Disrupting health care: the shift to personalized and patient-centric care

The health care industry has witnessed a drastic transformation due to technological breakthroughs, changing patients’ experiences, and the need for cost-effective care outcomes. This shift demands health care companies and other industry professionals to adopt a smarter, simpler, digital and result-focused approach. 

At the forefront of this transformation are health care payers, who must align their strategies to keep up with the evolving expectations of providers, members, and regulators. In this article, let’s delve deep into the current landscape, trends, and actionable recommendations on how health plans lead the charge in this dynamic ecosystem. 

The future of health care is value-focused

“Global value-based health care market size was valued at $3.9 billion in 2023 and is expected to reach $20.5 billion by 2032, at a CAGR of 7.5%, during the forecast period 2023 – 2032.” - Custom Marketing Insights | 2023 

The multi-billion-dollar market highlights the need for a change in strategy and prioritizing patient outcomes and cost efficiency over focusing on just the volume of services provided. Patients today want personalized care, transparency and better control over their health care choices. Seamless digital access and action to reports, bills and scheduling appointments have become a priority. This behavioral shift calls for new ways to engage patients, share data, and deliver care.

Trends shaping modern health care

Effectively navigating the advancing landscape requires health plans to stay up to date on emerging industry trends. From data-driven predictive modeling to personalized engagement, here are some notable trends shaping the future of health care payers.

Enhanced data analytics and predictive modeling

According to MarketsandMarkets, the global health care analytics market’s revenue is poised to reach $85.9 billion by 2027, growing at 25.7% from 2022. Additionally, the global health care big data analytics market is also expected to show a promising growth of 16.7%​ ($134.9 billion) by 2032, in a span of 10 years. This growth highlights the vital role of data analytics in predicting trends, enhancing patient outcomes, and maximizing operational efficiency.

Personalized member engagement

Personalization has a direct impact on patient loyalty. A report by Invoca revealed that personalizing customer interactions helps around 49% of patients feel their health care providers care about them, and 47% of those are more likely to choose them over others. Another Tebra survey found that over 50% of patients prefer digital options for scheduling appointments and managing their health records, underscoring the significance of digital engagement in modern health care​. Streamlined administrative processes

Dealing with administrative inefficiencies can be expensive and time-consuming. The smarter approach is to leverage automated solutions to significantly ease the administrative burdens and improve cash flow. For instance, automated insurance verification has been shown to improve payment speeds and reduce claims denials​.

Collaborative care models

When payers, providers and patients coordinate and efficiently work together, this powerful collaboration leads to better health outcomes and cost efficiencies. Recent American Journal of Managed Care research claimed a significant reduction in total medical costs (per member, per month) for patients in collaborative care management compared to the control group. Collaborative care models enable providers to share critical member information more efficiently, leading to better decisions and personalized treatment plans. 

Security and data privacy

The rise of electronic health records and telemedicine has made data more accessible, but also more vulnerable to breaches. In 2023 alone, 725 data breaches were reported to the Office for Civil Rights, and across those breaches, more than 133 million records were exposed or impermissibly disclosed. Therefore, ensuring complete data protection is essential. There is a strong need to implement robust data governance and cybersecurity measures.  

How can payers lead the charge to superior quality care?

Health plans can drive transformation by empowering providers and enhancing member experiences. For providers, this translates to streamlining administrative tasks and ensuring efficient communications. Accurate data and streamlined workflows help build a strong, collaborative provider network. For members, health plans need to focus on personalized experiences and timely services. 

Here’s how one can achieve this:

• Embrace low code: A low-code platform approach transforms end-to-end member and provider journeys with intelligent automation, deep integrations, and pre-built accelerators. It ensures interoperability, custom configuration and seamless integration with native systems. A platform approach not only enhances the scalability, but also helps deliver value-based solutions at speed
• Invest in data analytics infrastructure: Payers must forge partnerships with organizations that specialize in artificial intelligence and machine learning to interpret data and make informed decisions. They must utilize predictive modeling tools to identify at-risk populations and uncover insights to ensure better patient outcomes
• Implement omnichannel engagement capabilities: Omnichannel engagement platforms help personalize communications while leveraging member data and create tailored care plans. These platforms allow patients to access health care services anytime, anywhere, with mobile and online access for added convenience 
• Streamline administrative processes: Payers should invest in intelligent automation tools to reduce administrative burdens. An intelligent automation solution simplifies end-to-end processes to minimize errors and maximize efficiency. It empowers users to refine administrative workflows regularly to enhance productivity and ensure frictionless operations.
• Foster value-based partnership: Teamwork is everything in modern health care. Develop collaborative care models where everyone — patients, providers, and payers — and prioritize coordinated care to enhance patient outcomes. Promote shared decision-making by engaging patients and providers in the process. Supporting coordinated care initiatives ensures patients have smoother digital experiences. This builds trust and leads to better health outcomes for everyone involved.
• Strengthen security measures: Protecting sensitive health information is non-negotiable. By regularly updating cybersecurity measures, Payers can stay ahead of potential threats and improve security protocols. Conduct regular audits and risk assessments to mitigate security vulnerabilities, ensuring the highest standards of data protection.

Looking ahead

As the health care landscape evolves, payer organizations and their advisors must lead with innovation, collaboration, and a focus on patient-centric care. By adopting the recommended strategies, payer organizations can adapt to the dynamic landscape and play a crucial role in reshaping the future of health care. 

Manish Jaiswal is the head of gealth care at Newgen Software.