Rejuvenating the online experience of health insurance members requires a balance between conflicting interests. The more one knows about health options, the more informed medical and lifestyle decisions one can make. Yet information given to insurance companies can potentially be used against one, resulting in higher premiums or loss of coverage. As a result, careful consumers will not provide more medically related information than absolutely necessary. How can the insurance company provide a more meaningful personalized experience for its members? This Solution postulates that a health insurance website can become the conduit for medical information as well as insurance policy information.
Summary of Current Offerings
UnitedHealthCare has a website for physicians and healthcare providers at www.unitedhealthcareonline.com/, which includes a page of health resources for their patients. The patient/member site, http://www.uhc.com/, provides a fact-based set of information to guide decisions. One example is a page that explains the tradeoff of lower premiums/higher deductibles. Another page describes the Health4Me app, which serves as a shortcut around automated phone messages to provide medical locations and insurance status. The wellness offerings include OptumizeMe, an app to create a network of people and design physical challenges to promote healthy lifestyles.
A site aimed at entertaining while informing, www.healthcarelane.com attempts a lighthearted approach to informing members about aspects of offered healthcare plans as well as healthcare reform summaries. The site contains numerous videos that give background information, but the user needs to have time to spend browsing.
Other Insurance Company Websites
Examination of insurance websites discussed here is limited to pages available to non-members. These may or may not reflect password-protected areas.
Websites maintained by other insurance companies provide various profiles to the public. Some have an initial ‘folksy’ feel with photos of smiling families and children. Others, such as www.StateFarm.com, lead with a very stark text-only page. This latter leads only to a State Farm agent with no further options to prospective members.
The www.Aetna.com site, featuring a smiling child, contains immediate information links such as  Find a Doctor and  Get a Form. Featured prominently are links to online tools and information for making healthcare decisions. According to short videos, Aetna provides members with a payment estimator based on the medical facility and procedure, specific to the member’s plan. Answers to specific questions can be tracked down readily and are provided in an upbeat but time-efficient manner. Personal medical records are updated by the physicians as they interact with the insurance company. Alerts based on age, gender, and medical history are sent to the member as well. Lacking from Aetna is a prominent section on healthy lifestyles.
A site such as www.Humana.com features photos of elderly couples and nearly all text. Healthcare information is limited to a few low-information videos. A ‘healthy living’ section has a few (only 19 posted since 2009) text-heavy/information-light articles. Overall, the feeling is stark, with significantly better access to medical information available elsewhere.
A mother and child are featured at www.HealthNet.com, although the site offerings are severely limited. Users can shop for insurance quotes or sign in as members. Very little basic information is provided outside the password-protected zone, although members have access to tools for evaluating expected costs. Even healthy lifestyle information remains behind the firewall.
Considerations and Assumptions
Websites and phone apps provided by insurance companies can guide choices of insurance plans and outline the criteria for healthy choices. Yet even the call center nurses provided to members have limits of what medical information they can provide.
Each access site, whether web or phone app, can be open or password protected. The insurance company might choose an intermediate level of security which identifies the user only as a member but not which specific one. The information exchanged at increasing levels of security can become more personalized.
The insurance company has a record of expenses paid for each member, and hence can form a profile of recent medical history. In an age where people choose to share far too much personal information on social networks such as FaceBook and Twitter, it is possible that members may choose to provide personal medical information. While allowing for this possibility, the Solution will not rely on it. The Solution will assume that specific medical information will be provided only to an attending physician.
The Solution consists of opportunities for websites and phone apps, at open access and password protected levels. This 2×2 grid will be supplemented by the option of an intermediate login level, where the user is identified as an anonymous health insurance member. Below we consider how to provide medical value such that members would consider it worth interacting with the insurance company’s sites.
Path to Medical Value
• Medical information provided by current insurance websites is generic and contains enough caveats to be of little use for members’ healthcare decision making.
• Members discuss medical issues only with their physicians with a confidentiality barrier between them and insurance carriers.
• Therefore specific medical information cannot be provided through insurance industry media.
