Health insurers are banking heavily on artificial intelligence and data analytics that scan medical records and then alert members on how to improve their health. The challenge: Getting people to listen is hard.
Now the companies say they’re figuring out the best way to get people to respond, an effort that may include tapping consumer behavior experts and training nurses about the finer points of a phone call.
Health insurers like Cigna corp.
and UnitedHealthcare say they are exploring the idea of targeted medical interventions. By applying data analytics or AI algorithms to data from claims documents, electronic medical records and other sources of information, they are able to determine when a member may be at risk for a particular condition or further complications of an existing condition, the companies said .
These conditions run the gamut from diabetes to obesity, depression and heart disease, they said. If the data shows that a member’s blood sugar or cholesterol has risen, that person can be contacted by phone call, email or text message to join a program offered by the company designed to help them manage – ok with the problem. But in many cases the members do not respond.
“We respect people’s right not to participate or not to do so. It’s their choice. But we’re also working to see: can we make it appropriately compelling for the individual? what’s missing Why would they deny us?” said Glen Stettin, chief innovation officer at Evernorth, Cigna’s health services business.
Dr. Stettin said that when, for example, a group of people with diabetes is contacted about joining a diabetes program, roughly 40 percent say yes. He said the rate would go up if a smaller group of people who don’t manage their blood sugar very well were specifically targeted.
More precise targeting would lead to higher enrollment rates, but it could also lead to missing some people who need help, Dr. Schettin said.
According to Stefano Puntoni, a professor of marketing at the Wharton School at the University of Pennsylvania, one of the reasons people don’t respond to targeted recommendations is when they feel the recommendation has fundamentally misunderstood them as people, especially in areas like health that are closely related with a person’s self-esteem.
Dr. Stettin said the company is doing qualitative research with users, including people who have opted out of the programs, to work out their motivations.
That work overall is currently one of Cigna’s biggest focuses from an innovation perspective, he said.
It’s also an important priority for UnitedHealthcare, according to Chief Medical Officer for Employer and Individual Rhonda Randall, who said the company is making $5 billion in annual investments in data, technology, research and innovation.
Dr. Randall said the company chose to contact members primarily through phone calls made by a nurse management team because of the personal touch it provides. Some nurses go through more than 30 weeks of training to learn how best to gather additional information from members and guide them to the next best steps, the company said.
“A lot of people still like to talk to a nurse on the phone, and that’s really the intersection of technology and human interaction,” she said. At the same time, she said, “Not everyone answers the phone.”
The company also began targeting members when they called about simple issues like losing their ID cards. As a result of this initiative, the company has seen a 10 percent increase in clinical program enrollments, she said.
The company said it uses a team of behavioral experts to help nurses use motivational interviewing and listening skills and ensure conversations are conducted in a sensitive and respectful manner.
“There are ways of communicating information to people that will make it better or make it worse,” said Danton Char, associate professor of anesthesia, perioperative and pain medicine (pediatrics), and of medical ethics at Stanford Maternal and Child health Research Institute.
“Whether it’s an AI tool or whether that suggestion is given by a human, there’s an art to that data communication,” he said.
chief information officer, Sam Deshpande, said the company is exploring the best way to reach members that actually makes them want to change their behavior.
Once insights are drawn from the data, it’s about knowing how to reach out in the right way, whether it’s a phone call or text, through a clinician or another route, he said.
The project took on increasing importance for Humana after it completed its acquisition of Kindred at Home, the largest home care organization in the United States, last year, Mr. Desfand said.
Write to Isabelle Bousquette at [email protected]
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