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6 Steps to Create the Health Plan of the Future

Analysis  |  By Laura Beerman  
   December 10, 2021

Health plans need to get familiar with consumerism as they plan for the future.

Digitization must come to healthcare, which is easily 10 years behind its industry counterparts. The good news? Progress is here, but it must integrate consumerism to impact all aspects of business strategy. In making these decisions, health plans must decide whether to buy, partner, or compete their way ahead given the growing role of healthcare startups.

These topics were covered in The Health Plan of the Future, a December 8 online panel featuring consulting firm Oliver Wyman and two newly merged digital health companies HealthEdge Software and Wellframe. The panelists offered these insights from their work with payers. The panel was hosted by Highwire PR and moderated by Matthew Holt, founder of The Health Care Blog.

1. Digitize the core parts of your business now.

Marcia Macphearson, a partner at Oliver Wyman, reported that health plans have made "good strides investing in consumerism, including mobile and digital apps, around the core parts of their business such as benefit and plan detail look-up. Macphearson noted that "legacy modernization in these areas is the low-hanging fruit" and something many plans are achieving quickly over 12–18 months.

2. Shift your mindset.

Jake Sattelmair, co-founder and CEO of Wellframe, noted: "A lot of plans have had a legacy B2B mindset from working with employers." Citing this as a contributor to lagging progress in healthcare consumerism and digitization, Sattelmair advised plans to shift from B2B to B2C by focusing on areas like care coordination and navigation. "The expectations of consumers have moved on precipitously, and new healthcare industry entrants are pushing the envelope. Incumbents understand this and are positioning themselves for long-term success."

3. Use a customer experience to break down silos.

Coding consumer experience into digitization can also help payers better integrate their business functions—a strategy that can improve everything from Net Promotor Scores (NPS) to Medicare Advantage Star Ratings. Sattelmair: "Plans can learn from and partner with customers to break down silos across their clinical, administrative, benefits, and care management teams." Steve Krupa, CEO of HealthEdge Software, added payment integrity, claims accuracy, prior authorization, and high-risk member identification to this mix.

4. Strengthen personalization through data, advanced analytics, and robotic process automation.

Again noting the industry's slower progress, Macphearson stated: "We don't yet have personalization in healthcare like you see in other industries. Companies like Amazon know how to personalize transactions at a fraction of penny across a portfolio of companies." She identified advanced analytics to "help data feel more personalized" and robotic process administration and mobile solutions more generally as the necessary components of the modern and personal digital healthcare experience. "Mobile is the new front end and can help position a health plan as a consumer advocate."

Krupa added that health plans need digitization on the front and back ends for better customer experience. "This is the investment cycle plans will be doing over the next 10–20 years, digitizing more aspects of consumer experience to become a truly modern digital company."

5. Treat virtual health as both a service and business model.

The health plan of the future will need to take a micro and macro view of virtual health. Telemedicine as a service must maintain what Sattelmair called "continuous memory" with in-person care. This through line is critical for payers that evolve their virtual care services into virtual-first networks and products. Macphearson added that consumer uptake, including employers, and price differential will be key metrics for payers over the next few years.

6. Balance buy-partner-compete strategies.

Health plans can't achieve digital transformation on their own, and the exponential growth of venture capital and startups in healthcare is a powerful indicator. Krupa: "The flood of capital tells you it's become a mainstream idea that healthcare will go through digital change." These partners can help plans achieve transformation faster, better, and cheaper. But as Macphearson noted: "Investment is coming from big incumbent players in healthcare." This includes payers that have their own venture arms.

Regardless of approach, most health plans are working toward the common goal of using digitization to make care more personal and customer centric. Focal areas include delivery innovation, population health management, and risk. Macphearson summed it up: "Health plans see rich opportunities … to create new approaches, manage in different ways, and transform how they serve patients."

“We don't yet have personalization in healthcare like you see in other industries. Companies like Amazon know how to personalize transactions at a fraction of penny across a portfolio of companies.”

Laura Beerman is a contributing writer for HealthLeaders.

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