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Participatory Medicine Meets Participatory Design

Most times when the word “participatory” enters my lexicon it is closely followed by the word “medicine”.  I’m a fan of participatory medicine.  If you don’t believe me, then you can look here, or here, or here for written proof.

Participatory medicine is a care model in where the role of the patient is active, enabled, and emphasized.  Participatory medicine requires the “mindful” inclusion of the patient in the care delivery process.  When you see online patient communities forming, then you see participatory medicine at work.  You will also witness shared decision making, patient participation on the treatment team, and evidence based patient choice.  The director of the U.S. National Institutes of Health has been quoted as saying:

As opposed to the doctor-centric, curative model of the past, the future is going to be patient-centric and proactive. It must be based on education and communication.

These are the types of sentiments that make someone like me very happy.  The fact that I get to play a role, even though quite small, in this movement is the kind of intrinsic motivator that gets me up each day happy to do my work in Connected Health.

hands-raised-participateIn Connected Health we design technologies meant for patient engagement.  They are the communication lines that extend outside of the eight minute patient visit and into the lives of patients wherever they are when healthful decision making counts.  As a result, another participatory term set is beginning to exit my mouth more frequently.  That is, namely, participatory design.  Participatory design, also known as cooperative design, emphasizes active inclusion of all stakeholders, even those that do not know how to use Photoshop, in the design process.  Key to this end is the end user.  In our case that means the patient.  By using participatory design, we are able to create environments that are more responsive and appropriate to a patient’s cultural, emotional, spiritual and practical needs. User empowerment is built into the core of this process.

So, what if patients were crowd-sourced more regularly to solve all of those challenging patient engagement issues?  For example, many of the biggest challenges I see on provider websites occur because it is challenging for an employee of a health system, the ones actually making the final decisions, to release their mind from the confines of their day job.  This usually means that the content of the public website is architected in the way that employees see the organization: by department or facility.  Problem is, this gets in the way of patients trying to find the information they need to be more healthful.  Patients shouldn’t have to navigate 5 layers deep to find content specific to their condition or health concern.  Patients won’t work that hard.  Instead, the hub of digital patient engagement should have, at its core, the patient user experience.

Not being new to the public website creation rodeo, I’ve found the process and final product to be greatly improved through the addition of patient voices throughout the entire website design process.  I’ve never met two patient populations that are the same, so while there is general advice on tailoring a message to patient needs, insight should always be collected from the target market in question.  This insight informs the nuts and bolts of information architecture and the engagement of graphic design.

As a result, a one and done approach to patient feedback is good.  An iterative approach to patient feedback on site design is better.  Co-designing a site with patients?  I would love to see that on every provider website.  By using participatory design to reach out to patients in the beginning of the relationship, with the website that engenders a culture of participation, then it makes it that much easier for that participation to be embedded throughout the entire collaborative care model.

The Social Support Group Coming to a Provider Near You

What are the benefits of online patient communities?

I find myself answering this question quite a bit lately.  It struck me this week that I have never answered this question on the blog.  But, first things first, what is an online patient community?  Online patient communities are, essentially, condition specific socially enabled support groups.  These networks provide patients with an opportunity to connect with those that are experiencing similar challenges.  Together this collective of voices provides helpful discussion and the sharing of resources.  By their very nature, their benefits are many.  However, when they are organized by a trusted authority in care, namely healthcare providers, the benefits grow quite dramatically.


So, here is my list of the benefits of online patient communities.  Have any more to share?  I’d love to hear more from your experiences in the comments section below.

  • Social provides connections to those that are not mobile.  Let’s just be honest, appointment scheduling conflicts and transportation difficulties are typically a part of the patient experience.  It is oftentimes the case that patients and patients-by-proxy (caregivers) cannot physically attend a support group.  Any opportunity to lift barriers during the course of treatment is a welcomed reprieve from everyday turmoil.
  • Patients-by-proxy are more likely to open up.   According to Pew research, while 33% of patients participate in online patient communities, more than half of patients-by-proxy do so.    In that same survey, 34% of these caregivers actively read patient commentary about a specific medical issue online and 22% of those caregivers actively reach out to those that might have similar concerns.
  • Online patient communities provide support without bounds. Social networks are used, quite frequently, by the retail and consumer goods industries for consumer outreach purposes.  I don’t know of a loyalty program  stronger than one that could be used to save lives.     Social communities are a fabric of ties that lead to sources of support, information, and collective experience.  The goal of these communities is to foster communication between those without knowledge and experience to those that can “mentor” and provide support.  More informed patients are healthier patients.  Some of the tangential benefits of this enablement include: 1) Better understanding of health and medical conditions, 2) Improved recall of the care plan, 3) Feeling more in control of care, 4) Taking better care of themselves, and 5) Better adherence to medications as prescribed.

