Frontiers Health roundup panel discussion on: How are insurance incumbents driving innovation by building digital health ecosystems.

Frontiers Health roundup panel discussion on: How are insurance incumbents driving innovation by building digital health ecosystems.

Digital health technologies are transforming the insurance landscape. Health tracking sensors and wearables, apps, artificial intelligence and telehealth/RPM services impacted all parts of the value chain. To drive innovation, insurance incumbents partner with digital health innovators to build an ecosystem of 3rd party solutions that are integrated into insurers’ core business. The variety of digital health offerings within the ecosystem leads to more personalized member experience and better engagement, reduction of pay-out costs and ultimately a better health outcome for their members.

At Frontiers Health event #FH2021 in Milan, Research2Guidance’s team hosted a virtual “Innovation & Partner Integration: How are insurance incumbents driving innovation by building digital health ecosystems” panel discussion with global thought leaders.

Happy to share some of the key takeaways and market insights from the workshop-like conversation led by Rainer Herzog, VP at Research2Guidance.

Cases and highly insightful market insights were shared by

The impact of advanced digital technology on the health insurance industry is accelerating with the increasing adoption of health tracking sensors, mobile apps, remote patient monitoring and telehealth services. The pandemic has also changed the way healthcare is delivered and it has created the need for different stakeholders to build ecosystems that are based on collaboration and innovation.

Established healthcare companies have the opportunity to design new commercial models and build ecosystems by venturing into partnerships with digital innovators. For insurers and insurer-tech companies many of the newly created business models aim at either acquiring new members or providing better service to existing members via digital platforms or digitally assisted services.

At present, some of the digital health ecosystems, such as Collective HealthFind Care (Walgreen), One Elevate (Vitality), have reached substantial sizes. Collective Health, for example, has more than +80 partnerships with digital health companies. Digital ecosystems focus varies from chronic care, mental health, clinical trials, weight loss, coaching and behaviour change to cost management. The integration level also varies significantly, as some of the insurers provide to their members just a link to a partner and others have truly integrated 3rd party solutions into their dashboards and their databases.

In his presentation, Ralf (Research2Guidance) touched upon several key points that set the scene for an engaging and inspiring conversation.

What comprises a digital health ecosystem being built around a health plan and how that is being done.

There are three stakeholders that are forming the digital health ecosystems.

  • Health plans – have an interest to better support their members with the help of digital tools.
  • Insure-tech companies – have built their ecosystems and integrated virtual care platforms to deliver a better customer experience. They offer their services to their members or sell them to employers or partner with health plans. OscarOttonovaCloverEvernorthCollective Health are just a few of the names that stand out in this space.

“Digital health eco-systems of payers are not a standard yet. US and Asian health plans are leading.” Ralf-Gordon Jahns, Managing Director, Research2Guidance

  • Digital Health companies – like One DropOvivaAda HealthOmada Health are highly effective in their respective niches with increased member engagement and proven health outcomes. Their solutions can be used and integrated into the digital health ecosystem of an insurer to serve their members, the doctors and employers.

What are the challenges faced by payors?

This is a challenging time for payors. Health plans struggle with differentiationengagement and adoptionretention and reducing claims. Members / patients are the most important part in the game, and they should be involved in the development of a DTx solution and insurers’ digital programs and service offerings. Usability is very important. Medication that is not taken can’t have the desired effect on patients and this is true for the digital solutions. If they are not used, they can’t support a treatment or better the well-being of a patient.

Engagement is a key. Creating one coherent member journey with the least amount of friction is important. What we see today, especially in the US, is that some key industry players are moving into delivering care with digital tools, coaches, with people on the ground to service their members best. In a way they are turning into healthcare providers.

What is the core set of services around which health insurers & insure-tech build their ecosystem?

The insure-tech digital health ecosystem model is built around a core set of in-house layer and partnership layer services and offerings. Within the insurer-tech core, usually, there is a member admin part which is responsible for getting information about health plans, or sending in claims, or there is concierge who helps members navigate throughout the system. Some of the core systems also include monitoring and tracking solutionsHCP support allowing the first contact into the healthcare system. Data analysis and risk management are also part of the in-house layer which is managed by the insurers.

