The document discusses several issues impacting the global healthcare sector, including demographics, financial pressures, changes in the health industry, regulatory issues, medical advances, and emerging technologies. It notes that an aging population, rising rates of chronic diseases, and increasing consumerism are driving changes in healthcare. Healthcare costs continue to rise globally due to these factors, putting financial pressure on governments, insurers, and consumers. The healthcare industry is also transforming as physicians take on new roles, technology companies enter the space, and alternative payment models emerge. The document outlines some of the key regulatory issues around patient safety, cybersecurity, and fraud prevention. Finally, it briefly highlights several medical advances and how technologies like 3D printing, digital health apps,

1. WHAT NEXT CHALLENGES WILL HEALTH INSURANCE
FACE?
WILL ONLY INNOVATION BE ENOUGH?
Rafael Senén
CEO & Co-Founder
privateandconfidential|coverontripdigitalinsurances.a.|2017

2. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

3. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

4. DEMOGRAPHICS - AGING
72.3 years
73.3 years
Population aging is accelerating rapidly worldwide.
Life
Expectancy
2014
2019
People aged 65+ worldwide to over 604 million
10.8 %
20.8 %
“Contrary to common assumptions, aging has far less influence on
health care expenditures than other factors, including the high costs
of new medical technologies.”
World report on aging and health, World Health Organization, 2015
private and confidential | coverontrip digital insurance s.a. | 2017

5. DEMOGRAPHICS - CHRONIC AND COMMUNICABLE DISEASES
Increased Life
Expectancy
Proliferation of chronic diseases
Obesity
CV Diseases
Hypertension
Dementia…
Challenging
Health Systems
Drugs and
treatments
The current number of people with diabetes globally is 387
million and that number is expected to increase to 592 million
by 2035, according to the International Diabetes Federation.
private and confidential | coverontrip digital insurance s.a. | 2017

6. Diabetes is a global threat with prevalence rates,
which vary from region to region from 5.1% the lowest, to 11.9% the highest.
Source: Juvenile Diabetes Research Foundation International (JDRF)
DEMOGRAPHICS - CHRONIC AND COMMUNICABLE DISEASES

7. DEMOGRAPHICS – CONSUMER ENGAGEMENT
q Consumers are more informed, involved in, and financially responsible for their
healthcare decisions
q Consumers now are more actively involved in their personal health rather
relying only on doctors’ expertise
q Consumers increasingly value online and mobile information exchange with
their provider and health plan
Consumer behaviors drive health management
Patient Empowerment
Consumer Engagement
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8. q Preventive healthcare is becoming widely known as consumers are
increasingly concerned about health related issues and healthcare costs
q More people are adopting digital health apps to manage their care when and
where they want it
DEMOGRAPHICS – CONSUMER ENGAGEMENT
feel comfortable consulting with a
provider via email or phone
of consumers would like access to
technology that enables review of quality
and satisfaction rankings
of consumers have no concerns
about using mobile technology to
pay their medical bills
Deloitte’s 2015 Survey of U.S. Health Care
61 %
36 %
52 %

9. (*) Health purposes include learning more about and/or sharing personal experience with a specific illness, injury, or health problem; specific prescription
medications or medical devices; specific doctors or hospitals; the health care system in general; health technologies that can help you diagnose, treat, monitor, or
improve your health; or other health -or care- related purposes.
Source: Deloitte 2015 Survey of US Health Care Customers.
Use of social media for health purposes(*)
28%
37%
22%
21%
22%
18%
6%
8%
2013 2015
Millenials (18-33 years)
Seniors (70+ years)
Gen X (34-50 years)
Boomers (51-69 years)
DEMOGRAPHICS – CONSUMER ENGAGEMENT
private and confidential | coverontrip digital insurance s.a. | 2017

10. Proper environmental conditions are critical for healthy living and
can help to prevent diseases.
by 2050, 66 per cent of the world’s
population is projected to be urban.
Cities usually grant better access to
healthcare services but are sources of
pollution (air, water, soil, sound, ...)
URBANIZATION
54%
World population lives in cities
DEMOGRAPHICS – ENVIRONMENT
WATER
748 million people
remain without access to an
improved source of water
The number of people whose right to
water is not satisfied is even greater,
probably in the order of 3.5 billion.
private and confidential | coverontrip digital insurance s.a. | 2017

