HealthMine Blog

The HealthMine Blog

Health Plans: Are You Collecting Data or Insight?

April 18, 2017
HealthMine Team
A new Premier survey with 63 healthcare executives found that healthcare systems are now shifting their focus from recording data in EHRs to integrating and combining this data to aid in decision making. This is a welcome development for providers and a nudge for health plans to move themselves in the direction of a single, integrated technology platform. After all, integrating data eliminates redundancies, creates efficiencies, and lays a foundation for population analytics and insight. That can lead to closing more gaps in care and lowering costs—both for members and the plan.

For health plans, creating one comprehensive, integrated platform would facilitate more effective management of and improvement in the health and wellness of their diverse populations. It would streamline internal workflows, reduce the cost and duplication associated with maintaining multiple, separate systems, and enhance the member experience through better data coordination and sharing of information.
For example, a single, digital platform could support patients taking charge of their own health by unifying content, tools and resources. Fifty-three percent (53%) of consumers say they can't access all their clinical health data from a computer. By integrating legacy systems and uniting electronic health records and other clinical and behavioral data into a single platform, health plans can facilitate member access to health information. They can help provide better connections between patients and physicians outside the doctor’s office.
Perhaps the biggest gain for health plans who can move to an integrated platform is the advantage they would have in population health management. An integrated system offers a more complete look at member populations, enabling plans to segment members into risk levels and focus on those with the most intensive needs.
Organizations in other industries have long been reaping the benefits of an integrated technology platform. Verizon saved $1.6 Billion in three years, and Sprint saves millions each year by integrating legacy platforms, sales and customer service into a single platform.
If you have invested in a diverse set of technology systems to capture and collect member data, now is the time to consider moving from “meaningful use to meaningful insight.” Integrating data from separate sources and improving the interoperability capabilities of existing health technology is the first step toward raising your plan’s health intelligence.

[Photo credit: Global X via Creative Commons.]

Are You Shifting Health Intelligence to Your Members?

March 6, 2017
HealthMine Team

Your members may feel that taking charge of their own health is like swimming upstream. Overwhelmed by an increasingly complex sea of medical choices and data, Americans can easily get lost, and carried away by the inertia of leaving their healthcare to providers. The consequences are grave, particularly for those with health risks and chronic conditions. In healthcare, being an engaged consumer is essential to promoting positive outcomes and lowering costs.
The problem lies in an imbalance of health intelligence. Before the Internet, smartphones and social media, knowledge about conditions, treatments and medication lived mostly with providers. Diagnostic tools and devices were accessible only in the doctor’s office, and the patient’s health record sat in the physician’s file cabinet. Recently, advances in technology have enabled a shift of information directly to patients. But not everyone is accustomed to finding, interpreting or applying the vast amounts of health data now available to them.
That’s why providers are beginning to implement new tools and strategies to educate and empower their patients to become more active participants in their healthcare. These include providing a clearer look at care options, making complex information simpler, and improving access to electronic records. All of these tools swing the balance of health intelligence to the patient.
The benefits are measurable. According to a 2013 study in the journal Health Affairs, patients who were encouraged by health coaches to review options and get more involved in choices had 5.3% lower overall medical costs, 12.5% fewer hospital admissions and fewer elective surgeries.
But providers aren’t the only members of the healthcare system who can help shift the balance of health intelligence. Health plan sponsors have a role to play, too. You can throw a life vest to members by giving them greater insight into health status and risk, sharing clinical guidance on necessary health actions, and offering personalized motivation to close gaps in care.
To improve health intelligence in a population, plan sponsors must first shore up their own programs and systems. Five key strategies can help: 1) strive for 100% engagement, 2) go digital, 3) close gaps in care, 4) move to a single integrated platform and 5) implement constant intelligent improvement in real time. In subsequent posts we’ll examine these strategies one by one.
As the current of healthcare changes with advances in technology and shifting payment models, the healthcare industry must do a better job of buoying consumers with knowledge and guidance. For plan sponsors, making members feel lighter and stronger in their healthcare journey lifts everyone up.
[Photo credit: Ruth Hartnup via Creative Commons.]

