< Health and Wellness Customer Experience

Monday, July 03, 2006

 

Seriously, this was my idea

Since no one is really reading this blog, I figured I'd start being less professional and more honest. Really, the readership of this blog is pretty similar to the audience for my radio show in college (I had the primo 4am-7am spot) . And by not listening, they missed some seriously radical 80s tunes from the Wolfman Beck and The Priss Meliss. But I digress.

Fast Company magazine writes about the Portable Biosensor that will allow farmers to test the health of animals without bringing them in, and eventually, home testing for diseases such as the flu and cancer.

http://www.fastcompany.com/subscr/107/next-jetsons-labs.html

I did actually invent this in my information technology class in grad school. I wrote about home diagnosis and interaction technology that would prevent an ailing patient the inconvenience of having to make a trip to the doctor's office. Aah...another lost opportunity...

Monday, June 05, 2006

 

Employers are culpable, too...

It has been popular ever since managed care hit the scene in the late 80s/early 90s to blame health insurance companies for all the evils of unpaid claims, slow turnaround, confusing and bad service (that one I can't disagree with) and driving down costs on providers.

The truth, though, is that your employer is making your healthcare decisions. Especially in the case of a large employer - but in all cases - they are trading health benefits for profits. That's not to say that that's not a smart decision - one could argue that they aren't in business to provide health insurance; and US employers have long complained that they can't compete effectively v. foreign companies because of the additional burden.

But let's be straight - it is during annual negotiations between employers and plans that decisions get made about whether your grandmother's convelescent care is covered. The employer is given various plan options, some of which cost more and cover more - others which cost less and cover less. And they are also offered 'a la carte' services - additional benefit 'riders' that they can add to your options. They choose - and they decide how much they will contribute to the cost. The remainder is your premium - but the benefits you have are then based on the plan that your employer has chosen.

Even those deep in the industry don't seem to realize this...recently a group (http://www.athenapayerview.com/) began evaluating health plan performance from a providers' perspective. Very useful and interesting approach as a tool to understand the providers' perspective - but was disappointed that a number of the weighting criteria centered around things like '% of claims denied'. It isn't the health plan that determines denial - a denial comes from the intersection of a submitted claim with a code (combined with a provider ID from a specific location type) that is not covered by the member's employer (and member) determined benefit. No doubt this process is very complex and set up in a way that requires a costly infrastructure to deliver - and often with many more mistakes than should be allowed in a professional organization who theoretically cares about process excellence. But still...contrary to popular opinion, there isn't a large sweaty guy with a short sleeve oxford and a bad tie sitting in the back room with a big red stamp ready to mark your claim.

So next time you get pissed off at your health plan for denying your claim, find out whether you are shooting the messenger.


Monday, May 29, 2006

 

Online doctor/ patient visits

There are a number of activities going on in the world of healthcare automation that have benefit for doctors, plans and other stakeholders but fundamentally appeal and address the deep need for improved service and convenience to people needing health advice or services. Today's focus is online doctor-patient visits.

How many times have you had just a simple question you'd love to ask your doctor - but have to instead take the time to schedule an appointment, wait weeks (if you're lucky) to see them, drive to the office and wait 30-60 minutes to get in, and then pay a $30 copay just to ask this simple question? Doesn't seem very customer or patient focused. Sometimes you just don't ask the question or wait until the issue gets worse - the result being greater problems later (not only, most importantly, for you or your family member), but for your employer and plan. And your doctor lost a business opportunity and the chance to further improve your health. Or you use a call-in nurseline - staffed by expensive live nurses creating cost by the minute who don't know your circumstance or medical history. (Nurselines, however, are crucial as just-in-time triage and are available late at night - and/or are a very good option for asking simple questions if your plan and/or doctor doesn't offer anything other than in-person visits.)

As an alternative, a few plans are offering online appointments - the patient and/or plan pays a small fee to make it worth the providers' time, and providers find they have much more flexibility to get their work done and schedule people who do require in-person visits. You get your answer with 24 hours from the doctor you know and trust, you've paid a small fee, the program represents a small cost to the plan or doctor for additional medical revenue and improved customer experience,and the doctor has more freedom and control and ability to help. Not to mention the most important point -- you avoided probably 3-4 hours of appointment making, driving and waiting and you feel comfortable now that your question has been answered.

Check out Relay Health, one of the vendors offering this to plans today...

One important part of this offering is ensuring doctors get paid for their time so that they continue to want to serve patients in this way. Because the Center for Medicare and Medicaid Services often drives new payment model innovations for physicians, it is interesting that in this case most of the payment innovation has come from health plans. However, in December 2003 the American Medical Association approved a new CPT code (which allows physicians to submit to plans and CMS for payment) for online services....paving the way, as more plans come aboard, for this becoming a typical interaction between doctor and patient.

Relay Health reimbursement page

A study by Relay Health in 2003, performed by UC Berkeley and Stanford University, conducted with
282 physicians, 3,688 patients, and a matched control group, showed results such as physician satisfaction rates over 90% for highest volume users, more than half of physicians preferring the online option to in-office visits for non-urgent medical issues, and patient satisfaction rates exceeding 90% when they received a response by the next business morning. Both patients and providers preferred online visits to phone calls for non-urgent issues, and 75% of patients said it improved access to their doctor. (Relay Health website, May 2006).

