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Engage Consumers July 18, 2016

Health Information and Vulnerable Populations: Health Information Companies

Partner, Health and Life Sciences, Oliver Wyman
Principal, Oliver Wyman
Key Takeaway
To capture full market opp, #healthinformation cos need to cultivate demand among orgs serving vulnerable groups

To gain a better understanding of how various healthcare stakeholders see their role in developing and providing health information to vulnerable populations, Oliver Wyman, with support from the Robert Wood Johnson Foundation, is conducting a multi-disciplinary study of the health information landscape. Over the course of the spring and summer of 2016, Oliver Wyman conducted interviews with nearly 100 marketplace leaders. The preliminary findings from that research were previously published. (Read the report.)  

Here, Oliver Wyman Partner Helen Leis and Principal Graegar Smith, with consultant Gary Zhu, provide further details from our interviews with health information companies. They detail the current landscape; highlight efforts that these companies are making to provide more effective health information for low-income, uninsured, and non–English speaking individuals; and identify where future efforts should be targeted:

Organizational Priorities

The health information companies we spoke to are looking to establish themselves in an increasingly crowded marketplace. Four-fifths of these companies are new enterprises, having only been established in the past several years. In fact, the average age of digital health companies (including health information ones) is just 6 years, according to this report. We know from our broader consulting work that an organization’s age and maturity influences company behavior significantly. Newer companies need to secure customers and revenue streams quickly, as this funds further customer acquisition and product development, and also attracts outside investment.

Consequently, age and maturity have great influence on target-customer selection; and so it was not particularly surprising to learn that nearly all of the companies we interviewed are prioritizing development and sale of products for commercially insured populations. Specific reasons for focusing on the commercially insured included: clarity on whom the buyers are (commercial plans, employers, and increasingly providers); strong demand signals; an established and attractive pricing structure or revenue model. “The majority of our revenue, our membership, and the consultation come from the commercial side,” one company executive told us. Another executive added: “We have gone after the commercial high-deductible population first because we felt that gave us the most [economic] drivers.”

The companies interviewed had a range of offerings, including products that help consumers understand benefits, access care, and manage health and wellness. Most products are designed for specific uses, such as healthcare shopping or price transparency. However, a few firms are taking a more platform or portal technology approach, addressing multiple use-cases or needs-states with their own sub-offerings; and some are making outbound referrals to other companies. One firm was specifically focused on non-English speaking populations, specifically Spanish.

Relevance of Current Health Information Offerings to Vulnerable Population Segments

While we learned that Medicaid and non-English speaking populations are not a current priority for nearly all the companies we interviewed, we believe that some of the commercially oriented products and services are transferable to vulnerable populations. (Telehealth offerings or condition-management programs, for example). As such, we sought to understand companies’ views on the needs of vulnerable population segments and their efforts – however preliminary – to customize offerings for vulnerable population segments.

All companies generally acknowledged the unmet needs of these populations, and many saw an opportunity for their products and services to have impact. A handful of companies indicated they are starting to develop a business case for entering the Medicaid space. However, they also are struggling to identify straightforward and cost-effective approaches to “porting over” their current offerings. For example, internet bandwidth-heavy applications may not work well – or at all – if someone has only basic internet service or is only able to access the internet via a mobile device.

A few companies also expressed concern that their models will not work as effectively in a Medicaid population and that poor outcomes data could have repercussions for their business overall. For example, the benefit design of a typical Medicaid plan does not provide any incentive for a Medicaid consumer to change how they shop for healthcare services. Thus, health information companies that focus on shopping may not see consumer use and engagement because the system is not set up to reward that customer behavior.  

Indeed, research conducted by our study partner Altarum Institute indicates that low income and non-English speaking consumers do have unique needs and challenges in accessing and effectively using information. For example, focus groups indicated that most vulnerable consumers rely on mobile access to internet-based information, health or otherwise. Also, visual imagery is important. Vulnerable consumers may be less likely to trust or engage with websites and apps that repurpose images originally selected for commercially insured populations. (Read more about challenges that vulnerable consumers face in accessing health care information.)

This market represents a sizable growth vector if health information companies are able to encourage and cultivate demand for their products amongst plans, providers, and employers serving vulnerable populations.

Examples of Innovative Health Information Company Thinking

Several companies have deployed innovative models to improve health information effectiveness in commercially insured populations. Similar thinking and approaches could be applied to the development and tailoring of offerings for vulnerable populations.

