Health Insurance Disruptors: Going Digital

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Publication Date:
October 2019
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Health insurance: how to thrive in an increasingly digital health world

Health insurers are being challenged to develop a portfolio of digital services with limited knowledge of their effectiveness and at a considerable cost. But are things about to change? While integrated digital platforms can deliver significant patient, operational and commercial benefits to all health insurers, disrupter companies such as Ping An in China have developed radically new online/offline healthcare ecosystems with digital solutions at their heart. What could this mean for the health insurance sector and what role can pharma play?

Health insurance businesses are facing fundamental change and companies that fail to implement effective digital solutions across their business will be left behind. That is why in, Health Insurance Disruptors: Going Digital we interviewed experienced payers to help you understand the current challenges and solutions and to explore the disruptive technologies and approaches that could shape the future of health insurance delivery.

Experts explore the health insurance landscape

  • What is the current focus of digital technology services and how are they being employed to improve patient care?
  • To what extent is artificial intelligence and digital profiling used to understand customer preferences and what impact has it had on the services provided and business strategy?
  • What do you see as the main barriers to the adoption of digital technologies and what can be done to overcome them?
  • What can health insurance companies learn from the experience of other service sectors?
  • What are the opportunities for payers to collaborate with pharma companies and/or other health stakeholders to develop digital solutions that will improve outcomes and/or lower overall health costs?
  • What will the health insurance landscape look like over the next five years?

What our experts say…

"I think there's going to be a massive change ahead and this will result in changes in the big players in the insurance industry. Insurers who are able to adapt to this change are going to be singularly successful but others are going to fall way behind the curve."

"Over the next two to five years we will see more technology innovation coming into the health insurance space and that's very exciting. There was a meeting recently between the big technology companies, Apple, Google and the US health insurance industry, and they came to an agreement regarding a standard for a personal health record which includes health records and insurance claims. That's really exciting and will change things significantly. You'll be able to put information into a digital environment in a way you haven't been able to do before."

"I see that the market is ripe for disruption, new entrants are coming in with new digital technology, which will expand consumer choice. Up until now we've been really selective about what's appropriate for the industry. Excitement around digital technology is great, but the execution is slow. While we may prophesize big changes over the next five to 10 years, the pace of adoption is always a bit slower than you would expect because of execution and barriers to adoption. The healthcare industry as a whole has lagged behind other sectors, and I think that will continue to be the case. But I do think some of the disruptors like Oscar or Ping An will start to show the way, and others will follow that model"

What could a health insurance model of the future look like?

Imagine this...patients could have access to 24/7/365 healthcare ecosystems whereby individuals can pay a premium to access online care and health support any time on an ad-hoc basis. If care needs to be escalated to an offline facility, the health insurer will organise access to the nearest doctor, pharmacy or hospital.

What to expect

  • A detailed report examining the opportunities and challenges for health insurers of developing and implementing digital infrastructure and the radical thinking that could usher in new commercial models
  • An examination of 6 key issues which health insurance planners needs to understand and respond to
  • 25 targeted questions put to the experts
  • Their perceptive responses that provided 26 insights supported by 68 directly quoted comments

Expert contributors

The report harnesses critical insights and opinions from industry experts who have had at least three years' experience with a leading payer or service provider to the health insurance market, and has been involved in implementing digital solutions within the healthcare sector.

Contributors to the report

  • Payer 1 is a Chief Medical Officer for a leading US payer with more than 20 years' experience in the managed care industry. Payer 1 oversees clinical programme development and implementation, formulary management, clinical policy development, innovative solutions in patient outreach and clinical assessment, pathway development, analytics and strategic solutions and has extensive experience in customizing health plans and innovative programmes of clinical and economic value. She has been responsible for medical policy development and implementation, correct coding initiatives, detecting fraud/abuse and physician profiling in the US.
  • Payer 2 has been the Chief Operating Officer and Executive Vice President PBM/Health Informatics at a leading Pharmacy Benefit Management company in Europe and has more than 24 years of experience in healthcare, working with the large insurers, health plans, pharmacies and pharmaceutical companies. His experience includes pharmacy operations, clinical operations, formulary and rebate management and disease management programmes.
  • Payer 3 is a Pharmacy Director with a leading US Payer and has been working in the payer environment for more than 20 years. Payer 3 acts as a clinical consultant to managed care health plans and is involved in assessing new services and technologies that can support and improve client access to healthcare.

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