Obeo Health

Obeo Health featured in Gartner report

The following article is taken from the recent Gartner report – Hype Cycle for U.S. Healthcare Payers, 2016, published: 1 July 2016.

 

Smart Health Plan Selector Tools – Analysis By Constance Sjoquist


Definition:
Smart health plan selector tools apply advanced analytics, such as machine learning
and cognitive computing, to large and diverse datasets to assist consumers in shopping for a
suitable health plan based on factors such as their health risk, financial risk tolerance, current
prescriptions and physicians, and experience preferences. These tools are in contrast to simple plan
selection tools that use rule-based scoring to sort and filter health plans.

Position and Adoption Speed Justification: Smart health plan selector tools are advancing to aid individuals in picking health plans that most closely align with their personal, financial, and health risk tolerance and goals, and are being adopted in response to the increase in:

 

■ Use of enrollment portals where individuals go through the plan selection process alone — with minimal knowledge of plan designs and little human support

 

■ Number of health plan designs that individuals choose from on enrollment portals, making the decision process for individuals overwhelming

 

■ Number of employers switching to defined contribution benefit designs to cap their benefit
costs and shift costs onto individual employees, with the assumption that more choices will
make up for higher individual out-of-pocket costs

 

■ The government’s, employer’s and payer’s desire to align an individual’s health plan selection
with their health history to determine the health plan that will result in the best health outcomes
Most health plan selection tools are embryonic and not truly “smart,” but rely on decision workflows and Excel worksheets to facilitate individual plan selection. Smart health plan selector tools are often coupled with online or mobile enrollment solutions. Expect their velocity along the Hype Cycle to closely align to the velocity of private exchange technologies and other online and mobile enrollment solutions.

 

Health plan selector tools are often integrated into payer, broker or group enrollment, or private
exchange portals. The limitations of Generation 1 (rule-based) plan selector tools are triggering
Generation 2 plan selector tool development and adoption. With the addition of smart technologies, such as virtual consumer assistants and recommendation algorithms, we expect the rate of adoption of smart health plan selector tools to increase.

 

User Advice: Healthcare payer CIOs and chief marketing officers (CMOs) should understand that
there are few vendors who actually use smart technologies — the use of data analytics and
algorithms — in their health plan selector tools. Most representative vendors we listed are largely
aspirational. Look for vendors whose solutions can perform perceptual tasks — classifying large
and variant data input streams in nonobvious ways — to inform decision making at a greater depth than using only member-, payer-, provider-, or employer-specific data. By combining health and financial data with behavioral, social, demographic, and other nonhealth data, payers can expect to more closely align individual plan preferences with health outcomes.

 

Payer CIOs and CMOs should:

■ Drive awareness and quantitative analysis of the growing impact of plan selector tools on payer revenue.
■ Track emerging vendors in this space, paying special attention to evidence of their incremental
growth in efficacy compared with Generation 1 tools.
■ Assess the opportunities for internally built cognitive solutions in this market. This begins with
an inventory of the structured and unstructured data available to train against, including claims,
products, provider network, member profitability, member satisfaction, and renewal.

 

Use the data from smart health plan selection tools as early in the enrollment phase as possible —beginning with post enrollment data from current plan years. Review how well individuals were
matched to plan selection and what modifications can be made for the next enrollment cycle.
Following the member’s health journey, look for over- or underutilization of benefits, customer
complaints or confusion of how to use their benefits.

 

Business Impact: All areas of the payer are impacted by the use of smart health plan selector tools.While the decision to implement these tools may reside with sales and marketing leaders, benefits derived will be evident beyond the enrollment stage of the member life cycle, as the payer’s success depends on members who understand how to choose and use their health benefits. Smart health plan selector tools help payers provide members with the optimal health plan that addresses members’ particular health and financial interests in a way that paper- or rule-based health plan selection tools cannot.

 

By incorporating data analytics and algorithms into the plan selection process, payers can go
beyond simple workflows and lead members along an enrollment path that is more personal and
results in a more suitable health plan match. Substantial consumer value can be unlocked using
cognitive approaches to match consumers to plans that improve their health outcomes and
experience, and lower their health costs. While payers may take a near-term hit on profitability, as enlightened members choose “skinnier” plans, their value will accrue value through improved
competitiveness, sales effectiveness, and member loyalty.

 

As this space matures and tools incorporate more cognitive capabilities, payers should expect to
improve product placement for desirable members, similar to search engine optimization. Cognitive plan selector tool algorithms can be used in the aggregate to determine whether a payer or an exchange vendor’s product portfolio has an appropriate mix of appealing and beneficial products for their prospective members.

 

Benefit Rating: High

Market Penetration: Less than 1% of target audience

Maturity: Embryonic

Sample Vendors: Array Health; ConnectedHealth; Obeo Health; Picwell
Recommended Reading:

 

“Predicts 2016: U.S. Healthcare Payers Are Challenged to Become Digital Health Payers”

“Industry Vision: Mass Personalization of Consumer Healthcare Engagement”

 

Study Quantifies The Value Of Health Plan Member Engagement

Employers and health plans have long sought after a clear understanding of the benefits derived from engagement. It is widely understood that engagement results in positive business outcomes for both types of entities; however, some would argue that too much engagement is a bad thing. Regardless, few studies have been published that quantify the financial impact of engaging employees and members…until now. A new report shows the value of consumer engagement in health plans.

Through an analysis of 14 years of consumer health insights, more than a billion interactions with consumers, and an extensive amount of academic and industry research, the study revealed that health plans can generate significant short- and long-term value by engaging members in their health. In fact, the report suggests that engaging healthcare consumers can be one of the highest value activities a health plan can undertake.

