An ounce of prevention is worth a pound of the cure. There’s a growing consensus throughout the healthcare industry that the best way to bend the cost curve is to get ahead of costs by addressing underlying issues such as unmet social needs or care gaps. This presents an enormous opportunity to reduce costs and improve healthcare services, but only if we can do it at scale.
Unfortunately, we lack the leading indicators that can give us insight into unmet patient needs. We don’t have real-time visibility into a patient’s situation once they leave the four walls of the health system. Only patients and their caregivers know what is happening at any given moment.
Furthermore, nursing shortages have made it difficult to scale care management beyond the sickest 5% of the population that accounts for 50% of all healthcare spending. Within this group, about a third are experiencing a one-time health catastrophe, another third has high-cost conditions that will never go away, and the final third have one or more chronic illnesses that are largely preventable. In general, there is little we can do to reduce the spend for the first and second groups. Instead, we should focus our energies on the third group and work to prevent the preventable chronic illnesses.
So, how can we reduce healthcare costs at scale?
To reduce the burden of chronic illness over time, we must engage a larger portion of the population, identify leading indicators of patient decline, and address needs before they spiral into a chronic illness. This requires our care management programs to scale their reach by at least 15X (increasing from a reach of 5% to 80% of the population of all US adults). Given our current provider shortage, we should consider how technology can be a force multiplier.
Marketing technology enables organizations to engage consumers in high volume, real-time, AI-driven interactions.
These digital conversations can provide the insight and scale required for population health. Pega is a global leader in marketing technology. Our Infinity AI platform powers the digital experience and customer service dashboards of the largest payer and provider organizations companies in the world.
Pega’s always-on brain interacts with people through chat-bots, SMS text, web, and other digital channels, discovering actionable insights like changes in health, unmet needs, or gaps in care. This self-reported data (combined with data from patient records, claims history, and other sources), is used by our brain to determine which next best action to take, such as:
- Educating to improve self-management
- Sending an assessment to gain further insight
- Orchestrating a response to address an unmet need
- Engaging a clinician to pick up the conversation
What does this interaction look like at the end of the day? It looks like technology that identifies and addresses needs automatically and escalates to clinicians when appropriate. Here are some examples. A grandfather with known transportation needs is automatically offered a rideshare voucher to get to and from his primary care appointment. A patient recovering from knee replacement surgery is asked for any infection warning signs. The patient reports a fever and gets a call from a nurse right away. We’re simply triaging patient needs for millions of people at a time.
Forward-thinking payers and providers who have piloted programs to proactively address unmet needs have achieved a remarkable reduction in emergency visits and hospitalizations, ranging anywhere from 20% - 50%. At scale, this approach could equate to billions of dollars per year in medical cost savings.
None of these concepts are new, but the use of marketing technology in population health is disruptive. Marketing, at its best, is more than just cross-selling or up-selling. It is about meeting customers in their moment of need, showing empathy, and offering the right solution. That’s our prescription for healthcare.
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Why healthcare engagement should be proactive, personalized, and preemptive
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