There are some additional benefits for the healthcare provider as well:

  • Better sample groups mean better research.  For those researchers aimed at helping through analysis, online patient community demographics are actually a more accurate representative sample of a given patient population than can be found in a traditional support group.  There are two studies that back this claim up.   One study looked at an online patient community specific to scoliosis.  Researchers found that the members of this community had similar demographics to the scoliosis population as a whole.   Another insight is taken from the fibromyalgia group on PatientsLikeMe that showed this group to be representative of those with that condition at large.  Why is this?  Breaking down geographic boundaries is a great way to also break down the socioeconomic and cultural chasms that often exist in traditional groups.
  • Time efficiencies in group care. Check out any online patient community and just underneath the surface you will find the voice of the members mentioning that they were unable to get the medical information they needed from their clinician.  So, these patients often turn to Dr. Google.  Using these communities, clinicians can provide accurate information is a mass customized format to an entire community of similar patients.  This is particularly helpful in those instances when new information or alerts need to be provided to the entire population at one time
  • Strengthens the partnership between patient and provider.  Let’s just be honest, a typical physician schedule does not often leave time for participating in support groups.  With a provider sponsored online patient community, a clinician, in the form of the community manager, is on call 24/7.  Provider sponsored clinicians that act as patient advocates to address general and condition specific questions to the entire community are a valuable asset.  Many clinicians are surprised at how different the questions patients will ask in online patient communities are from those they will ask in the doctor’s office.  For example, migraine patients will often ask Dr. Google “will I die from this?” while physicians rarely if ever hear that question in the office.
  • Social synchronization with care protocols.  When these social features are enabled through the patient portal, patients become truly enabled with knowledge.  There, within a single view, patients can take their new found knowledge and then apply that knowledge to their care protocols.  This experience can be taken a step further through gamifying that experience.  For more information, please check out “Healthcare Gamification: Is it time for Physicians to prescribe gaming to patients?” and “Beyond Gamification: Revolutionizing Healthcare with the Quanitifed Self“.

Getting Scientific About Healthcare Social Media: Medicinal Sites

© elkor 2009The journey into the (officially scientific) exploration of healthcare social media would not be complete without a look into the realm of healthcare specific networking sites that I’ll playfully call “medicinal sites.”  These are closed sites that are aimed exclusively for those with either a certain designation or disease state.

In today’s lineup, we will explore two specific sites.  One of these sites is meant for physicians and the other is meant for patients.


Although Doximity was not mentioned in the University of British of Columbia study that spawned this blog series, I am going to start here for good reason.  Although they are a relative newcomer to the space,  Doximity has experienced very strong growth.  Last year Doximity doubled their network to a total of 250,000 members, which is 25% of all physicians in the US.  What I find fascinating about Doximity is that it was started by the AMA.  It’s oftentimes the case that, in the David vs. Goliath world of social media, hip start ups are the ones that people want to follow.  The AMA now finds themselves in a situation where they have more users of their social network than they do actual members.

Doximity does a few things right.  It’s most popular features, beyond making upgrades that make the user interface more like Facebook or LinkedIn, include:

  • An API that enables “Facebook Connect” for easy authentication
  • A built in recruiting tool called Talent Finder
  • A continuing medical education (CME) platform
  • A “digital fax line” that allows physicians to receive their faxes (I know…don’t get me started) through their network via a personal fax number


PatientsLikeMe is a site where e-patients can collaborate with one another in a peer-to-peer supportive setting.  The site was launched in 2004 by the family members of an architect that contracted amyotrophic lateral sclerosis (ALS) at the age of 29.  They had originally raised millions, literally, in a failed attempt to find a cure for ALS.  They also created this patient social network to go along with that effort.

PatientsLikeMe now has over 200,000 members with groups for approximately 1,800 disease states. The most popular networks are neurological diseases such as ALS, multiple sclerosis and Parkinson’s, but there has been growth in members with HIV/AIDs and mood disorders like anxiety and depression.  Cancer, with its numerous subtypes, has been a more challenging group to tackle.  I have found that these subtypes often form their own online patient communities.  You can find a list of these on e-Patient Dave’s website, which I definitely recommend you visit if you want to learn more about how patients are using social in life altering ways.

One of the most incredible things about PatientsLikeMe is not as obvious.  Let’s consider a typical patient journey: we get sick, we go to the doctor, the doctor captures data during that visit including family history, bloodwork, scans, biopsies, etc.  Then there is the follow up appointment.  Perhaps a follow up call by a nurse.  But as I often say, that’s only 1% of the story.  It is the other 99% of the time when that patient is out there in the real world that matters a lot.  So, where do we get all of that data that takes place during the “meantime”.   PatientsLikeMe is often heralded as the producer of the most compelling clinical data the health care industry has ever seen for this reason.

