How has the role of data transformed health plan communications and interactions with today’s consumers? With the dynamics and complexity of the healthcare landscape, health plans are increasingly seeking and leveraging first and third party data to drive member experiences that are relevant and meaningful.
Listen to Dr. Aaron Novotny, Director of Healthcare Economics at Arkansas Blue Cross Blue Shield, and podcast host Alan Tam, as they share how the rise and adoption of data is transforming how health plans are engaging with their members and the new challenges it brings.
This conversation is brought to you by Actium Health in partnership with the Forum for Healthcare Strategists.
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Director of Healthcare Economics
Arkansas Blue Cross Blue Shield
Chief Marketing Officer
Alan Tam (00:00):
What continues to be the gap in the challenge for health plans today?
Aaron Novotny (00:05):
Data. I think data is a big, big issue when it comes to how we’re going to be able to facilitate all of this, because let’s be real, people don’t want to talk about their health. I mean, the fact that more people are willing to engage in behavioral health services isn’t necessarily indicative of them wanting to talk about what’s going on.
Alan Tam (00:38):
Hello healthcare, the dynamics of the healthcare landscape is ever-changing and very complex. Few industries are probably more complicated than healthcare today. When you take a look at health plans, providers, employers, it becomes mind-boggling. Throw in their trends of healthcare consumers, where are we to focus and how do these organizations interact with today’s ever-changing ever dynamic healthcare consumers? Today I have the pleasure of joining me, Dr. Aaron Novotny. Dr. Aaron Novotny is the Director of Healthcare Economics at Arkansas Blue Cross Blue Shield. Aaron, welcome to the show.
Aaron Novotny (01:22):
Hey, thanks for having me, Alan. Really appreciate it.
Alan Tam (01:24):
I’m excited to have you here, and I think you’re the first Director of Healthcare Economics that I’m talking to. What do you do in your role, and what is the Director of Healthcare Economics?
Aaron Novotny (01:35):
That’s a great question. I have to actually tell people that I work with that all the time because I’m the first one ever at Arkansas, Blue Cross Blue Shield as well. My elevator speech is typically around the ROI. Right? What’s the return on investment for some sort of intervention, benefit design, or strategy to kind of get engagement? At the end of the day, I always see us as more of a kind of an R&D shop. We do a lot of research, we do a lot of evaluations, and then we start to try to understand and develop how to better hone those types of programs. So it’s really exciting, fun work, and I think of it as cutting edge.
Alan Tam (02:15):
I love it, and I love always from a marketing perspective, understanding the market and doing that research. So what are some of the research trends that you’ve been able to identify that’s helping Blue Cross Blue Shield?
Aaron Novotny (02:29):
All that, I love this. No, I mean, I think Covid kind of opened up that box and one of the key things that we got to see was the explosion in behavioral health utilization, right? Mental healthcare, virtual healthcare, and bringing all of these things to the fore. But what was really interesting is that as we started researching how employer groups and just populations at large started to engage this mental health paradigm shift, we started to really understand, Hey, wait a minute. There’s some interesting dynamics happening here, so you don’t really think about it. But when we started looking at gender matched with providers, there was a greater possibility of them actually going ahead and seeing that person, in-person not actually engaging in virtual care the way during the pandemic. And so this identification of how people saw their provider, saw their healthcare professional was kind of a driver in how they wanted to actually engage them and probably just another proxy for trust.
And that’s something that just kind of exploded in my mind because these ideas of healthcare revolve around this idea of acceptability, availability and accountability, what’s really acceptable to these people? And that’s when kind of the big idea hit me on that with behavioral health. And so that was the biggest one, and we’ve now taken that research into how do new mothers engage in services? How do you better get them to engage earlier, more often, postpartum care, all of those types of things. And so really starting to think about it more from a consumer framework I think was kind of the big, big shift for us.
Alan Tam (04:20):
So I’m interested, share with me a little bit of that secret sauce.
What is driving folks to engage now, especially as we kind of exit that pandemic? I’m wondering if you’re seeing changes as we exit the pandemic? Are we starting to revert back a little bit to where we were pre-pandemic? Do you see it heading in a different direction? What are some of those behavior changes that you’ve discovered?
