Electronic Health Reporter

By Mary Langowski, CEO, Solera Health

Investments in digital therapies and solutions are making it easier for consumers to obtain the help they need, whether it be for sleep issues, stress, anxiety or other conditions. Frankly, this digital transformation could not come at a better time for patients and payers, who have waged an uphill battle to deal with rising healthcare costs.

To cover escalating costs, payers have been forced to raise premiums and deductibles to the point of straining consumer budgets, which risks discouraging some patients from seeking care for chronic issues that can lead to more serious conditions requiring costly treatments. A recent study by Kaiser found that annual family premiums for employer-sponsored health insurance increased by 4% in the past year alone. The study also found that average family premiums have increased 55% since 2010 – at least twice as fast as wages (27%) and inflation (19%). 

After searching for more affordable alternatives, consumers and a growing number of payers and employers are discovering virtual-first healthcare, a more consumer-centric approach to addressing health needs by beginning with online resources and service providers. This emerging ecosystem is improving healthcare outcomes by giving consumers greater control and choice to treat chronic conditions, mental health concerns and other challenges through inexpensive digital experiences. 

In addition to treating illness, individuals are using these online resources to make lifestyle changes ranging from tobacco cessation to weight loss; address stress and anxiety or social isolation; slow or prevent diabetes; or reduce their risk of falls. Available programs can help individuals understand and influence their social determinants of health, reducing the likelihood of developing chronic illness and avoiding the need for costly treatments down the road. In the area of mental health, digitally accessed meditation, mindfulness, and stress relief services are allowing people to live healthier, better lives.

Despite an abundance of providers offering exceptional digital experiences, the online landscape can be difficult to navigate and not easily accessible for some consumers. In the past, difficulties like these may have deterred some employers and payers from attempting to integrate digital-first providers in their care options. 

Administrative costs may also factor into those decisions since it could take hundreds of hours for an employer to study service options, choose focus areas, vet providers, and monitor their performance each month. It is not surprising that payers historically have gravitated to large or national healthcare providers offering a wide range of services and treatments, which reduced the number of vendors to be vetted and monitored.

A better solution to the challenges of navigation and access to digital-first providers is to work with a third-party network or platform provider. Along with providing consumers with a more user-friendly experience, a network operator may handle vendor administrative tasks that would otherwise fall to a payer or employer.

Curated Digital-First Solutions 

A well-managed platform creates a single touchpoint for condition management and streamlined engagement, making it easier to match consumers to their best-fit digital solutions in the health community. A dynamic platform will provide intensive, evidence-based lifestyle and behavioral social interventions to address the most prevalent and costly chronic conditions.

Consumers can explore the platform’s options with confidence, knowing that the system’s operators vet each provider in their curated network. As an extension of that vetting, the platform operator can seamlessly handle the most irksome aspects of program administration, including claims processing, compliance, consumer engagement, eligibility checking, consumer matching and vendor management. For some organizations, offloading those duties can represent millions of dollars in savings each year.

A payer can choose to integrate a digital-first platform with their own provider selection infrastructure to deliver a seamless experience to their consumer populations. Over time, the third-party platform operator will continually adjust its mix to bring in new provider partners so payers, employers and members can rest assured they stay on the cutting edge of innovation. 

Looking to the future, digital-first solutions have the potential to stay the relentless escalation in healthcare costs. Platforms will fill an integral role in the future by helping consumers easily access the right solutions for their specific needs and bring the streamlined efficiency of curated networks to payer organizations. With these ongoing changes, individuals will be able to access low-cost resources to live healthier, fuller lives and reduce their risk of developing ailments that can drive up healthcare costs for us all.