Prime Health recently spoke with Firdaus Bhathena, Aetna’s Chief Digital Officer, about the rise in consumerism in digital health, and how Aetna is leveraging technology and apps to deliver a hyper-relevant experience to its members.
Aetna is moving from being a healthcare financier to becoming a health and wellness partner for consumers at large. What are the some of the key initiatives that Aetna is implementing to make that shift?
As a healthcare financier, we help our members pay for healthcare and navigate the healthcare system. However, that’s not enough anymore. When you look at a person’s overall wellness, 10% of it is determined by clinical health, 30% of it is determined by genetic factors, and the remaining 60% is based on social determinants. Right now, we’re only addressing clinical health.
"When you look at a person’s overall wellness, 10% of it is determined by clinical health, 30% of it is determined by genetic factors, and the remaining 60% is based on social determinants."
Your zip code and socioeconomic status is more important than your genetic code. Overall health is not just a result of not being sick. It is based on a complex combination of environmental and social determinants, including:
· How is your physical and emotional health?
· How is your financial health?
· What are your social connections?
· Do you have a sense of purpose?
These determinants influence our health trajectories. So, how do we understand them? How do we then enable people to lead happier, healthier, more productive lives? It’s a combination of better understanding of the data, gaining feedback directly from the consumers, and academic insights. For example, Aetna has a research partnership with the Harvard T.H. Chan School of Public Health to study the determinants of well-being including: physical health, emotional health, social connectedness, financial security, purpose and character strengths. The results of the study will inform future initiatives and allow us to create programs to help improve the well-being of our members.
How does Aetna Digital plan to leverage its deep data assets and technology expertise to deliver an outstanding consumer experience?
We have a mantra here at Aetna, “we need to separate the signal from the noise.” There is a tremendous amount of data and research out there. We need to boil it down and simplify it, so we can help consumers go down the right path. We must provide our members with the information they need to make the best possible decisions for their particular healthcare situation.
"We must provide our members with the information they need to make the best possible decisions for their particular healthcare situation."
It’s hard to make sense of the huge amounts of data. At Aeta we use artificial intelligence and machine learning to derive insights for Next Best Actions (NBAs) that target a member’s specific health profile. We then explain to consumers why they should take a specific action during their wellness journey.
For example, research shows that people who haven’t visited a primary care provider (PCP) in the past two years are five to eight times more likely to have an avoidable ER-related visit. We can show consumers how to use our digital tools to make an appointment, go see their PCP, and avoid the ER. It’s a win-win for everyone. We did a pilot with a few thousand users where we actually demonstrated value to the user based on strong data science. It led to a 100% increase in visits to PCPs. Now we’re looking at the data to see how it decreased avoidable ER visits. Other NBAs include:
· Enabling members to better follow their diabetes management plan
· Enabling members to better adhere to their medication regimen
· Increasing utilization of tele-health solutions when appropriate
· Ensuring that members are getting the screenings they need for conditions such as breast cancer and colorectal cancer
· Enabling members to better follow their discharge instructions after an acute care episode
How will the proposed acquisition of Aetna by CVS benefit healthcare consumers?
The most important point to be made is that this is a vertical integration as opposed to two companies who do much of the same thing coming together to increase market share. Combining Aetna’s managed care benefits and services with CVS Health’s unmatched local presence, and clinical and pharmacy expertise creates a consumer-oriented, vertically integrated care delivery model that has tremendous benefits for the consumer from a cost, convenience, and access to healthcare standpoint. The goal is to provide high-quality healthcare wherever and whenever the consumer needs it in as cost-effective and accessible a manner as possible. Digital tools will surround the consumer with an always-on health and wellness partner, while connecting the consumer to the appropriate local care provider in a timely and efficient manner.
We want to be the best in the business at understanding consumers’ healthcare needs and health ambitions, and providing personalized solutions tailored to each person’s individual situation.
Aetna Digital recently "sunsetted" its iTriage app in favor of the Aetna Health app. What, if any lessons or best practices from iTriage are you applying to Aetna Digital?
iTriage and other solutions had very powerful concepts built into them. Over time, there’s been an increase of point solutions, and the user experience was becoming disjointed. We’re not thinking about our app from a feature standpoint anymore. Now we’re thinking about it as a user experience.
We’re asking, “What is this person trying to achieve? What are their health ambitions?” iTriage was doing this within a very narrow domain. We looked at our inventory of digital solutions from the member point-of-view and used Aetna Health to integrate various point-solutions for a better user experience.
We’re asking, “What is this person trying to achieve? What are their health ambitions?”
Considering the next generation of healthcare consumers, what are the key goals you would like to see addressed with technology over the next three to five years?
We need to push interoperability across different systems. Data is tied up in different silos. Healthcare is sensitive to the issues of privacy and security which is limiting the value of the data in these silos. We need private, secure access to data. The future of digital health needs to bring this together. How can we leverage AI and machine learning to access this data in order to fix the healthcare problems that this country faces?
Aetna is using advanced analytics and machine learning to act upon the data we have right now, but it’s still pretty cumbersome. Lag time is a problem in healthcare data. Right now, we don’t receive indication of a health issue until a claim is filed. Connected devices will allow for real-time data direct from consumers, allowing us to find these insights directly from the source.
We’re at a major inflection point right now. Healthcare is a national issue that affects all of us in a personal way. Every patient has a story about a healthcare experience where there was room for improvement. Improving this experience means changing the way we do business and leveraging technology to drastically improve the way patients interact with the healthcare system.
Every patient has a story about a healthcare experience where there was room for improvement. Improving this experience means changing the way we do business and leveraging technology to drastically improve the way patients interact with the healthcare system.
Learn more about Prime Health here.