Aaron Novotny (04:46):
Well, I definitely think people are willing to engage. I mean, lots of trauma happened, lots of things to be talked about and kind of hashed out, especially in that mental health framework. But I think of these things in more of a kind of contextual basis. And one of the key pieces to this as just how people continue to engage, I think has some spillover effects within people in the household. We don’t think about it when we think about eating food. I like a certain type of food because mom fixed that food. And I think healthcare is very much the same, how people want to engage and what their expectations of healthcare are kind of evolve from that household unit. And that’s one of the really neat things for us to begin to continue to explore and just kind of drill in on. But those community characteristics and how the providers start to bring new solutions to the space. I think there’s so many moving parts to this, but at the end of the day, I kind of get to be Alice through the looking glass, like watching everybody, I guess.
Alan Tam (05:58):
Right? I love it. So share with me what health plans are doing from all this research that you’re doing, all these great insights that you’re providing them. How are they changing their engagement with healthcare consumers? What are some new programs and technology that’s being applied there to accelerate what they’ve learned from you?
Aaron Novotny (06:20):
So for that, we start to think about trajectories. And so it’s not very widely understood. Say CKD stage progression. Somebody presents with CKD stage 3A, how fast do they get to CKD stage 5, what’s the appropriate solution, and what are you really going to basically change or shift in kind that cost or utilization pattern? And so that’s one of the things that we’re starting to do is start to understand, okay, the old healthcare model is about these catastrophic instances. Nobody wants to go see their PCP. Nobody wants to even go get a vaccine shot, especially after the pandemic. Nobody wants to think about it, but at the same time, it’s something that needs to be thought of early and often. And so being able to devise strategies and bring in little solutions. So it’s these little things that we do to bring them along and kind of hopefully mitigate some of those catastrophic instances down the road. And I think that’s where you start filling in the gaps. This solution kind of can meet the need between the ER versus the urgent care. This solution meets the need between urgent care and say PCP visit and starting to understand those dynamics so people don’t lose that time, that money, and of course they’re not doing something they don’t want to have to do.
Alan Tam (07:45):
What continues to be the gap in the challenge for health plans today?
Aaron Novotny (07:51):
Data. I think data is a big, big issue when it comes to how we’re going to be able to facilitate all of this, because let’s be real, people don’t want to talk about their health. I mean, the fact that more people are willing to engage in behavioral health services and isn’t necessarily indicative of them wanting to talk about what’s going on.
And I think that’s going to be the challenge, is identifying these attitudes and this idea of acceptability, what really is acceptable to a person, and when? You don’t go approach a blue collar worker the same way you would approach a white collar worker, I learned that from one of the anecdotes from one of our medical directors. Arkansas is kind of a funny place, but at the end of the day, there were two types of people. There were the Hill Folk and the Flatlanders, and you could always tell the difference between the Hill Folk versus the Flatlanders because the Hill Folk would always come in with cancerous lesions on both sides of their mouth. That’s when they presented, whereas, the Flatlanders would only present with on one side of their mouth. And so you could immediately see these attitudinal differences towards just even, I’m sick. Right?
Alan Tam (09:01):
Aaron Novotny (09:02):
And I think that’s going to be a key understanding is again, this idea of consumerism and what flags are people willing to give? And being able to capture the data to get them to the right place.
Alan Tam (09:15):
So how does the data, assuming you have access to the data, which I can’t imagine that it’s not there, but in terms of driving and being much more proactive and preventative for your members, what’s being learned? What are you sharing that can help drive those programs and what’s being done so that these folks are not coming in with two lesions?
Aaron Novotny (09:44):
Right, too late. Yeah, I think that’s where, and I hate to paint a silver lining on Covid by any stretch of the imagination, but I think it really pulled back the veil on how people thought about care. And in my world, you can start to think about attitudes towards one thing or probably attitudes of how they’d feel towards say, engaging a PCP or getting a childhood vaccination shot or just even simply just going to get an A1C check. And so thinking about what we’ve learned from the past, especially from the Covid pandemic, we’ve started to really apply some of that data. The other side of it too is that sometimes you don’t have to have perfect data. I kind of mentioned mental health and virtual care, and the opposite, that counterintuitive relationship between provider and member. But there’s simpler things too. There’s multiple kids in the household. Are you willing… You’re less likely to engage. Do you have an internet desert? You’re less likely to engage. Just these simpler things to where you don’t need a member level identification, but you need to kind of understand the community at large because they’re going to be part of those behaviors that shape that member.
Alan Tam (11:04):
So what would be your recommendation and advice then to these health plans, maybe not only to Arkansas, Blue Cross Blue Shield, but just to the industry in general in terms of, “Guys, this is what you guys need to be focused on. Here’s where the healthcare consumers are and these are the expectations.” What would your advice be to the industry as a whole based on the work you’re doing?
