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Patient Engagement

Fueled by the pandemic that boosted at-home consumer testing for Covid-19 as well as by increased investment over the last few years, the diagnostics industry is rapidly developing at-home testing capability.

However, it would be wise to focus less on features and more on the user experience.

“I have been in many different companies, financial services, healthcare gaming, et cetera, and people tend to focus on the product. How good is the product? Is it the most advanced? Does it have the most features? Does it have all of these kinds of things? I would rather have less features, 50% less features and a fantastic experience,” said Susan Moon, senior vice president, Customer & Digital Experience Team, Exact Sciences. [Exact Sciences makes and sells the at-home Cologuard colorectal-cancer screening tool. ] 

Moon was speaking Friday at the MedtechVision 2022, a hybrid conference organized by MedtechWomen. Her co-panelists were Archana Dubey chief clinical officer, AliveCor and Maital Rasmussen, chief commercial officer, Octave Bioscience and the panel was moderated by Lilly Li, principal, Northpond Ventures.

The focus on the consumer experience is especially key in the world of at-home diagnostics. First, because taking note of the consumer experience is part and parcel of developing a patient-centric healthcare world that everyone is striving for. And secondly, because, many consumers especially in the U.S. have a certain “opening the box” experience for tech devices driven by the likes of Apple.

“Think about when you open, uh, iPhone box or when you first got your Apple watch, right?” Moon prompted the audience. It’s like, pleasure.  You open it up. There are no instructions. It automatically starts. It’s very logical. That’s what has to happen to this space in, in care and in diagnostic tests and wearables, all of those kinds of things, because if they can’t figure it out, they’re not gonna do it or they’re gonna do it incorrectly. And that creates even more dissatisfaction.”

A good consumer/patient experience also helps to acquire an intangible commodity that has been sparse among certain sections of American society especially as it relates to Covid vaccines: trust.

“I think it’s applies to all of us who are working in MedTech — member experience is where you win trust,” said Dubey with AliveCor that has developed a mobile, personal EKG device that connects to a person’s smartphone to help monitor heart health. “So your EKG changes when you are running, when you are laying down, when you’re even in your sleep suits sometimes. And when the symptom happens, you have to make a doctor’s appointment. It’s two months away to get an EKG [appointment] …and  you will miss the diagnoses. So [our founder] took that big old [EKG] cart and put it in this credit card like device in the hands of people where they live, when, where heart disease or heart care is happening.”

Taking something that was only available in a clinical setting and democratizing that technology to be accessible in the home built trust between people who bought the device for use at home and AliveCor, Dubey said.

Another panelist implied that the focus on experience – be it the consumer/patient’s experience or the physician’s experience – needs to be in the DNA of the entire organization.

“It’s a whole company actually, it’s from the design of the product and it’s from the person who picks up the phone and it’s from the sales people. So you wanna create experiences, not only for the patients, but also for the physicians that actually supposed to, endorse it and bring it to the patient themselves,” said Maital Rasmussen, chief commercial officer, Octave Bioscience. “So it’s really — experiences is a currency right now.”

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The recent data from KLAS, the highly regarded health IT research firm, reveals that capabilities which allow patients to digitally interact with healthcare organizations aren’t always available. More people are connecting with care providers via online and mobile channels than ever before, yet there is work to be done to meet patient expectations.

In the Patient Perspectives on Patient Engagement Technology 2022 report, surveyed patients identified in-demand digital tools and expressed their desire for more “actionable” capabilities. These include functions that add convenience—like appointment self-scheduling or requesting a referral—and provide easier access to manage healthcare services like prescription refills. Most respondents also stated that better, more frequent communication about healthcare visit preparation could enhance their experience.

Yet healthcare organizations don’t consistently have these types of features. For some, cost and infrastructure inhibit adoption. Others have attempted to add functionality via patient portals, but this technology offers limited real-time interaction and can be complicated for patients to navigate.

The KLAS report recommends exploring other solutions, including automated patient outreach or engagement, as one way to bridge this gap between patient needs and existing capabilities. Automated engagement involves sharing real-time messaging, links, education, and instructions via text or other methods that don’t require manual outreach. This simple communication option is preferred by many individuals.

