Trends in Healthcare Payer Innovation
The SARS-CoV-2 pandemic has posed enormous challenges across the healthcare ecosystem, and the payer segment has been no exception. The interruption in elective (but often necessary) procedures, coupled with the reluctance of consumers to visit their doctors for tests, regular check-ups and non-urgent care has caused many payers to become concerned about the impact on potentially undiagnosed disease or the worsening of existing conditions.
At the same time, the pandemic has accelerated the pace of innovation in clinical care, nowhere more so than in telemedicine and remote care. It seems highly likely that many of these innovations are here to stay, advancing the way healthcare is practiced and consumed in fundamental ways at an unprecedented rate.
Adapting to these unexpected conditions has, however, not been without its challenges. In early March, Ogilvy Consulting brought together three leaders in payer innovation – Dr. Mona Siddiqui, Senior Vice President Clinical Strategy and Quality, Enterprise Clinical Management at Humana; Kate Merton, Staff Vice President, Digital Care Delivery at Anthem; Payam Parvinchiha, Corporate Vice President, Network Quality and Innovation for the Scan Health Plan – to discuss the opportunities and challenges of the emerging healthcare environment.
Three critical themes quickly emerged from the conversation – new channels of care such as telehealth and care in the home, the dangers of exacerbating inequities in care through technology and creating innovative partnerships to support clinicians without duplicating what they are doing. In addition, the increasing recognition of the importance of the social and behavioral determinants of health such as food insecurity was a thread that ran through all of the critical themes.
Telehealth & Home Care
The explosive acceleration in telehealth fueled by the pandemic revealed what many had already surmised which is that certain clinical care activities could be conducted as well or even better remotely than in person. This was seen to be particularly true of behavioral health – itself a topic of increased focus in the environment of enforced isolation – with the data showing that many people in need of behavioral health support were more likely to seek help if it was offering online than in person. Remote monitoring expanded significantly and was seen to be preferable to frequent visits to a doctor’s office for check-ups.
What was less predictable, according to the panelists, was how many questions the wider adoption of telehealth and home care would throw up. What is, in fact, the right mixture of home health services for different segments of the population? When someone receives a health visit at home, who should the “visitor” be? When and with what frequency should these visits or online chats take place? Efforts to answer these questions are shedding a broad light on the consumer’s experience with healthcare leading to fresh and more holistic thinking about what ultimately leads to better outcomes for the whole person.
Inequities in Care
Looking specifically at telehealth, the panelists pointed to the ways in which differences in access to technology were creating increasing inequities in care and access to care. Poorer patients, often older patients of color, with limited band width or limits in their data plans face significant obstacles to getting the remote care they need. While many older Americans are increasingly savvy about the use of technology, there are still significant pockets of the population who are not at home with smartphones or the internet. As Payam put it: “No matter how great the technology is, just like today, you’re going to have little blunders and you can’t have that in healthcare. If you have a 75-year old with congestive heart failure and they can’t connect with you immediately, they’re going to end up in the emergency room.”
Solving some of these challenges, has led payers to explore innovative partnerships both with communications companies and with providers, strongly supported by employers who are the health plan sponsors. As Mona pointed out, “the key is to innovate in ways that don’t duplicate what clinicians are already doing.” For her, it is critical to engage at the ground level because that is where care is delivered. We need, she said, “to be intentional about bringing in others in local healthcare into the conversation.”
For Kate, the most important piece is to focus on taking care of the whole patient and not be distracted by technology innovation for its own sake. “I’m not really interested in the latest innovation shiny bauble. Sometimes you don’t need the latest and greatest tech. Sometimes what you need is the thing that’s getting in the way of the patient getting the right care.” This view was echoed by Payam who said that his company was addressing this issue by embedding its employees with providers to ensure that patients had the help they need in managing the complexity of navigating a provider network.
All three panelists agreed that the primary challenge they are addressing is how to lead with the consumer healthcare experience which also means ensuring that the increasing volumes of healthcare data can be put to use to lead to meaningful action for the individual. This means breaking down the silos between data sets and speeding up data exchange so that the right information is available to clinicians and patients at the right time. This includes making sure that new sources of data about the patient ranging from the outputs of sensing devices to social and behavioral data are available to the provider. This complex mix of technological, operational and human challenges, said the panel, requires a carefully mix of immediate fixes and long term process engineering in order to achieve the right results. Successfully determining which innovation initiatives to prioritize, they said, will be the key to long term and long lasting improvements in the consumer healthcare experience, a goal to which the payer segments is more committed than ever.