Pushing the portal: Health Exchange going high-tech

There’s NOT an app for that – but there probably should be.

 California has until 2014 to create a system for enrolling its 4.7 million uninsured and underinsured citizens who are eligible for new benefits under the federal Affordable Healthcare Act. The state’s powerful Health Benefit Exchange Board is working to create a web portal with some ambitious goals: allowing Californians to check their healthcare eligibility, compare cost options, and enroll in an insurance plan, all in real time over the Internet.

But there’s a problem.

“We’ve been looking at the digital divide for some years now,” said Carla Saporta, health policy director at the  Greenlining Institute. “Digital inequality is affecting communities of color in that they don’t have the same access to broadband at home as other communities.”

According to a new report from the Greenlining Institute, many of the people the Health Exchange is trying to reach get Internet access only through smart phones.

In fact, the proportion of people who connect only through smart phones is highest among a key set of demographics the healthcare law is trying to bring into the system  — younger people and communities of color.

And reaching this group may be crucial to the program’s success, due to another of their key characteristics: They’re healthy.

The Health Benefit Exchange works by pooling consumers together, creating the kind of negotiating leverage enjoyed by corporations and agencies like CalPERS. But having a good number of healthy individuals participating will also play a role in keeping the costs of insurance down.

Unfortunately the cell phone-government program relationship is largely uncharted territory. Examples of public health campaigns using text messages for educating and reminding patients exist, though many are too new to gauge their success.

On the bright side: Text4baby, the nation’s first free, cell phone-driven health-education program launched in 2010, is turning out positive results.

Text4baby is a bilingual text message service that sends new and expecting mothers important health tips timed to their baby’s due date. Some 250,000 women have enrolled nationwide, over 20,000 in California alone, since the campaign began.

“Our health care system has to start using digital tools, cell phones first and foremost, to help support and interact with patients, because we can’t afford the model we’ve got, which only pays for certain face-to-face interaction,” said Paul Meyer, cofounder and president of Voxiva, the company behind the text messaging platform.

Preliminary research released this month revealed the program helped these women remember critical appointments, inform them of warning signs, and engage their doctors.
Its success has green lighted other messaging services targeting diabetes prevention and quitting smoking, and the creation of an HHS task force, text4health.

Even in this nascent stage, the importance of mobile devices for public health campaigns is gaining wide recognition, including within the national design effort behind the health exchange.

The project, known as User Experience 2014 (UX2014), is a public/private partnership of federal agencies, states, healthcare providers, insurance companies, and the design firm IDEO (known, amongst other impressive feats, for designing the first mouse for MAC).

UX2014 has undertaken extensive consumer research, actually visiting people in their homes in several states, and designing a simple and inclusive system for states, to be released in spring 2012.

A list of mobile features in the works include applications locating nearby assistance, tracking status of enrollment, or sending reminders to renew insurance and complete payments.
A particularly neat design would allow someone to use their phone’s camera to upload missing documents, like wage stubs, into the system.

But actual enrollment through a smart phone application may not be on the table because of limits within the Affordable Healthcare Act itself.

The federal law requires a uniform enrollment process across all platforms: online, mail, over the phone, or in person.

“We think mobile is really important because there has been a huge penetration of the use of cell phones and smart phones,” said Sam Karp, VP of Programs at the California Healthcare Foundation on the design side of the project, “But we don’t see a smart phone as having a large enough display for doing the complete application.”

But enrollment is also only half the battle, and not even the first half.

As noted by Saporta, “Outreach and education needs to start yesterday. Just because you build a system, doesn’t mean people are going to utilize it.”