Empowering Health Coverage: Strategic Approaches To Approval And Claims

 Empowering Health Coverage: Strategic Approaches To Approval And Claims - Several factors are driving demand for healthcare—and health insurance—in Asia. This presents growth opportunities for insurers that focus on health in their portfolio. In addition to vertically integrated payer-provider models, insurer options to differentiate and win include:

To implement, insurers must leverage data insights and define how to successfully deliver personalized health journeys for policyholders, direct targeted health interventions, and do so in a holistic, value-based approach. to do with They must elevate and enhance salesforce capabilities, including the use of technology. The journey of health insurance development in Asia is just beginning, but the first steps must be taken soon.

Empowering Health Coverage: Strategic Approaches To Approval And Claims

Asia1 1 In this paper, referring to Asia, we exclude Japan and Korea because of their advanced state of development and quite different health care systems.

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Notes: 1 In this paper, when referring to Asia, we exclude Japan and Korea due to their advanced state of development and quite different health care systems.

Growing rapidly, driven by the convergence of three trends: an expanding middle class and aging population, access to universal health care; And medical innovation improves survivability and increases the cost of care. As a result, healthcare spending in Asia is expected to continue to outpace inflation and GDP. (See Exhibit 1.)

Across Asia, the burden of funding health care falls disproportionately on consumers. This is due to two factors. First, universal health care schemes, now common in much of Asia, provide inadequate coverage. In addition, middle class consumers are increasingly demanding higher quality care that government schemes can provide. To address this high cost, consumer demand for health insurance will continue to grow significantly. (See Exhibit 2.)

Health has long been at the forefront of consumers' minds and is often the basis of their engagement with insurers, in many cases as a key driver of an initial product purchase. The Covid pandemic has been a catalyst for consumers to focus on their health and wellness, in terms of practicing healthy behaviors and reviewing the adequacy of their health protection. The pandemic also triggered an increase in consumer acceptance of digital care or telehealth, particularly at the beginning of the patient care journey and in the management of chronic disease. Consequently, the digital wave in healthcare is at an inflection point, enabling insurers to engage consumers and policyholders in ways not previously possible and presenting an opportunity to radically differentiate from competitors. do

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Now is the time for the insurance industry to focus on health within its portfolio. The question is: What does it take to succeed, compete and win in this space? Before we delve into that, let's first look at the current state of the game.

The health insurance space in Asia today is defined by several realities that point to opportunities to create a winning model for health insurance.

Health, primarily, has emerged as a major business line of life insurers as a result of their significant scale in distribution. Today, health-focused products account for about 25-35% of total premium volume and are one of the fastest growing insurance product lines. Health insurance across the region generally includes two major product groups: fixed benefit plans, such as critical illness, and medical indemnity plans.

Since their emergence in Asia in the 1980s, critical illness plans have come to dominate the health insurance landscape. It is driven by affordability, comparison to medical indemnity plans, and simplicity, with benefits focused on diseases and conditions that concern most consumers, such as cancer, heart disease, and stroke. Additionally, critical illness plans are often sold as income replacement products, enabling larger premium sizes and thus higher commissions for distributors and others driving scale. Insurers have sought to differentiate by providing broad coverage across many disease types and stages and multiple events. Yet the potential for further innovation with these vectors is limited, and critical illness is increasingly commoditized, resulting in price as the major battleground as margins shrink.

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Medical indemnity products are likely to best serve consumers seeking private healthcare funding. As with critical illness, medical compensation has increased significantly. But even the most "health-evolving" insurers will admit that this growth has preceded the development of technological health insurance capabilities—especially true compared to relatively more sophisticated insurers in Europe, North America, and South Africa. , many of which are far away. A more active role in policyholders' care pathways.

In addition, many insurers continue to measure the performance of their health insurance business using life insurance frameworks and metrics – sometimes leading to limited understanding of profit drivers and difficulty in realizing expected profitability. Efforts to separate the health from life insurance dimension are further complicated by the many medical indemnity products with riders on life and savings plans, such as investment-linked plans.

From a proposition perspective, many insurers have tried to leverage the theme of health and wellness to differentiate, appeal and engage deeply. These programs have enjoyed varying degrees of success—marketing and positive-selection benefits are important and need to be balanced against ongoing investment, low engagement and utilization, and proven effects on policyholder behavior change. difficulty in In regions outside of Asia, some insurers have been successful in driving sustained engagement and behavior change that delivers significant health benefits. The question remains to what extent this can be replicated in Asia. Despite this, insurers have proven that policyholders are ready and willing to engage with their insurers on the topic of health and wellness beyond a purely financial security basis.

Digital solutions enable insurers to improve access to care and deliver interventions at scale and at lower cost than traditional channels. These solutions also facilitate data collection, which, in turn, enables an unprecedented degree of product personalization.

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Policyholders want to engage with insurers on the topic of health and wellness apart from a purely financial security basis.

Finally, there remains a large pool of consumers whose needs are inadequately addressed today, including those with chronic illness or adverse medical histories—which means they often have to access health care. struggle This pool provides opportunities for insurers to innovate, disrupt and lead, although the main reward remains standard risk.

Insurers have many options to differentiate and win in Asian health insurance. These include vertically integrated payer-provider models; Health care service offerings that enable the transition from pure payer to partner; digitally-enabled engagement to improve overall health and well-being; and clinical capabilities to enhance the experience and quality of care pathways.

Regardless of the strategy deployed, there are common threads to building a winning model. We dispel six critical questions that insurers must address to define their own unique and successful initiatives.

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Key considerations include how to deliver propositions to underserved segments and consumer confidence by better aligning product economics with improved health outcomes (eg, through severity-based incentives, early detection and prevention). How to make Another is looking at how to best appeal to top-of-the-line concerns (such as cancer and diabetes) and providing a holistic proposition that includes relevant clinical service components to partner with consumers and truly provide better health outcomes.

How do I build data and analytics capabilities that provide insights to enable population health risk management through risk stratification and targeted interventions?

Insurers will need to consider where the sources of this data exist—whether from insurers, policyholders, or their health care providers—how to access the data, and if incentives are provided to facilitate its exchange. will need to go To implement, insurers must leverage data insights and define how to successfully implement three actions: personalized health journeys for policyholders, directly targeted health interventions, and such in a holistic, value-based manner. do it

The outcome that the delivery of these services seeks to drive is as important as the choice of service as well as the delivery method. This is true whether the insurer wants to offer wellness engagement or population health services, drive better clinical outcomes, or reduce health care costs. It is also important to determine whether these services need to be provided by partners or can be created internally. Finally, consider whether the services can be funded — and whether the policyholder sees enough value to pay for them.

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Considerations here should include where digital should be emphasized as a touchpoint during the typical purchase-service-claims journey and how digital complements other channels, including agents, for a seamless experience. In terms of value proposition, think about the role of digital in relation to engagement, behavior change, and delivery of healthcare services — either directly or through partners — and its impact on the technology stack.

What technological capabilities must be built to deliver sustainable health care funding, and what is the optimal operating model?

Insurers will need to establish a clear understanding of their health insurance economics and baseline to enable sustainable management of their portfolio. This includes looking at how to build these capabilities and, for multinational insurers, how to balance them between business units and central functions. A partnership model between insurers, health care providers, and other stakeholders should be considered, as well as how to create incentives that prioritize value-based care and cost efficiency. And promote good results. In addition, in context

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