My Health Plan PHR Experience
By Josh Seidman | Popularity: 7%One of the challenges we have faced in the PCHIT Initiative is the best role for health plans to play in promoting personal health records (PHRs) and other HIT applications for their members when the plan is distinct from the providers (as opposed to integrated delivery systems like Kaiser Permanente, Group Health, etc.).
Some health plans have made investments in portals that provide their members with access to health content, tools, claims/benefits summaries, and PHRs. Part of the challenge relates to whether the health plan can provide valuable enough information in its PHR (largely generated through claims data) to make it worthwhile for its members to use it.
I decided to log onto my own health plan PHR at myuhc.com (I remembered having done it once before and not going back, but it was worth another test drive to better figure out why). After I went through the exercise of logging in (which required several steps since I can never remember my usernames and passwords if my standards aren’t allowed or are taken), I came to a waiver I had to sign. I wasn’t too crazy about it because it didn’t (as best I could tell) seem to create any firewalls between my PHR and the health plan’s data collection for business purposes. Recalling the valuable insight shared with us by Deven McGraw about a different health plan’s PHR, I therefore thought it best to think carefully about how I shared my personal health information (PHI).
Having no choice but to “agree” in order to even see what I had access to, I checked the box and proceeded to find out what I could access. What I found was somewhat disappointing: a couple of office visit claims (well-care visit from September and a visit to an orthopedist 18 months ago for a nagging running injury that has since mostly subsided); a TB test from December (that I got for the PCHIT Initiative shadowing I’m doing); and a few lab tests (e.g., cholesterol panel). There was no valuable information stored here from those visits (I probably spent 30 minutes with my primary care physician–it was a new patient visit–and I barely remember what we discussed), and no lab values were associated with the lab tests, so there’s no way that I can use that data for historical comparison or any useful purpose, except the date it was done.
I could theoretically self-populate the myuhc PHR with PHI that I provide. That might help UHC to send me targeted health content (I don’t know if they have built that kind of Ix functionality), but I have to make the calculation as to whether it’s worth it without my knowing what they’re going to do with that data. Moreover, it’s a lot of work on my end–do I really want to invest that much time up front without having some sense of what I’ll get returned?
I look forward to learning from other health plans how they are making their PHRs more intrinsically useful to their members and/or supporting their network of providers to adopt them.
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January 3rd, 2008 at 3:47 pm
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January 7th, 2008 at 6:41 am
[…] (as opposed to integrated delivery systems like Kaiser Permanente, Group Health, etc.).” Article Josh Seidman, PCHIT, 3 January […]
January 17th, 2008 at 9:50 am
You have exposed the single, most sensitive nerve in the entire PHR discussion….where is and to whom goes the value of the PHR and who should pay for it. Having spent the past 8 years promoting the social benefits of EHR/PHR/EMR and even going so far as to promote the NHII (now NHIN or RHIO projects) I can tel you that the value proposition is spread across all healthcare constituents. But, and this is a hard pill for some to swallow, the PHR is “personal”. What I mean is, that the personal aspect of the record is the core driver in determining value. I would argue that in today’s short-sighted, give-it-to-me-now culture that the personal benefit will “win” and that the patient will end up registering and paying for their personal health record tools. I know, the big payers think they are doing everyone a favor by “giving” these tools to their members. But did you know that in many (if not all) cases less than 1% of a payer’s member base has ever logged into the portal…and fewer than .05% have used it more than once? I wish the payers would stop paying for these tools which their members aren’t using, and put their money into the pockets of the physicians where the care is actually delivered!
January 17th, 2008 at 12:20 pm
Hard not to feel some sympathy for health plans…at least those reporting HEDIS performance measures for accreditation by NCQA. They are accountable for the quality/effectiveness of care delivered by independent physicians who are often overburdened by multiple relationships with other plans and are still in many cases resistant to the concept of rating outcomes or performance. Plans scramble to come up with interventions to improve HEDIS scores at the physician level (P4P, care reminder/alert letters, updates on clinical quidelines, etc). Physicians frequently respond with indifference and/or frustration and often shift responsibility for better health outcomes to issues with patient compliance. So in what appears to be a logical step, plans develop interventions to connect directly with “members” to influence quality, health behaviors and provide support for chronic care management in particular. (other motives such as market share/competition are involved of course) PHRs, Health Risk Appraisals, screening reminders, etc are some of the tools that plans might employ to influence patient compliance and improve health outcomes and risk reduction.
Personally I am more concerned about the overuse, underuse and misuse of health care that could be caught through EHRs and the potential benefits for continuity of care across time and across providers offered by interoperable EHRs than building a personal electronic repository for my health care records/concerns/behaviors. But agree with JGO that I would encourage plans to devote scarce financial resources to physicians…just not toss into their pockets but to reward practices for EHR adoption and to support physicians that are actively using patient centered HIT systems to truly improve quality and effectiveness of care.
January 25th, 2008 at 2:39 pm
[…] The time we’ve been spending in the exam room shadowing clinicians and patients has been invaluable. But it’s also important that we observe how consumers are using HIT applications in their homes–after all, for most people, more than 99% of the time they are outside of traditional care delivery settings. For that reason, we have done things like shadowing consumers using PHRs in their homes and described our own experiences in using PHRs. […]