Lessons Learned From Health Plan Transformation

By December 10, 2023 blog No Comments

In the face of market pressures and business model changes, health plans are innovating in ways other companies may find instructive.

Health plans have faced a complex series of challenges and developments in recent years. Rising costs from inflation increases in wages, and workforce shortages could hike costs by 7% in 2024. Simultaneously, consumers are becoming more discerning about their healthcare options and expecting greater convenience, transparency and value from plans.

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All this is happening when many health plans are aggressively transforming their infrastructure and business model. Many are ramping up efforts to integrate electronic health records, ensure data security, and build better interoperability, which continues to be complicated by a changing regulatory and policy landscape. Beyond digital transformation, plans are also increasingly moving away from value-based models designed to better manage chronic disease and help decrease treatment costs.

As businesses across sectors face the same labor, cost, consumerism and transformation challenges, keeping a close eye on how health plans adapt can shed light on novel ways that other businesses can successfully shift when feeling squeezed by external pressures. Health plans are responding to market challenges with strategies that could benefit other organization types:

Expanding Services

In many ways, health plans are evolving into more full-service entities. Instead of focusing on transactions and reimbursements, the new era of health plans also includes programs and support for member wellness, disease prevention and holistic care. Elevance Health, for instance, recently expanded a program to provide digital concierge care to members living with chronic conditions, such as Crohn’s disease and diabetes. Instead of simply reimbursing for treatment of these conditions in the way of a traditional insurance interaction, this program actively connects members with relevant clinicians and creates a personalized care experience. The program not only includes clinical care and care management but also a slew of patient education tools and gamification within the program’s app.

Similarly, more and more insurers are doubling down on increasing offerings, coverage and incentives—more like a health partner than a reimbursement organization. UnitedHealthcare rewards members who wear activity trackers like a FitBit or Apple Watch. Cigna offers free health coaching programs for those struggling with weight loss, tobacco use or general stress. Optum has a variety of maternal health programs, including 1-on-1 access to maternity nurses and parental education and coaching.

Why are health vendors focused on expanding these sorts of solutions? It isn’t simply a nice gesture. There is real return on investment (ROI). Take Elevance’s chronic condition program: Given that 60% of U.S. adults have a chronic disease, this value-added service could be a critical component of a member’s care journey. Not only does it proactively engage patients in a novel way, but it also empowers members to manage their conditions, providing tools and guidance along the way. Ultimately, this not only results in a deeper connection between the plan and its members but also likely improves health outcomes over time, leading to lower costs and healthier members.

Developing More Capable, Scalable Infrastructure

The digital transformation of healthcare has moved far beyond offering a web portal and remote scheduling. From health plans to hospital systems, health organizations of all kinds are finding new ways to reduce costs, improve efficiency, increase patient engagement, gather better data analytics, offer more telehealth services and use technology to serve both individuals and large populations better.

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Today, patients everywhere can take advantage of far more personalized diagnosis and treatment options than they could just a generation ago. This is in part because of astounding medical breakthroughs, increased diagnostic expertise, much higher computing power, and the digital capture of petabytes of historical medical data. Perhaps most important of all is vastly increased access: Telehealth has extended specialty physician expertise formerly available only in select urban areas to virtually every spot on the globe. Devices such as Fitbits or watches and rings that record and transmit data on everything from your heart rate to blood pressure are part of the increasingly popular “wearables” category of medical devices, which is forecast to increase 20x from 2020 to 2030. Telehealth access at scale may be the biggest medical revolution of our lifetime—and it makes for a more convenient and simple patient experience, too.

Wearable devices and health apps today allow patients to track their health in real time, providing valuable data to healthcare companies for early intervention and prevention. As telemedicine advances, healthcare companies can extend their reach to rural and underserved areas, providing medical consultations remotely and offering both valuable second opinions and previously unavailable expertise.

Zooming out from the individual to the group, population health initiatives today help communities identify at-risk populations, track health trends and implement targeted interventions to improve overall community health.

Change-Driven Innovation

The considerable levels of change and growth that health plans have encountered have led to a tremendous amount of innovation. That innovation supports more measurable ROI to health plans, better patient outcomes and increased administrative ease and efficiency for providers.

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It pays real returns to continually evaluate and evolve services and invest in expanded digital infrastructure. That’s true whether an organization is forced to evolve because of unforeseen events such as the pandemic, driven to evolve by more foreseeable market and demographic variances, or motivated to evolve by simple business prudence. Most businesses today could benefit from similar strategic initiatives.

In the context of the Industrial Revolution, applying technology to operating mechanisms in each organization is extremely necessary, and is also an inevitable trend to minimize workload while still ensuring efficiency and enhance its competitive position in the market. Furthermore, applying management software into a business will also help build an organization with a clear system, promoting consistency, transparency and accuracy. Tasken eOffice, researched and built by Opus Solution – a business consultant in Vietnam – is an internal work management system as well as the management of automated, online, user-friendly approval processes, allowing businesses to operate more effectively on the path of digital transformation.

Forbes

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