Data highlights show what matters most to patients

Responses indicate that patients insist on online appointment scheduling abilities. Sixty-seven percent of respondents want the ability to schedule/reschedule an appointment, yet only 37% report the ability to do so.

Prescription refill services are also important. Half of these individuals indicated they want to be able to request prescription refills digitally, yet this is only available to 29% of those surveyed.

This desire for appointment management and prescription functions is aligned with general consumer demand for more digital interaction with the healthcare system. Another industry survey of millennial patients revealed that 92% want two-way communication with their healthcare providers, and 71% expect online scheduling abilities.

One area where digital tech has arguably met patient expectations is in the realm of virtual interaction. Now, this feedback is informing how healthcare organizations provide this popular delivery channel.

For example, KLAS found that pre-visit preparation and post-visit follow-up are of high importance to patients when it comes to virtual care. Respondents who felt neutral or some level of dissatisfaction with the quality of their telehealth experience stated that better preparation is needed.

This preparation could take a variety of forms. Nearly one-third of respondents said sending appointment links (32%) and receiving information about their condition and its appropriateness for a telehealth visit ahead of time (33%) would improve their experience.

Patient engagement technology also has the potential to drive improved outcomes following regular, in-person healthcare interactions. Studies show that nearly one in five people experience an adverse event within three weeks hospital discharge—but almost 75% of these could be prevented or corrected. Staying in contact with these individuals via digital channels can help care teams stay abreast of changes in status and offer patients an easy way to provide feedback or updates.

Giving patients control over their care improves experience, outcomes

All of these in-demand capabilities can impact the patient experience, close care gaps, and improve outcomes. As evidenced by the report, respondents most value technology capabilities that directly impact their ability to receive and control their care. The question is how to deliver these capabilities without overwhelming health system staff or patients with complex technologies.

Automation may be one answer, according to the report. It states automated tools can provide simple communication options and access to information. It also recommends that organizations evaluate new technology to enhance system capabilities and meet patient needs.

What does automation look like in the realm of patient engagement? In its early days, it began with basic reminders sent before a scheduled appointment. But today, it involves multichannel communication (including SMS text, interactive voice response or IVR, and email) to interact with individuals for all types of healthcare needs and services.

Some platforms offer interactive functions like two-way messaging. This means patients can respond to notifications just like they would during a one-on-one interaction. For example, patients can schedule or reschedule an appointment, or request support prompting pre-visit instructions, education, or clinical preparation in advance of a procedure. In this way, automated engagement can improve care gap closure.

This automated approach aligns with several specific recommendations outlined by KLAS. For one, multimodal outreach gives patients the option to participate in the way that is most comfortable for them. And enabling bidirectional communication means patients can stay involved in their care.

Given these benefits, why aren’t more health systems deploying automated engagement today? Some use technology to engage, as evidenced by the study. But they may not offer the right tool for the right job.

Patient portals are still widely used for engagement, but they have significant limitations. Portals are more complicated, less user-friendly interfaces, and require logins and passwords. In comparison, rescheduling an appointment over text happens via a device most people already use every day. Portal technology should be reserved for more complex tasks like reviewing test results or medical records. KLAS recommends that healthcare organizations supplement the portal with other technologies to engage patients in ways they find convenient and useful.

How automation works in practice 

Automated patient engagement works best when integrated with the EHR, meaning it can tailor outreach based on information contained in this system. Such platforms interpret patient record data to identify care gaps, pending referrals, and other needs for care, in addition to honoring scheduling “rules” and communication or language preferences.

Then, as patients respond, their replies are captured and written back to the EHR. Health teams can then document care gap closure and even a lack of patient response (indicating a need for follow-up).

One example of this level of automation in action was demonstrated by a health system looking to reduce its bad prep rates for colonoscopies and canceled procedures. Two-way appointment SMS text and IVR reminders were sent so that patients could respond and confirm, cancel, or reschedule their appointment. Patients received additional reminders to pick up the required prep from the pharmacy, were sent educational information about the procedure, and received a final appointment reminder. After implementing the workflow, the health system saw a marked reduction in canceled procedures, and this approach involved no additional manual lift from staff members.

