Health Plan IT Execs Break Down the Platform-Industrial Complex

Leaders from three very different organizations discuss the rapidly changing state-of-play surrounding platform strategy.

Editor's note: This article is based on a roundtable discussion report sponsored by Zelis. The full report, A One-Of-A-Kind Discussion On Healthcare's Platform-Industrial Complex, is available as a free download.

From the importance of composability to buy-versus-build decision paths, there is a common takeaway regarding healthcare platforms: the need for nuanced strategies executed with unrelenting focus so payers can make the most of digital disruption.

No single answer for buy versus build

The best platforms—bought or built—reflect a mature vendor API strategy and user interface, paired with openness and integration and the underlying characteristic that maximizes every opportunity: composability, the capacity for modular components to work together to form more complex systems.  

Says Jesse Horowitz, chief product officer for Oscar Health: "You may say that we're going to become the best-in-class algorithmic, medical, clinical, coding, AI company, and so we want all this in house. Most payers probably are not saying that and so really what you want to have is the easiest plug-and-play with any vendor on the planet."

Horowitz adds: "What has already become very universal is the improvement of economics. The need now, more than even six to 12 months ago, is to show a tangible result. I think it's been easy over the past number of years to talk about buying capabilities, but capabilities don't translate to results."

Alex Zavgorodni, VP of Enterprise Architecture at Healthfirst, notes: "You've got to be in a position to take advantage of what's to come. If you don't have a composable way to participate in the evolving ecosystem through digital channels, you will miss out."

Integrating the three-legged stool

Just as platforms cannot be monoliths, neither can approaches to meeting payer, provider, and customer needs.

"Our platform decisions are driven by our need to ensure the connections between all three are well thought out and allow for easy integration," says Tom MacDougall, CITO for L.A. Care Health Plan. "As a payer we are accountable to the member first, followed very closely by our commitment to the provider. We have begun to place an increased focus on the data we as a payer maintain which is utilized to assess the health of our members."

Data is the tie that binds stakeholders, with Zavgorodni adding: "I would argue that any plan that is looking to build a better consumer experience based solely on the information they control within their four walls will result in a very short journey."

The Healthfirst VP adds: "Melting away administrative efficiencies on the part of providers and payers is what's going to allow us collectively to focus a more intentional and cohesive consumer experience. That's a very interesting kind of dynamic in how you think about what issues platforms can solve."

Innovation accelerators and detractors

Regulation and process approach can either help or hinder platform-driven progress.

"I think that regulation is the catalyst for other significant change, but I think there are also two other factors. Who can come up with good, useful applications that are going to play into either the consumerization aspect or drive extreme amounts of efficiency," says Oscar's Horowitz.

Zavgorodni agrees. "The shift that's unstoppable is the digital disruption around consumer experience in everyday life. What's holding us back is the notion of a human wrapper in how companies operate. An enormous amount of money is spent on administrative functions."

MacDougall added the importance of iteration. "To not stall innovation, the focus must remain on 'the need,' 'the benefactors,' and 'the delivery of V1.' There needs to be an understanding of who owns the product, what the regulations are that shape its functionality, and who makes the call. It's okay to go out early and a bit ugly as that's where the rubber hits the road and true progress begins."

View the complete HealthLeaders Roundtable report: A One-Of-A-Kind Discussion On Healthcare's Platform-Industrial Complex.