Control Your Digital Destiny or Big Tech Will
Our current global journey — pandemic-induced, tech-enabled — offers a rare opportunity for dramatic step changes in entire systems such as healthcare. COVID-19 has forced our hand, demonstrating the possibility of unprecedented digital connectedness. We face a new frontier with many players vying to serve our healthcare needs, offering the promise of better outcomes via more personalized, holistic, and convenient interactions.
Consumer Self-advocacy is Driving a Dramatic Shift
Healthcare consumers make hundreds of decisions daily regarding their health.
Only about 16.5 seconds of each day, on average, is spent interacting with “traditional” payer and provider organizations.Gartner
With the evolution of technology and the constraints of the pandemic, patients and members are increasingly turning to non-traditional care options to access the care they want.
Figure 1 shows that 49% of healthy individuals prefer to partner with big tech or a digital health startup when addressing health concerns proactively. Those with health issues continue to partner with traditional inpatient and outpatient providers at a rate of about 60%.
However, the “face” of that interaction is increasingly via video. And the role of big tech and startups in this space, although a smaller share of the pie at 20% (Figure 1), is growing. Consider: Livongo experienced a 3x increase in clients from 1Q2019 to 1Q2020 and the global internet of medical things (IoMT) market is enroute to quadruple in valuation from 2017 to 2022.
Who is the Preferred Partner for Patients with Health Problems and Healthy People?
In this context, consumers are orchestrating their personal blends of services, apps, and technologies to manage their lives as efficiently and effectively as possible, driving the growth of services and resources rendered at home and via digital channels.
While some consumers have created a curated patchwork of healthcare options to meet their needs, others struggle to find choices and gain greater access. The inner workings of these choices and connections, typically, are not visible to payer or providers.
Three Steps to Seize the Moment and the Market
As healthcare professionals, we now find ourselves in a significantly more complex and diverse ecosystem — where consumers are adopting and trusting new healthcare entrants, creating endless combinations and permutations of how consumers manage their health day-to-day.
This moment calls for traditional payer and provider organizations to take three steps:
Step One: Acknowledge and discern the effect of these changes on your consumers, ecosystem, as well as creating opportunities for new digital connectedness
To genuinely understand reality, it is crucial to walk in your consumers’ shoes. In addition to what is known from traditional interactions, what other services and activities are in play, why, for how long, and with what success? Draw from this an operational view of your ecosystem — patterns of usage and value (including combinations and durability) to complement patterns of availability and access.
Step Two: Differentiate and deliver more value via interoperability
Differentiating on interoperability is more strategic, valuable, efficient, and longer-lasting than implementing interoperability “for mandate.” It means creating conduits of information flow for clear business value and better health outcomes: putting the right information from any appropriate source (clearer due to step 1) in the right hands at the point of interaction and decision.
Designing this successfully requires addressing process, systems, and data within and across traditional and non-traditional organizations. And, it is necessary to execute dynamically in real-time, via a business, operational, and digital engine that can flex and adapt at speed and scale because the ecosystem is fluid and fast-changing. This is the crux of frictionless healthcare experiences for employees, business clients, and members or patients.
Step Three: Seize this moment and the market by expanding benefits and services thoughtfully and strategically
With the increased understanding of consumer reality and effective means of ecosystem interoperation, the value of and path toward expanded services – with appropriate digital leverage — becomes clearer. In this context, business, product, data, and technical professionals in healthcare can, together, fully appreciate the “whole person” and understand the degree to which patients are meeting their needs on their own or have needs yet unmet. That’s when healthcare partnerships become aligned, highly creative, and collaborative. They can rapidly and effectively expand types and channels of health services toward that person in situ.
Whether they accomplish this via partnering (and interoperating) with other service providers or by augmenting their portfolio, the value of the investment is made visible, making the decision and implementation processes more tractable.
Accomplishing all of this can feel overwhelming, perilous, and hopeful all at the same time. As with any complex situation, taking a systems thinking approach is crucial. It avoids the pitfalls of exhaustive undertakings, analysis paralysis and siloed thinking. It is the means to quickly see patterns and find leverage points –small, well-placed interventions with big impacts.
Use Systems Thinking to Create Models for Digital Connectedness
One starting point for a systems view is to consider two worlds circulating and integrating in real-time at each point of interaction:
- Consumer-centric personal network: Includes who and what the consumer chooses to engage
- Business-centric network: Includes who and what organizations offer and make available, inclusive of affiliations and interoperation (traditional & non-traditional providers, payers, employers, and community resources)
This perspective serves as a backdrop for business and technical stakeholders to jointly create models of connected data, organizations, people, and services, as well as their required technical solutions.
Your model of digital connectedness might include:
- Consumer patterns of non-traditional service choices
- Causal models linking choices (traditional and otherwise), activities, and outcomes
- Decision models at points of interaction
- Information flow across boundaries (interoperability)
- Possible paths from current to future reality (scenario planning)
These models become the decision guide and roadmap for incremental change toward a bold new reality.
Your Digital Destiny Awaits. Will you seize it?
Healthcare is at a critical crossroads of humanity, technology, and business. Consumers are embracing new technologies and service providers, de facto decentralizing the healthcare ecosystem. While this has increased the complexity of information sharing and decision-making, it also offers an opportunity to attract and engage consumers who want care in diverse channels that fit their life and level of self-advocacy.
SDLC Partners has the healthcare business and technical capabilities to build frictionless experiences that harness a greater share of consumers who want more from traditional payers and providers as they shift their focus towards big tech. The tangible rewards for those sharing this vision are potentially significant: increased ratings and enrollment and, ultimately, improved outcomes and fiscal health.
Let’s demonstrate the impact a one-star increase can have on finances.
If a health system is growing their Medicare Advantage business, whole person care and patient experience scores have a significant impact.
If services are extended, as discussed in this article and in alignment with CMS Supplemental Benefits, it can drive improved experience measures and ratings. In turn, that can result in increased reimbursement, bonuses, and enrollment.
By the numbers, a one-star rating increase can translate into:
- 12% enrollment boost
- $12-55M bonus* (depending on your ratings starting point)
- 30-45% PMPM rebate
Conversely, a decline in ratings, which can happen simply due to recent changes in how experience measures are weighted, could result in a $44M loss.
*Calculated using average membership, bonus, and enrollment increases however rebate, bid, and MLR advantages are not reflected.
How will you respond to the drive for greater digital connection in healthcare?
While the requirement for connectedness is growing, the way that works best for your organization and consumers could be quite different. Our healthcare services team has the experience and expertise to co-craft a strategic vision, create a roadmap, and deliver on the right user and architecture design to succeed and scale.