Udvarhelyi discusses how Blue Cross Blue Shield is enabling patient-driven care by looking at three key questions.
Key Takeaways: Patients have been demanding better and easier ways to navigate care and large plans are beginning to make big moves to address these concerns and bring about better care.
By Michaela Katz
Blue Cross Blue Shield Louisiana is working to deploy artificial intelligence, combined with benefits plan incentives, to shape a better customer experience for its members.
“We’ve developed a series of iterative predictive models using machine-learning, AI tools,” said Steve Udvarhelyi, President & CEO of Blue Cross and Blue Shield of Louisiana in an interview at the Health Evolution Summit. “We’re seeing results from trying to focus on a subset of people that meet two or three different criteria.”
Udvarhelyi explained the three questions the payer started with when designing the AI.
First, “Who is at high risk for events that you’d like to avoid?” said Udvarhelyi.
Although this first step sounds simple, it cannot be done blindly or without further analysis after initial identification of at-risk patients because there is a subset of people who are high-risk but there is little that can be done to decrease their risk levels.
Patients on dialysis, for example, are typically high risk but, “it’s very hard to get them off of dialysis unless you transplant them,” explained Udvarhelyi. “That’s an example of a high-risk person you can’t do much about.”
Second, “What can you identify that’s modifiable either by intervention from the physician or the care team, or a behavior change on the part of the patient?” he added.
Third, “How do you identify the individual characteristics of a person that make them more likely to engage with you to change?” Udvarhelyi said.
Blue Cross and Blue Shield of Louisiana is seeing success with this method of AI to enhance consumer-driven care and yield better outcomes.
“We find that if we really focus on a small number of people who are high risk, have modifiable factors and are likely to engage, we can make very significant improvements on a population basis,” said Udvarhelyi “We run that on daily and each day it’s a different group of people.”
Blue Cross and Blue Shield of Louisiana is just one organization working in this space but there are a number of others making strides toward aligning incentives and driving consumer-driven care.
“We need to be smarter as an industry,” Udvarhelyi said. “Those of us that are providing incentives to patients through benefit design and other things need to do it in a more precise and thoughtful way and understand how to incentivize and reward the behaviors that we want.”
GE Ventures former CEO Sue Siegel and Section 32 Managing Partner Mike Pellini discuss the four aspects of health care coming together to advance diagnostics in ways never before possible.
Key Takeaways: Diagnostics in health care have historically fallen short compared to other sectors in terms of both spending and research. However, increased demands regarding personalized medicine, predictive measures and early identification of disease are pushing the industry to enable new breakthroughs in diagnostic science.
By Michaela Katz
Today, there is a huge disconnect between diagnostic spending and the health care industry’s reliance on the tools and findings. At the same time it’s becoming increasingly clear that diagnostics will only become more important, if not strategic, in the massive shift toward value-based care.
“Two percent of the spend goes toward diagnostics — and it fuels 70% of the spend on the decisions made from it,” said Sue Siegel, CEO of GE Ventures and Chief Innovation Officer of GE in an interview at the Health Evolution Summit.
This balance clearly doesn’t make sense but, fortunately, things are beginning to change.
“Diagnostics used to be about the today, and diagnosing disease, and now we’re moving into a world where it’s all about potentially diagnosing something…where there might be no action ability, or prediction. And there’s power to that,” Siegel noted.
What’s driving this opportunity to make diagnostics a more valuable part of the equation?
“There’s an emergence of data, the utilization of data, the mining of data in a way that we’ve never really been able to do until this point in time,” said Mike Pellini, MD, Managing Partner of Section 32 and Chairman of Foundation Medicine in the same interview.
Data is just one piece of the equation. Another is the emerging technology that enables new capabilities every day and not just for diagnostics or health care but for every industry.
“We have data, we have technology, we have diagnostics and we have therapeutics, and all four of these pieces are coming together in a way that we’ve never seen in our lifetimes or, frankly, anyone’s lifetimes,” continued Pellini.
It is clear that acknowledging the value of and increasing investment into diagnostics will have a large impact. This increased emphasis will allow for the application of predictive analytics, will decrease spending for unnecessary treatments and lead to earlier and better treatments of serious and life-threatening diseases.
Beyond its impact in the clinical setting, diagnostics will have far-reaching effects in areas key to the changing health care ecosystem.
“Diagnostics drives personalized medicine,” Pellini said. “Diagnostics are the linchpin to success in personalized medicine. Diagnostics are the linchpin to even value-based care.”
