By Daniel Bates
Healthcare doesn’t have to remain a fragmented, bureaucratic, and costly puzzle for payers, providers, and patients, driven mainly by illness and health crises. Not if Highmark Blue Shield can help it.
The time is right, according to Highmark officials, for a strategic convergence of shared insurance and clinical data analytics, artificial intelligence, digital technologies, preventative medicine, and new administrative efficiencies designed to foster better health across a greater population of patients. This innovative approach is called Living Health.
“Living Health is really putting payer and provider together to solve the fragmentation that is occurring currently in health care,” said Dr. Anil Singh, executive medical director of clinical solutions, design and implementation at Highmark.
Added Dr. Tony Farah, chief medical and clinical transformation officer at Highmark and the other clinical architect of Living Health : “We have doubled down on how we take care of people, but really take care of more of them, knowing all those barriers, whether it’s social determinants that are problematic, whether it’s lack of affordability, whether it’s lack of interoperability, in improving the health of the population we serve, not just one by one, but really at a much larger scale.”
The new strategy is based on the understanding that the insurer and providers must work closely together to solve the challenges health care is facing. It’s important that this transformation fits naturally into clinicians’ daily work and helps them to practice at the top of their license, without weighing them down with administrative burden.
“What we need to do is reduce the administrative burden and give them the most actionable information, without them having to ask for it, that allows them to do what they do best,” Dr. Farah said.
The new initiative is finding ways to bring together big data and personalized data from both the insurance and clinical side to make stronger and more accurate assessments that allow for better clinical decisions, often before health care issues arise, and engagement strategies that get patients more involved in health and wellness. And all of that ultimately saves money for the patients and payers.
“If you look at the National Medicare data, about one out of four patients – sometimes one out of three – who have been hospitalized with heart failure, come back to the hospital within 30 days, which is crazy and unacceptable,” Dr. Farah said. “We’ve been able to prove through our pilots that you can reduce that to a single-digit number just by doing more of the things we know how to do. So now you start adding digital and virtual, analytics, artificial intelligence, and the algorithms that allow us to give our clinicians and clinical teams that information, and we therefore can move the care upstream.”
Part of Living Health’s engagement strategy calls for the creation of more digital solutions that allow patients to better track their health while sending data in real time to clinicians and health coaches who can respond to changes faster, before they become bigger issues.
“As we begin to digitize manual efforts in healthcare, we will create efficiencies for patients and physicians to make the experience better for both,” Dr. Singh said. “There is inherent richness when we combine insurance data with clinical data that will inform the ‘next best actions’ clinicians can take to help engage and manage patients.”
How it works
One of the initiative’s early solutions targets members with type 2 diabetes.
Members receive a free digitally connected blood glucose meter, test strips, and an app that gives access to a virtual health clinic with a team of care leads who provide personalized, proactive support.
According to Dr. Singh, “Instead of waiting for somebody to get sick, we can continuously monitor somebody’s blood sugar. If the patient develops a low blood sugar, for example, the patient will be alerted via the app, and may receive a call from a health coach to check on the patient.” The coach helps the patient navigate through that issue. It may be that they alert the pharmacist or a physician to adjust the medication regimen or further manage that patient’s issue. I think the genesis for better health is the ability to have insight to what is actually happening with a patient when not being physically seen and why a certain behavior is leading to a potentially poor outcome.”
Perhaps even more importantly, Dr. Farah added, is the idea that Highmark now can target a whole population of diabetics collectively, at scale, with this same predictive, proactive digital approach to managing members’ diabetes better.
Solving health issues at scale
“We do have data,” he said, “that has allowed us to demonstrate that, if you take diabetic patients who, let’s say, have a high A1C level, we’ve taken those populations and, within three months, brought the majority of those patients’ A1C levels down to within normal. And that is not easy to do. We know how to do it one by one, but to be able to do this for large populations is amazing.
“You can see how those early proof points allow us to do much better by the populations we serve,” Dr. Farah continued. “Same with high blood pressure. We know we can bring anyone’s uncontrolled blood pressure down to normal. We just need to do it at scale. We need to do it for more people. Our goal is to really improve the health of hundreds and thousands more of those members that we serve. We are mission-based, and I would tell you that it’s our responsibility to do this.”
Dr. Singh could not be happier about the effort.
“I’m most proud of being at an organization that really cares about the health of its members and is willing to address the needs of providers,” he said. “I’m proud that we are working in a blended way by putting payer and provider together and really beginning to solve that problem. That’s what keeps me going every day.”