THOUGHT LEADERSHIP
Moving from fragmented vendors to a connected member health journey
By Bill Rodakowski, Vice President, Health Plan Strategy, Teladoc Health
For much of the past decade, digital health solutions had to prove they could improve access, engagement and outcomes. In conversations with health plan leaders, we’re no longer debating whether virtual care works because they’ve seen the value it provides.
The problem is that healthcare has become exceptionally good at solving individual problems. The challenge is that success within individual programs doesn’t automatically translate into population-level results.
“Point solution fatigue” has been a topic for years, but it was never just about the number of vendors. The fragmented experience created by specialized programs has been limiting health plans’ ability to achieve the outcomes they care most about.
Not long ago, health plans were focused on identifying the best solution for a particular condition. Success was measured program by program. Today, the focus is expanding. Health plans are increasingly evaluating how care is delivered across members’ entire journey and the impact on their overall health and not just individual conditions.
This shift reflects the realization that the biggest opportunities to improve outcomes exist in the gaps between conditions. A diabetes program may improve diabetes outcomes, but members rarely experience diabetes in isolation. Obesity, hypertension, depression and other conditions are often present.
Bringing together solutions across related conditions is an important step forward. Still, each solution provides only a limited view of the members’ overall health. Where health plans are finding opportunities to improve outcomes is seeing the full picture rather than a collection of individual conditions.
Healthcare doesn't suffer from a shortage of innovation. If anything, it has an abundance of it. Members may have access to behavioral health, weight management, chronic condition management and more. As healthcare has become more specialized, the burden has fallen on the member.
With each program providing a slice of members’ overall health, they are asked to navigate multiple entry points, repeat their health histories to care teams outside the program, manage separate digital experiences and determine for themselves where to go next. Every individual solution may perform well, but the fragmentation between them becomes more than an operational challenge. It becomes a barrier to better outcomes.
Health plans are balancing enormous expectations: managing rising medical costs, improving quality and member experience, supporting providers, helping employers deliver more value and expanding access while addressing increasingly complex clinical needs.
Meeting these expectations requires more than excellent individual programs. Health plans increasingly recognize that results improve when members receive the right support before risk escalates.
That requires a complete understanding of each member, combining data from digital health solutions with clinical sources. As patterns emerge across physical and mental health conditions, behaviors and care experiences, the full picture of a member’s health becomes clear. That visibility creates opportunities for earlier intervention, more personalized support and better outcomes over time.
The shift from optimizing point solutions to enabling a more proactive care experience has important implications for health plans serving self-funded employers. Over the past several years, employers have invested heavily in expanding their healthcare and well-being offerings. In many cases, they have assembled a portfolio of specialized vendors designed to address individual health needs.
This creates an opportunity for health plans. Rather than serving primarily as administrators of multiple healthcare programs, health plans can become strategic partners that help employers create a more integrated healthcare experience. This means helping employer clients move beyond vendor selection and toward models capable of outcomes across their covered populations.
I believe the health plans that will lead over the next decade won't necessarily be those with access to the largest number of digital health solutions. They will be the ones that make healthcare easier to navigate.
The conversation is no longer about replacing one point solution with another or simply connecting programs. Reducing the burden on members to coordinate their own care and create a more proactive approach to health management requires a fundamentally new approach. One where risks are identified earlier, support arrives sooner and members spend less time figuring out what to do next on their own.
Members don't experience healthcare needs one point solution at a time. The future of healthcare shouldn't ask them to.
