Health insurers have the data. Will patients listen?

Health insurers are betting heavily on artificial intelligence and data analytics that scan medical records and then alert members on how to improve their health. The challenge: It’s hard to get people to listen.

Now companies say they are looking for the best way to get people to answer, an effort that may include eavesdropping on consumer behavior experts and training nurses on the finer points of the call.

Health insurance like Cigna corporate

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

These conditions range from diabetes to obesity, depression and heart disease, they said. If the data shows that a member’s blood sugar or cholesterol has risen, that person may be contacted by phone, email, or text message to participate in a program offered by the company designed to help them better cope with the problem. But in many cases, members don’t respond.

Glen Stettin, chief innovation officer of Evernorth, the Cigna healthcare company.


Cigna Corp.

“We respect people’s right not to participate or not to participate. This is their choice. But we also work to see: can we make it suitably compelling for the individual? What is missing? Why should they turn us down? ”Said Glen Stettin, chief innovation officer at Evernorth, the Cigna healthcare company.

Dr Stettin said that when, for example, a group of people with diabetes are approached to participate in a diabetes program, about 40 percent say yes. He said the rate would rise if a smaller group of people who didn’t manage blood sugar levels particularly well were specifically targeted.

More precise targeting would result in higher enrollment rates, but it could also result in the disappearance of some people who need help, said Dr Stettin.

According to Stefano Puntoni, a marketing professor at the University of Pennsylvania’s Wharton School, one of the reasons people may not 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 to a person’s sense of self.

Dr Stettin said the company does qualitative research with consumers, including people who have turned down the programs, in order to come up with their reasoning.

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

“Many people still like to talk to a nurse on the phone, and that’s really the intersection of technology and human interaction,” said Rhonda Randall, medical director of the employer and individual at UnitedHealthcare.



It’s also a significant priority for UnitedHealthcare, according to Rhonda Randall, chief medical officer for employer and individual, who said the company invests $ 5 billion annually in data, technology, research and innovation.

Dr. Randall said the company chose to contact members primarily via phone calls made by a nursing management team because of the personal touch it provides. Some nurses take more than 30 weeks of training to learn the best way to gather additional information from members and guide them to the next best steps, the company 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,” she said. At the same time, she said, “Not everyone answers the phone.”

The company also began targeting members when they called with simple questions like the loss of their ID cards. As a result of that initiative, the company has seen a 10% increase in the number of enrollments in clinical programs, he said.

The company said it uses a team of behavioral experts to help nurses use motivational interviewing and listening skills and ensure conversations take place in a sensitive and respectful way.

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

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

Human Inc

Chief Information Officer Sam Deshpande said the company is looking for the best way to reach members that actually leads them to want to change their behavior.

Once the information has been gleaned from the data, it’s about knowing how to connect the right way, whether it’s by phone call or text, through a doctor or some other route, he said.

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

Write to Isabelle Bousquette to [email protected]

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