By Gina Veazey

It has been a big month for health care, most recently with the Supreme Court’s decision overturning Roe v. Wade. But it’s also been an important time for consumer health engagement. AHIP brought the payer community together in Las Vegas recently for AHIP 2022 with an agenda that, perhaps unsurprisingly, mentions the word “engage” a whopping 27 times.

Among the many excellent AHIP speakers on engagement was Kathleen Ellmore, a pioneer in the use of consumer marketing best practices to motivate health decisions. She is the Managing Partner of consumer health engagement and experience firm Engagys, LLC, which this week announced the launch of its subscription-based Executive Advisory Services.

Health Data Buzz connected with Ellmore for more on this new service from Engagys.

HDB: First things first. What is consumer health engagement?

KE: That’s a great question, Gina. Consumer health engagement is comprised of the measures individuals take to become better educated and more proactive about decisions and behaviors that affect their health. Everybody who visits the doctor, uses health care services or devices like glasses, or takes medicine is a health care consumer. The engagement part is related to how involved consumers are in their own health care.

We all know the reasons why we should get our cancer screenings, get a yearly checkup, or take our medications as prescribed. But there are many things competing for our attention, and often times our own health care can fall to the bottom of a long and ever-changing ‘To Do’ list. Consumer health engagement is simply prioritizing health and putting it back towards the top of the list.

How powerful a force is the consumer in health care?

KE: The consumer is an extremely powerful force in health care. When you hear goals such as improving health equity, increasing access to medicines, and lowering medical cost spend, none of these are possible without getting consumers engaged.

When consumers are engaged in their own health, and actively doing things that will improve their health, the implications of that are felt across the health care continuum. Think of how much better off a person is who catches a cancer diagnosis in an early stage during a preventive screening versus treating it farther down the line. It’s also true of those of us with chronic conditions. When proactively managed, some chronic conditions like diabetes have far fewer complications. And of course, when we get the care we need before catastrophic events happen, it costs less money for the individual, for the health plan, and health system in general.

To solve our country’s health care problems, we need to address consumer health engagement, and engagement starts with creating the right experience to enable behavior change on the consumer’s terms.

Have we even begun to test the limits of consumer health engagement?

KE: The health care industry has made strides in improving consumer health engagement, but there are still many levers to pull. The health care industry is missing consumer engagement opportunities by not using time-tested techniques employed by other industries. Consumers no longer compare their health care experiences to other health care organizations; they compare it to their favorite brands and the bar is high. Just take Starbucks as an example. Using an AI algorithm within the Starbucks app, they send more than 400,000 message variants to promote unique offers based on each consumer’s personalized preferences, activity, and buying history. The health care industry arguably has the most consumer data of any industry and is just now understanding how to use it to communicate with consumers to affect positive behavior change.

What was the impetus for the Engagys Executive Advisory Services (EAS) and the process for bringing it to market? What did you learn along the way?

KE: At Engagys our mission is to help clients change the way their members and patients engage, leading to improved health, increased revenue, and lower costs. We wanted to expand our offerings with an affordable subscription service for health plans, health systems, and health care technology leaders. Executive Advisory Services is designed to deliver actionable advice, insights, and best practices that health care consumer engagement practitioners can put to work quickly.

We’ve learned that not every client needs consulting services, and some that do may not have the budget available to secure consulting services. We often have requests from clients for discussions that support concerns and questions outside of the scope of our consulting services. There appeared to be a need for an ad hoc “phone a friend” service that allows access to expertise for a point in time need. Some of us at Engagys have also experienced this need personally, and we saw an opportunity to bring that to our clients, and the broader health care market, in a more dynamic format.

Our team set out to consolidate our knowledge and organize it into a framework that would support the product and the market. We evaluated client needs and infused their pain points into the features of the product – focusing on topical research, an interactive knowledge platform, benchmarking, discussion forums and most importantly, advisory support through our inquiry process. The effort to consolidate our amassed knowledge and shape it into a library of artifacts took well over a year, but it was an incredibly insightful journey. Not only did it support the initial product framework, but it informed every other feature of the product and expanded our perspective on our capabilities and the support we could offer just by sharing “off the shelf” artifacts.

