Experience with Health CoachMediated Physician Referral in an
Employed Insured Population
Karen Donelan, Sc.D.
AcademyHealth
June 30, 2009
The Institute for Health Policy at
MGH/Partners Health System
Collaborators
• Institute for Health Policy
– David Blumenthal, MD, MPP
– Sowmya Rao, PhD
– Robert Rogers
• General Electric
– Robert Galvin, MD
– Angela Cafferillo
– Peggy Damiano
– Ginny Proestakis
The Institute for Health Policy at
MGH/Partners Health System
Context
•
•
•
•
Value Based Purchasing of Physician Services
Low Use of Consumer Tools
New Employee Benefit
Can Health Coach offer value:
–
–
–
Assist employees to find high quality physicians
Achieve high awareness
Provide high level of customer service
The Institute for Health Policy at
MGH/Partners Health System
Exhibit 1. Health Coach Process Flow
Incoming Call
Assess Insurance/Service Eligibility
Assess Reason for Call
Explain Services
Create Record
Plan
Information/Provider Search
-Routine, urgent/emergent
-Check provider databases
-Premium Networks
-Certifications
Check coverage and network
Verify provider Information
Provide options to Customer
Assist
with appointments and records
The Institute for Health Policy at
MGH/Partners Health System
Sample and Data Collection
• Study population:
– Employees and covered dependents ages 21 and over
– Users and Non-Users of Health Coach during the period
10/1/07-2/29/08
– 1750 Users, proportionately sampled from 2 vendors
– 1740 Non-Users, stratified by age group and number of chronic
illnesses
• Data Collection:
– Conducted August 2008-October 2008
– Self-administered mail survey
– Incentives: Gift (thermometer, all ) and cash ($2 persistent nonresponders)
– Fieldwork by Intelliscan; identities not provided to employer,
MGH
• Response rate: 55%
• Final Sample n=1825 (Users n =970 , Non-Users n = 855)
The Institute for Health Policy at
MGH/Partners Health System
Characteristics of Reported Users & Non-Users
Vendor Group 1 Users
(n = 291)
Vendor Group 2 Users
(n = 333)
Non-Users
(n=855)
Age 21-49:
0 chronic conditions
1-2
3-4
49
20
23
6
58
31
22
5
54
26
21
7
Age 50-64:
0 chronic conditions
1-2
3-4
51
10
25
16
42
10
23
10
46
8
27
11
23
44
33
25
45
30
23
45
31
9
51
19
21
9
58
14
19
6
67
17
10
Wage:
<$50k
$50k - $100k
100k+
Region:
Midwest
Northeast
South
West
The Institute for Health Policy at
MGH/Partners Health System
Health Coach Survey Metrics
All Respondents
(User, Non-User)
Use of/Unmet Needs for Health Information
Consumer Activation
Key Health Events
Aware of
Health Coach
Used
Health Coach
Provider Referral
(PCP, Specialist, Hospital)
Not Aware of
Health Coach
Did Not Use
Health Coach
Health Information
Services
User Experience
(change provider,
value of consult
value of coach)
The Institute for Health Policy at
MGH/Partners Health System
Demographics
Knowledge & Use of
Health Coach from GE
Had you heard of Health Coach
prior to this survey?
100
Have you used Health Coach in
the past year?
100
85
80
80
64
60
46
Users
Non-Users
40
20
60
Users
Non-Users
40
20
0
5
0
% Saying Yes
users n = 970
non-users n = 855
% Saying Yes
The Institute for Health Policy at
MGH/Partners Health System
Health Coach Users vs. Non-Users: Interactions with
Health Care
% of Respondents who in the last year ...
11
Changed PCP
15
Got second opinion
26
24
51
Specialist Visit
Hospital Inpatient
15
20
Informal Caregiver
18
18
0
users n = 970
non-users n = 855
20
40
Non-Users
Users
61
60
The Institute for Health Policy at
MGH/Partners Health System
80
100
Use of Provider Referral Services
All Users
(%)
User Group 1
(%)
User Group
2 (%)
Requested Provider Referral
PCP
Medical or surgical specialist
Hospital
33
52
9
29
55
9
36
49
9
Given Provider Referral
In-Network Referral
Out-of-Network Referral
89
**
84
**
95
**
81
**
79
**
82
**
Visited Recommended
Provider
In-Network Visit
Out-of-Network Visit
User Satisfaction: Health CoachRecommended Providers (%)
100
90
80
70
60
50
40
30
20
10
0
2
6
15
4
3
14
4
5
14
34
35
36
37
38
34
Ability to schedule
physician
appointment as
soon as you need it
Quality of medical
care provided by
the physician
Value of
consultation with
the physician
Poor
Fair
Good
Very Good
Excellent
Note: Bars do not stack to 100% due to inclusion of valid missing responses and rounding
User Satisfaction: The Health Coach Service (%)
100
80
60
40
20
0
5
5
14
4
5
17
7
7
15
30
28
28
44
44
38
42
37
Assistance in
understanding
health
information
Speed in
providing
health
information
Helpfulness of
the health
information in
making a
decision
compared with
other
resources
Accuracy of
information
about
physicians
Assistance in
preparing for
physician visit
Excellent
Very Good
1
3
13
2
7
14
37
Good
Fair
30
Poor
Difference by Vendor
User Group 1 vs. User Group 2 Customer Experience
(User Group 1: n = 164, User Group 2: n = 212)
Health Coach
Helpfulness vs.
Other Resources
Speed of Health
Coach in Providing
Information
100
80
8
7
3
10
12
18
60
4
8
3
2
16
17
5
5
11
29
25
28
4
4
17
31
40
Assistance with
Comprehension from
Health Coach
30
29
51
47
20
35
27
51
35
0
Group 1
Group 2
Group 1
Group 2
Group 1
The Institute for Health Policy at
MGH/Partners Health System
Group 2
Poor
Fair
Good
Very Good
Excellent
Would you recommend Health Coach?
All Users N = 624, Group1: N = 291, Group 2: N = 333
100
90
80
70
60
50
40
30
20
10
0
2
6
27
2
8
2
5
22
32
71
64
58
All Users
Group 1
Group 2
The Institute for Health Policy at
MGH/Partners Health System
Definitely not
Probably not
Probably would
Definitely would
Discussion
• High awareness for a new service
• Overall users report very positive experience, and high willingness
to recommend Health Coach to others
• Substantial proportion of designated users do not acknowledge use
• Majority of provider referrals are for specialists, but substantial
activity for PCPs
• Vast majority in network, very low out of network rate
• High uptake—people saw the recommended MDs
• User experience did vary in many dimensions by vendor – these
differences held even after controlling for age, health status, income
and geographic census region and business unit.
The Institute for Health Policy at
MGH/Partners Health System