Digital health ecosystems: opportunities for insurers

Digital ecosystems put the user, or a patient at the centre; and allows to manage their lifestyles far better than before.

Ecosystems are based on technology platforms that act as a digital backbone, granting connection among all stakeholders. An ecosystem facilitates data exchange and allow participants access to a variety of services.

The emergence of new service offers gives those parties the opportunity to engage with consumers more regularly through a variety of channels. These regular touch points, along with the digital health services, create an opportunity to improve user experience.

A digital ecosystem allows real-time services connection with the aim to provide a complete healthcare offer to every user. The user will find all services available with the aim to stay health.

Ongoing healthcare transformation

Digital health ecosystems are a recent business model that is affirming its value in recent years. The creation or the participation in a health ecosystem is a key strategic decision for an insurer, it is a creation that can lead to incremental value and robust competitive position.

Changes in the healthcare arena require every insurer to take a well-informed decision regarding their role in the health ecosystems world.

Some key trends are the foundations of digital health ecosystems

Ageing populations and chronic diseases

Life expectancy is steadily increasing in western countries, in the European Union life expectancy at birth is steadily increasing both for males and females: between 2002 (the first year for which life expectancy data became available for all EU Member States) and 2017, life expectancy in the European Union increased by 3.2 years.

Another dynamic of great impact on the world of health, both public and private, is the growing spread of chronic diseases. The high chronicity is a hallmark of advanced economic development countries and is at the same time an element of criticality for their health systems. The problem of chronicity is, however, a challenge of primary importance for the future of all world populations since, as the World Health Organization highlights, chronic diseases are "health problems that require continuous treatment over a period of time for years in decades ”and will require the commitment of up to 80% of healthcare resources worldwide.

Data proliferation via sensors and high-end technology

This decade the generation of health data increased exponentially; International Data Corporation (IDC) estimates that health data volumes are growing at the rate of 48% per year. One of the biggest challenges of the healthcare industry is that all these data are located in silos that very often are not connected to each other, as electronic health records (eHR), claims systems, clinical data and a new type of data as those that are generated by wellness platforms. In some country also public and private data communication represent an important issue. The need for standard is evident and will allow the development of the industry, and therefore of our health, at a greater speed.

Digital therapeutics

Digital therapeutics (DTx) deliver evidence-based therapeutic interventions to patients that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes. In general digital therapeutics are defined as treatments based on digital and web-based tools to cause changes in patient behaviors.

Digital therapeutics relies on the usage of large amounts of clinical data, they also need extensive research and trials, which also need to be tested for efficacy of results.

Digital therapeutics effectiveness can be leveraged within an ecosystem, due to the availability of a broad set of data; users and patients are also getting more open to digital interventions. The flexibility, the avoidance to travel and the time saved are key features that also an insurer can benefit from.

Consumers demand digital health experiences

Healthcare industry is not as developed as others in terms of customer experience. But patients are already used to top end customer experience in other sectors, therefore they are expected to be treated accordingly also when their health is concerned. Healthcare executives in a recent survey reported by the New England Journal of Medicine (NEJM) said an improved customer experience is the top area in which healthcare can learn from other industries.

Current Issues

Digital health ecosystems can provide a response to the main healthcare issues.

• They enable the foundation of data bridges along the patient journey, that in most of the cases is fragmented.
• Today most of the actors along the patient journey cannot have access at all relevant patient’s data, that are split into silos.
• Little prevention is part of our life; we encounter the healthcare world when we are already sick

ECOSYSTEM STEERING

The role of the insurer will depend on who controls the ecosystem. Different parties can control an ecosystem, who controls critical points in the ecosystem will impact other stakeholders.

Government steering

Government define general policy; it is less likely that it controls engagement. The government set policies regarding data, and the criteria of sharing and access. Its role and contribution vary by country and can be one of the most relevant success factors as an innovation enabler.

Ecosystem players steering

Some ecosystems can be steered by the health tech players that designed the interface. As ecosystem sponsors define how data are exchanged between parties, they define sector standards. Apple is taking on such a steering role, shaping use cases, solutions, contracts, and policies.

Healthcare provider steering

Healthcare providers can steer an ecosystem managing most of digital assets. Healthcare providers can be both a payer and a provider within the same ecosystem, managing end users and generating loyalty with value-added services.

Insurer steering

One insurer can steer and own at the same time an ecosystem. Additionally, an insurer can play different roles. For example, an insurer can manage financials, set up personalized services, define access criteria, and data sharing rules. Therefore the role of an insurer can be extremely relevant embracing many services and having control of several aspects of the ecosystem.

DIGITAL HEALTH ECOSYSTEMS: VALUE AND BENEFITS

Being part of a digital health ecosystem provide participants with several benefits.

• Innovative solutions targeted to individuals. The availability of data is a great value for all ecosystem’s partners. Payers, providers, fitness devices can develop better, and innovative solutions targeted to individuals and to groups.
• Communication improvement. The utilization of data that previously were unused will allow stakeholders to develop a robust comprehension of user needs.
• Increased automation. Data sharing among all parties will enhance data availability and data quality; as a consequence, manual processing is reduced, and advanced automation technology can be developed.
• Early detection and intervention. Especially for chronic disease continuous monitoring will allow both to adopt a better lifestyle and to understand as soon as a symptom arises.

CHRONIC DISEASES AND MENTAL DISORDERS

Mental disorders are common in chronic illness

Mental health disorders are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. They are medical conditions that often result in a reduced ability to cope with the routine daily activities such as going to work or managing a family. As chronic diseases, mental health disorders can be treated.

4.3 % of all deaths in the European Union resulted from mental and behavioral disorders and 14 % of all hospital beds in the European Union are psychiatric care beds; 1 in 10 Europeans aged 75 years and over reported chronic depression.

Mental and behavioral disorders include dementias (mental disorders characterized by memory disorder, personality change), schizophrenia, and lifestyle influenced disorders (such as alcohol use or drug dependence). As for chronic diseases, there are certain factors that can increase an individual’s risk of developing a mental health disorder.

Ecosystem approach to chronic and mental diseases

The patient journey enabled by a digital ecosystem can leverage all the data and information regarding the patient to grant timely support also for mental disorder’s needs.

According to the National Institute of Mental Health of the United States people who suffer from a chronic disease are more likely to also suffer from depression and other mental illnesses; therefore a holistic treatment of both chronic and mental illness can provide great value to all stakeholders, also to employers.

The ecosystem model has all the features to provide great responses to today’s issues related to the fact that seldom the patient journey encompasses both chronic and mental illness needs.

Innovative solutions that can be part of an ecosystem

Digital therapeutic solutions can be part of the digital ecosystem, have great potential in overcoming the problems inherent in traditional approaches to mental therapy. Some innovators in this new arena are Talkspace, an online therapy app that links users with licensed therapists; Calm, a sleep and meditation app; and Feel, a wearable designed to monitor the user’s emotional state.

An insurer that is willing to manage a digital health ecosystem should adopt a broad view embracing also mental disorder, to provide the greatest value to patients and all stakeholder.