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PwC Proposes Innovative Frameworks for Individual and Population Health

As the healthcare industry continues to shift toward a value-based care model, health plans will need to embrace technological advancements and adopt new ways of thinking in order to retain members, stay competitive and succeed in a quickly changing environment.

To do so, plans should align with one or more of five models identified by PwC’s Health Research Institute (HRI): Consumer Advocate, Bridge Connector, Lean Advocate, Analytic Sensor and Care Integrator. Some of these models suggest that insurers should work more closely with healthcare providers, establish themselves as sources of data and analytics, and manage population health to keep people out of the hospital. Other models encourage insurers to focus more on consumers and to cut healthcare costs by giving members sophisticated digital and human support so they can make better healthcare choices. To develop its models, HRI surveyed more than 100 health insurance executives, 1,750 American adults, and healthcare leaders from across the industry.


All five of these models have three things in common: An increasing drive to be value-based, a focus on the consumer, and an emphasis on leveraging technology. However, it’s important to note that all healthcare models must keep prevention and early detection of chronic disease at the heart of individual and population health efforts. Despite a growing emphasis on health testing, millions of chronic and pre-chronic health conditions go undiagnosed each year. BioIQ is helping health plans change that by offering convenient at-home health testing programs to identify members at risks for chronic conditions, such as colorectal cancer, kidney disease and diabetes. BioIQ also offers a means to intervene – through a unified solution for testing at-risk populations, analyzing data and providing individuals with resources to help them improve their health.

Whether health plans identify with HRI’s Consumer Advocate model, the Bridge Connector model, or any other forward-looking framework, they must shift their emphasis from dealing with the approximately 10 percent of the population that is sick to engage 100 percent of the population, with the goal of helping all members maintain their optimum health. No healthcare model will succeed if it doesn’t help people engage with providers, understand their risks and manage disease conditions. That’s why BioIQ works with healthcare stakeholders to drive at-risk patients into appropriate care, based on their personal health results. The BioIQ Platform serves as a central hub for connecting enterprises, health plans and individuals with health testing solutions — helping health insurers adopt workable models that deliver on the full promise of value-based care.

“The health insurer of the future should pair thoughtful digital tools used directly by consumers with technology investments that enhance interactions between client-facing employees—like customer service agents or care managers—and consumers.”  — PwC Health Research Institute

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