Frontiers Health roundup panel discussion with key thought leaders on: Innovation & Partner Integration: 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 this years’ Frontiers Health event in Milan, Research2Guidance’s team together with key decision-makers from two well-known health insurance companies from the US and the Netherlands, a leading multinational telemedicine and virtual healthcare company, and a top global Pharma company delved into how insurance companies are embracing the digital health, what are the core set of services around which health insurers & insure-tech build their ecosystem, what should innovation look like, the role of DTx in transforming the reimbursement landscape, how pharma companies use different partnership channels to drive innovative healthcare solutions and the success drivers for ecosystem innovation.

On November 11, 2021, Research2Guidance hosted a virtual “Innovation & Partner Integration: How are insurance incumbents driving innovation by building digital health ecosystems” panel discussion at Frontiers Health with global thought leaders.

What made this session so unique – our guests and their first-hand business cases from US, the Netherlands and Germany, vision and thoughts about how digital health ecosystems can play a pivotal part in the healthcare journey, the role of DTx and how Pharma partners with DTx companies to support care around and beyond their products and offer a new treatment model, innovation management and how to turn partnerships with insure-techs into viable business models!

The workshop-like discussion was stimulated by a short introduction from Rainer Herzog, VP at Research2Guidance and the session moderator, followed by key insights on how building digital health ecosystems can unlock value for insurers, an insure-tech digital health ecosystem model, what are the tactics used by three main stakeholders to build an ecosystem, R2G’s five steps innovation management via partnerships approach for building thriving ecosystems and what are the breaking points and success factors of a partnership, presented by Ralf Jahns, MD at Research2Guidance in front of the global digital health community.

Cases and highly insightful market insights were shared by

Wiet de Ronde, Manager Product Development, Menzis
Dr. Darren Schulte, President Advanced Technology, Centene Corporation
Dr. Klaus Suwelack, New Business Development & Innovation Management, Janssen Germany
Thomas Geuenich, Commercial Director, Germany, Teladoc Health

The lively market picture was completed by an interesting and inspiring discussion. Together we delved into digital health ecosystems, virtual healthcare delivery & partner integration and the conversation moved along the lines of

What should innovation look like? And top reasons why health insurers are building digital health ecosystems.
What is the core set of services around which health insurers & insure-tech build their ecosystem?
What are the tactics used by insurers to build digital health eco-systems?
What are the best examples of digital health ecosystems?
What are the challenges faced by insurers and what are the opportunities?
Is the major road to market for DTx solutions health insurance?
What are the breaking points and how to successfully build partnerships?

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 Health, Find 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. Oscar, Ottonova, Clover, Evernorth, Collective 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 Drop, Oviva, Ada Health, Omada 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 differentiation, engagement and adoption, retention 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 solutions, HCP 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-management, adherence, preventive care, coaching, telehealth, diagnosis, data storage, analysis.

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 is a five-step approach

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.

At Research2Guidance, we provide innovation and partner integration support to different healthcare stakeholders, including insurers to help them increase the number of successful partnerships. Our five phases of innovation management approach help our clients navigate the complexity and uncertainty of innovating within an organization and identify and integrate digital health solutions into their service offerings throughout all phases.

Awareness & Insights – Understanding market trends and competitor activities.
Prioritization & Roadmap – Defining partnership areas with highest impact.
Screening & Partner Search – Identifying and selecting best partners.
Partner Management – Starting and testing partnerships.
Upscale Integration – Integration into organization and service offering.

Today, more and more healthcare companies and digital health start-ups form partnerships to drive innovation. Yet, 1 out of 5 partnerships in digital health is unsuccessful. Most of the time and effort is invested in the beginning of the partnership, while the later stages are more critical. More than 100 digital health market leaders from around the world have shared their experience and knowledge with us on how to identify, integrate and manage partners and solutions. (Check out the “Partnerships in Digital Health: Success Factors and Breaking Points“ whitepaper with our survey results.)

At R2G, we welcome any opportunity to discuss and exchange opinions about innovation and partner integration and building profitable digital health ecosystems.

We invite you to read R2G’s digital health ecosystem series as we define, evaluate, and explore the implementation of digital health ecosystems.

Part 1: Enabling incumbents: building digital health ecosystems to unlock value for insurers.
Part 2: Enabling Incumbents: Top 4 Reasons for Health Insurers to Build Digital Health Ecosystems.
Part 3: Enabling Incumbents: 5 Main Steps How Insurers Can Build Digital Health Ecosystems.

Share your thoughts with us in the comment below or get in touch with Stela Nikolova & let’s keep the conversation going: [email protected]