While much of the excitement in mobile medicine has centered on clinical and wellness tools for doctors and patients, there is a third player in the health ecosystem that plays a major role: the health plan. Whoever is paying the medical bills, whether it is the government or an insurance company, has access to vast amounts of data on drugs, providers and, of course, their members. Yet, the large majority of Americans probably are only dimly aware of the role their insurer plays in their health care and mostly perceive them as an impenetrable edifice.
But what if a health plan made their information stores easily accessible to their members ? Rather than appearing as a capricious dispensary of payments, the insurer could be a resource, pointing to cheaper drug alternatives and helping to locate in-plan physicians. Patients could then find out how much of their doctor’s bill has been paid by insurance and how much they owe. And, maybe they would not have to suffer through deciphering the explanation of benefits (EOB), that bane of doctors, to figure this out for themselves.
As Julie Kling, Mobile Executive Business Lead at Humana, explains in this interview, this is the vision that drove Humana to develop the MyHumana Mobile app for their members (iTunes,Android Market) . After initially defining their goals, they did further market research and presented it to focus groups. The preparation and execution paid off and the app won the 2011 Appy awards for the Best Medical App, presented by Media Post. We also note that the success of this app represents an example of how providers and institutions are likely to provide more clinical apps in the future, as discussed in a recent post titled “In the future, your medical app may come from your hospital not from an app store”.
Read on to learn Humana’s strategy and the steps they took to develop their app.
interview with Julie Kling, Mobile Executive Business Lead at Humana
How did you develop an interest in mobile software ?
I was previously a nurse and worked in diabetes education for 10 years. After a while I realized I can impact a larger group of people by working in different venues. Later I worked in in disease management at CorSolutions (now Matria) where Humana was actually one of our customers. We did a lot of work in telehealth, including development of software for nurses to do telephonic care. We also developed educational curriculums so they the nurses could learn health education skills. Later, I worked at Caremark, Blue Cross Blue Shield Association and SHPS. I developed conferences and worked in product management in these organizations.
Eventually I moved into clinical strategies at Humana. There, we realized there are a lot of things that Humana can do to mobilize the resources we already have. We understood how many people were going to convert to the phone as their primary means to access the web. For example, by 2014, more people will be using phones than all PCs combined to access to web. We thought Humana needs to be there.
What were your goals for the MyHumana Mobile app ?
Primarily, we wanted to meet our consumers’ needs. We have three mobile assets: the app, the mobile-optimized website and text messaging. We had three strategic objectives: service efficiency, medical trend/expense containment and value proposition.
1. Service Efficiency
We want to allow provide more self-service for our customers. Thus, the app will help you find your spending account balance, whether a particular doctor is in network, find an alternative cheaper drug when receiving a prescription. With the app, the phone can also function as your insurance ID card, so you never forget it. Verification of benefits can be performed live, and can be faxed to the doctor from the app ahead of the visit.
This is not only more efficient for the patient, it can also reduce administrative costs. This is a convenient alternative. Just like using an ATM, you don’t have to see a teller to get banking services.
2. Medical trend management/expense containment
We want to reduce the rising cost of care. So we have included drug pricing tools. These include out of pocket cost information for each retail pharmacy, and for mail order. We specifically provide out of pocket costs, based on their personalized plans, not just the retail price. There are apps for doctors that provide information on formulary [insurance payment] tiers for each drug but these are not specific to the patient.
We can help members get to a nearby urgent care center instead of an ER, when that is all they need. We can remind members about their flu shots. These are examples of how health plans support keeping their members healthy. We are rated using HEDIS measures, which are like a clinical quality report card for health plans. Employers and CMS use HEDIS measures to compare health plans and include measures such as flu shots, hemoglobin AIC, mammograms, prostate screening, etc.
Some of the other valuable mobile trend containment efforts in the works include medication reminders and refill reminders.
3. Value Proposition
We want to be providing the best experience for members. This leads to better member retention and acquiring new customers. We want to reach them regardless of how they arrive, for example if they go to humana.com on their phone, they will be redirected to mobile web site.
What information does a health plan have to affect health behavior ?
We have the patient’s medication list, at least all pharmacy claims which will show when each drug was prescribed and filled. While we won’t have information about sample medicines provided by the doctor, or over the counter meds, we do have a good start to the complete medication list. This will be useful for the patient when they are at the doctor and trying to remember their medications – the phone becomes their medication list. People have told us this is a valuable tool on our iPhone app store reviews.
We have medical claims, which list the doctors they have seen and their treatments. If given a diagnosis at time of referral, having access to plan [in network] doctors can be very useful. This data includes hospital affiliations, languages spoken, doctors’ CV and directions. These are the types of reasons people call into call centers.
What was the design process for the app, how did you decide what features to include ?
We did consumer research, on our own customers and other health plan companies’ members. We asked what are your pain points, challenges, etc.? At a large organization like Humana, we want to make sure it we are developing something that meets members’ needs. We also used an outside agency to provide this market research. Information was collected in three cities from people with mobile phones with data capability, the minimum being texting, but most had web access and some had app phones.
We also did usability testing where everybody brought their own phone, and we had our prototypes. We saw where they had problems clicking through the app or had problems with terminology. We had them create their ideal app from Humana, where they could cut & paste pictures of buttons.
We looked at the primary reasons for customer service phone calls. We looked at the most used web pages: providers search, claims, benefit validation, drug benefits, spending account balance, or remaining deductible. We then sifted all this data through our 3 strategic goals.
How are you letting your members know about it ? Do you have any data on usage thus far ?
We have multi-pronged approach to communication. Email has been best pickup for app. During on-hold messaging, we tell people about mobile services. There have been over 20k downloads of apps, and over 30,000 mobile web hits every month.
We redirect people to the mobile website because we know it is a bad experience if people view a non mobile-optimized site when using their mobile devices. With automatic redirect to m.humana.com, page views have increased. We know when we collected home phone numbers, 37% of our customers gave us mobile phone numbers, so we need to be prepared to provide mobile services to our members.
Your web site states that Humana has been identified “the most innovative health plan in the mobile space” by Celent, a consulting company. How do you see mobile software and technologies changing the relationship between patients and their health plans in the future ?
We believe it builds a closer relationship and aligns with our tag line: “guidance when you need it most.” Mobile is a communication channel that enables you to get information when and where you need it.
We also want to encourage healthy behavior and well being in general, e.g. social relationships and security. We can build a much closer relationship than a “benefits statement” and we have had great feedback from our customers and outside validation, like you mentioned above.
I have sat on panels with our competitors e.g. United Health, the Blues, Kaiser and know what they are doing now and a little about what they are going to do in the future. Most health plans are starting with provider search, using the GPS, and a handful have some of our offerings, such as the ID card, claims and spending accounts. We have lots of plans for future development to stay ahead of our competitors.