Voices of Innovation - Payers : Opportunities for Creating Solutions to Improve Member Experience and Health

As the health delivery landscape in the United States evolves in a post-COVID-19 era, both incumbents and new entrants are reimagining models of care. Technology and medical advancements are transforming the way care is delivered and experienced, and changes in regulations and incentives across the industry are redefining how the healthcare system works and interacts. As a result, care delivery is undergoing several transformations: from sick care to preventative whole-person care, from intermittent to continuous care, from facility-based settings to omnichannel offerings through virtual care and video or telephonic technologies, and from standardized to personalized solutions. In addition to healthcare providers, payers are also redefining their role in care delivery through provider ownership, technology, and provider enablement to deliver higher-value care to members. While the payer community has been slow to innovate, they now have an opportunity and an incentive to play an active role in reimagining the future of care delivery. In the past year alone, significant disruptors have entered the provider space threatening the existence of payers, specifically self-funded programs such as Amazon and Walmart. This has served as a giant wake-up call that healthcare has shifted.

Now, more than ever, there is an emphasis on the patient and clinician experience. Perhaps hastened by the pandemic, the race is on for innovations from the payer community to improve patient and provider engagement. Unlike other players, payers have end-to-end visibility into individual care needs and utilization patterns across providers and settings. This perspective can provide informed choices around optimal care models, unlock value through improved health outcomes, and lower the total cost of care for members and customers.

This book is loaded with numerous case studies and interviews with healthcare leaders from the payer community, helping stakeholders understand how to leverage innovation leading them to superior business and clinical outcomes. The book also discusses how and why data is key to innovation activities and how partnerships are key to using data effectively.