How health systems can address patient needs

As recommended by KLAS, healthcare organizations should consider new and different technology to enhance engagement. Here are three ways an automated engagement approach can improve experience scores, close care gaps, and meet patient technology needs:

Automation can power digital, self-service tools. The report states patients 18-34 years old are almost twice as likely to choose provider organizations that have digital access tools.

Automation can bolster virtual care. Pre-visit preparation can make or break care delivery. According to KLAS, health systems should share instructions, emails, texts, and educational materials to help individuals make the most of their healthcare visit.

Automation can allow for multi-modal communication. One recommendation from the report suggests providers include other solutions that can automate access to information and provide simple communication options.

Based on these findings, hospitals and health systems should consider implementing automated patient engagement technology that supports functions individuals value most—those that directly impact their ability to seek and receive healthcare. With benefits spanning patient experience improvement, a reduction in staff burden, and more easily delivered care that encourages higher visit volumes, this approach is poised to address today’s patients’ expectations.

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A major concern during the Covid-19 pandemic has been that Americans, especially those with underlying conditions, will delay necessary care. New survey results show this concern is not unfounded.

As of last September, about 40% of Americans with one or more chronic health conditions reported delaying or avoiding care, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

Report authors analyzed data from the second wave of the Urban Institute’s Coronavirus Tracking Survey, a nationally representative survey conducted Sept. 11-28, 2020. The survey polled 4,007 adults, ages 18 to 64 years.

About 36% of Americans said they delayed or did not receive healthcare due to a fear of exposure to the coronavirus or because a provider limited services during the pandemic, the report states. Black adults (39.7%) were more likely than white (34.3%) or Hispanic/Latinx (35.5%) adults to report delaying or forgoing care because of concerns about virus exposure.

About four in 10 adults with one or more chronic health conditions (40.7%) said they delayed or avoided care because of the pandemic, as compared with 26.4% of adults with no chronic conditions.

In addition, more than half of adults with both a physical and mental health condition (56.3%) reported delaying or avoiding healthcare due to the pandemic. About 43% of this group also reported delayed or forgoing multiple types of care.

The impacts of delaying or avoiding care were acutely felt by those with chronic conditions, the report shows. An estimated 23.2% of these adults reported that going without or delaying care worsened a health condition, 21% said it limited their ability to perform daily activities and 15.2% said it limited their ability to work.

Further, the report shows the kinds of care that Americans were avoiding. Dental care was the most common type of care adults delayed or did not receive because of the pandemic (25.3%), followed by seeing a general doctor or specialist (20.6%) and receiving preventive health screenings or medical tests (15.5%).

“Tackling unmet healthcare needs requires effectively assuaging fears about exposure to the coronavirus,” report authors concluded. Providers need to reassure patients that they are following public health guidelines and that these precautions can effectively prevent virus transmission.

“More data showing healthcare settings are not common sources of transmission and better communication with the public to promote the importance of seeking needed and routine care are also needed,” the authors wrote.

Photo: YinYang, Getty Images

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Digital health startup Sharecare plans to go public through a merger with a special purpose acquisition company. Photo credit: Sharecare

Digital health startup Sharecare confirmed reports that it plans to go public through a merger with a blank-check company. The Atlanta-based startup plans to merge with a special-purpose acquisition company created by Alan Mnuchin, CEO of Falcon Capital and brother of former Treasury Secretary Steve Mnuchin.

The deal would value Sharecare at $3.9 billion and add $400 million to its balance sheet. It plans to use the funds to  grow its business, build out its salesforce, and help pay for its recent acquisition of healthcare artificial intelligence startup Doc.AI.

Sharecare was founded in 2012 WebMD creator Jeff Arnold and TV personality Dr. Mehmet Oz. Started as a health and wellness social media platform, the company later began working with heath plans with its acquisition of Healthways’ population health services business in 2016. It has raised $450 million in funding to date.

