Health insurers have the data. Will patients listen?

Health insurers are investing heavily in artificial intelligence and data analytics that scan medical records and then warn members about how they can improve their health. The challenge: It’s hard to get people to listen.

Now companies say they’re figuring out the best way to get people to respond, an effort that could involve eavesdropping on consumer behavior experts and training nurses on the finer points of the phone conversation.

Health insurers love

Cigna Corp.

and UnitedHealthcare say they are exploring the idea of ​​targeted medical interventions. By applying data analysis or AI algorithms to data from claim documents, electronic health records and other information sources, they can determine when a member may be at risk for a particular condition or further complications from an existing condition, the companies said.

These conditions range from diabetes to obesity, depression and heart disease, they said. If records show that a member’s blood sugar or cholesterol levels have increased, that individual may be contacted via phone call, email, or text to participate in a program offered by the Company designed to help them deal with the problem better. But in many cases, members don’t respond.

Glen Stettin, Chief Innovation Officer at Evernorth, Cigna’s health service.


Cigna Corp.

“We respect people’s right not to participate or not to participate. That’s their choice. But we also work to see: can we make it attractive to the individual in the right way? What is missing? Why would they reject us?” said Glen Stettin, chief innovation officer at Evernorth, Cigna’s health service.

dr. Stettin said, for example, when a group of people with diabetes is approached to participate in a diabetes program, about 40% say yes. He said that percentage would increase if a smaller group of people, whose blood sugar levels were not particularly well controlled, were specifically targeted.

More accurate targeting would result in higher enrollment rates, but could also lead to missing out on some people who need help, said Dr. stettin.

According to Stefano Puntoni, professor of marketing at the Wharton School at the University of Pennsylvania, one of the reasons people don’t respond to targeted recommendations is when they feel the recommendation has fundamentally misunderstood them as people, especially in areas like health. , which are closely related. linked to one’s sense of self.

dr. Stettin said the company is conducting qualitative research with consumers, including those who have declined the programs, to find out their reasoning.

This work as a whole is currently one of Cigna’s biggest focuses from an innovation perspective, he said.

“A lot of people still like talking to a nurse on the phone, and that’s really the intersection of technology and human interaction,” said Rhonda Randall, chief medical officer of employer and individual at UnitedHealthcare.



It’s also a major priority at UnitedHealthcare, according to Rhonda Randall, Chief Medical Officer for Employers and Individuals, who said the company invests $5 billion annually in data, technology, research and innovation.

dr. Randall said the company has chosen to contact members primarily through phone calls from a nurse management team because of the personalized approach it offers. Some nurses take more than 30 weeks of training to learn how best to collect more information from members and guide them to the next best steps, the company said.

“A lot of people still like to talk to a nurse on the phone, and that’s really the intersection of technology and human interaction,” she said. At the same time, she said, “Not everyone picks up the phone.”

The company also started targeting members when they called about simple questions, such as losing their ID card. As a result of that initiative, the company saw a 10% increase in clinical program enrollments, she said.

The company said it uses a team of behavioral experts to help nurses use motivational conversation and listening skills and ensure conversations are conducted in a sensitive and respectful manner.

“There are ways to communicate information to people that will make it better or worse,” said Danton Char, an associate professor of anesthesia, perioperative and pain medicine (pediatric), and medical ethics at Stanford Maternal & Child Health Research Institute.

“Whether it’s an AI tool or a person making that suggestion, there’s an art to that data communication,” he said.

human Inc.’s

Chief Information Officer, Sam Deshpande, said the company is researching the best way to reach members who actually lead them to want to change their behavior.

Once insights are gained from the data, it’s about knowing how to connect the right way, whether it’s a phone call or text, through a doctor or another avenue, he said.

The project has grown in importance to Humana since last year it completed its acquisition of Kindred at Home, the largest home health care organization in the United States, said Mr. Desphande.

write to Isabelle Bousquette at [email protected]

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