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

Trends Affecting Healthcare Communications

• Regulation• Complexity• Technology• Customer retention• Cost control• Market

Trend: Regulatation

• PPACA + HCER• SCHIP

• HIPAA 5010 • HITECH• ICD-10

• State regulations

• Dodd-Frank• CFPB

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-defined complexity• Multiple channels• Multiple types of communications• Multiple partners• Internal policy

Trend: Complexity--Regulatory

• Regulatory-mandated complexity as discussed in first slide

• Communications with multiple new offices established by PPACA

• Portability

Trend: Complexity--Multiple ChannelsMultiple 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 mailings Wellness newsletters• Policy annual Privacy notices• EOBs Loyalty programs• Special offers Quotes

• Inbound• Automatic

• per internal processes• per regulatory mandates

• Real-time• Provider diagnosis Provider charting• Patient Pharmacy• Policy

Trend: Complexity--Multiple Partners

• Providers Out-of-network providers

• Payers/Insurers alliances ACOs• Pharmacies Patients• Agents Employee wellness

clubs• Employers Government reporting• Small medical groups HMO• Counsel of various sorts Drug manufacturers• Research facilities Buying alliances• Internal employees

Trend: Complexity--Internal Policy

• Care analytics• Manage increasingly complex plans• Communicate plans to customers• Complex rulings• EOB simplification, bundling• Fiscal planning• Marketing/customer touch• Competing initiatives

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: Technology--Clinical Tech

• Nanotech• AI

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

Trend: Market

• Maintain profitability• Efficiency

• Retain customers• Service• Speed• Accuracy

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‐basedtechnology 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

• Types of info: patient self-access– EOB Wellness education– Tracking Policy terms– Coverage schedules Wellness programs– Billing communications Provider lists– Pre-approval

• Types of info: outbound– Marketing mailings Wellness newsletters– Policy annual Privacy notices– EOBs Loyalty programs– Special offers Quotes

• Partners– Providers Agents– Employers

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

Healthcare opportunities

• Technology

• PPACA • Alliances

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.