What is the hope for the EAS? How will you know it’s been a success?

KE: The hope for EAS is to expand the knowledgebase of every subscriber and to help them, and their team, work smarter and faster to achieve their goals. Our client’s measure for success is our measure for success. On a traditional consulting engagement, we don’t always have the opportunity to see the full impact of our work. Because EAS is an annual subscription, we plan to be along for the ride!

As an example, one of our clients recently scheduled an inquiry for assistance with launching a new product. Within a couple of weeks, we were able to provide them several artifacts to inform their approach, validate their own research, and accelerate their efforts on a very aggressive timeline. We hope to support them throughout this journey and see their success in real time. Client satisfaction is always our highest bar, and with EAS we’ll have real-time KPIs to ensure we meet that standard.

Health care is awash in smart people eager to share their good ideas with stakeholders. What does the Engagys EAS bring that’s unique and, importantly, valuable?

KE: The complexity and nuance of what we do is not well represented in the market. Similar services provide features like ours, but they don’t offer the depth of health care consumer engagement expertise that our team can provide, and we saw that as a critical gap. Every single employee at Engagys has deep health care industry experience, and our EAS subject matter experts have insights, knowledge, and experience from millions of health care consumer interactions and thousands of program implementations.

And it all goes back to the health care consumers. As I previously mentioned, health care consumers are increasingly measuring their experiences against the highly personalized and targeted interactions of players outside of the health care space like Amazon and Netflix. And health care consumers are dynamic. Just when you find something that works to reach consumers, it might change based on the environment. SMS texting works beautifully with consumers, but as more and more companies inside and outside of health care use text to reach consumers, we are in danger of consumer fatigue. Staying on top of the latest insights of what works for which populations to drive which actions is critical to keep consumers engaged. There are a lot of challenges to address before health care is delivering those same personal and proactive interactions, and we think we’re in the best possible position to help change the game.

How can a plan, health system or tech leader sign up?

Send an email – info@engagys.com. We’ll get an introduction scheduled and take it from there.

Gina Veazey is a writer and consultant focused on health care. As the former editor of the America’s Health Insurance Plans print magazine, Coverage, her interests and experience are far-reaching and include topics in public health, consumer health engagement, precision medicine, health information technology, Medicare Advantage, and many others. She can be reached at gina@veazeymedia.com.

By Gina Veazey

A new federal rule aiming to give health care consumers more meaningful information about the cost of care obligates hospitals to reveal certain negotiated prices and give consumers an interactive, shopable tool. But a new study, “Early Hospital Compliance With Federal Requirements for Price Transparency,” published in JAMA Internal Medicine, shows hospital compliance with the rule is disappointing. Researchers found only about 20 percent of hospitals were in full compliance as of March, following the January 1 compliance deadline. Moreover, researchers found that many high-revenue hospitals were sidestepping provisions that could help identify market distortions and inform negotiations and price analyses.

The rule, “Price Transparency Requirements for Hospitals To Make Standard Charges Public,”pulls back the curtain on hospital-insurer negotiated prices and is intended to give patients access to information about the market-based cost of care. It expands the information hospitals are required to disclose expands the information hospitals are required to disclose under section 2718 (e) of the Public Health Service Act. Hospitals had previously been able to satisfy those requirements by posting a chargemaster, which contains information that is of little value to consumers.

The new requirements give consumers access to the real-world prices that hospitals and health plans have negotiated as part of their contracts, as well as the hospital’s discounted cash prices. For consumers, these prices allow meaningful price comparisons and better planning for health outlays. The rule requires hospitals to post standard charges prominently on a publicly available website. It instructs hospitals to give patients a shoppable tool, allowing consumers to compare the costs of services like a colonoscopy or an MRI at different hospitals. It also instructs hospitals to post the pricing information in a machine-readable file (such as an Excel spreadsheet). And that’s where the researchers spotted issues.

