BYOD for Healthcare Payers

 

 

As with many industries mobile has become a dominant, disruptive force.  The Radicati Group performed a study in 2014 and found that mobile devices in use, including both phones and tablets, will grow from over 7.7 billion in 2014 to over 12.1 billion by 2018.  The statistics are staggering:

•                    2015:  205 million estimated mobile apps downloaded (Gartner)

•                    2015: 51% of the population have a mobile device (GMSA Intelligence)

•                    2015: 72% of all page views via mobile device (GMSA Intelligence)

•                    2018: 84% of the world population will be using mobile technology (Radicati Group)

•                    2018: average of almost two mobile devices per mobile user (Radicati Group). 

•                    2018:  If you take into account purchasing power in developed vs. undeveloped countries, many mobile users in the US could have 3-4 devices!

 

Members have become so reliant on mobile applications in their everyday life they now expect payer access anywhere, at any time.  Employees also expect to be able to perform their jobs using mobile devices.  This is especially true for those that travel and perform business from remote sites.  Bring-Your-Own-Device (BYOD) programs address these market trends for payers.  BYOD brings great potential benefit but comes with significant constraints and risks. 

Benefits include:

•                    Consumerism programs can benefit from providing access to member services via mobile

•                    Mobile access can be a great differentiator leading to higher member satisfaction and revenue growth, especially in Medicare STAR rated programs      

•                    Letting employees utilize their own mobile devices significantly reduces capital outlay, depreciation cost and risk of technical obsolescence for payers

•                    Employee mobile access can increase employee engagement and job satisfaction

Constraints and risks include:

•                    A poor mobile experience can damage member and/or employee satisfaction

•                    There is cost and complexity involved in managing duplicate infrastructure and applications

•                    Security

·                     HIPAA provides penalties but little guidance on PHI security methods and the mobile security market is immature

·                     Controlling security on mobile devices can be difficult on payer owned devices, more difficult on BYOD devices

·                     It’s not just managing the download or access of data through controlled applications, it’s access to data in any form including in transit (i.e. cell towers, Wi-Fi), at rest on company servers, at rest on mobile devices and through the life cycle of the mobile device (i.e. active / authorized, post termination, theft, etc.)    

So what is required to build a successful BYOD program in the payer world?  Many organizations see the BYOD program as an extension of IT infrastructure.  Isn’t it just extending access to applications through mobile devices? The answer is a resounding no.

Although many business applications are web based, mobile web browsers do not have the same maturity and often can’t be used effectively on mobile devices.  Moving to native mobile OS applications (i.e. iOS, Droid) provides more functionality, but requires development and maintenance of duplicate applications.  Building cross-platform applications is an option, but requires unique skills and development tools.

There is also the issue of user experience across platforms.  Members and employees expect to have a similar experience and usability across channels.  If the mobile user experience is poor or inconsistent with other channels it can seriously damage customer satisfaction.  In fact, it could drive additional calls into customer / technical support raising the cost of operations.  This is the exact opposite of its intended effect.

In regards to the infrastructure, managing the platform requires unique skills and technological controls to meet HIPAA requirements.  Data at rest inside the payer network already has HIPAA related controls.  Logical access is controlled at the application layer.  The infrastructure security gap comes in regards to data in transit to the mobile device, mobile OS layer and device storage level data access.

First, Profile based rules should be downloaded to the device enforcing basic, required controls in the mobile device UI.  This creates consistency in security enforcement and multiple layers of logical security to protect PHI.

Applications should be placed on the mobile device to manage the entire PHI life-cycle of the device.  Data should be encrypted in transit and at rest on the device.  Applications, data and access rights should be controlled remotely by the payer organization.  In this way the data can’t be read without having the proper rights as granted by the payer, even if the device is stolen.  Rights, applications and data can be removed from the device at any time by the payer (i.e. job change, termination, theft, etc.)       

BYOD programs don’t just extend existing applications to mobile devices.  Mobile is a new channel with unique needs and capabilities.  It ties into the payer brand and has a significant impact on customer and employee satisfaction.  Managing it properly can be a differentiator.  Managing it poorly can significantly hurt employee and customer satisfaction.

 

If you need assistance in planning, implementing or outsourcing your BYOD program contact:

healthcare@igate.com 

We manage mobile application development and BYOD programs for the best known insurance organizations in the world.  Our customers range from middle market to the Fortune 500.

 

David Lung is a Director in IGATE’s Healthcare Services practice.

 

Healthcare Payers: Impact of Pay-for-Performance (P4P)

In the zeal to reduce healthcare costs one thing has become self-evident.  Payers have been targeted as change agents due to their influence on the industry.  Is it fair?  Is it the right place to pioneer change?  Everyone has an opinion.  The truth is opinion doesn’t matter much.   

