Convenience Medicine

Health Plans’ Digital Efforts Should Be App-y Experience

Insurers need to think strategically to ensure that beneficiaries remember to keep going back to their app for health information.

Jan Greene

Last year, investors pumped more than a billion dollars into the idea that Americans really want to use smart phones, fitness trackers, and other devices to nudge themselves into better health. Health insurers are part of the trend, developing mobile apps that let members use their health benefits on the go and track their biometrics. There’s a lot of hope—and hype—about “digital engagement” being the lever that finally turns around a lot of scary lifestyle-related health problems such as type 2 diabetes and obesity. Make healthy habits fun and simple, the theory goes—just part of the typical American’s day with the device that controls her social life, finances, entertainment, and so much more.

But these are the early days in the digital health revolution. So far, it seems consumers are most excited about the features that remove some of the aggravation of having health insurance. UnitedHealthcare’s Health4Me app has been downloaded 1.4 million times to do everything from finding a doctor to estimating out-of-pocket costs. The most popular features, though, are the electronic version of a member ID (“I don’t have to carry around a card anymore!”) and a “call me back” function that bypasses the dreaded customer service phone tree and has the person you want call you back directly.

“It was surprising the reaction we got from consumers,” says Craig Hankins, vice president of consumer engagement products for UnitedHealthcare. Something simple like an electronic ID card can resonate with people whose lives have become very complex. “There’s a ‘less is more’ mantra” the company has adopted in developing apps, Hankins says. “Keep it focused and make it easy, and people will keep coming back.”

That’s known as “stickiness” in the digital world. Given that they are competing with the likes of Candy Crush and viral squirrel videos, not to mention 165,000 health-related apps, health plans have to be smart and strategic in finding ways to get consumers to click on their insurance company’s logo in those empty moments waiting in line or during a lull in the action at a child’s soccer game. The idea is to keep chipping away at the dizzying complexity of using health insurance and health care so the convenience factor is closer to consumer experiences that offer instant gratification, such as buying a book on Amazon and having it show up the same day.

Karen Marlo

“Mobile apps offer new opportunities to connect with people,” says Karen Marlo, vice president of the National Business Group on Health.

Banks and retail have mastered the consumer engagement game, notes Adam Nelson, vice president of health care and life sciences for NTT Data, an IT services company. “You know a check is being deposited but people check anyway,” he says. “There’s an engagement, there’s change. There’s a stickiness factor that is something they are involved in.” Health plans need to find ways to keep users coming back to their apps. There’s a history of wellness apps being downloaded and used for a couple of months and then forgotten, he says. Apps, it seems, may not be different than the exercise equipment that ends up gathering dust and resolutions to improve diet that erode with time and temptations.

Easily accessible

So to begin with, insurers have had to wade into digital with the basics—such as a mobile version of their website—to provide the service that their members and employer clients require, notes Karen Marlo, vice president of the National Business Group on Health (NBGH). “Generally, they want to be sure the information the employer needs is easily accessible, such as having a mobile-enabled version of the website where the employee can go for all their health benefits information,” she says.

Employers see mobile as a way to reach employees with benefits messaging, particularly for those who work in settings without a desktop computer with email, Marlo says. Even if those employees have a computer at home, chances are they don’t want to be logging on to read email from work when they get home. “Mobile apps offer new opportunities to connect with people,” she says. The small screen makes brevity not just a virtue but a necessity, so human resource offices need to boil down dry benefits information into shorter, compelling messages. At the same time, Marlo noted, they can also use mobile apps to personalize information to the individual.

Technologies used in health engagement promotion

2013 n=367, 2016 n=213

Source: Xerox Human Resource Services and the National Business Group on Health, “Emerging Technology to Promote Employee Wellbeing,” April 2016

Larger employers are jumping into mobile technology, with 56% in an April 2016 NBGH survey saying they use mobile technology to promote employee health engagement and 38% saying they use wearable sensors. More specifically, 74% said they use contests such as weight loss or walking to improve employee health, 51% use interactive mobile apps supporting health insurance, prescription refills and the like, and 37% use activity tracking. Their motivations, said the survey, were largely around helping employees become better consumers of health care (79%) and improving workforce health (73%). NBGH reported the results of a similar survey three years ago. Back then just 16% of the responding companies said they were using mobile technology in their health-engagement effort. Now half say they are.

