The appetite for digital health is increasing in the country. This is where developing metrics that capture the economic value of digital applications for patients could help health insurance payers negotiate prices effectively and thus drive further consumer adoption, said Sally Else, president, Mphasis Javelina.
In 2018, the global venture capital invested US$ 9.5 billion into digital health. The key investment areas included consumer health information, digital gym equipment and healthcare consumer engagement. However, these areas largely do not impact healthcare delivery despite these offerings being available to providers, members and payers. The US industry too historically lacked incentives for the roll out of digital care primarily because it is structured on a Fee-for-Service model and therefore provided little incentive for use of telehealth/telemedicine, she added.
Health insurance payer organizations are increasingly making digital practices available to their members often via partnerships with technology providers. For instance, the US-based health insurance company Aetna partnered with Apple to offer members ‘Attain by Aetna’ which offers rewards and the opportunity to monitor health activity via a wearable device, Else told Pharmabiz in an email.
Mphasis as an IT service provider in the cloud and cognitive space adopts artificial intelligence among others to assist its customers in knitting together available technologies. Ongoing consideration, of course, is driven by the need for security across the data landscape, within the back-office and at the member identification level, Else stated.
Sharing some cases of digital technology adoption in the healthcare sector, she said, “Simple examples include using an app to find a health insurance provider with an advantageous location, quality score, price for the treatment being sought, use of automated customer service agents like BOTS to respond to enquiries regarding benefit plan features, eligibility and potential medical fees or the status of a previously submitted claim are all available via smart phones. Another example is wearable devices that can sense movement like for instance a fall, weight loss or gain to support patients at homes rather than accessing an in-facility care.”
With the changing behaviour of members who expect a higher standard of service including access to information which allows them to customize their experience, the healthcare industry is now embracing a ‘consumer-centric’ value proposition. This is a phenomenon being observed globally and being answered with the adoption of digital point solutions be it pricing transparency tools to support their choice of care, wearable devices to monitor health and access portals that offer a centralized view of their healthcare experience or insurance claims status.
The challenge, however, is in enveloping these individual digital solutions into a single holistic and engaging view for the member while also allowing efficiencies along with a framework for lean healthcare operations. Together with the member, an optimal solution that supports the provider or payer business entity is also a must. This is where Mphasis helps healthcare insurance payers transform their businesses to modern back-office operations. Here our Front2Back framework provides allows access to relevant and timely data, she said.
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