Enabling Healthy Decisions

Both Rob Webb (CEO of OptumHealth Care Solutions) and Chad Wilkins (CEO of OptumHealth Financial Services) were presenting at the WHCC in DC and were able to sit down with me for an hour to talk about their business.

Let’s start with some of the basics:

• OptumHealth is part of United Health Group.
• OptumHealth Care Solutions provides consumer advocacy, wellness, health care decision support, disease management, case management, health information portals, and specialized networks.
• OptumHealth Financial Solutions is a health care financial services provider which provides consumer health accounts (HSAs, FSAs, HRAs), benefits administration, and debit cards (among other things).

In preparing to write up my notes from the interview, I retrospectively read the press packet. My one takeaway is that most of the programs here (e.g., dental or incentives) are not what you typically think of when you think of UHG. They second caveat I will add is that we jumped around a bit as I was interested in learning about lots of little things versus creating one big story.

I began by asking them what they thought about using flat dollar copays on drugs versus percentage dollar copays. [Dr. Gupta from CNN had done a report that morning around how patients should look for health plans with flat dollar copays. And, the WSJ had earlier in the week had a story about how percentage copays on specialty drugs disadvantage the sick.] I think their response (rather than no comment) was appropriate in saying that:

• In general, simpler plan design eases adoption which I take to mean drives the intended behaviors. (and I know it reduces calls)
• Using a percentage copayment brings the condition into play. (I completely agree)

We moved on to my favorite topic – communicating with patients. We talked about how socio-economic conditions play into prevalence of conditions and phases of change in terms of messaging. Rather than being big believers in the Pro-Change model, they talked about focusing on “how compelling is the case for change”. They focus on delivering a message that says something like “we have something for you to consider” and including some data to reinforce that suggestion. I will have to follow-up with them to get the data, but we then spent some time talking about using inductive call logic versus deductive call logic.

I can’t talk about communications without talking about messaging channels so we addressed that next. I specifically asked them what if anything they had done on the SMS / text messaging front. Although I am generally a skeptic about text messaging in healthcare for things that require lots of PHI (protected healthcare information), I do think there is a role for some wellness type activities like smoking cessation and weight loss. There has also been a study done over in Scandinavia that had positive results (although the cell phone culture there is more like Japan than the US). They mentioned two things:

• They added a second phone option for cell phones several years ago.
• They recently added an “opt-in” type of field for patients to say they were willing to accept text messages. (Since some people still get charged per message, this is important.)

After that, we spent a few minutes talking specifically about each of their businesses. First, Chad talked about the Financial Services business giving me some of the history. We then talked about their scope of services. A couple of interesting takeaways were:

• They are able to take the card data and integrate it into their PHR. (Which I think every PHR should do.)
• 27% of the people with HSA plans used to be uninsured. This is a very interesting fact.
• Since it was Earth Day, their PR person pointed out the amount of paper they save per year by moving all these things to electronic.
• He talked about linking accounts, cards, and incentives.
• We also spoke about the impact that the economy would have on the business. He pointed out that at $1 to print a check, $30 to talk with a provider, and $5 to re-process a check that the current downward trend in the economy would likely drive cost-focused programs.

Next, I talked with Rob specifically around Care Solutions. A few of my takeaways here were:

• They focus on trying to identify why a patient has (or could have) a gap in care and solve the problem systemically (what I would call quality at the source) versus how he positions their competitors as focusing on the gap in care.
• Since United Health Group is the biggest buyer of their services, he believes they bring a healthy skepticism to the table in terms of evaluating program outcomes and ROI.
• I asked him about their predictive engine which I know companies like ActiveHealth have. He talked about the fact that they have a similar model, but that ActiveHealth has done a great job of bringing back the appeal of the predictive engine. And, he talked about their interest in pursuing a low-cost model for intervention using letters at $1.50 per intervention. [It was hard for me not to point out here that for similar or less cost we could probably get them a much higher response rate and ROI using our personalization engine and automated outbound call technology at Silverlink.]

Overall, I found it a very interesting conversation about two areas of United Health Group that aren’t always the first thing consumers think of. I am sure our interactions with them are more that each of us think given their market prevalence.

It’s amazing to me that a company that hasn’t launched yet has been at two conferences with standing room only (in the hallway), but that is the story for American Well. At both Health 2.0 and at the WHCC 2008, the crowds packed in to hear Dr. Roy Schoenberg (CEO and founder) speak. Fortunately, I had scheduled a meeting with him offline so I got to spend an hour talking with him about what they are up to.

So…who are they:

• “American Well has created a new healthcare marketplace where consumers and physicians can come together online to acquire and provide convenient and immediate healthcare services. Using the latest technologies in Web communications and digital telephony, American Well extends traditional healthcare services to the home setting.”
• Roy is a physician who previously founded CareKey which was sold to Trizetto.
• Their solution (launching at the AHIP conference later this year) plans to create a win-win-win for patients, providers, and payers:
  • Patients get a convenient, easy to use solution for anytime access to physicians. (Depending on the payer model, they may get a lower copay.)
  • Providers get a new revenue stream, access to new patients, and an opportunity for a new business model without traditional limitations and costs (i.e., space, office staff).
  • Payers get a new service to offer patients which should avoid urgent care and emergency room visits ultimately saving them money.