According to the survey, which was co-sponsored by Xerox, return on investment (ROI) is not necessarily a requirement anymore, with just 20% of employers saying they bothered to measure it for the health technologies they used. “Employers are trying to move on from trying to get an ROI on everything,” says Marlo. “Especially with human capital, it’s really hard to make the connection with direct financial impacts.”

That doesn’t mean companies are willing to buy into every new digital health startup. “We regularly have meetings with startups, some of which are really compelling in concept,” says UnitedHealthcare’s Hankins. “We do believe these concepts are where health care is going,” he says. “But employers really are looking for ROI” for disease management-related apps, he says. New apps and devices also need to both be sensitive to patient privacy and offer a benefit to the individual consumer, he says. He described UnitedHealthcare as “tiptoeing” into apps and devices that use real-time data to track patient health. The company wants to see outcomes before investing in new ideas, Hankins says. Members can share the number of steps they take with their Fitbits, for instance, but those data are not yet analyzed or used for clinical or wellness purposes.

Instead, the company’s Health4Me app is focused more on using the health plan. So it includes a locator service that shows the closest emergency department, urgent care or convenience clinic. Users can pay their medical bill through the app. Nonmembers can use a UnitedHealthcare app to estimate the cost of a medical service based on geographic-specific data contained in a national claims database maintained by FairHealth in New York.

Health 4Me app

UnitedHealthcare’s Health 4Me app includes a locator service that shows the closest emergency department, urgent care, or convenience clinic.

Of course, the apps are only as good as the databases behind them. Consumers can get estimates of what an in-network service might cost, but because of the variability of out-of-network provider billing, that remains as opaque as ever.

Other insurers offer similar basics with their mobile apps. Humana, for instance, maintains MyHumana, which gives members access to ID cards, claims, and local providers and health care locations. Its Vitality app lets members participate in health challenges and competitions and set healthy habit goals. The company’s pharmacy app, including a version for Apple Watch, lets users scan and refill prescriptions, get reminders, approve payments and track shipments. Humana’s MyHealth is a biometric tracker (such as blood sugar and weight) and medication list.

The company is moving toward “engaging with our members through personalized mobile experiences” to help them meet their health goals, says San Banerjee, director of digital consumer solutions for Humana.

Aetna has also been busy producing mobile apps, with 15 each in iTunes and Google Play. Its iTriage app has been downloaded more than 15 million times and continues to get regular use, according to an email from an Aetna spokesman. It and Aetna Mobile provide the usual array of basic health plan management options, including managing personal health records. The email said a 2014 analysis of iTriage found it drives more appropriate care. When users search for providers based on nonacute conditions, they select emergency departments 40% less frequently.

Parties communicating with employees through social media

2013 n=237, 2016 n=108

Source: Xerox Human Resource Services and the National Business Group on Health, “Emerging Technology to Promote Employee Wellbeing,” April 2016

Buying from an app

Mobile apps could also have a future in helping consumers evaluate and choose health plans. Joel Ario, a former Obama administration official in charge of setting up state insurance exchanges and now a managing director at Manatt Health, is bullish on the potential for mobile in buying coverage. “My boys who are 20-somethings will be purchasing their health plans and learning how to use their health plans on mobile,” he predicts.

He envisions apps that ask the user a series of simple questions and arrive at the best choice for that individual. “The apps that will win the day will be the ones that ask the fewest questions of the consumer and most quickly” come up with a recommendation, he says.

NTT Data’s Nelson is even more enthusiastic about the possibilities of digital strategies for health plans. He sees insurers as being in an ideal position to manage population health by using what they know about individual members to provide one-on-one advice, most likely through connecting the user to a 24-hour advice nurse who becomes a case manager. “Health plans have the ability to create more of a relationship with you,” he says. “The payer more than anyone should own that online relationship.” Whether a public long distrustful of health insurers will be willing to let that happen is another story.

While a main goal of disease management apps is to improve the health of those already struggling with chronic illness, Nelson argues that the next step is to use digital health to predict which members could develop chronic conditions. Using clinical and claims data, the plan could assign a risk prediction number to an individual and then track that number based on continued input, such as weight, heart rate or activity level. “Maybe I’m at 67% risk of type 2 diabetes,” he explains. “My phone knows if I’m at a McDonald’s drive-through. Depending on what I order, my risk factor could go to a 66 or a 68. Some people could see this as Big Brother,” he acknowledges. “Others as a motivator.”

Jan Greene is a veteran health care journalist based in northern California. Her work has appeared in the Los Angeles Times, Health magazine, Annals of Emergency Medicine, and many other publications.

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