Digital transformation helps employers build superior health benefit experiences
Benefits decision-makers need to determine which innovations provide optimal results for delivering patient-centered, quality and cost-effective care.
The digital transformation in health care is nothing short of remarkable, as employers recognize the value of meaningful digital solutions to provide greater health benefit experiences for their employees and retain members during open enrollment season. Digital health has the advantage of providing access to care no matter where people live or work and at any time. In this process, it is essential for benefits decision-makers to determine which innovations provide optimal results for delivering patient-centered, quality and cost-effective care.
Building a strong foundation for digital transformation
Prior to the pandemic, there was marginal adoption of digital health solutions compared to the uptake and utilization surge that ensued with the widespread prevalence of COVID-19. The phenomenal, growing adoption of telehealth, for example, provided access to health care when in-person provider visits were simply not possible. As a result of these virtual experiences, people are now more confident in telehealth and dependent upon digital health as an essential component of everyday health care along with in-person visits.
Additionally, there are demographic changes in the U.S. driving this digital transformation, especially an expanded aging population which will need more advanced care. More and more people want to see their doctors virtually and get bloodwork online — rather than traveling to a physician’s office or lab if they can possibly avoid doing so.
But digital transformation doesn’t happen overnight. Over time, it requires a connected health care ecosystem of many players working across silos to provide the best care. Key to this change is enhancing the patient experience, a conclusion reached in a recent survey of health plan technology leaders which reported that building a strong foundation for digital transformation is part of enriching the patient journey.
Digital solutions address another significant concern: the Association of American Medical College reports that the U.S. faces a shortage of 21,400 to 55,200 primary care physicians by 2033, with the pandemic only highlighting this challenge to accessing care.
An effective digital patient engagement strategy directly addresses these issues with emerging support for moving away from a reactive approach to health care to a proactive model in which engagement tools and support bolster both patients and health care providers. Clearly, integrated digital solutions that improve coordination between all stakeholders – providers, patients and payers – is improving the quality of care, access to treatment and outcomes.
The alarming state of America’s mental health
In 2019, just prior to the COVID-19 pandemic, 19.86% of adults experienced a mental illness, equivalent to nearly 50 million Americans. While quarantines imposed by the pandemic have had a lasting effect on people with diagnosed mental health conditions – including feelings of isolation and loneliness — they are also bringing about a new wave of depression, anxiety, and substance abuse disorders for people who have no prior history of mental illness.
Suicidal ideation continues to increase among adults in the U.S. with 4.58% of adults report having serious thoughts of suicide.
What is more disturbing is over half of adults with a mental illness do not receive treatment, totaling over 27 million adults in the U.S. who are going untreated. The percentage of adults with a mental illness who report unmet need for treatment has increased every year since 2011. In 2019, 24.7% of adults with a mental illness report an unmet need for treatment.
What is most promising in addressing the mental health challenges for millions of Americans is the emergence and adoption of digital health solutions. During the pandemic, digital health was a lifeline for those already suffering from mental/behavioral health issues and those who were dealing with pandemic stress
The future is customer-centered
Health care organizations increasingly recognize the need to evolve with their customer needs or risk losing market share. By adopting a customer strategy that includes developing and promoting digital tools, health care entities can provide personalized health care tailored to individual needs and expectations. When incorporated in a hybrid approach, clients can access both in-person and telehealth visits throughout their treatment process, depending on their preferences.
In their efforts to provide a more tailored, personalized approach, benefits consultants and advisors are recommending virtual primary care, which can be used for a triage experience for more acute care. Patients describe their symptoms, and the physician can treat them or send them to a specialist or surgeon. This is an important component of a segmentation strategy whereby virtual care can also provide preventive care. Further extending the value of virtual primary care is the inclusion of laboratory services, providing physical packages delivered to the home that enable patients to generate lipid profiles and total blood chemistry.
The bottom line is to match digital offerings with the right customers. Younger populations may be ready to make a more complete transition to the world of digital health care while the elderly is less comfortable with technology and will need digital training along with telephonic support to use digital health solutions. Astute benefit planners will take the time and resources to employ population health management principles, stratify and understand the needs of specific groups and leverage the opportunity for digital resources to deliver value.
The marketing adoption of the digital medical home
During the open enrollment season, benefits decision-makers are discovering the power of digital health solutions to bridge the gaps in care, make health care more accessible and improve outcomes. The emergence of a “new perspective” in digital health opens a world of opportunities for helping employees seek a health plan.
It is advisable that the search for digital resources begins with identifying a fully integrated portfolio of curated digital health solutions. Characterized as the Digital Medical HomeTM, (DMH) this framework provides an upstream pathway to wellness and downstream exposure to expensive pre-acute and post-acute care. The DMH elevates the interaction between the physician and the patient longitudinally pulling in relevant diagnostic elements that patients traditionally get in a clinic setting — whether it’s labs or key biometric information. The DMH also engages and supports ancillary and specialty providers offers assistance to family caregivers and accounts for social determinants of health.
With DMH at the intersection of plan and payor interactions, this “digital-first” approach establishes a digital front door for key stakeholders: it is scalable and makes it easy for payers, providers, health systems and patients to find, support and implement digital innovations that impact the entire health care journey.
Designed to scale to the needs of employer populations varying in size and scope, and fueled by process and structure, these digital solutions can generate meaningful measurement metrics. These metrics include quality improvement for medication adherence, treatment compliance, cost avoidance and more. Such measurements are critical for value-based reimbursement, ensuring more appropriate care, reduced hospitalizations, ER visits or readmissions and costly interventions.
In this era of digital transformation, the DMH facilitates an engagement strategy across the health care continuum. It is designed to house the tools, resources and support needed to manage a variety of health care issues and conditions in one place, while providing superior health benefit experiences, and helping to retain members at the same time.
Michael Gorton, MS, JD, is CEO, and founder of Recuro Health, and founding CEO and Chairman of Teladoc.
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