It was once a good idea – to find a point solution for a specific service offered by a new, innovative company to fill a gap in your benefits package. It has now become a huge challenge. With thousands of point solutions in many overlapping categories, it has become a huge challenge to find the differentiation between them. The problem goes much further. Even after you have found the right point solutions, it is difficult to engage your members in these programs. They all have their own logins, assessments, front doors, and pathways – with no integration with other ‘point’ solutions. This is creating a lot of administrative burden for the benefits teams. The reality is that while some of these solutions are really great and solve unmet needs of the member populations, the influx and the magnitude is adding to our already fragmented healthcare system. People are more confused and often lost. Most of these solutions are very narrow in functionality and address only a tiny percentage of your overall health spending. They all show demonstrated savings, yet the total healthcare spending continues to go up. Given where inflation is going, many plan sponsors will welcome a reduction in their overall health spending.
Some companies have tried to solve this problem by adding human advocates. Human support is great for high-cost, high-need members, but it is very cost-prohibitive to have this available to all members at all times. A few others have come up with prebuilt ecosystems, but these are not customized for your populations and force you into an environment that you may want to avoid.
To drive maximum value from your investments, these point solutions should be integrated around your people and fit your larger objectives of improving health and outcomes, not the other way around. Your people will value having one entry point to all their healthcare benefits, while you will find the value with increased engagement, utilization, and cost savings that comes with it.
Finding the right solutions around sources of value
The first step is to find the right solution. Begin with the end in mind. Healthcare, digital or not, is experienced differently by different people. Social, economic, behavioral, and language are just some of the many factors that influence our consumption of health and healthcare. We already know that people with health disparities have different utilization of high-acuity care vs. others and different outcomes for the same chronic conditions. As a plan sponsor, you can benefit from the best insights into your members’ health conditions, demographics, and socioeconomics. The right way to start is by integrating claims, clinical, social, and other sources of data and getting a clear picture of all of your members.
After you have access to the data, the next step is to analyze it highlighting areas of the largest health care spending. At this stage, you should consider health disparities into the equation. A high-flying executive has a different lifestyle and access to resources than a factory worker in the same organization. By including additional factors such as socio-economic (education, neighborhood, and physical environment, job profile), geography (attitudes, lifestyle factors, and cultural practices), and specifics (race, ethnicity, or sexual orientation) into your analysis, you can find the gaps at the subpopulations level, where a point solution could be most impactful. You may find a specific source of value where simple benefit design change could make a very big difference in the lives of a significant number of members, or find a point solution that can provide members with a specific condition (for example MSK) an alternative lower cost option that is lower-intensity and effective in reducing costs associated with orthopedic surgery.
Creating an integrated experience
After finding the right solutions, the next step is to connect your member with the right solutions for their specific needs. People can become overwhelmed and discouraged when trying to figure out what solutions they should choose for their unique health journey. The digital navigation solution plays an important role in this stage. The solution centralizes all of your point solutions into a single hub, and integrates them with the larger healthcare and social support ecosystem – to help you replace a disjointed experience with one connected system and drive more value from your investments.
For members that have social needs, the solution enables the care navigators to find and refer the patient to a local resource. When the patient connects with or receives the needed support, the case manager is alerted. The loop is closed.
The digital navigation solution responds to the preferences and evolving needs of each member by connecting with them at the right time, at their preferred channel (web, mobile, email, text). It provides all members a simple way to understand and access the right benefits for them at that point in time. No matter where they are in their journey, they have the technology and tools to make better decisions to choose the right care from the right provider for the right price.
Encouraging member engagement
Most organizations do not know when someone is going to make a significant health decision and don’t have the right mechanism to segment the populations and target them with the right messages at the right time. With the digital health navigation solution, organizations can personalize messaging and content to groups of members with specific needs at the moment that are most relevant to them. In this way, you can connect your members with the appropriate programs, services, or types of care they might need – when they need it. Low-value service utilization is optimized when members are provided the right treatment options before they make care decisions.
Evaluate and optimize
With a real-world picture of your member’s journeys, treatment pathways, and health outcomes, you get the line of sight to see which current point solutions are driving meaningful and verifiable outcomes and which ones are not. This provides you the flexibility to swap in and out of any benefits program anytime.
Digital point solutions broaden access to the kind of support that your people are looking for when it comes to whole-body health and well-being. However given the poor engagement, overlapping capabilities, and high costs, employers and plan sponsors need an entirely new strategy for deploying point solutions — a better platform for driving education, awareness, engagement, and utilization. A digital platform that can streamline the member experience and guide them toward the right care in an increasingly fragmented and difficult-to-navigate ecosystem of point solutions. Connect with us to learn how our digital health navigation solution connects all the point solutions in one integrated system, reconfigures it around the needs of your members, and make it easy for you to see what’s working and fix what’s not.