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Health insurance plans have been expanding their use of information technology to address problems, improve operations, facilitate service to members and ensure they’re getting care that addresses their health concerns. Health insurers have long used IT to manage the claims process and settle payments with provider organizations, but as technological capabilities have grown, they’re using IT in ways that they would not have foreseen even a couple years ago. Here, Health Data Management offers some snapshots of innovative uses of IT by payers.
On-demand telehealth app supports new moms
Gateway Health has joined with Pacify Health, a telehealth technology firm, to improve the health and well-being of new mothers and their babies. Pittsburgh-based Gateway, a managed care organization, will initially pilot the use of Pacify Health's telehealth mobile app to 1,000 mothers in four Pennsylvania counties. Along with live video chat, Pacify features regular push notifications, alerts and various educational resources related to prepartum and postpartum well-being. Pacify staff submit chart notes after each call with findings and recommendations. A Pacify membership provides on-demand, video-enabled access to a nationwide network of maternal and pediatric specialists.
Signage is displayed outside the Humana Inc. office building in Louisville, Kentucky, U.S., on Saturday, Nov. 26, 2016. The Justice Department sued in July to block the union of Aetna Inc. and Humana Inc., saying they would reduce the number of large, national health care insurance providers, leading to increased costs for their clients. Photographer: Luke Sharrett/Bloomberg
Humana is collaborating with electronic health records vendor Epic as both entities seek to bring together patients, providers and insurers to advance value-based care. The organizations will integrate technologies, advancing interoperability to promote open communication and information transparency. The goal is to give patients and clinicians real-time access to patients’ medical history, health factors and treatment options with the intent of reducing costs and improving quality and patient satisfaction. This will help patients and the insurer to weigh outcomes with patients’ medication costs and coverage, according to Alan Wheatley, President at Humana’s retail unit.
Optima Health applies AI to ‘rising risk’ pop health
Optima Health and Cardinal Analytx Solutions are entering a partnership to benefit Optima’s members in Virginia in the “rising risk” category. Palo Alto, Calif.-based Cardinal Analytx’s AI-enabled predictive analytics will help Optima proactively address members with health risks that, if left unmonitored and untreated, could move up to the highest risk and highest cost category. Cardinal Analytx combines AI-enabled predictions with an assessment of a member’s clinical impactibility and likelihood of engagement. According to Linda Hand, CEO of Cardinal Analytx, engaging members earlier in a more proactive way enables them to live healthier lives and reduces costs for both individuals and plans.
Golden State Medicare tries analytics to aid med adherence
Golden State Medicare Health Plan will deploy advanced analytics to improve medication adherence and patient outcomes. The Newport Beach, Calif.-based HMO has announced it will use applications developed by AdhereHealth, a healthcare technology solutions company that offers advanced analytics solutions to identify members of the HMO who need support in their medication adherence. Often, these patients are the ones most challenged by social determinants that include poor health literacy and access to care. AdhereHealth uses the analyzed data to mobilize a nationwide network of licensed clinicians to engage directly with the consumer and their doctors to improve adherence.
Passport Health to expand partnership with Evolent
Passport Health Plan, a Medicaid provider based in Louisville, Ky., is expanding a financial and operating partnership with Evolent Health, provider of an integrated value-based care platform that uses advanced data integration, predictive technology and analytics. Evolent will continue to provide management assistance and technical support for Passport’s coverage of more than 300,000 beneficiaries. Under the newly anticipated 10-year agreement, Evolent will add additional clinical program support, network optimization and specialty care management, particularly in the fields of oncology and cardiovascular services.
Analytics help Blues plan, Landmark aid vulnerable members
Filipino care worker John Denmark Pineda assists an elderly resident at Eisei hospital in Tokyo, Japan, on Monday, Dec. 6, 2016. Strict regulations mean that only about 2,600 nurses and caregivers from Southeast Asia are working in Japan. Pineda, now married to a Japanese citizen and aiming to pass the country's notoriously difficult nursing qualification, said that migrant workers should be allowed to play a bigger role. Photographer: Akio Kon/Bloomberg
Blue Shield of California and Landmark, an in-home senior care company, are using data analytics to drive care for the health plan’s most vulnerable population. The results of the analytics initiative are exceeding expectations for the San Francisco-based insurer. At the end of the first year of the partnership with Landmark, BSC reports enrolling 3,500 more eligible members, completing more than 15,500 home visits and making 33,317 phone contacts. Some 92 percent of the BSC participating members are enrolled in a Medicare, MediCal or the Cal MediConnect plan offered by Blue Shield or Blue Shield Promise, with the rest being members of Blue Shield’s commercial health plan.
