Many people believe the key to employee wellness is education. The idea is that if people were better informed about their own health, they could take more responsibility for it. This train of thought has led to the creation of personal health records and their subsequent increase in use.
“One of the easiest ways to pass that information around to the appropriate parties is through the technology of personal health records,” says Albert Ertel, chief operating officer of Alliant Health Plans. “It’s not meant to be big brother. It’s truly meant to give people access to that information in one place.”
Smart Business spoke with Ertel about how personal health records are changing health care.
What is a personal health record, and how can it help?
A PHR is a tool which enables individuals to play a much more active role in managing their health care. Whether you are active and healthy, managing a chronic condition, or caring for children or an elderly loved one, PHRs can help you manage all your health-related information.
A PHR permits an individual to securely gather, store, manage and share their own health information with whomever they choose: physicians, family members, hospitals. PHRs allow users to accomplish many tasks, like track medications, view insurance plan information including prescription drug benefits, view and update family medical and treatment history, view recently filled prescriptions, store important health care documents like living wills, view recent office history, and store physician contact information.
Members can go online and print out the information, or input all the typical information they are going to be asked when they go to a doctor’s office and are handed ‘the clipboard.’ You get a chance to fill out that information when you are thinking about it, not when you are under the stress of trying to get in to see a specialist.
PHRs are portable, too. So if you’re on a vacation and have an emergency, you can go online anywhere and pull up that information and your health history.
What types of PHRs are there?
You can get generic PHRs — they are equivalent to an electronic file cabinet. The individual has to manually input all that information, even scanning his or her own lab results. It’s essentially a personal vault. It doesn’t update information automatically, so the individual is required to keep it up to date. Unless someone is completely tech-savvy and willing to stay up with it, the value proposition is limited.
However, a personal health record that is provided by your health insurance carrier will capture not only claims information but health care encounter information as well. That means the PHR will include not just the treatment the carrier paid for — it may include information the doctors provide to validate treatments and to prove medical necessity. It should also include the prescriptions previously paid for by the drug benefit payer (usually included in the medical coverage) as well as the diagnosis as provided by the physician and any lab results.
How are PHRs accessed?
PHRs should be permission-based because it truly is personal health information. That means the carrier captures all the information, but the insured party has to give permission to the appropriate parties — like doctors — to access and disseminate that information.
One way PHRs can be accessed is through a Web portal. For example, PHRAnywhere is a medical information storage bank that also offers an individual the ability to carry a pocket card (smartcard), which provides physicians and other health care providers access to all this information through the use of a key code provided by the insured.
Assuming the insured individuals give permission, their doctors, both primary care and specialists, will have access to all the information. Any emergency room physician across the country can access the records; they only need access to the Internet.
How can insurance providers help people use these records?
Some carriers provide incentives for employees to lose weight, exercise, use generic drugs and get primary care such as physicals, colonoscopies and mammograms. Some things are captured during the claims system; others are self-reported.
For example, Alliant provides incentives for people to keep up to date with information online. To get points in their wellness program, we’re asking them to provide updates via their PHR versus faxing in a form or something like that. It’s pushing people to use technology in ways that will pay off in the future.
How does it benefit business owners to look for carriers with these personal health records?
The more people take responsibility for their health and are doing things with a positive approach to improve or get better, or at least be aware, you’re going to see less inappropriate care and the excesses are going to be reduced. Any time people need less care, costs are going to go down.
An employee involved in keeping up his or her PHR tends to be more involved with his or her health. If an employee is paying close attention to her health, she will know when it’s time to get a mammogram, which could lead to early detection of breast cancer. If you catch breast cancer early enough and you perform a lumpectomy instead of a radical mastectomy, the savings are huge — to say nothing of the emotional aspect that a woman and her family goes through with a mastectomy. It all adds up pretty quickly.
Albert Ertel is the COO of Alliant Health Plans. Reach him at (706) 629-8848 or email@example.com.