HEALTH PLANS/TECHNOLOGY: AHIP impressed with itself yet again, with UPDATE

Long term THCB readers will know the the term “AHIP report” tends to put me in a just a little bit of a tizzy, given the generally shoddy “research” they’ve been foisting on those of us who bother to read the PR wires.  For that matter the mention of AHIP’s President’s name tends to drive me equally bat-shit, given the tissue of half-truths, crass ill-informed generalizations and self-serving platitudes that tend to emerge from any document with “Ignagni” as author. And it looks like they’ve done it again.

You may believe that America’s health plans aren’t exactly hotbeds of delightful consumer experiences. And you’d be right. While any corner store in the world can take your credit or ATM card and whisk your info to your bank and back, the majority of health insurers still send out paper ID cards to their members, which get photocopied at the doctors office. Most have customer service systems that only allow the poor sap on the phone to see one claim at a time for the member trying to piece together a series of care encounters. Hardly any allow their members to access their own information in a useful manner integrated with other medical information (Empire, Group Health in Seattle, and a few others being honorable, but recent exceptions). And they all still send out EOBs which require a masters degree in accounting BS to decipher. In fact probably only hospitals and doctors are worse.And of course they’ve continued this ineptitude while their prices to their consumers have increased at a rate of 10% a year for more than half a decade.

But have no fear.  Despite consumer reputation ratings that are in the tank, according to the latest AHIP report on its insurer members’ activities are going great guns. In fact the very title is that  Through IT, Companies ….Achieve Impressive Results in Quality, Ease of Use, Cost, and Efficiency.

Read it and weep. For example, I’m particularly impressed by the example from my health plan Blue Shield of California which, bless its heart, has been at least trying on some of these tech issues. They’ve been trying to promote Relay Health’s physician email service to their members and to California’s 60,000 odd physicians. The report details their great strategy. The last number I heard was that after 5 years of trying, only 1,000 had signed up. My doctor was one of them, but when I sent him an email, 3 months later I got one back saying that my application to email him was rejected!

I can’t complain about a series of case-studies about health insurers trying to get better at this IT and customer service stuff. There may be some useful stuff in here. But how about calling it “Through IT, health insurers achieve impressive results in managing to stay in business and increase their margins while denying their clients what’s been seen as standard practice in every other industry for years…..but are now getting around to slowly thinking about changing”.  That would be closer to the truth — although telling the truth may be a dangerous habit for AHIP to adopt.

UPDATE: Arien Malec from RelayHealth has sent me what he terms a few corrections which indicate that RelayHealth has been slightly more successful than I stated, and I promised him that I wouldn’t mention how much cash RelayHealth has burned since its inception! Here’s Arien’s points:

1)     The current number is 3000 physicians in CA who are fully up and running with RelayHealth

2)     We (and BSC) are working medical group by medical group to bring on physicians, concentrating on primary care providers, so the denominator of 60,000 isn’t quite fair

3)     The first few years of the BSC relationship with RelayHealth were mainly focused on a trial of clinical messaging, not a wide scale rollout, so “5 years of trying” also isn’t quite fair (more like 2 years of active wide scale deployment).

 In the East Bay, Sacramento, and some parts of SoCal, penetration among primary care providers is pretty good; in other areas, there are holes. That’s the reality in trying to get adoption in this business… If we look at the measure of “how many Hill Physicians primary care doctors are up and running with RelayHealth,” the picture looks much more favorable.

 As for BSC’s role here, they obviously can’t “roll out” this program to all of “their” physicians, because this is an industry of small boutique businesses that aren’t owned by anyone.

Finally, with regard to your own doctor, we’ve had some issues with doctors who got set up before they were willing to accept online patients. I’m sorry that happened in your case, but it shouldn’t be taken as representative of the program as a whole.

 The larger point still stands, but in an industry where change is this hard, it’s not quite fair to knock those organizations that are at least trying.

Now it’s good news that something is happening, but it’s evident that the four most important functions of the “personal health record” view that the bigger provider groups (like Group Health of Puget Sound, Partners, etc) are offering their clients online are a) appointment scheduling, b)drug prescription renewal request c) email communication with the doctor, and d) access to lab results, rather than the actual ability to look at the health record per se. Survey data going back to the 1990s shows strong demand from patients for these exact services. Given that RelayHealth (and for that matter in the dim distant past Physicians Online) has offered these functions to physicians on an ASP basis for several years at almost no cost to them and requiring no change to their basic day to day activities, it tells me that they’ve felt no incentive to offer these services to their patients. And 3,000 is better than 1,000 but not by too much. And what have the plans done?  When the plans wanted to actually make doctors change their behavior they can. When back in the 1990s when Blue Cross wanted to receive claims electronically, they mandated the change to their doctors and wouldn’t pay them for non–electronic claims.  That got the docs to change in a big hurry. You get the impression that the insurers don’t care about their doctors improving their online services to their members nearly as much, as there don’t seem to be any penalties for the doctors who don’t sign up and/or don’t use the service if they do. Frankly to this point the majority of IT support from insurers to doctors seems to be PR-inspired (like Wellpoint’s useless $40m computer giveaway) rather than trying to enable them to deliver better services to their patients.

Still I’m a big fan of RelayHealth and I really am not slamming them—the insurers  and the doctors, I’m not so impressed with.

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  1. Choosing Hill Physicians is misleading since they are the one of the most progressive groups with some of the best support for member physicians and some of the best structured incentive programs to achieve objectives. On top of this, Hill Physicians operates in one of the most tech savvy regions of the country so the doctors and patients are prejudiced in favor of these types of systems. So RelayHealth says they are doing quite good in the easiest environment possible. That does not give me a whole lot of confidence in their ability to operate in even somewhat favorable conditions and no confidence that they can ever penetrate places where they would actually have to change people’s minds.