Aaron Novotny (11:28):
That’s a good one. And when I think about it, I think about something really simple. Know your customer. I mean, at the end of the day when I came in, it wasn’t necessarily a well-known, established fact of the food deserts in the state and bring in a model about that and start talking about it, and all of a sudden you’ve got a problem when you’ve got diabetics and they’re in a food desert and you’re expecting quality food. There’s a disconnect there. You don’t know your consumers, because it’s so multifaceted. And the other side of it too would be to leverage those things that we know also impact health, whether you’re close to a walking trail, you’re close to a Fresh Market grocery store, those things matter because they’re going to be kind of those nudges for people that want to go get care. And so thinking about more broad based holistic ideas of what drives better health, I think is probably something that I think where we need to go as an industry at large.
Alan Tam (12:37):
Give me an example of something that is moving towards that and you think is a exemplary showcase of, you guys are doing it right. This is the right type of program, this is the right type of campaign, and we see the outcomes in the results.
Aaron Novotny (12:55):
So there’s a lot of, I think, really good programs and they have a hard time telling their story. But in Little Rock, Arkansas, we ran a small scale pilot around just, I wouldn’t call it a concierge, I wouldn’t call it anything other than we had a paramedic that was also, well-versed in social work, and they would essentially identify high risk members and just start to engage them. And you started to see a really interesting pattern develop because it wasn’t just the member that was maybe noncompliant, or unwilling, or however you want it to frame them. There were so many different social dynamics at play to where these paramedicine individuals, they would be taking them to and fro helping explain. So there were so many facets to just the education, the access, and then of course just the adherence and the willingness that members had to fight. But at the same time, we saw such great results from those types of programs. At the end of the day, I think meeting people where they are is going to be probably the best and only way to get them to engage in their own health. And again, not present with two sore. So just present with one or maybe even earlier, right?
Alan Tam (14:24):
Aaron Novotny (14:24):
Don’t chew tobacco.
Alan Tam (14:25):
So where are these folks, you talk about meeting them where they are, where are today’s consumers and where should health plans start meeting them?
Aaron Novotny (14:35):
Well, I mean, there’s a lot of different places, but when you really, really want to boil it down, there’s a lot of members, especially in the poor populations, they’re in homeless shelters. I mean, you have plans that want to say close a gap in care. Somebody had something that happened 12, 24 months ago, or a woman needs a mammography and she hasn’t had one in three years. Oftentimes one of the addresses that we have on file is a homeless shelter. And that’s the trick is that this isn’t just a health problem as much as there’s a lot swirling around to be able to get that member to really do the things because that member’s not going to come in for their mammogram. Right?
Alan Tam (15:29):
Aaron Novotny (15:29):
They are going to crash into the ER because something else happened and boom. And I think that’s going to be the biggest and hurdle for us to overcome just from an industry, from society. There’s just a lot of sick people out there, but at the end of the day, they’re not hard to find.
Alan Tam (15:50):
So for a lot of these health plans, that particular demographic may or may not be a focus. Sure, there’s Medicaid and some of these other government subsidy programs that can help, but there’s also a lot of commercial payers as well, where potentially they have a lot more data that can help drive the care plans and the actions that they want these folks to take. I guess my question there is, is there a focus for these plans to leverage that data to drive these patients that perhaps they can influence and control a little bit more that are not homeless and what is being done there?
Aaron Novotny (16:29):
Yeah, no, I think is, I think there’s a lot, and I do think a lot of this stems from these ideas of different point solutions because I mean, I think to your point, I think somebody that wants to be engaged and still has capable means to do so, but maybe they do need a ride or maybe they do need care-taking, respite. I think those will be important aspects that we start to fill in those gaps to be able to allow them the opportunity to go seek care. I always think about pregnant mothers when it comes to something like this, because on one end of the spectrum, let’s say you’ve got dad to the family has a heart attack. Well, what happens to healthcare utilization consumption for the other family members? Well, it jumps, right? It’s a big issue. It’s something that’s important. Are we all healthy? This isn’t going to happen. And I think mom or the chief health officer of the family is driving a lot of that.
