One Health Insurer’s Strategy for Patient Engagement

September 10, 2014
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Somesh Nigam IBXFirst published on MedCityNews.com. The point of care is just one place where innovation is happening in healthcare. Behind the scenes, new technologies are being used to improve communication between caregivers, to make administrative tasks more efficient, and as Dr.

Somesh Nigam IBXFirst published on MedCityNews.com. The point of care is just one place where innovation is happening in healthcare. Behind the scenes, new technologies are being used to improve communication between caregivers, to make administrative tasks more efficient, and as Dr. Somesh Nigam will tell you, to help insurance companies be more proactive about their members’ health.

Dr. Nigam oversees the informatics division at Independence Blue Cross which is charged with developing reporting tools and analytics to better serve customers, improve care and lower costs. He’ll be talking about how the insurer gets and uses feedback from customers at MedCity ENGAGE, the premier conference on patient engagement in healthcare, Sept. 30-Oct. 1 in Bethesda.

Learn more about the other innovative payers, providers, policymakers and health IT professionals who will be sharing the stage, or register here.

He’s a sneak peak at some of the ways Dr. Nigam sees technology changing health insurance strategies.

How is big data changing the physician-patient relationship?

The growing application of big data in healthcare is facilitating more personalized patient care, more-informed decision making, and improved outcomes. There are numerous high-value, low-cost tools and innovative solutions available today that promote member engagement and enhance patient care using big data and predictive models. Providers can glean new insights from big data into their patients at highest risk for developing chronic conditions and for whom they can intervene by providing more specialized care and treatment.

For example, Independence Blue Cross is partnering with New York University to develop models that can predict members who are likely to develop diabetes within the next two years. This will allow us to work with providers to intervene, apply appropriate clinical measures, and change the course of a member’s disease.

Further, Independence has developed big data-based models that can predict member concerns and complaints, sometimes weeks and months in advance. This allows us to engage these members proactively in order to address their concerns before they escalate and, ultimately, to increase their satisfaction levels.

Finally, Independence uses models that can predict the likelihood of hospitalization (LOH) for members with chronic diseases like Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and diabetes.

As a result of our use of big data, Independence has seen a significant increase in provider, member, and patient engagement, and improved clinical outcomes.

For patients, the logistics of healthcare is often the hard part of getting care. How is data analysis changing how healthcare is delivered?

Today, data analysis is redefining how healthcare is being delivered by providers, consumed by patients, and the way in which quality of care decisions are being made at various levels. The shift towards more personalized, high-value information is helping individuals make more informed lifestyle choices, improve patient health, enhance quality of care, and reduce costs.

For example, Independence has changed our care management program and uses primary health coaches to coordinate care for our members and their families around the clock. These coaches are nurses, who serve as the single point of contact for guidance managing challenging health conditions, answering questions, and addressing concerns, including coordinating care after surgery or a critical illness and helping manage chronic conditions.

This new approach to member care is fostering a higher level of engagement and helps our members reach their goals. Coaches can help our members understand new prescriptions, a diagnosis and treatment options, or assist members in making lifestyle choices that help reduce health risks.

Independence is also promoting the adoption of wellness programs to our members, which have demonstrated significant improvements in clinical outcomes, including reductions in weight, BMI, lipid profiles, blood pressure, and HbA1c rates (among diabetics) for our members.

What’s the best patient engagement tool you’ve seen?

There are numerous tools and innovative solutions available today to help patients manage their healthcare.

Independence, in collaboration with the University of Pennsylvania, has utilized GlowCap, a Bluetooth-enabled, prescription bottle cap, to promote medication adherence among heart attack patients.

Independence also provides real-time data on care gaps, via NaviNet, for providers to engage their patients. This information facilitates richer interactions between providers and patients about the course of care they should receive.

Finally, the IBX mobile application (for iPhone and Android) is being utilized in myriad ways to help members manage their health. For example, there are various calculators available for members to determine their BMI, target heart rate, hydration needed during exercise, and a Doctor’s Visit Assistant tool that allows members to view their health history, track their prescription medications, check on the status of referrals and claims, and manage their health on the go.

Who inspires you?

There are many innovative thinkers in the healthcare and information technology worlds that inspire me.

Among the lesser known pioneers, whose work did not make front-page headlines, is Jerry Morris. Dr. Morris was a British epidemiologist, whose data-driven research in the late 1940s, the first of its kind, looked at the correlation between physical activity and cardiovascular disease by analyzing the heart attack rates of double-decker bus conductors and drivers in London. Bus drivers sat for 90 percent of their shifts, whereas conductors climbed roughly 600 stairs each working day. Dr. Morris’ data revealed that conductors had fewer than half the heart attacks of their sedentary colleagues.

This newly identified relationship between exercise and heart attack rates was contrary to the dogma at the time the study was conducted. As a result, it took Dr. Morris until 1958 to publish his groundbreaking work. Today, over five decades later, we still see that medical breakthroughs and study results can take many years to make their way from initial discovery to practice.