In recent times, health insurers have increasingly focused on preventative care models. Providers have moved from reactionary care to more anticipatory approaches that seek to foster healthier lifestyles and early intervention.
This provides opportunities to not only improve outcomes, but also manage cost of care by moving it upstream to tackle the root causes of disease. The impact can be big. Indeed, research shows that 55-65 % of a typical health insurer’s claims costs can be impacted by preventative or mitigative actions (1).
Today, digital technology is playing an increasingly important role within prevention-focused care models and in this article, we explore how.
Increasing control and access
Part and parcel of prevention is empowering members to take greater ownership of their health. The key element here is individual control. Indeed, 60% of members say they want more control over their health, their wellbeing, and their insurance products. And yet only 20% believe they get it from their current provider (2).
Putting control truly into the hands of your members can support better choices and engage individuals more closely with their health plan. Today, digital platforms, mobile applications and wearable devices are playing a central role in this regard, enabling individuals to track their health. Apps can monitor physical activity, nutrition, sleep patterns, and other health metrics, providing personalised recommendations and incentives for healthier behaviour.
Platforms may also connect the individual with a range of care remotely, making it easier to access preventive care, consultations, and routine check-ups. With health systems across the globe often fragmented and complex, providers can help individuals to navigate care systems, accessing care appropriate to their specific needs. Timely access to right care in the right setting can produce better outcomes for the individual, providers and society.
Supporting risk stratification
The prediction and early identification of personal risk is also a foundational element of any prevention-centric care model.
Using data analytics to identify trends and patterns in health data can enable insurers to pinpoint where interventions are required, and tailor them accordingly to a given member. Insurers can proactively reach out to those identified at higher risk of certain conditions and provide personalised guidance on preventive measures and lifestyle changes.
Online health assessments may also help members understand more about their health risks. These assessments can include questions about lifestyle, family history, and health habits and offer tailored recommendations for prevention. While machine learning and AI can be employed to predict health risks and suggest interventions. AI-powered chatbots or virtual health assistants may also provide members with information about preventive measures, schedule screenings, and answer health-related questions.
Improving care management
Reducing the burden of chronic disease on the health system is a major challenge for both public payers and private providers.
Many strides have been made in recent years with the increasing adoption of remote monitoring and digital care pathways for individuals living with complex conditions. This can both enable individuals to engage with care regularly in low-risk, low-cost settings, and also facilitate multi-disciplinary approaches, allowing the individual to consult with a dedicated remote care team.
Remote monitoring devices can also support conditions that require ongoing management like diabetes or hypertension. These devices can transmit data to healthcare providers, enabling timely interventions to prevent unnecessary admissions. While health coaching may also be provided through video calls and messaging platforms, connecting members with qualified health coaches who can offer guidance and motivation for healthier lifestyles.
To ensure sustained, long-lasting behaviour change, insurers need to engage individuals throughout the lifecycle of their plan.
Gamification is a key tactic that has been shown to deliver results. Interactive apps or programs may reward policyholders for meeting certain health goals, such as increasing physical activity or quitting smoking. Incentives and rewards can also equal success. Here, members who actively engage in preventive health activities, such as attending wellness programs, may receive discounts on premiums or other incentives. This can encourage ongoing engagement in healthy activity.
By leveraging these digital technologies and strategies, health insurers can play a proactive role in promoting preventive care and improving the overall health and well-being of their policyholders, which can ultimately lead to cost savings and better health outcomes.
How we can help
Livi is the digital partner of choice for health insurers and the biggest healthcare provider in Europe. We know members want minimal wait times, greater choice and better healthcare experiences and help our partners to deliver just that with our private offering.
We use our clinical expertise to treat, assess and direct members to the right care for their needs, in primary or secondary care, and we support partners to control medical costs. By providing data insights that support predictive models for claims outcomes and underwriting decisions, we help to reduce operational expenditure and administrative burden.
1.PA. From reaction to prevention – rethinking the role of UK health insurance. Available online: paconsulting.com/insights/from-reaction-to-prevention-rethinking-the-role-of-uk-health-insurance. Accessed September 2023.