What Health Plans Wish the Healthcare Innovation Ecosystem Knew
By [Author Name]
Embracing 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.
Compliance 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.
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…