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Payers Get Personal With Online Records
Health Data Management Magazine, February 2007
Meanwhile, some of the nation's largest self-insured employers, including Wal-Mart, Intel Corp., Pitney Bowes and BP America are pushing PHRs too.
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PHRs = better health awareness
Managed care plans and self-insured employers hope that as more consumers rely on PHRs, they will be more likely to get tests done on time, follow up on disease prevention, get their children immunized and take other steps that will keep them healthier. Ultimately, that could lead to fewer cases of serious illnesses, fewer hospitalizations and lower costs. And if that happens, insurers might see bigger profits and consumers might see lower premiums.
Simply put, a personal health record is a patient's view of their medical record. It's different than the "official" electronic medical record because the patient can add or remove information from it and can control who views the information.
A wide variety of PHRs are available, including some created entirely by patients. But managed care plans pushing PHRs are building them by posting medical claims data, pharmacy benefits information and lab results from multiple sources to an online record that members can access.
Members can then add a medical history, take a health risk assessment and find information about their specific health conditions. In most cases, payers are enabling their members to share the PHR with their physicians.
Managed care plans believe they are in a perfect position to offer PHRs because they gather information from multiple providers. In contrast, a primary care physician's electronic medical record for a patient might not include the medication records from a specialist who also is treating the patient.
"PHRs can help connect a fragmented health care system," says Archelle Georgiou, M.D., executive vice president of strategic relations at UnitedHealth Group, Minnetonka, Minn. "People see multiple doctors from multiple offices and have multiple medications, and the PHR enables that information to be housed in one single place."
During the two years or so that major payers have been offering PHRs, the biggest challenge they've faced is persuading their members to use them. Some doctors have proven reluctant to get on the bandwagon as well.
Managed care companies want patients to check health records the same way they might check their bank account. But so far, the rate of adoption has been somewhat disappointing, prompting a few payers to offer cash incentives to members who sign up.
Privacy is paramount
Perhaps the No. 1 concern that consumers have expressed, payers say, is whether sensitive medical information that's accessible online will remain truly private. To help address that issue, payers are enabling members to limit who can see the information and what data is populated in the record.
In addition, some physicians and others have expressed serious concerns that PHRs may do more harm than good.
Because many payer-initiated PHRs offer consumers the option of hiding certain information from physicians, this could lead to a misdiagnosis or harmful drug interactions, some opponents contend. Some physicians also point out that the information gleaned from claims may not accurately reflect all the complex details of a clinical diagnosis.
As a result of the slow adoption rate, the jury's still out on whether PHRs will achieve payers' cost-cutting goals.
So far, the rate of PHR adoption has been higher among those enrolled in consumer-driven health plans, high-deductible insurance plans in which the member is responsible for much of the upfront costs.
Because enrollees in these plans are accountable for more of the cost, the PHR acts as a starting point for them to access information and find out how they can save money and manage their health. Enrollees can access a PHR linked to their health savings accounts, which the member and employer fund to pay for the initial health care costs.
Although most consumers want to have easy access to their medical records, they have apprehension about having sensitive data online, according to a recent national survey.
Ninety-six percent of Americans say it's important for individuals to be able to access all of their medical records to manage their health, according to the survey of consumers sponsored by the Markle Foundation, a New York-based organization focused on accelerating the use of technology in health care and national security.
Also, 97% of those surveyed say it's important for their doctors to be able to access all of their medical records to provide the best care.
"The survey shows that consumers want access to medical information to make sure it's accurate, to improve doctor-patient communication and to prevent the duplication of information," says Zoë Baird, president of the Markle Foundation.
Verifying vaccines
But consumers have many other good reasons for improving their access to information, says Lynne Dunbrack, program director for health payer research at IDC Corp., a Framingham, Mass.-based research and consulting firm. For example, parents want PHRs for their children so they can check vaccines and other information at any time.
Also, many aging baby boomers want to keep track of their health conditions online. "There are more consumers with multiple chronic conditions, and you have to manage them and have one place where all that information is located," Dunbrack says.
In the Markle survey, 90% of respondents said a PHR would be important to track symptoms or for help with disease management. Also, 83% of parents would be interested in using a PHR to check on their child's health, such as tracking dates for immunizations.
But only 65% of those surveyed would like to access all of their own medical information across an electronic network. Concerns about identity theft or fraud are high, with 80% of those surveyed concerned about these issues. Seventy-seven percent of consumers are also worried about their medical information being used for marketing purposes.
Consumers have other anxieties as well, Dunbrack says. "Do you want to tip off your health plan that you have a history of cancer in your family? Then they might be leery of having you as a member," she says.
Payers are keenly aware that security and privacy are concerns and want members to feel safe using the online records, "Only 7% of people in the U.S. use PHRs despite the fact that they're broadly available," Georgiou says. "About half of those non-users don't use them because they are concerned about privacy and security, and the other half don't know they exist. Unless the consumer feels safe they won't use it."
