Health Plans

Health plans and other payers advance digital transformation and personalized care efforts

March 24, 2022 | Article | 6-minute read


Like other consumer-facing industries, healthcare continues to grapple with how to integrate technology to fundamentally reshape its operations and more meaningfully engage with the people it serves. Advances in critical infrastructure and greater access to mobile devices and applications have led to significant strides, even as some gaps in care widened and progress on the path to connected health occasionally stalled.


At ZS, we surveyed health plans and other payers (e.g., pharmacy benefit managers and integrated delivery networks) to understand their current efforts to increase digital adoption and deliver personalized, preventive care. Seven key insights emerged from our research.

What’s on the minds of health plan leaders today?

To understand how health plans and other payers are using information and technology to improve health and wellness, ZS polled senior leaders in the U.S. and four other countries (Australia, Germany, New Zealand and the U.K.). The research uncovered intriguing insights we presented at the  2022 HIMSS Global Health Conference & Exhibition.


HIMSS (Healthcare Information and Management Systems Society) is a global advisor, thought leader and member-based society committed to reforming the global health ecosystem through the power of information and technology. The collaboration stems from ZS’s partnership in the HIMSS Trust, a consortium of leaders from across the healthcare and technology space who are collecting, analyzing and reporting on in-depth, data-driven market intelligence. Insights gathered by the HIMSS Trust unveiled trends and challenges to help the industry prepare and predict for the next three to five years.

A benchmark for health plans and other payers within the healthcare ecosystem

ZS’s latest report, “State of Healthcare: Payer Insights,” surveyed an international cohort of health plans and other payers. Most of the organizations surveyed—which operate at national, regional, state and community levels—cover more than a million members. Through our benchmark analysis, ZS captured a glimpse of where healthcare leaders see the current state of digital transformation and personalized care models.


Insight No. 1: Digitally integrated care-delivery adoption has accelerated during the pandemic


When we compare international and domestic digital initiatives, we see U.S. health plans focused more on leveraging telehealth, home health and remote patient monitoring. In contrast, international payers are concentrating on leveraging connected devices and health fitness apps to improve member health and social well-being.


Of note for U.S. health plans is the more than 70% of large national plans that are working toward greater digital adoption. We’re also seeing state and local plans making notable progress.


Insight No. 2: Accelerated digital care adoption has enabled select personalized care models


More than half of global health plans and other payers say their current digital transformation objectives are focused on four areas, both for members and the healthcare system as a whole:


Objective U.S. International
Improved access to care 51% 38%
Improved member experience     82% 69%
Address health equity challenges 70% 78%
Reduce waste 72% 78%



Insight No. 3: Payers are actively leveraging nontraditional care sites for enhanced personalization


Another trend that emerged from our current survey—and one that dovetails with our previous research—is the shifting of care from hospital to ambulatory and home healthcare settings. Health plans and other payers are engaged in leveraging nontraditional sites of care to offer more meaningful levels of personalized care delivery.


Here in the U.S. we see trends converging around the integration of clinical, mental and behavioral health services. Internationally, efforts are centering on leveraging home and remote patient monitoring. National health plans are in a better position financially and operationally to drive this adoption.


Insight No. 4: Financial and technical barriers continue to affect digital adoption for regional and state payers


Financial and technical barriers continue to be a roadblock in the U.S., where they’re especially pronounced for regional and state health plans. National health plans tell us they’re better positioned to drive digital adoption and personalized care. Internationally, health plans and other payers report greater confidence in their digital transformation and personalized care journeys.

Insight No. 5: Payers are globally building and/or acquiring capabilities to resolve technology barriers


As health plans and other payers advance their digital transformation initiatives, we see different appetites for developing technology capabilities in-house versus looking outside the organization. Large national health plans in the U.S. lead the way with building them internally, followed by single state and regional plans, likely because of healthcare ecosystem regulatory and technology complexities.


We see digital adoption and transformation gaining greater international momentum. From a financial perspective, payers outside the U.S. prefer an acquisition model.


Insight No. 6: Ongoing evolution of reimbursement models from a regulatory and technology perspective will enhance digital care adoption


Disconnects in consumer confidence in digitally enabled care, compliance, waste and complexity persist for health plans and other payers working to advance new healthcare models. At the same time, we have seen greater traction in adopting value-based care (VBC) arrangements and aligning incentives between payers and providers from a digital transformation perspective.

The progress we saw last year with wider technology adoption for telehealth and virtual care services has been met with challenges in building provider workflows. These areas will need more attention going forward to enable personalized care delivery with consistent member experiences. Evolving reimbursement models will similarly remain a focus.

Insight No 7: Payers are undertaking specific approaches to address mental/behavioral health issues and health equity gaps


A whole-person care model is emerging with the integration of mental health, behavioral health and social well-being services. Personalized care models are looking beyond how care is delivered in specific settings to consider where patients are socioeconomically and how health plans and other payers can best drive clinical and financial outcomes.


Member populations with behavioral or mental health issues and lower socioeconomic status have been globally identified as areas where personalized care is having most impact. In the U.S., large national plans are similarly focused in this area, though we also are seeing interest from regional, single-state and local plans.

What can we do today to prepare for tomorrow?

Even as we make inroads with digital transformation and personalized care initiatives, health plans and other payers will continue to address near-term technology and regulatory barriers. We see continuing investment in—and innovation around—interoperability as a critical factor in delivering on the promises of connected health and accelerating virtual care advances made during the COVID-19 pandemic.


Actions that center on working through the key takeaways of our survey will improve healthcare experiences and treatment outcomes. They will help equip the right provider with the right information at the right time, improving both the quality of care and reducing the cost of it. Healthcare works best with transparency, trust and equity—and when people feel cared for, empowered and heard.


Stay tuned for the next article in this series, where we will discuss the future state of healthcare and the implications it has for health plans. 

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