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Health Insurance Top Trends 2021

A combination of factors, including demographic changes, evolving consumer preferences, and regulatory and compliance mandates, were already spurring change in the health insurance industry. Enter 2020 and the COVID-19 pandemic, which is having sweeping implications for the industry.
At the peak of disruption, the focus was on ensuring business continuity, but new initiatives are cropping up to tackle the challenges as the industry adapts to the new normal.
Furthermore, some changes are here to stay, and it will be prudent for the industry players to be resilient to the market shifts by being agile, improving member centricity, making processes intelligent, and embracing the open ecosystem.
Read our Health Insurance Top Trends 2021 report to explore the strategies insurers are adopting to manage the external pressures.

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Health Insurance Top Trends 2021

  1. 1. 1© Capgemini 2020. All rights reserved | Health Insurance: Top Trends 2021 November 2020 Link: https://www.capgemini.com/top-trends-in-2021/
  2. 2. 2© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: 1World Health Organization, “Ageing and Health,” February 5, 2018; 2New York Post, “Humans are living longer — but they’re also getting sicker,” January 26, 2018; 3 4Capgemini | Efma, World Insurance Report 2019, 2020; 5Capgemini Research Institute, “COVID-19 and the financial services consumer,” April 2020; Capgemini Financial Services Analysis, 2020. Customer demand for health insurance has increased by 10 percentage points compared with pre-COVID-19 levels The global pandemic has intensified external pressures on the health insurance industry
  3. 3. 3© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. Health insurers must pivot fast to ADAPT to market shifts
  4. 4. 4© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Check for auto- adjudication Run through rules to determine if the claim can be auto-adjudicated Flag fraud Identify outliers or suspicious claims and filter them for further investigation Document pre-processing Ensure provider submits all the information Fast track payouts To offer greater convenience to members and providers Trend 1: Insurers are leveraging AI-based solutions to improve claims processing Artificial intelligence can help insurers improve claims management to enable real-time claims processing Real-time claims processing in health insurance
  5. 5. 5© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Trend 2: Cognitive digital-automation powers intelligent, personalized member engagement Health insurers are leveraging cognitive automation to power emotionally intelligent, real-time interactions with members How cognitive automation empowers intelligent real-time customer interactions UrgentNon-urgent Faster resolution Customer service request Cognitive chatbot/ service portal Refer to human representative Recommend a solution Recognizes customers’ emotions/urgency Cognitive digital assistance
  6. 6. 6© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Trend 3: Pandemic catapults health and wellness into the global spotlight COVID-19 changed the way people led their daily lives in 2020 – insurers are responding with member-centric wellness initiatives Fitness tracking and management Health tips Incentivizing healthy behavior Community connection Health and wellness initiatives by health insurers
  7. 7. 7© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Trend 4: Data interoperability enables seamless, coordinated care delivery Benefits of healthcare data interoperability Value propositions: healthcare data interoperability Seamless data sharing Turn-around time reduced Better health outcomes Personalized healthcare recommendations Actionable insights Eliminate redundant procedures Interoperable healthcare data will give insurers and providers a holistic view of members’ health, enabling them to deliver faster, more accurate, and coordinated care
  8. 8. 8© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini | Efma, World InsurTech Report, 2020; Capgemini Financial Services Analysis, 2020. TA D A P Trend 5: Customer-centric BigTechs enter health insurance As tech giants step into the health insurance ecosystem via investments and partnerships, they are driving innovative solutions to improve CX Policyholder interest in purchasing insurance from BigTechs is on the rise 17% 30% 36% 44% 2016 2018 2020 JAN 2020 APR
  9. 9. 9© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Trend 6: COVID-19 accelerates telehealth adoption Leading health insurers quickly scaled up telehealth operations during the 2020 pandemic to ensure seamless care delivery and experiences that mirror in-person care What’s driving telehealth adoption? Social distancing mandates Relaxed regulations Scarce medical resources due to COVID-19 Convenient care delivery
  10. 10. 10© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Trend 7: Insurers are stepping up digital capabilities to offer virtual care services Health insurers are launching quick access to care management and risk assessment via digital channels Benefits of virtual care management services Digital care management Personalized health guidance Reduce strain on healthcare system Cost control with less ER visits Preventive healthcare services
  11. 11. 11© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: HealthyPeople.gov; Capgemini Financial Services Analysis, 2020. TA D A P Trend 8: Recognizing social determinants can improve health outcomes Insurers are expanding coverage to address social determinants that impact members’ health to gain insights and improve outcomes Five key areas of social determinants of health (SDOH) SDOH Economic stability Education Social and community context Health and healthcare Neighborhood and built environment
  12. 12. 12© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 Top Trends in Health Insurance for 2021 by Capgemini Source: Capgemini Financial Services Analysis, 2020. TA D A P Trend 9: Insurers guide members’ healthcare journey to coordinate care, control costs Payers are collaborating and vertically integrating with providers to offer members streamlined and coordinated care ‒ cost-efficiently Why is member steering important for health insurers? Drive adoption of network providers Deliver coordinated care Reduce healthcare costs
  13. 13. 13© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 A strong focus on trends with high business impact will help insurers build business resilience and will separate future frontrunners from laggards Priorityofadoption(2021) MediumHighSignificant Business impact (2021) Medium High Significant 1 9 4 8 3 2 5 TREND 1 TREND 2 TREND 3 TREND 4 TREND 6 TREND 9 TREND 7 TREND 5 TREND 8 Insurers are leveraging AI-based solutions to improve claims processing Cognitive digital-automation powers intelligent, personalized member engagement Pandemic catapults health and wellness into the global spotlight Data interoperability enables seamless, coordinated care delivery COVID-19 accelerates telehealth adoption Insurers guide members’ health care journey to coordinate care, control costs Insurers are stepping up digital capabilities to offer virtual care services Customer-centric BigTechs enter health insurance Recognizing social determinants can improve health outcomes Source: Capgemini Financial Services Analysis, 2020. 6 7  Priority of adoption refers to the urgency of adopting a particular trend to maximize value creation in 2021. This rating is based on the identified trends for an insurer operating in the current environment.  Business impact represents impact of an identified trend on an insurer’s business in 2021. The impact could be on customer experience, operational excellence, regulatory compliance, or profitability.  This matrix represents the view of Capgemini analysts for an insurer working in the current operating environment: ‒ Low interest rate environment ‒ Operational disruption due to COVID-19 ‒ Uncertain regulatory environment ‒ Highly competitive environment and increased focus on customer centricity due to new-age players ‒ Emerging consumer preferences. The factors above will vary by insurer depending on business priorities, geographic location, and several other factors. For specific requirements, please contact insurance@capgemini.com
  14. 14. 14© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020 A global leader in consulting, technology services and digital transformation, Capgemini is at the forefront of innovation to address the entire breadth of clients’ opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50-year heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations. Capgemini is driven by the conviction that the business value of technology comes from and through people. It is a multicultural company of almost 220,000 team members in more than 40 countries. The Group reported 2019 global revenues of EUR 14.1 billion. About Capgemini Learn more about us at www.capgemini.com This message contains information that may be privileged or confidential and is the property of the Capgemini Group. Copyright© 2020 Capgemini. All rights reserved. People matter, results count.

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