TECH: PHRs for health plan members…maybe, maybe

And in the bitter, twisted segment of THCB this week, apparently Empire Blues will be offering personal health records to their patients. And the records will be prepopulated for the members with information gleaned from claims data. including outpatient lab test results, physician visits, hospital stays, reported diagnoses and prescriptions. They can also (self-enter, I assume) values, such as cholesterol levels, that can be grouped together and graphically tracked over time. They’re using WebMD (who bought Wellmed, the last man standing in the PHR space phase 1 c.2002) to provide the service.

This is a screamingly logical thing for health plans to do. It gives them a compelling front end web application for their members, and thus gives their members a reason to stick with the plan (given the choice, although I know a lot of members are not). In addition they are the only ones who’ve got the majority of a member’s data all in one place. The only real exceptions are providers with a full service HMO like a Kaiser or a Group Health of Puget Sound who can then offer views into their electronic medical record system (e.g. MyEpic). For the traditional health plans, who’s CRM for their members has been completely crap for decades, this is an easy and relatively cheap way to improve their "customer service".

I’m just a little bitter that they’ve decided to do it now rather than FIVE years ago when I was selling exactly the same thing….

However, if any health plan or tech company wants to know more about this, I will work for food.

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6 replies »

  1. It’s only a matter of time before the underwriters or nurse interviewers gain access to your supermarket shoppers card/credit card data to find you’re gobbling nachos despite your $150/month Prevacid prescription, diabetes and last year’s cardiac bypass.
    That aside, it’s about time the payors used the information at their fingertips (the claims data) to help their policyholders and the doctors who treat them. Why should patients have to sit in my waiting room with a clipboard, filling out their past medical history, allergies and medication list. Their insurance company could minimize errors from poor memories or literacy skills by forwarding an accurate list to the specialist who’s expected to make a diagnosis and treat them next.

  2. Brian — It’s worth knowing that for example First Health Inc and AdvancePCS bought a version of an online health record in 2001 from my company — and never deployed it. So the technology has been around for FIVE years The fact thatso few have one in place — and that Group Health of Puget sound is trumpeting it in their advertising – reflects the crappy regard in which health plans hold their members

  3. Its worth knowing that several other plans around the country have had similar approaches in place for awhile, though the larger plans have taken longer to adopt this technology. A 320,000 life coalition in Las Vegas – comprised of hotels and food service workers in Las Vegas – has had a similar system underway for a couple years, using Worlddoc under the direction of Jerry Reeves, MD. Dr. Reeves is a former national Medical Director for Humana. Worlddoc is a patient-decision support tool that also creates an individualized online health record that incorporates claims information as well as self-reported information from health risk appraisals. This tool, used in conjunction with several other by this innovative plan, has been very effective, dramatically dropping costs.

  4. Matthew this is the part that gets tricky and I’m going to quote from the reference you gave: “Members can access the software from a secure Web site to enter and maintain such records as medical histories, health risks and allergies.”
    Obviously some of that data will be documented in medical records and that data should be legitimately documented–but if individuals like this feature enough to enter medical data they learn from family histories, etc. they may add to their risk rating without understanding the implications.
    As an example, let’s say a woman participating in this program starts updating her medical history. She finds out at a family reunion that great-grandmother or great-aunt had breast cancer–so she adds that risk to her file. That’s great for her gyn who may be assessing frequency of mammogram requirements, but potentially risky if it somehow becomes part of future underwriting data. It wouldn’t show up on her underwriting health questionnaire but if her medical records were accessed, it could be a red flag that otherwise would not have been disclosed. Or lets say she gets a cholesterol test at the gym after work. She hasn’t fasted, might have hit McDonalds for lunch, and her numbers are pretty high. She enters that data in the health record for comparison to future tests and it becomes a data point. That’s the issue I worry about. I would never have gotten my hiatal hernia formally diagnosed if I had understood the rating it carried. I suspected I had one, but really didn’t need to have it confirmed. I’m concerned that this move to share and document detailed medical histories may end up coercing information out of patients that they wouldn’t volunteer or speculate on if they understood the underwriting implications longer term. The nurse interview I’m supposed to do involves lifestyle questions–we can discuss what I eat, how much I exercise, undiagnosed symptoms I may be experiencing, anything I have questions about. On the surface, it seems like a great idea. On paper, I would be adding documentation to risk analysis and it ain’t going to happen. I expect to see more “wellness” initiatives that actually serve to gather more detailed data to create a detailed health profile. If that information is never part of underwriting, it would actually be a great tool. But, once it is in a database, the risk of sharing in unanticipated ways is there. I’m sorry to be paranoid, but every month I get a reminder in premium amount about the foolishness of documenting health conditions while self-employed.

  5. Yeah, but I’m referring here to the information about you that the plan has already got being presented back to you NOT you giving more information than you want to.
    Agreed though that we need a system in which your fears are removed by strong legislation against underwriting.

  6. While conceptually that is a great idea that long-term could benefit people and health care professionals, as the “victim” of aggressive underwriting, I can tell you my current policy is “don’t ask, don’t tell.” I will disclose what I am legally require to disclose but I’m not providing any information voluntarily that isn’t absolutely required as part of plan. I recognize that claims data will get added, but I would not voluntarily expand that database by adding information the insurance company would not otherwise see. My new insurer provides the benefit of a nurse who will fill out a health questionnaire over the telephone and make wellness recommendations. I can tell you that she and I will be having a very short conversation–punctuated by references to invasion of privacy. In a more reasonable environment, I’d view my insurer as partner in helping control health care costs–but in the current environment I trust used car salesmen more.