Market scope of US health insurance industry

Presented by
Rony Debnath
Rony.cse09@gmai
l.com
Understanding Market Scope of US
Health Insurance Industry

www.relisource.com 1-877-735-7729 info@relisource.
Table of contents
• What is health care insurance
• How health care insurance works in USA?
• share of people with public health insurance
in the United States
• Market share of leading health insurance
companies
• Total revenue of life and health insurance
industry in the United States
• The Use of Technology With the Health
Insurance Industry
• problems that are health insurance
companies facing today
• Scope of improvements in healthcare
information technology
• Number of health insurance home-office
employees in the U.S
• Possible opportunities
• Major Companies & products
• What Relisource can offer
• Proposed system
• Disclimer

What is health care insurance?
Health Care insurance is a type of insurance
coverage that covers the cost of an insured
individual's medical and surgical expenses.
Depending on the type of health insurance
coverage, either the insured pays costs out-
of-pocket and is then reimbursed, or the
insurer makes payments directly to the
provider.

How health care insurance works in USA?
The US government does fund two kinds of health plans though: Medicare and Medicaid. They are
especially designed for the elderly, disabled, poor, and young.
However, many Americans have their healthcare paid for by their employer. It's often included as a
fringe benefit in job packages.
There are a lot of Health insurance providers working in various states throughout the country.
According to CMS, the annual U.S. spend on healthcare is nearly three trillion dollars which is more
than 17 percent of its GDP.

share of people with public health insurance in the
United States
the number of U.S. Americans with government
health insurance coverage from 1997 to 2016. In
2016, 36.8 percent of people in the United
States had public health insurance and its
increasing every year.

Market share of leading health insurance
companies
The statistic shows the market share
of leading health insurance
companies in the United States by
direct premiums written.

contd: Market share of leading health insurance
companies
According to the 2015 market share numbers the NAIC published, UNITEDHEALTH
has the highest number of 11.4% health care insurance market worth of $98.5
billion dollars and Anthem Inc has $52.4 billion dollar worth of premium
collection with 9.2% market share.

Total revenue of life and health insurance industry in the United States from
2009 to 2015
This statistic shows the total
revenue of the life and health
insurance industry in the
United States from 2009 to
2015. In 2015, the U.S. life and
health insurance industry
generated a total revenue of
848.2 billion U.S. dollars.
*Figures are in billions

The Use of Technology With the Health Insurance
Industry
Technology continues to bring exciting changes to the health insurance industry.
Electronic claim filing, payment options, and web-based tools allow providers and
health care consumers to manage their health care more effectively than
traditional paper-based systems. This technology is not only convenient; it makes
submitting claims more efficient and speeds up payment to physicians.

problems that are health insurance companies
facing todayThe insurance business is competitive nowadays. Especially in
the healthcare insurance companies. Following are the most
problems facing today.
• Development of Long-term Client Relationship: It is
genuine in these days. Most of the agents and brokers
looking for long-term client relationship but fail to find
so. This is due to lack of resources and various possible
management problems.
• Lack of Demand: Market is shifting and hence business
needs to move consequently. At the same time, it is not
possible to introduce the new products in the market
which is opened up.

Contd: problems that are health insurance companies
facing today
• Enhancement in Technology: In some reasons, a revolution in technology regard to management
occurs which is extremely expensive and yet not functional thus most companies are unable to
accept it.
• Lack of Development Skills: In the modern era, where priority given to certain specific processes
like accounting, data entry, finance system, documentation, claim settlement, commission
management, policy contracts and their functions . The management fails to handle it to process
them in faster and within accuracy.

Contd: problems that are health insurance companies
facing today
Primary care average wait times in
selected U.S. markets, 2014.
Image Credit: Merritt Hawkins

Number of health insurance home-office employees in
the U.S
The statistic shows the Number
of health insurance home-office
employees in the U.S from
2000-2015

Possible opportunities
• Modernizing legacy systems for operational efficiencies: With operations spread
across geographies, spanning over decades, insurance companies are inhibited with
legacy systems, outdated technologies resulting in high maintenance costs. The
proliferation of modern technologies like mobile and cloud computing has changed the
way organizations do business. And, healthcare insurance companies also embracing
the latest technologies.
• Going mobile to offer on-the-go services: The health insurance industry is steadily
implementing mobility as part of their business strategy. Through the mobile apps,
customers can easily request a policy quote, locate an insurance agent, calculate
premium and store the policy data with themselves.
• Offering innovative and personalized services through digital touch points: In order
to retain floating customers and build deep customer relationships, the insurance
companies are investing in customer engagement activities using various digital touch
points say the web, mobile, social media, email, etc.

Solutions that exists currently on market
There are many software & tools that Health care insurance companies use to
conduct their business.
• Policy management
• Claim Management
• Commission Management
• Reporting Tools
• Customer Relationship Management

Major Companies & products
These are some of the renowned companies that are delivering software solutions to
the health insurers:
 Oracle Health Insurance Solutions & Netsuite
 BSI Health CRM
 SAP business One
 Code Evolution’s virtual claim adjuster
 A1 Tracker
 INSIS Health
 EHR & EMR Solutions
 And much more…

360
SOLUTION
Proposed
system
Insurance
administration
Data &
Analytics
Consumers
satisfaction
Secure archiving of
documents
• Integrated document management
system that store customer
applications, insurance policies &
other sensitive information and easy
retrieval of them
 Mobile App for simplified treatment cost
estimator, online appointment scheduling,
doctors schedule notification, simple access
to health records
 IoT devices for tracking health data more
accurately and sending wellness tips
customized by consumers heath records
• Bridging the gap between EHR and
clients data taken by insurers by easy
sharing tools & Actionable analytics
 Simple yet ergonomic web & mobile
app portal for policy & claim
settlement, billing & collection, agents
& commission management.

Why Relisource should build this 360 platform
Since a huge number of health insurance policy consumer is elderly and they don’t have that much
demand, except for a simple insurance cost calculator, access to their health records easily, mobile
notification of their doctor schedule meetings, online appointment and payment system within in-network
provider, Relisource can have a 360 consumer centric solution that would meet their demands.
In order to win consumer engagement, trust, and loyalty, payers are investing in developing basic
capabilities focused on cost, transparency, and convenience that streamline the healthcare experience. A
recent survey revealed some 97% of consumers are willing to share their health data and non sensitive
information to the insurers if it would enhance their care. Health insurers can use this data & analytics to
improve people’s wellness so that the insurance claims stay at a lower number.
Wellness & Fitness apps are another technology trend player and IoT will significantly change the health
insurance system in coming decade. These are the field that can be improved and relisource can invest in
these under developed systems.

disclaimer
All information contained herein is obtained to make this presentation is from sources believed by it to be
accurate and reliable. Because of the possibility of human or mechanical error as well as other factors,
however, all information contained herein “As is” without warranty of any kind.

Thank you

Market scope of US health insurance industry

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