Meet Steve Roberts -- family man, world traveler, seasoned health IT exec, industry advisory board chair for Eclipz Cybersecurity and Minerva CQ, and board member at MyndYou. For close to a decade Steve served as the CIO of the Carelon division at Elevance Health (formerly known as Anthem) and before that President & CIO of Population Health at Aetna.
As part of our industry executive series we asked Steve to share some of his industry knowledge, observations, and lessons learned from his decades long experience as a technology leader in healthcare.
Tell us about your work in healthcare and what inspired you to start your journey in that field?
I've had the privilege of serving as a leader in healthcare for over 30 years. And during that time, I was able to work across the entire continuum of healthcare including providers, payers, life sciences, and pharmaceutical organizations. I was always challenged by, and attracted to, bringing the entire ecosystem together to better serve members and patients.
In regards to what inspired me...years ago I started my journey in healthcare because I witnessed family members go through the healthcare ecosystem. Long story short there were a lot of areas that made it difficult for them to receive the support they needed. I wanted to improve the overall experience - to help create cost transparency and continuity so members, just like those in my family, could better navigate care.
What do you see as the biggest challenges facing healthcare payers today?
There are a number of major challenges that we need to tackle. As with most of the issues facing healthcare it will take time to overcome those. Today those that come to mind are:
Enhancing security - Healthcare data is worth 3x more in the open market. The last thing anyone wants is identity theft, someone stealing your birthdate, SSN, or even private health information.
Shifting healthcare models - We are at an exciting and critical time as the industry moves from fixed-based fees for care delivery to value-based care -- where the focus is on delivering results. The challenge is for healthcare organizations to effectively take the right snapshots of members over time, determine risk for members, and improve members' overall care.
Improving member engagement - Healthcare insurers need to meet members where they are in their respective healthcare journeys. Being able to understand the member, any chronic conditions, and their environment is vital. For example members, typically over the age of 50, have more than one chronic disease state. Insurers need to take that into account when engaging and interacting with members. Also insurers are getting more involved in the local communities to engage members at that level that helps drive better member engagement.
Supporting home care - And lastly, it is about migrating from hospitals to home care. This is a huge shift in care delivery and business models for healthcare organizations. We will see more outpatient procedures and home-based services which are designed to drive better efficiency and effectiveness in care delivery and quality of care.
I wanted to circle back to value-based care...can you talk more about the dynamics of value-based care and what that means for the industry?
Yes. Insurers and providers are working closer together to deliver the right kinds of services that will produce the key values that members want to see. And with that, insurers are interacting with and understanding if Doctor Hong is seeing improved results versus Doctor Spera -- and breaking that down. From there it comes down to understanding why there are better results and how to transition to more evidence-based and cost-effective treatments.
So, there is always an ongoing dialogue in terms of the services that are being provided. But at the end of the day, it's about results and the members improving their overall wellness. There is an ongoing discussion between insurers and providers to ensure they are doing the right things for members going forward.
Can you talk about a major challenge during your days as a CIO at Anthem or Aetna?
Absolutely. I was proud to serve as one of the thirteen CIOs at Elevance Health and had the pleasure of being the CIO for the CarelonDvision for that organization. At the time our clients saw a critical need to enable members (their employees) to access their health data and manage their insurance plans digitally. While members could access the wellness platform online, we needed to rethink how engagement could be delivered, and delivered well, through smartphones - which we called at the time Anthem Anywhere.
...so what did you and your team do to build and roll this out successfully to Anthem members?
Our goal was for members to use the app on their home screen, just like texting and e-mail or their favorite navigation app, blending it right into their lifestyles. If we heard members ask, “How did we ever live without this?” we would count that as one more major measure of success. The mobile app focused on the end-to-end experience because it signaled a radical shift in how we can engage members and make our services a constant in their lives. After conducting extensive research and focus groups to find out what members wanted, we determined that the app would initially offer recommended health actions, coach messages, digital coaching, and health assessments and incentives, all personalized for individual members. We had to focus a lot of energy on ease of use and the members’ experience with the tool. We addressed these questions from a member’s perspective:
How does it connect with my life?
How will it always be available to me?
How does it stay smart about me to tell me what to do?
How does it track all data associated with me that I am willing to share?
How do I customize it to make it more personal to me?