Building information + guidance models. A number of companies expressed the belief that simply making health information available is not enough to bring about desired outcomes. “We really believe that when people have information that is usable – not just information, but guidance – they will come to a better outcome. [That] creates higher satisfaction for not only the patient but the [customer] and ultimately controls cost,” one executive told us.

To that end, several companies are building proactive guidance and decision-making support into their health information offerings. Indeed, several of these companies have integrated human support into their platforms, either through text-based chat, video chat, or the telephone. These resources help consumers navigate the information presented and support their decision-making process.

Further, an entirely new category of information + guidance company is emerging. These companies are built on the premise of being a consumer’s trusted advisor or advocate. They support consumers in their entire care journey, and importantly position themselves as working on behalf of the consumer, not the health plan, employer, etc. Vulnerable populations would benefit greatly from such information + guidance models. We can envision the guidance aspect building trust amongst vulnerable consumers and addressing challenges these consumers face in seeking information, comprehending the information presented, and ultimately acting upon it.

Designing culturally relevant offerings. While efforts to develop more culturally relevant solutions, even for commercially insured populations, are still in their early stages, a handful of companies identified this as an area of focus. These companies all have started with efforts to provide Spanish-language information on their websites and in their apps and also have Spanish speakers available in their contact center, if one exists. Said one executive: “[We are] building in interpreter and translation services. We're very cognizant of that, as we're thinking about expanding into different populations.”

Two innovative health information companies are taking that cultural point further. They believe that simply translating content is not sufficient because this approach ignores cultural differences that are key to consumer engagement and, ultimately, behavior change. Thus, these companies are building culturally relevant and competent offerings for commercially insured populations from the ground up. This can be a significant investment and not easy for early-stage companies to undertake. However, we expect some of the insights gained and products developed in this process to have application to vulnerable consumers segments, as well; and so there is an opportunity to get a larger and better return on these companies’ investments.

Ways to Accelerate Progress

In order to increase health information companies’ product offerings for vulnerable populations, the following issues need to be addressed:

Demand must be established. Recognizing all for-profit companies, particularly early-stage ones, must see a fairly quick positive return on any investment made, it is unrealistic to expect much investment in health information for vulnerable consumers if market demand and willingness-to-pay is not established. Consumers, generally, are unwilling to pay out-of-pocket for the services and products of health information companies, and vulnerable consumers’ ability to pay is low. The health information companies we spoke to said the primary would-be customers of their services (health plans, employers, and providers) are thus far unwilling to purchase or subsidize the services on vulnerable consumers’ behalf. These customers must show an interest, e.g., through their public-facing strategy documents and requests for proposals, in paying for solutions that provide health information for vulnerable populations before we will see significant shift in strategy.

Effectiveness of technology-driven solutions must be proven and trust earned. There were concerns amongst a few of the companies we interviewed that vulnerable consumers are less able to effectively access and utilize technology. Since these companies’ offerings are fully digital and remote-based, as compared to say, heavy on human interaction and community-based, these interviewees expressed concern that their offerings would not work and other offerings would be more effective. In addition, one executive was concerned that the public health community was confusing technology access with fluency, going on to say “just because you have access to technology doesn’t mean you’re fluent in using a program that’s based in technology.” Based on our research to date, this is a misconception that needs to be corrected and efforts like ours will hopefully go a long way.

Finally, a few interviewees stated their belief that vulnerable consumers are less likely to trust new companies in the healthcare space, and they are more comfortable using solutions that are branded with their employer’s, health plan’s, or provider’s name. We know from our consumer research that trust is, in fact, an issue.  It suggests that going forward, partnerships, or even “private-label” offerings, will be key to improving consumers’ technology fluency and comfort levels.

Market Opportunity

Health information companies, in general, have done little to create and offer health information products specifically for vulnerable consumers. Yet, the market opportunity for these companies could be significant, as there are 55 million U.S. consumers enrolled in Medicaid and an estimated 20 million U.S. consumers that use mainly Spanish. There is particular opportunity in mobile apps and information, as smartphone penetration among lower-income groups is high, and many lower-income consumers depend on mobile phones as their sole connection to online information.

This market represents a sizable growth vector if health information companies are able to encourage and cultivate demand for their products amongst plans, providers, and employers serving vulnerable populations.

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