Digital Health Ecosystem Series, Part 1: Enabling incumbents: building digital health ecosystems to unlock value for insurers

As digital ecosystems are disrupting the insurance industry, they are quickly shifting from nice-to-have to must-have platforms for insurers. Insurers who build digital health ecosystems have the opportunity to improve their member experience, drive healthcare value, reduce claim costs, and remain competitive in the changing landscape. Join us for this digital health ecosystem series as we define, evaluate, and explore the implementation of digital health ecosystems.

While digital ecosystems as a business model predates COVID-19, the rapid shift towards digitization caused by the pandemic gives ecosystems the potential to unlock immense value for insurers. Insurance ecosystems drive disruption and increase competition. Consequently, those who can build best-in-class ecosystems will be at the forefront of this disruption.

To fully understand the opportunities associated with adopting a digital ecosystem model, we do not need to look much further than Amazon, Apple, Google, or Uber. These companies use their customer base and ecosystem model to grow revenue and users and deliver better products and services. Although these ecosystems comprise different partners, competitors, customers, and businesses across multiple industries, they are similar as they have swapped the “control and centralize” approach for a “connect and combine” mindset.

In healthcare, digital ecosystems follow a similar approach to that of these tech giants. Digital ecosystems of an insurer can encompass the entire customer journey from quote to claim. However, we will be taking a closer look at how insurers can build digital health ecosystems with third-party providers for virtual healthcare delivery.

Amid COVID-19, digital health ecosystems proved effective as many avoided going to healthcare facilities because of safety concerns or were denied access due to social distancing measures. These digital health solutions provided an alternative to the traditional care settings, helping care seekers receive care in the absence of physical interaction.

A digital health ecosystem is a technological infrastructure that delivers various healthcare services across a digital platform. The goal is to facilitate and encourage interconnectivity between various healthcare stakeholders, ultimately improving healthcare outcomes.

The principles of openness, flexibility, and self-organization are characteristic of digital ecosystems. They are complex networks of stakeholders (usually connected applications and technologies) that interact digitally to create value for all. When it comes to a digital health ecosystem, the whole is greater than the sum of the parts.

These are the “parts” that stellar digital heath ecosystems include:

Increasing focus on trust

New digital business models are built around trust instead of control.

Increased member knowledge

Members are encouraged to share their health and lifestyle data.

On-demand consumption

There are adjustable plans and dynamic coverage to meet members’ changing demands.

Increased member empowerment

New digital business models provide tools to support member self-management.

Automation

Automation of all member processes with limited human intervention.

From payer to caregiver

Moving into healthcare provisioning and connected caregivers ecosystems.

While the steps to create a digital health ecosystem will differ for each health plan (discussed in a future blog), given the above criteria, some of the best examples of digital health ecosystems come from:

CVSHealth – Point Solutions Management

Point Solutions Management is a digital health ecosystem created by CVSHealth, which simplifies the management of third-party digital health solutions to help minimize spend and maximize benefits.

CVSHealth has built a best-in-class ecosystem as they deliberately prioritized the main areas of need for their users, namely:

  1. Area of high cost, where digital tools can improve clinical outcomes.
  2. Area of productivity and member quality of life that can be impacted by improved health habits and clinical coaching.
  3. Areas of care complexity, where clients seek improved member engagement and ease of member navigation to maximize their health benefits.

Evernorth – Digital Health Formulary

Digital Health Formulary is a digital health ecosystem created by Evernorth, which creates a reliable pathway for digital health solutions to improve health outcomes. The ecosystem promises clinical effectiveness, security and privacy compliance, value and affordability, and a user-friendly experience.

Evernorth focuses on making the digital health journey easy for users to navigate. The following are cornerstones of their ecosystem:

  1. Making digital health reliable.
  2. Making digital health simple.
  3. Making digital health affordable.
  4. Making digital health personal.

Walgreens – Find Care

Find Care is a digital health ecosystem created by Walgreens, acting as a digital “front door” to an integrated healthcare experience. Walgreens is not a health insurer, but they have built an impressive ecosystem available to payers and health systems.

Due to COVID-19, the Find Care platform has grown substantially with new and extended service providers. Their platform saw a rapid increase in popularity to nearly 20 million visits, equal to a 13-fold rise in web traffic compared to the previous year.

R2G Insights_Health Plans have started to offer digital ecosystems to their members

Other insurers have or are in the process of building their digital health ecosystem, but this is not yet something we see at scale. The disruption that these ecosystems will have within the health insurance landscape is tremendous, and insurers should start thinking about creating an ecosystem environment of their own.

Insurers that invest in open ecosystems and best-in-class components will experience improved customer satisfaction, lower costs and remain competitive in the changing landscape. Stay tuned as the next post will address why insurers are building these ecosystems and how they benefit.

Research2Guidance has done extensive research and projects within the health insurance industry. We understand the challenges and opportunities that accompany the digital health ecosystem model, as we hope to help you unlock its value.

Get in touch if you want to learn more about building digital health ecosystems and how our team can assist you.

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