Idaho Blues' episodes of care program posts savings
IBM has awarded Blue Cross of Idaho the 2019 IBM Watson Health Advantage Award for its use of data analytics to improve outcomes and lower costs in episodes of care. The program has saved Meridian, Idaho-based Blue Cross of Idaho $6.5 million annually at its latest ROI analysis. Blue Cross of Idaho’s three-tiered commercial fee schedule, which uses IBM Health Insights software, reviews the total cost of care for a medical episode and then tiers the physician or clinic on performance. Physicians and clinics then undergo a peer-to-peer comparison to evaluate efficiency across the state. Blue Cross of Idaho processes more than half of its member claims through value-based arrangements.
Geisinger Health Plan sees benefits from HIE participation
Gordon R. Wenzel
Geisinger Health System and its health plan, Geisinger Health Plan, are working together to advance healthcare through the use of the organization’s Keystone Health Information Exchange. Before now, health plans have not thought extensively about the use of HIEs, but that’s changing, say executives at Geisinger. With value-based care growing, the environment is ripe for change, as healthcare providers and organizations across the continuum strive to find ways to improve care while holding costs down. As evidence of this trend, Pennsylvania has indicated it wants to close care gaps for chronic conditions and is encouraging healthcare organizations, including health plans, to participate in HIEs.
UnitedHealthcare using tablets to assess SDoH in Hawaii
UnitedHealthcare will use a new tablet-based screening program to assess social determinants of health needs for its members on the Hawaiian island of Oahu. Funded by a five-year, $4.5 million federal Accountable Health Communities grant, UnitedHealthcare will have its members self-assess their needs on tablets at several clinical sites. UnitedHealthcare is further supporting the program with an additional $6.4 million investment, and patients do not need to be enrolled in a UnitedHealthcare Medicare or Medicaid managed care program to participate. “This award will enable UnitedHealthcare and our clinical partners to identify the needs of some of our most vulnerable residents and connect them to community-based organizations that can help them live healthier lives,” says Katherine Keir, UnitedHealthcare Hawaii state director.
A new Medicare Advantage plan—created by North Carolina’s Blues plan and a major integrated delivery system—will rely heavily on data analytics to focus efforts on treating chronic conditions. Blue Cross and Blue Shield of North Carolina (BCBSNC) and Duke University Health System are forming the new MA plan, called Experience Health. Expected to launch January 1. it will encourage stronger patient-physician relationships through enhanced communication and team-based care, company executives say. The new plan will have improved care coordination, simplify the way members make appointments and handle billing, and how they will access their healthcare providers.
Plan, subsidiary gets virtual ICU services from Mercy
Highmark Health and its subsidiary, Allegheny Health Network, will be adding intensive care telehealth services to the portfolio of services they offer. Highmark, a Pittsburgh-based health plan, and AHN—an integrated healthcare system serving the greater Western Pennsylvania region—will contract with St. Louis-based Mercy Virtual's virtual ICU (vICU) program. Mercy offers vICU in more than 20 states, and it has evidence to suggest that the approach lowers mortality rates by 35 percent and can reduce time spent in the ICU by 30 percent, compared with predicted lengths of stay.
Humana to use analytics to improve care for cancer
Humana is starting a program to improve patient experiences and outcomes in cancer care, offering analytics and other incentives to providers. The Louisville, Ky.-based insurer has set the program in motion, making it the fourth specialty care payment program it has launched, intended to offer support to providers in making the transition to value-based care. The programs enable personalization of care, better access to care, outcomes-based reimbursement to physicians and the ability to leverage technologies, such as analytics, which connect physicians and help them work as a team to coordinate care around the patient.