By Merrill Matthews, Ph.D. and Edward M. L. Peters
If there are two things we can count on, it is that the cost of health insurance is constantly going up and thecost of technology is constantly going down. It is almost as if they exist in separate universes. While health insurers use technology to pay claims and enroll members, they haven't fundamentally changed the dynamics of how health insurance is offered and used.
But what if in return for a much lower premium a health insurer offered a policy that integrated technology into the policy provisions directly and in a way that fundamentally changed how policyholders managed their health and interacted with providers, pharmacies and insurers, find the best values, and even pay their out-of-pocket expenses electronically? In other words, technology usage is an integral part of the policy provisions, it's not just pasted on.
What would such a policy look like? Start with the centuries-old trip to a doctor's office for an in-person visit. Today, technology connects us to friends, family and colleagues virtually, so why not to our health care providers?
Instead of heading to the doctor's office, the policy might first require the patient to connect online (emergencies excepted). For those who do go to the office, a virtual follow-up visit might save both time and money. And for bed-ridden patients and the homebound, tele-health visits using a computer or mobile device would be the modern equivalent of a house call.
Chronic medical conditions such as diabetes, hypertension, heart disease, asthma and arthritis make up 65%of corporate health care spending, according to an Aon Hewitt report. Helping patients better manage chronic conditions could save $331 billion over 10 years, according to an Urban Institute study, while improving peoples' health and quality of life.
For example, there are Bluetooth enabled devices that check a diabetic's glucose level and send the data through a smartphone to a monitoring station. Algorithms would constantly check for problems; if one arises the system could send a text to the patient and the doctor.
Patient compliance with their medication regimen is also a major challenge. A recent IMS Health study suggests that getting patients to take the right medication at the right time could save $213 billion a year. A reminder text message from the doctor or pharmacy could improve compliance significantly and prevent costly complications.
Unhealthy lifestyles, such as smoking and obesity, can also impose significant costs on the health care system. A technology-based policy would connect with those flagged with lifestyle issues to provide tips and motivation. An app already available even provides interactive games and the ability for users to track their progress and stay engaged.
The government has been trying to get doctors and hospitals to shift to a system of electronic medical records for years, with only limited success. But a personal electronic medical record (EMR), stored in a smartphone or in the cloud, would be a fundamental part of a health-tech policy. That personal EMR would need to be encrypted and integrated with a patient's medical providers, pharmacies and insurer to help manage the information and flag problems.
A technology-oriented policy is going to challenge old ways of reimbursing for care. Several states have passed laws requiring insurers to reimburse doctors who see patients virtually. But insurers and providers everywhere will need to rethink access to care and compensation for it.
Other obstacles are political rather than technical. For example, most states impose restrictions against a patient residing in one state seeing a physician located in another state. But technology doesn't recognize geographic borders. Patients will soon be able to go anywhere and see anyone virtually. Health insurance and the legal system need to catch up.
This innovative approach focuses on information, rather than "brick and mortar" services. As information and technology get ever cheaper, policyholders and insurers can take advantage of them directly, thereby reducing costs and improving health outcomes. And it would reduce administrative costs because technology, rather than office workers, would be managing most of the information.
Not everyone would take advantage of such a policy, but if health insurers were able to offer one at a significantly lower price, millions of Americans might jump at the chance. In an age of near-constant connectivity, where people use apps to manage everything from travel directions to dinner recipes to bank accounts, insurance policies that encourage consumers to embrace technology and information may be the key to bending down the health care cost curve.