Targeted Messaging Emerges as an Essential Service in Post-Reform Health Care

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1 Targeted Messaging Emerges as an Essential Service in Post-Reform Health Care Turning Messages into Positive Action What to Look for in a Messaging Platform How a Messaging Platform Works Conclusion About RxEOB

2 2 Targeted Messaging Emerges as an Essential Service in Post-Reform Health Care In response to rising co-pays and higher deductibles, more consumers are seeking information that helps them access higher quality, more cost-effective care, to maximize their health care dollars. The number of individuals who use their smartphone to access health and medical information is also growing, giving payers, providers and employers an opportunity to curb costs. Author: Robert Oscar, R.Ph., President and CEO, RxEOB The U.S. health care system is shifting toward higher quality, cost-efficient care, with a significant focus on the patient s role in maintaining and improving health. Payers, providers and employers are seeking new ways to encourage more responsible choices in the care chosen by the public. The collective goal is to empower individuals to understand when they need to act, how to outline optimal choices, and then direct them to proper care settings. mhealth, the use of mobile software and smartphone technology in the health care industry, is growing in popularity and playing a major role in patient engagement by offering individuals access to medical information and tools for improving compliance, all while lowering health care costs. Benefiting the nation s employers and health plan providers, a well-designed mobile-access and mobile-platform technology strategy makes meeting health care needs where and when they are needed much more efficient and convenient for the patient. In addition, these mhealth strategies greatly streamline the management of chronic diseases and pharmacy utilization. The most effective use of mhealth is to give patients the information and guidance they need at the trigger points. Taking advantage of data analytics to detect a consumer s current status and automatically initiating relevant communications, this trigger point strategy prompts plan members to take health and wellness actions. More than 50 percent of health plans intend to invest in trigger-based communications. 1 mhealth has extended personalized health interventions and research beyond the reach of traditional clinical care. Platform Builds claim databases rules analytics messages message triggers Messaging Platform personal, secure and relevant communication Platform Manages preferred channels message response outcomes reporting access & approvals Platform Schedules message testing scheduling campaigns message archives 1 Source:

3 3 The Current State of Health Care Messaging Messaging is a broad concept with efficacy often hampered by a lack of actionable information. Too often, communications are inconsistent, uncoordinated and fail to reach patients where and when they want to be reached. Worst case scenario: Communications provide incorrect direction or simply become noise to the stakeholder. Best case scenario: Communications are not coordinated with the health plan, miss costmanagement opportunities and, as a valuable service, become an afterthought. Clearly, stakeholders have an opportunity to drive better choices through targeted communication if executed intelligently and with the right messaging platform. To prevent the perfect solution from being an enemy of a good solution, stakeholders might consider the benefits of integrating readily available data sources (e.g., daily pharmacy claims data, benefits and formulary data) to deliver actionable cost savings messages to members. Turning Messages into Positive Action Health care messaging is at its best when it identifies a population and quickly delivers appropriate content or information in a form that can result in an action being taken by the recipient. It should also provide multi-modal communication with stakeholders across the health care continuum with particular attention paid to rapid or real-time trigger messaging via text message/sms or push notifications. As the patient s cost-share grows, through increased co-pays and higher deductibles, so does the opportunity to assist them in vital decision-making. Increasingly, individuals seek information to help them maximize their health care dollars. Studies show that 21 percent of consumers want to receive health information via SMS text message, and 77 percent of patients find technology inviting rather than intimidating when it comes to helping them manage their health. Source: In the new patient-centric health care environment, offering secure messaging channels and virtual private networks for communicating with patients is of paramount importance for every stakeholder. A robust messaging service has the ability to analyze an individual or population s demographic and health care data, and communicate with them in an effort to prompt action that will contribute to wellness or care, covering a number of topics: Adherence Reminders for medication/dose and prescription refills or for returns to a care provider for followups are encouraged. In addition, prompts for physical therapy or rehab activities can benefit from messaging. Disease and condition management Messages specifically geared to medical conditions like diabetes, pregnancy, chronic heart failure, asthma and others, are well-accepted. Patients want help and guidance with these intimidating conditions but often fail to receive enough face-time with their doctors to discuss. Messaging enables better care management, both between visits and as a whole. Education Messaging can also prolong wellness by delivering useful materials for educational purposes such as how-to videos for rehab exercises, two-way communication for surveys or data collection projects and telemedicine. Wellness reminders Measurements as well as prompts for exercise, attitude, diet and other activities have been shown to have a substantial impact on wellness. Monitoring Keeping track of information about the patient with regards to blood pressure, weight, blood sugar, mood and pain levels can help providers get in front of the health issues of their patients representing real opportunities to improve outcomes and cost savings. Once a patient shows up at the emergency department (ED), an opportunity is lost.