UnitedHealth combats the security issue by building in security and offering members control over who sees the data in the record, Georgiou says. Members can send their physician messages that would enable doctors to see the information stored in the PHR, but the member also can limit access to that data as well.
"The member can choose to allow certain people to see certain information or nobody to see the information in the record," she says.
PHRs have been available to all of UnitedHealth's 20 million members for about two years, but only 5% to 7% of them are using them so far, Georgiou says. Ninety percent of the information in these PHRs is from claims information.
When a UnitedHealth member logs into a PHR, they see a summary of their medical history, including existing and prior conditions, surgeries, hospitalizations, X-ray reports and medications that were filled. They can add self-reported information, such as family history, and other information such as a list of herbal supplements they take or a flu shot they received at work.
UnitedHealth has seen greater adoption of PHRs among those enrolled in consumer-driven health plans.
Enabling better choices
Members covered by consumer-driven health plans are responsible for making more of their own health care decisions, which, over the long haul, should be a motivator for them to use PHRs, Georgiou says. "It's important for them to have PHRs to offer them more information to make better decisions," she says.
For example, if a patient is seeing a doctor for the first time and the physician wants to order a round of tests that the patient knows already was performed by another provider, the patient can show the doctor those results through the PHR, Georgiou says.
UnitedHealth enables the physicians to access the PHR by swiping the magnetic stripe on the back of the membership card through a reader attached to a computer, Georgiou says. The ID card acts as a key and opens up a Web page containing the PHR. Swiping the card also confirms eligibility and enables the member to make a payment through the HSA or a credit card account.
UnitedHealth has also integrated the PHR with its health risk assessments, Georgiou says. After completing the online evaluation, that information is automatically populated into the appropriate areas of the PHR.
Another challenge with the PHR is making sure the member can understand the information in the record. To simplify the information, one payer, Indianapolis-based WellPoint Inc., is taking steps to offer consumers more than just a list of CPT codes and long names for conditions and tests.
For example, cholesterol test lab values are displayed with arrows and in different colors depending on whether the results are high or low, explains Lisa Mast, director of 360 Degree Health, WellPoint's care management system.
Members also can access more information on particular conditions or a diagnosis by clicking on links in the record.
WellPoint's PHR is slightly different from other payer efforts because patients can elect to exclude all claims data in the interest of privacy, Mast says.
All of WellPoint's members have a PHR, but not all have accessed them or chosen to load claims data. But so far, 40,000 members have opted to load claims data.
WellPoint also offers online messaging, similar to e-mail, to PHR users. "We can remind them to get flu vaccines or mammograms," Mast says. The payer soon will enable physicians to send messages through the PHR as well, Mast says.
Hartford, Conn.-based Aetna Inc. also is offering messaging tailored to the conditions a member has or is at risk for having, says Lonny Reisman, M.D., CEO at New York-based ActiveHealth Management Inc. The PHR company is a wholly-owned subsidiary of Aetna. Reisman says 13 million consumers are using the CareEngine, some of which are Aetna customers.
The PHR contains all the members' medical claims data and information from their health risk assessment. This data is then analyzed by the company's CareEngine decision-support system so that recommendations can be made to the member and their doctor.
"We send specific alerts to the doctor and member around certain conditions," Reisman says. "We can also identify risks at the patient level and see where it can be mitigated."
But even with extra benefits, like messaging, getting members to sign up for PHRs is proving challenging. That's why some managed care plans are offering cash incentives of $50 to $100, Reisman says.
This approach is similar to the incentives some payers already were offering for those who fill out a health risk assessment or take part in wellness programs, such as smoking cessation or weight loss programs.
Physician acceptance
For some managed care plans, getting physicians to jump on the PHR bandwagon is proving to be as big a challenge as enticing consumers, says IDC's Dunbrack.
"Physicians are leery of recognizing billing data as a description of clinical data," she says. "They tend to disparage payer PHRs because they might not accurately describe what's happening."
Dunbrack suggests that payers use tools that validate the claims data before populating it into the record.
Some physicians are reluctant to use a PHR because it may not be a complete view of a patient's medical history because the patient has the ability to hide certain information. This lack of information could lead to inaccurate diagnosis, some doctors fear.
Sidebar
Grants Support New Functions for PHRs
The Robert Wood Johnson Foundation, Princeton, N.J., is funding research efforts designed to expand the functions of personal health records so they can be more useful to consumers.
"We want PHR applications that focus around the needs of the consumer," says Stephen Downs, senior program officer and deputy director of the health group at the foundation. "We want to show PHRs can improve daily life and improve health in practical ways."
The foundation has awarded grants to eight multidisciplinary teams that will design new applications that can be built into a PHR.
