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April 19, 2004

Getting Personal
By Ralph A. Korpman, MD
Vol. 16 No. 8 p. 17

Perhaps the earliest premise of “e-health” was that extensive content about health issues could be loaded onto Web pages, where consumers would revel in their newfound knowledge. As healthcare content continues to proliferate on the Internet, it gives consumers potential access to valuable information that might help them better understand and manage their own health and medical conditions. However, for most consumers, wading through the vast quantity of Web content is challenging, to say the least. Not only must germane content be found, but each piece of content must be assessed both for its credibility and applicability to a particular user’s specific medical condition. Otherwise, the content, while interesting, likely won’t make a real impact on the patient’s life. Yet, the goal of healthcare is to impact each patient’s health and disease for the better, not to deliver an encyclopedia. Clearly, a new approach is required.

This new approach is to provide consumers with information about themselves, tailored to enhance their wellness and the management of their diseases. Providing consumers with personalized, high-quality healthcare information is the only way to ensure that they receive information that is “actionable,” meaning that it has direct relevance to their own health situation. Unfortunately, to date, few organizations have been able to provide personalized content that is substantive enough to support this role. This clear need provides an extraordinary opportunity for health plans and other health organizations that interact with patients to step up to provide such a patient service.

By using the proper tools and technology, member/patient information, and provider relationships, health plans can now support personalized e-health programs for their members that can substantially increase member satisfaction, demonstrably enhance health, reduce costs, and provide a competitive advantage.

Patient-Centric Content
Health plans are in unique position to support patient-centric e-health. First, health plans have a philosophic and financial stake in improving each member’s health. Second, each health plan’s information system maintains a broad range of patient information gathered from a variety of sources. Health plans generally have a complete set of patient demographic data and a robust index of clinical encounter information. Providers, on the other hand, typically have only snapshots of information since most patients have several (and sometimes many) providers.

While it is true that providers will (and should) always have the most detailed clinical information for a patient, much of that information has limited long-term use. Health plans, on the other hand, often have somewhat less detailed information from far more care venues; this generally provides a better overall snapshot of a member’s problems, treatments, and health status.

With this in mind, forward-thinking health plans are beginning to offer patient-centric electronic health records (EHRs) and personal health records (PHRs) to their members. These EHRs and PHRs, which are populated with information derived from all patient claims, Pharmacy Benefit Management (PBM) data, patient and provider entry, and disease management programs, enable members to manage and enhance not only their disease states but also their health.

Until recently, most Internet-based PHRs have required users to populate the record with information. This has kept use of such tools at an immeasurably low level. For the first time, the new generation of EHR/PHR tools allows members and patients to have a record that not only includes their self-entered information but also key clinical information derived from claims, PBM data, disease management programs, and provider contributions. Now, when members access an EHR/PHR that is integrated with information sourced by the health plan, they see a record that is already populated with personalized information about their condition(s) and past medical history. With a baseline in place, other desirable features, such as integrated health calendars, health reminders, medication alerts, and provider visit coordination, become relatively easy to add.

Providing consumers with personalized content provides them with a much more powerful health management position. EHRs allow consumers to act more proactively and better manage their own health. Since the only leverage point left to the healthcare system is the patients themselves, an EHR becomes one of the key elements in optimizing the limited healthcare resource. And, of course, a well-constructed EHR/PHR is fundamental to the long-term success of health plans’ consumer-driven initiatives.

Content That Has an Impact
Current studies estimate that anywhere from 35% to 75% of consumers use the Internet to access health information. While this number is appreciable, it is clear that the Internet is not yet routinely used to manage or improve health. Further studies make clear why that might be.

For example, in a recent study conducted by the University of Michigan Health System, researchers searched the Internet for information concerning a single type of cancer. What they found was that nearly one-half of the resulting Web pages contained information that had not been scientifically validated. More troubling was the fact that a significant percentage of those pages had inaccurate information and still others were misleading. In addition, the search turned up hundreds of expired pages, inaccurate links, and pages that had no medical information whatsoever, even though they were found in the search.

Knowing this, health plans are able to provide members with an invaluable tool. Properly designed Internet-based health management tools allow members to turn on their computers and access reliable, health plan-approved, scientifically validated, and, most importantly, personalized clinical information, as well as timely news about health issues of particular interest to them. Importantly, such information need not rely solely on often incomplete patient-entered information. Rather, patients can rely on health information populating their EHR that comes directly from the health plan.

How is this EHR integration accomplished? An Internet-based portal product, such as HealthTrio connect, that is based on a comprehensive health information model uses plan data and member interaction to create a personal health record for each member and then delivers scientifically validated, personalized clinical content to members. Content is derived from the plan, from the patient’s providers, and from external teams of physicians and nurses through a partnership with content providers such as Healthwise, a developer of validated health information content for consumers.

EHRs such as this also show members specific illnesses or conditions they have had or currently have and their linkages to their prescription histories. So, a member with diabetes accessing their EHR would have direct links to prescription and diabetes information already in place without having to search or figure it out on their own.