As compelling as this data may be, it’s only a speck of sand on the beach.  There is far better data capture to be had by socially integrating patient and physician in a meaningful way.  This takes me back.  Way back.  To a post I actually wrote in 2011.  What I said then will be where I end here today:

“Patients are online.  Physicians are online.  However, these two groups are running in different social circles…this presents a true medical problem.”

Getting Scientific About Healthcare Social Media: Social Networks

shutterstock_126905108Thus far we have covered both blogs and microblogs as we walk through the official scientific study that was completed by the University of British Columbia on the uses of social media in medicine and healthcare.  Today we move into the wide world of social networks.  Ask ten people in the know to define what a social network actually is, and you will get as many answers.  The study provides a legitimate definition as follows:

Social networking sites are defined as Web-browser and smartphone accessible services that allow users to create social connections in a public or semi-public form (through the use of profiles) in order to share information updates with other site users.

Today we will focus on a current leader in social networks:


Here are some fancy facts on some pretty neat uses of social networking sites in the practice of medicine and healthcare:

  • Researchers found that most common type of groups on Facebook were peer-to-peer networks centered on specific medical conditions These groups fall into four broad categories including:  1) fundraising, 2) awareness, 3) marketing, an 4) general support
  • Researchers often join these groups as a means of disseminating information.
  • With the good come the bad.  While there are plentiful examples of epatients using online patient communities to support one another through illness, there are also a select few that self-aggregate in “negative-behavior support groups”, which are typically focused on the promotion of alcohol consumption.
  • Here’s an idea I’d love to import.  In Taiwan a well-known emergency physician blogger created a public group on the topic of improving patient wait times in the ER. The group went viral in less than a month.  A majority of emergency department staff from around Taiwan joined the group and commented.  The group got so much attention that the Minister of Health and his staff joined the group and commented directly.  As a result, the minister began making visits to ERs in ten different cities with a promise to improve funding to reduce wait times in collaboration with the Taiwanese Bureau of National Health Insurance.

One of the great features of social networks like Facebook, which have yet to be used much in healthcare are third-party applications.  Here we integrate application programming interfaces (APIs) into Facebook.  This allows outside software and data to be visualized and tied directly to the social network.  Candy Crush is likely the most popular third-party application at this time if I had to wager.  We have a long way to go until health apps are actually helpful in Facebook.  In fact, less than 30% of listed applications in the health category are real.  The rest are spam.  Of the ones that do exist, many focus on weight loss, smoking cessation, fundraising, and health education on specific conditions.  From what I can tell those are dwindling.  In fact, of the three mentioned in the study, only one still exists.

  • Get Up and Move: (no longer exists) allows users to challenge their friends to engage in physical activity and report on it after they have completed it
  • START: (no longer exists) Brought to you by the American Heart Association, this app allows users to answer questionnaires on the topic of cardiovascular health and upload the data to a health portal
  • HealthSeeker: this is a diabetes app that provides health education and the ability to win points as an incentive

In an attempt to reach as many people as possible all at once, social networks are no longer the “up and coming” medium.  They are the “here and now”.  There are many ways that Facebook is being used in medicine and healthcare, and there are still much open opportunity.


Getting Scientific About Healthcare Social Media: Microblogs

hashtag3-ccIn this blog series, we are highlighting the social media categories presented in “Social Media: A Review and Tutorial of Applications in  Medicine and Health Care.”  This was a study conducted by the University of British Columbia, which offers an extensive digest of the vast uses of social in medicine and healthcare.  Today we’re going to talk about the emergence of Twitter as an important communication medium in this industry.

The study correctly titles Twitter as a “microblog.”  With microblogs, we take many of the same concepts found in my previous post about blogging, namely community and collaboration, and we widdle them down to 140 characters or less.  Twitter is that place where communities of people that are interested in a similar topic, be that interoperability or Oscar night, digest a lot of information quickly together.  I rely on Twitter heavily to keep me up to date on everything related to #hitsm (health it), #hcsm (healthcare social media), #mhealth (mobile health) and #connectedhealth (I’m sure you’ve got that one without need of assistance).

