search Inloggen search Registreren

Jouw profiel

Registreren Inloggen



MedCity News

november 22, 2023


What Health Plans Wish the Healthcare Innovation Ecosystem Knew

We must make it easier for innovation to take root and thrive within our health and social services ecosystem. Stifling change in favor of doing what’s always been done is simply not working: a recent report ranks the U.S. last in access to care, administrative efficiency, equity, and health care outcomes compared to other developed countries, despite more than $4 trillion invested annually.

Thankfully, countless innovators around the world are tirelessly dedicated to improving our health and well-being. Combining their solutions with the resources and expertise of established health plans like mine holds promise to more effectively and quickly deliver better outcomes for patients and communities. It also encourages a swift pace of innovation, keeping everyone on their toes and focused on addressing major issues in healthcare, from supporting a sustainable primary care future to value-based care implementation and adopting data sharing standards. But first, we must together overcome what is today an arguably byzantine system to make these solutions a reality.

I’ve worn a lot of hats throughout my career —  a health educator and community mobilizer; a quality improvement leader and an early-stage startup operator, and I also led strategic engagement for a health system venture fund.  Today, I focus on industry alignment and policy movement that drives the change needed to scale and sustain transformative innovation from within a major health plan.

Based on my own experience navigating our healthcare ecosystem, here are three things I wish all entrepreneurs knew about how to most effectively bring their ideas to market and initiate successful collaborations.

Embrace the operations side

Entrepreneurs who recognize and take the time to consider the complex standards, best practices, and contractual considerations that dictate health plans’ operations are better positioned to help meaningfully address industry pain points. When approaching health plans, they should articulate their patient or community value proposition and identify how it aligns with key business processes and the goals of health plans, such as reducing hospital readmissions. Demonstrating the value of innovation is key. A data-driven approach that showcases both the effectiveness of the innovation and its outcomes will support downstream adoption. Innovators should be prepared to demonstrate business model alignment with health plan revenue structures and illustrate mutually beneficial success.

Comply with regulatory standards

Entrepreneurs must ensure that their ideas comply with relevant healthcare regulations and data privacy laws. Health plans need to prioritize patient privacy and adhere to legal requirements, so solutions must align with these guidelines. It’s also important to understand that these rules and regulations may evolve according to the state, region, and specific populations being served. Meeting these requirements should be considered foundational to the solution when looking to partner with health plans. Solutions that don’t easily integrate, don’t deliver safe access, or lack the ability to scale will struggle.

Champion co-opetition 

Healthy co-opetition has historically been beneficial, and even required, to tackle some of the most difficult challenges in healthcare. Entrepreneurs should carefully consider the limits of their own skills and operational capacity and consider partnering with complementary organizations, solutions or even competitors to create a more comprehensive solution to modern healthcare challenges. For instance, our primary care payment innovation work wasn’t done in a vacuum; we worked for two years with Integrated Healthcare Association and the California Quality Collaborative to convene our peers, with six of them putting out a public memorandum of understanding for advancing primary care payment that is focused on implementing and improving whole person care.

We have an incredible opportunity to embrace and encourage innovation by empowering and partnering with entrepreneurs. For all of us to work together most effectively, it’s critical that innovators create solutions that embrace operational excellence, meet high regulatory standards, and consider unconventional partnerships that further align missions. When we embrace and encourage innovation, the ecosystem operates more effectively, and patients and communities realize better outcomes.

There’s no better time to be an entrepreneur working toward change—or a large organization leader wanting to support the innovation revolution.

Photo: HAKINMHAN, Getty Images

What's your reaction ?

Comments (0)

No reviews found