Perhaps more than ever before, payers are trying to encourage lifestyle changes in their most at-risk members, sometimes bypassing providers with the opportunities of the Internet and mobile technology.
The legacies of the American health system have created some friction for the personalized health, prevention and engagement movements, but that's starting to change as self-monitoring and molecular diagnostics grow in capabilities and affordability, as Thomas Goetz, an entrepreneur-in-residence at the Robert Wood Johnson Foundation, will explain at America's Health Insurance Plans' forum in Chicago Nov. 18-20.
Goetz, a former Wired magazine editor and the author of a book called The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, leads off an afternoon of presentations on using and navigating today's technology and planning for the future, for providers and consumers, who most insurers feel compelled to engage directly regardless of the success of public insurance exchanges.
For Americans to be able to harness the power of the Internet and mobile techology, Goetz argues in his book that it's important to understand some of the main factors that motivate and incentivize people to make healthy choices.
While the development of the concept of health risks by the 65-year-old ongoing Framingham Heart Study was a huge leap forward, Goetz writes that today the "flood of warnings, research and findings make life feel like a walk through a minefield," with so many choices for unhealthy products and behavior and such complicated, sometimes contradictory health advice and advertising.
With many insurers offering some type of interventional wellness program for members with diabetes, obesity or metabolic syndrome, two crucial elements are feedback and community, Goetz argues -- much as the Stanford-developed "Better Choices, Better Health" online diabetes program has found in letting patients read or attend workshops and then share their experiences with others in a web forum.
"By paying heed to our healths and taking advantage of tools for self-monitoring, feedback and community, perhaps we can empower our own actions and skirt the disease risks that life throws at us," he writes.
Goetz also argues that people actually have to feel empowered in their health, regardless of their socioeconomic status, as demonstrated by the U.K. Whitehall Study, another landmark work of epidemiology with a number of findings worth keeping in mind for lower-income Americans now buying insurance or enrolling in Medicaid managed care.
Offering members new digital technology, risk assessment and self-management options raises some questions about bridging a line into clinical services, an issue that biotech firms are cognizant of when providing genetic tests on contract with payers, which are being integrated into some interventional wellness programs.
But as those issues in personalized health are sorted out, there's also a large space of opportunity to improve care and costs with effective IT. Among other sessions at AHIP forum is a presentation on "missing links" in interventions and disease management, by SDLC Partners, a presentation on virtual payment and automated reimbursement, by MasterCard Worldwide and Medagate, along with presentations by Accenture, Edifecs, Optum, TriZetto and Wonderbox Technologies.