Insights: Who Pays for HealthTech?

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Asia’s Most Wanted – Digital Health Part II is part of a three-part HealthTech special series organised by BlueChilli healthtech and TechNode Global to shed light into burning topics and emerging developments in Asia’s healthcare industry.

The global pandemic has brought forth massive demand shifts, and an urgent impetus for digital health solutions adoption. The landscape for payment models is also changing fast. To unleash the full potential of HealthTech to meet Asia’s health needs, we have to answer the perennial question: how will adoption of these solutions be financed, and by whom? To answer this question, I brought together three experts for a live discussion on Oct. 7, together with participating members of the community. I am very grateful to the following speakers for their contribution:

  1. Indira Umareddy, Virtual Healthcare Customer Insight Generation Lead, Sanofi
  2. Scarlett Chen, Managing Director, Prudential Corporation Asia
  3. Wai Mun Lim, Founder & CEO, Doctor Anywhere

This is an insights piece on the topic, laying out the five key themes that emerged from our discussion:

  1. Shift to Consumer Centric Demand
  2. Target Those Who Suffer Most (Immediately) from Inaction 
  3. Align With the Top or Bottom Line
  4. Back-solve Using What They Will Pay For
  5. (Re-)Allocating Cost of Health

1. Shift to Consumer Centric Demand

“Customers don’t want products, they want solutions. When they buy a health policy, they want to be healthy and they want certainty.”

Scarlett Chen, Prudential Corporation Asia

Before we can understand who pays, we need to address what drives demand. Our experts had different answers, but converged on consumers being the main force in generating demand and strategies for customer engagement. 

Scarlett said that insurers’ interest in digital health solutions is driven by changes in customer expectations. Digital natives in particular want real time responses and the ability to search for answers themselves. For health policies especially, customers actually want to be healthy and they want certainty that they can receive support to solve their health crises when they arise so they preserve their health. As such, insurers are looking to incorporate health management services.

Scarlett said that she engages HealthTech startups through partnerships and investments. For partnerships, the startups have to provide value add in at least one of two categories: (1) capabilities—enabling the insurer to augment their value propositions to customers with new offerings; (2) distribution—expanding reach to new customers (this typically requires the startup to have a huge user base rich in data). For investments, Prudential’s corporate venture arm is a strategic investor that only funds startups/companies that the corporation will work with. 

Indira said that direct clinical interventions affect only 10-20% of health outcomes. Other factors are not dealt with when tackled from the perspective of treating diseases, which was the initial focus of the industry. Hence, pharma companies are now looking beyond drugs.

Explaining the shift from engaging healthcare providers to engaging consumers, she said that “50% of the problems come from drug adherence, and that is a problem that can only be solved with patients.” Her work in Sanofi therefore looks at specific population segments, partnering with payers and HealthTech companies to explore solutions that can improve health outcomes and service delivery sustainably.

Wai Mun said that when Doctor Anywhere first started in 2016, they were a purely tele-medicine platform. However, they realised that video calls can only address 60-70% of the problems that brought customers to GP clinics. In Southeast Asia, physical touchpoints are still crucial for consumer engagement, because of a preference for tangibles. In order to grow as a trusted platform in health, they decided to establish their own clinical facilities to better understand and address their customers’ needs. 

 2. Target Those Who Suffer Most (Immediately) from Inaction 

“Who should pay goes back to whose problems you are solving.” 

Indira Umareddy, Sanofi

In arriving at an answer on who should pay, we began by asking why the innovation needs to exist, and then aligned it with who the solution provides most value to. The party who is suffering the most (and immediately) from the consequence of non-action is likely who you will find traction with as payers.   

Indira said that people pay for drugs to the extent they believe the products have a demonstrated ability to fix their problems (e.g. prevent complications, address pains), helping them prolong their life or improve their quality of living. Following the need to always focus on your target customers for problem solving, she laid out her advice for HealthTech solution providers:

  • For your solution to be applicable to health and life insurers, it needs to target users who are working age and who are either covered by employers and/or able to pay premiums. 
  • For national payers (i.e. governments), the proposition needs to reduce cost at the systems level. Hence, preventive approaches sit well with such payers.
  • For direct consumers, your solution has to manage their specific disease or condition, and/or individual wellness.

