Kevin Maher, MHA is VP of product and outcomes management at McKesson Health Solutions.
Give me the elevator pitch on Personal Health Advisor.
I think about Personal Health Advisor as a multi-channel consumer engagement platform at its highest level. It’s really aimed at helping consumers to help them utilize online health tools and, in general, to provide consumers with both inbound and outbound health advice, recommendations, and services.
Who is the targeted user or customer?
The targeted users are health plan members and the target clients are typically health plans, which I would describe as any organization that holds some degree of financial risk for a population. That could translate into at least three segments. Certainly the payer segment, which is where we are focused today. Second, the employer in the self-insured employer market. Third would be the kind I like to describe as the fledgling ACO market.
There’s always a survey claiming consumers want to use tools like secure e-mail, personal health records, and assessment tools. So why don’t they?
I think our point of view on that would be that a lot of the lack of use goes to a few things. One is not enough skin in the game overall today. I agree that consumers are still largely shielded from the financial cost and burden of delivering healthcare.
I think a second issue we’re dealing with is who’s the trusted source for information — the payer or the provider? Our position is that the provider is a much, much better trusted source than the payer, so anything sponsored by the payer — or potentially, by the employer — in and of itself will create some barrier to use.
I think some of those barriers can be removed if the design of the benefit structure encourages the use of online, member-focused tools, which is what we are beginning to see with the clients that we’re working with on this solution.
So you’re saying an insurance company might say, “Sign up for our personal health record and get a gift certificate or get a discount on your premium”?
Correct, and it has to be meaningful. I think what the research has shown, and what we seem to see, is at the individual level, you’re talking somewhere around $500-$600 a year. You’d need to see that level of impact — the consumer would need to see that, and at the family level, at least double that to $1,200 or so — to really move the dial on engagement.
So to your point, without the right level of incentive, we’re seeing use rates in the single-digit range. When we see that level of benefit impact, whether or not it’s discounts or reductions in premium or gift certificates, we can see engagement rates upwards of 50%. That seems to be the big dial that the payer has ability to control and throttle.
When they provide these incentives or whatever encouragement that form takes, how do they do that beyond “you have to complete a questionnaire”? Are there targets that encourage actual outcomes that are wellness related and not just looking at a screen?
I would say that there are probably a few health plans that have moved to outcomes. Or, I wouldn’t even say health plans. I would say more employers, that have moved toward more outcomes-based rewards model, vis-à-vis the Safeways of the world.
I think most of the market is still on “perform an activity and we will reward you.” I think that transition from activity to outcome is likely to be a 3-5-year transition, but we’re certainly beginning to see clients thinking about using more biometric results to ultimately get that, or give that reward. So, whether or not it’s some kind of annual biometrics that’s evaluating blood pressure, LDL panels, BMI — that’s certainly the early, preventive information that consumers need to know about.
More employers and providers also talk about the use of Bluetooth wireless devices that are providing more immediate or more continuous feedback on some of those key metrics versus a 12-month look at it. But I would say again, most of the market today continues to be focused on — and I say this because it’s the reality and it’s relatively still a new concept — but most of the market is paying for activities today. That activity could be, to your point, completing a HRA, participating in a program, getting the biometrics done, seeing their physicians for preventive care testing, etc.
McKesson operates a 24-hour-a-day nurse hotline. In terms of a key differentiator, what resources does that require on McKesson’s end and what infrastructure do you have in place?
We’re the company that was formerly known as AccessHealth, which was actually the first company that offered a nurse hotline to the payer market. We, today, have about 30 million lives under management that we’re providing nurse line services to.
Approximately 600 nurses is a major differentiator. I mean, it provides that human channel, and I think a number of things that we are doing to tie the offline world and online world are, for example, nurses or nutritionists or pharmacists we have available. So we think about our line as a clinical hotline, not just providing nurse recommendations for acute health problems.
The nurses reinforce getting the preventive testing. They’re able to use that information to reinforce the availability of incentives that the sponsor is offering if a member performs a certain function. A clinical staff has the ability to push content after a call to a secure message center as a reminder — could be content, could be videos.
The ability to take information from provider, member, and health plan data and make that information exposed to the nurse, and make that nurse or that clinician smarter about the member’s health. Remember when we get that data, we’re able to push content from the call center or from a telephonic interaction into an a member care plan and tie those two again, those two different worlds come together through the integration of data.
I’m interested in the data sources that the Personal Health Advisor can collect and put together for the subscriber to review.
We have core data sources as follows. It’s basic member eligibility information. It is provider linkage information of provider files, again, from the payer. Medical claim information, pharmacy claim information, HRA health risk assessment information; and biometric information. And the biometric information at this point is contained to blood pressure, BMI, validated smoking cessation smoking status, and the lipid profile.