11. Climate change affects the social and
environmental determinants of health –
clean air, safe drinking water, sufficient food
and secure shelter
CLIMATE
250.000 additional
deaths and millions of
chronical diseases per year
DEMOGRAPHICS – ENVIRONMENT
private and confidential | coverontrip digital insurance s.a. | 2017

12. Breathing PM is associated with increased
risk of heart attack, stroke and other
cardiovascular disease; respiratory illnesses
such as emphysema; and cancer.
Air pollution only in California kills 25,000
people per year and costs $200 million
worth of medical expenses.
AIR
1 year
is the life expectancy decreased
in the European Region by exposure
to particulate matter (PM).
DEMOGRAPHICS – ENVIRONMENT
Smog glows in the sunset in Shanghai, China. (Matt Mawson/Corbis)
private and confidential | coverontrip digital insurance s.a. | 2017

13. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

14. FINANCIAL - GOVERNMENT SPENDING
HEALTH CARE IS ONE OF THE LARGEST
INDUSTRIES IN THE WORLD
9.9% GDP
10.0% GDP 17.1% GDP
9.1% GDP
Source: The World Bank
2014
Governments
Universal
HCS
Optimizing their supply chain
Revenue cycle, using bulk purchasing
Reducing labor expenditures
Improving clinical efficiency
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15. FINANCIAL - ALTERNATIVE MODELS
Value-based care has emerged as an alternative and potential replacement for
fee-for-service reimbursement based on quality rather than quantity.
There are different VBC models that are currently been implanted by different
governments, but also big payers.
Shared Risk
Shared Savings
Bundles
FFS
• Full-risk arrangement
with provider receiving
PMPM payments
regardless of services
used and bearing the full
impact of any upside or
downside
• Could be condition- or
population-focused
models with risk across
multiple populations
• Requires mature
capabilities
• Paid under FFS until
year-end
reconciliation.Upside bonus paid if
costand quality goals met
within a pre-
determinedcorridor; downside
risk for portion of
spending that
exceeds cost
containment targets
• Typically multi-year
risk- sharing
contract with
integrated systems
or large physician
groups
• Arrangement with
predetermined
reimbursements for
clinically defined
episodes/bundles of
care instead of
separate payments to
hospitals, physicians,
etc.
• Includes upside
potential and
downside risk
• FFS until year-end
reconciliation plus
gain-sharing or bonus
contract with
physician groups for
attributed members
based on overall
quality and medical
cost versus target.
Savings come from
better coordination
and population health
management (e.g.,
using PCMH)
• Volume-based, low-
risk model where a
set fee is paid for
each service or
procedure provided
Increasing level of risk and capabilities required
Capitation
RANGE OF PAYMENT MODELS
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16. In more basic terms, value-based care models center on patient outcomes and how well
healthcare providers can improve quality of care based on specific measures, such as:
• reducing hospital readmissions,
• using certified health IT
• and improving preventative care.
FINANCIAL - VBC
Last year, US HHS announced that
20 percent of Medicare payments in
2015 were made through a value-
based, alternative payment
(30%/2016 – 50%/2018)
20%
Medicare payments
VBC payments
VBC payment models helped
reduce hospital readmissions in
Medicare beneficiaries by eight
percent in 2015
(12%/2016 – 20%/2018)
8%
Medicare hospital
readmissions down
Other Big Payers
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17. Amid the reform-driven shift to outcomes-focused and value-based
payment many countries are instituting reform-driven drug price
controls.
FINANCIAL - DRUG PRICE CONTROLS
U.S. health plans try to control pharma costs
through reference pricing, formularies, and co-
payments
Germany moved to a highly regulated
pricing regime from a free pricing market in
2011
China, the government mandates that all
public hospitals procure pharmaceuticals
through a provincial, centralized bidding
system
U.K. uses quality-adjusted life years to
evaluate the cost-effectiveness of treatments.44
private and confidential | coverontrip digital insurance s.a. | 2017