Digital Intelligence Will Transform Your Business

February 8, 2017

What if an intelligent application could diagnose a health condition as quickly and precisely as a human doctor? A Financial Times story features a digital diagnostic app called Babylon that crunches through billions of data points collected from thousands of test consultations to help pinpoint an ailment. This is just one example of how machine learning, also known as artificial intelligence, is transforming healthcare.

Babylon is just one of a growing collection of intelligent tools that can empower people to manage their own health. Last year, the US Food and Drug Administration approved 36 connected health apps and devices, from mobile lung-function monitors to blood-glucose tests, that provide medical advice to consumers—at a fraction of the cost of a provider visit or traditional lab work. 

As we collect and store more and more data about consumers’ health and lifestyles, there is an incredible opportunity for health plan sponsors to capture and apply this data to transform their business. They can integrate and analyze this valuable data by using machine-learning algorithms in the cloud. Applying machine learning can enable plan sponsors to pick out trends and interactions at the population level and — ultimately —predict and prevent disease before it even occurs. 

If you’re skeptical about how machine learning can transform business, just look at three behemoths: Airbnb, Uber and Google.
Airbnb uses big data and machine learning to guide hosts to the perfect price and deliver a better experience than a traditional hotel service model. In New York, Airbnb rentals now represent 25% of all lodging, and the company is grabbing market share from traditional hotels. Airbnb is now valued at $30 Billion.
Uber uses machine learning to find customers, set competitive prices and create a more convenient ride than a taxi. In doing so, the company is displacing the taxi industry. Uber is now valued at $62.5 Billion.
And of course, let’s not forget about Google. By tracking Web browsing, emails, chats and more, Google has become a dominant force in digital ads. It mines that wealth of personal data to present ads to the people most likely to care about them. Google’s parent company, Alphabet Inc., relied on that ad machine for about 88% of its $75 billion in revenue last year.
Right now, plan sponsors are collecting terabytes of data on their members. But how many are integrating that data, analyzing it, and intelligently applying it to detect and predict disease and anticipate members’ healthcare needs? Plan sponsors that integrate intelligent learning into their health plan/wellness program will be the game changers in the payer industry.

[Photo credit: NEC Corp. via Creative Commons.]

A Prescription to Combat Rising Drug Costs

January 13, 2017
HealthMine Team

The prognosis for prescription drug costs in 2017 is not good. Prescription prices are projected to jump 11.6 percent in 2017 for Americans under 65 years old, and increase 9.9% for older Americans. This growth outpaces both the cost of living and wages, which are expected to rise just 2.5 percent this year, in contrast. The data comes from a new report by Segal Consulting.
Hours of congressional investigation into U.S. drug prices have done little to soften the hit to American consumers, and it’s no surprise that four out of five Americans say that drug prices are unreasonable (Henry J. Kaiser Family Foundation).
Yet despite the fact that prescription prices can vary widely by pharmacy, 70% of Americans still don’t price shop for healthcare services including prescription drugs.
Rising prices could easily lead to more Americans skipping doses or essential medications altogether; in fact, about one in 10 American adults don’t take their medications as prescribed because of the costs. Add to that narrowing formularies that are increasingly shutting off access to previously covered drugs, and it’s easy to see how consumers are losing both power and ownership of their healthcare. Prescription drugs now account for almost 17% of personal healthcare expenditures.
This is a wake up call for health plan sponsors, who have an obligation and vested interest to help members gain greater ownership of their health. One effective step would be to educate members about drug price variation. But today, less than a third (29%) of plan sponsors offer a price comparison tool in consumer wellness programs.
Do you know whether your members are adhering to their medication requirements as prescribed by their providers? Do you offer them a price comparison tool to pinpoint the lowest-cost sources for their needed medications? If not, now is the time to equip members the health intelligence they need to become better healthcare consumers. This is a critical step in the path to lowering population health costs.
[Photo credit: Casey Fleser via Creative Commons.]