The partner layer and all the extra digital services offered to the members are managed by the digital health companies. And here we have solutions that cover, e.g.: patient self-managementadherencepreventive carecoachingtelehealthdiagnosisdata storageanalysis.

What tactics are companies using to build their ecosystems?

Partner model is a key to drive innovation. At present, there are two key partner models used by insurer-tech companies: co-development or a client and customer relationship, where a health insurance company is using licenses from digital health companies.

Health plans are also using different tools to make most use of the experience they gain from adding a digital health solution to another solution. For example, playbooks, a written manual of how to introduce another partnership or test clinics, where new digital solutions are being placed and tested before they are scaled up to a larger member base. We can also see test patient and member panels, whose role is to test the solutions and services before they are launched to a larger database.

KEY TAKEAWAYS

  • Shift towards payment for value, not pay for volume.
  • Design one coherent member’s journey with the least amount of traction and more touch points throughout the journey!

“Transforming the health of the community, one person at a time …healthy individuals create healthy communities!” Dr. Darren Schulte, President Advanced Technology, Centene Corporation

  • Patients and patient data are at the focus of emerging new business models.
  • Data structure is used to design new and more individualized offerings with the ultimate goal one day to have a personalized health plan to each member with a tailored set of offerings, network and incentives.
  • Health plans can be part of different collaborative ecosystems and play different roles, for example, being just a facilitator or orchestrator of a service offering.

“Menzis, part of multiple health ecosystems.” Wiet de Ronde, Manager Product Development, Menzis

  • Transition to virtual and home-based care alternatives in services – provides a better approach to proactive care, e.g., whether for wellness, chronic care management.
  • Create a front door to healthcare to get patients a good orientation and then a platform to be referred to other offerings (therapies, telehealth offerings, etc.).
  • Focusing on a person’s overall well-being rather than looking at a person in terms of a set of conditions and diagnoses but treating the whole individual.
  • DTx will change the value chain in healthcare.

“DTx must fit into the patient journey. It can be a cross-sectional technology to allow integrated care provision.” Dr. Klaus Suwelack, New Business Development & Innovation Management, Janssen Germany

  • Two key areas to focus on are management of chronic disease and behavioural health needs.
  • DTx solutions should address an existing problem and solve it. Content is key and the providers must know the patient pathway. Having evidence for the efficacy of the solution is extremely important and it is a prerequisite for reimbursement.
  • Long term commitment – A DTx should be a living piece of the technology and it has to be developed further and constantly updated based on the feedback of patients / users.
  • Ultimately, successful ecosystems help insurers improve their value propositions with new and improved services and capabilities.

“We really need to strive for good integration between telehealth and analog care, because the journey will be a hybrid one!” Thomas Geuenich, Commercial Director, Germany, Teladoc Health


Innovation management: Building a digital health ecosystem via partnerships

Building an ecosystem of third-party digital health solutions is of strategic relevance for most established healthcare companies. Health plans build ecosystems to increase the value for their members and to improve their overall well-being with services and solutions around health and self-care. However, worldwide success stories are not that common. Today, most of the processes used by different industry market players to build ecosystems have little impact.

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At Research2Guidance, we support Pharma, Health Insurers, and MedTech companies to form integrated and impactful digital health ecosystems with R2G’s innovation management approach.

Our approach consists of four steps:

PRIORITIZATION & ROADMAP - The first step is to define the partnership areas that bring the highest impact to the company’s value propositions.

PARTNER SEARCH - R2G helps identify the best candidates to create synergies from the ecosystem. This step provides briefings to screen available solutions and holds partner workshops for evaluation.

PARTNER MANAGEMENT - Often projects get stuck in the partnership ideation or pilot phase due to a lack of a clear integration process. Partner management aims to develop an operational model that efficiently allows the healthcare company to partner with multiple digital health start-ups.

INTEGRATION & UPSCALING - Now it is time to integrate the operation of both parties and scale up the ecosystem service offerings.


R2G's innovation management approach has successfully been adopted to help various healthcare companies create a digital health ecosystem for their customers. R2G team understands the challenges and opportunities that accompany the digital health ecosystem model, as we hope to help you unlock its value.

Want to know more about digital health ecosystems? We are happy to connect.

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