One of the things that interested me after the e-Patient Dave fiasco at Beth Israel Deaconess was information that may be correct or meaningful for billing purposes that may not be something that a consumer should be turned loose to interpret. Is there any level of oversight or preparation to ensure that what lay people see on the site is something they won’t misinterpret?
The medical claims, I think, is where it gets dicey. What we’re doing there is all of that information is being coded. It’s being coded using the SNOMED standard terminology codes. When members see that information in their personal health record, all they need to do is basically hover over whatever detail is on the page.
Say one of the line items was diabetes. You hover over that, click on it, and it presents a consumer definition of whether or not is was a diagnosis or a procedure code. It provides a consumer again, some sort of definition associated with each of the pieces of information that are being generated by claims data.
Underlying that is that we have mapped all of our clinical reference system content, and you may be familiar with that content. That content, historically, was sold into the provider market, continues to be a strong leader in the provider market. Providers historically printed these kinds of one- to two-pagers out for their members when their members would leave the office, explaining what their upcoming procedure was or their condition is that they’ve been recently diagnosed with.
That’s how we’re handling that pure medical information.
Who do you compete with in reaching the consumer and how is your offering different?
There are two or three big competitors that we see. I think, first and foremost, is WebMD. I think what’s different about our solution than WebMD probably revolves around the point that you made earlier — the telephonic channel, in addition to just the online channel. That’s number one.
I think, secondly, I’m not sure I’ve seen a whole lot of momentum or press release around extending the channel to a mobile channel. We’ve added three capabilities to our mobile channel for PHA. One includes taking the PHR and making that available through the mobile device. Second, is a pharmacy adherence tool. Third is a messaging tool that leverages our clinical staff.
I think it’s the telephonic channel and the mobile channels that we believe are our key differentiators from a WebMD. And then we’ve got our classical health management payer/employer competitors such as OptumHealth, Health Dialog, or Healthways. But we also see ourselves competing with other services that would be competitors of A.D.A.M. I mean, those are potential partners, longer-term.
Do your offerings leverage RelayHealth’s tools?
We looked at that. We do not leverage the RelayHealth tool today, but certainly know that long term, we’re going to need to figure out — along with the rest of the industry — how do you tether this PHR closer to the doctor? I think that’s a downfall in any PHR that is not somehow associated with, tethered to, or connected to that provider’s EMR. We know that’s a challenge we’re going to have to solve in order to make that PHR ultimately more valuable to both the member and the provider.
Quite frankly, the reason we did not reevaluate that when we were first building that, and the big drawback that we could not solve with Relay, was the belief that in the markets that we were selling to, that we needed to be able to pre-populate these personal health records with some type of information in particular, given that we were focused on the payer market.
We felt that we needed to be able to pre-populate this information with claims, and I think we all are aware that there’s significant … it goes back to one of your questions about ‘why aren’t these tools used as often as they are?’ At the time, clearly one of the big feedbacks that consumers were giving around PHRs is too much time to populate that information. We wanted to remove that barrier by pre-populating, and unfortunately, Relay did not have that capability.
What tools are needed to make a difference in either improved outcomes or reduced costs?
I think we think several things. We need to continue to evolve this solution to provide tools that focus on members that are driving the spend, which typically are members with chronic disease. I believe we’re going to need to add a number of features, both through the mobile channel as well as the online channel, that focuses on members with chronic disease.
I think number two is something that we’re working on right now that would tie together the concepts of multi-source data, number one.
Number two is using this data, and then be providing very clear information as it relates to this data — where they can go to take part in programs that utilize this information and where they’re sitting on this data. So are you in range or out of range on your blood pressure or whatever? Letting the member know what the incentive opportunity is and then making it clear in a single view. What are the activities, or what are the metrics you need to get to in order to collect that measure?
This is something that we’re working on right now. We’re calling it a Health Report Card, but it’s literally, you can think of it as a stoplight report — a red, yellow, green report that is a single view, that again, pulls together all of the major sources from claims data, self-reported data, biometric data – that presents whether or not incentives and opportunity, and if an incentive is an opportunity — if the member has to do these three activities, all in a single view — I think we view that as a critical aspect as well.
Pulling together the pieces from the various tools into a single actionable view for the member, and I think ultimately, this data — because of the conversation we had — needs to be able to be accessed to the provider as well. So much of this comes down to — is the provider also focused on making sure that the member’s getting the preventative testing that they need and helping support the messages that the payer is trying to deliver to that consumer, in terms of behavior change?