Health Information & Vulnerable Populations: Providers
To gain a better understanding of how various healthcare stakeholders see their role in developing and providing health information to vulnerable populations, Oliver Wyman, with support from the Robert Wood Johnson Foundation, is conducting a multi-disciplinary study of the health information landscape. Over the course of the spring and summer of 2016, Oliver Wyman conducted interviews with nearly 100 marketplace leaders. The preliminary findings from that research were previously published. (Read the report.) Additional results from consumer-focused research will be released over the next few months. Here, Oliver Wyman Partner Dr. Aaron Gerber and Principal Graegar Smith, with consultant Gary Zhu, provide further details from the interviews with provider leaders. They also highlight efforts that hospitals and health systems are making to provide more effective health information for the vulnerable population:
Organizational Priorities
Provider organizations are facing reimbursement pressures that are straining their financial performance. In addition, a wave of provider consolidations has shaken up the healthcare landscape. Thus, when asked about their current organizational priorities, providers focused on the aforementioned changes and did not mention health information provision as an area of focus.
That said, many providers do provide some level of health information – primarily related to accessing care and managing health and wellness. Some noted mission and philanthropic purposes as reasons to provide this information. Others cited the use of health information to drive better financial outcomes and ultimately attract more patients to their sites of care. “Serving that health information is another way to attract [new patients] to us and to grow our population,” according to one system executive.
Current Health Information Offerings
Most providers made their information sources (including physician directories, cost estimates for commonly performed procedures, and guides on healthy living and condition management) publicly available to all. In fact, very few providers viewed vulnerable consumers as a separate population segment; consequently, few have focused on tailoring information offerings for those individuals.
However, some providers are now starting to customize offerings to vulnerable consumers via translation and more culturally relevant content. In addition, some providers are working to increase access to care and health information resources by improving how existing content reaches consumers. When asked about serving vulnerable populations, one system executive said, “I continue to believe one of the ways in which we can fulfill our mission is by more informed targeting of our resources to where it's needed most.”
Success Stories: How Providers are Improving Health Information for the Vulnerable Population
Creating new delivery methods. A key challenge that providers face in caring for vulnerable populations, generally, is these consumers’ lack of healthcare knowledge and low literacy levels. In order to overcome that hurdle and provide more effective health information, some providers have taken steps to provide information that is user-friendly to vulnerable individuals. For example, an executive at one health system discussed the use of videos in place of written materials. “Rather than give [patients] a hand out, we have a video … patients love that,” the executive told us.
Utilizing specialized communication channels. A few providers recognized the need to communicate with non-English speaking consumers in more culturally relevant ways. An executive at one health system discussed disseminating information through ethnic media outlets. “We hired a media company that specializes in communications to the under-served. We used Latino radio and we created spots about pre-diabetes,” the executive told us. Another health system went one step further and engaged community health workers to deliver information to consumers face-to-face. “We have these community health workers and they are being very effective in helping to influence patients. Providing them with the information in a culturally appropriate and health literacy appropriate manner because these are laypeople,” said a system executive.
Increasing access to information. Providers are generally attuned to the barriers that prevent vulnerable consumers from accessing care – these include distrust of the healthcare system and lack of resources to seek care. Several providers saw telehealth as a way to increase access, and, secondarily, serve as a distribution channel for health information. Telehealth can also serve as a triaging function that helps consumers decide the most appropriate care options. “We have tele-medicine efforts going on in a variety of ways to address the whole notion of access through virtual visits,” one interviewee said. In another effort, a group of providers teamed up to send mobile clinics to rural communities. While the mobile clinics primarily aim to conduct screenings and deliver preventative care, there is a health information component and consumers can learn about the value of preventative medicine or methods to treat certain conditions.
Ways to Accelerate Progress
Providers acknowledged the importance of health information in helping to achieve broader organizational goals. However, future progress on health information strategies and efforts will depend on overcoming the following obstacles:
Reimbursement. Despite the continuing shift from fee-for-service to fee-for-value reimbursement model, much of the industry still operates in a volume world. Under this model, providers have found it challenging to invest in health information because they are not incentivized to do so. Indeed, as one health system executive lamented, “The big question is, how are we going to pay for it? How do we provide services that we don't get paid for?” A natural solution to the issue could simply be more risk-based contracts. One executive summed up the issue this way: “More risk-based and value-based reimbursement is bringing the system back to that original model; but before then, there’s no payoff for providing health information.”
Regulatory issues. A few providers expressed frustration with government regulations they view as detrimental to their efforts to improve business and patient outcomes. One executive complained about deficiencies in the healthcare industry that prevent organizations from customizing their communication with consumers due to regulations that prevent the sharing of certain information. According to that executive, “Every other industry seems to be able to tailor messages pretty impressively. We can't, even though we know everything about these folks in terms of medical need or medical history. … Obviously you want to be mindful of HIPAA and privacy, but how do you help cultivate and tailor messages to folks so that they respond positively to it?”
Shift to Value-Based Care
Providers certainly recognize the unique needs that vulnerable consumers have and some are working to devise specialized offerings for such consumers. However, in their efforts to provide customized offerings, many struggle to determine whether it is more effective to directly provide information to consumers or to provide that same information through other means (e.g., physicians and other in-office personnel.). As more providers make the shift towards value-based models – models in which health information plays a prominent role in the care of patients – we can expect to see progress accelerate.