April 13, 2020

The Rise of Technology for Medicare Insurers

Deanne Gertner
From the introduction of the smallpox vaccine to the invention of the hypodermic syringe, healthcare technology has not only improved health but extended longevity.

In fact, technology in healthcare has been so successful that humanity now has something its never had before: the oldest population. Ever. In the history of the world. Let your brain wrap around that.

However, this major success is not immune to a host of challenges. Like caring for people into extended old age, especially those with more chronic, complex conditions. Like helping people maintain their autonomy as long as possible. Like dealing with a dearth of gerontologists while demand for them continues to increase. Like designing homes and cities to accomadate an older population. The solution to our technologically induced problems? More technology. 

For Medicare insurers, technology could improve efficiencies and lead to better member outcomes. Here’s how.

Scaling Up

Fun fact: Massachusetts General Hospital pioneered telemedicine using closed circuit television in 1968. So why has it taken so long for it to be adopted en masse? Sure, we’re creatures of habit and medicine often requires the laying of hands. The status quo compels us in powerful ways. It’s not until necessity dictates a change in perspective and habits that we even consider doing things differently. 

All along we could have avoided the hassle of getting to the doctor’s office and waiting and then waiting some more for non-urgent health issues. We could have saved those with mobility or transportation issues from spending so much time and money getting to and from to the doctor. Now, more and more seniors are discovering there’s a better, faster, easier way to connect with a medical professional and—surprise!—it’s not so bad after all. 

Until recently, consumers, payers and governments saw telemedicine as the red headed step child of healthcare. Medicare, for example, only paid for telehealth on a limited basis: in designated rural areas or if it originated at a medical facility. Medicare now recognizes a broader range of telehealth services including virtual visits and e-check ins and allows people to use telehealth from home in order to keep seniors safer and prevent overburdening the health system. Even the Federal Communications Commission has stepped in to help hospitals and health systems scale up their telehealth services through grants that support device and network upgrades. While these changes have been critical in keeping at-risk populations safe and healthy in the short term, they have the potential to change the future of healthcare for the better by expanding reach and access while controlling costs. 

But government support through policy and regulation solves just one part of the equation. Medicare insurance companies and providers must work together with technology companies to expand reach, capability and sophistication, especially for seniors to maintain continuity of care with their primary doctors. Organizations like Iora Primary Care and Oak Street Health have rapidly expanded their telehealth services. Medicare insurers must also lead the way not simply follow. They must work with providers, especially those in primary care, to deliver exceptional not just necessary care while also maintaining continuity.

It’s Personal

How do you scale care while maintaining what seniors value about great providers, that personal touch? Keep the human element in the forefront. Seeing a medical professional’s face via video certainly helps. Personalized email or text messages put human connections at the center of technology. Voice assistants like Alexa and Amazon Echo issue friendly reminders about medication adherence. Chatbots with human names like Felix and Florence continue to proliferate. Artificial intelligence (AI) could help improve efficiencies and even interpersonal connections. Social robots could offer another solution. A group in Scotland wants to determine whether robots can support elderly patients at home or in the hospital

Whatever the technology, the method of design should focus on the end user and be rooted in empathy and understanding. Don’t assume what seniors want. Ask them. Loop them into the process. Learn from their insights. Listen to them. Watch how they interact with the technology. And then adjust it to make it more intuitive, more inclusive, more human.

Work Smarter

It’s not just consumers who need better healthcare technology. Providers and Medicare insurers do, too. 

The HITECH Act of 2009 paved the way for electronic health records (EHR). What was meant to be a time saver ended up being a huge time suck due to coding complexities, inconsistencies and poor design/user interface, which has led to more physician burnout according to numerous studies. Some have described the current state as spaghetti code or, in other words, a hot mess. Providers need a standardized, simplified reporting tool instead, one that allows a wide array of data to be extrapolated and analyzed.

Medicare insurers, especially during critical and peak usage times, need to be more agile and streamlined when it comes to pre-authorizations. They need a better way to expedite the process rather than bottleneck it. Insurance companies could develop better systems which integrate algorithms and AI to speed up the pre-authorization and keep the overarching health system moving as fast as it can.

Everything is Connected

Interoperability, the ability of health information systems to work together across organizational boundaries, will only increase in importance. Interoperability has the capability to help improve health outcomes, increase efficiency and improve profitability. Interoperability could expand to include data outside a typical medical record such as travel history as well as socioeconomic and geographic context. The internet of things and smart devices such as thermometers may be able to spot infectious diseases in advance. With more companies gathering real-time health data outside the doctor’s office, the possibility for big data to transform healthcare hovers on the horizon. Medicare insurers could partner with these outside companies and leverage the data to help members and providers make more informed and healthier choices.

Privacy & Policy

Whether you attribute the idea to Voltaire or Uncle Ben in Spider Man, the sentiment remains: “With great power comes great responsibility.” One could argue information is the new power. Yet too often in recent history data have been breached, hacked or downright hijacked. Privacy and security remain as tantamount for healthcare information as they do for financial data. With the ability of consumers to now obtain their health records through consumer apps, the possibilities for data abuse run even more rampant. Apps could license data for marketing purposes or lease, lend or sell personal information to third parties. Right now, it’s up to individual consumers to protect and secure their privacy once records leave the provider. The country needs policies that protect consumer privacy while allowing business to flourish. 

But rather than leave the policies up to the politicians, Medicare insurers as well as other American businesses should not only address but embrace consumer privacy. Rather than make policies full of legalese, Medicare insurers should make them simple and easy to understand. They should be transparent. They should invite customers to opt in rather than out. 

Think for the Future

If technology has taught us anything, it’s that we should take a long term approach instead of a short term one. As Plato said, “The beginning is the most important part of the work.” Solving problems isn’t just about fixing the immediate need but understanding how that solution could cause issues down the line. Medicare insurers need to think for the long term not just quarter by quarter. To do that takes imagination, critical thinking, empathy, compassion, humility and the willingness to fail better.