How health insurance companies can become more profitable


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  • Insurance companies need to find ways to differentiate themselves from the competition. Fraud is causing loss to occur Consumers see little value or benefit Health insurance has focused on the illness, not on the health of their customers.
  • How health insurance companies can become more profitable

    1. 1. Dr Aniruddha Malpani,
    2. 2. Your pain points todayIntense competition - health insurance hasbecome a commodity. You need to differentiate !You lose money per customer because of fraudYour customers do not see any benefits - feel it isa waste of their money when they do not make aclaimToday, it is illness insurance – not healthinsurance !
    3. 3. Our solution allows you toReduce your claims loss ratioAcquire new customersRetain your old ones
    4. 4. TodayYour subscribers hear from you only when:The premium is due to be paidThe claim they present is rejected
    5. 5. Using the internetYou need to proactively establish a morepositive relationship with their customers. When people fall ill, they use the internetextensively to research their treatmentoptionsOver 200 million Indian internet usersCan you help them in their time of needwith Information Therapy ?
    6. 6. Your website is a problemPoor content - focus on your company andnot on your customerProviding the patient with what he wantsto know – information about his symptomsand his treatment options can build trust.Why not embrace that opportunity ?
    7. 7. Not an easy task !Writing high quality medical content specificallyfor patients is difficult and time consumingYou can now instantly license the informationyour subscribers need to manage their healthconcerns from the world leader in patienteducation, Healthwise Knowledgebase ! !
    8. 8. Knowledge is powerDeliver health information anywhere, anytime –in an engaging fashionHealthwise offers a digital platform, based onwhich you can provide patient support programsand coaching to help your members remainhealthyWe help you create cost-effective solutions thatuse time-tested channels and integrate cutting-edge new ones to deliver results.
    9. 9. Patient education makesbusiness sense !Well informed patients make better andless costly health care decisions, helpingyour bottom line.This has been proven by research.Educating diabetics reduces medical costs.Studies Health Technology Information. 2009;143:258-63.Potential Return on Investment (RoI) on web-baseddiabetes education in UK. Shabestari O, Roudsari A.
    10. 10. Patient education reducesunnecessary surgeryWell informed patients say no tounnecessary surgery, thus reducinghealthcare costs.E. Murray et al., “Randomised Controlled Trial of anInteractive Multimedia Decision Aid on Benign ProstaticHypertrophy in Primary Care,” British Medical Journal 323,no. 7311 (2001): 493–496
    11. 11. Patient education reducesunnecessarysurgery( hysterectomy)A.D. Kennedy et al., “A Multicentre Randomised Controlled TrialAssessing the Costs and Benefits of Using Structured Information andAnalysis of Women’s Preferences in the Management of Menorrhagia,”Health Technology Assessment 7, no. 8 (2003): 1–76.The use of decision aids, consisting of evidence-basedinformation reduces health service costs as well asimproving patients’ satisfaction.The reduction in hysterectomy rate is consistent withtrends observed in other studies looking at conditionswhere patients have a choice between conservative andradical surgical options.
    12. 12. Shared decision makingreduces costs ( hip and kneesurgery)Group Health Cooperative (an integrated insurer andhospital system) gave all 660,000 of their patientsaccess to decision aidsAfter introducing decision aids, rates of hipreplacement fell over 25%; knee replacement wentdown 38%. Total spending went down 21% on patientswith hip osteoarthritis and 12% for knee patients --but for the whole study population.Introducing Decision Aids At Group Health Was Linked To SharplyLower Hip And Knee Surgery Rates And Costs . Health Aff September2012 31:92094-2104. Arterburn, D et al. Group Health Research Institute,USA.
    13. 13. Shared decision makinggenerates savings for healthinsurance companiesPatients who received these tools had 5.3 percentlower overall medical costs.They had 12.5 percent fewer hospital admissions and9.9 percent fewer preference-sensitive surgeriesincluding 20.9 percent fewer heart surgeries.Enhanced Support For Shared Decision Making ReducedCosts Of Care For Patients With Preference-SensitiveConditions. David Veroff et al. Health Affairs. Feb 2013.
    14. 14. Shared decision makinggenerate savingsA “remote” model of support combining telephoniccoaching with decision aids constitutes a low-cost andeffective intervention that could reach broaderpopulations without the need for direct involvementof regular medical care team members.Enhanced Support For Shared Decision MakingReduced Costs Of Care For Patients WithPreference-Sensitive Conditions. David Veroff et al.Health Affairs. Feb 2013.
    15. 15. Health insurance portabilityChallenge and opportunity !You need to create customer loyalty !1. Build stronger relationships with existingmembers2. Attract customers from competing healthinsurance companies by providing a uniquedifferentiator!Better than wasting money on generic advertising!Our solutions can help you attract and retainmembers now—and in the future.
    16. 16. Healthy customers = healthierbottom lines !Promote SelfCare. Help them to do as much forthemselves as they canProvide Evidence-Based Guidelines, so that theycan ask for the right medical treatment that theyneed - no more and no lessProvide Veto Power, so they can say No tomedical care they don’t need, thus preventingovertesting and unnecessary surgery.
    17. 17. Healthwise Knowledgebase
    18. 18. BenefitsYou will be promoting health – not justselling illness benefits !Proactively helping your customers toremain healthyMajor differentiator – stand out from yourcompetitors
    19. 19. Learning from the USAAll the Top 10 health insurance plans in the US usethe Heathwise Knowledgebase on their website
    20. 20. Value addEngage with your membersEncourage them to call you as point of firstcontactBuild trust and loyaltySend regular ezines to help them remainwellReduce unnecessary surgery (such ashysterectomies and caesarean sections)
    21. 21. You have many needs –we provide many solutions !As healthcare costs rise, helping yourmembers manage their health becomesincreasingly important.Reach your entire population with a scalableinteractive health management platformDeliver targeted clinical education programs to at-risk segments.Provide condition-specific health information formembers managing chronic conditions.
    22. 22. Very cost effective investmentAnnual license costs only a few rupees per customerGreat way to create customer delight !The knowledgebase is a digital platform which servesas a necessary starting point to engage customersYou need to build upon it further – for example, byusing a call centreHelp your members achieve lasting health behaviorchange through a highly personalized, multi-modalityapproach.
    23. 23. White labelledYour logo here
    24. 24. Engage with Health Guardian/Health Coach
    25. 25. Rich actionable content –changes behaviour !
    26. 26. Shared decision making withinteractive decision aids
    27. 27. Try it out yourself