How do I use it to get to a real outcome?
What is my overall end-to-end experience?
...and what did you do to add more levels of personalization to improve member engagement?
We had a member credo “you don’t join us; we join you” and we put a lot of effort with our mobile app. Through the app, we wanted to issue offers and reminders that made sense in the context of where individual members were and what they were doing. If the app knew a member is in a pharmacy, that was a great time to send a prescription refill reminder. One challenge was keeping the app integrated with the web platform; another was achieving the right balance between the app’s proactive offerings and its responsiveness to members.
In tandem with the digital mechanics of an engagement experience, we continuously refined how to help members effectively engage with care managers to meet personal goals, such as remembering to regularly take medicine for a chronic disease or meeting weight loss and fitness targets. Whereas one member may be willing to walk an extra thousand steps for a gift card; another may prefer to accumulate points in a competition with other members; and another may just want help organizing goals so there is some activity a member can accomplish every day.
We knew we must personalize member experiences because different age groups have different needs. A relatively healthy 20 year old may want fitness and wellness tips, while a 50 year old with a chronic health condition is likely to be more concerned about receiving medical advice or what to do if they forgot to take their medicine. It was about us addressing members' needs within the context of where they are emotionally and physically.
Do you have any thoughts on tech titans like Google, Apple, Amazon, and Microsoft entering healthcare and the impact?
Well it's good! These big name brands have been making a splash in healthcare on multiple fronts but where I see a major area of impact is the member touchpoint and engagement because these tech titans create and exist in ecosystems. There is not one major player that does it all.
It is about the connectivity and the integration across the healthcare ecosystems which makes member engagement easier, but also more seamless...and again, with the recurring theme of meeting members where they are at. And part of that is using technology, equipment, wearables (like watches) so engagement and interactions with members can help them have better health at the end of the day. For example, a key area that is moving forward is password-less logins so there is less friction (for logging in) which would simplify the experience and help drive more usage of the technologies and channels.
How about AI in healthcare...what are your thoughts of what's working and where we'll see better use of AI in healthcare?
We are seeing AI being used for more use cases in healthcare. Some notable examples in terms of how AI is being used successful today include:
clinical decision-making support such as more accurate cancer diagnosis;
back office where AI is being used in claims to pinpoint who is eligible for certain services and making sure that those are adjudicated on a quicker (the provider gets reimbursed quicker as part of that); and
conversational AI, mostly in member experiences, where chatbots and voicebots are being used to help guide members find information.
While AI is becoming more prominent, a person is still needed in some cases. In fact, looking forward we'll be sure to see more human intuition and machine intelligence coming together to produce better outcomes -- called collaborative intelligence. We're seeing this in the contact center today with member experience reps.
Shifting gears to experience -- do you have any examples of healthcare companies that go above and beyond when it comes to member experiences?
I've been impressed with Chenmed. It's a value-based care group that’s positioned for members and local communities. They have a direct interaction with those members to improve their overall health.
As the industry evolves, I see the promise of new business models that will help drive better member experiences. For example, bringing together a large health insurer and national retail like Aetna CVS. They are doing an excellent job because they are meeting the members where they are -- there is a CVS located about every 8 miles from local members. Also the organization's MinuteClinic and HealthHub are both innovative ways of delivering care and wellness support. And so, getting to those as local communities and integrating services for more personalized experiences and interactions with members on an ongoing basis.
There will likely be more partnerships that work towards similar models whether that's Rite Aid or Walgreens or with other components in that category. We are already seeing today Walmart is creating local clinics right now in the Florida region. The end goal for all these endeavors is improving access to care for everyone.
What advice do you have for health insurers today when it comes to member experience?
Both employers and health plans expect population and care management services will result in healthier employees and members who won’t need expensive health services or use fewer services because healthcare insurers help them manage their conditions effectively.
Similarly, we (as an industry) must do things dramatically differently to see the successful transition of health insurers to wellness companies. That’s our response to the healthcare industry’s changing reimbursement and value models, which will reward quality of care over quantity.
How will we measure success in such a complex world? We measure healthy days, the adoption rate for our services and, most importantly, whether adoption impacts medical costs. Coming full circle, our ability to engage members and keep them engaged with great member experiences will affect adoption rates and member loyalty.