How Payers Can Cultivate Consumer-Centered Digital Innovation

Assessing member demand for innovative, digital solutions

Payers rely on a number of strategies in order to assess what members want from their health plans’ digital strategies, the panelists noted. Some payers conduct interviews and case studies with health plan members to assess member preferences. Another indicator regarding consumers’ demands are uptake trends. 

By incorporating members’ input and assessing the data, the panelists identified three major trends in what members want from their health plans’ digital strategies.

Although the offering is still nascent, virtual-first health plans seem to be seizing members’ interests.

“We’ve had at least three health plans begin to offer virtual-first products in the commercial market so far,” Whitman said. “They are showing interesting early results: high satisfaction levels from the consumer and cost savings. Patients are saving money on their visits and it is a lower cost for the plan and the providers.”

ACHP health plans were among some of the first to initiate virtual-first health plans and they have seen strong member uptake in their first plan year. 

For example, Priority Health is a health plan with one million members. The payer began its MyPriority Telehealth PCP plan on the individual health insurance market and enrolled 5,000 members for plan year 2021, according to a report published in the New England Journal of Medicine. 

Around 40 percent of those new plan members—or 2,000 enrollees—came into the health plan from other Priority Health plans. The health plan’s premium is, on average, six to eight percent less expensive than other individual health insurance market plans. The payer indicated that it expected these savings to increase with time.

Harvard Pilgrim, Kaiser Permanente, and other health plans outside fo the ACHP community have also launched virtual-first health plans which will provide solid data regarding consumer uptake.

Members have also shown interest in using telehealth and virtual care tools for behavioral and mental healthcare needs.

“Patient demand is driving provider adoption of innovative technology,” added Picasso. “And it's not just younger patients. The senior population is demanding access to remote patient monitoring devices.”

Of the 8 million telehealth visits that Blue Cross Blue Shield of Massachusetts covered between March 2020 and March 2021, 54 percent were related to mental healthcare. The highest share of the claims—23 percent—were for members between the ages of 25 and 34. But 26 percent of the claims were for patients ages 45 years and older.

“Patients have really latched onto telehealth as the predominant way that they would prefer to receive care for mental behavioral health services,” Whitman explained.

Lastly, the panelists found that patients were eager to see payers’ social determinants of health support bolstered by the additional data gained through innovative technologies.

“One of the things that is super important and can potentially happen very well in a virtual-forward or virtual-first health plan is capturing those social determinants of health,” said Picasso.

It became quickly apparent during the coronavirus pandemic that telehelath and virtual care visits offered a special window into patients’ lives outside of the four walls of the clinic. Through that window, providers could gather more information about patients’ social determinants of health to inform treatment processes and health plan benefits.

According to Whitman, providers and payers were not the only ones excited about this development. Members are also becoming more aware of their health plans’ capabilities to address social determinants of health.

“This is what people want their plans to help them with—and that may be through telehealth, virtual-first products—is the identifying of what that patient needs in terms of social needs,” Whitman shared. “Once we are able to better identify what those social needs are, a plan can begin to address those.”

Driving innovative technology adoption among stakeholders

After identifying what members expect from their health plans’ digital health strategies, payers have to work with providers to implement the appropriate, innovative technologies. However, finding providers who will partner in digital innovation can be a challenge for payers.

When transitioning providers into more innovative digital strategies, payers must be honest about what the technology can do, Picasso emphasized.

“If you tell a provider the technology going to be perfect, it is inevitably not going to be perfect, and then they are going to hate you for it and they are not going to want to use the technology,” Picasso explained.

Picasso recommended being upfront about the fact that the technology will experience glitches and giving providers the tools to troubleshoot common technical issues.

Still, when many providers already do not trust health plans, payer efforts to develop digital innovation can be stunted.

Eighteen percent of primary care physicians have reported that they do not trust private payers and 16 percent of specialty care providers said the same. Provider trust in public payers was only slightly better, with 17 percent of primary care providers lacking trust in public payers along with 11 percent of specialty care physicians.

In a partnership where the provider does not trust the payer, the best strategy for payers looking to push forward digital innovation may be to look outside of the payer’s staff.

“One of the things that is highly utilized in order to improve provider buy-in is having a clinician champion—having somebody that utilizes virtual care, loves utilizing virtual care, and is able to bring other skeptical clinicians along,” said Picasso. “Clinicians listen to clinicians. Clinicians don't listen to me, a health plan in the ivory tower.”

Providers are more likely to be convinced to join digital innovation by a provider colleague or by reading peer-reviewed literature that supports digital innovation, the panelists explained. Thus, having data that supports a digital strategy can be a key factor in helping providers undergo a digital transformation.

“The best way to get a provider champion and to share that success is through the data,” Whitman stated. “How do we show value? How do we identify what high-value telehealth services are? We are still figuring out the best way to do that, but the only way that we can improve upon that is to try and show this data as we have it now.”

However, there is one other entity, aside from other providers, that can motivate providers to partner with health plans on innovative digital strategies: patients.

“Patient demand drives provider adoption as well in a lot of instances,” Picasso said.

The fact that patient demands can motivate providers’ technology adoption presents another reason why creating a consumer-centered digital innovation is so key.