Wai Mun’s view is that everyone is ultimately a payer for health. Be it via insurers or the government, the consumers pay one way or another. For instance, if you consume more healthcare and get it covered by your insurer, you will see your premium increase and have to pay for it subsequently. 

Scarlett added that in terms of who pays for healthcare, it’s not a single stakeholder-takes-all situation. Different actors in the system (e.g. governments, insurers, employers, healthcare providers, and consumers) pay for healthcare products and services, depending on which part of the value chain you touch. The same is true for HealthTech. 

3. Align With the Top or Bottom Line

Delving deeper into payer engagement, we discussed how HealthTech solutions can find traction with commercial payers. We touched more on insurers, though the point to demonstrate alignment with the top or bottom-line goal applies to B2B payers in general.

Scarlett shared that when working with insurers, a value proposition needs to address the company’s top-line and/or bottom-line objective to be compelling. Top-line growth means increasing premiums from existing customers or acquiring new customers (e.g. through appeal of access to valuable services). A bottom-line approach is often going to be about cost containment. Insurers will demand to see evidence for outcomes, often with a timeline for impact on morbidity and mortality.  

To engage large insurers, Scarlett said, it is important to approach different people and understand their Key Performance Indicators (KPIs). Your value proposition needs to speak to their KPIs. For instance, a top line growth approach might approach the sales and marketing team. For cost containment, it could be the chief operating officer, or teams that manage claims and finances. For radical propositions that could be a game-changer for the insurer, it is best to go straight to the CEO. The adoption of your solution depends on you  finding internal champions, and for that to happen, these champions need to have KPIs that your solution can help meet. 

Wai Mun added that cost containment has been central to Doctor Anywhere’s conversations with insurers, citing that often they want better service at the same or lower cost. To make this possible, in addition to using technology to augment services, his company aggregates demands with partners to bring about economies of scale.

For instance, Doctor Anywhere works with insurers and telecommunications companies to build a demand pool with more users in the ecosystem, help sourcing for services, and reduce overall cost. Noting that medication makes up about 60% of the bill size for outpatient expenses, they also negotiate bulk discounts for drugs to create savings for payers and ultimately consumers. They also bought managed care business Adept Health, to be embedded with a network of healthcare providers and partners. 

4. Back-solve Using What They Will Pay For

“People in Asia are more willing to pay for products rather than services. So we need to back-solve with what consumers are willing to pay for.” 

Wai Mun Lim, Doctor Anywhere

Moving onto building payment models, we discussed how HealthTech solution providers can find sustainable monetisation models by working around what their target payers value and have a pre-deposition to pay for. 

Scarlett said that the best mechanism to lock in your payment model with insurers is to have your solution integrated with specific insurance products. Before pitching your solutions to insurers, try to understand the insurers’ products so you know where your solution fits in. She added that consumers usually look to social security, and then then any insurance, before paying out of pocket. 

In the wake of COVID-19, consumers have shifted health to the forefront of their priorities and are now more educated on health services—especially telehealth, Scarlett said. She cited one of Prudential Corporation Asia’s investee companies Halodoc as an example, saying that their GP consults used to be free. When they started charging, consumers were still willing to use the service. She commented that this and other examples such as Ping An’s aggressive growth of monthly paying users are encouraging signals for B2C monetisation models.

Wai Mun added thatbringing customers onto a platform is relatively easy compared to getting them to spend. He cautioned that while free services can attract millions of users, many of these users disappear once you switch on the monetization tap. He added that companies such as Ping An are subsidising health services for their users, and drew the link that consumers in China are not willing to pay. For HealthTech solutions to take off, Wai Mun said, they need a high level of awareness among consumers, and services have to be made available at minimal or no direct cost. In Asia, he said, consumers value products more than services, comparing the issue to the absence of tipping cultures in the region.

Doctor Anywhere’s rise in the region, Wai Mun said, was about understanding what consumers will pay for and working around it. He said that the company was not the first to do telehealth in Singapore back in 2016, but they were the first to do medication delivery. They made the decision after finding that consumers do not find the platform appealing if they have to do more work to access the products needed after consultation. Ready access to products combined with good service was central to driving uptake from consumers. 

