Insurers Get Proactive

June 24, 2011
For several years Aetna Inc.'s MedQuery program has matched information gleaned from claims forms with clinical best-practice guidelines to offer

For several years Aetna Inc.'s MedQuery program has matched information gleaned from claims forms with clinical best-practice guidelines to offer doctors reminders about suggested tests or procedures. Now, along with a few other large insurers, Aetna is taking the next step and contacting members directly with personalized messages.

"You might be taking two drugs but your doctor may not know that you're taking a third drug, which may have interactions with the first two," explains Tina Brown-Stevenson, president of Aetna Integrated Informatics of Hartford, Conn.

With the rise of evidence-based medicine and greater computing power, health plans see an opportunity to close information gaps with their members.

"We can now run terabytes of data through an algorithm in an hour that used to take a week," Brown-Stevenson says.

Insurers are experimenting with direct member messaging to see if it can improve health outcomes and lower costs. "The model is to promote the patient's ability to take the initiative to improve their own care," says Constance Williams, M.D., associate medical director at Unicare, a subsidiary of Indianapolis-based WellPoint, Inc.

Looking for resolution

Last year, working with Resolution Health Inc. (San Jose, Calif.), Unicare completed a pilot project in Massachusetts that involved messaging 3,000 people with chronic conditions. Unicare did four mailings between November 2003 and July 2005 and nurses followed up with phone calls.

Unicare also identified a control group of 2,000 patients with chronic conditions. The conversion to alignment with best-practice guidelines among the study group was 31.8 percent, compared to 20 percent in the control group.

Williams says at first she was concerned about how members would react. "I thought it was important to provide nurses for members to talk to," she says. "When members get something out of the blue from their insurer saying they're not doing something they should or their doctor isn't, that could be upsetting.

Indeed, some insurers see messaging members as dangerous, says Alan Wright, M.D., Resolution's vice president of product strategy and business development. Wright said Resolution, which describes itself as a healthcare data analytics and intervention company, has to do some proselytizing to insurers because, "They have to be assured that the diagnosis is accurate and the phrasing of the message is just right."

Resolution works with health plans to communicate by way of print messages, e-mail if the plan makes that available, or Web portals that contain personal health information.

Aetna gets active

Aetna began its MedQuery program for physicians in October 2002 with 160,000 members and has since expanded it to 4.4 million members. To boost its internal information processing, in May 2005 it paid approximately $400 million for health data analytics company ActiveHealth.

After testing and refining the concept with a small group in 2005, Aetna rolled out its MedQuery Member Messaging in January 2006 with six large customers and about 100,000 members. Two weeks after a message is sent to a physician, if the doctor either hasn't acted upon it or indicates that the member hasn't complied with the recommendation, a message is sent directly to the member.

"We want to be seen as helpful," Brown-Stevenson says. "Not just annoying and not perceived as Big Brother."

Health plans also are eyeing other technology innovations to improve communications with members.

With the confusion surrounding Medicare Part D, several insurers have turned to automated voice messaging. Last October, for instance, Oxford Health Plans of Trumbull, Conn., began using voice technology from Burlington, Mass.-based Silverlink Communications to convey messages about the new drug benefit to approximately 85,000 eligible members.

The call is customized to the individual, says Monique Pierce, cost containment manager in the coordination of benefits group at Oxford. "Through voice recognition, we can respond to their questions using a decision tree or they can go to the Web site for more information or be transferred to a call center."

Author Information:David Raths is a freelance business writer based in Portland, Maine.

Sponsored Recommendations

Northeast Georgia Health System: Scaling Digital Transformation in a Competitive Market

Find out how Northeast Georgia Health System (NGHS) enabled digital access to achieve new patient acquisition goals in Georgia's highly competitive healthcare market.

2023 Care Access Benchmark Report for Healthcare Organizations

To manage growing consumer expectations and shrinking staff resources, forward-thinking healthcare organizations have adopted digital strategies, but recent research shows that...

Increase ROI Through AI: Unlocking Scarce Capacity & Staffing

Unlock the potential of AI to optimize capacity and staffing in healthcare. Join us on February 27th to discover how innovative AI-driven solutions can revolutionize operations...

Boosting Marketing Efficiency: A Community Healthcare Provider’s Success Story

Explore the transformative impact of data-driven insights on Baptist Health's marketing strategies. Dive into this comprehensive case study to uncover the value of leveraging ...