By Jacob Sattelmair, CEO and co-founder, Wellframe

August 2021– American healthcare has struggled for decades with two persistent, intractable problems: the rising cost of care and, simultaneously, a poor patient experience.  

The US spends nearly $4 trillion annually on healthcare. Many of us benefit from the most cutting-edge medical technologies and the best-trained professionals and caregivers. Yet we often don’t get the best health outcomes, due to inequitable distribution and the inability of the health system to address chronic conditions effectively. The pandemic threw these issues into stark relief.  

Inequitable access remains 

Most attempts to fix the system have focused on regulation, coverage mandates, and a variety of attempts to incentivize coverage. While coverage has increased, millions of people remain uninsured. The covered are no doubt grateful for access to some of the best healthcare in the world, but many remain frustrated with the quality of their interactions with the healthcare system. 

I believe the solution lies within the system. To address the challenges of cost and patient experience, health plans need to reimagine the nature of their relationships with members. The time has long passed when health insurance companies had a primarily financial relationship with their members, collecting premiums and paying costs.  

Now, increasingly, health insurance companies have a more symbiotic relationship with their members. A wealth of health data puts the organizations in unique positions to create new models of healthcare. They have an almost limitless ability to improve health outcomes and the patient experience. It’s time for them to recognize this and more fully engage and develop these relationships.  

The digital care opportunity 

The deployment of digital care is a large area of opportunity. The model can facilitate more consistent engagement between health insurance companies, healthcare providers and patients. 

For example, healthcare providers don’t often have the ability to connect directly with their patients outside of the walls of the hospital. Telehealth technologies have long been available but had not been widely adopted until the pandemic forced the need for alternatives.   

Once health plans started reimbursing for telehealth visits and regulators began encouraging virtual care in 2020, everything changed. It took a global crisis to simultaneously overcome these structural, behavioral and attitudinal barriers. 

From episodic care to continuous engagement 

But telehealth is only one component. Simply moving the current model of healthcare from doctor’s offices into virtual visits will not solve the problems. The healthcare system was built for episodic care, whereas the most serious health issues require continuous engagement.  

Clinicians’ primary jobs are to provide support to individuals in response to acute conditions, yet chronic conditions account for the vast majority of healthcare costs. According to the CDC, 60% of adults in the US have a chronic disease, and nearly 40% have two or more chronic conditions (aka multimorbidities). This accounts for 90% of the United States $3.8 trillion in healthcare expenditures. 

To care for people with multimorbidities effectively, support between clinical encounters is required — something that is very difficult for healthcare providers to do effectively in practice.  

This is where digital care can make an enormous difference. Digital care management technologies can help give care exactly when and where it’s needed. Health insurance providers can take advantage of smartphones, for example, to send medication reminders, offer wellness incentives, provide answers to common health questions, and communicate care, coverage and benefits information. 

The results can be dramatic. In a peer-reviewed study published in the Journal of Medical Economics, researchers found that ongoing digital health management through a smartphone app reduced emergency room utilization by 9%, lowered inpatient admissions by 17% and increased the use of preventive medicine by 29%. 

There was a follow-on benefit for the health insurance providers as well. The use of a digital care management solution resulted in a saving of $641 per member per month over the three-month period studied. 

This is a precious opportunity. If health plans can capitalize on it, they can change the paradigm of what it means to be a health plan, and contribute meaningfully to reducing healthcare costs, improving patient experiences, and improving healthcare outcomes overall.  

 About the Author 

Jacob Sattelmair is president, CEO, and co-founder of Wellframe. He is a Harvard- and Oxford-trained public health scientist and technologist. Jacob’s work and research lie at the intersection of healthcare, technology, data analytics and consumer engagement. You can reach him at jacob@wellframe.com.