Opportunity for Health Plan Payers in Second Half of 2018

Mark Bernstein
July 3, 2018

Opportunity for Health Plan Payers in the Second Half of 2018

Summer is officially here and healthcare conference season is largely over – at least until the kids go back to school. The speakers and exhibitors at major healthcare, pharma, medical devices and life sciences events have all shared their latest and greatest solutions for addressing the challenges, issues and opportunities facing healthcare stakeholders. What is known about the opportunity for health plan payers, hospitals & health systems, physician medical practices, and patients & consumers themselves in the first six months of 2018 has been shared.

And the tens of 1000’s of attendees and 1000’s of exhibitors at HIMSS, JPM, Health DataPalooza, WHCC, HLTH, AHIP Institute, HFMA, and the dozens of other lesser known events have all gone home.

So here in the middle of 2018, what are the latest and greatest opportunities and considerations for healthcare stakeholders – patients, hospitals, providers, payers, physicians & health plans?


What services and technologies are they all considering to digitally transform themselves and remain relevant in today’s uncertain but rapidly changing healthcare industry?

Mid-Year Check on Digital Transformation Opportunity for Health Plan Payers

Previously we shared some information about Opportunities for Digital Transformation of the Healthcare Ecosystem in 2018 and Beyond. We noted that Digitally Transforming Healthcare Takes a Village and highlighted some key areas and technologies that healthcare stakeholders (aka. Villagers) should consider as they transform healthcare and avoid being disrupted:

Opportunity for Health Plan Payers. Health Plans & Payers Hospitals & Health Systems Physicians & Medical Practices Patients & Consumers Partners & Investors

  • Health Plans & Payers
  • Hospitals & Health Systems
  • Physicians & Medical Practices
  • Patients & Consumers
  • Partners & Investors

The intention of this post and following posts is to provide a focus on where AAJ Technologies believes healthcare stakeholders can derive real value. We’ll share which services, products, technologies and partnerships may offer measurable ROI and strategic control for healthcare stakeholders. We’ll start our dive into health plan payers – aka insurance companies.

Health Plan Payer Services and Technologies in 2018 

In our original post, we noted the following as key areas of opportunity for health plans and healthcare payers:

  • Greater Emphasis on Alternative Payment Models and Risk-Contracting
  • Collaborative Partnerships in the Digital Transformation of the Healthcare Ecosystem
  • Member Engagement
  • Use of Social Determinants of Health to Identify and Manage Risk
  • Tools and Assistance to Improve Outcomes and Lower Costs

Areas of opportunity for health payers remain largely the same now as at the start of the year albeit with an important reordering of focus in the value-based care arena. The industry is realizing the importance of quality measurement aspects of value-based reimbursement arrangements.  Moreover, regulatory changes and new regulations like the Chronic Care Act are opening new opportunities. And new partnerships between non-traditional healthcare stakeholders like Amazon, Apple, Chase and other prominent American corporations promise further disruption.

RELATEDChronic Care Act Opens New Opportunities for Healthcare Stakeholders

Partnering to Improve Member Experience and Share Risk

Health plan payers continue to reinvent their business models by focusing on member experience, the move from fee-for-service payment to value-based arrangements, and the struggle how to address the impact of social determinants of health on health outcomes. All the while searching for and entering into partnerships that require data exchange and interfaces that are more easily described than implemented.

Areas of Focus for Health Plan Payers in the Second Half of 2018

Based on an informal survey of presentations and product exhibits at popular healthcare conferences, the following are popular areas of focus for health plan payers:

  • Services and tools that improve member experience and reduce administrative costs
  • Collecting patient, provider, clinical, financial and other data for analysis and reporting of value-based arrangements
  • Provider credentialing, attribution, contracting and network information on the blockchainOpportunity for Health Plan Payers. Member experience Value-based arrangements Provider contracts on the blockchain Analytics for reducing re-admissions Remote and assistive technologies Customer Relationship Management Non-medical social determinants of health AI-assisted chat options – online and SMS
  • CRM tools having omnichannel ways to interact with members and prospects
  • Payment for non-medical care coordination, patient transportation, nutrition and in-home modification services
  • Analytics and services having a direct impact on reducing use of emergency room services and minimizing unnecessary inpatient admissions and re-admissions – particularly within readmission penalty windows
  • Remote and assistive technologies such as telemedicine and smart-speaker voice technologies to enable and facilitate consumer, member and patient interaction and support
  • AI-assisted chat options – online and SMS – very popular with all people young and old

Opportunity for Health Plan Payers to Leverage Social Determinants of Health

Arguably one of the most popular themes at most healthcare conferences during the first half of 2018 is the continued focus on the need to address socioeconomic issues as major drivers of poor healthcare outcomes.  A large number of the sessions and exhibitors at recent healthcare conference events addressed social determinants of health is some form or fashion.

