The health insurance industry is evolving and undergoing significant changes. As the risk landscape shifts, insurers are working to improve operational efficiencies, meet evolving customer preferences, and align better with the changing business environment. Accordingly, payers must adapt and align business models and offerings. An incisive tactical approach is required to accommodate members’ needs and related emerging risks — medical, health, and environmental. Advanced technologies such as artificial intelligence, analytics, automation, and connected devices are enabling insurers to manage these changes proactively, partner with members, and help to prevent risks, all the while continuing to fulfill payer responsibilities. Read Top Trends in Health Insurance: 2020 to learn which strategies insurers are adopting to navigate and align with today’s challenges.

1. Top Trends in Health
Insurance: 2020
November 2019
Link: https://www.capgemini.com/top-
trends-in-2020/

2. 2© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Market forces push realignment pressure on the health insurance industry
Insurers become more transparent to bolster customers trust
A holistic insurance experience gives customers a wide range of value-added services
Insurance chatbots offer an engaging and guided customer experience
Wearables and digital platforms drive changes in behavior and increase Rx adherence
Insurers are leveraging predictive analytics for risk profiling and early intervention
APIs drive data interoperability within the healthcare industry
Automation boosts claims processing efficiency and may enable real-time payment
Changing
Business
Environment
Evolving
Customer
Preferences
Emerging Risk
Landscape
Enhancing
Operational
Efficiency
TREND 1
TREND 2
TREND 3
TREND 4
TREND 5
TREND 6
TREND 7
TREND 8
Source: Capgemini Financial Services Analysis, 2019
Health insurers are responding to shifting market dynamics
Top Trends in Health Insurance for 2020 by Capgemini

3. 3© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
3© Capgemini 2019. All rights reserved |
Disintermediation
Vertical
integration
Horizontal
integration
Cost sharing
Purchaser/
plan sponsor
Payer Provider Pharma
Collaboration and integration are happening across the health insurance value chain to
address emerging risks and to provide quality care to members
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 1: Market forces push realignment pressure on the health insurance industry

4. 4© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
4© Capgemini 2019. All rights reserved |
Customers are
seeking more
information
while purchasing
health insurance
plans
Regulatory
pressure to
improve
transparency
is intensifying
Trusted
players such as
BigTechs are
entering the
industry
Insurers can boost customer relationships by enhancing
transparency and empowering members with more information
about coverage and costs
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 2: Insurers become more transparent to bolster customer trust

5. 5© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
Value-added
services
Smartphone
use is on the
rise and the
app ecosystem
is strong
Differentiation is needed
in the highly
commoditized
insurance market
Collaboration is
becoming
easier because
adoption of
APIs is up
Consumers seek
convenient access to
innovative health
products and services
Value-added services can help insurers improve customer
engagement and differentiate offerings in a commoditized market
5© Capgemini 2019. All rights reserved |
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 3: A holistic insurance experience gives customers a wide range of value-added
services

6. 6© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
6© Capgemini 2019. All rights reserved |
Guided and comfortable
experience for customers
24 x 7 availability of support
services to customers
Cost savings for insurers
High scalability of customer
support services
AI-driven chatbots could help insurers interact meaningfully with customers –in a cost-
efficient way
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 4: Insurance chatbots offer an engaging and guided customer experience

7. 7© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
Wearables are helping
insurers gain valuable
insight into members’
lifestyles
Rising health care costs
are driving consumers
to adopt healthy
lifestyles
Members are willing to
share personal data for
better risk coverage and
discounts
Payouts are often
significantly higher
because of poor
medication adherence
Customers who adopt healthy habits and adhere to prescribed Rx would enjoy more
positive health outcomes and boost insurers’ overall profitability
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
7© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Trend 5: Wearables and digital platforms drive changes in behavior and increase Rx
adherence

8. 8© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
8© Capgemini 2019. All rights reserved |
Predictive analytics offer insurers insightful assessment of potentially
high-risk customers, which can mitigate loss and boost profitability
Early interventions
are needed
More data is available
than ever before
More customers are
willing to share data
Risk profiling accuracy
is critical
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 6: Insurers are leveraging predictive analytics for risk profiling and early
intervention

9. 9© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
9© Capgemini 2019. All rights reserved |
Interoperability
Interoperability will enable insurers to streamline data sharing and empower
patients with health data knowledge and control
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 7: APIs drive data interoperability within the healthcare industry

10. 10© Capgemini 2019. All rights reserved |Health Insurance Trends 2020 | November 2019
Source: Capgemini Financial Services Analysis, 2019
10© Capgemini 2019. All rights reserved |
Automation technologies can make claims processing faster and more efficient, which
satisfies members and reduces operational costs.
Faster claims
processing
Strategic
use of
human
resources
Top Trends in Health Insurance for 2020 by Capgemini Risk
Landscape
Operational
Efficiency
Business
Environment
Customer
Preference
Trend 8: Automation boosts claims processing efficiency and may enable real-time
payments

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