“We started Sharecare to leverage innovations in consumer technology – specifically the smartphone – to create a frictionless experience that engages people across the dynamic continuum of their healthcare needs,” Arnold said in a news release. “By integrating fragmented point solutions and bringing together stakeholders across the healthcare ecosystem into one connected virtual care platform, we believe that Sharecare is uniquely positioned to transform the way people access, providers deliver, and employers and health plans administer high quality, cost efficient healthcare.”

Blank-check company Falcon Capital Acquisition Corp. will bring $345 million of cash held in a trust to the deal. Private investors including Koch Strategic Platforms, Baron Capital Group, Eldridge, Woodline Partners LP and Digital Alpha will contribute $425 million in a private investment in public equity (PIPE).

Anthem will also make a direct investment into Sharecare for an undisclosed amount after its chief digital officer, Rajeev Ronanki, recently joined Sharecare’s board of directors. 

“Through this relationship, we will leverage human-centered design and digital technologies, including artificial intelligence, that increase consumer engagement, deliver more affordable healthcare, and achieve better health outcomes through services such as next generation personalized healthcare concierge and advocacy services,” Ronanki said in a news release.

After the acquisition closes, Falcon will own roughly 20% of the company. Mnuchin and Jeff Sagansky, an independent director of Falcon, will join Sharecare’s board.

Sharecare has a hodgepodge of features, from pharmacy discount cards to a smoking cessation app to a tool that’s supposed to detect a user’s stress levels from listening to their voice. So far, the lion’s share of the company’s business is  its work with health plans, which are expected to bring in more than half of its revenue for 2021, an estimated $227 million, according to the company’s investor presentation.

For example, Blue Cross and Blue Shield of Arizona began offering the app to its members last year, including rewarding them for tracking their steps. Users are also instructed to answer a lengthy survey for suggestions to improve their health. Some of Sharecare’s other customers include Anthem, Centene, Humana, Walmart and StateFarm.

Another portion of the Sharecare’s business is focused on offering solutions to payers and clinicians, which brought in roughly $80 million last year. For example, it acquired claims review company WhiteHatAI last year, and it also acquired medical records company BACTES, which it rebranded as Sharecare Health Data Services.

Sharecare also has an advertising business, which brought in roughly $56 million last year. Controversially, that included sponsored health advice in Q&As; the company offers condition-specific marketing to pharmaceutical companies and touts its “real-time health profiling engine” in investor slides. But it cannot target ads to users who access the app through their insurance, only those who download it for free, according to its privacy policy.

In the last three years, Sharecare’s revenue has declined slightly, from $347 million in 2017 to $340 million in 2019. Its expected revenue for 2020 is $330 million, with the company attributing the decrease to reduced physician visits and fewer visits at its in-person diabetes clinics, according to an investor presentation.

It reported a $40 million net loss in 2019, compared to a $55 million net loss in 2018.

Still, the company said it expects to bring in $512 million in revenue in 2022, and has “multiple paths” to more than $1 billion in medium-term revenue.

The deal is expected to close next quarter, with Sharecare trading on Nasdaq under the ticker “SHCR.”

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Metoprolol (muh•tow•pruh•laal). Eszopiclone (es•zoe•pik•lone). Hydrochlorothiazide (hy•dro•klor•oh•thi•a•zide). Amitriptyline (a•muh•trip•tuh•leen). Canagliflozin (kan•a•gli•floe•zin).

Are you able to recognize or pronounce any of these commonly prescribed medications? If so, you might be a pharmacist, or at least have experience providing patient care. It’s fair to say that most people find it challenging to pronounce drug names, and it may be even more challenging for the elderly.

It’s not uncommon for elderly patients to be prescribed multiple medications to treat multiple chronic conditions, and sometimes these medications come from multiple providers. In my experience, I have seen many patients fail to understand what, why and how to take their prescriptions. Some have the help of family or caregivers while others may not, which makes it even more challenging to manage. Many factors can contribute to these challenges including vision problems, memory loss, swallowing problems and or hearing loss. Medications can be extremely helpful in treating and preventing disease, or they can cause a major health setback if not taken appropriately.

