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1© Capgemini 2020. All rights reserved |
Health Insurance:
Top Trends 2021
November 2020
Link: https://www.capgemini.com/top-trends-in-2021/
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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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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Health Insurance Top Trends 2021

  • 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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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© 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.