Presentation on theme: "Welcome to Information Week Future of communications enabling technology in the healthcare industry Trends Challenges Technology solutions."— Presentation transcript:
Welcome to Information Week Future of communications enabling technology in the healthcare industry Trends Challenges Technology solutions
Healthcare today Global Information widely available Technology Aging population Insurance regulation Managed care
Healthcare today: Global Nutrition Access to basic health Global pandemics Travel Mobile population
Healthcare today: Information Availability Importance of accurate communications from provider, insurer, pharma, payment processor because consumer is more educated. Employee participation in health education “clubs”
Healthcare today: Technology In every sector of the industry MD orders Patient self-service Bedside Remote Transcription Nurse advice lines
Healthcare today: Aging Population Worldwide US From UN: Population ageing is unprecedented, without parallel in human history—and the twenty- first century will witness even more rapid ageing than did the century just past. Population ageing is pervasive, a global phenomenon affecting every man, woman and child—but countries are at very different stages of the process, and the pace of change differs greatly. Countries that started the process later will have less time to adjust. Population ageing is enduring: we will not return to the young populations that our ancestors knew. Population ageing has profound implications for many facets of human life. Disease trends Obesity Diabetes Heart disease Stroke Cancer
Healthcare today: Insurance Regulation New HIPPA PPACA outcome unknown
Healthcare today: Managed Care More small managed solutions appearing (vs. nation-wide HMOs) Population is more mobile Including more care analytics
Trend: Regulation--PPACA + HCER Patient Protection and Affordable Care Act + Health Care Education Reform Outcome unknown: legal challenge Retooling of processes will be necessary Challenge as well as opportunity: bring millions of new customers into the systems State-funded alternatives will require higher customer touch for retention Extended dependent coverage for adult children up to age 26 Compliance with nondiscrimination rules for fully-insured plans : possible rate changes need to be communicated Applications for retiree assistance Retooling lifetime or annual caps Coordination of dual eligibility claims What effect will there be for insurers to co-ordinate with SCHIP? Customer loyalty
Trend: Regulation--HIPAA 5010 + HITECH Health Information Portability and Accountability + Health Information Technology for Economic and Clinical Health Compliance with new electronic submission requirements HITECH: security of records may impact inbound customer requests HITECH: personally identifiable info may need to be normalized across communications while maintaining security Need to communicate new security measures to customers? ICD International Statistical Classification of Diseases: procedure and diagnosis coding compliance ICD: Could help insurers target member health issues for proactive communications. ICD: Will increase # of customer touches for many visits/procedures because of varying levels of compliance among providers
Trend: Regulation--State Regulations Requirement to be flexible to comply on state by state basis
Trend: Complexity--Regulatory Regulatory-mandated complexity as discussed in first slide Communications with multiple new offices established by PPACA Portability
Trend: Complexity--Multiple Channels Multiple channels for customer communications/customer sat Paper Web Mobile apps Portals Member Provider Broker Insurer Employer Mobile Desktop Secured terminal Unsecured terminal Multiple location sign-ons Self-service
Trend: Complexity--Multiple Types of Communication Outbound Marketing mailingsWellness newsletters Policy annualPrivacy notices EOBsLoyalty programs Special offersQuotes Inbound Automatic per internal processes per regulatory mandates Real-time Provider diagnosisProvider charting PatientPharmacy Policy
Trend: Complexity--Multiple Partners ProvidersOut-of-network providers Payers/Insurers alliancesACOs PharmaciesPatients AgentsEmployee wellness clubs EmployersGovernment reporting Small medical groupsHMO Counsel of various sortsDrug manufacturers Research facilitiesBuying alliances Internal employees
Trend: Technology Paper to E Econsumer Ephysician Epharma Eclinics Mobile population Health informatics Clinic Tech
Trend: Technology--Paper to E Patient education information available online Patient wants self-service access Enurse advice lines Physician bedside, orders, charting, Etranscription Rx communication Rx compliance Eappointment scheduling Social online patient to patient communication: require provider/insurer to use same channels to communicate to patients
Trend: Technology--Mobile Population Mobile apps-broadband, narrowband Multiple sign-on locations Remote physician In-home monitoring RFID
Trend: Technology--Health Informatics Process management in provider, insurer Technology provides ability to better understand business models; actuary Outcome monitoring Drives targeted treatment Drives wellness and prevention communications Insurer data shared with physicians to improve treatment protocols
Trend: Customer Retention Competition …drives customer service Personalization Value add Personalized education Wellness rewards Efficiency, accuracy Availability of information
Trend: Customer Retention--Competition New alternatives provide competition: small group self- insurance State-funded PPACA plans Increasing prices cause churn Patient is more educated; demands & expects more. Is also educated about switching options; less inclined to be loyal Good communications feeds into customer loyalty, retention
Trend: Customer Retention--Customer Service Personalization: where and how they want it Address management Delivery preferences Print Email SMS Phone Fax or Efax Language of choice
Trend: Customer Retention--Customer Service Value add Personalized wellness education both on- demand and push Including employee health clubs Wellness programs Rewards require tracking Rewards provide incentive to lower cost of care Efficient, accurate, speedy Clear communications the first time Importance of accurate communications from provider, insurer, pharmacy, payment processor because consumer is more educated.