Incorporating some accommodation for addressing social determinants of health is one of the major opportunities for health plan payers in 2018 and beyond.

Considerations in this area include data interchange and interoperability; being able to clearly identify all the stakeholders, affiliations and attributions, deal with large amounts of unstructured data, and determining how to measure and report stakeholder needs, services and outcomes. Closed-loop reporting is critical for proving value and ROI. Artificial intelligence, natural language processing (NLP) and graph databases are key technology components used in this area.

Developing Tools & Productizing Existing Intellectual Property

Health plans and payers traditionally have sophisticated information ecosystems that were painstakingly developed over many years. After application rationalization and as more applications and systems small and large are being moved to the cloud, health plan payers are becoming more focused on extracting value from legacy systems, competitive information, and their procedures and trade craft that can be leveraged with business partners and/or be licensed to others.

Some of the forward-thinking health plans are working with outside firms to ‘productize’ their internal assets. The ability to quickly interface with others for proof of concept and then scale via a coin-operated payment model is an important ability for health plan payers and all healthcare stakeholders, for that matter.

New Partnerships by Healthcare Industry Giants in 2018

AAJ Technologies AAJTech 2018 healthcare opportunities partners partnerships. Opportunity for Health Plan Payers

2018 has been an exceptional year for large healthcare announcements that are almost certain to impact health plan payers. Major companies – some without any significant presence serving the healthcare industry – are suddenly partnering with others. Or merging to create heretofore unknown competition for legacy healthcare stakeholders – including some of the largest healthcare insurance companies in the United States.

Amazon, Berkshire and JPMorgan Chase start a venture to radically change healthcare.

CVS to Buy Aetna for $69 Billion in a Deal That May Reshape the Health Industry.

Amazon buys PillPack for $1B and Wal-Mart loses $3B in market value.

Health Plan Payers Leverage Partnerships, Acquisitions & Investments

Everyone is sure to be impacted in some way or another by these large, news-breaking partnerships. And many will also be disrupted by smaller, not so newsworthy, but potentially also disruptive mergers, acquisitions, or partnerships between other organizations young and old.

Payers and providers continue to form product-based partnerships. Large health plans are purchasing physician practices, offering more robust telemedicine services and opening up retail health clinics. And startups are developing all manner of patient experience, telemedicine, and other care delivery products and services using powerful, increasingly cost-effective technologies.

RELATED: Top 50  Digital Transformation Disruptors

Transforming Healthcare Takes a Village

While no single stakeholder is likely to provide the complete end-to-end services and product set that today’s healthcare patient, plan member or consumer needs, health plans are in a natural position to serve a key role in convening and connecting physicians, hospitals, employer groups, ancillary providers, healthcare service providers, sponsor associations and others.

To serve this central role, health plan payers are increasing focus on approaches for addressing patient satisfaction and medical outcomes. Whether a health plan is directly involved with servicing their member/patient or not, patient satisfaction impacts the health plan payer. Increasing payer investment in preventive rather than remedial and restorative services should be more effective clinically and financially over time.

Next in the Series: Hospital & Health System Services and Technology in 2018 and Beyond

Opportunity for Health Plan Payers. Hospitals and Health Systems. patient satisfaction. Cost Efficiencies and Supply Chain Management. Value-based reimbursement models. EHR’s & Customer Relationship Management. Revenue Cycle Management. outpatient surgery, skilled nursing facilities, labs and/or imaging centers. Accountable care organizations (ACO), patient-centered medical homes (PCMH), pay for performance and bundled paymentsIn many ways, hospitals and health systems mirror health plan payers with many of the same challenges, issues and opportunities.  Like payers, hospitals are being rapidly disrupted by the move to value-based care and healthcare consumerism. In the next post in this series, we’ll review current services, products and technologies for hospitals and health systems.

Reach out to AAJ Technologies for insights and assistance on how to enhance patient experience via improvements and advancements in your current digital health technologies.  This is a great Opportunity for Health Plan Payers.  Contact us now for a complimentary discovery meeting. 

Mark Bernstein

ABOUT Mark Bernstein

Director of Marketing, Mark is a professional with over 20 years of experience and an outstanding track record of achievement in B2B and B2C marketing. At AAJ, Mark wears many hats and oversees the marketing department with a focus on digital marketing including events, email, websites, social media, and lead generation.

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