In the study, researchers looked at compliance by 100 randomly sampled hospitals and the 100 highest-revenue hospitals. Beyond the high-level finding — a full compliance level of about 20 percent overall — they also found “selective” compliance. “Interestingly, the highest-revenue hospitals exhibited selective compliance — 86% provided prices to individual patients through price estimator tools, but only 35% reported payer-specific negotiated rates in a file. This limits any real impact on prices,” said Suhas Gondi, one of the study authors, in a June 14 Tweet thread.

Unlike the consumer-friendly tool, which serves up a discrete set of information specifically for a given consumer, a machine-readable file unlocks access to a complete dataset. Indeed, the prospect of gaining easy access to a treasure trove of hospital pricing data has itself been heralded as an important element of the rule, with implications for driving down cost, for market analysis, and for future price negotiations. “Because patient-oriented price estimator tools make prices visible only for a given patient and insurance plan and not to payers or the public, selective compliance may fail to expose abuses of market power, affect price negotiations, or support broad analysis of price variation to the extent intended by the transparency initiative,” the researchers wrote.

Enforcement Measures

The research ultimately suggests that the measures used for enforcement of hospital compliance are an insufficient counterbalance to market-based rewards for keeping pricing information private. In the Tweet thread, Gondi says the study authors believe that enforcement provisions are insufficient to drive meaningful compliance by hospitals. The monitoring and compliance plan promulgated as part of the rule lays out a series of three successive actions that the Centers for Medicare & Medicaid Services (CMS) can take in the case of noncompliance — a written warning notice, a request for a corrective action plan, and imposition of civil penalties. The penalty portion of enforcement tops out at $300 per day, an amount that Health Affairs mocks as trivial, noting that, even if a hospital were noncompliant for an entire year, the penalty would be just $109,500, or roughly the “equivalent to seven c-sections.”enforcement

Commentary: Price Transparency in the Balance

Although it is understandable that hospitals would want to keep specific elements of their negotiated pricing private, as Gondi says in the Tweet thread, “If price transparency is going to have any impact, hospitals need to play ball.”
Hospitals have long been vocal about the hardships their patients encounter as health costs rise. And, they have complained that the trend toward higher deductibles has put more patient debt on their books. By their own arguments, hospitals win when systemic costs of health care decline and when patients become part of that solution.

Genuine market-based pricing information is the missing link that is preventing patients from behaving like true health consumers. Price transparency may not be the solution hospitals would choose, but outright subversion of the rule isn’t a productive solution either.

Gina Veazey is a writer and consultant focused on health care. As the former editor of the America’s Health Insurance Plansprint magazine, Coverage, her interests and experience are far-reaching and include topics in public health, consumer health engagement, precision medicine, health information technology, Medicare Advantage, and many others. She can be reached at gina@veazeymedia.com

Ann lived to be 95, but in some ways she never was old. Her code of life was timeless: generosity, kindness, understanding, and empathy. There are people in this world who had the heart of saints. She was that person.

Her life’s mission was to give, spread joy, give again. She rooted for you like no one else. Her laughter echoed through a room, and her solemn prayers were songs to her.

She would whisper her prayers at different times of the day. Sitting on the couch. Standing in the kitchen.

As a young woman, she was the one you turned to about feelings. She listened and would offer the most soothing words imaginable. She hardly ever raised her voice, was understanding, and always wanting to help others. Ann’s mom was her best friend.

Ann’s devotion to her family was paramount. She always pitched in to help family members and especially doted on her grandchildren and great-grandchild. She was there for you. She was ready for the call to watch the kids. She helped prepare the dinners. She washed the dishes. Loads of laundry, she was there. She was chairwoman of the ironing board.