A successful EHR also closes the healthcare loop and encourages provider, member, and payor collaboration. For example, when members access their EHR, they can see their specific prescription history and information from their provider encounters. They then have the option of contacting the provider through a secure message to the physician portal to ask any questions about the information they are viewing.

Valuable Health Management Tool
By using already captured diagnosis, procedure, and medication codes to categorize member issues, health plans can offer lifestyle- and disease-specific information to those who have health problems. What’s more, this information can be tailored to integrate with existing and new disease management programs, radically decreasing the number of expensive nurses needed to man the disease management call centers.

Field experience continues to underscore that providing validated, individualized information is a key to getting members to embrace the Internet as a personal health management tool. For example, through its use of HealthTrio connect, health plans have experienced a 90% compliance for its diabetes management initiative. With this kind of success rate, costs can be reduced as members take on more responsibility for their own health education and management.

One of the important uses of these next-generation approaches to patient/member interactivity is support of a continuing shift from “disease care” to “healthcare.” Supporting healthy lifestyle improvements and avoiding the associated morbidities and mortalities is clearly everyone’s goal but has been hard to achieve. Using this tool enables information to be tailored, specific, and attention-grabbing. Smoking cessation information is of most use to smokers. Information related to breast cancer screenings should go to females of a certain age, with increased focus if there is a family history or prior abnormal mammogram. Even patient location and seasonality can (and should) be available to automatically target, for example, seasonal allergy and asthma sufferers.

In actual use, results have been encouraging. For example, using HealthTrio connect and these interactivity tools, a typical health plan was able to get nearly 30% of its smokers to participate in smoking cessation classes. Today, 85% of those former smokers remain tobacco-free. The power of directed, tailored healthcare information constantly reinforced via the Internet is clear.

And finally, health plans should be able to deliver relevant information in response to member actions performed while using an Internet-based health management tool. A pregnant woman, for instance, might have questions about procedures during pregnancy. As part of an EHR-based, content-managed initiative, the tool should be able to tell her what is advised, where she is authorized to go, how many ultrasounds she is eligible to receive, and best practices for eating and exercise.

Since properly designed EHRs can have a measurable impact on healthcare costs, health plans can entice members to utilize EHRs through incentive programs. For example, during open enrollment, members sign on to using an EHR to manage their health and as a result get a lower premium, deductible, or co-pay. This is a win-win for everyone: health plan, employer, and employee.

Of course, members must stay committed to the program to retain a lower deductible or co-pay. If a member with weight problems makes a commitment to take a weight-reduction class or seek out professional help, the person must show his or her employer and health plan that he or she is following through on the commitment to retain lower payments.

Assuring Privacy/Security
With any electronic health management tool, privacy, confidentiality, and security are important issues. No matter what the benefits, an EHR must be designed to safeguard the patient record information from unlawful access and viewing by unauthorized individuals.

When deploying EHRs, the system must create a thorough and extensive audit trail. The first step is to create a user profile for each individual that makes it clear what features and functions they are allowed to operate and precisely what information they are allowed to view. Not every person is privy to all information about a patient just because they are privy to some; data element-level security is a key component of any qualifying security, privacy, and confidentiality assurance scheme.

With these measures in place, a health plan can determine the “who, when, and what”—who viewed an EHR, when it was viewed, and what exactly was accessed. This allows a health plan to create an audit trail that surpasses the Health Insurance Portability and Accountability Act’s requirements.

Why Invest In the New Generation of e-Health?
The advantages of e-health are clear: helping support proactive health management and enhancing disease management and wellness programs. However, there are numerous other stakeholder benefits, such as the following:
• Increased member satisfaction and retention. By empowering members to manage their own care, health plans can continue to better meet member needs.
• Decreased costs associated with chronic diseases. Members who know more about self-care are less likely to need medical services. For example, if diet information is delivered to appropriate diabetic patients, fewer acute care services will likely be needed.
• Reduced number of healthy members developing conditions. Personalized information can help to reduce costs by keeping healthy members healthy. For example, overweight members might use diet information to control their weight and, thereby, avoid developing costly diseases such as diabetes.
• Fewer calls regarding administrative information. Because members are motivated to access information via the Web, administrative information such as eligibility, claims, and provider status can be simultaneously delivered to members, reducing the number of calls that must be personally handled by administrative staff.
• Competitive advantage: By creating EHRs, health plans can offer employers a valuable new service that can ease healthcare costs.

The development of an EHR-driven personalized content e-health initiative can help health plans balance the drive for decreased costs, enhanced member satisfaction, and more consumer-driven health management. The next generation of e-health uses fully modeled information to provide patient-centered, integrated clinical and administrative services that help each patient manage his or her own health and disease and reduce costly administrative functions, such as call centers. Finally, disease management and wellness programs can become more proactive and member-driven, allowing consumers to have a stake in the improvement of their own health and well-being. And hasn’t this been a primary goal of healthcare all along?

— Ralph A. Korpman, MD, is president and CEO of HealthTrio, Inc., Nashville, Tenn., a leading provider of e-health applications and core business systems for the managed care industry, and a professor at Loma Linda University School of Medicine and the University of Tennessee.

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