The teams, selected from a pool of 165 applicants, will receive 18-month grants of $300,000 each. Each will spend six months designing specific PHR tools, then a year testing them with target populations.
Program costs are expected to total $4.1 million, of which the California HealthCare Foundation in Oakland contributed $600,000.
Patricia Flatley Brennan R.N., professor of nursing and industrial engineering at the University of Wisconsin-Madison, will serve as project director. Each of the research teams will work with a specialist in the ethical, legal and social implications of health information technology and personal data sharing. Kenneth Goodman, founder and director of the bioethics program at the University of Miami, will consult with the teams under a separate $149,000 grant.
The recipients selected for Project HealthDesign are:
* George Ferguson, research scientist in the department of computer science at the University of Rochester (N.Y.). His team will design a tool to assist patients diagnosed with congestive heart failure and heart disease in self-managing their condition at home.
* Stephanie Fonda, assistant research investigator at the Joslin Diabetes Center Inc., Boston. Her team will design an application for patients with diabetes that integrates and analyzes data, including nutrition intake, physical activity levels, medications and biometric information collected through personal monitoring, such as blood glucose levels and weight.
* Harold Goldberg, M.D., professor of medicine, University of Washington, Seattle. Researchers will design three related applications for overweight patients to facilitate effective, safe at-home changes in drug therapy in between office visits, and help patients and caregivers monitor blood glucose, blood pressure and exercise data.
* Kevin Johnson, M.D., associate professor, department of biomedical informatics, Vanderbilt University Medical Center, Nashville. His team will design a personal health record system that helps children living with chronic diseases to manage their medication and take a role in their own care process.
* Roger Luckmann, M.D., associate professor, department of family medicine and community health, University of Massachusetts Medical School, Worcester. This team will design an application, running on a PDA, which will interface with an individual's PHR to better meet the treatment and information needs of patients following common pain therapy plans.
* Barbara Leah Massoudi, senior research health scientist, Research Triangle Institute, Atlanta. The team will design tools that help inactive adults who are at risk for or suffering from chronic diseases become more physically active.
* Lisa Nugent, core faculty, graduate media design program, Art Center College of Design, Pasadena, Calif. This project is designed to help adolescents play a more active role in their health care as they move from the pediatric to the adult care systems.
* Stephen Eisenhard Ross, M.D., associate professor, division of general internal medicine, University of Colorado at Denver and Health Sciences Center.
The team will focus on older adults with multiple chronic conditions who undergo care transitions, such as seeing a new doctor or being discharged after a prolonged hospital stay, and how to better empower patients and caregivers.
Sidebar
Employers, Payers Launch Separate PHR Efforts
Employers and health insurers view personal health records as an ideal way to keep consumers better informed about their health care. If consumers have better access to information, they're more likely to seek out appropriate treatment or enroll in wellness programs. And that could help lower costs.
Two separate groups, one representing employers and the other payers, have emerged to offer personal health records to consumers.
America's Health Insurance Plans, the Washington-based trade group for managed care organizations, the Blue Cross and Blue Shield Association, Chicago, and Aetna Inc., Hartford, Conn. have joined forces to identify the information that should be included in PHRs. They're also working to determine which existing standards will enable members to transfer PHR data from one payer to another after a change in coverage.
The groups have set the lofty goal of offering portable PHRs to the 200 million members enrolled in their participating managed care plans by 2008.
On the employer side, Applied Materials Inc., BP America, Intel Corp., Pitney Bowes and Wal-Mart Stores Inc. have launched a PHR initiative called Dossia. The online records will be introduced to employees, dependents and retirees of the companies this spring.
Dossia founders have contracted with Omnimedix Institute, Portland, Ore., to build the PHR infrastructure, which will be a federated database, combing data from multiple sources. Dossia is based on the Common Framework set of design and policy standards from the Connecting for Health advocacy group funded by the Markle Foundation and Robert Wood Johnson Foundation. It will be the first real-world deployment of that framework.
Under this program, a consumer could enter data in the PHR. The record also could include information from physicians, hospitals, pharmacies, laboratories, health insurers and other entities. Dossia also will include other tools to help consumers manage their care. And individuals will be able to download their PHR to a portable computing device.
Dossia founders envisions their PHR as a portable, lifelong tool. It will be designed so consumers can continue to use it if they change doctors, insurance companies or jobs.
Similarly, the payers' initiative aims to create standard PHRs that could be transferred from one health insurer to another if a member switches plans. Core data would include patient histories, medications, immunizations, allergies, risks, plans of care and other information that physicians have identified as important. The PHR would contain information from all of a patient's physicians.
It's not clear if the two efforts will be at odds or work together. Representatives at the Blue Cross Blue Shield Association were reviewing Dossia's plans. Representatives from Dossia were not available for comment.
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