For more than two years now, the focus of healthcare conversation has been on how the provider community will ensure “meaningful use” of electronic medical records. Meanwhile, proof points exist for ways that the same data is being made meaningful to the other key players in the cost-utilization-quality conundrum that defines U.S. healthcare.
Supported by behavioral change theory, health and wellness programs are successfully deploying technology that brings actionable data to member participants, ensuring that they are maximally engaged and making smart decisions to improve their own health and ultimately wring costs out of the system overall.
The first step is not just gaining access to the right data, but collecting and responding to it in real time. In the past, many insurers outsourced their disease management and wellness programs, creating delay or outright gaps in their data collection.
Today, healthcare payers are optimizing their proximity to healthcare information and intelligently sharing that information to gain real advancements in their care management programs. Using the native system-integration capabilities of advanced business process management (BPM) software these organizations gather and process billions of bits of data about the health status of individuals daily, allowing some of them to assert they now have the broadest view of healthcare data in the U.S.
Adaptive analytics and real-time decision-making leverage the data, such as claims detail, lab values, home-based bio-metric input and responses to health risk assessments (which are done via the software’s multiple communication channels), and blend it with rules-based clinical protocols to determine appropriate care plans, global notification activities and best next-actions or process steps, all within the blink of an eye.
Driving personalized data
Next, in order to make the data actionable for individuals and also drive maximum participant engagement, health and wellness leaders have embraced today’s high-tech, consumer-driven culture to drive personalized information, messages and advice across the plethora of interaction devices used pervasively across geographies and throughout society today.
Smart care management portals, with their continuously updated longitudinal medical records, provide personalized disease-specific content across the patient support network, enabling the immediate and responsive assessment and management of an individual’s health. For example, a “Young Adult” signing on to his health portal would find health incentive programs specifically sponsored by his employer plus suggestions for the top local health clubs catering to the “Under 30” crowd.
Determining that he’s also asthmatic, the BPM portal also displays appropriate wellness content, plus proactively suggests that he enroll in the relevant disease management program where dynamic branching logic will guide him deftly through assessment and on-boarding steps, ensuring an enhanced experience that will maximize data capture and produce a valid enrolment.
Technologically savvy healthcare organizations are using BPM specialization tools for other forms of mass customization.
Portal navigation and user GUIs are also being dynamically and automatically personalized for the participant, driving greater value to the overall service experience.
For instance, a Hispanic Medicare member getting notification from her health plan about gaps in treatment such as missing a scheduled blood draw will get Spanish texts on her mobile device – and her health portal will be displayed in larger, CMS-mandated font size. Seamless and consistent multi-channel communication deployed strategically via BPM over iPads, mobile devices, fax, phone and web helps bring a personal touch to customer interactions, fostering loyalty, improving retention and optimizing engagement so individuals are empowered to make smarter healthcare decisions.
Healthcare organizations using advanced BPM for care management are seeing significant results from their personalized approach including increased participant engagement and improved health outcomes. Beyond consistent and customized interactions, these healthcare forerunners are also now able to streamline service.
Intelligent process management provided by the BPM technology efficiently orchestrates all of the people, processes, data and systems required to complete health and wellness activities and a full range of care management tasks including assessments, authorizations, program development and member enrolment. These organizations report massive speed and productivity improvements that meaningfully impact individual participants.
One company improved five-fold in employer group set-up time for multi-touch, multi-disease wellness programs. Another company raised participant engagement by improving the enrolment experience – reducing cycle time by 75 percent.
Getting complex
Of course, these healthcare organizations do not work in a vacuum. In fact, the radical changes taking place in healthcare today are driving business complexity by bringing on new organizations or changing roles of existing organizations across the healthcare ecosystem.
Already on the horizon are mandated State Health Exchanges and new service delivery mechanisms such
as Accountable Care Organizations and Patient-Centered Homes.
The BPM technology deployed today by numerous healthcare frontrunners to maximize participant engagement and health improvement activity is ideally suited for connecting people, data and systems across disparate organizations, orchestrating processes to achieve mutual goals. These health and wellness leaders are a shining beacon for the entire healthcare community, which is moving closer together to work on improving health outcomes and reducing costs for us collectively, by providing care, treatment and support at the individual level.
Elizabeth Hart, principal for Healthcare Industry Solutions, Payer Market, has been with Pegasystems for more than nine years overseeing its healthcare payer strategy. Before joining Pegasystems, Hart ran Medicare programs at Harvard Pilgrim Healthcare in Massachusetts.