• Physicians have little time to spend with each patient, and rarely provide websites of their own or other information sources that can be studied at leisure. Often, they may provide patients with brochures prepared by a third party for a specific disease or condition.
• Medical societies and nonprofit organizations exist for many diseases and conditions. The insurance company’s website can provide links to these categorized by organ or body part, disease, or other criteria.
• Features not easily accessible by other sites or sources must balance medical value with patient confidentiality and with performing medical services without license.
• Topics that the insurance company can provide within the above restrictions include better presentation of available information in an engaging interactive way.
• Patients most want to know available options in a meaningful manner. This includes medical options and financial options including repercussions of insurance decisions.
Path to Website Utilization
A site that provides useful and relevant medical information is of little value if no one uses it. The insurance company has thousands of models from current web and phone app offerings. The best time to showcase new insurance company offerings is the first time a new employee/member encounters the insurance company as an insurer.
What will engage a new user? This depends on the user’s health profile at the time of the encounter and can be described as:
1. Do I need to make insurance decisions now? In this scenario, the user is a new hire and must decide what plans and deductibles to choose. Rapid and clear answers can be provided without overwhelming text that confuses rather than clarifies. The costs under user-defined conditions can be provided graphically with numeric support.
2. Am I in pain right now? The user may have a medical condition that requires immediate attention. While the default response typically provided currently is “See your physician,” the insurance company can provide likely explanations along with “What to expect” discussions. Currently available apps to locate relevant medical facilities are incorporated here. The relevant web pages and apps need to be streamlined for rapid response and clear conveyance of information.
3. Am I just curious? The user wants background information on a disease or condition, or wellness information to guide lifestyle decisions. The web pages and apps for this scenario can use more intense graphics and seek to entertain as well as inform. The time limit of attention span should be assumed no more than three minutes, including effort to locate desired information or for browsing. Games would fit under this scenario.
Levels of Access
The Solution provides portals at three levels of access for users:
• Open Access – Non-members may view the site while shopping or considering employment that offers insurance through the insurance company. Open access may also be a convenience to members who seek information readily available elsewhere. Prominent in this section may be information relating to healthy lifestyles and lists of what is available to members. Key is easy access to tools that allow evaluation of plans with their costs and trade-offs.
• Provider-Specific Password Access – All members may have the same password to access features that are not member-specific but for which the insurance company wishes a level of control. This might be the same four-character prefix for member-specific passwords. Information available at this level may be comparison of costs and evaluations of medical facilities and procedures within the insurance company’s system and (as available) outside the system.
• Member-Specific Password Access – Each member will have a specific password to gain access to individual medical records. It is assumed that members will be reluctant to provide or share medical information, but the insurance company has the initial enrollment information plus results of any claims.
Open Access – The current insurance company websites contain insurance plan information in generalized terms. Health information must also be generalized since the website has no basis for specializing the information without additional user input. This input can be accepted by several methods. The increasing use of touchscreens on iPads and other tablets allows the site to focus on specific insurance and medical questions through graphic representations.
In many cases, medical animation can be provided to educate as well as provide a visually compelling experience. One example is that provided by the University of Pennsylvania. Examples can include simple illustrations:
More sophisticated illustrations include a video about Alzheimer’s disease:
The open access area may also be an arena for medically related entertainment, detailed more fully below in the discussion of phone apps. The general purpose of these games and demonstrations is to provide graphic information that comes across in text as dry and ‘preachy.’ The games illustrate medical principles as well as provide simulations of living with specific medical conditions or lifestyle choices.
Critical medical outbreaks can be of great interest to users, whether members or not. There are several worldwide medical surveys to track diseases such as flu, malaria, and tuberculosis. One example, shown below, is from tracking of H1N1 swine flu.
While the information is available retrospectively from the CDC, projects around the world seek to indicate worldwide and local incidence of infectious diseases as well as the incidence of leukemia and bone cancers. Presentation of these in graphical form can transform the insurance company’s site into a centralized clearinghouse of critical medical information. The presence of these visualization tools will need to be announced, possibly through partnerships and sponsorships of the Stop TB Partnership and other disease tracking groups.