The study gets extra points for classifying three broad categories of tweeting styles:

  • Substantive Tweets: a tweet that is independently understandable (e.g.,  title of a paper or blog, a brief comment, and a link to the publication)
  • Conversational Tweets: fragments of a new or ongoing conversation that draw on professional or personal interests or comment on current events. (e.g., there is no greater example of this than the Twitter discussion at HIMSS (#HIMSS14)
  • Hybrid Tweets: substantive and conversational at the same time (e.g., “let’s discuss patient engagement tonight at Sidewinder Coffee”)

According to the study, there have been over 140 documented uses of Twitter.  I’ve not met the person that is actually documenting these uses, but some favorite examples include:

  • The Pennsylvania State College of Medicine has used Twitter to augment peer-to-peer and instructor-to-student learning by stimulating topic discussions, providing feedback on critical thinking, conducting course evaluations, disseminating writing prompts, soliciting class responses, and monitoring student progress.
  • A junior doctor and a medical student started a Twitter Journal Club that functions in the same manner as traditional journal clubs, except that the means for discussion is Twitter. By using a combination of blog posts, where the paper and discussion questions are posted in advance, along with the hashtag #TwitJC, students, doctors, and anyone interested in the subject can engage and interact in a meaningful way.
  • Live tweeting surgeries and medical procedures.  Henry Ford Medical Center was the first to live tweet a surgery back in 2009.  Swedish Medical Center in Seattle has used this tactic very successfully.  One notable example was an overnight tweet up they did on sleep disorders.  Those impacted by sleep problems were able to watch what happens during a sleep study.

As mentioned above, the use of Twitter at conferences is powerful. Not the least of these examples is taking place this week in Orlando at the HIMSS conference.  At these conferences, Twitter is used to enhance learning through real-time interaction.  See for yourself by following the #HIMSS14 thread.

Getting Scientific about Healthcare Social Media: Blogs


Earlier this month, I happened upon an actual scientific study of the use of social media in medicine and healthcare conducted by researchers at the University of British Columbia.  The study was fraught with terms such as “positivistic epistemologies” and “critical-interpretivist theory” to add the requisite ambiance one finds in such studies. All kidding aside, I did find the study to be a great singular digest for how healthcare is using social.  However, while the study provided a good written history on each facet of social media, it did not go as far as to provide advice on the most effective uses of social.  This is where I’ll step in.

In this series, I will share some interesting tidbits found within the study for each category.  I’ll also highlight recommendations for the correct tactical use of these mediums.  We start with:


The study defines blogs as “communal websites where opinions on any number of topics are voiced to create communal, collaborative dialogues.”  I really love this definition because it relies heavily on the terms “community” and “collaboration.” The general direction of this definition towards the “we” and away from the “me” points us to one of the main mistakes healthcare bloggers tend to make, which we will discuss further below.

As mentioned in the study, these are the most common hospital uses of blogs:

  1. advertise facilities
  2. share positive patient experiences
  3. feature well-known physicians who treat celebrities
  4. disseminate disease-specific information for patient education

If I had it my way, tactic #1 would largely go away, and 2 and 3 would be used with great precision.  Since blogs are about communities and collaboration, there is very little room for those that wish to crow about themselves endlessly.  Treating a blog like a media room, where press releases are repurposed for web, is not the way to go.  A person or organization should generally not talk about themselves in first person (or third person for that matter).  Instead it is about disseminating information that your intended community would find useful.  For healthcare organizations, one of my favorite topics is preventative medicine, which highlights all of the small things patients can do to make a big difference in their overall health.

There are only a few instances where healthcare organizations have been “self focused” successfully.  This is typically done through sharing positive patient experiences.  Yet, again, the organization is not talking about themselves.  They are sharing the journey a patient has had through illness or wellness and sharing that with others that may find this information helpful.  As a result, I feel that sharing patient experiences is very much in line with disseminating healthcare information to an interested community.   Here are two of my favorites:

Henry Ford: Gail’s Video Blog

There have been a few healthcare organizations that have been successful at recruiting patient guest bloggers.  Henry Ford’s blog for their Bariatric Center is one of my favorites.  On this blog, Gail records her bariatric surgery journey over the course of a few months.  Blogs like this are great because there is no sharper lens for viewing the true patient experience than through the eyes of the patients themselves.

Mayo Clinic’s Piano Foyer Video

This one was quite a viral social media accident (as most things that go viral in social media are).  An orchestra had performed within the Mayo Clinic atrium, but weren’t scheduled to retrieve the piano until a day or two later.  Enter Fran and Marlow Cowan, who were visiting Mayo Clinic as patients from Ohio.  There they found this grand piano sitting by its lonesome and decided to do something about it.  Jodi Hume, another guest seated in the atrium at the time, found the pair so entertaining that she recorded them and uploaded that video to YouTube.

To date the video has been viewed almost 10 million times, and Mayo Clinic’s name is right there in the title for all to see.  Mayo Clinic has since asked the couple to return for a second performance, which can be viewed here:

Any questions on blogging?  I’d be happy to answer them in the comments section below.

App Annie Ranks #mHealth

app_annieFrom the fun-loving portal chap that brought us Find a Provider tools that don’t make babies cry (read: Mark Polly), I bring to you a ranking of Mobile Health apps by App Annie.  App Annie a ranking app that uses app store analytics and market intelligence to rank and visualize an app’s download, revenue, ranking, and review data.