As a pharmacist by training, or “pharmist” as my Grandpa likes to call me, I spend my time reviewing his medications when I’m in town to visit. He loves to sit down with me and tell me all about the medications he’s taking and what he takes them for.  At 87 years old, he’s impressively taking only three (3) medications. Up until last year, he was taking only taking one (1). He’s incredibly sharp and has never needed any extra assistance. My Grandpa is the perfect patient. He’s highly adherent and takes his medications every day, at the same time, right before his morning coffee. I understand the importance of adherence and adherence to the right medications, but I have never personally experienced or witnessed the challenges that come with adherence following discharge from a hospital stay, until now.

Covid-19 hit close to home and affected both of my grandparents this past Thanksgiving. After a few days, it was apparent they were unable to weather this virus alone. It severely affected their cognitive status and caused weakness so severe they were unable to stand or walk on their own. While staying with them during this time, a decision was made to take my Grandpa to the E.R., which led to a six-day hospital stay. Because I know he visits multiple providers and pharmacies, I knew the hospital wouldn’t have a complete record of all the medications he takes….and I was right.  I made sure he went with an updated med-list so that the doctors could give him his regular medications while in the hospital.  I knew this med-list would likely change following his discharge.

Upon discharge, I was provided with a long list of instructions from multiple people on the care team that was difficult to follow along even for me. First came a call from the nurse,  then a call from the provider, then a call from the pharmacist, and lastly a call from the company who would be dropping off his home oxygen. The pharmacist’s call was helpful, but not appropriately timed — I had no discharge papers to reference.  The provider called again, to go over the medications with us. The review was fast. Medications were discontinued. Medications were added. Some medications were named in their brand name while others were listed generically.

Who could possibly follow along? No one expressed to us the duration of these medications. When could they be stopped? Will they ever be stopped? Were refills needed, what doctor would continue to prescribe them? What if I had not been around to help?

Following my Grandpa’s return, I immediately sat down to review and organize all of his medications, new and old. One medication was discontinued, while 4 were added. My Grandpa went from taking 3 medications to 7 overnight, and each medication came with its own set of directions:

  1. Take this tablet with food.
  2. Take this tablet on an empty stomach.
  3. Take this tablet every day and skip on Saturdays.
  4. Take this tablet on Monday, Wednesday, and Friday.
  5. Skip this tablet for two days. Restart on Sunday.
    1. 2 days later* “Actually, take this medication every other day starting Tuesday.”
  6. Take this tablet every day.
  7. Take this tablet three times a day and make sure not to eat too much sugar or salt with this med.

With all of this information, I created a “Fridge Report” for when I’m not around. A Fridge Report is a simple and easy to read medication list. It displays all medications a patient is taking and how to take them in a nice visual display that is easy to follow. I also called and spoke with his primary care provider (PCP) and cardiologist to confirm his active medications and to notify them of the newly added and discontinued medications. I can’t imagine my grandparents, or anyone else’s grandparents, managing this without the help of a pharmacist. The Fridge Report was highly appreciated by my family.

“We need that (Fridge Report). It’s very detailed. No mixing up or second-guessing of medications. Now I know what to give and when to give it.” – Lorraine Armenta, My Aunt

According to the World Health Organization (WHO), care transitions threaten patient safety as they can increase the possibility of losing critical clinical information and require an increased degree of coordination. I believe a multifaceted approach is needed to improve care transitions and is especially needed for vulnerable and high-risk individuals. The transition between inpatient and community settings, in particular, is prone to medication errors related to a lack of communication between health care providers, missed patient follow-up, inadequate patient education, incomplete medication reconciliation, and the absence of patient involvement in medication management. Pharmacists can and should take a more active role in improving medication safety during care transitions; this could lead to a reduction in hospital readmissions and improved quality of care.

Pharmacists serve as quarterbacks of a patient’s at-home-care team, providing essential help to those who are taking multiple medications. We are medication safety experts and have access to sophisticated and innovative tools to better manage the medication-related needs of patients and mitigate adverse drug events (ADEs). Ultimately, engaging with your local pharmacist can reduce the burden placed on a patient’s family and the primary caregiver, while making the transition to at-home care manageable.  

Photo: JohnnyGreig, Getty Images

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Blue Cross and Blue Shield of Kansas City expanded its partnership with HealthMine, a technology company providing member engagement solutions, to build a rewards program for the payer’s individual and family Affordable Care Act members.

