Consumer driven health: Taking better care
Published: April 17, 2006
Like many organizations, Microsoft is deeply concerned about the costs of healthcare, not only for its employees, but for the country and the economy. And it is even more concerned about the need for consumers, doctors, hospitals, and insurers to work together collaboratively to achieve the best possible results in preventing and treating health problems.
"The old models simply have not performed. Misaligned incentives, runaway costs, growing consumer expectations, and a highly fragmented ecosystem: These are all significant issues that have not been addressed by the existing system," says Dennis Schmuland MD FAAFP, Director of Microsoft's Health Plan Industry. "New incentives, decision-making models, and supporting technologies are needed to transform how medical choices are made."
A new approach to health care may take many forms—health savings accounts, employer-funded reimbursement plans, portable insurance—but in the end, it will be driven by consumers. This shift in perspective from patients to consumers of healthcare is fundamentally changing the role of healthcare plan providers.
"People are getting much more sophisticated when it comes to their healthcare choices," says Travis Hatmaker, Marketing Manager for Microsoft's Healthcare and Life Sciences products and services. "So the direction from a provider and a healthcare plan perspective is to provide the end user, in this case the patient, with more information as well as robust tools to proactively manage their health and their finances."
Putting choices in the hands of consumers
For most health plans, "consumer driven health" has quickly evolved beyond the concept of a "product" to become a corporate-wide "consumer-driven" strategy. As such, it requires health plans to shift the center of their operational focus from claims and payment transactions to high-touch customer interactions. "Beyond simply designing and administering benefits and paying claims," says Schmuland, "health plans now need to deliver first-class service that focuses on the experience and health of the consumer."
Microsoft is working with its partners to help ensure health plan providers can do just that.
"We call it Knowledge Driven Health Plans," Schmuland says. "It is a vision, strategy, and blueprint to enable payers to transform into organizations that are consumer-focused, information-driven, and highly collaborative."
According to Schmuland, three key components are necessary for consumer driven healthcare to be successful:
1. | There must be appropriate incentives—for patients to take responsibility for their own health and wellness, including lifestyle choices, and for physicians to focus on quality outcomes. |
2. | Actionable information, programs, and tools must be within easy reach to help the consumer get healthy and stay healthy and help the physician deliver the highest-quality and most cost-effective care. Offering consumers incentives toward living a healthier lifestyle—including proper diet, exercise, and preventive medical care—won't be effective if information and trusted guidance about those lifestyle choices and cost-effective care is not readily accessible and easy to use within the context of their daily lives. Similarly, even with incentives to focus on long term wellness, physicians need complete information about patients' histories in order to better predict—and prevent—potential problems before they occur. |
3. | Care and a common care plan must be coordinated among providers and the health coach, particularly when patients are seeing multiple physicians for different problems or procedures. For consumers to effectively make choices about providers and treatment options, they must be confident that the entire community with whom they are working will be able to collaborate in providing care. |
These three components underlie the success of consumer driven health. As Schmuland says, "[Microsoft] wants to support new incentives and informed decisions by consumers and providers, ensuring that the best evidence-based care plans are followed, regardless of where the patient is seen."
Leveraging technology that empowers consumers
Microsoft is not only helping to define this vision, it is also taking steps to help catalyze the movement toward consumer driven health. "Microsoft is bringing new consumer technologies to enable health plans to move beyond the conventional consumer self-service Web site—now making it possible for health plans to integrate health improvement, incentive support, and security-[enhanced] messaging and collaboration into the digital lifestyles and homes of consumers," says Schmuland. "And [Microsoft] has an ecosystem of partners, each of whom utilizes Microsoft technologies to make all this real."
One Microsoft partner that has implemented a powerful set of technology tools to support consumer driven care is QCSI. Their revolutionary Web-based MyHealthBank product suite is being adopted by some of the large health plan customers in the country to enable consumers to more effectively manage their healthcare services.
These four MyHealthBank modules can function independently or work together to provide a complete, integrated consumer experience:
| • | Direct presents health plan components to consumers, enabling them to model and price different offerings and to enroll for the benefits that suit them best. |
| • | Navigator aggregates medical information—including information about the costs and outcomes of different procedures, different physicians, or different hospitals—so consumers can easily make informed medical decisions based on care quality and cost. |
| • | Finance assists the consumer in managing account balances and debit card transactions, especially important as more consumers pay for care through a health savings account. |
| • | Transact works behind the scenes to connect enrollment, financial transactions, and claims with other systems. |
"The healthcare consumer is a discriminating buyer," says Bruce Oliver, Vice President of Marketing and Business Development for QCSI. "They need information. That's where consumer-directed healthcare and technology come together. Our tool helps the consumers pick the kind of benefits they need, and, more importantly, pick them to [match] the budget they have."
Robust Microsoft platform for partner solutions
A solution such as MyHealthBank can integrate and deliver information to doctors, insurers, and consumers because it is built on a set of design standards—XML, Web services, and service-oriented architecture—that are implemented on a Microsoft platform.
"When we started QCSI 12 years ago," Oliver recalls, "we saw the kind of technologies Microsoft was building and that the ease of use of these technologies would be very important to our customers and to our customers' customers." The company took advantage of Microsoft technologies to help ensure it could meet the demands of even the largest and most complex healthcare organizations it serves.
It is these innovative tools and the underlying Microsoft technologies that drive them that can now give healthcare consumers and the physicians who serve them real-time access to all the information they need—helping them to make the best medical and financial choices, and then implement those choices.
The result, predicts Hatmaker, will be better for providers, consumers, and the economy overall. "Together with our partners, [Microsoft] will empower the consumer to make better healthcare decisions from an economic standpoint, from a lifestyle standpoint, and from a quality-of-care standpoint."
For more information about healthcare solutions provided by Microsoft partners, visit:
