Microsoft Unveils New Health Plans Blueprint to Better Connect Industry to ‘Where Consumers Go’

Editor’s Note, June 22, 2007
– The feature has been updated to clarify details around the Consumer Engagement Reference Architecture and the Connected Health Framework for Health Plans.

LAS VEGAS, June 20, 2007 — Today’s health plans are faced with three common challenges – rising costs, inconsistent quality and the uninsured. With each passing year, these seem to grow larger and stronger. In addition, poor health habits contribute to the growth of chronic disease and are a key driver behind the seemingly endless rise in U.S. healthcare costs that outpaces GDP growth by 2-3 percent year-over-year. Health plans are being challenged to provide their members with better information and tools than they have today to take better care of themselves and their health finances.

To engage consumers to take a more active role in their health and their care, health plans must “go where consumers go” and integrate incentives, insights, guidance and information into the digital lifestyles of consumers. Today, at one of the leading forums for the health plans industry, AHIP’s (America’s Health Insurance Plans) Annual Meeting, Microsoft is unveiling the Connected Health Framework for Health Plans to help organizations get there. To learn more, PressPass spoke with Dennis Schmuland, health plans industry solutions director, U.S. Health and Life Sciences Group at Microsoft.

Dennis Schmuland, Health Plans Industry Solutions Director, U.S. Health and Life Sciences Group at Microsoft

PressPass: What is Microsoft announcing at AHIP?

Schmuland: Our biggest announcement centers upon the launch of the Microsoft Connected Health Framework for Health Plans. The Connected Health Framework is part of our initiative to provide health plans with an open and extensible technology foundation, at no charge, to drive out the costs and complexities of connecting their core systems, service channels, new applications, consumers, devices and business partners. In a highly competitive market that now centers on the consumer rather than administrative transactions, health plans need a much more adaptive IT infrastructure that also costs less to run. This approach not only enables health plans to quickly seize new business opportunities but it also frees up new capital to execute on new business opportunities. Today we’re launching an open and extensible reference architecture and downloadable code – an accelerator of sorts – that is available at no charge for health plan customers and our partners to use with Microsoft technology as well as their existing core legacy systems.

This Connected Health Framework is important because service-oriented architectures are critical to breaking down the barriers between the people, information systems and processes both within the organization and beyond the organization with consumers, providers, employers and brokers. With this extensible reference architecture, health plans can now quickly create high-impact solutions with less custom coding and without the need for expensive, lengthy or complicated consulting engagements.

PressPass: What makes the Connected Health Framework unique compared to other prescriptive approaches in the industry today?

Schmuland: Our solution shows the breakthrough advantages that Microsoft’s “real world” approach to services-oriented architecture (SOA) brings to health plans and developers. Our “real world” approach enables health plans and industry solution partners to focus on immediate business problems and apply IT solutions in incremental steps to deliver near-term business results – regardless of platform or original programming language. By starting small in a specific functional area like launching a new product, consolidate acquired systems, business intelligence, or automating business processes and workflows, the health plans can achieve rapid success around a focused business problem. Then that focused business solution becomes the basis for broader SOA implementations.

This is what you might call a “minimally invasive” approach to SOA that allows health plans to deliver on business goals one need at a time while they service-enable their IT assets based on changing business requirements.

PressPass: What are the biggest challenges currently facing the health plans industry today – and how will technology play a part in solving them?

Schmuland: Today, health plans are faced with three big challenges – rising costs, inconsistent quality and the uninsured. And, with each passing year, these challenges are growing larger, not smaller. To put these problems in perspective it’s important to realize that the spiraling growth in medical costs is firmly rooted in our demographics and unhealthy behaviors – such as our neglect of health screening, smoking, unhealthy diets, lack of physical activity, non-adherence to prescribed care plans, sleep deprivation, and alcohol misuse. It’s these unhealthy behaviors that are driving up the prevalence of chronic diseases which, according to the Center for Disease Control, already affect 30 percent of the U.S. population and account for more than 75 percent of medical costs. All of this together means that unhealthy behavior is not only the single greatest influence on chronic disease and death, but it’s also fueling the medical cost growth trend that seems to defy both market-based and regulatory interventions.

