How Health Insurance is Moving from Covering to Caring about Customers Health

Transcription

1 How Health Insurance is Moving from Covering to Caring about Customers Health PATRICK SHEARMAN, CHIEF INFORMATION OFFICER TECHNOLOGY & INNOVATION THE FUTURE OF INSURANCE CONFERENCE 20 TH MARCH 2014

2 HCF Membership Transformation The Case for Change Health Insurers will need to emphasize different competencies to thrive in the changing healthcare environment. Competencies Empower Members Empower members to assume accountability and make more informed health and financial choices Collaborate with Providers Help providers become successful in a valuebased reimbursement environment Innovate Collaboratively innovate products and services, operational processes, and business models Optimize Operational Efficiencies Continue driving costs down in order to maximize margins in a highly regulated industry Enable through Information Technology Flexible applications, BI, on-demand information, effective operations/management & governance

3 Advanced Analytics Decision and Process Optimisation Our View of Big Data Combining our transaction processing capability with data analytics for enhancing collaboration and engagement with our members Service at the speed of light Knowledge at the Point of Action Enterprise Data Sources Marketing Attitudinal Interaction Web Call-center Operational Understand Predict Reporting Statistics Data mining Web mining Text mining Act & Process Campaign optimization Interaction optimization Real-time / Batch scoring Real-time risk assessment Feedback management Multi-channel CRM/CMS Acquisition Cross-sell Customer Service Predictive routing Service quality BPS Market, Product and Promotion Planning Brand perception Basket analysis Product design Health Preventive Healthcare My Home Doctor Dental Retention Segmentation Customer feedback & satisfaction Promotion & marketing mix PCEHR Telemonitoring Care in the Home Customer Contact Channels Website Phone Mail Branch Agent Mobile Social Media 3 Operations/Claims Claims STP Workflow Actuarial forecasting Real-time Payments

4 Advanced Analytics Decision and Process Optimisation Our View of Big Data Combining our transaction processing capability with data analytics for enhancing collaboration and engagement with our members Service at the speed of light Knowledge at the Point of Action Enterprise Data Sources Marketing Attitudinal Interaction Web Call-center Operational Understand Predict Reporting Statistics Data mining Web mining Text mining Act & Process Campaign optimization Interaction optimization Real-time / Batch scoring Real-time risk assessment Feedback management Multi-channel CRM/CMS Acquisition Cross-sell Customer Service Predictive routing Service quality BPS Market, Product and Promotion Planning Brand perception Basket analysis Product design Health Preventive Healthcare My Home Doctor Dental Retention Segmentation Customer feedback & satisfaction Promotion & marketing mix PCEHR Telemonitoring Care in the Home Customer Contact Channels Website Phone Mail Branch Agent Mobile Social Media 4 Operations/Claims Claims STP Workflow Actuarial forecasting Real-time Payments

5 A Case for Change A proactive, value-based health system should help move people from right to left and keep them there Health care spending Health Status 5 A value-based health care system 20% of people generate 80% of costs

6 Preventive Healthcare Stratification of members Different claim profile results in different value proposition and risk Number of Members $$$ Cost of Claims High Claiming Members Low claiming members who are likely to become high claiming members in the near future Low claiming members with high modifiable risk factors Low claiming members with no or few modifiable risk factors

7 Four Sites of Care

8 Digital Health

9 VRM Vendor Relationship Management Partnership are Important Smarter Health Management Connecting People to What Matters Most 9 Inspiring a healthier you

10 Telemonitoring Biometric real time monitoring tools including: Blood pressure monitor, Glucometer, Electronic weight scale and Oximeter. The results from these instruments feed directly into our coaching programmes and are available immediately for our registered nurses to provide the right support Data hosting and web services Telstra 3G or 4G Network Healthways nurse monitoring & support 10 Member self-help through MHG website and SMS/ warnings

11 Care at Home HCF has established a new business - More at Home. More at Home is a community aged care service that provides both clinical and non clinical support to people who want to remain at home as an alternative to seeking residential aged care services or returning to hospital. More at Home provides individualised care that is designed just for the client. Personal Care Services Domestic Assistance Respite Services Nursing Services Transition Care 11

12 26 MARCH,

13 Thank you and Questions