The Missouri-based payer, also known as Blue KC, has an existing partnership with HealthMine to offer a rewards program for its Medicare Advantage plan members. The program focuses on encouraging preventive health actions, such as annual wellness visits, flu shots and breast cancer screenings, by offering the ability to earn rewards in the form of gift cards to national and local retailers, Jenn Ader, senior director of client services at HealthMine said in an email.

“The program has also continued to evolve to provide additional features, including a digital health risk assessment delivered through the program application to help Blue KC better understand their members’ health status and risks,” she said.

Members interact with the program through a mobile app, web portal and live customer service support, she added.

Through the expanded partnership, HealthMine will build an incentive and rewards program for the insurer’s ACA members similar to the one for its Medicare Advantage members, giving the ACA members incentives to complete health actions and digital health risk assessments.

“The rewards program helps our MA members engage with their healthcare decisions and develop an ongoing relationship with their primary care providers,” said Lori Rund, vice president of government programs at Blue KC, via email. “We expect it will do the same for our ACA members, ultimately giving them the tools they need to successfully navigate the healthcare system and reach their long-term health goals.”

Creating incentive programs for ACA plan members is especially important, because these members tend not to seek routine medical care as they previously may not have had health insurance coverage, James Haskins, HealthMine’s director of government programs, said in an email.

These programs, “by rewarding preventive visits, encourage members to establish a relationship with a provider — this relationship is a launching point for the member on a journey of engagement in managing their health,” he said.

Engaging plan members in preventive healthcare has become even more challenging amid the Covid-19 pandemic, as the fear of contracting the deadly new coronavirus has kept people from routine care visits. By June 30, an estimated 41% of U.S. adults had delayed or avoided medical care due to concerns about Covid-19, according to data from the Centers for Disease Prevention and Control.

“There are ways to minimize the effects of Covid-19 on preventive care by providing a solution that seamlessly connects members to the care they need and incentivizes them to get needed care — that’s where rewards programs can come in,” Haskins said.

In addition, as the Covid-19 vaccine becomes more widely available, health plans need to be able to communicate with its members, especially the younger and healthier members that tend to have ACA plans, to give them information about vaccine availability and safety, he said.

“Offering an associated reward helps increase member interest and move those who may not have sought this vaccine otherwise,” he added.

Photo credit: ljubaphoto, Getty Images

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UnitedHealthcare is providing members of its Motion program access to Apple Fitness+ workout classes, powered by Apple Watch, for at least six months and at no additional cost.

UnitedHealthcare Motion is a well-being program that enables people to earn over $1,000 per year by meeting certain daily activity goals, Rebecca Madsen, UnitedHealthcare’s chief consumer officer, said in an email. People in the program have access to several wearables, including Apple Watches, at no additional cost and as buy-up options.

Beginning Jan. 1, UnitedHealthcare Motion enrollees with Apple Watches will have access to Apple Fitness+, which provides a variety of studio-style workouts, including high-intensity interval training, yoga, dance and cycling.

“UnitedHealthcare and Apple share a joint mission to help people live healthier lives,” Madsen said via email. “By making Apple Fitness+ accessible to UnitedHealthcare Motion members with Apple Watch, we are helping achieve that goal. Plus, with interest in at-home fitness resources surging amid Covid-19, this collaboration is another way to support our members on their journeys toward health.”

Eligible members will gain free access to Apple Fitness+ workouts for six months, after which they will be able to buy a six-month subscription using program earnings, a credit card or a combination of both.

Providing access to Apple Fitness+ is a part of the insurer’s broader effort to offer people digital resources and financial incentives that can help them better manage their health, especially their chronic conditions, Madsen said.

“UnitedHealthcare is dedicated to creating seamless, integrated health programs and resources that empower people to take charge of their health, more easily navigate the health system and help make care more affordable for all Americans,” she added. “We are helping accomplish those goals with UnitedHealthcare Motion and the new collaboration with Apple.”

A recent study, which followed 44,370 men and women for 4 to 14.5 years, showed that people who spent more time being sedentary faced a higher risk of death as compared to people who spent more time being physically active.