On unlocking value-based payment models, Indira said that the challenge is in getting data to establish evidence for justifying applicable solutions and costs to payers.. She added that pharma companies understand this and are generally open to collaboration in the ecosystem to help with establishing these evidence benchmarks.

5. (Re-)Allocating the Cost of Health

Discussing affordability, experts agreed that it is not just about making products and services cheaper. Rather, they said, the field must unlock value from expenses that go into allocating and organising healthcare. Incentives and expectations will have to be realigned to bring about more resource efficient delivery of health services. 

In terms of current cost breakdown for healthcare expenses, Indira cited the US as an example. She explained that while the US spends 16% of GDP spent on healthcare and is the largest pharmaceuticals market in the world, drug-related costs only account for 10-12% of the expenses. The majority of the remaining cost goes to administration of services. Hence, there is immense value to be unlocked by collecting and monitoring of data to allocate and deliver healthcare in more resource-efficient ways. 

Wai Mun said that in the region, administration makes up a good proportion of healthcare expenses. He added that by current design the incentives for the administrator are at odds with the insurer’s incentive, as the former a percentage fee of the total expenditure. 

On the issue of affordability, Wai Mun said that technology can augment services such that they can be provided at same or higher quality at lower price. The challenge to realising that potential is changing consumer mindset, as consumers now are not comfortable with paying for purely online services, even if they could potentially satisfy the same needs.

In a Nutshell

To recap the insights gained:

  1. Shift to Consumer Centric Demand: Consumers’ shifts in expectations are the most important force behind the rise and evolution of HealthTech.
  2. Target Those Who Suffer Most (Immediately) from Inaction: Those who are hurting the most from non-action and can see the immediate alleviation of pain from your solution are the payers you need.
  3. Align With the Top or Bottom Line: For B2B payers, successful engagement depends on offering value that is clearly aligned with revenue growth and/or cost containment, and finding champions who have relevant KPIs.
  4. Back-solve Using What They will Pay For: For sustainable monetisation, work around what target payers (be it consumers or B2B) value and have a pre-deposition to pay for. 
  5. (Re-)Allocating Cost of Health: Improving affordability doesn’t necessarily mean making provisions for health cheaper. Value needs to be unlocked from the allocation and organisation of services and offerings.

I hope you find useful insights from this article and welcome the opportunity to discuss the topic with you in comments! I have also included an epilogue below on our experts’ concluding comments on emerging opportunities in payer engagement. 🙂

Note: This session was the second in the three-part series “Asia’s Most Wanted—Digital Health” organised by BlueChilli HealthTech and TechNode Global. The article was first published on TechNode Global.

Epilogue: Emerging Opportunities for Payer Engagement

We concluded the discussion by asking where HealthTech solutions are going with use cases and adoption. These are our experts’ takes: 

Scarlett said that startups need to get creative, developing payment models where users may not be the direct payers. She reiterated that when customers buy health insurance, they actually want assurance of being able to maintain their health. So for example, if a customer gets diagnosed with cancer, the person actually wants options, not just a payout. She sees a growingly important role for health management services in an insurer’s product offering moving forward. These provide opportunities for HealthTech companies to get their solution priced into the insurers’ products.

Relating to emerging opportunities, Indira shared an example that while cardiac rehabilitation is established to reduce mortality rate in the next 30 days for people who suffered from a heart attack, take-up even in countries such as the US is limited due to issues such as transport and lack of time off from work. These are areas where technology driven solutions offer immense potential. However, potential payers need to be involved early to address any regulatory and systems level barriers to implementation of solutions, especially when it needs to be implemented in collaboration with national healthcare systems. 

On payer collaborations, Wai Mun noted that insurers and corporations are now much more open compared to when he first started in 2016. The pandemic had also helped fast forward adoption of HealthTech solutions by putting health at the centre stage and growing awareness of the potential of HealthTech. With the proliferation of corporate venture arms and “startups embedded within corporations”, these had also increased their risk appetite and willingness to experiment. 

On the next frontier, he said that solutions now tend to focus on the middle and upper middle class and the segment which is mainly covered by government reimbursements is falling behind. However this is a very tricky segment to monetise as they value price over quality and the largest competitor for service provision is the government.