But first some mobile health statistics:

  • 91% of US adults have adopted mobile technology (Source: Pew study)
  • 91% of adults keep their phones within arms reach 24/7 (Source: LeadersWest)
  • 75% of US adults even bring their phones to the bathroom (Source: Digiday, 2013)

As you can see, people really like their cellphones.  This love has brought us a bounty of mobile applications, and healthcare is no exception.  Here, I have listed for you, a ranking of those mobile health apps brought to you by App Annie.

Health & Living

Here we are looking at just Heath and Fitness.  Health insurance companies have been investing a great deal in this space for good reason.  As you can see, there are four large health plans that show up in the top 100 apps.  Who else is ranked in the top 50?  Think apps like Nike Fitness Club, Weight Watchers, Fitbit, Period Tracker, Baby Bump, and White Noise Lite.

Screen Shot 2014-02-11 at 2.57.56 PM



Switching over to the medical category we, not surprisingly, have Epic’s MyChart ranked #4, which is primarily charged by all of their healthcare provider customers that offer the MyChart app to their patients.  As shown below, the Mayo Clinic shows up at 106. There are 105 other medical apps more popular that the venerable Mayo Clinic.  These apps include WeedMaps, FRWeed, Epocrates.

Screen Shot 2014-02-11 at 3.02.56 PM


Other applications that are ranked higher in this category include:

  • #201: Novant Health
  • #369: Cleveland Clinic Today
  • #730: Spectrum Health
  • #818: Florida Hopsital ER Wait

The Bottom Line

So, what does this mean for hospitals and health plans considering mobile apps?  If you are a health plan, then you likely need a mobile app in order to take advantage of location services for pharmacy, find a provider, etc.  If you are a major health system, then you can also leverage the large number of potential users by providing a mobile application.  Others might consider specialized mobile applications that are specific to tasks like requesting appointments, refills, location based facility mapping, or information on specific diseases or chronic conditions.  With all of the data pouring in on the success of text messaging programs for health, you should be looking into these programs as well.

Virtual Ideation Sure Beats a Conference Call

globe-bulbBeing a consulting firm, here at Perficient we have a “live anywhere, work anywhere” culture.  What that means, essentially, is that while I live in Cincinnati, the colleagues that I work with daily live in places like Chicago, Phoenix, Atlanta, Houston…the list goes on and on.  Add to that all of the places we travel to work with clients, and you can bet that if there is a metropolitan area in this country, then there will be a critical mass of Perficient employees located there.

Since my coworkers are spread across this country, on a day-to-day basis I take part in a bunch of conference calls that span three different timezones.  As a result, this made viewing the video “A Conference Call in Real Life” the funniest thing I have viewed so far this year.

With the sounds of coworkers caught in tunnels and barking dogs dancing in my head,  I was quite happy to attend a session by Merck on Virtual Ideation during the IBM Connect conference in Orlando.  Like any company in life sciences, Merck is a company that grows based on ideas that spur innovation.  Without those ideas, Merck cannot compete effectively in their marketplace.  As a result, it behooves Merck to invest in better ways to ignite ideation in a global economy riddled with the dreaded conference call.

These facts behind them, Merck realized that a virtual collaborative ideation approach would be a major competitive advantage.  To make virtual ideation a reality, Merck leveraged the strength of virtual community engagement to effectively cover selected research topics in breath and depth using the Lab of the Future.  The virtual event concept IdeaBoost was used to activate and tap into the collective intelligence of a worldwide community within the confines of a four day virtual ideation event.  I’ve seen unstructured enterprise social collaboration become a powerful tool for healthcare organizations across the country.  Where IdeaBoost differs from traditional enterprise social is in the structure placed around it.  IdeaBoost essentially combines enterprise social with a pre-determined timeframe combined with effective moderation and analysis.

How do you push breakthrough thinking? 

IdeaBoost has three phases, which include:

  • Set the Scene: Making virtual ideation a success requires a great deal of prep work.  Merck conducted a “mega trend analysis” and recorded interviews with industry experts and customers in order to create a “springboard” towards new business opportunities.  Participants of IdeaBoost were able to take in this information in the days and weeks leading up to the event.
  • Identify & Refine Opportunities: This is where all of the voices that spur innovation collected together using social collaboration technology.   Merck had a total of 300 people “attending” the virtual ideation event.   In order to organize and make true meaning of this large collaboration effort, Merck had 3 moderators available for each IdeaBoost theme.  These moderators were behind the scenes helping shepard dialogue into complete ideas. Moderators were expected to commit to 3 x 1.5 hour training sessions, complete their individual preparation, and then moderate the four day event.  Merck found it effective to have all moderators in the same room during the four day event.  The closest example I can think of to these moderators would be the moderators of tweet chats.  If you would like to see one up close and personal, then please attend the weekly #HITsm (healthcare IT social media) tweet chat that takes place every Friday at noon Eastern.  Message me on Twitter if you’ve never tweet chatted before, and I’d be happy to show you the ropes.
  • Evaluate Opportunities: After the four day virtual ideation event was over, a team of Merck analysts combed through the “catalogue of ideas” to get a better sense of the true number of possible outcomes.  They combined this with market research to evaluate the size of the opportunity with a probability of success.  In a force ranked order, each idea was given an action plan.

Ultimately, this catalogue of ideas was then fed into R&D to create products that Merck can bring to the market.  Merck also learned through the IdeaBoost process that virtual ideation wasn’t just about getting ideas.  Through this process, Merck employees were able to learn what working socially really means.  They immediately found value from enterprise social in their daily work through learning together and understanding the knowledge across the organization.  It was shown to be an “eye opening” experience for the 300 individuals participating in the event.

Merck simply reinforced the notion that diversity fosters creativity.  Using enterprise social, when you bring diverse groups together ideas will naturally flow into the every day life of your organization.

Connected Health Trend Countdown in Review

Top TenOver the past five weeks we have been counting down the top 10 trends that will drive the use Connected Health over the next year.  Here they are at a glance:

10. M&A Meets Engagement

9. The Connected Healthcare Enterprise

8. Sharing Notes with Patients & Members

7. Care Knows No Bounds: Providing Remote Care

6. Evolution of Social Media into Care

5. Extended Timeline for Meaningful Use Stage 2

4. Gamification, Quantified Self, and the Internet of Things

3. Moving Beyond the “Sick Care” Model

2. Converting Unknown Consumers into Patients/Members

1. Health Plans Go B2C

Top 10 Connected Health Trends

So, what do you think?  Would you have re-shuffled my order.  Do you think that I missed a trend all together?  Please comment below.

Connected Health Trend Countdown: #1 Health Plans Go B2C

Top TenHere it is.  After 5 weeks of the Connected Health Trend countdown for 2014 we bring you:

Trend #1: Health Plans go Business to Consumer

Are you at all surprised that the top trend is brought to you by the health insurance industry?  Are you even more surprised that this is only the second time in this countdown that healthcare reform has been a catalyst for a trend?

Before we move into the world of member engagement, let’s understand what moved the market in more simple terms.  We all know that the Affordable Care Act has fundamentally changed the market for individual health insurance. Here are the nuts and bolts of how the exchange works:

  • The health insurance exchange provides the self-insured with a new way to shop for health plans
  • Health insurance brokers and insurers will also continue to sell plans directly to consumers
  • Insurers won’t be allowed to deny coverage to sick people, and premiums will only be permitted to vary based on a select list of factors,which include age, tobacco use, family size and geographic location
  • Every individual plan will have to cover a set of 10 essential health benefits, which include maternity, newborn care, hospitalization and prescription drugs
  • As opposed to having to pick from a patchwork of cost-sharing options, consumers will pick from four plan types on the exchanges: Bronze plans (pay for 60% of medical expenses), Silver plans (pay for 70% of medical expenses), Gold plans (pay for 80% of medical expenses), and Platinum plans (pay for 90% of medical expenses)
  • The maximum amount people will be on the hook for out of pocket will be capped at $6,350 for individuals and $12,700 for families.  (Sidenote: the game theorist in me would love to spend a few hours playing around on this one)
  • Whether someone shops on the state marketplaces or outside them, these elements are consistent among all plans.
  • There are subsidies available for people with incomes up to 400% of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013).
  • Some brokers and insurers will sell both exchange-approved plans that qualify for subsidies and standard, non-subsidized individual market plans
  • Thirty-six states are using the federal government’s site,  The other states have their own health insurance exchange.

The Census Bureau has estimated that about 48 million Americans lacked coverage in 2012 (about 15% of the population). Now the law requires virtually all Americans to have insurance or face a tax penalty after a coverage gap of three months.  The three big groups of potential consumers for the markets include: The Congressional Budget Office has estimated that about 7 million uninsured people will gain coverage through the online insurance marketplaces next year, but the role of the markets is actually much bigger than that. There are three big groups of potential customers for the markets:

  • Uninsured middle-class people now eligible for government-subsidized private coverage
  • Historically self-insured that are looking for better deals
  • Low-income people who will be steered to an expanded version of Medicaid in states that agree to expand that safety net program

The Insurers Battle for B2C 

Market movements the way they are, it is essential that health plans pursue high levels of consumer engagement.  This is a bit challenging given a few widely known facts:

  • Health insurers have long invested in business to business engagement since roughly 80% of their revenues still come from employer sponsored plans
  • Consumers really do not like health insurance companies.  Year after year, Forrester reports health insurance companies as receiving consumer’s lowest grade for consumer experience among all industries.
  • When asked, patients aren’t really interested in having their health insurance companies engage with them.  This largely boils down to trust, which is an important component in consumer engagement.  When ranking their trust of various healthcare entities, consumers trust for hospitals is between 60-80%, and their trust of health plans is only 10-20%

To get a glimpse of how major health plans are preparing for this market shift, we can assessed their web traffic,  number of inbound links, and Google PageRank, which have been combined into the Payer Web Presence Index.  In a nutshell, the index attempts to calculate how health insurance companies are marketing themselves to consumers.  The index only includes major managed care organizations operating in multiple state markets.  The seven top major insurers based on this  index are:

  1. Aetna (529)
  2. Cigna (451)
  3. UnitedHealthcare (373)
  4. Humana (333)
  5. Kaiser Permanente (323)
  6. Blue Cross Blue Shield Association (311)
  7. Anthem (WellPoint) (230)

So, how are health insurance executives responding?  Last summer there was a survey of 120 health insurance executives to help us figure this question out. One of the most significant findings was health plan recognition of the need to become more “retail oriented” in an effort to improve consumer experience.  More recently, another survey of 100 health plan executives shed even more light.  Health plans tapped improving the customer experience as their top priority for the coming year. 

So what does improving customer experience look like in action?  The survey shows that member portals and e-commerce are among the top plays health plans are making  to improve consumer experience. Embracing multi-channel commerce, mobility, and social media also rank high on the list of tactics.  Of interesting note, in a world where hospitals are dragging their feet in connecting patients with their electronic health information, health plans are highly motivated to connect members with their data.

The early winners in health plan consumer engagement

EveryMove 100 ranked health plans across the US based on how they engage with and empower consumers to manage their own health. Health plans are ranked by these five categories of consumer engagement and interaction:

  1. Social media: As we mentioned in our #6 trend, having social media accounts is important. However, having accounts that engage in active dialogue with consumers is crucial.
  2. Mobile strategy: Including a mobile website, user friendly apps, and apps available on multiple platforms.
  3. Website statistics: Traffic and content as compared with competitors.
  4. Customer support:  How easy is it to find contact information and how are plans using technology to make connecting easier?
  5. Customer satisfaction: Based on a survey of the EveryMove  user base (100,000 nationwide)

The top 10 health plans in terms of member engagement are:

  1. CIGNA
  2. Kaiser Permanente of California
  3. Premera Blue Cross
  4. Humana
  5. Anthem Blue Cross Blue Shield
  6. Independence Blue Cross
  7. Blue Cross and Blue Shield of North Carolina
  8. Blue Cross and Blue Shield of Illinois
  9. CareFirst
  10. BlueCross BlueShield of Tennessee

So, there you have it.  Stay tuned throughout the year as we keep a close eye on the movements within the Connected Health market.

Healthcare Gamification: Avoiding Chocolate Covered Broccoli

UntitledLast week, at IBM Connect, I met an individual with the coolest title in all Profession Land: Global Lead for Serious Games.

Her name is Phaedra Boinodiris, and after sitting in on her Birds of a Feather chat, along with a post chat dinner filled with good eats and new friends, I wanted to open up the conversation a bit for all to grow and learn from the gaming knowledge stored in this firecracker of a talent.

I’ll start you off with some stats Phaedra shared:

  • Average age of a gamer:  34
  • Games designed for women: 43% of PC games and 33% in general
  • Households that play video games multiple times per week: 67%

Today your average gamer is not just some young guy locked in his mother’s basement.  Your average gamers include employees, analysts, mothers, and business professionals named Phaedra and Melody.  As Phaedra pointed out, the first game advertising, for Atari, was aimed at the whole family.  Then there was a massive shift that aimed advertising exclusively towards boys.  However, once Nintendo Wii came out you started to see advertisements for the whole family again.

