July 10, 2020

Measuring Digital Health Maturity: The Adoption of Digital Health Solutions by Payers in the US.

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HealthXL Research Team
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For long, healthcare payers have been digital laggards, seemingly reluctant to embrace the many opportunities and benefits digital (health) has to offer. Digital disruption, however, has begun encroaching on the industry! Slowly but surely we are seeing payers explore and embrace the true value and potential of digital and yet, it is difficult to ascertain to what extent leading insurers are actually engaging with digital to drive real change. With this in mind, this quarter, we assessed the digital health maturity of leading plans in the United States.

A recap of the self-assessed maturity of some of the top US health plans

Payer coverage is heavily dominated by six large health plans, however, plan innovation and new entrants are changing the landscape. Digital (health) offers payers many great opportunities to tackle some of the industry’s greatest challenges. The potential modalities of engagement are manifold and the solution types are even more diverse - ranging from screening and diagnostic solutions to administrative focused solutions. Digital health can help payers improve member satisfaction, increase efficiency, whilst lowering costs, create better member outcomes and collect higher quality member data. Payer investments in and partnerships with digital health companies have grown nearly exponentially since 2013 (see Humana’s investment in Livongo; Aetna’s partnership with Talkspace etc.)

Increases in investment acquisition and partnerships over the previous 5 years
Increases in investment acquisition and partnerships over the previous 5 years

While there is clear evidence that payers are engaging with digital, we delved deeper in this latest report, honing in on digital health strategy & vision, investments & partnerships, outcomes & impact, culture & leadership, as well as resources & support. We asked the top health plans directly and here is an excerpt of what they said about their digital maturity:

Strategy and vision

Our investigation suggests that payers are actively engaging in digital health, with nearly half of respondents having a solid digital health strategy in place. Our data also revealed that payers are active participants in the investment craze - 88.8% told us that they invest moderately to extensively in digital. As the world adjusts to living alongside Covid-19 and the remote ways of life, we expect this figure to continue to rise. So while initial investments in this space may have been tentative and high-risk, engagement with digital is now essential for business to remain afloat alongside competitors. 

Extent of US payer investments in digital health 

Outcomes and impact

We investigated how outcomes and impacts of digital health solutions are measured and if they align with organization and member objectives. Currently, digital health initiatives reach as little as 35,000 members and as many as 2 million. Despite the enormous potential, less than half of plans say they have been able to demonstrate positive member outcomes and impact through these initiatives. This result reveals that although the value of digital health is evident and intrinsic to business solutions, ROI is more difficult to establish (in the short term) and may take longer to quantify.

Range of members impacted by digital health initiatives
Range of members impacted by digital health initiatives

Culture and leadership

Digital is gaining traction and payers are focusing on creating an adaptive as well as flexible culture to facilitate digital transformation and innovation. We found that over half of payers adopt a digital-first mindset when it comes to finding new solutions. Although positive and encouraging, these organizational tendencies do not necessarily translate into meaningful initiatives, unless, they are truly championed at the top. 

Extent of digital first mindset among payer organizations
Extent of digital first mindset among payer organizations

Resources and Support

We discovered that payers are well resourced to manage their transition to digital. 75% have dedicated budgets and funding in place to support their digital health strategy. This result is very reassuring as access to essential resources and support sets the scene for a successful digital health journey!

Extent of digital strategy and dedicated digital health funding among payer organizations
Extent of digital strategy and dedicated digital health funding among payer organizations


So, what next? 

Results of our assessment demonstrate a clear digital evolution in the US payer market. Health Plans are aware of the opportunities and have a clear digital health vision and focus. The majority of the plans we spoke with through the course of this report have been dabbling with digital health initiatives more actively than we previously knew. This surprised us - in a good way! However, experimentation with new business models, large scale investing and partnering across the spectrum outside of ‘member wellness’ or ‘employee wellness’ is still in its nascency. 

We have the data and we’ve laid out the facts! Now we want your opinions!  For payers, this report shows how you stack up in your digital journey against your competitors. If you work in the payer healthcare space, and would like to provide us with your feedback or participate in our post-report survey, get in touch with us! 

The full report is accessible to all HealthXL members on our Insights Platform. 

Not a member, but would like a copy of the report? You can get a free preview of the report here. If you would like to get access to the full report, contact our customer team here.



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