A key part of the open access area is a clear and concise representation of insurance plans that weighs costs and benefits. This may not include specific dollar per month rates for every case, but can provide ranges along with deductible trade-offs. One way to present this is a 2D or 3D plot of deductible vs. monthly premium. A 3D plot may add a choice of medical assumptions selected from drop-down lists. The resulting plots may be similar to Receiver-Operator Curves (ROC), while the 3D plots will be rendered as curved surfaces.
An example of a 2D ROC is:
The three sets of data points here could represent annual costs of premiums plus deductibles and co-pays under different medical emergency scenarios. Users can clearly see how rapidly their costs rise if there are more or fewer medical events.
An example of a wire-mesh 3D plot is:
In this case, annual cost can be plotted against two variables of concern to users. Note that several of these mesh constructs could be plotted on one graph by adding additional colors. One could thus present the results of multiple insurance plans under the same medical event assumptions.
These graphs can also be used to clearly illustrate risks of poor health choices. Graphs can depict how increased smoking increases the risk of lung cancer, emphysema, and other conditions. Dietary intake such as cans of Coke or jelly donuts consumed per day increase the risk of diabetes. Incidences of diseases could be gleaned from statistics, such as this map of county incidence of diabetes in the US:
More engaging, however, may be depictions directly linking a person’s consumption with risk. One medical study that comes close is this:
There remains a need for graphical and engaging illustrations of risky lifestyle choices that build upon these depictions.
It is understood that the insurance company may instead choose to place these graphical tools in password-protected areas. Presentation in the Open Access area, however, will aid in user engagement.
Password Protected – If the member enters a password-protected area, the information available can be specific to that member (or family, if the insurance company chooses). Features of this area include:
• A heat map thermometer that indicates current deductible status such as that provided by Castlight Mobile:
• Lists of prescription drugs ordered to date, with links to package inserts and drug interaction information.
• Maps of medical facilities including contact information, using sites such as Zillow.com as models. Symbols indicate type of facility and whether it is within the insurance company’s system or not. This might be located in the Open Access area, or in the intermediate password area.
• In a manner similar to that used by http://www.myheatmap.com/, a map of body health as a function of inputs from users. It is recognized that this requires an invasion of privacy. It is of most value when the condition is undergoing reimbursement and hence is known to the insurance company without additional divulging from the member patient.
The myheatmap.com site shows examples of reported crimes mapped on a city street map, nationwide distribution of discount coupons, and wildlife sightings. A medically related adaptation is an annual medical checkup that can display a heat map of patient results compared to normal values.
Open Access – Phone apps available through the insurance company should match and exceed offerings otherwise available for Android, iPhone, and iPad platforms. As of June, 2012, there were more than 2500 free apps available for iPad. These include MedScape, MicroMedex, and others. Epocrates is a popular free app for many phones, including Blackberry, and includes drug and drug interactions information. There are about 4800 medical apps for Android listed in the Google Play store.
There are many alleged medical apps with little or no medical value, and some are outright scams. Apps vetted and promoted by the insurance company can provide members with confidence. This provides users with a credible method to sift through the thousands of available apps. At some point as a bonus for membership, the insurance company may choose to offer a list of recommended apps that otherwise require a fee for nonmembers.
The cell phone app is the best place to locate a GPS-driven medical facility locator, complete with directions. Because it may be needed for emergency use, this should be in the Open Access area and focus on the phone’s immediate location. Other features, which might take more user time to navigate, can then allow input to expand or relocate the search.
It may be a sad commentary on our times, but Angry Birds is an amazingly popular time wasting device. There is no reason that a game called Angry Antibodies cannot be as popular. A direct transfer onto a popular game would not be well received, but games can be designed with medically relevant bonuses and penalties. The game premise is less important than its playability.
One example of a game concept can be an adaptation of the 1966 movie “Fantastic Voyage,” with inspiration from a story by Otto Klement and Jerome Bixby [This is often attributed to Isaac Asimov, who was hired to adapt the story into a novel]. This game involves fending off an attack in the bloodstream, with the player using resources of the immune system. An illustration or screen capture might serve as a creative basis:
A higher-level game may include the gamer’s point of view (POV) as altered by habits as input by the gamer. While the insurance company may or may not choose to pursue a game with the violence of Grand Theft Auto, the POV as altered by obvious forces such as alcohol can be amusing. Some pro-health announcements have gone viral in ways not initially anticipated. “This is your brain. This is your brain on drugs” is a classic example. While the insurance company will not be condoning drug use, the effects of conditions and treatments can be simulated in game form.