18. Generic drugs will continue to gain market share as both public payers and health
plans seek to reduce costs.
FINANCIAL - DRUG PRICE CONTROL
84 %
Is the generics’ share in the
United Kingdom of the
pharma market in 2012
11 %
Is the yearly growth rate
of generics sales in Brazil
80%
by April 2021 is the target of
Japan’s government for
generic use from 60 percent
by the end of April 2018.
70%
of the pharma market
by volume comes from
generic drugs in USA
Development and sales of biosimilars, biologic products which are similar but not identical to
reference biologic products — and less expensive — are accelerating, as well.
In EU more than 700 biosimilars approved or nearly.
private and confidential | coverontrip digital insurance s.a. | 2017

19. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

20. The healthcare ecosystem is a complex one with differentiated groups of key
players having relationship each other.
HEALTH INDUSTRY
private and confidential | coverontrip digital insurance s.a. | 2017

21. HEALTH INDUSTRY
• Contradictory reward system stressing efficiency pressures but still paying doctors
based on number of visits.
• Physician’s role changing from an undisputable expert into a therapy prescriber/guide
PHYSICIANS AND CAREGIVERS
Percentage of physicians who say they feel
responsible to control healthcare costs
38%
82% 81%
9 years
ago
4 years ago Today
Source: Bain Front Line of Healthcare, January 2015; Bain Physician Attitudes Survey, January
2011
private and confidential | coverontrip digital insurance s.a. | 2017

22. • The rise of big data predictive models and consumers’ growing comfort with tracking their daily habits
have accelerated the adoption of wearable technology, health apps and other high-tech digital
applications.
• Many technology and data based companies such as Google and Apple are developing long interests in
health and life science
HEALTH INDUSTRY
TECHNOLOGY AND DATA PROVIDERS
(1)TheStateoftheArtofmHealthAppPublishing.
(2)DISYS.
private and confidential | coverontrip digital insurance s.a. | 2017

23. HEALTH INDUSTRY
TECHNOLOGY AND DATA PROVIDERS
Project
Baseline
An ini.a.ve to develop a complete
model of the chemistry of a healthy
human body
Currently developing a smart contact
lens, solar powered, that collects
diagnos.c data using sensors
Curing
Heart
Disease
Entered into a partnership with the
American Heart Associa.on to drop
$50 million into funding a single
project beginning in 2016
Smart
Contact
Lenses
HealthKit
PlaHorm which allows the
development of health and fitness apps
to be used in gathering data from
individual
A plaHorm for researchers to build
medical apps and recruit pa.ents for
clinical trials
ResearchKit
CareKit
A framework for developers to create
apps that will enable you to manage
your own well-being on a daily basis
Using the smartphone Alexa
app, Echo owners enable
KidsMD from Boston Children's
Hospital
Introduced an app where
consumers upload an image
of their prescrip.on and get
quotes from nearby
pharmacies
As a result of its “Organ-
Donor Status Ini.a.ve”, organ
dona.on sign-up increased
21-fold over average on the
day it rolled out
private and confidential | coverontrip digital insurance s.a. | 2017

24. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

25. REGULATORY & ETHICS
Much of health care’s
regulatory focus is on
pa.ent and drug safety.
Regulatory agencies
con.nue to exert pressure
on pharma, biotech, and
medtech companies, with
increasing emphasis on off-
label marke.ng, failures to
disclose safety risks, and
concerns about the clinical
trial process.
PATIENT AND
PRODUCT
SAFETY
CIBERSECURITY
Regarding Cloud-based
compu.ng aacks; medical
devices security concerns
and control of privileged
access.
FRAUD AND
ABUSE
An important part the fight
against fraud and abuse is
the Industry be able of
tracking and analyzing the
rela.ons and
interdependencies that exist
within HC Ecosystem.
private and confidential | coverontrip digital insurance s.a. | 2017

26. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

27. MEDICAL ADVANCES
NANOTECHNOLOGY STEAM CELL TREATMENT
REJUVENATION
RESEARCH
TELOMERASE
MAINTENANCE OF
CONSCIOUSNESS
BIONIC LIMBS
GENETIC MAP DNA MANIPULATION
NEW CHALLENGES
regarding a new perspecNve about inmortality
private and confidential | coverontrip digital insurance s.a. | 2017

28. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

29. TECHNOLOGY & DATA
MAIN DRIVERS
according to a recent research by Gartner
3D PRINTING
of people in the
developed world will
be living with 3D-
printed items.
10 %
of surgical procedures
requiring prosthetic,
implant devices or
organs will use 3D
Printing as a critical
tool
35 %
by 2019
private and confidential | coverontrip digital insurance s.a. | 2017

30. TECHNOLOGY & DATA
MAIN DRIVERS
mHEALTH
Diagnostic tools will be used both for preventative / decision support and
treatment compliance purposes
Healthcare Wearable Device Shipments and
Revenue, World Markets 2015-2020 (1)
(1) Source: Trac.ca
private and confidential | coverontrip digital insurance s.a. | 2017

31. Wearable developments based on
new materials and miniaturization
allowing implantation into the
body’s various parts and systems
Wearables are backed with decision
support capabilities
TECHNOLOGY & DATA
MAIN DRIVERS
BODY INTELIGENT IMPLANTS & PROSTHESIS
private and confidential | coverontrip digital insurance s.a. | 2017

32. Applications may go from early
detection – action strategies, to support
AI systems to interact with persons
Current data processing capabilities
allow to analyze data which was
impossible to process years ago,
running more complex analysis and
using data in depth
TECHNOLOGY & DATA
MAIN DRIVERS
PREDICTIVE MEDICAL DATA MODELS
private and confidential | coverontrip digital insurance s.a. | 2017

33. TECHNOLOGY & DATA
MAIN DRIVERS
COGNITIVE TECHNOLOGIES AND AI BASED HEALTHCARE
Decision Making in Healthcare: The Growing Gap Between Available Data and Human Ability (1)
(1) IBM Watson Health: Capturing the Value of Big Data: Big Changes Ahead
private and confidential | coverontrip digital insurance s.a. | 2017

34. TECHNOLOGY & DATA
MAIN DRIVERS
AUGMENTED REALITY
AND VIRTUAL REALITY
TELEMEDICINE AND
REMOTE ROBOTIC SURGERY
HEALTH INTELIGENT
DOMESTIC OBJECTS
private and confidential | coverontrip digital insurance s.a. | 2017

35. DEMOGRAPHICS
FINANCIAL
HEALTH INDUSTRY
REGULATORY & ETHICS
MEDICAL ADVANCES
TECHNOLOGY & DATA
HEALTH CONDITION
ISSUES IMPACTING THE GLOBAL
HEALTHCARE SECTOR
private and confidential | coverontrip digital insurance s.a. | 2017

36. BUT WHAT ABOUT THE HEALTH INSURANCE INDUSTRY?
BIG CHALLENGES, FAST CHANGES AND NEW TRENDS?
IS IT READY?
privateandconfidential|coverontripdigitalinsurances.a.|2017

37. WHERE TO FOCUS?
SHOULD WE SHOOT ANYTHING THAT MOVES?
AGING
CHRONICAL DISEASES
AIR – WATER
CLIMATE – URBANIZATION
PUBLIC HC SYSTEM
MEDICAL ADVANCES
PATIENT AND PRODUCT
SAFETY
FINANCIAL MODELS
DRUG PRICE CONTROL
GENERIC AND BIOSIMILAR
CYBERSECURITY
FRAUD AND ABUSE
TECHNOLOGY AND DATA
PREVENTION
CARE UNITS
CONSUMER BEHAVIOR
PATIENT EMPOWERMENT
WE CAN DO OR WE CAN USE
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38. 1
2
3
4
FOUR GOOD STARTINGS
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39. 1
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40. HEALTH LITERACY PATIENT CONTROL PATIENT PARTICIPATION
Link between paNent
and his/her
understanding of
health informaNon
RelaNonship between
the paNent and the
management of his/
her condiNon
RelaNonship between
paNent and health
professionals
MEANINGFUL PATIENT INVOLVEMENT IN HEALTH
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41. private and confidential | coverontrip digital insurance s.a. | 2017