Ann never met a child who wasn’t adorable, sweet, someone who would brighten her eyes and dazzle her conversations. “Isn’t that baby beautifulllllllll,” she asked in enthusiastic exaggeration. There wasn’t any occasion she wouldn’t enthusiastically join in: shopping, dining out, music, theater, horse racing, and other social occasions. Whatever sports the kids were involved in, she was ready to cheer them on. She watched baseball and basketball games on TV and knew exactly who she was cheering for.

Ann spent much time crafting messages of love – cards, cards, cards. She loved greeting cards and would add her messages. She could have been in the Hallmark Hall of Fame. She loved putting everyone’s birthday or anniversaries on her calendars.

She was a bookkeeper and office manager. For several years she worked near the docks as she regaled family members with getting a ride by a distant relative so she could safely go to work one day and there could be trouble. She escaped any problem! Mom, mom, there were mobsters!

After her husband died at age 70, she maneuvered her own life, drew up the courage to move to move far away into her own condo, knowing and relying on a son and his family nearby.

Never enamored of animals, she did, however, take to the family pets. But don’t let insects or other “strange creatures” get in her path. When tiny lizards would make their presence known, she kept a wary eye on them, with a vacuum cleaner nearby.

Ann had quiet determination and turn-on-a-dime discipline. A non-smoker half her life, Ann took up smoking in her later years. But when she was stricken with an illness in her 80s, she quit, “cold turkey.”

As an octogenarian, she was walking a quarter-mile from her condo every day to see her son and his family. Sometimes people would see this elderly woman on the sidewalk and ask her if she wanted a ride. No, thank you.

That spirit of life helped her overcome many illnesses in her later years. She would get very very sick. And then bounce back, up to her old self.

The last time I spoke to her was probably a couple of weeks or more before she died. She was in the assisted living facility, ready to plan her day. She wanted to write checks. She wanted to go shopping. She wanted to get her hair done, all things she loved. Maybe get some chocolates. That was her plan, anyway. She would be a little upset when she saw her son unkempt in a video chat. “What’s up with your hair?” She asked. He had played tennis. “Did you win?” she asked. Yup, she was a bit competitive.

It is Mother’s Day weekend when we honor our moms. Ann was the embodiment of a Mom, and then some. – Joe Cantlupe, Health Data Buzz

Commentary.

We knew it was coming, didn’t we, a long time ago? No, not impeachment No. 1. No, not impeachment No. 2. I’m talking the arch of his character crash merely days before his final exodus. Did it begin in the 1970s in the Big Apple with rash and in your face developer Donald Trump, who talked trash against anyone, women especially. Or the last four years as he belittled anyone who opposed him, who failed repeatedly in carrying out promised policy, like healthcare, the futile mess of the coronavirus, and other ineptitudes, and thousands of falsehoods leading to the denial of losing the presidency, amid a cascade of untruths that the election was rigged, tainted and simply wrongly counted, in ways he roused his followers to destruction and death at the Capitol. In many ways, Trump stood in the mirror of his sharpest attacks against others: nasty, terrible, loathsome , despicable, no good, in the view of many.

When Trump wouldn’t disclose his tax returns, when he embraced the wrong side at Charlottesville, when he talked about hurricanes with a Sharpie, when he, when he, when he, ……….

Remember he was going to promulgate the greatest healthcare ever. Remember when he was going to knock the coronavirus on its collective butt, yet didn’t bother wearing a mask as even a symbol to help people, and when the number of deaths soared, he disappeared, and the logistics of vaccines vanished in the maze of this presidency. Speaking of vanishing — when — where were those taxes of his anyway?

Remember when he said would not lose votes even if he shot someone on Fifth Avenue.

Remember he’s the President of the United States who has made about 20,000 false or misleading statements, according to the Washington Post.

Remember he’s the guy who said “love you” to those who erupted and trashed through the U.S. Capitol, in a riot that left 5 people dead. When his Vice President Mike Pence could have been in danger from the hoodlums, extremists and zealots, – did Trump try to intervene, and say he was sad?