How often do you find such a win for healthcare consumers, doctors and plans?

 

Walk-in and mobile clinics; Lower cost medical products made accessible for the Third World

I'd like to share some innovations I've seen that improve the convenience, cost and accessibility of healthcare. I'd like to hear your discoveries, thoughts and interests as well.

As discussed in my First Post, healthcare in the US is notoriously confusing and inconvenient, not to mention costly - even for those with insurance - but certainly for those who are forced (or choose)to go without because of its high cost and/or lack of useful coverage. CVS, Walmart, Target and other pharmacies and retailers are improving this problem (and generating revenue) with their convenient walk-in clinics offering basic preventive services for reasonable and clear prices. These ideas make it easy for people and their families to get basic care in the places they already are (pharmacies, stores) without an appointment, by qualified clinicians, at prices that are posted on the wall. Many insurers are already covering these clinics - but if consumers are uninsured or underinsured - it's a clear and affordable way to address simple issues.

Minute Clinic: A clinic vendor
Post-Gazette article about this phenomena
Take Care Health: Another clinic vendor

Along a similar customer-focused line, some entrepreneurs are bringing healthcare to where consumers work - so they don't have to take time off (and lose hourly wages) and don't have to lose hours of their day waiting in a doctors office. One example is Casino Direct Health Services - a dental care cart serving casino employees in Las Vegas. Patients can watch cable TV while they wait, and medical records are all electronic:

Mobile dental clinics

There are also people changing the game for medical products and pharma companies - some of the (if not the) most high cost growth areas in the US healthcare sector. They are doing this by finding more efficient and accessible ways to make these products without the overhead inherent in the US economy. One good example is David Green and the Project Impact team, creating same-quality medical products in lower cost countries (while creating job opportunities in those countries) in order to make them accessible to third world citizens:


Fast Company article about David Green and Project Impact


Please share some of your discoveries and ideas about how we can make healthcare more clear, affordable and convenient.

 

First Post

Hi out there -- I'd like to open a discussion about how we help generate business ideas that improve the cost, convenience or experience of healthcare and those products that improve our health (organic or vegetarian foods, no-animal testing cosmetics, convenience in getting access to your doctor, etc.).

For the past century, we have diminished the health and long term welfare of our world’s citizens in the name of progress and efficiency. Precious resources continue to become increasingly scarce and the environment in which we live is progressively more dangerous to our health. We continue to demand and consume disposable materials that cannot be reused or recycled. Our diet, overuse of gasoline-powered transportation, suburban communities far from stores and employers, and chemically-laden manufactured culture is leading to increasing rate of obesity, cancer, heart disease and other health problems. Recent political experiences in the United States have highlighted what many in Europe have known for years – reliance on oil to power our modern lifestyle is not only an unsustainable strategy but also a politically disadvantageous one.

Public health research or education about healthy lifestyles has never been adequately funded or encouraged either by our governments or by our commercial markets. America spends 1 cent on every healthcare dollar on healthcare research and 66% of American citizens think that is too little.[1] The health of our communities is in decline and care is unattainable to a widening pool of poor and even middle class world citizens who cannot afford the drugs and technologies that we spend trillions to develop and deliver. In the United States, we are often known for the most advanced healthcare technologies and pharmaceuticals in the world. However, our system is so expensive, ineffective and confusing that patients often go without the care they need -- because they cannot access or afford care, or simply because they are confused about how to obtain and pay for it. At the same time, businesses are shifting significant portions of healthcare decision making and costs to consumers who can ill afford to accept them nor have the resources they need to make appropriate decisions. The U.S. government has been unable to pass any significant healthcare legislation since the 1960s.

Our current approach to use of natural resources and healthcare delivery cannot go on without increasingly devastating effects on our way of life and the health of our families and communities. Waiting for our government or large established businesses to turn the ship around is like asking the fox to guard the henhouse. Even those with good intentions often have too much infrastructure and established ties to produce rapid or effective change.

Many entrepreneurs and the business media have begun to see not only social good but business opportunity in improving our environment and the health of our communities. Organizations like Whole Foods, Starbucks and the rising popularity of hybrid cars have shown us that eating healthy, respecting our natural resources and the communities in which our products are made are fashionable and growing in popularity at a rapid pace. Entrepreneur, Fortune and Fast Company recently highlighted the growth of ‘green’ businesses as the wave of the future. Further, as Baby Boomers get older and require more healthcare, as resources become more scarce and costly, and as globalization increases, organizations will need smarter, more efficient and more sustainable ways of creating healthy, fulfilling and stable products, lifestyles and health information and access for the world’s citizens.

It is my belief that with the right environment for creative development, design and delivery of ideas – along with strong networks providing necessary skill-sets and funding, successful businesses can be created that will serve the growing market need for products and solutions that improve the environment in which we live, and the manner in which healthcare is maintained and delivered.

[1] Harris Interactive for Research America, 2005.

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