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Health Care Reinvented

Apr 10, 2023

Did you know that connecting to your doctor is literally just a text away?

On this episode of the Highmark Health Care Reinvented Podcast Series, Benjamin Edelshain, MD , Vice President, Clinical Engagement & Digital Innovation at Highmark Health, gives us the whole story on how a secure mobile text messaging platform is building better patient-doctor connections for healthier outcomes. 

The platform was deployed at the height of COVID-19, immediately proving its effectiveness in a world where people could not easily meet with health care providers. Ben shares some encouraging and surprising stats on how many patients are using the platform and how text messaging has improved customer engagement.

Discover how a simple text message is part of an ever-growing ecosystem of engagement tools to ensure access to care. 


Welcome to Healthcare reinvented, exploring the intersection of healthcare and technology brought to you by Highmark, here are your hosts, the Pittsburgh technology Council's Audrey Russo and Jonathan Kersting. This is Jonathan Kersting. With the Pittsburgh Technology Council. This is the next episode of healthcare Reinvented, where we explore the intersections of technology and healthcare. Today's interview will be a lot of fun. It's a follow up from our previous season and today we are going to be talking to Dr. Ben Edelshain, and he's with Highmark Health. And I love the fact that that Highmark is finding ways for its patients and doctors to better connect and using technology where it makes sense. And in our first interview that we had was, I can't believe it's, I think, more than 18 months ago, and I'm so excited to follow up on this. It's all about just using the simple concept of using texting to talk back and forth with your doctor. And it sounds easier than you think, especially in the medical setting.  So I'm excited to learn a the progress of it and some new things they might be working on and get some numbers around this as well, too, just to see how effective it's been. So Ben, welcome to the show today. We're so glad to have you. And it's great to reconnect.

Yeah, Jonathan, thank you very much for having me. I'm honestly super excited to share some updates. And it's always great talking to you. And just coming back again, is a privilege and an honor. very humbled. Yeah. Looking forward to sharing some exciting stuff. And you know, following up from where we left off,. A year and a half ago, just flown by and you had a child. Congratulations.

Thank you so much. Yes, we we had our second little Clara, and she's turning one soon. So very cool. Very cool. You got to be stoked about that. Absolutely. Very cool. So before we get things kids, I'm just refreshing our listeners, maybe are they forgotten or there's the first time listening, could you give us your background and what you do with Highmark Health.

Very happy to do so. So I am Ben Edelshain. I've been with Highmark, for about four years now, I'm a vice president in our enterprise clinical organization. I'm originally from the UK, hence the accent and used to be a national health service doctor back in London, but been stateside for about 10 years. And so my responsibilities at Highmark Health include kind of trying to push us to be more tech driven, more consumer focused. And then operationally I run a department to telephonic nurses who support our customers, as well as care navigate navigation as well, helping members find the best possible care.

That is interesting, that's gonna be a very rewarding job, because you're actually seeing the work that you do improves the quality of patients lives. It just, I think that's going to be so much fun.

I say this without any sort of sarcasm, and I love working. And I see a lot of similar missions to, you know, socialized care where I came from our country, slightly different by country and in the US. And but I think in Pennsylvania and Pittsburgh, we're doing something special to try and change the paradigm. And I'm very excited to be part of that journey.

So that's why I love having these conversations, because I think you said the right word. I think Highmark is doing so much to change the paradigm. I mean, the idea is using technology to empower people. And it's not just about the technology, because there's technology all over the place. But how you can apply it in a way that people can actually use it, and use it to actually make the experience better make their health better. That's why I thought it was so much fun when we first talked to you know, just detailing how using something as simple as text messaging, as a really effective way of being able to keep that connection going between doctor and patient, which is just so vital. Tell us more about how that kind of started up. And then really how this has been now it's up and running for more than a year and a half now.