He’s the one-term who’s now been impeached twice, he is Super Hit 1 in the gallery of impeachments.

He’s Super Hit Worst President.

The sad thing is, he got away with his terribleness for too long, too many of his followers looked away, too many Republicans stood by his side, and the first Democratic led impeachment process a year ago was a fiasco in its too many bungled accusations buried in legalese, and trumped by former AG Barr.

This morning, Trump left for Florida, while incoming President Joe Biden attended a church service in Washington D.C. with congressional leaders. In his closing remarks and before, Trump never mentioned Biden’s name. However, Trump left a note for his successor, becoming the 46th president, according to CNN.

For the health of all of us, — yes even the 71 million who voted for Trump (what were they thinking?) – Today shines bright, a new day. A day that Donald Trump left the White House.

Joe Cantlupe – Health Data Buzz

America trembled tonight.

This evening, inside the Capitol in Washington D.C. as lawmakers tried again to count the electoral college votes to reaffirm Joe Biden as the next President of the United States, there was oratory from the mouths of lawmakers covered with masks.

They were shaken. The turmoil of the Trump presidency is not flagging. Through Trump’s entreaties, chaos ruled today as his supporters attacked and rushed inside the Capitol, causing destruction, resulting in injury and even a death.

The stain on our democracy won’t be erased, said Minority Leader Chuck Schumer, senator of New York.

Too many people believed in Trump over truth, said Sen. Corey Booker of New Jersey.

There was no theft of the Trump presidency as his mob of supporters thought. Instead, Trump is stealing our soul.

We live in the shadow of the COVID-19, which reached its highest daily death count yesterday. The crowds will result in even more illness and death.

Today, even covid seemed secondary.

Our mental health, our psyche was cracked by this attack in DC.

“A house divided against itself cannot stand,” said Abraham Lincoln.

It can’t.

— Joe Cantlupe, Health Data Buzz

It’s over, done, but I never knew as 2020 slogged on, the pandemic year, that I would want to hold on to it, a bit more.

When many people think of 2020, it may have been a bit easier to think of gratitude and less so of happiness.

Happiness seems to crush the reality of 2020, it seems for many many people, especially those who lost loved ones because of COVID-19.

For me, too, not because of covid. My wife died a few weeks ago of cancer and yet I hold on to 2020. Only weeks before, I was drafting a story to write off 2020 as a complete disaster. Now I miss most of 2020, of course.

In her journals over the years, and in her life, Michele, an education writer, held on to moments of gratitude and happiness that she searched and lived for, and embraced with her many friends and family members. These are things I’m trying to learn.

A decade ago, she wrote: “Happy New Year and New Decade!!!!”

“I have so much to be grateful for. I can walk, jog, think, talk, connect, sing, I can learn,” she wrote.

She mentioned about being grateful for her family and even a 22-inch snow, and to “be able to shovel snow from that snowfall!”

“Today, I’m grateful for too much work because that means I have some!” I can see her excitement in the curls of her words, the exquisite penmanship.

In a Happiness Project journal, several years later, walking still brought and continued to deliver much joy for her. “I know I shouldn’t keep writing about my walks,” Michele wrote, but they were certainly a highlight.

For me, I’m grateful for those in healthcare who worked like crazy not only for my wife but for others, during this pandemic. I’m also grateful for the cascade of cards and letters, from people who expressed sympathy and echoed reminders of the joys of being together, with her.

On a national level, I’m grateful for the glimmer of hope in the presidential election as the harsh mirage of Donald Trump eventually escapes as the pandemic will itself, and the vaccines take hold. Grateful.

Happiness, well, I’m not there.

“Times does not heal,” observed a former colleague, a wise editor who lost his wife 33 years ago. “ If anything time numbs the memories.”

As Michele would say, it’s time for a walk. – Joe Cantlupe, HealthDataBuzz

I knew I was running late, and nearly sprinted to the doctor’s office, on the second floor. I had a small card, a symbol of thanks, in my hand. I wanted to see the doctor and tell her, just to look into her eyes as my wife did for years, looking for hope, even the illusion of it, which I had none.