According to the analysis, health plans could potentially double their net income by engaging an additional 10% of consumers with their health. “For example, a one million-member commercial health plan in the individual marketplace could produce over $130 million in new value by engaging just 10% more members. This value is comprised of key medical and administrative cost reductions and revenue increases, resulting from an array of specific actions that consumers take in response to being more engaged. The report also revealed an even higher value of engagement among Medicare Advantage ($302 per member per year) and Managed Medicaid ($157 per member per year) populations.”

The key takeaway is that small increases in engagement can have big impacts on financial outcomes. The silver lining is that most employees and health plan members are woefully disengaged, which means the opportunity to achieve small increases in engagement are certainly attainable. With 60% of human resource leaders viewing wellness as an engagement tool and health plans focusing on engaging members in wellness, technologies and solutions that can engage users effectively and affordably will be highly valuable to these entities.

It is also important to note that this analysis considers a broad range of benefits that result from engagement. Traditionally, employers and health plans tried to constrict the gains from engagement through an analysis of hard savings, or return on investment (ROI), rather than considering all the benefits, often referred to as value on investment (VOI). Employers are beginning to shift their perspective to VOI as noted by a survey suggesting the majority of employers now consider VOI.

This post has been reproduced from the Wellable Blog.

A generic drug strategy is essential for cost savings

Generic drugs are an essential part of any solution to sustaining our health system and are central to efforts that increase patient access and generate savings for patients, taxpayers, employers, payers, providers and others.

Nearly 3.8 billion of the total 4.3 billion prescriptions dispensed in the U.S. in 2014 were filled using generic drugs. This means that generic drugs now account for nearly nine out of every 10 (88%) prescriptions dispensed in the United States. Yet generic prescriptions account for only 28% of total drug spending. Generic drugs were responsible for $254 billion in health system savings in 2014, bringing the total savings over the last 10 years to $1.68 trillion. Generic drug manufacturers can proudly point to a legacy of savings and access that brings expensive treatments within reach for millions of people. It is important to note that savings are growing and are expected to continue to grow.

• The 2014 Express Scripts Drug Trend Report shows that SINCE 2008, THE PRICE OF BRAND DRUGS HAS ALMOST DOUBLED but the PRICE OF GENERIC DRUGS HAS BEEN CUT ROUGHLY IN HALF.

• A May 2015 report from AARP notes that RETAIL PRICES FOR GENERIC DRUGS FELL AN AVERAGE OF 4% IN 2013, marking nearly a decade of consecutive years of decreasing generic drug costs. That report also notes that 73% OF GENERIC DRUGS in the study EXPERIENCED PRICE DECREASES.

• An August 2015 Drug Channels blog noted that in the SECOND QUARTER OF 2015 ALMOST HALF (44%) OF GENERIC DRUGS EXPERIENCED A DECLINE IN COST.

As an employer in the ‘self-insured’ space it is essential to adopt a comprehensive strategy with respect to the use of generic drugs. This involves providing education on this topic for employees and suggesting generic alternatives. Having access to prescribing data can be used to assess generic usage and illustrate possible cost savings. For more information on this topic please contact a team member at Obeo Health.

Why we started Obeo Health

Welcome to the Obeo Health blog! Obeo Health was created to enable better healthcare decisions. We’re passionate about bringing much-needed transparency to the healthcare choices employees make and transforming the whole experience for consumers and employers alike.

Healthcare choices often leave consumers feeling disempowered and frustrated. Every step can be confusing and almost every encounter within the sector is completely opaque. Employees struggle to choose the health plan that is best for them from both a coverage and cost perspective – often leaving their health plan selection unchanged from year to year because of the lack of information and clarity. Making sense of doctor, insurance and hospital bills is a nightmare. Navigating the system with a chronic disease or serious medical condition can be incredibly overwhelming, taking away from what people should be focused on – their health.

Our founder and CEO, Naveen Saxena, the former CTO of Castlight Health, the groundbreaking enterprise healthcare cloud company, met Adrian Rawlinson, MD, who shared the same concerns about the healthcare system from the perspective of a practicing physician. Many of his patients were struggling to understand their bills; unclear on the jargon; didn’t understand what was or wasn’t covered; and had no idea how much they were actually paying for procedures. Together they recognized the need and opportunity to transform the experience and enable greater engagement and understanding of healthcare choices. During a long meeting in a coffee shop, they discussed all of the issues around lack of transparency, costs of procedures and how people make choices and learn about costs. They recognized with the lack of transparency also comes a great amount of fraud, waste and abuse in the system.

At the same time that the team at Obeo were developing their idea, the healthcare landscape was changing rapidly.  The Affordable Care Act was signed into law and employers were shifting to high-deductible health plans (HDHPs). HDHPs combined with an HSA (tax deductible health savings account) have the potential to be very advantageous to both the employer and the employee. However, the concept of an HDHP is often hard to grasp and the systems in place to explain HDHPs and HSAs to employees during open enrollment were sorely lacking. This underscored the need for tools to increase employee engagement and understanding of complex healthcare choices.

By creating radically simple tools with a strong focus on user experience, Obeo Health has found a way to empower consumers to make better healthcare decisions while at the same time lowering costs for everyone. The team is made up of a diverse group of individuals bringing together experts in clinical medicine, insurance, data science and user experience who are committed to opening up better transparency in healthcare.

Contact us to learn more about how Obeo Health can help your organization increase employee engagement in healthcare decisions and lower costs for everyone.