Straight from the CEO: Turning Consumers into Quarterbacks

_{David Holmberg, chief executive officer, Highmark Health}

From a high-level perspective, it’s not hard to spot similarities among the organizations leading transformation in the health industry. For example, most are increasingly focused on whole-person health, including addressing social determinants of health. Most have accelerated the use of virtual and digital health options, and are ahead of the pack in finding ways to use data and analytics and emerging artificial intelligence tools. Most share a commitment to value-based care.

Digging a little deeper, there are also real competitive differences between organizations. To me, the differences that matter most come back to the impact on the consumer. Who excels at meeting people where they are and helping them be healthier? Who does the best job of making sure people can access high-quality care when needed? Who is proving that they can reduce the cost burden that health care places on many families and employers, and on all of us as taxpayers? Those are the competitive wins we’re after.

Better, clearer choices for health, coverage and care

Our consumers are first and foremost the people covered by Highmark health plans. They don’t necessarily care how our Living Health strategy fits into health industry transformation trends. What they care about are the experiences and products we provide through that strategy. When it comes to our mission to “create a remarkable health experience, freeing people to be their best,” those health plan members get the final say on how well we’re doing.

Although we are just beginning to tap the potential of what we believe Living Health will deliver, we are very encouraged by what consumers are telling us about solutions already in market. As I wrote at the start of 2023, the launch of the My Highmark app was a great leap forward in our vision of creating an integrated health experience platform. It will continue to expand, but right from the start My Highmark offers a “one-stop shop” where health plan members can find more of the tools, information and resources they need. Through the app, they also get “next best step” suggestions that help them be more engaged in managing their health. Since the app is still being rolled out, it’s a little early to dive into specific metrics, but we are seeing strong initial adoption and engagement numbers, and getting lots of positive feedback from member surveys.

Depending on their health plan, most members also have access to a growing suite of high-level care management and digitally enhanced health solutions. Care navigation and management solutions for self-funded customers have overall satisfaction rates above 95%. Scanning the survey comments our team shared, I also noticed multiple uses of phrases like “above and beyond” — a real testament to the people behind these solutions.

For the past two years, health plan members with type 2 diabetes have benefited from a comprehensive diabetes management solution that provides glucose testing supplies, a personalized management plan, convenient virtual access to endocrinologists and remote prescriptions, and care coordination with primary care physicians. In addition to strong customer satisfaction scores, the solution is meeting our clinical outcome target of more than 50% of members successfully reducing or maintaining A1c levels, a key clinical measure.

We’re also seeing great results from a home-based digital and virtual program for people with back and joint pain — 93% of members say it is easy to use, they’re reporting reductions in pain and related areas like work impairment, and in some cases it’s helping them avoid surgery. It’s less expensive than traditional physical therapy, and it’s also reducing costs related to unnecessary ER visits.

In some regions, members have been enjoying a simpler digital bill paying experience through our partnership with Cedar Pay, which has customer satisfaction rates of close to 90%. In the weeks ahead, all health plan members will start noticing redesigned Explanation of Benefits communications that make it easier to understand what is covered and what they owe after a visit or procedure.

Looking ahead, a partnership with Spring Health, announced at the HLTH conference in October, is now expanding virtual access to a wide range of mental health services for health plan members, including those in underserved rural areas.

From a consumer perspective, all of these solutions come down to having better, clearer choices for health, coverage and care. At every point in a person’s health journey, that’s our guiding principle: What can we do to give someone better choices, help them understand their choices, and empower them to make the choices that are right for them?

Personalization through purposeful use of data and technology

Your health is as “personal” as anything can be — and yet, for most people, the health experience has traditionally involved a lot of one-size-fits-all interactions and approaches. My Highmark and solutions like those I mentioned are the proof that smart, purposeful use of data and technology can go a long way toward delivering a much more personalized health experience.

That’s not just about having an interface that looks and feels more like other consumer experiences and brings together more of what you need in one place. What health plan members see via My Highmark is also specific to their health situation and preferences.

That gets to something I emphasized during a panel on personalization at the 2023 Health Evolution Summit. We don’t want to overwhelm people with complicated data and an endless list of disconnected digital apps — that would just be a high-tech version of the same old fragmented, frustrating health experience. The real challenge, and opportunity, for organizations like ours is to take the data and technology available to us, make it relevant and simple to understand, and deliver it at the right time and in the right way to be useful. If we work together to do that, data and technology become a superpower, helping people be more engaged and effective in improving their health.

When we think about how and when to use data and technology as part of our Living Health model, we always go back to our idea that it should create a simpler, personalized, proactive, and connected experience. We also look very carefully at data security and privacy issues. So yes, we are excited about potential uses of generative Artificial Intelligence — we have evaluated hundreds of use cases and have dozens of active pilots touching multiple areas of our business. We are also highly engaged with partners like Google Cloud and League who are leading development of new tools and platforms. But ultimately our decisions will always come back to the impact on the health experience and health outcomes.

In many respects, this is a natural extension of our role in building high-performing provider networks to ensure that health plan members have access to high-quality, high-value care. Living Health is about also building a high-performing digital and virtual infrastructure for those members. When someone logs on to My Highmark, they can trust that the information, tools and solutions they find have all been carefully assessed and curated. They should see what is relevant to them and what they choose to see. As our integrated health experience platform continues to evolve, it will also help connect and coordinate even more of their health information, solutions and providers. The experience will not only be highly personalized, it will be whole-person health.

Turning consumers into quarterbacks

Given that I started my career in retail, it’s no surprise that I often refer to the people we serve as consumers, and believe that consumer needs and preferences should drive changes in our industry. But I do understand why some people have concerns about using the word “consumer” in health care. For one thing, compared to most consumer purchases, there are profound personal consequences and societal costs to consuming health care that is unnecessary or poor quality.

Similarly, if you’re in the consumer electronics industry, you don’t need to think much about whether people need every TV and device you sell. In our industry, the shift from volume-based models to value-based care means a very different mindset — we are saying let’s do everything possible to align on improving the health experience and health outcomes, which also means we don’t believe anyone should get tests or procedures, or take medications, or spend time in hospitals, unless they’re needed and have proven value.

Getting back to our Living Health strategy, the goal is to make health and care proactive, not reactive. Instead of just consuming care when something goes wrong, we want to help people produce health every day. In that sense, we’re turning consumers into quarterbacks. Our job is to give our health plan members the playbook, coaching, support and surrounding team they need, but they’re not spectators on the sidelines watching the game, they’re making decisions and leading the offense.

I will stick with the word “consumers” in most instances — but I envision a future with many more “health quarterbacks.” That’s partly demand — people want to make their own choices and do things in their own way. When we talk about “personalization,” it should include respecting the range of choices and priorities people have when it comes to health, and making sure our support matches up.

The other factor is technology. In the decade ahead, I think we’ll see an evolution of wearable health technology and home-based devices with transformational impact comparable to what happened when the earliest cell phones were replaced by the powerful mobile computers we now carry in our pockets and take for granted. It’s going to become easier for more and more people to actively track and take charge of their health day to day. If we get it right, they’ll want to, and organizations like ours will be trusted partners supporting them in achieving their goals.

By:  David Holmberg

Originally Posted:  January 11, 2024 on Highmark Health

David L. Holmberg is president and chief executive officer of Highmark Health.

_{This article was first published in Highmark Health Digital Magazine and is used with permission.}