The Next Challenge in Digital Health – Payers in the Room #DHIS2022

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Digital Health has embraced customer experiences and practitioners as it widens its focus from clinical applications of digital technologies. There is a deepening recognition that holistic approaches and co-design is essential to the success and adoption of digital health programs. Yet how we change models of payment for care and how services are paid remains a gap in the focus of the digital health agenda.

The Missing Role of the Payer in Digital Health

I spent yesterday at the Digital Health Institute Summit in Melbourne. The event was a fantastic example of the exciting projects across Digital Health in Australia and beyond. Strong progress is now being made to leverage digital technologies into fundamental transformation of the delivery, management and monitoring of care.

The explosion of telehealth in the last two years of the pandemic was repeatedly celebrated as a highlight of the evolution of digital health. The technology, vendors, practitioners willing to use digital means and demand for telehealth were already in place at the start of this period. A key factor in accelerating the adoption and telehealth activity was the openness of Medicare and other payers to fund telehealth to ensure the continuity of care in times of strain on the health system.

Digital health transformation requires us to rethink our approaches radically with a focus on sustainability, We cannot leave how healthcare is funded and paid out of that equation. Multiple speakers across the event referenced the challenges of investment, funding and being paid for service delivery under new models of digital care. However, in many cases the payments were left in a section of presentations as blockers or omitted entirely. Damian Green of Deputy Director General for eHealth, Queensland Health, called out changing models of care and payments as an enabler for the Virtual Healthcare strategy in the state. In the same presentation, Damian highlighted that virtual healthcare is a key part of Queensland Health’s efforts to make healthcare delivery sustainable in the state.

Payments listed as an enabler

Sustainability will mean looking at the value of care and how it is delivered. There are real opportunities to deliver better care for all system participants improving outcomes for patients, payers and providers.

Bringing Payers into the Room

We have realised that digital health solutions can’t be designed without consumers and practitioners in the room and explicitly considered within the solution design. Today, most digital health solutions take payments as a given and sometimes even an issue for later resolution. We cannot move forward throwing the challenge of payments over the fence to finance and operations to manage with payers. Failing to bring payers into the room to support and drive the future of digital health will constrain the next level of transformation.

Payers are not as monolithic as many expect. I work with payers across the digital health landscape every week. The Payers, whether multiple levels of government, government agencies, private health insurers, other insurers, or private individuals are intensely interested in better modes of care delivery and sustainability. Many of these people are creating their own solutions or partnering at the edges with those vendors who will invite them into the room. Through our work at LanternPay, we have seen consistent interest from payers at all levels to drive new digital solutions and to support the payment changes required to make different models of care available.

Fundamental changes in payment structures, process are required to ensure that payments do not become a burden for practitioners or consumers as digital health evolves. Payers want to ensure that these changes contribute to better outcomes, efficiency and sustainability. We need to ensure payments is seen as essential to any digital health project and does not limit the potential breadth of digital transformation in healthcare with a goal of enhancing both outcomes and sustainability.

Payments can be a potential source of complexity for practitioners and consumers, particularly when models begin to change. Bringing Payers into the room to develop solutions that work for all parties, are supported by digital solutions and can contribute to sustainability is key to the next phase of digital health.

Simon Terry is the Chief Growth Officer of LanternPay, a healthcare, disability and aged care digital payments platform. LanternPay delivers health providers and payers innovative simple solutions for the complexity of care delivery across Medicare, government claiming and private health insurance.

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