Plan Sponsors Can Buck the Trend

December 13, 2016
HealthMine Team

We spent nearly $10,000 per person on healthcare last year. That’s a higher healthcare bill than Americans have ever paid, and it accelerated at the fastest rate ever since the Great Recession in 2007. This new data comes from the Department of Health and Human Services.

We know that this astoundingly high number is largely driven by the expansion in healthcare coverage for millions of Americans enabled by the Affordable Care Act. We also know that rising prescription drug costs played their part. It’s not surprising that the lion’s share of our $3.2 Trillion health bill was spent caring for the sickest of patients suffering from largely preventable chronic diseases.

While the federal government and households were hit the hardest, businesses who sponsor employee and family health plans also took a big blow; they payed 20% of this bill. 2015 saw a notable increase in enrollment in employer-sponsored plans (1.4%) as the labor market continued to improve.

But there are bright spots--pockets in America that have been able to hold their healthcare bills steady, despite external pressures. Chicago is one such anomaly; for the past five years, the city has kept its healthcare bill for employees and retirees roughly flat, at about $450 million a year. We can learn a lot from their strategy, particularly as it relates to employer-sponsored healthcare.

Although the cost to cover employees has grown by 25% over the past 5 years, a few of the strategies Chicago used to counteract this trend included:
  • introducing incentives for employees to seek higher-value doctors and other healthcare providers
  • offering incentives for members to buy generic drugs rather than more expensive branded versions
  • redesigning its copayments to encourage people to see primary care physicians
  • creating incentives for employees to obtain MRIs and other scans at independent facilities, which often charge less than hospitals do
By continually measuring, educating and reshaping the behaviors of its citizens, Chicago has been able to improve the value of its healthcare while holding costs stable. The endeavor has required constant attention and effort. And to continue its progress, Chicago will have to keep making changes, but unlike many other parts of America, it is headed in the right direction.

Plan sponsors: you can also transform your population into a success story that bucks the national trend. Start by empowering your members with health intelligence that is actionable. Then steer and reward them to manage their health continuously. Your wellness program is the perfect place to start.

[Photo credit: m.a.r.c. via Creative Commons.]

Who is the Captain of Your Members’ Health?

November 29, 2016
HealthMine Team

Patients are increasingly influencing the direction of medical research, according to a recent story by NPR. This is exciting and promising news. But how about patients influencing the direction of their own medical care? Is there a lesson to be learned about that?

Profiling a parent who took over the medical research of her young childrens’ rare genetic disease, the NPR story described how patients are participating directly in the design of experiments. This gives them a stronger say in driving the outcomes they want. Because of the profiled parents’ self-driven exploration, they were able to develop a diagnostic test and potential therapies for their childrens’ disease.

The growth in patient directed research has extended to areas including arthritis and organ transplant, and is even starting to have an influence over the way the FDA approves new drugs.

We wish we could applaud the same progress in patient ownership in the world of medical care—particularly among patients with chronic illness like heart disease and diabetes. But unfortunately, chronic patients struggle to manage their own healthcare, and to be the captains of their health.

A recent survey showed that 73% of patients with diabetes reported difficulties in coping with their condition, and 66% felt their diabetes was not totally under control (HealthMine Diabetes Report). What’s more, 39% of people with heart disease report difficulty managing their illness/risk and 46% of those individuals say that knowing the right actions to take is the most difficult aspect of managing their condition (HealthMine Cardiovascular Report).

Part of the problem lies in patients being disconnected from their health data and from valuable tools to help them manage their disease. While roughly half of Americans suffer from at least one chronic condition very few--only 7 percent according to HealthMine’s 2016 Digital Health report--are using a disease management tool. Additionally, only 22 percent of patients using digital health are accessing electronic health records to help make medical decisions.