Trend: Customer Retention--Customer Service Availability of information: self-serve or on-request EOB Wellness education tracking Policy terms; coverage schedules Wellness programs Billing communications Provider lists Pre-approval
Trend: Cost Control Cost of repetitive user communications Quality & content control for communications Increase self-service communications Lower cost of partner communications
Challenges: Insurers--Communications Echoing similar communications issues to those of providers Partners Payment processors Providers Members Customers internal Regulatory compliance medical chart access customer satisfaction outbound customer communications inbound customer communications
Challenges: Providers Decline in wellness Access to care Patient education Legal and financial Customer service Communications & Documentation
Challenges: Providers—Decline in Wellness Aging issues Sedentary lifestyle Bad diets Global
Challenges: Providers—Access to Care Smaller communities Global Uninsured
Challenges: Providers—Legal & Financial Insurance reform Student debt Research funding Malpractice insurance Drug prices Fiscal planning Competing initiatives
Challenges: Providers—Customer Service Scheduling Communications Because of the 24 × 7 nature and criticality of operations of healthcare organizations, especially hospitals, thus making peer interactions and support a key driver of or barrier to such e-healthcare system use
Challenges: Providers—Customer Service Care Mgmt, Data Analytics, and Informatics: As new and more adopted technologies such as EMRs, Computerized Physician Order Entry (CPOE), e-prescribing, on-line reporting and appointment scheduling become more pervasive, critical programs such as wellness, disease management, mental/behavioral health support systems, real-time decision support, case management, customer segmentation, and protocol/rules development will drive more investment in data and analytics. Developments will also move these functions from the back-office to a more prominent role in healthcare. Real-time, actionable, operational, clinical insights will help to eliminate errors, better identify care options, improve outcomes, quality and lower costs. Challenges will include new and disparate data sources, new ways to access the data, determining where and how to store the data and data exchange strategies to prioritize, manage, analyze, track and communicate outcomes and adjust protocols. Clinical information, supported by health plans, will be broad and deep, enabling caregivers to more precisely identify diagnoses and target treatment.
Challenges: Providers—Customer Service New Provide Payment Models and Delivery Systems: ACO partnerships and quality collaborations with health plans could be vital to maintaining a reasonable risk profile and an overall cost effective population health management. Reform’s uncertainty is unlikely to curtail general ACO formation that seems to “have a life of its own” and is proceeding nationwide. To improve outcomes at lower cost, enhance clinical interaction, and bundle payments, more providers will consider new care delivery structures and reform-defined governance of ACO/PCMH’s and incentives. The future will see healthcare evolve from an uncoordinated, encounter ‐ based system to structures that are more accountable, reliable, patient ‐ centered and quality ‐ based. Questions remain within new value ‐ based payment models as to how to ensure that strong, robust patient ‐ centered primary care remains a foundation of ACOs – which may define a “middle ground” for both legislators and healthcare stakeholders. Health plans will need to help address the financial implications of ACOs (MLRs, insurance risks, shared savings, etc) and gain agreement on quality and cost/efficiency measures. Bend the Cost Trend: Reform legislation lacks details on bending the cost trend, which is part of the underlying challenge facing healthcare. Industry focus on increased wellness program, prevention and consumer education; reduced physician practice and quality variation through evidence ‐ based medicine and comparative research; more population ‐ based information (and informed consent for sharing 2011 MCEG Top 10 data) on sensitive and chronic conditions; and improved care management for high need patients and those with chronic conditions will be growing priorities for health plans.
Customer Communications Technology From care management to how we market health care, the more technologically savvy consumer of the future will drive how information is presented, utilized and shared. The delivery of handheld device apps to remind members of appointments, medication refills, and presentation of diagnostic videos will be realized in the near future. Follow up appointments are expected to be via video appointments, informational YouTube links, and end ‐ user pod casts ‐ all a new reality in the delivery of health care. Social networking and other technologies will increase consumer involvement in PHRs; value based engagement, wellness programs and other product offerings, benefit design, cost, access and convenience. Consumers will demand integration between web ‐ based technology and administrative services to improve their customer experience. By personalizing the traditional member portal, and enhancing it with an online social community, the member portal will become more personal, private and secure ‐ and increasingly valuable in effective consumer engagement in quality, cost and healthy living.
Customer Communications Technology Addresses Delivery preferences –Print –Email –SMS –Phone –Fax –Multiple languages of choice –Portal Member Provider Broker Insurer Employer Mobile Desktop Secured terminal /unsecured terminal /Multiple location sign-ons
Customer Communications Technology Patient has access to more information; is more educated; expects more Patient is more educated about switching options; less inclined to be loyal if not getting service they want Good communications feeds into customer loyalty, retention
Customer Communications Technology Challenges Adherence/compliance management Regulatory compliance Prescription management Appointments Medical charting Customer satisfaction Outbound customer communications Inbound customer communications Quality & content control of standard communications Cost of repetitive user communications
It’s all about… Talking to the customer Healthcare Communications & Documentation Technology In healthcare the ability to manage complex communications with partners, providers, members and customers while adhering to governmental regulations and policy guidelines—all with pinpoint accuracy and good speed—is critical to ongoing success and competitive advantage. An enterprise-wide document strategy is essential for creating outstanding experiences for internal and external customers.