And so to your point, I think having all of those solutions and those capabilities available I think are going to be very, very important. But on the flip side, when mom’s the one that’s down and we need the partner to manage all of those things, we’re actually doing some research to understand where does that same spike in utilization happen? Does utilization drop, right? Do we see fewer wellness visits, fewer vaccinations? What happens to the other kids? And so I think being very creative about what those data elements are, because at the end of the day, health may be about the individual, but it’s also impacting other people around us. And I think that’s going to be the contextual glue that holds everybody together and says, “Hey, this is important and we need to do it.” And so I think it’s a big part of having those capabilities and having that data and making sure that those marriages are there. But then also to your point, maybe people that aren’t necessarily a priority or not necessarily on the radar as much. I think it’s also that recognition to say, “Hey, there’s more to be done.” So-
Alan Tam (18:45):
You bring up good point and interesting insights. A lot of times we find provider organizations health plans talking about the chief health officer of a household, and I think that’s a right focus. And I guess that spurs the question for me of, as a healthcare consumer who is responsible for my health? Is it me? Is it my health system? Is it my primary care doctor? Is it my health plan or myself? Who’s responsible?
Aaron Novotny (19:20):
Oh, that’s the million-dollar question, right? I mean, that’s the influencer culture at large, right? Who’s driving, who’s pushing those… Kind of that dynamic of engagement? And I think at the end of the day, I think there’s so many facets. So I always think of community health workers. They’re not necessarily people we think about on a regular basis, but they’re those people in the community that let others know that it’s something that to be important. And so to your point, I mean, I don’t know because at the end of the day, I’ll know more about somebody’s dog than I will know about that person’s health because people are so reserved and close to the vest when talking about it. But talking to somebody close or like I said, seeing an event happen, now all of a sudden there’s a point of entry. And so to kind of mitigate some of that, I think it’s about knowing when to talk to people more than anything else, because I don’t think there’s necessarily the right person, but I think there’s a right time. I think the right person’s going to differ across different populations and communities.
Alan Tam (20:34):
I agree with you 110% on the right time. I think that could be more correct. I look at healthcare like a financial advisor, and I have my health advisor. If my financial advisor knows the recession is coming, or we have a bull market, you’re the expert. I’m paying you. I expect you to make the right decision so that I hit my financial goals. When I look at healthcare, I’m not sure who I’m looking to for that. I think my expectation comes from the provider organization, because you have my medical history, but some of us, if I have a provider or even a health plan, you have access to my health records and my health data. Shouldn’t you be guiding me? Alan, you’re going to be 50, time for you to get your colonoscopy or time for you to get your, I don’t know, Covid shot, or a flu vaccine, or whatnot. Is that the expectation that I should have as a consumer?
Aaron Novotny (21:36):
I don’t think it should be the expectation, but I don’t know what, there’s a good expectation. I’ve actually had this conversation with other people and I said, “Health insurance is different, car insurance. They can have all of the fun commercials because driving is fun, getting the keys to your car, 16, getting your license, going out on the road, all of that. Those are memorable events.” Alan getting his colonoscopy at 50, no. Right? Kind of want to not think about that after the fact. And so I think to that end, it’s always a really big balancing act because we can’t tell you what to do in that regard as a payer, a provider, a pay either. I mean any of those types of paradigms, because the only person that really can actually choose to do it is you. And so I think that comes back to the fundamental aspect of your analogy there is that you chose to go talk to somebody that you trusted about your financial wellbeing. I think we’ve got to start understanding that it might not be the PCP, but who are those people that people do trust? And oftentimes it does come back to mom, dad, or some sort of a community family leader. And I think those are the people we’ve got to get engaged and start getting the right information to not letting TikTok dictate to 14 year olds how to do whatever exam. Right?
Alan Tam (23:11):
Right. Absolutely. But I go back to time, which is what you mentioned earlier, is can healthcare organizations in a timely fashion deliver the right content and message appropriately to the individual for preventive care or to guide them through the right journey? I think what healthcare is lacking oftentimes is that proactive. You should know me because in other aspects of my life, Amazon tells me when I need to order the product next. Netflix tells me what to watch, next. FinTech tells me what I need to do next, but healthcare, there’s a gap. It’s just like all of a sudden it’s like, you’re not telling me I’m on my own and granted that it’s transactional and it’s not something you want to do, but being top of mind and helping to guide me through that process, I think is critical.
Aaron Novotny (24:13):
Yeah, no, I completely agree. I completely agree. And I think it has to be multifaceted because I think again, it comes back to whatever nuclear structure, whether that’s just your household, whether that’s flatmates, whatever you want to classify, people around you that care. And I think that’s where, coming back to the mental health, it’s like, do we want these things to be unknown, especially from people that will be the ones having to take care of it? Because for you buying Tide or getting your groceries delivered, I mean, that’s a choice, you want it, it’s done, and that they only have to interact with you. But for getting say some sort of procedure, that’s not just a you thing, right? Somebody’s going to have to come with you. You’re going to have to have the support structure in place. Your eyes get dilated, you’re not driving home.