The doctor’s office was closed, and I was despondent and headed to the elevators. Then the door opened slightly, and I recognized the secretary, who let me in. I was welcomed into the waiting room where I sat down and saw the doctor and she waved that she would come by soon.

They all tried, for a long time. My wife didn’t want extraordinary measures at the end, and waved off the doctors. There was a small oxygen mask, and the breathing ritual still haunts me, it seems like she needed to work too hard.

The metastatic breast cancer moved seemingly everywhere, the liver, the brain. When it hit the brain, the constant light of confidence in Michele’s eyes noticeably dimmed. My wife became more frail as the months went on, but she kept working, and even wondered herself why she did. She held her laptop and wrote away, until she was too tired for another word.

I still need to process all that went on, her battle with cancer over the years, how it went away and we were so joyous for that time, and how it returned and did so with a vengeance. She had these pains in her back and thought it was rheumatoid arthritis, and scans showed differently, the cancer had spread. “Devastating,” she said. Still, she didn’t fold. The end came, last Saturday.

As cancer works its march, the headlines over the past year turned to the major healthcare concern of 2020, the COVID-19 pandemic, that still drops bombs everywhere.

A month ago, she was a cancer patient facing the prospect of not only being in the hospital, there was the concern and worry over treatments, and the haunting spectacle of the coronavirus was there. There were rumors, then whispers that someone on the staff had the virus and had to stay away from work. A patient down the hall had it too.

So that confounded the fears, certainly, about the cancer sickness. Was covid also part of the growing concern? It was not, inevitably, but there was worry and stress.

In her final hours, as she struggled to talk, no words came out, just a flurry of gestures. Her grip remained strong, and that gave me hope, silly me. The nurses were remarkable, checking on her comfort levels, talking to her gently, asking if she needed anything. They were doting, loving friends to her, even at the end. It could have been another day and they would be having coffee.

When I saw the doctor, she told me how they had a nickname for her, the “little sparrow,” how she continued to bring joy and meaning with every visit, as she became more frail.

The great French singer, Edith Piaf, had that nickname. It was a culture and language that Michele embraced. “Non, je ne regrette rien,” Piaf sang, “no regrets.”

Joe Cantlupe, Health Data Buzz

President Donald Trump goes to his bunker, his twitter account. He crows about the election, I won, damn it, I won.

Trump keeps tooting his unmusical tunes. Now 250,000 Americans have died because of COVID-19, which is ravaging the country. President Elect Joe Biden’s transition team is trying to coordinate with the White House to begin getting a handle on this virus. He’s being shut out.

Trump stays out of sight unless on the golf course. His team is shying away from being responsible, from officials of the Department of Health and Human Services to the General Services Administration.

Concerned health advocates are asking the Trump Administration to share “all critical COVID-19 information” with Biden’s transition team, which it has refused to do. Typically whiny kindergartners, some of the Trump bunch. Give me my candy, give me my candy.

A letter from the American Medical Association (AMA), American Hospital Association (AHA) and American Nurses Association (ANA) expresses “fears about the rising number of COVID-19 cases, hospitalizations and deaths that will increase greatly through the holiday season.”

“Confronting the challenges of the pandemic is imperative to saving American lives,” they wrote to the Trump administration. “Real time data and information on the supply of therapeutics, testing supplies, personal protective equipment, ventilators, hospital bed capacity and workforce availability to plan for further deployment of the nation’s assets needs to be shared to save countless lives.”

Haunting chants before Thanksgiving, a day of sharing and giving.

Our country was built on that premise. In 1863, President Abraham Lincoln proclaimed a national Thanksgiving holiday in the midst of a terrible Civil War.

Again, we are at war, against the virus. Sorry, the president is busy tweeting. — Joe Cantlupe, Health Data Buzz