A growing number of employers are using digital platforms to bridge the gap between plan participants and virtual health providers.
The product is approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder and for use as an add-on treatment for depression in adults. The system works by sending a message from the pill’s sensor to a wearable patch, which then transmits the information to a mobile application so that patients can track the ingestion of the medication on their smartphone. Patients can also permit their caregivers and physician to access the information through a web-based portal.
A year of the pandemic has underscored a critical gap in traditional approaches to keeping Americans healthy. That shortfall is the payer-based health care system’s inability to adequately reach patients in their day-to-day lives, where educated choices and lifestyle adjustments can preserve good health and prevent many chronic illnesses.
While staying at home and practicing social distancing has helped to control the spread of COVID-19 and other illnesses, isolation and stress have worsened chronic challenges and driven many people further into destructive behaviors. Patients often let these conditions develop unaddressed, and payers aren’t aware until they experience serious outcomes and costly treatments down the road. The pandemic has accelerated the process.
Some 50 to 100 million individuals struggle with sleep-related disorders, for example, and nearly 200 million are dealing with anxiety and stress, now exacerbated by COVID-19. Many have sought to ease their distress through overeating, binging on screen time, using tobacco, or abusing alcohol or drugs. This puts them at greater risk, however, as obesity, diabetes, heart disease and respiratory problems are not only potentially life-threatening in themselves but also are among the primary contributing factors in severe cases of COVID-19.
Unfortunately, the traditional health care system has a better track record of treating disease than of promoting healthy living to stave off debilitating conditions. This may be one of the reasons that half of American adults have at least one chronic illness. And although both community-based organizations and digital start-ups are innovating to address chronic conditions, neither camp is all that equipped to sync up with the traditional health care system.
Payers and employers are aware that earlier treatment and prevention of chronic illness through intensive lifestyle, behavioral and social interventions is key to reigning in preventable higher-cost events and conditions. However, with such a fragmented marketplace, it is administratively inefficient to keep up with the many community and digital niche providers who deliver evidence-based services and difficult to successfully engage the consumer in a field experiencing continuous innovation.
A growing number of payers are overcoming these challenges with technology, however. Using platforms available on the market today, they are bridging the gap between plan participants and low-cost, community-based and digital providers to deliver a seamless patient experience. With the right system, a health care organization can efficiently increase member engagement in low-cost, high-touch, frequent and convenient programs to preserve good health, while lowering overall treatment costs by decreasing the advancement of chronic conditions. Let us look at how it works.
Digital point solution management
A digital health management platform can help individuals navigate and make sense of the evidence-based lifestyle, behavioral and social solutions available to them. Based on submitted user data, the system can quickly suggest community and digital providers that match their needs, serving as a digital front door to curated options. Moreover, people are paired to their level of acuity by condition with the ability to move up or down as needed based upon ongoing data monitoring of how consumers are progressing. This ensures that people are getting the right level of support that they need.
Integrating the platform into existing care management or health care management systems creates a uniform and seamless, one-stop user experience in a framework that plan members already use. Point-solution providers are already vetted, and the integrated platform clarifies services covered under existing payer plans, eliminating the guesswork for health plan members.
A high-quality platform seamlessly handles the most painful tasks associated with delivering programs to drive whole-person health, including claims processing, compliance, consumer engagement, eligibility checking, consumer matching, and vendor management. When the platform provider vets, contracts, and manages the entire suite of point solutions, it can offset the payer’s and employer’s costs by millions of dollars each year, while making sure the plan offers the best-performing and most in-demand solution providers.
Bringing simple, vetted point solution connectivity to plan members enables them to improve their health through lifestyle, behavioral and social management. By reducing the factors that lead to chronic illness, these measures are an investment that will reduce overall health costs for all plan participants.
Mary Langowski is CEO of Solera Health.