Our perspective: Digitally enabled healthcare

Perspective: Digitally enabled health | By: Carelon

Healthcare organizations have never been more ready for change.

A study by health industry publication Healthcare Innovation  found that healthcare firms typically lag about a decade behind other industries in adopting business technologies that would help with customer engagement1. For context, in that same 10-year time frame, Apple will have debuted approximately 10 new iPhones. 

The impact of that technological delay is staggering. Broadly, an antiquated operating system within healthcare isn’t helping reduce the $760 billion to $935 billion waste in the industry2.

The delay is affecting stakeholders, too, likely contributing to rising and alarming dissatisfaction among clinicians: 47% of physicians feel burned out3. Similarly, 34% of nurses plan to quit their job in 20224, with 44% blaming burnout and a high-stress environment.

The lagging adoption of new digital technology has affected consumers’ perceptions, too. A 2020 survey by The Harris Poll, for example, found that 62% of consumers said that the healthcare system seems designed to be confusing, and 66% feel so overwhelmed by healthcare tasks that they “feel like a general contractor5.” That burden of healthcare navigation has likely delayed  recommended care, such as cancer screenings, immunizations, and palliative care. 

For some payers, the historically slow pace of digital transformation has likely limited the systemwide exponential impact they have long wanted to make. As the debt from their legacy systems compounds, health plans struggle to orchestrate and advance their strategic priorities around whole-person health, affordability, and operational excellence.


Our perspective: Digitally enabled health is the future


How we believe health plans can make a difference
Health plans can begin to realize the promise of a digitally powered healthcare system. The can adopt AI-, machine learning-, and blockchain-driven technology, and make the right care, clinical expertise, and data easily available to those who need it.  As part of this transformation, forward-thinking plans can focus on four areas:

Making whole-person care easier to access
Outcomes-focused health plans are expanding their definition of “healthcare.” To them, care is no longer only about what’s delivered during a doctor’s appointment – it’s about members’ whole health, and all the factors that contribute to it.  

To make their longitudinal, holistic perspective of healthcare come to life, health plans are refreshing their technology stack. They are leveraging an AI-driven care ecosystem that enables them and their provider networks to scale high-value decision-making, engage individuals at the right point of their healthcare journey, and improve condition management, transition of care, complex care management, and care coordination. 

Helping providers work smarter, not harder 
Today, from primary care physicians to oncology nurses and orthopedists, providers are playing new roles and assuming even greater responsibilities than they have in the past, and assuming risk for managing population health under ACOs and other payer-provider partnerships. 

Health plans are helping clinicians rise to these new challenges through interoperable digital tools that better connect data. This way, providers can focus more of their time and attention on delivering personalized whole-person care for individuals.

Streamlining health administration
Ambitious health plans aren’t hiding their desire to simplify healthcare for the stakeholders at scale. They’re also not hiding that to achieve that goal, they need to commit to exceling at the operational fundamentals of health plan administration.

Increasingly, they’re turning to AI and digital tools to do this. These market forerunners are automating the most difficult business problems to streamline their core operations, like claims processing, reporting, and payment accuracy, and architect a new digital core that they can build on efficiently and quickly over time.


Partnering to solve today’s and tomorrow’s challenges


Many health plans are focused not only on reducing complexity in the healthcare system today, but they’re also preparing for the complexity of tomorrow. They’re turning to partnerships and innovation communities around the world to help.

Realizing that innovation rarely is sparked in a vacuum, more health plans are partnering with health-tech startups, venture capitalists, incubators, and more. By collaborating with these once-considered-foe stakeholders, health plans can nimbly develop solutions that sit on top of the digital core they’re building today.


Healthcare’s never been more ready


The healthcare system has never been more eager for digital transformation. For health plans, the technology and the expertise needed to drive change is now available. For providers, healthcare data that once was once siloed can be exchanged more easily. For individuals, accessing care has the potential to be as easy as accessing on-demand, streaming services and digital marketplaces tools that form the backbone of consumer businesses like Uber and Amazon to simplify how healthcare works, for everyone.

So, the question, then, is no longer “When will health plans begin their digital transformation?” Instead, it’s now “Which health plans will the healthcare system look up to for guidance?”


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1 Healthcare Innovation: Study: Healthcare Lags Other Industries in Digital Transformation, Customer Engagement Tech (accessed June 2022): hcinnovationgroup.com 

2 JAMA Network: Waste in the US Health Care System: Estimated Costs and Potential for Savings (accessed June 2022): jamanetwork.com 

3 AMA: Practice Transformation: Research (accessed January 19 2023): ama-assn.org 

4 National Library of Medicine: Challenges and Opportunities Facing Medical Education (accessed January 2023): ncbi.nlm.nih.gov 

5 Healthcare Finance: Half of consumers avoid seeking care because it's too difficult (accessed June 2022): healthcarefinancenews.com 

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