3 Strategies for Sustaining Payer Innovation Momentum Post-COVID

September 21, 2021 - The coronavirus pandemic set off a whirlwind of payer innovation, largely out of necessity.

In the health insurance world specifically, payers continued to advance new products during the pandemic. Aetna started its new employer-sponsored health plan that uses CVS HealthHUBs and the payer’s I-35 Performance Network of providers. Google’s Verily launched a self-funded employer plan and Walmart ventured into Medicare coverage.

The healthcare industry as a whole has grown more adventurous in its technology utilization. Venture capital investments in healthcare technology doubled in 2020 to hit $14 billion, the highest level of investment in at least a decade. Investors anticipate pursuing long-term opportunities into 2021.

As a result, some major health insurers—such as Centene—sought to acquire healthcare technology companies to support their innovation.

McKaye Black, senior design and business innovation strategist at C1 Innovation Lab, and Summer Wright, associate vice president of design and innovation at Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma, and Texas, were in the thick of this whirlwind. 

READ MORE: How Payers Can Cultivate Consumer-Centered Digital Innovation

Blue Cross Blue Shield’s C1 Innovation Lab is a solution hub that serves five HCSC Blues plans. The lab’s role is to forge creative solutions for improving member experience and supporting member health journeys. The team members have experience in customer service, design, data analytics, technology, research, and more.

To Wright, innovation is part of a health insurance company’s job description.

“There is a huge responsibility that we have—even outside of digital—in being a part of that process to help ensure the support needed for individuals’ health journeys,” Wright explained to HealthPayerIntelligence. “Whether it be through the provider network, the care management support that we're providing, benefits administration, end to end payers are a part of that. So it's our responsibility to improve and positively affect that experience in any way that we can.”

Based on their experiences in the C1 Innovation Lab, Black and Wright identified a couple of key areas for payer innovation and shared how payers can accelerate innovation with member involvement and effective data collection and utilization. 

Identifying opportunities for innovation

Black and Wright highlighted three major spaces that are particularly ripe for payer innovation as the pandemic becomes more manageable.

READ MORE: Lessons from Medicaid on Social Determinants of Health Innovation

First, care delivery and access to care in behavioral healthcare have seen a lot of development in the past year as the coronavirus pandemic forced payers and members to rely more heavily on technology for behavioral healthcare services. 

Despite the advancements in behavioral healthcare innovation among payers during the pandemic, the industry still faces unresolved issues in this space. 

Stigma, gaps in the scientific knowledge around certain behavioral health conditions, workforce shortages or overall restricted access to care, and a lack of interoperability continue to pose barriers to behavioral healthcare, according to a Deloitte report. 

Aside from directly addressing each of those four issues through cultural change, scientific advancements, better access to care, and improved interoperability, the industry should enable members to make informed decisions about their own behavioral healthcare, the researchers argued. Each of these action items provides opportunities for innovation.

Caregiving is another area that could continue to experience a lot of innovation when the coronavirus pandemic’s grip on the nation starts to weaken, Wright suggested. 

READ MORE: Top 4 Recent Health Payer Innovative Consolidations, Partnerships

For example, during the coronavirus pandemic Blue Cross Blue Shield’s Regence health plans in Idaho, Oregon, Utah, and Washington collaborated with Best Buy Health to connect Medicare members with caregiving technology.

In order to alleviate the burden on caregivers, the app supports autonomous living among seniors. Its features include a personal emergency response system and social determinants of health resources.

While caregiving is most often associated with care for the elderly, Wright pointed out that caregiver innovation could also be crucial for situations such as handling self-care after surgery. Caregiving technologies like Regence’s tool can include features that allow caregivers to check in on their loved ones remotely.

Third, payers may build up impressive momentum to pursue community or social determinants of health innovation following the pandemic. 

Healthcare leaders have indicated that they are eyeing these areas for innovation in the future. California Health Care Foundation and Manatt Health surveyed almost 200 health care experts across various sectors of the healthcare industry and published its findings in February 2021. 

The researchers found that behavioral health and social determinants of health referral platforms were two types of technologies that experts expected to have the most significant impact on California’s Medicaid program in the next ten years. 

Eight out of ten respondents thought that the coronavirus pandemic had amplified technological innovation related to social determinants of health.

Only a small share of healthcare leaders thought that caregiving technologies would strongly impact the future of technology innovation in that state specifically, but the possibility still surfaced.

Involving members in the innovation process

In order to improve healthcare innovation for members, Wright and Black recommended that payers involve members in their innovative processes. As with any effort to improve member experience, gathering member insights and data can ensure that payers are channeling their energies into the most effective solutions.

At C1 Innovation Lab, there are a couple of ways that the payer innovation space receives member feedback.

Individuals can call into the lab in order to share their member experience and ask questions. In these situations, members proactively reach out to the payer team to offer direct feedback. The lab’s experts are trained to understand the expressed and unexpressed needs in these conversations, Wright said.

Additionally, C1 Innovation Lab may conduct “onsite” engagements. 

The lab’s experts will reach out to clinicians at appropriate care sites in order to better comprehend the challenges that a certain member population may face. Then, the payer may contact individuals in that member population to interview them about their own decision-making processes and barriers that they may face.

The lab has taken this approach with musculoskeletal issues, oncological challenges, member engagement improvement, and on-demand pediatric care.

Finally, the payer will engage in an iterative approach to including member experiences in the innovation process.

Using the data gathered from brainstorming sessions, interviews, claims, and other sources, the payer will begin to build a solution. As the payer tests its solution, it brings in individuals from the target member population to get their input.

Leveraging data for innovation effectively

As C1 Innovation Lab’s member involvement strategies demonstrated, data is key to innovation. Finding data to analyze is not a barrier. The industry has more data at its fingertips than at any other time in history.

Wright recommended starting with the big picture and then using data to fill in potential knowledge gaps.

“There is so much data that you can really get lost in it,” Wright said. “So it goes back to our ethos. It is really important for us to start with the opportunity area, the challenge, the member journey, and then work backward to appropriately line up all of those ways to understand the problem better through data.”

Black added that partnerships are key to using data effectively in innovation.

“We recognize we can't possibly know everything that there is to know about healthcare or about people's healthcare or health journeys in general just on our own,” Black acknowledged to HealthPayerIntelligence. “So it is really important for us to connect with other groups, with other community partners, with the academic community, with the startup community.”

For this reason, the payer designed the C1 Innovation Lab to be a hub that can bring together partners from various backgrounds with different data resources in order to forge solutions.

“In the last four years since we’ve opened, we have put different strategies in place where we have opened our doors to communicate with providers, with academic systems, with our Blue Cross partners,” Black shared. “One of my goals for the future would be to continue on that path.”

The wave of accelerated innovation in the healthcare industry does not have to end with the coronavirus pandemic. Payers can continue the momentum by seizing opportunities, incorporating member feedback, and employing data appropriately.