Consumers definitely need better information to make value-based decisions. But when it comes to modifying unhealthy behaviors, even “the right information at the right time and right place” alone is seldom enough to change unhealthy behaviors. And we all know from personal experience that information alone has never been sufficient to change our stubborn unhealthy habits. Health habits are just not a natural human behavior for most people.

This is why cracking the code on engaging consumers is so critical. Our vision of consumer engagement is for health plans to “go where consumers go” and integrate incentives, actionable insights, trusted guidance and communications into the digital lifestyles, devices, homes and personal channels of consumers. Microsoft is focused on providing health plans with the technology and partners to get there.

PressPass: What is the significance of the Consumer Engagement Reference Architecture, the first module being released under the new blueprint?

Schmuland: In a world that’s increasingly interconnected and always on, many organizations are evaluating ways to leverage technology to better engage consumers in a way that enables them to change their behavior in the direction of better health. However, high-impact customer service, wellness and disease management services just aren’t very scalable today because they’re labor intensive and rely mostly on phone- and paper-based communications. And engaging consumers to log on and use member portals where health plans are now stockpiling growing mounds of health information, personal health records, tools and guidance is harder than it looks.

The Consumer Engagement Reference Architecture will enable health plans to address this challenge and also help position themselves as health advocates with consumers. Rather than passively waiting for consumers to adapt their lifestyles to their member service portals, this architecture makes it easy for health plans to take advantage of direct-to-consumer channels and software agents that can, digitally, go where consumers go. By going where consumers go digitally, health plans can use innovative technologies to generate what we’re calling new and personalized “moments of participation.” These moments of participation are best described as “polite and personally meaningful interactions with people, software agents, software interfaces and devices that promote incremental behavior changes in the direction of better health habits and value-based decisions.” Moments of participation offer new and highly innovative technologies for health plans to engage and continually re-engage members by politely — and, of course, with their permission — assisting them to improve their health habits, self-manage their conditions and make informed financial and clinical decisions.

PressPass: This was a big launch year for Microsoft. What are the benefits of Windows Vista and the 2007 Office system for health plans?

Schmuland: These new versions of Windows and Microsoft Office will benefit health plans by simplifying how employees and customers communicate, helping to protect sensitive information and amplifying the impact of people, teams and partners—both within and beyond company boundaries.

Whereas pre-2007 versions of Microsoft Office used to be about creating information and improving individual productivity, the 2007 Office system can help health plans expertly manage and optimize information, insights, people-driven processes, and increase not just the productivity of individuals, but now the productivity of teams, partners and the entire organization.

They’ll also change the way people and teams communicate and collaborate. Windows, Microsoft Office and Exchange deliver communications capabilities that can make it much easier to manage and control all forms of communication, and they provide new collaboration features that will transform the way health plans share information with provider organizations, and work in teams.

Protecting customer privacy is also a critical imperative, and these products will provide health plans with reduced business risk and increased compliance by better protecting member health through features like User Account Control, which limits access by unauthorized users and applications. And Windows Vista BitLocker Drive Encryption allows a user to fully encrypt an entire volume on their hard drive so that, even if the laptop or hard drive falls into the wrong hands, the contents of the hard drive remain protected.

PressPass: How is Microsoft investing in the health industry overall?

Schmuland: Microsoft has been focused on the health industry for more than 10 years, growing from a team of six to a global team of more than 600. Our team includes physicians, nurses, pharmacists, and other clinical staff with experience working for health and life sciences organizations. The Microsoft health and life sciences group is made up of five subcategories to better address the specific needs of each key industry: providers, health plans, pharmaceuticals, biotechnology, and medical devices.

The Connected Health Framework for Health Plans and the Consumer Engagement Reference Architecture are exciting examples of our continuing and expanding investments in health being made here at Microsoft. Our goal is to create low cost, quickly usable, and scalable breakthroughs to an industry that’s desperately in need of breakthroughs.

Related Posts