The Digital Transformation of Payers in Healthcare

In recent years, the healthcare industry has experienced significant disruption due to technological advancements and changing consumer expectations. This has led to a shift in the role of payers, who are now embracing digital health platforms to improve operational efficiencies, enhance the patient experience, and drive cost savings. This article explores the opportunities and challenges that payers face in adopting digital health ecosystems, and how they can leverage these platforms to transform the healthcare landscape.

The Acceleration of Change in Healthcare

The healthcare sector has long been subject to constant change, but in recent years, the pace of change has accelerated significantly. Consumer expectations are rising, driven by advancements in other industries. New data-driven technologies are spurring digitization and automation across the board. These dynamics, combined with rising prices and the availability of more advanced medical services, are causing true disruption in the healthcare market.

Despite the sometimes dizzying pace of change, this disruption is creating new opportunities for payers to solve long-standing problems. Digital offers have been shown to deliver experiences that meet the expectations of today’s consumers, and payers can take advantage of new technologies to automate core processes, strengthen partnerships with providers, and reposition themselves at the center of the healthcare landscape.

The Power of Digital Health Ecosystems

Digital health ecosystems provide a range of consumer-centric services by establishing a network of digital service providers. These ecosystems run on technology platforms that act as a digital backbone, facilitating data exchange and giving participants access to new services. The goal of each ecosystem is to improve healthcare outcomes.

By participating in digital health ecosystems, payers can drive healthcare value and improve administrative efficiency. Regular communication between patients, providers, and payers can advance care integration and optimize health monitoring, reducing the risk of medical errors and increasing the use of preventive health services. Moreover, by enabling seamless data sharing among all parties, digital health ecosystems can improve the quality and availability of data, reducing the need for manual processing and driving administrative cost savings.

Digital health ecosystems also have the potential to strengthen the underlying technology and data foundation of healthcare delivery. By leveraging previously unavailable information, stakeholders can gain a comprehensive understanding of consumer needs and preferences, leading to more personalized and effective care.

The Benefits of Virtual Care in Digital Health Ecosystems

Virtual care is one of the key components of digital health ecosystems that payers are embracing. It allows for the delivery of healthcare services without the limitations of geography and physical space. Virtual care enables seamless connectivity among healthcare teams, improving care integration and optimizing health monitoring.

Through virtual care, payers can establish regular communication between patients, providers, and themselves, leading to better care coordination and improved health outcomes. By leveraging technology to facilitate virtual interactions, payers can reduce the risk of medical errors, increase the use of preventive health services, and enhance overall care delivery.

In addition to improving care, virtual care also enables more seamless data sharing among all parties involved. This improves the quality and availability of patient data, allowing for advanced automation technology to reduce the need for manual processing. By leveraging virtual care and data sharing, payers can achieve operational efficiencies and drive cost savings.

Unlocking New Revenue Channels through Digital Health Platforms

As payers look to control costs and drive operational efficiencies, many are turning to digital technologies. Automation is seen as a key enabler of cost control, with 60% of payers looking to digital technologies to achieve operational efficiencies. By 2023, it is expected that the number of payers seeing large gains in operational efficiencies through automation will double to 18%.

In addition to cost control, payers are also exploring new revenue opportunities through digital channels. Increasingly, payers are delivering services to customers through digital channels, with almost one-third of payers generating 10% to 20% of their revenues through digital channels. This shift to digital revenue channels is driven by the desire to improve the customer experience and capitalize on the growing demand for digital healthcare services.

Digital health tools, such as electronic health record (EHR) and practice management platforms, play a crucial role in enabling payers to unlock new revenue channels. These tools integrate with payers’ platforms, capturing key patient insights and refining workflows for greater efficiencies. Partnerships between payers and technology providers, such as Anthem’s partnership with Canvas and Highmark Health’s partnership with Verily, enable the integration of digital care tools and advanced analytics, resulting in better patient outcomes and cost savings.

Enhancing the Patient Experience through Digital Engagement

Payers are increasingly focused on enhancing the patient experience through digital engagement. By adopting digital engagement tools, such as mobile apps, online portals, messaging apps, and call centers, payers can support patient empowerment and improve connectivity between patients and their care team.

These digital engagement tools provide patients with personalized and convenient access to healthcare information and services. They allow for greater customization and support for patients with ongoing care needs or chronic conditions. By investing in digital engagement, payers can gather valuable patient data insights and deliver a connected digital experience that improves patient outcomes.

To orchestrate the connected patient journey, many payers are deploying single platforms that manage all interactions, both human and digital. These platforms serve as command centers for health plan member interactions, supporting omnichannel digital engagement. By coordinating responses through the preferred channel of the customer, payers can improve the patient experience, speed up resolution times, and enhance brand value.

The Role of Payers in Digital Health Ecosystems

In the digital health ecosystem, payers can play various roles depending on their market position and strategic objectives. These roles include orchestrator, convener, service provider, data subscriber, and lead subscriber.

Orchestrators have the most control over the ecosystem and its data, serving as the central entity that manages the platform and orchestrates interactions with consumers. Conveners bring together like-minded payers to form a consortium, increasing the incentives for partners to participate. Service providers offer their specialized digital health services through the ecosystem, while data subscribers leverage available data to optimize their businesses. Lead subscribers participate in the ecosystem to generate new leads and cultivate users for their core business.

The optimal role for a payer in a digital health ecosystem depends on its market position and strategic goals. Payers with a relatively weak market position may choose to participate in existing ecosystems or offer their services through digital channels. Payers with a powerful market position can become conveners or orchestrators, leveraging their size and resources to drive the ecosystem’s success. Leading payers can establish their own ecosystems, taking control of the consumer interface and data to deliver innovative healthcare services to their members.

Overcoming Challenges and Driving Transformation

While the adoption of digital health platforms presents significant opportunities for payers, there are also challenges to overcome. Provider-centric approaches and inadequate data access and privacy management can hinder progress. However, technological advancements have made it easier to surmount these challenges, and the value of digital health ecosystems for payers is clear.

To succeed in the digital transformation of healthcare, payers must act decisively and focus on delivering value to their members. By embracing digital health platforms, payers can improve operational efficiencies, enhance the patient experience, and drive cost savings. The digital revolution in healthcare is well underway, and payers have a crucial role to play in shaping the future of the industry.

Conclusion

The digital transformation of payers in healthcare is driven by the need to improve operational efficiencies, enhance the patient experience, and drive cost savings. Digital health ecosystems provide opportunities for payers to leverage new technologies, such as virtual care and data sharing, to achieve these goals. By adopting digital health platforms, payers can transform the healthcare landscape and deliver better outcomes for their members.

While there are challenges to overcome, such as provider-centric approaches and data privacy concerns, technological advancements have made it easier for payers to navigate these obstacles. Payers must act decisively and focus on delivering value to their members to succeed in the digital transformation of healthcare.

The future of healthcare is digital, and payers have a crucial role to play in shaping this future. By embracing digital health platforms, payers can drive innovation, improve care coordination, and enhance the overall patient experience. The time to act is now, as the digital revolution in healthcare is well underway. By seizing the opportunities presented by digital health ecosystems, payers can lead the way in transforming the industry and delivering better, more efficient healthcare for all.