Motivation, engagement and education are other factors influencing patients’ involvement—or lack thereof—in managing their health.

Wellness programs can help bridge these gaps in care between provider visits and healthcare at home—helping individuals become the captains of their own health. By engaging members successfully in wellness programs, health plan sponsors can help champion higher quality and more effective healthcare for their populations.

[Photo credit: farmerdave8n via Creative Commons.]

Are Your Members Skipping Their Medicine?

November 21, 2016
HealthMine Team

More than 30 percent of patients with hypertension aren’t taking their prescribed medicine, according to a new study published in the Journal of Evaluation in Clinical Practice.

Medication adherence is a problem for more Americans than we realize—even those who have medical and prescription coverage. Of the approximately 187 million Americans who take one or more prescription drugs, up to one-half do not take their medications as prescribed. Patients missing out on their medication or taking the wrong dose cost the U.S. health care system $290 billion each year (New England Healthcare Institute).

Patients who adhere to their medication plans, on the other hand, can safeguard both their health and their wallets. The savings come from reduced progression of diseases, lower hospitalization and emergency room charges, and lower mortality rates.

As an employer or health plan sponsor, odds are that you have members in your population who aren’t adhering to their medication. This portion of your population may be growing larger as both pharmaceutical and out-of-pocket costs rise. You can bet that non-adherence is costing you. Despite this, medication adherence programs are one of the least included components of wellness programs, offered by only 16% of wellness programs, according to HealthMine’s 2016 Consumer Wellness Report.

Medication adherence is an opportunity for wellness programs, who can fill the gap between provider visits and patient home care with improved care coordination. This includes monitoring, reminding and financially incenting medication adherence. Enhancing engagement and education about treatments increases the likelihood that members will take their medications as prescribed. Wellness programs can also utilize technology—including e-prescribing and sharing of near-real time prescription data between patients, providers and pharmacists—to improve adherence in their populations.

[Photo credit: Dvortygirl on Flickr via Creative Commons.]

The Gap In Smoking Cessation Support

October 31, 2016
HealthMine Team

The American Cancer Society released new data spotlighting smoking’s leading role in cancer-related deaths. According to the study, cigarettes are to blame for nearly 3 in 10 cancer deaths in the U.S. And the damaging effects go beyond just cancer.

Smoking is also responsible for nearly one-third of deaths due to coronary heart disease. Smoking also causes chronic obstructive pulmonary disease, diabetes and rheumatoid arthritis, among other ailments, according to the Surgeon General. 

This information is disturbing but not surprising. What’s more startling is that, despite this knowledge, the parts of the country that need the most anti-smoking efforts still have the least amount of support in place.

Southern states (including Kentucky, Arkansas, Tennessee, West Virginia, Louisiana, Alabama and Oklahoma) have a disproportionately higher number of cancer deaths whose smoke trail leads back to cigarettes. But virtually all of these states have weaker tobacco control policies and programs than the rest of the country.

Specifically, the states with the highest prevalence of smoking have the lowest anti-tobacco spending, the fewest restrictions on indoor smoking, and the lowest excise taxes on cigarettes. And only seven states out of fifty have Medicaid programs that provide comprehensive coverage for smoking cessation services.

We know that quitting smoking leads directly and immediately to improved health, and we know now that we can’t rely solely on national and state support to facilitate smoking cessation. This is a call to action for health plan sponsors to fill the missing gap.

Quit smoking programs are low-hanging fruit for wellness programs, especially since someone who quits smoking costs $1,000 less to care for per year than someone who continues smoking. Plan sponsors should not only promote these programs but incentivize them strategically. Newer research shows that a combination of carrot and stick may be a more effective approach to maximizing success.

No matter how they do it, there’s a lot at stake for health plan sponsors who can extinguish smoking in their population. And if they don’t tackle the problem, who will?

[Photo credit: QFamily on Flickr via Creative Commons.]

