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4 Reasons Why Health Plans Struggle with PHRs

Aetna recently made another big announcement relating to their PHR.  While the concept of what they’re doing is very appealing, it strikes me that health plans in general face an uphill battle in getting consumers to adopt and use personal health records (PHRs).

I’ll describe 4 factors behind my thinking:

  • Lack of Trust
  • Lack of Access to Clinical Data
  • Lack of Permission
  • Lack of Convenience in Consumer Workflow

Aetna’s latest announcement describes personalizing searches based on a patient’s claims data and PHR data. 

“Aetna is focused on becoming an industry leader in delivering personalized health information to members,” said Meg McCabe, Aetna’s vice president of medical and eHealth product. “Aetna SmartSource pulls information from a variety of Aetna web resources to intelligently organize search results based on a member’s insurance plan, zip code, and overall health, thereby helping members to become more engaged in their health care decisions.”

To ensure search results are relevant, Aetna partnered with Healthline to build a search engine that takes into account specific information about each user’s gender, age, zip code, health care plan and employer, as well as information stored in their PHR. The result is a customized search tool that integrates a member’s health profile with a robust suite of online tools and information, providing a single place to get personalized information on health, health care costs, and health care providers. Aetna SmartSource delivers information from the following resources:

* Aetna InteliHealth, Aetna’s online consumer health information website, offers easily accessible health information and content developed jointly with Harvard Medical School and Columbia School of Dental Medicine.
* DocFind, Aetna’s online provider directory, helps members find local physicians, hospitals, specialists, dentists, pharmacies, eye care centers and other health facilities who participate in their plan.
* Estimate the Cost of Care provides average in- and out-of-network costs for prescription drugs, medical and dental procedures, office visits and medical tests based on a member’s zip code.
* Healthwise Knowledgebase supports members with information to help them choose health care treatment options that best suit their needs and preferences.

Others who have commented on Aetna’s plans include John Moore (Aetna Keeps Pushing the Envelope and The Business Case for Aetna’s SmartSource) and Matthew Holt.

Here’s where I think health plans in general will have trouble with PHRs:

1) Lack of Trust. People don’t trust health plans…this is left over from the “managed care” model of the 1990s. I suspect even Google Health and Microsoft HealthVault will rank higher on trust than health plans. It would be interesting to see some comparative survey data.

2) Lack of Access to Clinical Data.  To date, automated data streams have consisted primarily of administrative and financial information — in the case of health plans, it’s claims data they use primarily for transacting payments. 

Over the next few years, the emergence of clinical data into automated data streams could be very disruptive; care providers will be positioned much better to use this higher quality, real time data than are health plans.  Thus, care providers are potentially positioned much better than heath plans to do high quality care management and care coordination on behalf of patients.

Let me say that again because it’s an important point:  due to the impending emergence of clinical data into automated, electronic data streams — care providers (doctors, nurses, home health agencies) are potentially much better positioned to do care management and care coordination than are health plans.  

However, care providers have a lot of work to do to be (e.g., the medical home model) to be able to take advantage of this positioning.

3) Lack of  Permission.  Consumers have to give health plans access to their existing claims data…it’s fundamentally part of the service that health plans provide — payment to doctors, hospitals, labs, etc. But why would consumers give permission to their health plan to see their clinical data?  While subtle, this is a different point than the general trust issue mentioned above. Health plans will have to work VERY hard to establish a value proposition to convince consumers to share their clinical data with the plan.  Would you share your clinical data with your health plan?

4) Lack of Convenience in Consumer Workflow.  People are used to organizing their computer lives around Google — search, gMail, Picassa for photos.  But who organizes their daily computer workflow around a health plan?  It seems much more natural that a PHR becomes an extension of daily gmail than an extension of a monthy visit to a health plan website.

These are not insurmountable, but they are BIG challenges to effective health plan effective implementation of PHRs.

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