Health Ecosystems: To steer or not to steer

At this point in time most in the insurance and healthcare industries have heard about the benefits, and the inevitability, of digital ecosystems. The integrated digital future is already reality for a select few and they are reaping the benefits from greater efficiency and effectiveness. The majority of healthcare-related players, however, remain on the side for now. Key reason for this inaction is a lack of understanding.

It will be all about a healthier populations, employees, patients, and policyholders. Therefore, effectiveness and efficiency are at the core of highly integrated health ecosystems.
Evangelos Avramakis, Head Digital Ecosystems R&D, Swiss Re Institute

In this article we explore the various players that form part of a health ecosystem with concrete examples; their focus, and the benefit each draws from taking a leading role by steering such an ecosystem. Governments, healthcare providers, tech companies and insurers can all take that leading role – but should they?

Explore Swiss Re Institute's Health Ecosystems publication

To steer or not to steer: The decision is one of vital importance that comes with all the known challenges, such as disruptive technologies, legacy systems, regulatory requirements and data privacy concerns. These challenges are on the surface, clearly visible. There is, however, another challenge waiting beneath that surface – the challenge of culture. Any existing entity embracing the ecosystem path will embark on a change management journey that is likely to fundamentally transform the company. With all of this in mind it may appear smarter to stick to a core offering, to simply be a niche provider of solution X or service Y, and to plug that into existing ecosystems.

With these challenges in mind, why is it that health ecosystems, steered in various ways, begin to blossom and flourish around the world? Let's begin by taking a look at government-led health ecosystems.

Government-led ecosystem

The healthcare value chain comprises everything from wellness and prevention, to diagnosis, treatment, recovery and reintegration for the customer. In terms of government, the customer is the citizen and several countries already do engage them in value-adding ways. When a government leads an ecosystem effort, the focus is less on engagement and far more on data standards. Any country's top priority should always be on the safety and wellbeing of its citizens – a government-run health ecosystem provides the basis for healthcare that offers holistic services in cost-effective ways. At the same time, such an ecosystem is an opportunity to drive unified standards that deliver on shared data value, data privacy protection and R&D opportunities.

Government-led ecosystem

Israel: The Clalit Health Services began over one hundred years ago and, linked to the Ministry of Health and its national database, makes integrated use of decades of full life-span data of over four million people. Equally integrated – on a single platform - are data sources from every aspect of healthcare such as laboratories, hospitals, primary care clinics and pharmacies. Customers/citizens can go to a website, or use a mobile app, to access their information and find support on their health journey. For Israel this effort has led to improved healthcare, greater efficiency and, thanks to unified data sets, to value-adding research resulting in new insights and solutions.

Denmark: In a similar example of blurring and breaking down traditional silos, the National Danish e-Health Portal has integrated every aspect of healthcare. By bringing the data from physicians, hospitals, pharmacies, laboratories and government agencies together in the Danish Health Data Network, Danish patients reap the benefits. To offer just one example. The dispensation of medication requires a doctor's prescription, something that traditionally means time and effort on behalf of both doctor and patient. In Denmark, as all data is stored on a single platform, a patient can pick up the medication by simply showing identification.

Singapore: Here the government is taking a different approach, one driven by the desire for a population that is incentivized to stay healthy. Singapore explores the use of technology to support new models of care, in both home and community settings, with telehealth – long distance delivery of clinical care via electronic communications. Furthermore, Singapore collaborates with Fitbit. Every citizen is given a device practically for free. What is simply required is a $10 a month commitment (for one year) for the Fitbit premium service that comes with guidance and one-on-one coaching.

Tech company-led ecosystem

Tech companies, such as Amazon or Google, taking the lead on healthcare, has been popularized for some years now. With their massive customer base and in-depth customer knowledge, they are uniquely positioned – and it can come as no surprise to learn that they are indeed preparing to fully step into health ecosystem mode: Google is heavily investing to foster population health; Amazon is set to disrupt medical supply services; Apple is building on its Apple Watch and app store success to improve remote patient diagnosis and monitoring (such as heart rhythm, sleep apnea, diabetes and hypertension). 

