The healthcare payer landscape is changing fast—and payers must change with it in order to stay relevant. Today’s consumers have higher expectations, and competition from healthcare disruptors continues to increase. To remain competitive and meet consumers’ changing expectations, healthcare payers need digital-first innovation.

Consumer Expectations Evolve

 In recent years, as a result of high-deductible health plans and other industry shifts, healthcare users have taken on more responsibility for their own care. As healthcare consumers have more say in how their healthcare dollars are spent, they expect to have the same type of interactions with healthcare payers and providers as they are accustomed to with other service providers.

For example, consumers who are accustomed to shopping, banking, attending school and working via computer and mobile devices want the ability to interact with healthcare providers and care teams at their convenience and via the platform they prefer. They also expect service providers to provide personalized interactions, proactively guiding care transitions, suggesting resources that match their needs, and minimizing their out-of-network costs.

Disruption Drives Innovation

 The healthcare industry has always attracted disruptors and innovators. As the healthcare landscape continues to evolve, industry leaders must continually strive to improve care, enhance operational efficiency and address financial challenges. (Attendees of the 13th Annual Meeting of Becker’s Hospital Review, which will focus on disruption and innovation in healthcare, will surely discover new strategies and technologies for doing so.)

As an example of disruption driving innovation, when the COVID-19 pandemic forced widespread shutdowns, easy-to-use telemedicine platforms emerged to facilitate the need for virtual healthcare. As providers and healthcare consumers have become increasingly comfortable with virtual care and the digital technologies that power it, digital disruptors continue to gain a foothold.

Likewise, as the pandemic drove an increased reliance on technology to manage tasks and interactions that would have traditionally happened in person, it also spotlighted socioeconomic inequities that lead to health disparities.

Tomorrow’s healthcare leaders will be the ones who find new ways to overcome the challenges of social determinants of health such as food insecurity and lack of transportation or housing. For example, by partnering with technology companies, cutting-edge payers and care managers can design and provide remote monitoring services, allowing providers to keep tabs on their patients without requiring them to make appointments and travel to a clinic for every needed check-in. They’ll also be the ones that understand and embrace the value of digital care management tools, automation to streamline workflows and curb costs, and consumer-centric practices that have become the drivers for success in other industries like retail and travel.

An Innovative Solution

Payers striving to deliver on the promise of better care management while meeting consumers’ changing expectations and building competitive resilience will need innovative solutions to be successful. Fulfilling all these demands will require innovative care delivery models and a digital-first approach.

The right solution for healthcare payers to meet the needs of consumers while remaining competitive in the marketplace will require a number of provisions, including:

  • A digital-first approach. Today’s healthcare consumers want the option to manage their care and accounts virtually, through options such as virtual triage and patient services navigation.
  • Collaboration and information sharing across all care teams. The right solution will allow care teams to intervene and engage across multiple channels. Care managers should have the actionable data, integrated systems and reporting tools necessary to address gaps in care, and they should be able to share data across medical, behavioral and community-based providers to increase the value of every interaction.
  • Digital care management. Today’s technology makes it possible for a great deal of care to happen outside of the traditional office visit. Payers and care teams should ensure that home-based care–supported by digital care management, wearables for tracking health-related activities, remote patient monitoring tools that send important information to providers, etc.–is available when possible. This encourages better outcomes and provides members with greater autonomy and convenience.
  • Digital consumer engagement. Each consumer needs to have the option of using their preferred communication channels to interact with their payers and care teams. Innovative solutions should provide cohesive, end-to-end member experiences that streamline care transitions and implement digital experiences that keep members feeling connected to the organization through personalized communications and highly targeted care management.
  • Market-leading automation. Choose technology that automatically triggers care management workflows based on member events and the goals of the plan. Digitize and automate referrals and approvals where possible to deliver faster response times and improve member and provider satisfaction.

Creating Your Digital-first Ecosystem

Clearly, delivering better care requires an innovative solution—and Medecision has it. Power your care management program with Aerial™, a HITRUST CSF®-certified, SaaS solution from Medecision.

Aerial drives technology-enabled care and engagement across complex care, rising risk and wellness. The Aerial platform can ingest and synthesize multiple types and formats of data to enable a 360-degree view of individual and population health. It seamlessly connects the healthcare ecosystem to powerful data and insights so care teams can identify and close high-priority gaps and focus on members’ most immediate needs. And, Aerial drives meaningful consumer engagement while creating efficiencies to reduce costs and support effective care, case and utilization management. With this platform, healthcare organizations can introduce market-leading automation and built-in workflows and configurations to streamline processes, gain better control over utilization, and avoid wasteful spending.

Learn more about Aerial and how it can provide the innovation you need to meet your goals.

Next Steps for Payers

  • Read our tip sheet “Choosing the Right Partner for Healthcare Innovation” to learn the six characteristics to look for in a transformation partner.
  • Download our solution overview to learn how Aerial drives technology-enabled care and engagement across complex care, rising risk and wellness.
  • Subscribe to the Medecision blog for more healthcare trends and strategies like this.

Subscribe to our blog

Don't forget to share this post!