Harvard Pilgrim is not new to using digital health technology to improve patient care and wellness at home -- the health insurance company worked with health engagement platform Eliza back in 2006 and with smart pillbox maker MedMinder in 2009, before signing its recent deal with Voxiva's Care4Life. But Harvard Pilgrim is careful about the partnerships they engage in, making sure they're both accessible to their target population, and create independently proven improvements in outcomes.
Lydia Bernstein, the director of clinical programs at Harvard Pilgrim, said that the traditional ways of reaching out to patients aren't cutting it anymore, and digital channels are just now getting to the right level of reliability.
"It's a different world right now," she told MobiHealthNews. "Largely, the medium we have been using has been mail. We did some interactive voice recognition technology [with Eliza], and that worked fairly well, but I think that more and more people are texting. It's easy, it's with them all the time. I think we looked at this several years ago and we kind of postponed it because people still didn't have the unlimited texting and we were concerned about having to promote something where people might have to pay. But most people do have unlimited texting now as part of their services. I think this is another way to reach out to our members. Not the only way, but another way."
Bernstein said the system cut ties with Eliza, with whom they had worked on both diabetes management and colorectal screenings outreach, when their research arm, the Department of Population Medicine, determined that they weren't really getting value out of phone calls. (Eliza has only recently added mobile outreach to their offerings.)
"We found that it wasn't any more effective than what we were currently doing in terms of outreach," she said. "Once they reached the people, they were very satisfied, but it's difficult to catch people at home and we don't have cell phone numbers for most people, so we wound up leaving messages. That's why we're looking at more of the mobile technology."
Bernstein is excited about Voxiva's Care4Life. In fact, for some time Harvard Pilgrim has been recommending Voxiva's Text4baby service to its pregnant patients. But, she said, it's still important to subject the program to scrutiny.
"This is our first real use of texting that we're sending to a targeted population," she said. "So we are having discussions now with Voxiva about evaluating the program, in terms of member satisfaction with the program, engagement with texting, and then also how to better get members engaged in their own healthcare. Those are the sorts of things we're looking at and trying to measure, so we've had some initial conversations with Voxiva about that and folks from our research arm. ... [Voxiva] has done some focus groups which they're going to send us. They've also looked at the data of people currently enrolled, and they've seen some improvement in [A1C] and medication adherence, but those are all self-reported."
Like many health plans, Harvard Pilgrim is looking for low-cost, effective programs to improve wellness and self-care among members. Partially, this has to do with the changing payment models in healthcare.
"We have a number of different types of contracting mechanisms now," said Harvard Pilgrim spokesperson Mary Wallan. "We have quality grants that are given to help [providers] get ready for what's coming and we actually do have some bundled payment models and some shared savings models and an ACO. So yes, we're working with many of our providers on that basis and Harvard Pilgrim is very much embracing the new world and trying to provide better value for our patients while keeping the quality and helping the nation as a whole reduce our cost of healthcare."
Bernstein thinks that Care4Life has potential to engage more people with diabetes because the user has so much control over how much they want to engage with the platform: They can just sign up for generic tips and reminders, or they can use a web portal to set up tracking or targeted reminders via text messaging.
If Care4Life goes well, Harvard Pilgrim intends to introduce some additional Voxiva programs for wellness and smoking cessation. In addition, the payor is a few months away from announcing a deal with an undisclosed "wellness vendor." All in all, Bernstein sees the provider's role as curating all the mobile health apps out there that could help their members.
"I think the difficulty is really weeding through all of the different apps and making sure we're promoting or telling our members about reputable apps," she said. "We're learning that we're not going to build anything, but we have to figure out what the best way is to identify those that would be valuable to our members in terms of managing their own health and wellness."