Patient engagement has been a struggle for the healthcare industry, as it moves to value-based care approaches from a fee-for-service focus.

Previous reimbursement models left consumers with little reason to get involved with providers until they got sick—then, insurance companies paid their bills. For providers, there was little point to building relationships with patients and working with them to optimize health—there was no money in that, when revenue was based on treating sick patients.

Now, patients carry high deductibles, and providers are taking on more risk in caring for populations. While these incentives for engagement are growing, it’s still a struggle, and providers are only in the early stages of determining how information technology can facilitate engagement.

Constance Sjoquist

Technology can play an important part in engagement, believes Constance Sjoquist, research director for the Healthcare Payer Industry Segment at Gartner Inc. and co-author of a new report, “Leveraging IT for Effective Healthcare Consumer, Member and Patient Engagement Primer for 2016.” She recently spoke with HDM contributor Bob Violino about the CIO’s role in emerging engagement approaches. This is an edited version of that interview.

What was the primary reason for doing the research?
Healthcare payer and provider CIOs are challenged to catch up to other industries, such as retail and banking, which have adopted technologies that are responsive to the particular interests and needs of individuals.

Payers and providers are increasingly being disintermediated from their members by disruptive consumer healthcare technologies such as FitBits and a plethora of mobile health apps and devices. Consumers now expect their health plan to provide tools and information to simplify the process of selecting, managing and paying for their healthcare.

Consumers also want information and decision tools to help them understand their health status and treatment options, including which providers have the best health outcomes, and what the out-of-pocket costs will be.

The majority of payer and provider CIOs are still running their administrative operations on legacy mainframe applications. In addition, they lack many of the necessary IT resources to identify and manage newer technology solutions. To remain relevant, payer and provider CIOs need to understand the strategies and technologies that will enable them to support the transformation to consumerism in healthcare. This research is intended as a primer that covers all these areas.

What did you find out when you asked which technology-enabled consumer/member/patient engagement strategies can healthcare payer and provider CIOs leverage to improve satisfaction, lower the cost of care and improve healthcare quality?
To meet the growing expectations of consumers, payers and providers need to adopt technologies that can personalize information, support real-time decision-making, and inter-operate with one another, as well as with a growing ecosystem of partners, and even non-healthcare entities.

One key strategy when looking at newer technologies is the ability to move into real time response. If a payer and a provider are managing a given population in a shared risk arrangement, they need to know what conditions their members are dealing with, whether they are being taken care of in a timely fashion, any improvements in health conditions, and whether they can pay for the services they are receiving.

To be successful, payers and providers need visibility of member data in real time, and the information needs to be accurate. Imagine the improvements in care and cost that can occur if members are participating in the decisions and the management of their care. Through real-time engagement technologies such as Web portals, mobile apps and wearable monitors, members, providers and payers can collect and share data, and communicate and coordinate health decisions in real-time and drive toward better healthcare and lower costs.

What technologies, vendors and solution architectures can enable healthcare payers and providers to realize the benefits of their consumer engagement strategies? What did you discover?
Payers and providers need technologies that are designed to support and leverage consumer-facing smart technologies, such as mobile phones and wearable devices. It’s critical that these devices be coordinated with other IT components, such as member portals, payment technologies, decision tools and engagement and support systems. Consumer engagement “hubs” should sit at the center of these technologies and provide customer service representatives with a dashboard of member information—their health status, needs, and how they prefer to be engaged and supported. And Web portals can provide shared access and point-of-service, bringing to bear transparency and real-time data.

How should healthcare CIOs go about implementing these strategies and architectures?
They can’t do everything right away. Gartner recommends a Pace-Layered Application Strategy, which is a methodology for categorizing, selecting, managing and governing applications to support business change and innovation. CIOs should look at all the applications in the business and understand which are systems of record that are needed to run the business, which are needed to distinguish them from their competitors, and which will enable them to innovate and transform their business model.

Then, they should adopt a bi-modal strategy for IT. Mode 1 would be responsible for running the parts of the business that require consistency, are highly process-oriented and predictable, and have less appetite for risk or change. Mode 2 would support people, processes and technologies that are transformative, are early adopters and often running in “pilot” mode. Mode 2 has an opportunity to be more risk oriented, and move faster and be more agile, to help the organization transform.

Most importantly, they should look through the lens of the consumer in prioritizing the strategies and technologies required to provide effective consumer, member and patient engagement in healthcare.

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