Lisa Marshall

 of the National Coordinator for Health IT (ONC) is has been leading the discussion about healthcare gaming-that is, using electronic games to engage consumers in learning about health and acting on health information. In fact, ONC participated in a gaming conference in June to advocate for gaming's potential. 

There is a growing business case for health plans to consider the gaming strategy. 

Ricciardi says that the overall market for electronic game hardware and software this year is expected to reach $68 billion-of which $6.6 billion is attributed to health-related games. She sees this growth as an opportunity for engagement. 

"There is data to show that people who are engaged in their health are likely to have better health outcomes and are more likely than less-engaged patients to avoid errors resulting from poor coordination of care," Ricciardi says.  

One of the trends helping to drive engagement through gaming is the declining cost of devices, specifically smart phones. Popular devices in the hands of consumers open up channels for health plans to serve customers individually wherever they are, says Mark Boxer, Cigna's chief information officer.  

"Over time, the healthcare model in the United States and globally is shifting toward the individual customer who will be making decisions," says Boxer. "And that's who we need to influence." 

Mobile devices lower the barriers to program participation because consumers can use them virtually anywhere any time. The presented health-related information can reach members when it is most relevant and help them visualize positive change.  

"We have data to show that searches for health information from mobile devices tend to be much more personal or socially sensitive," says Ricciardi.  

But what does it mean to gamify an interaction?  

Dan Brostek, Aetna head of member and consumer engagement, says that social media can add game mechanics to an otherwise bland experience. The key ingredients are: game mechanics; audio, visual and textual media used in novel ways; multiplatform access; and behavior-enabling design.  

"It's part of a broader user experience, such that the game aspect is a piece of the puzzle, but it's not the complete puzzle," he says. 

Almost any member-facing function can be gamified. Cigna is in the process of gamifying a health risk assessment, says Boxer. The goal is to create a fun activity that a member can complete on any device. 

If the experience earns members' attention, it is then possible to further the relationship and start changing behavior. Built-in motivators and incentives, such as rewarding members for exercise or changing their eating habits, help turn the engagement into action. 

Aetna's Brostek says a key aspect to deploy game mechanics might include motivational triggers placed in front of members that result in small steps along the way toward a significant goal. He believes incremental steps are valuable. 

Articles

Healthcare gaming has made progress in the past year by allowing consumers to engage in health via mobile devices.

Games for health have become serious opportunities for plans

IT analytics are beginning to take hold in healthcare, and payers must consider how they will approach the trend. They must structure administrative workflow and technology systems around big data, and then use the results to create value. The key concept is to leverage historic member information on a forward-looking, predictive basis. 

"Big data comes from the notion that we generate a large quantity of information about ourselves," says Joseph C. Kvedar, MD, director of the Center for Connected Health, Partners HealthCare. "We leave transactional and informational 'bread crumbs' around every day." 

"The technology part is not futuristic," says Kvedar. "The application in healthcare will take some time, but it will get there. Most health plan executives have an analytic mind and an analytic strategy."  

Being able to scale big data is key. Some health plans are large enough to draw data from a significant population, while the smaller plan might need to pull in data from other sources to create a complete picture. With sophisticated analytics, a variety of source data can be extrapolated into actionable business intelligence.  

The promise of big data hinges on being able to find patterns that predict expected outcomes and the influence of member decision making.  

"Good decision making is a huge part of healthcare costs and outcomes," says Ahmed Albaiti, CEO of IT consulting firm Medullan. "So that's the big deal for big data: being able to create that decision-making opportunity before actions are taken-before specific tests are ordered, a diagnosis is made or treatments are prescribed."  

The opportunity to influence comes at the decision point, which means the timing of the outreach is important. Although review of claims data, for example, provides member-decision information, the knowledge comes after the fact. Big data will facilitate faster responses on the part of health plans that want to prevent downstream costs.  

Albaiti says plans have access to relevant claims information at virtually any moment. However, the time lag in the analysis doesn't provide an opportunity to change the dynamic quickly. Specifically, systems must move from today's less frequent batch processing to ongoing real-time processing. 

"We're at a point with technology where big data can be instantly discovered and navigated without having to move it into a database," says Shawn Dolley, vice president of big data, healthcare and life sciences at IBM. "This means healthcare organizations can now look at any and all data, and decide what to analyze to improve research and patient care, and better manage operational costs. Big data changes how a health plan can do business."  

The difference, compared with even four years ago, is that such ambitious analytics can now be performed cost effectively. And the technology can scale to a population.  

"Big data is aggregate, comparative-effectiveness, outcomes analytics," says Dolley.  

He says improved-outcomes measurement and cost components should be part of a plan's analytics system. 

IT analytics help plans identify patient populations and anticipate member behavior.

Plans must translate big data into actionable intelligence

But integration and analytics are a struggle for most health plans. Simultaneously, payers are fighting a flood of mandated and competing IT projects, driven by healthcare reform and the technological evolution. 

"We're a small company, and we're cranking out more than 300 different file feeds every week," says Martin Watson, CEO of SeeChange Health.  

Brokers often send data on paper for small groups or in electronic feeds for larger groups. Employers or larger firms might send eligibility feeds. While consuming all that incoming data, plans are simultaneously tying into other external sources, such as wellness vendors, disease management companies, pharmacy benefit managers and biometric screeners. Each of these partners is different in how it sends data and what it expects for reporting. 

Data integration could be a relatively simple operation for the self-contained health plan taking a risk on claim exposure. The plan would need to connect with outside entities, but it might have a single PBM, biometric vendor, eligibility source, and so forth.  

A managed care organization that provides an administrative solution to employer self-funded plans, however, will likely deal with almost every PBM in the marketplace. And that adds more layers of complexity, says Watson.  

"Large third-party administrators manage self-funded companies that may have different plan designs, geographic areas, and networks, and have various ways they want to use their data," he says. 

The purpose of the data must be considered. Increasingly, data is used for strategic analytics well beyond just claims processing. 

 "It's all about using data to manage the potential risks and predict the future costs, so that you can put the appropriate tools in place-through data integration, through analytics, through cost management," says broker and consultant Kristy Long, COO of Premier Consulting Associates. 

The ability of the plan to integrate and use data from its sources drives better management practices and helps control claims costs. Such capabilities are in greater demand as more plan sponsors opt to self-insure. 

"Most claims administrators say 'we integrate all your data,'" Long says. "As an employer, you need to know what that means. You want to understand the risk inherent in your high-dollar claims. You can identify a potential high-risk claimant by diagnosis, or the member may have a pharmacy claim or an outpatient treatment that could lead to a high-cost claim in the future. An employer wants to know the potential costs associated with that risk-short and long term-and to understand how the administrator identified or integrated this episode or claim with all data-both medical and pharmacy-and how it is being managed."  

Well-constructed data integration strategies can help manage the swelling data flood.

Author | Lisa Marshall

Articles

Games for health have become serious opportunities for plans

Plans must translate big data into actionable intelligence

Shore up IT systems in stages to better manage the data flood