UnitedHealthcare Motion enables members to earn financial incentives based on reaching daily fitness targets, which include completing 300 steps within five minutes, six times per day, at least an hour apart.

Since the launch of the program, UnitedHealthcare Motion participants have collectively walked more than 511 billion steps and earned $60 million in rewards, Madsen said.

Photo credit: martin-dm, Getty Images

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Easy-to-understand bills and access to more payment plan options would improve their payment experience at hospitals, a majority of patients said in a new report from healthcare revenue cycle firm Waystar.

Billing and patient collections are a uniquely frustrating pain point in the U.S. healthcare system. As a result of rising out-of-pocket costs and the opacity of the insurance system, healthcare consumers are increasingly saddled with bills that are confusing and often, surprisingly high.

About 56% of healthcare consumers say they have received an unexpected medical bill, and 48% have been late on paying a bill, a survey conducted by Waystar shows. The survey polled 1,000 U.S. residents in October who had received a medical bill from a hospital or specialty provider within the last six months.

A majority of consumers (51%) said that they were not able to pay their bill because of financial reasons, while 37% said they assumed their health insurance would cover the bill and 19% said they were unclear on how much they owed.

Healthcare consumers tend to find medical bills confusing, the report shows, with only 43% saying they fully understood their bill. This figure drops to about 37% for Generation Z and millennials. Most survey respondents (46%) said that an upfront explanation from the provider detailing what insurance would pay would help them better understand their bills.

It is important to note that the billing experience has an impact on consumers’ care choices. Almost half (49%) said they would consider switching physicians over a bad billing experience, and 45% said their most recent experience with a hospital billing office made them more likely to recommend that hospital to a friend. In addition, 81% said they would more actively pursue care if they knew their out-of-pocket cost. [Click to enlarge graph]


To improve patient experience, consumers said that hospitals could offer simpler bills that show the total balance (41%); more payment plan options so that they can pay the bill over time (37%) and access to an online payment portal (32%).

In 2021, hospitals will be required to provide a list of standard payment rates for 300 common procedures to the public. But, about 65% of survey respondents said they were not aware of the price transparency rule.

When respondents were asked whether having this publicly available list of standard prices would be helpful for understanding their healthcare costs, 90% said it would be somewhat helpful, but only 59% said they plan to use it. Gen Z and millennials appear more likely to use the information, with 70% saying they would look up the lists when they’re available compared with 59% of Generation X and 45% of Baby Boomers.

Photo credit: cat-scape, Getty Images, graphs from Waystar report 

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Ontrak, a company that works with insurers to identify employees with untreated behavioral health conditions, acquired health coaching startup LifeDojo. Ontrak CEO Terren Peizer said the deal would expand its footprint with health plans and employers.

The company acquired LifeDojo for about $10 million in cash and equity, Ontrak confirmed in an emailed statement.

“We will endeavor to make additional strategic purchases that expand our addressable market and maximize customer value,” Peizer said in a news release.

Formerly known as Catasys, Ontrak uses analytics to predict people whose chronic conditions will improve with behavior change, and connects them to care coaching and treatment. Some of its customers include insurers Aetna, Centene and Cigna.

LifeDojo would add to Ontrak’s list of coaching services with several programs for behavior change. In addition to modules for healthy eating and exercise, LifeDojo also has programs for managing stress and resilience. The company primarily sells its services to employers.

“We are thrilled to be combining forces with Ontrak,” LifeDojo CEO and Co-Founder Chris Cutter said in a news release. “We are proud to have built a trusted platform for some of the most demanding digital health clients and tech companies in the industry. Like Ontrak, we have engagement rates that are many times higher than the industry average and we look forward to delivering a comprehensive ecosystem of health solutions to high and low acuity Ontrak members.”

Cutter and LifeDojo’s CTO, Patricia Bedard, will join Ontrak’s leadership team. Ontrak said the deal would expand its addressable market by adding a lower-cost digital solution. The data from LifeDojo’s apps would also feed into Ontrak’s AI capabilities and be used to further personalize its coaching.

Photo credit: exdez, Getty Images

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