Looking Behind the Curtain at Breast Cancer Screenings

October 17, 2016
HealthMine Team

A new argument for not participating in health screenings involves a theater analogy. Two researchers, Dr. Andrew Lazris and Erik Rifkin, ask you to imagine a sold-out house of 1,000 playgoers or concertgoers, all getting a particular kind of screening. When the curtain falls, everybody helped by the procedure gets up and leaves. The researchers argue that it’s only a few people—sometimes nobody—who get out of their seats.

They highlight breast exams as an example, asserting that only one woman in the thousand-person theater receiving mammograms over a lifetime is saved from dying by detecting a cancer before it spreads. At the same time, hundreds of women in that audience will receive “false positives,” which, they contend, will potentially lead to unnecessary, costly tests and treatments.

Americans have more responsibility than ever for both the cost and control of their health, yet they are getting confusing guidance about how frequently they should be assessing their health risk. Even the U.S. Preventive Services Task Force has recently called for less frequent screenings--breast cancer among them. But we’re not getting any healthier. One out of every two Americans has a chronic disease.

Since it is October and Breast Cancer Awareness month, let’s pull back the curtain on this disease in particular.
·         One in eight women (12%) will develop an invasive form of breast cancer over the course of their lifetime ( That means, when you go to the       theater for real, it is likely that someone in every other row has faced or will face a diagnosis of this devastating disease.

·         Studies have shown that mammograms are finding more breast cancers early, when they may be less complicated and less costly to treat.

·         One study found that the average 24-month cost of treating breast cancer when diagnosed at stage 4 is nearly double ($182,655) the cost of treating a stage 1 or 2   diagnosis ($97,066).

·         Knowledge empowers people to take action and Americans want to know. 71% of insured women get their mammograms. What’s more, 73% of women surveyed     believe mammograms should start before age 50 (the current USPSTF guideline) and another 60% of women say every-other-year mammograms are not frequent             enough (January HealthMine survey).

·         A quick Google search will pull up countless stories of women sharing how a mammogram saved their life. For these women, the potential harms and risks of a         mammogram are a hard argument to sell. They pale in comparison to the vivid, life-saving knowledge this test delivered to them.

In absence of a cure or inoculation, early detection is our best weapon against breast cancer and many more diseases that are often first identified by a routine screening. Health plan sponsors, be sure you look behind the curtain and carefully consider all of the data—and the voices of your members—before choosing whether or how aggressively to promote screenings in your population.

[Photo credit: Marina on Flickr via Creative Commons.]

The Best Thing You Can Do For Members with Chronic Disease

September 21, 2016
HealthMine Team

People with chronic conditions spend 99% of their time outside of the doctor’s office. What they do in that time determines the quality of their health—and the cost of their healthcare. That’s why healthcare plans and employers are starting to invest more in “self-management” or chronic disease management programs, according to a recent analysis by Kaiser Health News.

Recent studies of diabetes patients and other chronically ill populations who participated in chronic disease management programs show that these individuals were better off than those who didn’t participate. They had healthier biometric measurements, took their medication more regularly, and were overall better healthcare consumers.

But too few individuals have access to these types of programs. A new HealthMine report found that only 29% of wellness participants say their health plan offers a disease management program. Just 14% said their wellness program helps them better manage their disease.

If your members have a chronic condition--and nearly half of Americans do, according to the CDC--then they are their own best friend. But they must be equipped with the knowledge and the tools to help themselves. That’s where disease management programs come in.

These programs can help members set goals about their own health, provide personalized steps to reach those goals, and reward effort and progress. Disease management programs aren’t just for those with diabetes. Members with heart disease, depression, arthritis and other chronic conditions can benefit, too.

It’s time for wellness programs to do more than offer lifestyle management tools. If you want to empower the members in your population who need the most help, teach them how to manage their own conditions. That will help them become better users of healthcare dollars, too.

[Photo credit: Wiloma on Flickr via Creative Commons.]