ACA, patient sentiment and industry trends have shaped the current environment and the expectations are set.  As the baby boomers age, Medicare and Medicaid expenses were always expected rise.  However, the rate of Medicare and Medicaid is outpacing expectations.  Government based health payments now exceed commercial sources giving them more power and influence. 

One of the key drivers of change in this environment is moving from “fee-for-service” to “pay-for-performance” (P4P).  Debate over the virtue P4P is heated, lengthy and won’t be discussed here. If this is your interest a great place to start is:    

·         http://www.unitedhealthgroup.com/~/media/UHG/PDF/2012/UNH-Working-Paper-8.ashx

·         http://www.mhpa.org/_upload/35.%20The%20Coming%20Impact%20of%20Payment%20Reform%20on%20Medicaid%20Health%20Plans%20(Jay%20Sultan).pdf

·         http://healthjournalism.org/blog/2015/01/hhs-faces-daunting-challenge-in-moving-away-from-fee-for-service-payment/

·         https://www.healthcatalyst.com/hospital-transitioning-fee-for-service-value-based-reimbursements

·         http://www.medpagetoday.com/PracticeManagement/Reimbursement/49742

An undisputed fact is that P4P is not the traditional model for most healthcare systems.  It is not the model that was used to build processes and software that run in the payer world. P4P requires significant changes to technical infrastructure. This impact has gone largely unpublicized.  This problem weighs heavily on the minds of payers. 

P4P requires definition of performance measures (KPI’s), many of which haven’t been well defined yet by HHS.   Even if meaningful and well defined, they would still be hard to implement.  John O'Shea, MD, visiting fellow in the Center for Health Policy Studies at the Heritage Foundation stated in an interview with MedPage Today’s Joyce Frieden:

"I don't know where these [alternative payment] models are going to come from," O'Shea continued, noting that in a previous job on Capitol Hill, "I did a fair amount of work developing alternative payment models for specialty care and these are not easy to design and implement."     

Once KPI’s are defined all payer processes must be adapted to accommodate collecting quality data from providers, calculating KPI’s, tracking performance and paying claims based on said KPI’s.

This requires new contract vehicles, new analytics models, tools, advanced analytics software and changes to core software systems.  The real cost impact of these changes won’t be known for some time.  But payers have to make these changes now to meet business and regulatory requirements.    

So what’s your story?  How is this change affecting you?  I’d love to know.

 

IGATE has experts to lead payers through this daunting task.  With 14 years in the healthcare payer BPO/ITO world we serve some of the best names in the industry.

If you want to discuss ideas or options in moving to pay-for-performance (P4P) contact me directly or send an email to:

healthcare@igate.com

 

David Lung is a Director in IGATE’s Healthcare Services practice.

 

Does the annual enrollment period impact STAR ratings and enrollment numbers?

In 2009, CMS began aggregating the domain level quality scores into an overall STAR rating for Medicare Advantage plans and made available to beneficiaries. Beginning in the 2012 enrollment period, contracts were incentivized to receive a high rating through rating-dependent reimbursement schemes.  But what has been the real effect of these changes on payers?

According to market data, after 2010, there has been a significant increase in plan ratings.  This has narrowed reimbursement gaps.

What has become painfully clear is that seniors are paying close attention to the STAR ratings.  STAR ratings directly impact enrollment.  In fact, authors affiliated with CMS conducted a study of almost 1.3 million Medicare beneficiaries. They found a positive relationship – a one-star higher rating was associated with a 9.5 percentage point increase in likelihood to enroll. (SEE “http://media.jamanetwork.com/news-item/higher-quality-rating-for-medicare-advantage-plan-associated-with-increased-likelihood-of-plan-enrollment/”)

This number is actually conservative.  IGATE, a large BPO/ITO vendor in healthcare, has experienced one Payer’s enrollment drop between 30% - 40% based on their STAR rating!  How?  CMS in their push for quality actively promotes moving to 5 STAR plans.  So much so they offer a “5-star Special Enrollment Period” that lasts almost a year allowing members to switch to any 5 STAR rates plan.

One key measure used in the STAR rating system is “customer experience with the plan.”  Remember the phrase “there’s no chance to make a second good impression?” A member’s experience starts with the Annual Enrollment Period (AEP).  IGATE’s experience fixing the AEP can have an immediate and long lasting impact on STAR ratings.  Of course, getting a 5 requires a commitment to 3-4 other key measures (depending on MA vs. Part D).  But without a positive AEP experience, a Payer is doomed from the start.

If you need to boost your STAR rating contact to discuss AEP in a Box at:

healthcare@igate.com 

This proven service is the key to success at one of the largest payers in the country.

David Lung is a Director in IGATE’s Healthcare Services practice.