Startup Helps Health Insurance Cards Go Digital

In an era of e-tickets, bitcoins and app-based banking, it seems pretty antiquated that we still have to fumble through our wallets for an insurance card each time we go to the doctor's office. But USA Today reports on a Philadelphia-based start-up that has a plan for making those flimsy pieces of cardboard digital — and the upside isn't just the potential for going paper-free.

With the rise of high-deductible plans, patients are increasingly on the hook for more of their medical expenses than they've ever been before. For patients, that means a bigger need for tools that provide more transparency about health care costs. And for doctors, particularly independent physicians, said Medlio co-founder and CEO David Brooks, that means a growing problem with collecting payment.

According to a 2007 report from McKinsey, hospitals and providers usually only collect about 50 percent of the postinsurance balance (or the amount owed by the patient beyond what insurance covers or what they pay at the time of treatment). That's not because patients are inherently delinquent, Brooks emphasized, it's often because they're either too confused about what they need to pay or they don't believe that they were billed correctly.

The company, which is part of the new Dreamit Health start-up accelerator, said the first version of its app is still a few months away. But the initial plan is a free mobile app that enables patients to check in from their smartphones. Instead of handing over a physical card, patients would use the app to provide doctors with their insurance information and the app would automatically verify insurance eligibility for the provider. Medlio also intends to give patients an estimate of their treatment's cost before they receive it, and it enables patients to initiate (and doctors to collect) payments directly through the app.

New App Matches Potential Patients to Providers by Naming a Price

The new PokitDok app allows consumers to search for value among health care providers as travelers might use Priceline: by naming their price. More than a million health care providers participate in the program, which responds to Web-based or mobile requests for a price quote indicating a consumer's budget, payment method and needs, as well as practitioner preference. Doctors have an incentive to join the system to connect with patients paying out of pocket or through a health savings account or flexible spending account, says PokitDok CEO Lisa Maki.

Launched by Maki after her own frustrating experience with the healthcare system, PokitDok provides a web-based community and marketplace for health and wellness. On the site, people can communicate directly with physicians, personal trainers, massage therapists and other specialists, as well as purchase health products and treatments. In July, it opened in beta and raised $1.3 million in seed funding.

BPC Releases Report on Potential for mHealth

A report from the Bipartisan Policy Center’s Health Project, led by former Senate majority leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.), says that mobile health is a promising avenue for increasing patient engagement, which should be one of the major goals of health care reform. But barriers to mobile adoption and increased engagement include lack of awareness, lack of innovation, and privacy concerns. The BPC was founded by Daschle and other former Senate Majority Leaders Bob Dole (R- Kansas), Howard Baker (R-Tenn.), and George Mitchell (D-Maine) in 2007, and its mission is to “drive principled solutions through rigorous analysis, reasoned negotiation, and respectful dialogue.”

The BPC Health Project highlighted patient engagement as a key goal in their January report “Transforming Healthcare: The Role of Health IT.” By reviewing a wide range of available literature, they found that patients who are more directly involved in their health have less pain and faster recovery, are more adherent to doctors’ treatment plans, and are less likely to choose elective surgeries. In the latest report, entitled “Improving Quality and Reducing Costs in Health Care: Engaging Consumers Using Electronic Tools,” the BPC looked at two categories of electronic tools, those that promote education and self-care, and those that enhance patient-physician communication.

In the report the center outlines some suggestions to the government for overcoming the barriers to adoption. Increasing awareness of electronic tools among both consumers and providers is one suggestion. Employers could play an active role in increasing awareness of such tools. The report also emphasizes the need to develop and disseminate standards and best practices for adoption, especially in small clinics where the cost could be prohibitive.

Population Health, Value-Based Care Drive Health Information Exchanges

The pursuit of population health and value-based care "may be reviving the business case for organizations to join health information exchanges," according to a HealthLeaders magazine article. Now more than ever, providers need accurate and complete patient data to effectively manage chronic care populations and earn incentives or shared savings; they need their own data as well as that of their affiliates and competitors. Bringing down costs in the health care system as a whole depends on sharing data. Nevertheless, although preliminary results suggest HIEs can help health care organizations save money, some are still reluctant to participate.

An HIE is an organized regional network that enables hospitals, physicians, and other care providers to upload and access patient health information. HIEs connect data for organizations—from affiliates to competitors—to share clinical data that can improve a patient's overall care. The HIE is generally connected through a provider portal, giving easy access to clinical applications that allow caregivers to see all of the patient's clinical information in real time while restricting access to any claims data or other financial information. Early data indicates the HIE can reduce costs for participants. But one of the main barriers to participation may be issues associated with costs; and not just the actual dollar amounts required to make the investment, but who makes the investment and who controls the flow of capital. Whether to participate in HIE is a strategic conversation, but all the participants have to be willing put aside their individual issues and agenda and to work toward a solution that's best for the patient.

Although the American Recovery and Reinvestment Act (ARRA) allotted grants to encourage the establishment of HIEs, participating in an HIE still doesn't come free. Participants must have an EHR in place, and most HIEs ask participants to pay a fee to connect; that price can vary depending on an organization's size and the degree and complexity of the connectivity needed. Employers have a unique role to play as purchasers in the encouragement of HIE establishment because employers all need employees whose health conditions are well-managed. HIE establishment presents a unique opportunity for employers to partner with and work directly with providers.

IOM Report Release: Best Care at Lower Cost

On Thursday, September 6, the Institute of Medicine will be releasing a new report from The Learning Health Care System in America project. Describing the path to continuously learning health care, Best Care at Lower Cost explores the innovative opportunities to use emerging technology and science to address one of the nation's most fundamental challenges: getting better value from our health care. Working against the backdrop of a compelling and rapidly growing urgency, the report identifies three major imperatives for a change in approach: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. But the report also points out that emerging tools like computing power, connectivity, team-based care, and systems engineering techniques—tools that were previously unavailable—make the envisioned transition possible, and are already being put to successful use in pioneering health care organizations. Applying these new strategies can support the transition to a continuously learning health system, one that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost. The report’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation.

You are invited to participate via the live webcast.

Insurers Embrace Virtual Doctor Visits

A joint Kaiser Health News/USA Today story reports that insurers such as UnitedHealthcare, Aetna and Cigna, and large employers such as General Electric and Delta Air Lines are getting on board, pushing telemedicine as a way to make doctor "visits" cheaper and more easily available. Proponents also see it as an answer to a worsening doctor shortage. But some physician and consumer groups worry about the trend.

Although telemedicine developed more than 40 years ago as a way to deliver care to geographically isolated patients, its growth was slow. That's changed in the past decade thanks to the development of high-speed communications networks and the push to lower health costs.

Carmen Balber, a spokeswoman for Consumer Watchdog in Santa Monica, Calif., is concerned that lower co-payments, and other incentives, will spur consumers to see doctors or nurses online just to save money. "People will choose the more economical option, even if it is not the option they want," she said.

Employers, however, say they're getting mostly positive reviews.

"Our employees just love the convenience, the low cost and the efficiency," said Lynn Zonakis, managing director of health strategy and resources at Delta Air Lines, which offers NowClinic to some employees for $10 a consultation.