What if employee wellness was simpler? What if we could connect the dots along each person’s health journey? That way, every individual could receive personalized care on a proactive schedule — before chronic health conditions and serious illnesses arise.
That's the vision with Highmark Health plans — a collaborative meeting of the minds of insurance payers, health care providers, and empowered patients. The approach combines predictive data analytics, artificial intelligence (AI), preventive care, and process automation to improve quality of and access to care.
It’s called Living Health.
Living Health is a foundation for transforming the health care industry away from its current incarnation as a costly administrative puzzle.
“Living Health is about putting payers and providers closer together to solve the fragmentation that is occurring in health care,” says Dr. Anil Singh, executive medical director of clinical solutions, design, and implementation at Highmark.
Highmark’s large data stores make it possible to personalize care based on both individual characteristics and population health measures, including known barriers to good health. Barriers may include social determinants of health (SDOH), lack of access or funds, poor health literacy, and/or lack of system interoperability across payers and providers.
Dr. Tony Farah, chief medical and clinical transformation officer at Highmark, joins Dr. Singh as clinical architect of Living Health. He says that understanding widespread challenges can “improve the health of the population we serve. Not just one by one, but at a much larger scale.”
The ultimate success of the Living Health approach depends on the ability of health insurance payers and health care providers — and their respective information systems — to work together. They need to be interoperable.
Interoperability means providing integrated access to electronic health data to improve health outcomes for individual patients and population groups. It allows providers to get a full picture view of health needs, with a better chance for positive outcomes at lower cost.
Highmark has created a shared transformational strategy that facilitates access to patient data and reduces manual tasks. “What we need to do is reduce the administrative burden and give providers the most actionable information, without them having to ask for it,” Dr. Farah says. “That is what allows them to do what they do best.”
A combination of public health data and personalized patient data — from insurers and providers — helps caregivers make stronger and more accurate assessments that allow for better clinical decisions. Comprehensive, clinically accurate patient information also facilitates early intervention and empowers members to get more involved in their health and wellness.
Another part of the Living Health strategy is creating a suite of digital solutions to help eligible members achieve greater health and wellness. Today’s consumers want tools to manage their own health, on their own terms, between doctor visits.
Highmark sees a future where all members track their health metrics and send that data to their doctors, specialists, or health coaches in real time. The strategy focuses on early intervention to catch any problems before serious illness occurs.
“As we digitize health care, we create efficiencies for patients and physicians to make the experience better for both,” Dr. Singh said. “There is inherent richness when we combine insurance data with clinical data to inform the ‘next best actions’ clinicians cantake to help engage and manage patients.”
One of Living Health’s early solutions is for members with type 2 diabetes. Eligible members receive a free digitally connected blood glucose meter, test strips, and an app connected to a virtual health clinic for personalized, proactive support.
“Instead of waiting for a member to get sick, we can continuously monitor their bloodsugar,” explains Dr. Singh. “If they have low blood sugar, for example, they will bealerted via the app and may receive a call from a health coach.” The health coach serves as a navigator, alerting the member’s provider or pharmacist if the condition warrants.
The type 2 diabetes solution gives providers real-time insight into their patients' individual behaviors and outcomes. Being able to scale this solution could positively impact an entire population of people with diabetes.
The same premise can be applied to members with chronic high blood pressure. “We know we can bring anyone’s uncontrolled blood pressure down to normal,” says Dr. Farah. “We just need to do it at scale, for more people.”
As a mission-driven company, Highmark has a responsibility to improve the health of all members whether they are on an employee health benefits plan or any of the other health plans Highmark offers.
“I’m most proud of being at an organization that really cares about the health of its members and is willing to address the needs of providers,” concludes Dr. Singh. “I’m proud that we are bringing payer and provider together and beginning to solve problems. That’s what keeps me going every day.”
All references to “Highmark” in this communication are references to Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association, and/or to one or more of its affiliated Blue companies.
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