In the US, the role of payers has grown from a simple checks-and-balance player to ensure cost-effective treatment to one that has significant sway in the direction and advancement of new health programs. This is especially true now as healthcare payers demonstrate the ability and desire to embrace new technology to stabilize their business and expand into new digital opportunities. It’s no longer just providers and health systems that are adopting new health tech, payers also want to increase implementation of AI and machines to garner cost-efficiencies. Will payers be the right catalyst to fuel the development of a new digital-first future?

Virtual care replacing traditional settings
Payers are seeing value in using virtual care to drive healthcare value. Without the limitations of geography and physical space. Virtual care also helps to speed connectivity among a healthcare team. For example, regular communication among a patient, provider, and payer can advance care integration and optimize health monitoring, which then reduces the risk of medical errors, increases preventive health services, and improves overall care delivery – all without ever seeing a patient in person. 

From a connectivity perspective, payers also view virtual care as an avenue to enable more seamless data sharing among all parties. The quality and availability of patient data presents a foundation for using advanced automation technology to significantly reduce the need for manual processing.

New digital revenue channels 
For payers, job one is targeting cost control. A majority (60%) of payers say they are looking to digital technologies to achieve operational efficiencies through automation. By 2023, those who said they will see large to very large gains in these areas will double, to 18%. In pursuit of new revenue, many payer executives expect to increase their use of digital channels to deliver services to customers. Almost one-third of payers are now generating 10% to 20% of their revenues through digital channels – double the percent of the cross-industry average who said the same. As even more payers shift into this revenue range in 2023, the ratio between payers and the cross-industry average is expected to be maintained. 

Digital health tools on the rise
Payers are also pushing health systems and providers to adopt new EHR and practice management platforms, due in part to their ability to integrate with payers’ platforms, capture key patient insights, and refine workflows for greater efficiencies. In the past few years, Anthem inked a new partnership with Canvas, an EHR and practice management platform, to integrate the companies’ technologies so Anthem’s machine learning insights can be delivered directly within Canvas’ workflows. In a similar fashion, Highmark Health grew its partnership with Verily. With the new partnership, Highmark will add Verily’s digital care tools for managing chronic conditions, including congestive heart failure and chronic obstructive pulmonary disease, to its Living Health model for patients and clinicians. All this digital health collaboration adds up to greater patient insight, more advanced tools to mitigate excess costs, and support a focus on patient outcome models that will yield better results, with less costs, in less time. 

Focus on the patient experience
Payers are also pushing to adopt digital engagement tools to support the focus on patient empowerment and more connectivity among patients and their care team. This includes large investments and partnerships that offer Mobile apps, online portals, messaging apps and call centers that integrate to deliver a connected digital experience for patients, while yielding greater patient data insight into their treatment journey. These new digital points also allow more personalization and custom support for those who need frequent contact with their health plans due to ongoing episodes of care or management of chronic conditions.

To orchestrate the connected patient journey, many large payers are deploying a single platform to manage all interactions — human or digital. These platforms serve as a command center for health plan member interactions by supporting omnichannel digital engagement. Such platforms can coordinate responses to member questions and requests through the channel preferred by the customer, including via live agent. The platform also integrates with CRMs and enables cross-channel support that speeds time to resolution, improves the patient experience, and enhances brand value.

Payers are seeing the digital revolution as one that can positively impact the future of the healthcare industry and pushing hard to adopt new technologies for cost efficiencies, deeper data insights, and greater patient engagement. While there is still much debate about which areas will prove most beneficial for payers, it’s clear that digital health has moved beyond just a tool for providers and is transforming the entire healthcare industry to deliver better outcomes, and more cost savings.