The industry must aspire for one universal healthcare information platform to connect payers, providers, and patients – The internet of healthcare
The perception of the utility of future technologies in any industry fluctuates through a phase of hyped and deflated expectations. It is very prudent for the executives to stabilize their viewpoint regarding the use cases of the upcoming technologies. Gartner’s 2020 hype cycle for health plan payers provides some very valuable future looking insights for the executives to strategize. In a nutshell, the investments would fuel creating digital platforms, data bridges, consumer engagements, and enhancing value-based care.
Technologies are like fruits; they should be harvested at the perfect ripe moment.
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Let us explore the impact of technologies and their timeline in the health plans and payer industry.
Now: Immediate Need
Gartner indicates that developing a strategy roadmap to invest into and develop artificial intelligence (AI) assets is the topmost exigency. The future looking algorithms and models behold significant complexity. There exist months to years long lag time between planning, developing, training, and implementing an AI solution. If an executive envisions the role of AI in their organization within next 3-5 years, the time to build a strategy for it would be now. The strategy should capture the considerations to improve workflows, financial planning, regulatory nuances, and change management processes. Executives should be developing a list of strategically relevant questions and their ballpark answers. If not already done, this is about the time when CFOs, CIOs, and CTOs should meetup to discuss the next steps regarding a firm’s AI strategy. While CTOs and CIOs must prepare the business cases to show the return on investment through AI, CFOs must be committing initial investment into these initiatives. If necessary, hire a consulting firm to get access to ready made templates and springboard the strategy development process. Also, start conversations with large vendors like Microsoft, Google, Amazon, etc. to understand what is in the store, and gain a broader understanding of future technologies.
Soon: Within 2-5 Years
The first promise of technology in health plan sector is to improve operational efficiency and improve customer engagement. As cultivating talent is becoming a challenge in healthcare sector, technology is committing to partially fill that gap through automation and better management of resources. The coming 2-5 years are all about setting your ducks in a row and run the organization like a swiss clock, with the help of technology. Remember the AI strategy that executives should be developing in 2020-21? That strategy would steer the initiatives from 2022 to 2025. Here are a few major trends that should be considered while planning for the first half of the coming decade:
- Consumer behaviour is evolving to adapt better to the conveniences created by the technology. The coming generation of healthcare consumers will have a very different buying behaviour and equally unique expectations from their insurer and healthcare provider. Tapping into the consumer needs early on is going to be the key to secure revenues. Developing tech enabled platform is one key strategic investment that would get “bang for the buck” in getting consumer engagement and retention. These tech platforms would constitute hassle free instant insurance purchase, automatic clinical data transfer, and digital concierge for continuous support across the patient life cycle. Later in the future, these tech platforms would consolidate into a single universal healthcare engagement hub (discussed later in the article).
- Explosive availability of clinical data is going to keep actuaries, statisticians, and engineers swamped in the coming five years. Insurers need an infrastructure where this vast amount of clinical data is storable, administrable, transferable to third parties, and available to the consumers for instant access. Such features call for an immediate shift to the cloud-based platforms because the current server-based platforms do not suffice all the demands. The value is not in holding the data, but in analysing it and developing insights. Actuaries and statistician need much more advanced techniques and tools to make the best use of this data asset. Insurers must invest in training and cultivating the talent to be able to unlock the true potential of clinical data. The cybersecurity of such data demands a blockchain based platform, but 5 years is too early. Executives must invest in alternative solutions to keep health data secure.
- Newer sources of data are emerging in healthcare. Genetic testing is on the rise, telemedicine is the new normal, and internet of things is knocking the doors to rush into the lives of individuals. Traditional models and mindsets cannot leverage this new information swiftly. Fluid-less underwriting and claims, dynamic insurance premiums, and genetic treatments are some of the emerging consumer needs that require newer sources of data to be tapped into. Now is the time for executives to study the regulatory and technological nuances of incorporating these sources and serve the consumers with the right products they need.
In right time: 5 years or later
The technology is pushing human race to democratize the power of data and networks. Providing the power of clinical data back into the hands of the rightful owners (the people) would warrant for unprecedented transparency in pricing and demonstration of value add at each step. A seamlessly interconnected world with perfect data interoperability would enable a true value-based care. Executives of tomorrow should begin to envision their version of this future, and start laying the foundation in the following fields:
- Universal Health Information Hub: How often do physicians (or providers) reach out to insurance companies with an ask to cover a particular procedure for a patient, in order to save the insurer more money in the longer run? If this is the trifurcated win-win scenario, it should become the norm. The future would see mushrooming of such digital interaction hubs, like a business-2-business version of LinkedIn or Facebook. Eventually, fragmented market of insurance engagement platforms will begin to aggregate and consolidate to form one universal healthcare information platform. Executives should plan to invest, build, and participate in the network platform that connects to population, patients, providers, and fellow insurers. This digital platform is going to be “the” source of community knowledge, share payment exchange, managing retail experiences, operational support for integrated solutions, and source data hub. Simultaneously, blockchain solutions would mature enough in about 10 years to make this platform as secure as cryptocurrencies.
- Value Based Ecosystems: Healthcare providers are experimenting with the value-based care system, with limited success. The value-based healthcare aims for generating the best value, as in clinical outcomes, through the judicious use of limited resources such as hospital beds, clinicians’ time, payers’ money, patients’ decisioning, and available treatment options. To create the best value, treatments are becoming more precisely tailored for everyone, transforming away from generic clinical protocol approach. Technology is the catalyst for a composite function of payer, provider, and patients in generating value and precision-based healthcare. Payers must deign insurance products that deliver highest value (not necessarily highest coverage), clinicians must be paid based on value delivered, provider must be ranked based on value created, and patients must pay premiums based on how they safeguard the value of their own health. Technologies like advanced analytics, value-based algorithms, and value-based payment reconciliation systems are the future where value is delivered precisely.
“Payers must deign insurance products that deliver highest value (not necessarily highest coverage), clinicians must be paid based on value delivered, provider must be ranked based on value created, and patients must pay premiums based on how they safeguard the value of their own health.”
Gartner Hype Cycle educates the executives to cancel out the hype around a technology and focus on a planned timeline to implement a technology. Developing a technology driven strategy is the starting point. There is no rush to boil the ocean in a single go. Technologies are like fruits; they should be harvested at the perfect ripe moment. Investing too much ahead of time or the fear of missing out (FOMO) reflect an uncoordinated strategy. Unless the strategy is to not invest in technology, not investing enough signals a lack of strategy. Executives have time to regroup with the various vertical heads, advisors, and industry experts to develop a fundamental plan to imbibe the future technologies at the sacrosanct moment.
Unless the strategy is to not invest in technology, not investing enough signals a lack of strategy.