Innovation plays a role in making healthcare experiences more intuitive, accessible, personalized and affordable.
But navigating the forest of today’s healthcare innovations and services can be just as complicated as picking one’s way through the care delivery journey itself.
“The market is flooded with point solutions, and none are really integrated,” Markus Waite, president of Empara, told PYMNTS CEO Karen Webster for the PYMNTS Matchmakers Series.
“That’s why having a single solution that encompasses all benefits, not just medical or pharmacy but even vision and dental, too, is key,” Waite said.
“Benefits are still very complicated, and folks don’t have a lot of time to understand or navigate them,” he added, explaining that he still finds himself looking up the difference between co-insurance and deductible at times.
The frictions and complexities endemic to the contemporary healthcare landscape make it challenging for both individuals and administrators alike to navigate the world of benefits, even those with years of experience.
“There are so many things that we have as part of a benefit plan that unless you study your summary plan design every weekend, you’re not going to remember those things,” said Waite.
That’s why there is a need for single, simple platforms that simplify benefits, enable self-service and provide easy access to resources when needed.
“There are a lot of different parties in the value chain,” Waite added.
Addressing all of them holistically is key to scaling.
In the world of self-funded plans, where members’ choices can impact costs, empowering them with knowledge and guidance is crucial to providing a best-in-class service.
Having been primed by seamless and informed experiences across the remainder of their lives, today’s consumer wants to be able to understand their benefits, make the appropriate choices for providers, and even evaluate the cost of procedures before taking the next step.
“There are a lot of folks that feel they have to take branded drugs,” Waite said. “They don’t understand that a generic is clinically equivalent … so there are a lot of levers that can be pulled. Most people just don’t have the time or knowledge of what those levers are.”
Making the healthcare benefits journey more accessible and user-friendly, while ensuring that members have the support and resources they need to navigate their health plans effectively, is a way to stand out in the space while building a competitive moat of lifetime value.
“I think the biggest challenges that are out there today are from an interoperability standpoint,” he said. “Until we have unique patient identification, being able to connect all these different systems together and share information seamlessly is such a challenge. [Users] don’t want to have to bounce around and log in and authenticate via the creation of different IDs across different marketplaces and apps.”
“At the end of the day, it comes down to clean data,” he added. “By having clean data and putting solid data quality and data governance practices upfront, you can streamline and simplify some of those challenges.”
That’s why Empara announced the release of its Health Engagement Platform. The platform reshapes complex self-funded health plans into intuitive healthcare experiences for both plan members and administrators.
While Empara’s primary focus is on the member experience, the platform also benefits employers and third-party administrators (TPAs).
Employers that offer self-funded plans require greater visibility into their plans’ performance and the ability to monitor and manage costs effectively, Waite explained, and analytics and metrics can help provide employers with insights to make informed decisions and avoid unexpected spikes in spending.
But Waite emphasized that the lack of unique patient identifiers remains a central and ongoing issue across healthcare, making it difficult to connect disparate systems and share information.
“My name is Marcus, but it’s spelled with a ‘K,’ so you’ve got Marcus, Markus, Marc, Mark … good luck matching all my records — everyone spells it differently,” he explained. “I really think it’s going to be the government that needs to promote this unique identifier until we can make healthcare much more seamless for everybody.”
Modernization can also enhance interoperability and information sharing among healthcare systems.
Hospitals, large health plans, and legacy systems wield significant influence in the healthcare ecosystem. While innovators are working to effect change, the healthcare industry remains entrenched in legacy systems and practices.
“To go back and modernize and re-engineer some of these legacy systems [it’s a huge lift],” Waite said. “Hospitals have large influence; the big health plans and big payers have a lot of influence.”
It will take a collective effort from innovators, providers, payers and patients to drive meaningful change in healthcare, he said, adding that there is “no shortage of innovators out there.”
As for the road ahead, Waite said Empara’s platform is still in its early stages, with a rich product roadmap around the corner, including plans to integrate with wearable devices and health monitoring applications to promote wellness and preventive care.
Additionally, the platform will leverage artificial intelligence and natural language processing to simplify complex healthcare documents and provide users with clear, actionable information.
The journey to improve healthcare experiences is ongoing, but every small step helps carry the sector forward, he said.
We’re always on the lookout for opportunities to partner with innovators and disruptors.
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