Preventive Care Investments Help Healthcare Payors Reduce Costs and Improve Quality of Care

With the rise in healthcare spending, payors are evaluating different methodologies to contain costs and improve care delivery.  Major strategic goals for payors include incorporating Social Determinants of Health (SDOH) in policy calculation, shifting to a value-based care model with price transparency, and adhering to interoperability laws. However, the most critical goal is to invest in preventive care and facilitate the shift from reactive to proactive care. Payors can achieve up to 42% ROI over three years by implementing preventive care measures such as promoting lifestyle modifications, building digital health platforms, and launching apps.

These emerging trends are covered in Avasant’s Healthcare Payor Digital Services 2022–2023 RadarView^™. The report is a comprehensive study of digital service providers, including top trends, analysis, and recommendations, taking a close look at the leaders, innovators, disruptors, and challengers in this market.

Avasant evaluated 45 providers using three dimensions: practice maturity, partner ecosystem, and investments and innovation. Of those 45 providers, we recognize 21 that brought the most value to the market during the past 12 months.

The report recognizes service providers in four categories:

• • Leaders: Accenture, Cognizant, Infosys, Optum, and Wipro
  • Innovators: Capgemini, HCL, IBM, Infinite Computer Solutions, NTT DATA, and TCS
  • Disruptors: Atos, Firstsource, Mphasis, Tech Mahindra, and UST
  • Challengers: Exela Technologies, Hexaware, Mindtree, Persistent Systems, and Virtusa

Figure 1 from the full report illustrates these categories:

“Payors are under constant pressure to optimize the cost of care while improving its quality,” said Nishant Verma, Avasant partner. “Through investments in preventive care, payors are not only containing costs by reducing admission rates and identifying high-risk patients, but they’re also establishing a direct connection with members.”

Matthew Barlow, partner, Avasant, added, “Payors are investing heavily in digitally-enabled platforms, tools, and devices to get closer to members, offer price transparency, and remotely monitor patients through preventive apps, wearables, and IoMT devices.”

The full report includes a number of recommendations for healthcare payers, including the following. Healthcare payors should:

1. Expand their focus on preventive healthcare to manage costs and the quality of care.
   • Increase direct and real-time connection with members through apps and health monitoring devices to intervene proactively and facilitate home-based care.
   • Leverage population health analytics to identify high-risk patients with chronic diseases for developing targeted campaigns, spreading awareness, and providing personalized services.

2. Accelerate investments in interoperability to comply with regulations and enhance care delivery.
   • Assess evolving regulatory mandates, cybersecurity, and broader digital transformation requirements to facilitate a secure exchange of health information within the healthcare ecosystem.
   • Develop digital platforms, frameworks, and application program interfaces (APIs) in-house or in partnership with major healthcare platforms such as EPIC to expedite interoperability adoption.

3. Prioritize investments in intelligent automation (IA), artificial intelligence (AI), and analytics to manage claims, providers, and members.
   • Integrate IA into core processes (such as auto fills for pre-authorization in claims, answering member queries, and extracting and validating provider data) for streamlining processes.
   • Scale-up investments in AI and analytics to accelerate the shift to value-based care and provide price transparency and provider reviews for enhancing member experience.

“Digital technologies such as predictive analytics, AI, and RPA are vital to estimate policy price and risks, provide personalized care, and improve member engagement,” said Pooja Chopra, research leader with Avasant. “To assist with prioritization of digital investments and projects, progressive payors must partner with the right service providers.”

The full report also features detailed RadarView profiles of the 21 service providers, along with their solutions, offerings, and experience in assisting healthcare payors in digital transformation.

This Research Byte is a brief overview of the  Healthcare Payor Digital Services 2022–2023 RadarView™ (click for pricing).