Payors have never been more open to integrating solutions from healthcare innovators, but it takes more than just great ideas or even great results to seal the deal.

The healthcare system is undergoing a paradigm shift that will open new doors for healthcare technology and service providers, but attracting payors takes more than just a great proof of concept.

In the past five years, our healthcare system has started to shift from a fee-for-service mentality to a value-based care model —a trend that has only been accelerated by the Affordable Care Act. The criticality of embracing new technologies and approaches has been further underscored by the devastation wrought by COVID-19.

Health disparities have been blatantly obvious, with the formal health care system and the populace alike calling for solutions that improve access, drive equity and improve outcomes. There is a growing recognition that a blend of culturally-relevant traditional models, telehealth and social media-driven/grassroots outreach must be integrated for the system to function optimally on behalf of populations.

This transition to integrated modalities is long overdue, and it holds tremendous promise. Payors and providers alike recognize that health is determined more by our zip code than our genetic code, with factors as diverse as access to transportation, fresh food, housing and spiritual support having an enormous impact.

This shift has created a new openness to creative and inclusive ideas about healthcare delivery, and it is opening doors for companies that can help payors impact consumer engagement, identify and reach vulnerable populations, and improve health outcomes. But if you’re the leader of one of those companies, you first need to understand their needs and align your business model with their expectations and priorities.

Show payors how you support consumer engagement and retention

The uneven and erratic way in which people interact with the healthcare delivery system is a major pain point for payors, making them highly motivated to reduce churn and keep members from hopping from one plan to another. Healthcare technologies and services that help reduce these behaviors will be seen as especially attractive partners.

Solution providers are not used to describing their value in terms of impact on member retention, but if you can demonstrate ways in which your solutions and services are “sticky” as well as beneficial to member health over the longer term, you’ll position yourself ahead of other solution providers.

For example, companies are deploying unique approaches to foster consumer engagement such as digital technologies that “nudge” the consumer to the desired behavior through texting and other outreach based on predictive algorithms that consider individual preferences and population characteristics.

On the “high touch” side, plans are investing in solutions that support peer and community health workers on the ground in communities. By using a blend of face to face, telephonic and digital outreach to engage with the consumer population, community health workers are able to foster relationships that are more culturally relevant.

These methods have been seen to result in improved health outcomes, reduced total cost of care and enhanced consumer engagement and satisfaction.

Go beyond ROI to articulate short-term and mid-term benefits

Every payor wants to see full ROI from the healthcare solutions they invest in, but they also want to deliver short-term value to members who may not stay with the plan two, three or more years into the future.

That’s why it’s so important to quantify the impact that your solution offers across the treatment lifecycle. If full ROI is not realized for 36 months or longer, how can you communicate the value your solution delivers at earlier points? What’s that ROI journey—including top-line revenue and bottom-line profitability— from the point of diagnosis on?

Can your solution prevent churn, close gaps in care, improve HEDIS ratings or star ratings, or help with NCQA accreditation? Reframe the value in terms of payor pain points and articulate the financial and qualitative gains that accrue at six months, 12 months and 24 months as well as the ROI payors can expect to see at the maturation of the intervention.

Every payor wants to see full ROI from the healthcare solutions they invest in, but they also want to deliver short-term value to members who may not stay with the plan two, three or more years into the future.

Help payors connect point solutions and deliver holistic care

Payors want to help members make better choices for their health at every step, but system complexity and lack of connectivity makes it difficult to achieve this goal. The future and the promise of a value-based delivery system is predicated on collaboration, so when healthcare companies are able to provide “plug and play” solutions that help members navigate their options, that delivers tremendous value to payors and the entire healthcare ecosystem.

If your solution is capable of helping payors manage the total cost of care and support a more holistic approach to health, it will be more valuable to payors than an isolated point solution, no matter how good that solution is. For example, look at ways that the touchpoints built into your solution could further the patient’s health by connecting them to complementary support or other types of care that go beyond solving the immediate health issue.

Payors are more open to innovation than ever before, but they are also bound by the realities of the existing system. When a solution is designed to embed into the traditional delivery system and connect the dots, that has transformative potential. It helps payors improve retention and outcomes, it helps purchasers reduce out-of-network migration and health insurance costs, and it helps members improve their health and see greater value for their co-pays.

Find new ways to unlock the value of payor data

Payors are under pressure to analyze and use the valuable data that flows through the system to improve the quality of care, but the reality is that most are hamstrung by their limitations in data analytics capabilities.

For example, technology companies with the ability to sift through that wealth of claims data are looking at a huge opportunity. The resulting analytics will play an indispensable role in helping payors identify populations at risk, analyze geographies for social determinant barriers and risk levels, identify new interventional models and so much more. For companies that can come to the table able to articulate that degree of sophistication, the applications—and the business opportunities—are limitless.

Fill the gaps and share in the global risk and reward

There is a growing consensus among healthcare experts that health systems will become more integrated. And while some providers still hold firmly to a fee-for-service, heads-in-beds mentality, many are buying ventures, establishing joint ventures or developing preferred provider relationships that extend their capabilities beyond inpatient beds.

As health systems help payors create a patchwork quilt of healthcare delivery to wrap around patients, those systems are reaching a point where they can either become payors themselves or integrate with payors by accepting global risks for a geographic population that lives within their boundaries.

This, in turn, creates an opportunity for healthcare companies that can fill in system gaps. Startups or younger healthcare organizations that are building well-defined niches in areas such as behavioral health, home care, hospice care, and post acute, to name a few, have a crucial role to play. They have domain expertise that the broader systems can’t match as well as being smaller and able to pivot faster.

By clearly demonstrating how they fit into that integrated system, these companies can help payors direct global risk contracts and develop a joint operating model to manage that risk.

Showing a willingness to put up money of your own or align your profits with shared savings and shared risk can significantly increase your chance of securing a payor’s attention and a contract—even for a proof of concept.

Put some skin in the game

Understanding the system of healthcare delivery from the payor’s perspective and being able to communicate the value of your technologies and solutions in those terms is important, but it’s equally important to signal your own belief and commitment by putting some skin in the game.

Showing a willingness to put up money of your own or align your profits with shared savings and shared risk can significantly increase your chance of securing a payor’s attention and a contract—even for a proof of concept.

Here’s the bottom line.

Payors have never been more open to integrating solutions from healthcare innovators, but it takes more than just great ideas or even great results to seal the deal. Healthcare technology and solution providers who want to take advantage of this new era in value-based healthcare need to understand the system’s greatest pain points and articulate the ways they can solve them.