and communcation strategies which is being increasingly adopted by the insurers and agencies. The corporate social media policy dictates the process keeping in view the various regulatory rules.

Application of augmented reality to Healthcare

Augmented reality has always held the fascination of science fiction writers and found its implementation in many sci-fi novels, comics and movies, though quite a bit of that is reality today. Game consoles like the Sony PlayStation, Nintendo Wii, and Microsoft Xbox have hardware which provides an augmented reality dimension to virtual gaming. Mobile phones come equipped with various augmented reality apps such as Layar and Wikitude that can direct you to your favourite coffee shop or take you on a guided tour an unknown city. Now, with the advent of wearable computing devices, such as the Google Glasses, its usage will become as common as smart phones. Discussed below are some views on how healthcare industry can leverage augmented reality to improve the services.

Continue reading "Application of augmented reality to Healthcare" »

May 22, 2013

Social Media Adoption in Health Insurance Industry - Part 2

The payor organizations are facing major challenges which prevent them from the widescale adoption of  social media. In this blog we will briefly touch upon on some of these key challenges.

• Tagging, Monitoring and Archival of employees' posts in social media - Organizations often lack suitable processes and systems to keep control over tagging, monitoring and archiving the their own employees' postings in social media. The organizations need to block any content that is clearly not as per organization standards. Most often the organizations including payors lack an internal social media policy which is a common challenge faced by all organizations. 

• Controlling  the negative posts from the policyholders and partners - For many payors, it is highly possible their brands are being represented without their involvement and maybe even without their knowledge, much less their participation and guidance. Management of brand and image is crucial for all insurance organizations. Organizations that are not actively managing their image in social media will find their employees and customers misusing it through various social media postings and the perception generated by social media can be negative.

• Handling appropriately  policyholder's feedbacks - Most of online consumers want the organizations to have a social media presence. These are the consumers who are going away from the customary  sources of information, such as advisers and brokers, to seek the online views of fellow consumers on price and product or service performance.

• Complying to regulatory laws in the product advertisement and branding - The laws surrounding social media for the health insurance industry continue to evolve. The management of social media, and the content of the posting and platforms used, have become much more difficult for the insurance organizations today due to evolving and stringent regulatory laws.

April 30, 2013

Social Media Adoption in Health Insurance Industry - Blog 1

Social Media has brought a wide range of opportunities to the Insurance industry for reaching out to consumers with a view to improve performance in the areas of Marketing, Sales, Knowledge Dissemination, and Recruitment. The traditional ways of conducting business in these areas are now going to be redefined in the era of social media. However, leveraging social media in the business operations requires careful planning and execution as there are quite a few constraints to be overcome.

In this blog and in the next set of blogs, I am going to discuss the challenges and constraints faced by the healthcare payors and the various ways of overcoming those in order to stay competitive in the market.

Social media is gaining the attention of the healthcare payors, insurance agents, brokers, healthcare providers due to its wider accessibility to the healthcare consumers across the world. The social media is one of the fastest means to reach out to consumers and create brand image. This is also one of surest ways to engage the existing members/policyholders and retain them. However, the insurance industry especially the healthcare industry has been a highly regulated industry. Even though more and more payors are adopting social media, still majority of them have been very cautious in their adoption.

I think it is a good way to start the discussion by focusing on the key areas where there is an increasing demand for social media in the health insurance industry.
• Communication and stakeholder engagement : Payor organizations leverage social media to achieve effective communication to its   members, collection of feedback from members , and better collaboration between payors and the members.
• Creating public awareness on the social initiatives of the Organization : To disseminate  industry related  information to its members and educate them on various government regulations
             o New laws enacted by the Government (such as Health care reform laws in the U.S.)
             o Government regulations (e.g HIPAA, CMS regulations)
             o Fundraising event organised by the organization for a social cause
             o Organizational news (such as such as new program launches and enhancements)
• Brand and Image building
• Creating various social forums where public can participate and give feedback
• Social Media Campaign - In the last few years, Centers for Disease Control and Prevention (CDC) in the  U.S.  has developed a number of integrated social media campaigns, including campaigns for the novel H1N1 flu event, the Salmonella Typhimurium outbreak associated with peanut butter and peanut-containing products , as well as seasonal influenza vaccination campaigns. Each campaign integrates innovative social media products with research-driven strategies to ensure that CDC protects and promotes the health of diverse audiences.

March 31, 2013

Applications of Big Data in Healthcare - Part 5

With the introduction of health insurance exchanges, guaranteed issue will bring 35 million (approx.) new customers into the U.S. healthcare marketplace by 2016. It is highly likely most of them will have higher than average medical costs, thereby raising premiums for everyone in the insurance pool.  The onus will be on the individual members to take the ownership of their own healthcare expenditure and support the payors in controlling the rising premium. 
We will focus in this blog how the payors can involve the members more by introducing member centric programs in the plan design and how big data will be leveraged to provide the required intelligence to the payors to achieve it.

The member wellness and preventive care program is already a key focus area for the payors.  However, these programs need to be customized for the specific needs of the members rather than being offered as a generic program. In my point of view, following could be reasons why this is not very effective yet.
• The wellness and preventive programs are generic which might not suit to the needs of the members.
• The members who need specific programs often do not find those being offered by the payors or do not get the required incentives or mandates from the payors for adequate usage.
• The patients are often not knowledgeable on the needs of the wellness program so as to take it seriously.

If we analyze the problem critically, it can very well be inferred that payors usually lack the intelligence (information perspective) which will enable them to customize the wellness program for a member. With the help of Big Data analytics, the data, already available in abundance from multiple sources, can be analyzed to get the information on the risk exposure of an individual to certain diseases (current or in future). Utilizing this information, the payors can come up with the following.
• Design the wellness and preventive programs for a member.
• Come up with the incentive or penalty structure to encourage the member to take up these programs seriously.
• Continually educate members on the diseases and on the availability of the required preventive programs.

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