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New programs make it easy for consumers to be involved in their own health

Stage 2 of the federal incentive program for "meaningful use" of electronic health records, the wider spread of high-deductible insurance and competition from nontraditional healthcare providers have created an imperative for health systems to get people involved in their own care and start viewing patients as consumers.

Several sessions at last week's 12th annual WTN Media Digital Healthcare Conference in Madison addressed this, highlighting how important consumerism is becoming in healthcare.

Conference chairman Dr. Barry Chaiken, chief medical information officer of business software developer Infor, said that consumers with out-of-pocket responsibility for healthcare costs are more likely than others to compare prices. "They're going to vote with their wallets," he said. People are starting to consider how long they will have to wait for services or how easily they can fill a prescription.

However, it is still difficult to shop around for health services in the absence of true price transparency; a new article in Consumer Reports takes a tone of exasperation when it comes to figuring out the true cost of health insurance. However, retail and convenience clinics are changing the equation among care providers.

Kenneth Kleinberg, managing director of the Advisory Board Group's health IT practice, said that the biggest competitor for health systems in 2020 might very well be Walmart. The world's largest retailer did $469 billion in sales in 2012, larger than the GDP of 158 countries. Walmart handles 1 million customer transactions every hour and has amassed a database of 2.5 petabytes worth of consumer records.
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He cited Accenture research showing that there will be more than 2,800 retail clinics in the U.S. by next year, up from 1,743 in 2013. This, according to Kleinberg, shows that consumers like convenience.

And these retailers are embracing IT and digital health. In February, Walgreens and CVS Caremark joined with Verizon Communications, Welch Allyn, Cardinal Health, insurer WellPoint, as well as five telehealth companies and three former U.S. senators to form the Alliance for Connected Care. This group has said it will advocate for policy changes that pave the way for more telehealth and remote patient monitoring.

Adam Pellegrini, vice president of digital health for Walgreens, presented at the conference about the nation's biggest pharmacy chain's strategy for "omni-channel digital health," which Pellegrini also called "digilog," a hybrid of digital and analog. To succeed, Walgreens - or any other healthcare company - needs to meet consumers where they want to be met, whether it be online or in person, he explained.

Walgreens has been successful with its consumer-facing mobile apps and with its Healthy Rewards loyalty-card program, according to Pellegrini. He said that the company processes more than one prescription refill every second from requests sent through mobile devices.

A year ago, and with no marketing behind it, Walgreens started Balance Rewards for Healthy Choices, a campaign to promote health by offering rewards points simply for being physically active or taking steps to improve or manage health. Walgreens offers 500 points, worth 50 cents in store credit, for each immunization scheduled or prescription filled, 250 points for linking a home medical device or app, plus 20 points for each mile walked, day keeping a fitness log or testing blood glucose with a connected device.

To date, Walgreens has given out 2 billion Healthy Rewards points, or $2 million, and counts more than 1.4 million active users. "This program exploded by word of mouth and social," Pellegrini said. "People are just going out and walking."

The device linkages came about after Walgreens' digital health braintrust started wondering what would happen if the pharmacy giant started rewarding uploads of blood pressure and glucose readings. Within a month, users had uploaded 80,000 readings, according to Pellegrini. Each week, 2,000 new devices get connected, he said.

But, perhaps emblematic of American healthcare in general, Walgreens does not use such data for clinical purposes, even with user consent, nor are the home devices connected to any patient records, Pellegrini said.

Also, there are ways to game the system, as Pellegrini noted. "You could put a pedometer on your dog and get 10,000 steps while watching TV," he quipped.

Pellegrini, who formerly was a product manager for Microsoft's struggling personal health records platform HealthVault, acknowledged the ongoing challenge of consumer engagement. Technologically, HealthVault was "incredibly solid," he said, but consumers didn't see much value, and thus have not adopted it - or any other standalone PHR product - in great numbers. "We didn't make it easy for the consumer."

Kleinberg said the Walgreens experience demonstrates that traditional health systems should look to "mobile 2.0" technologies - high-speed networks and touch-screen devices with user-friendly interfaces - to engage patients, support collaborative care and better manage population health.

Mobility can provide value in telehealth, for example. It is relatively easy to implement mobile technologies for providing quick second opinions, automating referrals, enabling e-visits and offering remote home monitoring to prevent hospital admissions. And such interventions offer good value to health systems, Kleinberg said.

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