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Earl Steinbrg is CEO of Resolution Health, a company that uses health plan data for advice to consumers as well as to providers of health care. “Our customer is whoever is at financial risk for the health care dollar, and companies that help those at-risk entities manage their financial risk,” he says. As the financial responsibility shifts from traditional “payers” – employers, insurers and health plans – to consumers, so is Resolution Health shifting – or at least adding – focus on individuals as active participants and potentially even customers for its services.

Its current customers include several Blue Cross/Blue Shield plans (including CNET Networks’ provider BC/BS of CA), the Group Insurance Commission of Massachusetts, Northrop Grumman, Verizon, Caremark and consulting firm Wm. M. Mercer. By year’s end, Resolution will be assessing data on 50 million patients.

“For a [given patient] population we integrate all the data provided by our clients and create a longitudinal record for each patient. We pass that data – and monthly or quarterly updates of it — through a thousand algorithms in order to characterize each patient, and identify actionable opportunities to improve quality and reduce cost. By analyzing each person’s insurance benefits, in addition to their demographics, diagnoses, tests and treatments, we can determine exactly how much money could be saved by payers and patients if specific changes in care were made.” And, notes Steinberg, RHI recommends actions…to physicians, care managers, plan administrators and yes, patients. Steinberg believes that telling patients what’s in it for them is critical to achieving behavior change. “Direct- o- member is the most exciting product we have because it has the greatest potential to change the behavior of patients and physicians,” says Steinberg.

Periodic statements
“We’re focused totally on actionability. We send each patient a monthly or quarterly statement [on paper or electronically or both, as the patient prefers], but we limit it to one page.” That requires RHI (on behalf of the patient) to prioritize – as opposed to, say, RealAge, which serves up advice of varying relevance once a day. Perhaps some combination of the two would be helpful. The page includes several sections: one on how to improve health or care, (e.g., Because you are a persistent asthmatic, you likely would benefit from using a controller medication; or it’s been more than a year since you received a mammogram, or you would benefit from enrolling in a free cardiac rehab program offered by your health plan), a second on how and how much you could reduce your out-of-pocket costs (e.g. If you switched from Brand Drug X to the generic form of that drug, you could save 0 per year out of pocket), and a third section that summarizes all the services the member received from different providers since his last report. This summary helps improve coordination of care provided to patients by multiple physicians because it enables Doctor Juan to see what drugs and tests Doctor Alice has prescribed or ordered for the patient.

RHI has begun testing an optional new feature for its direct-to-member (DTM) program – the “SmartSwitch” coupon program. In this program, RHI sends selected patients coupons that provide a financial incentive to change behavior. For example, patients who are taking certain drugs for heartburn such as Nexium, Prevacid or Protonix could save a lot of money by changing to over-the-counter Prilosec. A 30-day supply of Nexium retails for about 0, while Prilosec can be purchased for . Monthly co-pays for Nexium can be as high as . Says Steinberg, “We send patients a DTM report that says that there is no evidence that Nexium is safer or more effective than Prilosec. We enclose a coupon for free Prilosec and say, ‘If you try it and like it, we’ll keep sending you coupons for free Prilosec. Or, if you prefer, you can keep paying per month out of pocket for Nexium.’ It’s the ultimate in ‘It’s up to you!’ “ The coupon has an ID that can be tracked back to the patient and is used to determine who redeemed the coupon and file a claim for the OTC product to be paid for by that person’s health plan or pharmacy benefits manager (PBM). The result: The patient gets “free” drugs from his plan, and the plan saves money. RHI is also working on coupons for preferred testing labs, radiology centers and the like.

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