How 3 payers are using digital health platforms to improve members' outcomes

As payers increasingly look to meet their members where they are, digital solutions, platforms and benefits have become a widespread expectation from consumers and employers.

But choosing the right vendor to partner with on what will be a long and complex integration process is key to ensuring the program's success and above all, improving members' health.

Becker's sat down with product executives at three leading payers from across the country to learn more about where they are in the process of implementing or using Virgin Pulse digital health and well-being platforms to improve patient outcomes — and what other payers should know when looking to invest similarly.

Priority Health 

All of Priority Health's commercial, individual and Medicare members have access to the Virgin Pulse Wellbeing Hub, which is about 800,000 people. The Wellbeing Hub has tools and resources designed to help members track their health behaviors and learn new behaviors to improve their health. Large commercial groups have access to PriorityWell, which includes more engagement opportunities such as robust digital journeys, incentives, programs and challenges.

Though only recently launched this year, Grand Rapids, Mich.-based Priority says it expects the new offerings to translate into higher member productivity, less illness and chronic disease, and improved overall mental well-being. 

"We're really confident that this is a comprehensive approach to employer well-being and member health engagement that will garner positive outcomes and results that we're looking for," Alicia Coronas, vice president of employer solutions products, said. "It's really about helping our community of members that we serve to manage and improve their health beyond just processing claims and other responsibilities."

Priority's goal is to create a balance of program efficiency, ease of customer use and meaningful customization at the member level that drives engagement. 

Ms. Coronas' advice to other payers looking to implement similar programs is to recognize that implementation is not a one-and-done deal. Priority looked for a platform partner that could easily grow with members, provide flexibility to large and small customers, and one that is aligned with its own mission and strategy. The company wanted to know about Virgin's use of data and its knowledge of the market. Finally, a platform that was able to seamlessly integrate with Priority's systems was key.

"As long as you are aligned on that strategy upfront and the vision you're seeking in terms of outcomes, and identifying key needs like integration, then you can work through the implementation challenges," Ms. Coronas said.

Medica 

Medica is a Minnetonka, Minn.-based payer that provides health coverage to 1.5 million members across 12 states.

Medica has offered digital health and well-being platforms to its members for over two decades and has been with Virgin Pulse for four years. Through the platform, members can access health journeys, healthy habits resources, incentives and challenges, and integrate their health journey with wearables. Ken Dickson is the company's senior director of commercial product strategy and development and said the two companies also integrate their individual third-party point solutions with one another.

"They help us keep up and we push each other to get better in our spaces," he said. "I think we do it better together than we could if either of us were doing it by ourselves."

According to Mr. Dickson, Medica is able to offer products that engage with members more deeply through the Virgin platform, which are the types of benefits employers want to attract and retain talent. He says the integrated platform with an easy-to-use interface is a key piece of the platform's success with Medica's members.

In terms of improving members' health outcomes, engagement with the platform tools has led to improved health risks and non-deterioration of health compared to members that aren't as engaged with the platform content. For example, if a Medica member becomes pregnant and seeks support through the digital platform Ovia Health, Medica can then start providing them with immediate support instead of waiting for claims information from a checkup to inform the payer that the member needs maternal support.

When beginning the search process for a digital health vendor, Mr. Dickson said it's a companywide effort. Medica's service center is consulted to assist with evaluation to ensure the two organizations' cultures and technological abilities align. Medical and health services staff are consulted to guarantee that the content offered aligns with Medica's mission. Other criteria include being clear about what technology is needed, member satisfaction with the product, quality measurements and cost. The total process, which includes advisory panels made up of providers and members, takes around 12 to 15 months.

"It all goes back to getting the member to be curious and to touch something that they think is going to benefit them," Mr. Dickson said. "And having that user experience be rich enough and the content be something to pull them in so that they engage and it becomes a sustained relationship between the members and our tools." 

BlueCross BlueShield of South Carolina

Columbia-based BlueCross BlueShield of South Carolina is the state's largest payer and has operated there for more than 70 years. 

BCBS is currently in the throes of implementing its partnership with the Virgin Pulse platform and expects just under a million members to gain access starting in 2023.

Kasey How is the director of product development/management and marketing communications and said the Virgin offerings that appealed to the company include how it engages with members, the platform customization, the ease of integration with BCBS, the nonstatic experiences and the cost.

"When we make these transitions, it's not a quick turn," she said. "When we're making the investment of time and resources, we want to make sure that we're finding a partner that can be that fit in the long term."

Through the platform, member benefits will be able to be customized by group to potentially include reward programs that incentivize exercise through additional paid time off, copay waivers, health savings account deposits or even annual premium reductions. 

Ms. How said the platform will help the company focus on members' social determinants of health, find care gaps and communicate with members about those gaps using better data and analytics. 

"If we know that you have a chronic condition, or we know that part of your wellness program is an annual wellness tracking and you're not doing it, we'll be able to see that," she said. "If they haven't done XYZ, they get the email and they get the text, they get all of that. Those kinds of nudges and prompts help us close gaps, and that's one of the measurement points — the percentage of people that did what they were supposed to do versus those who didn't."

Ms. How's advice for payers looking to implement similar programs is to go deep into the details because every partnership with every vendor will be different, and being intentional about what you are looking for will help accomplish the outcomes you're looking to achieve.

"I wouldn't underestimate how complex these things can get," she said. "The goal is to build it right the first time so that there's not a lot of manual intervention as we go, or member disruption. Also be really upfront about where you are, your road map and don't bite off more than you can chew. It's okay to crawl, walk, run."


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