Yeah, so just if we rewind the clock, you know, even beyond, gosh, that year and a half ago, and you know, when COVID first broke out, right, and patients were rightly scared to go and see their doctors to engage in person with that health care. You know, what we discussed last time was we we challenged ourselves and said, Hey, look, we have this texting capability that traditionally use, you know, primarily for marketing purposes, right? We have adoption, why don't we try to juice it up and and use that one way messaging system and flip it to two way and then as people respond to us at Highmark, you know, let's have a nurse on the other end who's part of the benefit structure that I have or receives, and let's enable that nurse who's on the Highmark side, but to also be kind of that augmentative support for the doctor's practice. And, you know, for us that's, you know, really supporting our colleagues a lot to get Allegheny Health Network. But it's not it's not just a job. 

So that's, that's like I didn't think about is the whole point that this is actually a way to kind of help the doctor out as well too. Because if you have a nurse that's helping out, they're able to, you know, it frees up their time to put it where it's more important, and being able to then you but still give the care to the patient at the same time. So that to me, I think is really interesting. So the docs are probably saying, Okay, this is great, it's like a little relief valve that we can talk, we can learn about something going on before it becomes a serious problem that would require someone to come in to the doctor or something like that.

I agree. And I think part of the strategy moving forward is, you know, as a former physician myself, I empathize with, you know, those still in practice where they're forced to have really short consultation time. Right, right. I'm sure as patients, we experienced that, where it feels like, you know, you have 15 minutes, and that's it. And so, you know, perhaps this evolves into what those other topics that you maybe can't fit into 15 minutes, and then, you know, take it offline, or actually take it online, right, and have it in a more digitally enabled manner, and at the convenience of the customer, right at the convenience when they want to talk about it. And so, I mean, we've so a year and a half has passed, we have had, you know, specific to these, what I would call like health conversations or clinical conversations, say, a nurse or other kind of professional, like a pharmacist or behavioral health specialist. Since going live, we've had 30,000 interactions.

Wow. Yeah, that's, that's a lot. That's awesome. Wow.

You know, and to put that into context, that's just one year that was lost. And, you know, we use texting for other purposes, primarily, one way, we send about 4 million texts. You know, it's starting to become a decent chunk of Yeah. So, you know, again, changing the paradigm so that the conversation you have with your healthcare insurer, but you know, really, we're an integrated system, but the conversation you're having is more about your health and wellness, and less about your benefits and your right cetera.

Exactly. Just the fact that it just keeps you in closer touch with your caregivers, I think is just so important. And you can do it in a way that's not eating into the system and just wasting people's time. But it's like, no, this is a great way that you know, something's not right, you're concerned about something you're able to easily address it before becomes that bigger problem. It just makes me sick, more convenient. And it just, I'm curious, I think this is going to keep growing. Because I mean, the first year, I mean, 30,000 interactions. That's, that's pretty amazing. To me, I'm thinking this is gonna continue to keep building, and you'll probably find more use cases for it as well.

I hope so. And we certainly have plans. And you know what? I like the elegance of the simplicity. Yeah, definitely. Text is essentially free. Right? And, you know, maybe your conversation starts with a text then goes into a secure channel where you're drinking bidirectionally. And maybe you decide, hey, I do want to talk to you, and then you set up a mutually convenient time. Exactly. My dream, my aspiration by the end of next year, is to eliminate any cold calling, that's not expected. That comes from a nurse for my health plan to okay, just like there is no reason why we can't achieve that. So, you know, part of where we're headed is okay. We think texting works. Well, we know texting works, right? I'll throw you out of fun facts. So you're familiar, obviously, as a technologist, kind of the click through rate terminology, right? industry average for texting, click throughs, about 15%, one, five. But when you start due to doing two way and having a healthcare professional on the other side, and picking the moments that matter to the customer, we're at about 30% click rate.

Wow, you're doubling that. That's impressive. I mean, yeah, he's looking at a 30% engagement rate like that, click and through that you're having real conversations that I mean, this is something that people are in there. And the cool thing is when they have this good experience with it, they're gonna continue to rely on it, they're gonna see it as something that they can they can use. And I just think it builds a better relationship with your caregiver and makes you sometimes like less afraid. There's always that little bit that fear factor, the more you kind of start talking about something and the more you have to get the back and forth. I know for me, like just personally, I remember like, I've never liked going to the doctor, I remember being like, oh, I can do my virtual visits. And as I started virtual visits, I wasn't so free to actually go in and see the doctor. So I think it's it's a great way to kind of step things up as well to to get those of us who maybe have a little bit of the white coat phobia, I guess.

