What Shifting Health Plan Models Will Mean for IT

An intuitive web of connected devices that leverage preventive medicine and patient data has big implications — not only for cost-conscious consumers seeking greater control but also for the survival and profitability of health plans in a crowded marketplace. 

That’s the focus of a Deloitte report, “The Health Plan of Tomorrow,” which maps out challenges for traditional plans and urges them to invest in IT tools and strategies that could shift the nature of patient care. 

After all, it won’t be long before a person with asthma might wake up to a smartphone alert about the morning pollen count. With access to a patient’s phone contacts and calendar, a scheduling function can suggest moving an early outdoor jog to the afternoon, when conditions may improve. Another tracking app might detect a low supply of inhalers, triggering a home delivery. 

MORE FROM HEALTHTECH: Learn how telehealth programs can evolve to meet patient needs.

Such interoperability requires coordination and money. 

“Think about all the elements that have to come together,” says David Biel, a Deloitte principal who spoke to HealthTech about the report. “Traditional provider and health plan executives should really be thinking about these future scenarios and how the shifts are going to impact them.”

A key player in this transformation: IT teams that must make sense of proliferating options, persuade hesitant executives and deploy the right tools to work effectively and in sync. 

Biel, a former software developer, explained what these teams must consider when doing so. 

Support and Invest in Digital Transformation

As nimble, tech-centric players of all sizes seek a share of the health plan market, legacy plans that have relied on traditional models must shake off past practices and outdated technology.

“In order to do that, they have to focus a portion of their time and energy and dollars on pivoting their businesses to take advantage of a new health economy,” Biel says. Groups may consider investing in AI and analytics, automation, blockchain and cloud technologies.

Giving IT teams a prominent seat at the table can help achieve buy-in from executives. The technologies are meant to reduce cost of care, streamline processes and achieve better outcomes, but they won’t necessarily bring short-term returns on investment, Biel notes. 

Hire Forward-Thinking Tech Talent

Beyond having sharp IT leaders at the forefront, it’s also key to hire smart, adaptable employees that can handle shifting daily tasks and new workflows.

A worker’s duties, for example, may evolve from processing individual claims to managing and reviewing outputs from automated technology designed to outsource those once-manual tasks.

Access to an increasingly vast data pool will also require IT teams to be nimbler and more comfortable among a variety of sources and platforms to direct the necessary information to support care and claims staff. 

What’s more, patient privacy concerns, as well as regulatory and compliance issues, must be considered as new data collection tools flourish. Health plans, the report notes, need a strong information governance philosophy that defines data elements and the rules that guide their use across applications.

Still, Biel says that consumerism and the ease of personal technology has allowed many patients to feel comfortable sharing more data. IT teams must help craft that message in a way that is advantageous for the consumer and that also helps health plans with their top and bottom lines.

Such information has value: The report points out that data collection could help health plans tap new revenue streams through monetization of information, customized offerings and algorithms to help reduce errors and offer incentives based on healthful behaviors, among other objectives. 

Embrace Outside Collaboration

Big tech companies and small startups have a deep knowledge of consumer behavior and emerging technologies. They’re also free from traditional business-model constraints that might keep legacy health plans stalled at the starting line.

That’s why health plans and providers possessing the lion’s share of patient data must be open to working with both disruptors and competitors. The report cites the recent news of Amazon, JPMorgan Chase and Berkshire Hathaway creating a joint venture to overhaul healthcare for their 1.1 million employees. That, no doubt, required IT staffs to abandon their respective silos.

“The new health economy will be driven by the traditional players partnering with each other in a much more collaborative way,” Biel says. “The infrastructure is not going to reside in the walls of these organizations; it’s going to need to be deployed ubiquitously and globally to allow the interoperable connected data sources to come together to allow the new models to form.”