February 9, 2023How Payers Can Overcome Longstanding Barriers to Innovation & Growth

Healthcare Payers are frustrated by the long-standing challenges that have become a barrier to success. There are three main challenges that form this barrier.

The first issue is confusing and opaque pricing, which ultimately leads to unsustainable medical loss ratios. There is a universe of network and healthcare provider options available to you, but your time is valuable and finite. If you lack the data, analytical capabilities, and internal resources to adequately evaluate these options it’s impossible to select the optimal choice for your member populations. This scenario leads to higher costs for both healthcare Payers and patients.

The second challenge is that we are in an era of digital health vendor proliferation, which further exacerbates the confusion with more options to evaluate. With over 11,000 digital health vendors, it is overwhelming and difficult to thoroughly evaluate options and ultimately select best fit solutions. Every time you invest in a new point solution, technology solution, or digital health vendor, you’re taking a risk because of this gap in time and insight. The impact of making the wrong decision is felt for a long time, leading to slower decision-making processes and action-fatigue. Reporting on the success or failure of your solutions holistically is almost impossible, making it incredibly difficult to determine the next best action.

In a quote to Digital Health, Jared Antczak, Chief Digital Officer at Sioux Falls, Stanford Health said: “It can be really overwhelming to try and pick your spots as an organization to make sure that you’re going to get the best value for your patients and a good return on investment.” 

The third issue healthcare payers are facing is inefficient point-to-point connectivity. Each Payer has numerous supplier connections and continually adds more. These disparate connections limit flexibility and connectivity reusability, which in turn limit data aggregation, analytics and reporting capability, leading to higher administrative costs and inefficiencies in the healthcare system.

Payers are all too familiar with these challenges, but do not need to accept this as the status quo any longer. There is a solution: an Intelligent Healthcare Market.

What is an Intelligent Health Market?

An Intelligent Health Market brings the power of a marketplace to healthcare, using data to provide a guided purchasing experience of solutions that are specifically designed for you. Equipped with an unbiased view of the provider networks and health solutions partners that bring the most value and best fit the needs of your specific member population, you’re able to select solutions that reduce costs and improve healthcare quality. The decision-making process is easier, faster, and more holistic.

Intelligent Health Markets also enable healthcare payers to connect to their entire ecosystem of preferred partners through a single connection, performing seamless data and operational exchanges with multiple partners. This provides the flexibility to integrate with best-in-class service providers, drive down the cost of integration and deliver it on a much faster timeline.

In an Intelligent Health Market, payers are able to proactively identify additional savings opportunities and leverage those savings to fuel innovation and growth within their healthcare system. Altogether, it becomes easier to provide your member populations with better quality and better prices, while increasing performance within your healthcare system and conserving its resources.

MacroHealth creates Intelligent Health Markets

This is the MacroHealth Intelligent Exchange platform (see graphic). The platform provides a marketplace experience for payers to access and shop for healthcare services in a way that’s more intelligent, efficient, and holistic than what was previously possible. There are two main components which support and drive the marketplace experience: Optimize and Connect.

Optimize shows you the macro view of your opportunity. This component allows you to identify optimal provider networks and health solutions partners for your patient population – and ultimately find solutions that measurably and dramatically reduce costs without benefit erosion.

Connect enables you to integrate to your preferred networks and partners after you’ve created your solutions. For payers, integration with provider networks and health solutions partners has always been an arduous process, requiring significant amounts of time, cross-company collaboration and draining scarce resources. Through Connect, you have an easy and efficient, single-point connection to your entire healthcare ecosystem, so you can more effectively allocate time and resources. A single connection also allows you to understand the holistic performance of your solutions, and leverage endless opportunities to innovate and differentiate your network solutions to deliver high-quality, cost-effective care.

Underneath Optimize and Connect, the platform relies on a Data Factory and technical infrastructure to enable and support the marketplace experience. The Data Factory is a substantial data lake, which includes your data, 3rd party data, and MacroHealth data. This powers your ability to make actionable decisions and get in-depth reporting.

The infrastructure and our technical capabilities that underpin it all allows our platform to run intelligently. These powerful capabilities include AI and machine learning technologies which automatically recognize trends and patterns for you to leverage in your decision-making process. It also includes interoperability with our customers’ partner ecosystems which are compatible with both older EDI standards to modern FHIR standards.

Together, it all forms the MacroHealth Intelligent Exchange Platform, creating a seamless and intelligent marketplace for health services. An Intelligent Health Market.

Healthcare payers are presented with a plethora of obstacles which impede the ability to identify and capitalize on opportunities, evaluate performance metrics, and optimize efficiency and cost savings. However, it is no longer necessary to accept this as a regular aspect of your role and the industry at large. An Intelligent Health Market, like the ones created by the MacroHealth Intelligent Exchange platform, is a solution that can address these challenges by leveraging the power of data and a marketplace approach so you can drive savings and improve the overall performance of your healthcare system.

Sign up for the MacroHealth newsletter to learn more about how MacroHealth’s platform can help you overcome the challenges affecting healthcare business leaders today or contact us to speak with an industry expert.

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