You need an actual person that professional and, you know, maybe that comes into the a little nudge that says, you should really go see your doc. And, you know, the other added beauty over time is that, you know, with the customer, the patient's consent, like maybe we can prep the doctor right for the visit. So we know what's going to be top of mind. And what's the point? Yeah, that makes so much sense. Because like, yeah, if you're working with a nurse, and you had a, say, like a couple days of back and forth, and like, hey, why don't you come in next week, then that nurse can then provide that conversation, there's probably some detail in there that the Doc can look into, and really informs what he or she is able to, you know, do when it comes to treat the patient, and they're gonna, you're gonna get all that better care, when you're there seeing the doctor have a better experience?

Well, and then, you know, as a blue plan that has a hospital system, right? So that interaction with the nurse can be transitioned into, okay. Why can't I just book you in right now? Because I have access to a very cool, true one call resolution, right? True, nice.

This is all based on a very simple technology, which I think is just so awesome. Like, it's something that we're all very familiar with at this point. So Ben, tell me more about the engagement rate on this. I mean, especially across different age groups. I'm wondering, is there a difference between like younger people and older people using texting to talk with their doctors and nurses?

Jonathan, that's a great question. You might actually be surprised on this. I think, you know, in our society, we have this somewhat unfair perspective, sometimes that older folks don't use technology. And what we found actually, is that when you have a healthcare professional on the other end of the phone, and you're doing two way texting, the highest engagement rate we're seeing is amongst the senior population.

Interesting. I'm so happy to hear that. I think that we shouldn't underestimate kind of smartphone adoption amongst those 65 and older. And look, if you make the tech simple. And it works, and it drives again, drives value to the customer, we're seeing that senior, customers are engaging nearly double the rates that from folks who are under 65.

Well, that is just fascinating. I'm curious, are there any extra security concerns around this being being that there's probably HIPAA stuff at some point, depending upon what the conversation is?

Yeah, that's an excellent question, Jonathan. And I do want to make sure that it is clear to your listeners. So for us the text message, what you would see in like, iOS is the initial primer. And so it says, hey, you've got a message waiting for you. This is why it's also elegant, no download needed, it just opens up a secure browser. Gotcha. Which is like all sort of safe for the patient or the member opts in to say, Yep, I'm happy to keep going. And then, you know, we have very little security concerns at that point.

Very cool. And he had the idea that like, yeah, you're not downloading something, or it's like, I can't do that right now. It just opens up the secure browser. And there you go, and you know that everything is safe. And there's there's nothing to worry about. Very cool. I mean, makes it sound simple. I'm sure it's very hard to implement. But obviously, the user experience is easy. And that's what it's all about using technology to make things easy, not complicated.

We have a great partner, the company we work with is called Relay, and they have made our life very easy. I mean, I might have mentioned this before, but we went from one way texting to fully implementing two way and 12 weeks, which for any kind of tech project is like a backup. That's just 12 weeks. Oh, my goodness. Yeah, that's, that's very cool. Very cool.

And also some added benefits. I think that, you know, we I think about a lot, maybe consumers don't is, you know, the amount of satisfaction this brings to the health care professionals as well, that are being more efficient with their time, it's more meaningful, you know, they can have, you know, multiple chats open, if that's the way they want to work, and then, but then kind of, again, not be cold calling necessarily and actively engaging folks, and just the scale at which you can help people kind of grows exponentially in a very low fidelity manner.

I did. I didn't want to share one interesting thing with you. We did. This is a exclusive for your podcast.

I like exclusive that's what it's all about. Come on, man. Lay it on me.

