"Patient engagement" is a popular term currently, but the practice of providing consumers with relevant data about the clinical and financial aspects of their care is still in its infancy. Health Data Management talked with Doug Ghertner, CEO of Nashville-based engagement and education platform vendor Change Healthcare, about what the industry needs to do to tie users, providers, and payers together on applications everybody can understand and make use of.

If the statistics behind the firm's growth are any indication, it would appear employers and health plans are more than ready to provide such platforms to their consumers. Ghertner says Change Healthcare started 2013 with 200,000 users on the company's Software-as-a-Service platform; by year's end there were 5.5 million, and by early June, 2014, 7.7 million.

HDM: In a recent blog post on your site, you mentioned that consumers are finally getting ready to be more involved in coordinating their care, yet at this point, overall, really useful and friendly efforts to engage the consumer seem to be lagging. What have been the historic failings of healthcare marketing to the end user?

DG: We work with large self-insured employers and health plans. While they are all equally frustrated that their healthcare costs are increasing, they are as frustrated, if not more, that they invest in disease management, wellness, or advocacy incentives and can't get the consumer, the patient, to engage in those offerings. It's a function of two things. It's a function of education and awareness, and it's a function of a lack of personalization of the experience.

On the former, for example, George Loewenstein at Carnegie Mellon University published a paper last September in the Journal of Health Economics. He surveyed people on four very basic terms--co-pay, co-insurance, deductible and out of pocket max. He found that only 14 percent of people adequately understood what those terms meant. Yet those are the very dimensions on which they are making very important purchasing decisions about healthcare.

Blue Cross of Minnesota is one of our clients. They rolled out our interactive Healthcare University not just to their ASO employer customers, but to their own employees--and out of 3,500 employees, 40 percent accessed the platform. They watched 9,000 videos, played over 19,000 games, and took 7,500 quizzes on what you and I would argue is some of the most mundane content out there. But it told us the consumer does have an interest in this stuff. We have to find a better way to deliver it. We used game mechanics, unlocking strategies, and badges and leaderboards. We created that social dynamic, and while it may seem less than bleeding-edge progressive, which is where everybody in any industry other than healthcare is, it was progressive for healthcare. It's that type of lens we all need to take if we want people to engage.

The other is lack of personalization. There is so much media coverage today around CMS releasing chargemaster data from hospitals. There is all kinds of information about all-payer claims databases that states are creating. But much of that data isn't relevant to the individual consumer--if that database is compiled from Aetna, Cigna and United claims, but you have Blue Cross insurance, that isn't relevant. If that data will tell you total cost, but not what you're paying versus what the plan sponsor pays based on your plan design, it's not terribly relevant. The other piece of the puzzle is that very few people, irrespective of benefits design, take the initiative to seek out cost savings in healthcare. In fact, Catalyst for Payment Reform put out a paper in which they found 95 percent of plans have a transparency tool, yet less than 2 percent of their members use them. So that was the opportunity we saw to change and impact.

HDM: Historically, the way people end up choosing a doctor or a hospital has often defied conventional marketing methods. They are referred by a friend, or they are limited by their insurance plan to certain providers, for example. How hard is it to create a rational incentive tool in a market that has often defied rationality?

DG: We talked about the fact people don't take the initiative to seek out cost savings in healthcare. We built a set of proactive alerts that were constantly crawling through someone's claims data. We're looking at their utilization of common and recurring services and we're shopping on their behalf--identifying others in their network who have purchased the same service but paid less. We're not only looking at savings opportunities, but also your claims and demographic information, and at your user preferences, like how far you are willing to travel to save, and the level of savings that serves as the threshold of when you'd like to be notified, or if you want to be notified by text instead of email. The ability to obtain those preferences is really important to ensure the information you provide them is not only personalized, but that it is also timely, relevant, and specific.

HDM: There is a large community of people who are very active, and who document their activity. Avid runners and cyclists, for example, are often obsessive about logging how much they've run or ridden, yet there seem to be very few, if any, relationships between healthcare organizations and the developers of these platforms. However, Apple and Google are both announcing platforms that will enable people to connect their wellness data via their mobile devices. Do you see a role for Change Healthcare in entering that niche, to get data any other than the basic consumer data?

DG: I think there's a huge opportunity, generally. It is going to create a much fuller picture of individuals and the habits they exhibit, and provide some of the underlying data from a very user-friendly convenient utility. I think it's very exciting. We don't do anything in that realm today, but that doesn't mean there aren't going to be opportunities in the future.

