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.

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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.

Empowered Member
One of the key focus areas for healthcare organizations is chronic care management. As America is aging, the population with multiple chronic conditions in growing.

78% of Medicare beneficiaries have 2 or more chronic conditions & 14% have 6 or more chronic conditions(2)

One of the measures to control healthcare cost is to shift the care setting from expensive hospital-based healthcare to home-based healthcare. Self-management support is vital in enabling individuals with multiple chronic conditions to learn how to manage their overall health and make informed and intuitive decisions about care. It is most effective when patients have access to clinicians who are skilled in accommodating such self management supports. The systems and processes used by such healthcare organizations empower both the patient and caregivers.

Examples of self management tools -
• Online Health Education Materials
• Durable Medical devices like blood pressure cuffs, peak flow meter, etc
• Health Education Videos & Games
• Mobile Apps with health trackers
• Online Communities and Social networks

Telehealth programs have proved cost effective way for actively managed patient conditions in real time by connecting members to healthcare support and management tools from their home. Usage of biometric sensors & wireless communication devices have helped physicians keep track of patient's health conditions. Remote consultation via video conferencing has effectively delivered care to people who are disabled or live in remote areas.

50% of seniors and 57% of boomers are open to using self-monitoring, or remote health monitoring technology, which sends information to doctors(3)

Though there are many innovative ways to implement successful Care management programs, engaging & empowering the member effectively should be the key strategy. Today, we learnt how self-managed and well-connected member is vital to chronic care management.  In my next blog, I will explore some more trends such as advent of personal touch and social media in successful care management programs.

References -
1. Centers for Disease Control and Prevention.  Rising Health Care Costs Are Unsustainable. April 2011
2. Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012.
3. US Consumer Survey of 2012 by Deloitte

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.

Administrative Efficiency - ACOs would need to provide financial incentives to providers for improving quality and performance. There could be huge administrative burden on ACOs to monitor provider's performance & reward appropriately. Apart from the initial set-up cost, there would be ongoing cost for maintaining quality metrics, calculating healthcare costs, tracking patient-provider interactions, reporting clinical outcomes, etc.
ACOs should implement optimal processes & systems and avoid the additional administrative cost from overshadowing the cost savings.
 
Physician Habits - Physicians will need to change their approach in providing care. They will have to change their prescribing pattern from "best possible" or "most desirable" to "most effective" and "most appropriate". They would need to rely on evidence based guidelines and not on their own judgment or patient preferences. They would need to adapt to moving care delivery from hospitals to lower cost care settings.
ACOs would need to motivate & educate physicians to change their prescribing patterns and habits. Changing mindset may take time, but it is necessary.

Patient Behaviors - Most of the healthcare plans (like PPO, POS) have given significant freedom and choice to patients. They can obtain services from several disconnected providers. The fragmented care due to patient's choice has led to excessive utilization and poor outcomes.
ACOs and Insurers would need to educate and steer the patients toward most cost effective & high quality providers.

Accountability - In an ACO, everyone is accountable for care, especially physicians. Physicians recognize that the health outcome is partially under patient's control, so they can be reluctant to assume accountability. If the ACO's incentive program is not clearly outlined, it may not motivate the physicians to improve quality and performance.

It is essential for ACOs to have a well defined & transparent incentive program. Also, physicians should educate the patients on self management, and build a trustworthy relationship.

There are definitely more challenges and I may have over simplified them. But, I hope that ACOs are well-prepared to handle these challenges and risks, and will be successful.

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