One classic example of alteration is a poster seen in ophthalmology offices that illustrate the vision impairment of several conditions. Examples include Usher syndrome, macular degeneration, cataracts, glaucoma, hemianopia, and diabetic retinopathy. A software version was designed at Cambridge University for Ford Motor Company. Any game would be far more challenging if the image simulated a condition such as macular degeneration:
Illustrations, animators, and app programmers are readily available. Games can be cartoon-like similar to Angry Birds, or far more realistic. One example screenshot of a 3D medical illustration from www.BE-id.com is:
These and other renderings provide the scene, while depictions of components can include antibodies and other immune system components, viruses and bacteria, blood clot formations, inflammations and injuries, and other health-related factors. Risk factors can be added, such as ravages of inhaled smoke and asbestos, as illustrations of difficulties added by unhealthy lifestyle choices.
Password Protected – The member-specific information can include graphic depictions of insurance policy-related topics such as the thermometer depiction of deductible status (see above example from Castlight Mobile).
The heat map discussed above can also be a phone app, similar to one developed by Big Game Logic for mapping out hunting territory. In this case, the deer are replaced by the member’s medical interest such as an injury or disease.
The symbols indicate deer sightings, observation posts, camera locations, and other objects for the hunter. In a medical adaptation, the symbols represent symptoms, relevant vaccinations, medications, and other aspects related to the medical topic. For example, observations of skin can include symbols for moles, seborrheic keratoses, and suspected cancers.
Summary of Insurance Provider Criteria
In this Solution, each of the insurance company’s criteria were addressed as summarized below.
1. Value – How much additional value is provided to the member? Members are provided with immediate medical information, relevant insurance policy information, and educational entertainment. Information includes member location-specific direction to medical resources, centrally located medical information that is otherwise available but in less convenient sources, and specific insurance policy-related answers. The goal is to provide information without exceeding the bounds that require a licensed physician for dispensing. The information seeks to omit statements that are generalized to the point of uselessness. Specifically targeted for omission are statements that must point to a physician for finality.
2. Engagement – How much is the member’s engagement with the online experience increased? Members receive immediate answers for pressing needs, coherent answers for crucial but less time-dependent needs, and engaging entertainment that emphasizes healthy lifestyle choices without being cloying.
3. Personalization – How much is the online experience personalized to the individual member’s needs? The Solution employs several levels of security, which the insurance company can select as appropriate. Generalized information and entertainment are recommended for open access. A provider-dependent (but not member-specific) password-protected area contains more specific information, both medical and insurance-related. Finally, a member-specific password allows access to an area that incorporates all information available to the insurance company. This includes information volunteered by the member and that gleaned by the insurance company based on claims made and paid for the member.
4. Simplicity – How easy to use and intuitive is the online experience? For ease of use, the initial or home page is divided into three clearly marked sections. The initial page features an entertainment-related section to ensure obviousness of offerings. A ‘more serious’ section separately lists available medical topics and insurance-related topics. Medical topics are subdivided into Healthy Lifestyle questions and Medical Conditions topics.
5. Frequency of Use – How often is the member likely to utilize the applications and/or data associated? Members tend to use insurance company websites only when necessary. This can be increased by periodic newsletters or alerts. The Solution suggests that entertainment be prominent (perhaps 25% of screen view), not because of its importance but for its potential to engage the users. Follow-ups are recommended each time the insurance company receives a claim from a member. These can be driven by profiles of each member (and insured family members) based on demographics and recorded claims.
6. Health Impact – What is the probability that the resulting data composite can positively impact member’s healthcare decisions? Available information is often presented in a nagging ‘mother hen’ manner that shuts down user interest. Impact increases when the member is shown how information affects the user financially, as well as healthwise.