Integration Part II: Connecting the Dots

Shane Giuliani - Vice President

“Point solution fatigue.”

We’ve heard it from clients and prospects as well as partners and industry groups. You love solutions that work, but the more you have, the messier your benefits world begins to feel.

I hear you, as both a leader in a digital health company and as a healthcare consumer.

I attended the July 2022 HCAA TPA Summit, where keynote speaker Lee Lewis of the Health Transformation Alliance (HTA) compared this moment in digital health to the early days of the Internet, quoting John Allen Paulos: “The Internet is the world’s largest library. It’s just that all the books are on the floor.” Lewis’s point was: today’s digital health solutions are rich and plentiful, but navigating them is a nightmare, for plan sponsors and members alike.

Today’s digital healthcare market contains thousands of unique point solutions, with more entering the market each year. In the benefits realm, most health plans today manage somewhere between four and nine different point solutions. We recently spoke to one company with 40!

Point solutions are clearly here to stay. But for plan sponsors, the task of deciding which ones to offer can be overwhelming. And for members, engaging with multiple offerings to meet their needs can be challenging.

The solution? In a word: integration.

When it comes to integration, plan sponsors need to ask more of point solutions–and point solutions need to demand more of themselves

For point solutions to be effective–including our own here at WithMe Health–they need to be great at integrating.

Plan sponsors would rather integrate many point solutions than cut offerings that members have come to highly value. In light of that, I believe an effective point solution needs to meet these three value propositions:

  • Support the whole member: Even the most laser-focused solution needs to have–or be able to obtain–a picture of the whole member. It is within this whole member context that we must provide care and understand our impact.

  • Unify engagement: Point solutions should integrate seamlessly into the overall benefit, avoiding unfamiliar access requirements or cumbersome onboarding and connecting to other point solutions.

  • Measure rigorously to continuously improve: Accurate and timely measurement of our own solutions is just the start. We must also coordinate across other solutions to understand whole member impact.

Support the Whole Member

Any point solution needs to be able to see a broad picture of their members, but most data housed by a point solution today offers at best a partial view. We need to strive for more and better data, supplementing what we have, structuring it so that it’s actually used, and never losing sight of the individual for whom we are providing care.

Data doesn’t always come in well-packaged files. We need to be curious in our interactions with members and able to capture the data that isn’t readily available. Today, obtaining whole member data is a piecemeal effort. Most data is not yet centrally organized with a streamlined sharing mechanism, despite EHR and interoperability advancements. Because point solutions are operating in this reality, it is incumbent on us to develop processes for expanding our knowledge of the member beyond a narrow remit.

In my last piece, I discussed our belief that to be good medication guides to our members, we need more than just their pharmacy data. We chase down what data exists, including medical, lab, and SDoH data. But when data does not already exist–such as lifestyle data–we must obtain it.

Every time one of our Medication Guides speaks with a member about medication, we are also gaining information about the member as a person, including drivers and barriers to healthier and cost-saving behavior. And in so many cases, we learn the importance of not making assumptions. Every member has their own story, and we must seek to understand these.

One of our Guides recently spoke to a member who was struggling with adherence to blood pressure medication. The member said she had trouble getting up from the couch. We asked, would it make it easier to take your medication if we had it sent to your house?

What do you think the answer was?

No, the member said. I love my pharmacist. Going to the pharmacy and interacting with her is important to me. And it motivates me to get out of the house.

That’s the kind of insight that we look for, insight we wouldn’t have if we didn’t ask. And that very much informed our actions. In this case, we equipped the member with better information for her next pharmacy visit.

But even with more complete data, we can’t and shouldn’t operate in our point solution siloes.

Unify Engagement

The great thing about point solutions is often their laser-focus on solving a problem. An MSK program is the most effective at treating MSK. A diabetes program is a master at managing diabetes. And so on…

But this narrowness is a double-edged sword because members are complicated and so are their treatment needs. And the more logins they need to create, the more platforms they need to access, the lower their engagement will be with each of the solutions on offer.

Hence the urgent need to reduce complexity in healthcare. Christina Farr and Michael Yang of OMERS Ventures (note: OMERS is an investor in WithMe Health) broke down the role for different types of ‘navigators’ in healthcare in this article. They cited an AHRQ study: “Studies have found that only 12 percent of people have sufficient literacy to navigate the system, and even those individuals can struggle when they’re feeling sick and vulnerable.”

Only 12%. (And that’s likely more than reality, since it’s human nature to overstate our understanding of problems.) That leaves at least 88% of Americans who need significant help navigating the complexities of healthcare.

This is also true for plan sponsors who are further burdened by each solution that has individualized access, engagement, implementation, and data needs.

One way to simplify member engagement is to partner across specific point solutions. A good example of this is our partnership with RxNXT, a subsidiary of GoodRx. At least four out of 10 Americans use a drug discount program (1), and GoodRx alone now has approximately 20 million monthly active users (2). Historically, if a member is using GoodRx, they are going outside of their plan. This can create more complexity for the member as well as for the PBM and the plan sponsor, who lose sight of their activity.

We’ve established APIs with GoodRx in order for our integration to happen right at the pharmacy. Members don't have to do anything to get the best price, other than make sure their WithMe Health insurance information is on file. Here's how it works: our combined technology compares the WithMe member copay for a medication to the GoodRx discount card price for the same medication, so the member will pay the lower of the two costs automatically. And the plan sponsor will also save in many cases and have more complete visibility into their member’s pharmacy behavior.

Another way to simplify engagement is through the use of navigators. For our part, we are also a huge fan of ‘general navigators,’ like Castlight Health (a strategic partner for WithMe Health), Included Health, Quantum Health, and Well. These navigators are designed to standardize, coordinate, and integrate the different point solutions.

While not new, the navigator concept is gaining greater momentum. A full 60% of employers in this report from the Business Group on Health indicated they plan to use navigators to help with the complexities of the healthcare system and increase access to quality, seamless, and convenient healthcare.

Navigators are perfectly positioned to evolve into the hub for whole member data, and point solutions need to be equipped to participate in their ecosystems.

Critical to this evolution will be getting the measurement intention and execution right.

Measure Rigorously to Continuously Improve

“That which is measured improves.” This is an essential truth in healthcare, and it applies doubly to point solutions.

In healthcare the ultimate measurement is whether a therapy, procedure, medicine, or point solution intervention works to improve member health outcomes, member well-being, or healthcare spending. To assess this question, the measurements must be rigorous and timely. Any point solution must demonstrate its ability to produce measurements based on accurate and verifiable data.

But this should be only the baseline for what they can do. The next step is to open the data pipes to share that data across a plan sponsor’s point solutions, so that all solutions intervening with a given member have timely access to important data. There should be a striving towards warm hand-offs and the development of capabilities to measure a point solution’s impact–positive and negative–on all the other aspects of a member’s health outside the scope of the laser-focus. These handoffs should be measured, reported, and serve as a feedback loop.

None of this is easy. In digital health, we are still in the early stages of picking the books up off the floor. But the right platforms are now present or emerging, so it’s critical for all of us to keep to our higher-order missions: together helping patients lead their healthiest lives.

1. ConsumerReports.org survey

2. GoodRx Holdings Inc, February 22, Q4 21 Letter to Shareholders