Tech company-led ecosystem

With their existing digital ecosystems, adding a healthcare ecosystem into the mix comes with bountiful opportunities for tech companies. While they have not disrupted incumbent insurance players to date, it should absolutely be expected that this is part of the near future. They will connect their customer base with increasing healthcare services – and personalized, low cost, digital health insurance is bound to be a part of that offering. All of this will generate ever more, and ever more valuable, data sets – feeding a virtuous cycle that tech companies are highly unlikely to ignore.

Healthcare provider-led ecosystem

Healthcare providers traditionally are far from consolidated entities – for that reason, as a first step, consortia are being formed. At the core of a successful consolidation lie unified standards that will then allow for a) seamless customer care and b) the benefits flowing from such a data-rich environment.

Healthcare provider-led ecosystem

Kaiser Permanente is a US hospital chain that has achieved significant milestones in pushing EHR (Electronic Health Records), synthesizing all information and making it available to customers. As seen with previous examples, Kaiser Permanente also consolidates data from a vast variety of healthcare sector entities into one single platform, KP Health Connect – which in turn is used to great success as a decision support tool and an individual's personal health manager – all with the ultimate aim of the best possible patient care. One concrete example to showcase KP's success is their app for employers: By utilizing Kaiser Permanente's On-the-Job app, giving employees access to physicians, therapists, nurses, pharmacists and care coordinators, Macy's was able to drastically reduce employee claims.

Now is the right moment for (re)insurers to act as ecosystem orchestrators.
Evangelos Avramakis, Head Digital Ecosystems R&D, Swiss Re Institute

Insurer-led ecosystem

Now, with all of the above in mind, is it even sensible to consider a health ecosystem steered by an insurance provider? The answer must be a resounding yes. The challenges of creating such an ecosystem are there, but so are the opportunities. And there are examples that illustrate possible roadmaps to success.

Insurer-led ecosystem

China's Ping An insurance company has created a closed ecosystem that gives Ping An complete control over every aspect of this ecosystem, from data access to data mining, and from advertising to sales. Ping An Good Doctor, so the name of the platform, offers mobile patient engagement, corporate healthcare options and minute clinics (for virtual consultations and instant medication dispensation). Ping An offers its products via this platform, but also holistically addresses overall wellbeing and fosters healthy behavior via the app.

Insurers can be active ecosystem orchestrators, monetizing new technologies & services, and accessing new revenue pools.
Jonathan Anchen, Head SRI Research & Data Support, Swiss Re Institute

One size does not fit all

Health ecosystems provide vast potential for unified data and improved customer/citizen/patient care. Whether those efforts are led by governments, tech companies, healthcare providers or insurance companies depends on a variety of economic, political and societal factors and are thus very likely different from country to country.

As a Life & Health insurer, what role do you want to play? Do you want to be a modular producer (plugging your products into the ecosystems of others), an ecosystem bundler (offering products and services in collaboration with others) or an ecosystem owner (such as the aforementioned Ping An example)?

modular producer, ecosystem bundler, ecosystem owner

The answer lies with two questions – and both those questions require a good bit of honest soul-searching about who you are and who you want to be in the future:

1)  "What is in the best interest of the customer?"
You may want to own the customer relationship because you have a loyal customer base and local strength – but is that truly in the best interests of your customers? Or might they be better served by being plugged into someone else's ecosystem that offers customers more seamless experiences and a greater variety of services?

2) "How do you want to stay relevant in the future?"
Creating a healthcare ecosystem is a transformative and long-term effort. Is that what your company envisions strategically? Will you be able to make more of a difference, i.e. stay more relevant, by expanding your efforts and services – or is the smarter move to focus on your core expertise and partner with others to embed those offerings across any number of ecosystems?

In conclusion

There is a lot to be gleaned from health ecosystems around the world as illustrated above. The potential for increased efficiency and far greater effectiveness is apparent. The remaining uncertainties are, at this point, of a local nature. Any company's decision about the path forward heavily depends on the circumstances on the ground. Overall, however, there is unconditional certainty that healthcare ecosystems work and that they are the future – ignore them at your own peril.

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