Simple things like that to where do we send a message just to you and then trust that you’ll be the one to kind of convey that and find that person, because now it’s two layers of stress. You got to set up the appointment and you got to figure out how it’s going to all happen, or do you start to bring in more people into that mix? And I think that’s where kind of that fine line of what’s private, but what’s not, your results are definitely private. That’s your information. You have every right to that. But getting to the point of getting those results, where does that gray area of that privacy start to be invaded? Because we want your wife to know, or we want some sort of person that we’ve identified as being a support structure for you to know too. And so to your point, I think there’s going to be a lot of things to try, but I think it really comes back to kind of who you have around you. That’s going to be the biggest piece of making that happen.
Alan Tam (26:15):
That makes a lot of sense. So with regards to health plans, what are the key areas of focus today at Arkansas, Blue Cross Blue Shield, and other health plans?
Aaron Novotny (26:29):
Yeah, so I mean obviously mental health. I think mental health in the maternal space is a really big one. We find a lot of women just at the point of delivery, they’ve got a behavioral health flag. You couple that with being polychronic, so having diabetes or hypertension on top of it. I mean, you can just imagine the recipe for disaster in that context. So behavioral health, maternal health, and then diabetes. I think if we can’t start to grapple with diabetes and how to deescalate the metaphorical balloon that’s happening, we’re going to be in real big trouble in a couple of decades because we just can’t keep going at the rate we’re going and not make sure these people get what they need. And then the last one I think is kind of MSK, musculoskeletal disease states. I mean, whether it’s surgeries, I think there’s a lot of room for improvement and just more understanding more than anything in that space. I think that’s a very complicated space, but between work and what people are expected to be doing and then say being in CrossFit and other types of really intensive workout regimes, there’s a lot of utilization there. But at the same time, what is it really doing? And I think that’s a big question that I have on my end is how do we better understand that MSK process? So those three areas, and then maternity.
Alan Tam (28:10):
Okay. So given your role, you have an amazing crystal ball. Tell me where we’re going to be in two years?
Aaron Novotny (28:18):
Two years. Well, I think that in two years time, you’re going to see employer groups leading the charge for change. What that change looks like I think is going to vary regionally in the same way that probably health insurance was created in the forties because of World War II. It was an incentive because they had caps on manufacturing wages, so the Fords and the GMs of the world, they had to come up with creative ways to lure people in and health insurance was born. I think you’re going to see a similar kind of reemergence in that capacity. And so I think what you’ll start to realize is that you’ll have more choices, but those choices will be, does this identify with, say, your place of work? More blue collar, and really having benefit design towards what would be typical for that type of person. And of course, the right thing, the right intervention, right person, right time, versus maybe a more general plan.
And then I think you’re actually going to see a shift in, I think you’re going to see something similar to kind of an Aflac type thing to where the early entry into healthcare, I think they’ve got to lower that bar, and I think everybody understands that, right? We’ve got to get people in to see primary care docs, but there’s not enough primary care docs, and they’re all burnt out from the pandemic. We need more behavioral health providers, but I mean, they’re flooded with people. And then on top of it, there’s still a great need there. So figuring out a way to get people in, but then also to not losing and burning out your provider pool because we’re not creating those people. And so I think there will be a compromise, and again, I think that’ll probably be led by the employer space that you’re going to see different levels and almost a stratification. So coming back to the consumerism, we’ll have different strata of top tier concierge all the way down to it’s the Kias or whatever, how you think of a car company and the models and brands that they have. And so I think you’re going to start seeing that within healthcare in two years.
Alan Tam (30:58):
Awesome. Aaron, it’s been incredibly insightful. I want to thank you again so much for your time and sharing these amazing insights and the work that you’re doing. There’s a lot of people in the audience that would love to continue the conversation. What’s the best way for them to get ahold of you to continue these discussions and perhaps get some of the insights that you have and have been working on?
Aaron Novotny (31:23):
Yeah. I’m Aaron Novotny at LinkedIn, so I’m always good for a reach out on that. And then, well, sadly, I don’t do TikTok or anything, so there’s no dances or food challenges.
Alan Tam (31:38):
Maybe that’s an area of exploration.
Aaron Novotny (31:41):
Alan Tam (31:43):
Aaron, thank you so much again for your time. For those of you that are in the audience, Dr. Novotny is a wealth of information in healthcare economics. Some great insights were shared here today. Highly encourage all of you to reach out to him and learn more about what health plans and employers are doing. I’m really interested to see two years from now if what he’s predicted in that crystal ball holds true. Until next time, hello.
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