Healthcare at Play

Games are great at explaining complex systems.  There are fewer places one can find complex systems than in the micro and macro worlds of healthcare.  In healthcare we’ve seen games of multiple types.  Here are some great ones:

  1. Games that help modify user behavior: Phaedra pointed out Humana’s pioneer stance in the world of serious games in healthcare with their Horsepower Challenge.  Using the craze the followed games like Dance, Dance, Revolution, Humana used “exergaming” in 2009 to challenge 20 members of Congress and 2,000 5th and 6th graders nationwide as they “raced” across the country by taking steps with a pedometer.  She also harkened back to a healthcare game I mentioned in a post back in 2011, namely Re-Mission.  In Re-Mission, a nanobot named Roxxi is injected into the human body to fight particular types of cancer at the cellular level. Those playing the game are also asked to monitor the patient’s health and report any symptoms to the fictional Dr. West.  Each level of the game informs the player on a variety of treatments and on the importance of staying compliant with medical protocol.  HopeLab trial studies, that were published in peer-reviewed journals, revealed that playing Re-Mission led to more consistent treatment adherence, faster rate of increase in cancer knowledge, and faster rate of increase in self-efficacy. Most notably are blood test results, that showed the measured level of chemotherapy drugs in blood to be higher in players versus the control group.
  2. Clinical learning labs: These are the types of gaming environments where practitioners can train in virtual learning labs on an avatar.  A great one is foldit: Solving Puzzles for Science.  foldit, funded through a University of Washington grant, is an attempt by game developers to crowdsource scientific research.  Within a few paragraphs of texts, the gamer is educated on what proteins and amino acids are and why their shapes, and what those shapes fold into, are important.  The goal is to have human “protein folders” work on proteins that do not have a known structure.  Scientists can then take folding strategies that human players have come up with while playing the game and automate those strategies to make protein-predicting software that can fight HIV and cancer more effective.  Beyond protein prediction, protein design has even more direct implications to disable a virus.  Thus far there are not many automated approaches to protein design, so foldit’s human folders are a great source of research.

This is all gamification, right?

Gamification is the term we use to describe serious games that go beyond strictly trying to entertain.  They have a “higher purpose”, so to speak.  Designers use game techniques to get players to do something not game-like at all.  The possibilities in healthcare, as shown above, are truly limitless.  However, this has brought us an industry that is absolutely flooded with games.  However, as Phaedra points out, they are crippled by one false assumption created within the foundation of many of these games.  That is:

A gamified experience includes scores, leaderboards, and badge systems.

Let’s be clear.  Games can include scores, leaderboards, and badge systems.  However, not everything that includes scores, leaderboards, and badge systems can be called a game (at least not an effective one).  Instead, they are often just Chocolate Covered Broccoli.  A user will try it out, realize this is not what they ordered, and spit it back out again.

If you want to develop a serious game that works, you must, better than anyone else, understand the purpose of your game.  You must know to whom your game is targeted.  You must devote a lot of time to figuring out what motivates your intended audience.  That understanding must be crystal clear before you even consider how the game should be designed.  Document, in detail, what your experience needs to communicate with the gamer.  What kinds of puzzles best match this experience? Then consider what type of game genre matches these puzzles.  Lastly, consider what platform would need to be used to help the gamer bring action to play.

Building a game that is based on what motivates your audience is what makes a serious game a game.  Otherwise, all you have is Chocolate Colored Broccoli.

If you are interested in gaming, a source you can check out is Phaedra’s new book “Serious Games for Business: Using Gamification to Fully Engage Consumers, Employees and Partners”, which includes contributions by another great mind I met at IBM Connect, namely Peter Fingar.

Connected Health Trend Countdown: #2 Converting Unknown Consumers

Top TenWe are nearing the top of our list, and we bring you:

Trend #2: Converting Unknown Consumers into Patients/Members

Back in trend #6, I promised that one of the byproducts of the evolution of social media, namely this trend, would surface back up on the countdown.  Here it is as promised.

Before we get into the nuts and bolts business of converting unknown consumers, let’s spend a moment talking about what engaging consumers in healthcare is all about and why it is so important to both the engager and the engaged.  Yes, a growing population of engaged consumers ensures higher market share and revenue.  However, unlike in other industries, consumer engagement isn’t simply about making a quick buck.

Healthcare consumer engagement’s ultimate goal is to empower patients and their families with knowledge about their care.  A recent Health Affairs study suggests that the medical expenses of highly engaged patients were up to 21% lower on average, which highlights the critical role patients play in determining outcomes.  Patient empowerment has been a central feature in performance improvement programs such as Premier’s QUEST® collaborative and the Center for Medicare & Medicaid Innovation’s Partnership for Patients (PfP) initiative.  These consumer engagement efforts have paid off $9.1 billion over the passed 4 years not simply because of higher patient numbers but because of how engaged consumers interact with healthcare as compared to a disengaged consumer.

Another study in the Journal of General Internal Medicine found patients possessing a high degree of knowledge, skills and confidence (termed “activation level” in the study) were less likely to return to the hospital within 30 days.  The risk of 30-day readmission was almost twice as high for patients with low activation levels than for those patients that were truly engaged.  Low-activated patients also had a higher rate of emergency department visits within 30 days of discharge than highly activated patients.  I need only mention the term “emergency department” to ignite the high cost of care alarm bell.