So once we had the sort of texting apparatus if he would. We started thinking a bit about like, the words we use in that initial text, and we how we approach our customers, as well. Actually in in a world where unfortunately, you know people who scam innocent customers yes are doing more texting right and phishing, etc. So we decided it was it was after we last spoke it was kind of in the works, but we decided just after we spoke last time to partner with CMU, CMU. Sorry, Carnegie Mellon University. Absolutely, yeah. In our backyard. We partnered with Professor George Lowenstein, as well as Samantha Hall and Sammy, who's a PhD candidate. And they are both world renowned experts in behavioral economics. So as applied to healthcare, so the field being, you know, what are the words? What are what are the words, what are the kind of nudge tactics that you can use in a healthcare setting, to really empower an individual to be more engaged in their self care? Okay, you know, nudge tactics, for example, being kind of things like loss aversion, like, you know, you're missing out on benefits that are at no cost to you, people like you are taking advantage of this, why not engage with us? So we partnered on a project to start kind of seeing how we could tailor the words in our messages. And in two months, we increased our initial phone pickup rate by 16%. Just yeah, just by saying, hey, the nurse is going to call this customer this member, patient. Let's send a text an hour ahead of time, saying hello. says Hi, Mark. I'm calling from your healthcare team. I'm going to call you in an hour. Very interesting, huh? Okay. Alone, the telephonic pick up rate by 16%.

That makes perfect sense. You're giving that little bit that warning. So And plus if you feel like you know that someone's caring for you, right, yeah, I mean, you know, that, like you're, you're being looked after, and then you got the warning that like there will be a call coming. And it's a legit call. It's not gonna it's not a telemarketer trying to like, upgrade you on something, and it's just never heard of. Yeah, that's awesome.

So we've, I mean, again, like you send the text set an hour ahead of time, maybe the person that's the beauty of a two way system is they text back saying, Hey, I'm busy in an hour. Can you do 6pm This evening and say, Yeah, sure. But we're very excited about this collaboration with CMU. We're sort of working on some other plans. And with a view to publish in the academic literature. We think this is a joint partnership between Highmark and CMU. And we think, you know, again, it makes me sound silly to say groundbreaking and texting in the same sentence. But I think we might be onto something. 

No, I would call it groundbreaking because you're using a very simple and established and safe technology and using it to empower people to better take care of themselves. That's awesome. To me, I think that's something that the team should be super proud of. And that's why it's so much fun having these conversations, because, you know, over the years, we've been doing these with Highmark, looking at how Highmark works with the Carnegie Mellon with outside vendors that are taught that their games, taking that technology, and focusing it down to where it actually helps the patient. That's just tremendous. And that's why it's so much fun to explore these conversations. That's why I'm so glad I got to have an update with you, Ben about what you guys are up to because it's like, wow, you're getting people there actually 30,000 people using this, your great open rates, click through rates and people picking up the phone because they got a text message an hour before the call was going to help it.
Let me leave you with three kinds of additional teasers. Definitely. You know, one is we're working, in fact, the technology is live, we're just piloting that, to take it one step further, which is kind of the texting, that leads to a conversation that leads to a scheduling module, schedule the time just like you would with a doctor, just like with Open Table, right, like, but with your nurse. Right. So that's going live this year. The second is, you know, this, we're seeing good kind of engagement with employers, right people who provide health insurance and sort of, you know, they see the value, they see the values, encouraging their employees to update their contact information to consent to interactions of this nature with their health plan, because there is value here. And then the third part is just is about kind of value in general, I think. I think small wins like this forced us in the healthcare industry to continue to evolve into a b2c industry. And you can only become b2c if you deliver value to your customers. And that starts with trust. And I think this technology have a simple it is is an enabler towards building a more trust acknowledge the customer, the member and their health insurance provider, which is traditionally not the case, right. But at least by sort of driving home, the fact that we're giving value to our customers really, I think gives a new spin on the term value based care.

Absolutely. I think you summed it up perfectly. It's so much fun talking with you to tape and because this just goes to show you technology can really improve people's lives and watching Highmark use it in a thoughtful way. It's pretty amazing stuff. And we just love being able to tell these stories. Very, very cool. Dr. Ben Edelshain, you're the best. Get back to work. I know you're having a good time. I'll let you go.

Always a pleasure to spend time with you.

Absolutely. Just remind everybody This has been Jonathan Kersting with the Pittsburgh Technology Council, and of course tech vibe radio, having awesome conversations like this each and every day. Thanks for listening to healthcare reinvented, exploring the intersection of healthcare and technology brought to you by Highmark.

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