Digital health has presented many opportunities for people on all sides. Telemedicine and other forms of health technology have increased convenience and accessibility for patients, productivity for health care providers, and reimbursement for payers. But what most people don’t see is the shift from standard service-based care to unique, premium-based insurance products, such as case management, risk assessment, and analytics. While such services have consumed close to half of insurance company revenue, this category presents unique challenges for many parties involved.

Some health plans may experience losses early on due to investment in digital health startups. In most cases, the profits associated with these organizations are ample, so insurers can usually expect to recoup that money in time. However, some insurance companies may also need to absorb costs associated with management of these high-level partnerships.

Another potential obstacle to insurance companies is the competition between established providers and new acquisitions. This can be more difficult to manage, especially when conflicts arise. Similarly, insurance companies need to account for increased firewall and fraud protection to safeguard all members and providers.

Conversely, the surge in telemedicine also affords insurers and members opportunities. Since there is much more tracking and data associated with these forms of technology, there are many outcome measures to support this mode of service delivery. These metrics also allow insurance plans to connect their members with more effective and useful services.

As you can see, there are a range of considerations for any insurer when it comes to digital health. But the general consensus is that this trend is here to stay and insurers must invest adequate time and resources into this sector of health care. While it may seem that transferring risk from payers to providers is a sound move, this is not in the best interest of insurers. The best move is to distribute the associated risk evenly across all parties. This allows payers and providers alike to conservatively take advantage of all that the digital health arena has to offer.

If you want to further mitigate risk for your company and improve the status of your provider network, reach out to TOG today.