42. TOP THREE SERVICES AVAILABLE TO PATIENTS ELETRONICALLY
(1)Accenture.DoctorsSurvey.(2015)
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43. 2
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44. private and confidential | coverontrip digital insurance s.a. | 2017

45. private and confidential | coverontrip digital insurance s.a. | 2017

46. Members engaged in healthy ac.vi.es experienced
fewer admissions and lower costs than others.
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47. 3
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48. OSCAR´s PROPOSAL IS BASED IN:
1. SIMPLICITY IN THE OFFER (ONLY THREE PLANS)
2. DIGITAL AND SIMPLE CUSTOMER RELATIONSHIP
3. PREVENTION AND ENGAGEMENT THROUGH WEARABLES
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49. 4
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50. AND THE ELEMENTS ARE ALREADY THERE…
DIGITAL TRANSFORMATION INTERNET OF THINGS
BIG DATA CAPABILITIES TECHNOLOGY WELL USED
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51. SAND THIS IS WHAT INDUSTRY THINKS…
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52. Concept
InnovaNon
Founding
Year
Geographic
Scope
• The company gives
wearables to its
members, who get a $20
reward for mee.ng
ac.vity goals each month
• Oscar claims that people
is kept healthier through
these monthly goals and
by using wearables
• USA (star.ng in NY, NJ,
CA, TX, but expanding
na.onally)
• Tech plaHorm which
helps employers to
offer “health benefits”
to their employees
• Collec.ve Health helps
to customize individual
health plans for each
employee
• USA
• 2013 • 2013
• USA
• 2013
• USA
• 2012
• An advisor / concierge
on health insurance
plans
• Based on 38 factors
helps to compare and
fine the right plan for
each customer
• A life insurance provider
which charges each
customer based on their
specific physical ac.vity
• Through apps and
wearables, the company
monitors users’ ac.vity
and assists them to
accomplish their goals
INNOVATION IS HERE…
private and confidential | coverontrip digital insurance s.a. | 2017

53. INNOVATION IS HERE…
private and confidential | coverontrip digital insurance s.a. | 2017

54. Dr. Allianz
• Digital house calls-that
leverages mobile
technology to monitor
vitals in patient’s home
• Patients can contact Dr.
24/7; if needed, Dr. will
come to them
Ask a Nurse
24/7
• Users can call a
telephone number to
get immediate answers
to non-emergency
health questions from a
registered nurse
LiveHealth
Online
• Uses the video
capabilities of members'
computers to have a
face to face virtual
meeting with a doctor-
on demand.
Digital
Underwriter
• Insurance applicants can
apply from anywhere and
get instant decisions on
their smart-device
• The aim is to be paperless
for both parties
INNOVATION IS HERE…
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55. INNOVATION IS HERE…
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56. AS WELL AS FUNDING FOR START UPS…
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57. BUT IT IS NOT ENOUGH TO OVERCOME THE CHALLENGES
THE INDUSTRY HAS TO FACE TO WITHIN THE NEXT 5
YEARS
FINANCIAL MODELS
DRUG PRICE
CONTROL
GENERIC AND
BIOSIMILAR
CYBERSECURITY
FRAUD AND ABUSE
TECHNOLOGY AND
DATA
PREVENTION
CARE UNITS
CONSUMER
BEHAVIOR
PATIENT
EMPOWERMENT
CUSTOMER/PATIENT CENTRIC MODELS
STABLISHING VBC PAYMENTS
NEW PROVIDERS MANAGEMENT RELATIONSHIP
CREATING NEW PLANNS LINKED TO PHARMA COSTS
FUNDING SERIOUSLY PREVENTION CAMPAINGS,
RETHINKING CARE UNITS NETWORKS
among others…
HC INSURANCE INDUSTRY HAS TO WORK HARD
private and confidential | coverontrip digital insurance s.a. | 2017

58. THANK YOU
coverontrip.com
Rafael Senén
CEO & Co-Founder
privateandconfidential|coverontripdigitalinsurances.a.|2017