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How Payers Use Data Analytics for Personalized Member Experience

Aetna is using data analytics to learn more about its members and drive a simplified and personalized member experience.

member experience data analytics

Source: Thinkstock

By Sara Heath

- As the health payer industry has continued its focus on improving patient engagement and member experience, experts have observed a need for more personalized and simplified medicine. And for Firdaus Bhathena, Chief Digital Officer at Aetna, the road to doing is paved with better data analytics.

“You’ve probably never met anybody who said, ‘I love going to the ED,’ or, ‘I love hanging out in the doctor's office,’” he said in an interview with PatientEngagementHIT.com. “So, enabling members with the information and the actionable analytics that affects their wellness and well-being is a huge area of focus today at Aetna, and elsewhere, as well.”

And eliminating that friction is beneficial to all parties – patient, provider, and payer, Bhathena pointed out. When a patient stays out of the emergency department, they have a better experience.

Additionally, lower ED admissions cuts costs for payers like Aetna, and reduces stress and some uncompensated care for hospitals.

“It's a win-win-win for everybody involved,” Bhathena said.

READ MORE: Patient-Generated Health Data Bolsters Preventive Care Orders

To get there, Aetna is working to simplify the healthcare experience. Patients have numerous coverage options, treatment options, and options for accessing their care. What they need right now, Bhathena said, is more transparent and actionable information about what they can do to best take advantage of the healthcare system around them.

“Those are the kinds of things we're really trying to zero in on, by leveraging what is being done in our data science teams, and bring it to bear in the member experience,” he said.

Looking at patient data specifically has helped Aetna learn more about how to improve the beneficiary experience, Bhathena explained. And as that data becomes more sophisticated, so too do the analytics tools used to sift through data.

“It's well known that one of the biggest assets we have is the vast amount of data we have on our members,” Bhathena asserted. “We are getting better every day at leveraging that data to deliver value to our members. We have a very strong and competent data science team that's coming up with the notion of the next best actions that that consumers should take that are in their best interest.”

“But that kind of research, which is deeply rooted in strong data science, would only be a science project if you couldn't bring it to bear to impact the member experience,” he added.

READ MORE: Payers Face Disconnect in Beneficiary Engagement Preferences

Aetna delivers member experience through an omni-channel app that allows members to communicate with care managers, look at their own information, learn more about their health, and receive care support.

The tool does anything from allowing patients to schedule appointments with in-network providers to learning the next steps in a wellness plan.

These member-facing tools run on data, and that data needs to be plentiful, coming from multiple different sources and organized in a way that makes sense and makes an impact for patients, Bhathena explained. That is where connected health and other more emerging technical innovations come in.

“Connected devices, whether it's a wearable or some other device in your home, is a huge part of our strategy,” he noted. “If I was to talk about the areas where healthcare's going to be most transformed, or most disrupted, over the next five years, it's going to be with AI for healthcare, connected devices, and virtual care. Fitting those together in a valuable consumer experience is going to be critical to actually deliver the value that's needed.”

Aetna is beginning to implement some of those data analytics tools, he explained, and it has enhanced the patient experience with their member-facing tools.

READ MORE: Moving Beyond the Portal with Patient Engagement Technologies

“That's a tidal wave that's coming, and we're already seeing the beginnings of that,” Bhathena asserted. “Tying that into our data systems, so that we can actually run our machine learning models, and our deep learning models, on a far richer set of data, is a sure way to increase the value for the consumer.”

And because Aetna is able to learn more about its members, they can offer better, more personalized products for them. This means presenting patients with the tools that they want to make their unique healthcare experiences simpler. In doing that, Aetna is able to address one of the bigger challenges of patient engagement – meeting individual patients where they are.

“It can be overwhelming, when you come into the healthcare system, because there's so much information along so many axes, and we are trying our best to simplify, and yet personalize,” Bhathena said. “There's a huge emphasis on being able to look at the information we have about you in our back ends, but also how you're using the tools that we put in front of you, to be able to optimize that user experience, and surface for you the things that matter most to you.”

The data analytics tools embedded in the central Aetna app aim to simplify matters for the patient by putting frequently-used tools at the front of the app and other tools toward the back. The technology does this by observing and learning patient habits.

“You could be in our mobile app and be looking for something, and the analytics in our mobile app will actually, over time, learn more and more about the stuff that you care about and that you use most often,” Bhathena explained. “It will surface that more readily to you, as opposed to having you navigate through multiple screens to get there.”

These approaches follow a larger trend toward personalization in medicine, Bhathena added. As organizations work to tap into various motivational factors for individual patients, they also need to deliver individual care solutions.

If they haven’t already, Bhathena predicts other healthcare organizations are going to follow the same path for individualized medicine.

“We've been at it a couple of years at least now, in terms of emphasizing personalization as opposed to a one size fits all,” he stated. “Which is kind of common sense, because there are no two members who have the same healthcare needs out there. The previous approach of just presenting the user with a whole bunch of options and then having them find what they needed to find is changing, because it wasn't very effective, across the industry.”

Crucial to those pursuits is closing the loop between patient, provider, and payer, Bhathena added. The connection between patient and provider is sacred, he said, and free flow of patient information between all relevant parties will help support that important relationship.

“The big challenge here is the diversity of systems that are being used by providers,” Bhathena said, noting that even providers using the same vendor can have interoperability issues because of different implementations or customizations.

“That is not something Aetna can solve on its own, but the approach we're taking is actually partnering with multiple providers, and even talking to some of the other health plan providers in our space to say, ‘How can we start to simplify the experience for providers by, for example, all of us settling on using the same portal that a particular provider system wants to use, so that they're not going crazy connecting with multiple different entities to get what they need for different patients.’”

Empowering patients with their own data ownership will also help surmount interoperability issues, Bhathena said.

As far as we're concerned, we think that a good way to navigate this, at least in the short-term, is to put the data and control in the hands of the consumer,” he stated.

“Even if it takes a while to build pipelines in the back end between a provider's data systems and Aetna systems, consumers still have what they need and can share it under their control with their provider, should they wish to do so. But this is not an easy silver bullet answer, just because of the diversity of systems out there, and the custom configurations that seem to exist everywhere you look.”

Aetna’s work is proof that healthcare has crossed the digital threshold, Bhathena suggested. Going forward, Aetna – and other healthcare organizations – will begin to look increasingly like IT companies that specialize in healthcare and insurance.

“We have a deep and abiding commitment here now to really transform the way companies like Aetna actually does software, and builds its digital experiences,” Bhathena concluded. “That's an inside-out disruption that Aetna chose to do to itself, and a lot of the reason why a lot of us here are very excited about the future, because we see that commitment in an area that really needs it, and couldn't be more satisfying from a job fulfillment standpoint.”

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