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Customer Experience and Design

Encouraging Accountability and Good Behavior

Patients are demanding affordable healthcare, providers are asking for fair reimbursements and payors are suggesting that rendered care should be medically necessary and of high quality to be reimbursed. It is a rather convoluted situation where accountability lives with each player – but is legally placed on the provider (for the most part). After all, taxpayers can’t file a suit against Medicare and Medicaid recipients for negligence because they made poor choices that led to exuberant healthcare expenditures which ultimately were paid for with taxpayer revenues. Providers can’t claim gross negligence on behalf of patients for making poor choices that decreased a provider’s outcomes and overall ratings. This disconnect between accountability and the players lends itself to an ineffective healthcare system.

Because healthcare providers and payors are both striving to increase the wellness of patients, it is reasonable to assume that they must work together to increase outcomes and decrease overall costs by holding patients/members accountable for decisions that impact their health.

Step I: Identify the problem (HRAs)
Suggestions to include patients in the accountability circle must begin with a health risk assessment (HRA). According to the CDC, a HRA is “a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.” Patients voluntarily agree to participate in the assessment so that their care can be better suited to support them and their specific needs.

Step II: Classify the Problem (Population Health Management)
An HRA is the first step to population health management, which is known to increase outcomes and decrease health related costs by closing gaps in the care continuum. By identifying and attaching the root cause (i.e. behavior and choices examined within the HRA), population health management uses evidence-based practices to change the overall health of individuals. Population Health Management categorizes all individuals and suggests treatment for low and high-risk patients. The result is a healthier population in the long run by encouraging preventative services and providing disease management.

Step III: Treat the Problem (Gamification)
In a recent WSJ article, Anna Mathews examines how payors are using digital gaming to impact member’s health. These games are used to promote positive healthcare decisions by rewarding individuals based on choices that affect their health. United Healthcare VP, Bob Plourde, claimed that digital games are used to get members “engaged and excited.” The Humana CEO also claims that the games make positive impacts and the members find them “motivational.” An Aetna executive claims that their digital version leaves members eager to come “back for more.”

Gamification is emerging as a real care management solution, because it is tied to increases in outcomes. Some groups claim that their games will help society overcome epidemics such as smoking and obesity by rewarding good behaviors which are associated with better health. How does it work? For the most part gamification relies on the compounding effect of small daily choices for its success. It works because it gets patients accountable for the decisions they make and they are rewarded with positive reinforcement when good choices are made. While not all of us are intrigued, it appears to be a step in the right direction and considering the overall health of our population – nothing is off the table.

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Amanda Buie

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