Avoid the Garbage

Most of what health insurers send to physicians winds up in the trash. Who can blame doctors for hitting the delete button or finding the nearest wastepaper basket when an insurer, pharmacy benefit manager, or assorted vendor sends out yet another message about saving money?

The problem is two-fold: Doctors trust their own knowledge over a health insurer or vendor's software and physicians are inundated with so many communications that are either cost-driven or simply junk.

Dana-Farber Cancer Institute recently studied medication alerts in ambulatory care. The study found that electronic prescribing systems with decision support may well improve patient safety and protect patients against drug interactions, but physicians ignored most of the clinical alerts. Dana-Farber researchers suggested the current medication safety alert system is inadequate to protect patient safety.

Aetna's ActiveHealth Management has come up with a possible solution. ActiveHealth's Care Engine is a clinical decision support technology that gathers the medical, pharmacy, and laboratory claims data for members and compares it against the latest findings in evidence-based literature. The system sends clinical alerts, called Care Considerations, to physicians about potential issues, such as drug interactions, vaccinations, adding or intensifying therapy, and condition or drug monitoring.

The alerts are divided into three levels depending on severity. This means an e-mail alert is sent to physicians whose patients are in jeopardy while snail mail is the route for the patients with monitoring or preventive issues.

But, as I mentioned earlier, physicians often ignore messages. With that in mind, ActiveHealth recently tested whether sending the alerts to patients as well as physicians would improve overall compliance.

ActiveHealth found that informing both the physician and patient improved compliance to Care Considerations recommendations by 12.5%. They saw the greatest compliance increase in recommended screenings, diagnostics, and monitoring tests.

ActiveHealth gave three possible reasons why sending clinical alerts to patients as well as physicians benefitted results:

• Messages reminded patients and reinforced physician instructions.
• Patients who received the alerts brought information to the physician and reminded the doctor to write prescriptions or order tests.
• The physician alert was sent to the wrong physician, but the alerted patient brought the message to the correct caregiver.

Stephen Rosenberg, MD, MPH, senior vice president of outcomes research at ActiveHealth, says a patient notification system is one way to get patients more involved in their care.

"This in a way empowers the consumer. We are not just telling the doctor 'you ought to do this for the patient.' We are telling the patient 'this is in your best interest,'" says Rosenberg.

As ActiveHealth's study showed, involving patients in their care is beneficial, but engaging the physician is equally important. How does a health insurer do that? Here are two avenues:

• Stop sending self-serving junk that doctors don't trust or care about.
• Help doctors create electronic handshakes by donating/help fund technology upgrades.

ActiveHealth expects that all of its physician alerts will be conducted via e-mail within three years, but most doctors don't have the technology to communicate with health insurers in real-time. Given the increasingly grim economic picture, health insurers will need to help physicians acquire the technology necessary for real-time communication and reimburse doctors for participating and following suggestions.

That's a way to get the doctors to pay more attention to your communications. However, there is still the question as to doctors receiving too much information (most of it worthless). ActiveHealth is exploring ways to distinguish the company's correspondence from others and integrate the messages into physician workflow that doctors will know is worthwhile. This also means limiting communication to truly important outreach and focusing on evidence-based, quality care in addition to cost savings.

Providing only worthwhile communication coupled with proper payments creates a program that could win physician approval.

Effectively reaching physicians is difficult, but a combination of patient activation and creating a valuable message that stands out from the pack is a combination that could just work.