Some of the basic questions (coming from a blend of the press kit and our conversation):

• Don’t we already have this? Most services today are e-visits which are asynchronous (not live or interactive) while these are live visits.
• Will this be covered by my insurance? Yes. Payers are their clients.
• How will this compare with the retail clinics? It has the same concept of convenient, no-appointment care, but it is in your home and it is provided by physicians. Additionally, the patient has the option to choose the attributes of the physician they want and evaluate the experience.
• Will the patient or the physician be required to have certain hardware (e.g., web camera)? No. This can be done with a web camera or just over the Internet or just over the phone.
• Is the physician flying blind (i.e., having no data about the patient)? No. The idea of working with the payers is that they can have access to claims information about the patient. [This is a big step from other ideas I have seen. We talked about batch access and real-time access to the data which they apparently have both options.]

Roy is a very engaging and comfortable CEO. You can tell that he feels passionate about the idea and has been here before. He talked about being disruptive to the system but the importance of disrupting one area not the entire system with your solution. [This is a good point that I have never heard someone stress before.] Listening to him talk about working with the payers and comparing this to different models made me realize: (1) they basically have created a solution where the payers are their recruiter (for MDs) and their marketing arm (for consumers) and (2) will we see a place where there are additional tiers of copays (i.e., $5 for an e-visit, $10 for a virtual visit, $15 for a retail clinic, $25 for an office visit, $50 for an urgent care visit, and $100 for an ER visit).

I liked a couple of his vivid phrases. He talked about the need for high deductible patients to have a “GPS to navigate smartly” through their options. He also talked about an “end of days PPO” which (if my memory serves me) was referring to the open access to primary care and specialist through the American Well platform. We talked a little about the type of users they might expect from acute (urgent) to preventative (purely convenient) to chronic. It made me wonder in the last situation whether you could see plans pushing a visit for conditions where adherence or compliance with therapy is an issue and they are concerned about the patient. We also talked about their workflow type solution to capture data and push it along to the next visit to (for example) a specialist. It made me realize that there is probably a big drop off in visits to specialists based on the lag to get an appointment. If my PCP recommends I talk to someone, but it takes me a month to get an appointment, how likely am I to go?

I had a question about why you wouldn’t put the care team (MD, RPh, specialist) all on the session at the same time. I think his response about the challenges in doing this made a lot of sense. You put people who don’t know each other into a real-time session without a facilitator and would likely end up (in my words) with too many cooks in the kitchen.

Given all the talk about PHRs, I wondered how patients could extract information from their virtual visits and pull it into their PHR. He told me that this was part of the service and since they come from the PHR world, that makes a lot of sense. Since this also might create a two-way opportunity for the PHR to be used by the consulting clinician, it might actually impact PHR utilization and make it a more valuable tool.

Obviously, one challenge will be managing supply and demand especially around peak times. He talked about how many requests they get today (pre-launch) from MDs who want to participate. [Given the frustration I hear from many physicians, I believe it.] He talked about their matching algorithm along with their plan to predict volume and type of skill set needed to proactively recruit real-time logins (i.e., I predict we will need 3 oncologists in the next 10 minutes so let me send a call / e-mail out to 20 and see if they can log-in).

The patient will get a standard 10 minute interaction which is managed by the system and as the time elapses, there will be a gentle reminder. The physician will have the option to slightly extend the “visit” from a care perspective at no additional cost or offer to add 5 minutes at a cost directly billed to the patient. I wondered (perhaps naively) why you couldn’t just extend it for another 10 minutes with another copay, but he reminded me that no plan was going to allow you to go to the same doctor multiple times in the same day.

The other thing that I thought about but we didn’t discuss is the opportunity to use this for MTM (Medication Therapy Management) which is a service provided around Medicare Part D from pharmacists to patients. Could this become virtual which would make it more scalable.

Overall, very interesting. With 2 young kids, I know of many emergencies. As a working professional who travels a lot, I know the challenge of making appointments and even talking with my physician. I look forward to testing this service out later this year.

Do we really care? Maybe.  I found his movie on healthcare (Sicko) pretty interesting.

But, I don’t view it as realistic.  Change in the healthcare system is not going to happen without the establishment being involved.  Moore clearly doesn’t like the plans that exist and will likely alienate some of Obama’s potential supporters.  Could his endorsement rally the average consumer of healthcare?  I doubt it?

Borrowing another story from the CMG Summit, the write-up in Chain Store Age talked about making sure the reward you select is what the employee wants.  In this case, Joe Wheeler from The Service Profit Chain and “The Science of Delight” talked about Prairie Store Pharmacy in MN.  They offered their pharmacists a trip to Hawaii, but they didn’t want it.  They simply wanted more access to their customers.

I am not sure you will get that same passion in all settings, but the point is critical.  If you are going to design a rewards program, make sure you are (a) rewarding the right behavior and (b) offering an incentive that will get people to stretch.

NPS = Net Promoter Score = % of promoters – % of detracters

When working on my webinar on retention and how to improve loyalty, I stumbled upon this metric. I had used it informally without realizing there was a branded metric out there. You can get certified in it. There are entire conferences dedicated to it. It is featured in the book – The Ultimate Question. And, there are several blogs which focus on it.  [Boiling it down…it means asking customers whether they would refer you to a friend.]

Here are some scores from the top performing companies:

Not too surprising, but there weren’t any healthcare companies on this list.

So, are you capturing this today?  This is a simple predictor of loyalty and satisfaction.