One of the things we've seen is that our employers have said to us, "Not everything we want to promote is common and recurring, or financial in nature--how can you help us with other things and leverage the relationship you're built?" So we've just launched a whole new set of products called Targeted Engagement Alerts that do focus on the preventive and wellness initiatives. That to us is the bigger opportunity: How do you do a better job of building a relationship with the consumer in a very tangible dimension, and then, using that as a jumping off point, engage them across other areas of their benefits?

HDM: Is it hard for you to strategize your company's future moves when healthcare data exchange lags so badly behind others industries? There are silos and firewalls between consumers' providers, and between their providers and payers.  Does it make it harder for you to plan when you have to deal with all these incompatible technologies, and also a prevailing mindset where the consumer is not at the center of the perspective?

DG: That disaggregation or panoply of unintegrated services makes it very complex for the consumer. Part of our view is how to bring that together into one user experience, called the Transparency Messenger Platform. I think that's part of the value our clients see in us. For example, we have an employer client in New Jersey, covering 40,000 lives. They have a telemedicine provider, and an HSA administrator. They have multiple health plans and carve out pharmacy benefit. If you're an employee of that company, if you log into our platform, you can see your HSA balance, you don’t have to go to the HSA administrator. If you do a search for an office visit, we'll show you all the different providers in your community, but also, for the services that are relevant, we'll show you the telemed provider in the search result.

HDM: Has the need for efficient data interchange made the way HIPAA has been written and enforced obsolete? How much control should people have over their own data versus the entities that serve them?

DG: HIPAA is well-intentioned. Data privacy is of paramount importance. I do think often times, whenever we put regulations in place that are designed to solve for every edge case, we put something in place that becomes incompatible with reality. But HIPAA is an incredibly relevant thing we deal with. One thing we noticed: The female spouse is the primary decision maker about healthcare in most families. And one of the challenges we had was the primary beneficiary might be a male who wants his spouse to be able to get the emails we send out to manage their care. It used to be somebody had to download a PDF, fill out the authorization firm, mail it to the HR team, and the HR team had to update the eligibility file. There was very little pull-through. We built a really neat electronic utility where you can see on a de-identified basis the savings opportunities your dependents have. We have an electronic utility where you can solicit permission from your spouse to be able to view her savings opportunities. The efficiency of that process goes up significantly because now it is a digital process. We have created a mechanism that eliminates that friction point.

HDM: In general, stated costs in chargemasters often don't come close to matching real-world prices. What would have to happen on a regulatory basis or through the way markets open up to make your job at Change Healthcare easier to provide the best, most accurate information, and make it easier for consumers to understand?

DG: Availability of the underlying data is critical, first and foremost. The steps CMS is taking to make data available is a step in the right direction, but it has to be specific to the consumer. And if we've learned anything in seven years, cost is not the only dimension on which people make a decision--it is very much value based. Quality data matters. Convenience data matters. The consumer needs better outcomes data, and then we have to find a way to deliver that data in a format or manner they will understand. I think if that happens, we will make a lot of progress. And you have to be proactive in taking the information to the user instead of expecting them to seek it on their own.

HDM: On a platform like yours, how can you quantify the difference between different clinical techniques, such as robotic versus traditional surgical methods? Or is that something the patient has to find out on their own during the process of evaluating providers?

DG: On the facilities side, there is pretty good quality data out there. We pull in data from AHRQ, from the Joint Commission, from CMS--we can get god data there. On the individual physician side of things, outcomes data is definitely tougher to get your hands on. That's where the market has an opportunity for improvement, and I think it will be really important. The way our tool is constructed, you are going to see a provider who specializes in traditional methods of surgery, say, because that sort of procedure is likely lower cost than a robot. Our primary sort typically is cost. 

HDM: Will your tool roll consumer reviews of physicians in? 

DG: Today we do take in and provide a whole host of patient review information. But we learned that, while a review from some unknown person may be of interest, what's more relevant are reviews and opinions from your peers. So one thing we're excited about is creating a peer-to-peer review capability, where you can solicit your network of friends, coworkers, family, and  Facebook friends--"Hey, I'm thinking of going to Dr. Smith--has anybody ever had any experience with him?" And the responses you get will be from people you know and trust. We think that's the next forefront of that kind of thing. That element will be functional probably early next year.

(Editor's note: this interview was edited for length and clarity)

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