The health industry holds significant untapped potential for offerings that better address the needs of health consumers, in terms of both what care they receive and how they receive it. This is evidenced by the continued astronomical year-over-year growth of venture funding in digital health. Consumers have increasingly become more accustomed to the seamless, convenient and digitally enabled experiences and services that are available to them in other areas of their lives and have been trained to expect that all organizations that they engage with will do the same, including those in the area of health. This creates significant opportunities for small and large organizations alike to capitalize on these unmet expectations.
Health payers are investing to mitigate the risk that these new entrants and digitally native companies present, but more often than not these investments are modest, incremental improvements to transactional capabilities — for example, “provider finder,” remote consults or appointment scheduling — missing the true transformative potential of digital and the opportunity to reassert their role in the health ecosystem as more than a third-party administrator.
More forward-thinking insurers are using this digital wave as an opportunity to reimagine their role with their membership to be that of a trusted partner or advocate. They understand that being a health consumer tends to be complex, inconvenient and costly, and recognize the significant benefit — to both their members and those who fund their coverage — in helping their members navigate the health ecosystem. This reimagined positioning aims to place the insurer side-by-side with the member, arming them with the information and access required to empower them to make the right decisions to effectively manage their health throughout their lives.
To do so, insurers must increasingly tune their engagement to the context of each individual member, including their needs, desires and barriers, and must move beyond generic offerings directed toward customer segments and personas. For example, while one member may be motivated to manage their conditions through lifestyle adaptations that are achievable through available (and covered) community programs and simply need digitally delivered “nudges,” another may require transportation support for care visits and more proactive and consistent prescription refills. The most effective insurers will develop assets that allow them to support this “n of one” engagement model that aligns with their members’ personal health goals and considers their unique circumstances, resulting in more trusted relationships, more effective outreach, and ultimately lower costs and greater value to their members.
The current market landscape provides a strong foundation to build these capabilities upon, including a proliferation of novel data capture devices such as smartphones, watches and real-time monitoring devices, increasingly sophisticated data analytical tools and machine learning algorithms, robust service and engagement platforms, and unique “point solution” market offerings that address specific health needs. These in combination with some of the existing assets of health insurers — most notably the robust member data they have collected through claims, their financial incentives to improve health, and their strong relationship with their employer customers who strive for a healthier workforce — create a compelling case that insurers have a unique opportunity to capitalize upon.
As healthcare leaders are well aware, transformation takes longer than we often hope and expect it will. Barriers related to data sharing, regulations, market dynamics and disjointed systems all threaten the rate at which this future becomes a reality. However, I remain confident that transformation is a question of when, not if, the most successful health insurers will adopt these principles and enhance the way they engage with their members to ultimately create new value for their stakeholders.