4 4 Current messaging services fall on a spectrum. On one end, services tend to be more focused on the mechanical (delivery service), while the other end of the spectrum focuses on the more clinical (content-focused) service. Regardless of the form it takes, messaging holds the ability to speak to the patient or stakeholder where they live, in the format they prefer, in order to engage, educate and generate better health. Messaging offers cost benefits to various stakeholders across the health care continuum, including: mhealth By The Numbers 90 percent of U.S. adults own a cell phone 58 percent of U.S. adults own a smartphone 80 percent of mobile phone users say they get quicker responses from a text than from an or voic 52 percent of smartphone owners have used their phone to look up health or medical information Source: Pew Research Center Payers and large, self-insured employers Insurers and health care payers have a vested interest in managing care. Many take risk by insuring group/individual coverage or servicing Medicaid/Medicare MCO populations. Promoting cost-effective care is critical for managing this financial risk and generating value for shareholders. Provider-centric health care payers Integrated delivery networks (IDNs) represent an opportunity because despite operating like a payer, they inherently have a clinical view that supports quality messaging. In addition, Account Care Organizations (ACOs) are proliferating with 20.5M people enrolled in an ACO, 5M of them Medicare beneficiaries. Combined with the private sector, more than 428 provider groups have already signed up with an estimated 14 percent of the U.S. population now being served by an ACO. Despite the popularity, ACOs have financial risk, and rank care management based on integrated data as one of their top strategies. Messaging will be paramount to the ACO care management approach. Program administrators Messaging is critical to certain service providers. Pharmacy Benefit Managers (PBMs) have a need to communicate with patients and can impact the quality of care. Similarly, medication therapy management (MTM) vendors are tasked with improving care through patient communication, which makes targeted patient messaging an important factor. Providers Health care providers need assistance with effective prompting of patients to make good choices. Messaging can encourage self-induced patient care such as taking medication, rehab participation, doctor follow ups, and more. For hospitals, the challenge of encouraging this care is amplified, especially given the recently introduced penalties for poor outcomes. What s more, hospitals are scrambling to find better ways to reduce avoidable readmissions. Patients/small employers Direct-to-consumer messaging is not uncommon and is another reason to invest in mhealth. The proliferation of health-related apps (some of which are simply a string of text messages, or a messaging solution with a mobile handset wrapper), continues to accelerate. The challenge for all of these stakeholders is to find the most effective messaging platform.

5 5 What to Look for in a Messaging Platform Ideally, a multi-modal messaging service should offer configurable content and delivery options to support targeted messaging to members of a health plan, PBM or ACO based on their preferred communication channel. These include SMS, , web portals, mobile platforms, CSR outreach and print/mail. A messaging service should offer menu-driven options for creating manual, automated-driven, or serialized messaging campaigns delivered to members, providers, caregivers and pharmacists, and should cover such topics as: Pharmacy savings: generics, pharmacy network use Pharmacy compliance: refills, recalls, dosing, medication therapy management Medicine cabinet: drug search and use assistance, formulary criteria, co-pay discount offers Wellness care and immunizations: health maintenance suggestions, promotion of retail and alternative site delivery Increase Star Ratings, health care effectiveness data and information set (HEDIS) scores and Meaningful Use stages Medicare Advantage: reduce monthly Drug Summary print mailings A platform s analytics engine should leverage health care data to target recipient populations and personalize messages, as well as facilitate targeted member selection based on a variety of data elements, such as demographics, drug use and compliance history. Important features to look for in a messaging platform, include: Dashboard/Message Builder A dashboard is a place where messaging can be constructed with ease and allows users to select distribution settings. It should include message scheduling (with avoidance of SMS text deliveries at night), message management (i.e. how many messages individuals get and prioritization), and a message approval matrix to ensure appropriate (multi-tiered) approvals on messages before being sent. Outgoing Messenger/Delivery Service Message delivery should be communicated via a variety of channels such as SMS text, push, , portal messaging, CSR and print/ mail, and be specified by the member or recipient. Efficient Analytics Population segmentation should not require IT department programming support. Users should be able to efficiently define target populations for messaging and receive analysis results with seconds, not hours or days. Source:

6 6 Stakeholders Shifting Priorities A number of key trends have made targeted health care marketing not just a convenience, but a necessity: Need to Lower Cost of Care By 2020, national health spending is expected to reach $4.6 trillion and comprise 19.8 percent of GDP a trend that is insupportable. As necessity prompts activity, programs like messaging will be one of the go-to services. Meaningful Use Stage 2 Meaningful Use requires providers to enable patients to view, download and transmit their health information. Providers need to offer online access to more than 50 percent of unique patients, and more than five percent of the unique patients will actually need to view, download or transmit their health information. Stage 2 will also require that providers use secure electronic messaging to share relevant health information with patients. Technology Adoption There has been an accelerating adoption of, and a growing reliance on, technology, which has been driven by accessibility, availability and affordability. Market Value Estimates show that the mhealth market as a whole will reach $23 billion globally by 2017 ($6.5 billion for the U.S. alone). How a Messaging Platform Works In order to maximize ROI, stakeholders should consider outsourcing the function of an integrated health care messaging service. When deciding on a product, three major components need to be considered: Rules/Analytics Engine These should carry the ability to leverage health care data in order to target recipient populations and personalize messages, facilitating target selection based on a variety of data elements such as demographics, drug use, medical encounter data, labs and biometrics. Dashboard/Message Builder This component makes the process easy and efficient for the user, facilitating message construction, and allowing the user to select distribution settings. Outgoing Messenger/Delivery Service When reviewing this component, think of the messaging service provider as the mail carrier. The service should enable the stakeholder to communicate via a variety of modes (e.g., SMS text, push, , mail), as specified by the stakeholder or recipient. This level of efficient, tailored messaging requires substantially powerful technology. Source: RxEOB

7 7 Conclusion Messaging service benefits for health care organizations include improved care, lower costs, and maximum member engagement. In addition, a messaging platform with a simple user interface increases the productivity of the health plan and provider staffs responsible for communicating with members about programs to increase compliance with Medicare STAR and Meaningful Use rating systems. All stakeholders benefit from an efficient application that quickly creates and sends a relevant message to a member through a secure and preferred communication channel. Messaging services also greatly increase customer satisfaction. Patients appreciate easy-to-access, consistent messaging, as well as configurable communication settings to optimize their ability to communicate and feel empowered by their health care experience. Targeted delivery reaches individuals where they are listening, improves outcomes over traditional messaging approaches and, with a multi-modal real-time approach, offers a coordinated redundancy to ensure effective communication. Added value opportunities also exist and include translation services and message delivery verification. Ultimately, health care organizations should look for a messaging service partner that offers all of these functions, as well as the right combination of pharmacy intelligence, reputation and health care IT knowledge. About RxEOB For 15 years, RxEOB has been assisting health care professionals and patients improve the information needed to buy and adhere to prescriptions. Offering pharmacy benefit analytics, portals, mobile applications and reporting, RxEOB s products help health plans and PBMs engage patients for better pharmacy utilization and adherence. For more information on how RxEOB can help reduce your overall health care costs, please visit: or call Miliard, Mike; Payers moving toward trigger-based communications; Healthcare IT News; April 12, 2012; accessed September 19, Dolan, Brian; Text Message the workhorse of mobile health; MobiHealthNews; December 11, 2012; accessed September Monegain, Bernie; Consumers want technology help; Healthcare IT News; June 5, 2009; accessed September 19, Health Fact Sheets; Pew Research Internet Project; accessed September 19, Vernon, Ken; Everywhere All the Time; May 2010; accessed September 19, Pew Research. Gold, Jenny; ACO FAQ; Kaiser Health News; 2011; accessed September 19, pdf; accessed September 19, CMS; National Health Expenditure Projections ; downloads/stage2_epcore_7_patientelectronicaccess.pdf PWC; Touching Lives Through Mobile Health; 2012; accessed September 19, 2014.