Siegel emphasized the importance of the potential role of diagnostics in achieving value-based care, “With the change into fee for value and what’s happening in the health care system, diagnostics has to play a role that is much more powerful than it’s had a chance to play in the past.”
Health Evolution, with the support of Echo Health Ventures and Humana, convened its annual Corporate Venture Group (CVG) meeting in April 2019. A key outcome was the development of strawman Health Evolution CVC Performance Indices leveraging insights and viewpoints of CVG participants.
Feinberg said the transformation will require a new business model that does not involve ads or targeting individuals for health care services the way Google’s other businesses do today.
Key Takeaways: Feinberg joined Google because of its ability to reach billions of people. Achieving that and fixing the fundamental problems in health care, however, will require a new mindset of the company.
By Michaela Katz
When former Geisinger CEO David Feinberg, MD, left the health system to join Google, he was attracted to the company’s broad reach and the ways that can be leveraged to make more people healthier.
“There’s a fundamental problem in our health system,” said David Feinberg, MD, VP of Google Health in an interview at the Health Evolution Summit. “It’s a system that’s designed around providers. It’s designed around doctors and nurses and hospitals. Every other service industry is derived around consumers.”
It is time that companies in health care begin rebuilding the system and focusing on patient experience. But what is Google doing in the health care industry?
To some, it might seem like an odd pairing but, Feinberg said it’s a natural association. “Whether we call ourselves a new entrant or not, I think we’re already there when we look at the millions and millions of people that do a Google search for health care every day. When we look at the percentage of patients that go to Google 24 hours before any ER visit, it’s a huge number. So, we are in health care.”
Although Google may be in health care, Feinberg is hoping that he can make Google healthier. “I’m trying to turn Google totally into a health care company.”
Not surprisingly, Google as a health care company will be a completely different business model than what exists today.
“As we roll out what we think we’re going to do in the health care space, there will be no ads; there will be no targeting you as a customer,” Feinberg said. “If you’re giving us personal information, we want to have a very, very strong and easy way for you to say, ‘Okay, I’ve changed my mind. I want to pull that back.’”
At its core, Google’s impact in health will be its existing ability to reach people at scale.
Feinberg, who recently started at Google after a successful tenure as Geisinger CEO, noted the company’s large reach as something that excited him about working with Google — particularly being able to reach billions of people and treat them the way he would patients.
Feinberg added that Google’s foray into health care will bring a different type of health to people. “People actually don’t want health. They want their life to be such that they don’t have to ever worry about their health so they can get on with their life. That’s being helpful in peoples’ lives.”
Mark Ganz on making consumer needs a company priority and what that means at Cambia.
Key Takeaways: Across the health care industry, companies are working to better address consumer needs and create a better experience. This focus on the customer is pushing for personalized health care experiences, better stewardship of patient data and addressing consumer needs before they arise.
By Michaela Katz
Consumers are increasingly demanding a better health care experience—one that matches the consumer-focused aspects of other industries, notably retail. As such, it is crucial that health systems and plans understand the importance of making consumer-driven changes.
“When I became CEO I couldn’t believe how out of step health care was with all other aspects of my life and the lives of the people we serve,” said Cambia CEO Mark Ganz in an interview at the Health Evolution Summit. “You would think something that was so personal and so important would be the most consumer-focused industry. And yet, it’s the least.”
But what does it mean to be consumer-focused in health care?
There’s not one correct answer. Generally, however, it includes efforts to make health care a better, easier to understand experience for each individual and put the consumer at the center.
“It’s all about personalizing the experience and recognizing that when you talk about populations in healthcare, N equals 1. Or 1 plus the caregivers and family around them,” said Ganz. “People don’t want to be told what to do. They want to be offered options.”
Another big consideration in the push to consumer-focused health care is the use of patient data. Many organizations currently act as if once data is collected patients relinquish control of their data. If anything, the opposite is true.
“We are stewards of their data and everything we do needs to be built around how does that data flow to them and with them when they go on their journey,” said Ganz.
Ganz added that Cambia is making strides in its efforts to radically focus on the consumer, but its journey isn’t done and, it won’t be done alone, which is why the company partnered with Blue Cross and Blue Shield of North Carolina earlier this year to improve patient experience.
“There’s an alignment of values and vision and we both want to change the world,” said Ganz. “I think what we can do for consumers together versus what we could do separately is very, very compelling.”