Digital Health Platform: Enabling The Digital Transformation

WHITE

PAPER

DIGITAL HEALTH

PLATFORM : E N A B L I N G

THE DIGITAL TRANSFORMATION

WHITE

PAPER

DIGITAL HEALTH

PLATFORM : E N A B L I N G

THE DIGITAL TRANSFORMATION

Introduction DIGITAL STAKES

A CUSTOMER-CENTRIC APPROACH

The healthcare insurance industry has undergone major technology waves. However, whilst increased adoption of IT solutions has already enabled process improvements, insurers continue to struggle to get a grip on the myriads of stakeholders and privacy and regulatory concerns they must manage within their IT infrastructure. Following many inwardly-looking initiatives, the focus must now shift to improving end-customer interactions and addressing patient needs from a customer-centric perspective.

Gartner predicts that by 2020 poor customer experiences will destroy 30% of digital business projects2. How is the healthcare insurance industry tackling this shift towards customercentricity and rising expectations?

Digital lies at the heart of enabling virtually everything consumers want to do. Their high expectations are the same across many industries: 75% of the thousands of patients interviewed globally by McKinsey wish digital healthcare services met their expectations around needs (for example appointment management and relevant information) and quality1. Self-service portals and apps are no longer a differentiator: they are a basic requirement.

In other industries, many organisations have already developed new business models based on customer insights. Purchases are driven by personalized experiences, peer recommendations and real-time interactions.

Expectations have been altered forever: healthcare players must align their strategies to these trends and ensure their business evolves accordingly.

This holds true across generations. Digital services are embraced not only by millennials, but also by baby boomers and older customers.

This is why health insurers must adopt a customer-centric approach to understand their customers’ real needs and develop products and services that address them via the appropriate medium.

1 Healthcare’s Digital Future. 2014. Mckinsey, retrieved from: https:// www.mckinsey.com/industries/healthcare-systems-and-services/ our-insights/healthcares-digital-future

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To constantly improve the customer experiences, organisations must put their customers and their needs at the heart of product and service development. Insurers must ensure their culture combines the flexibility to react to customer demands and the ability to proactively anticipate their needs.

Customer interactions take place across many channels, such as the Internet, mobile apps, messaging apps and contact centres.

Health insurers looking to adopt a customercentric digital approach must lay in place an infrastructure that supports a great customer experience, starting with allowing customers to select how that experience will be delivered.

That’s why we are witnessing a shift from simple portals to end-to-end digital platforms that capture and engage customers and partners in e-business processes.

2 Is your organization customer-centric?.2018. Gartner, retrieved from:https://www.gartner.com/smarterwithgartner/is-yourorganization-customer-centric/

ADOPTION OF DIGITAL APPS Customer-centricity requires businesses to gather data across channels, wherever the engagement takes place. Challenged by the increasing use of apps and devices, insurers must turn this new reality into an opportunity, and do so in a futureproof manner that will allow for further channels of communication entering the mix.

Insurers must deliver assistance across multiple platforms and in multiple languages, whilst complying with multiple regulations.

Many businesses have found a solution to this challenge by integrating ‘conversational commerce’ into their strategies.

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‘Conversational commerce’ embraces chats, messaging platforms and other natural language interfaces designed to interact with existing and prospective customers. Chatbots have become popular across generations, and are fast catching up with human chats as the preferred means of engagement amongst customers. Advances in Artificial Intelligence are only going to accelerate this adoption.

By leveraging Big Data to enhance the interaction with their customers, insurers can strengthen those relationships. They can base their services on factual data, engaging with customers throughout their lifecycle to improve prevention, disease management and post-condition support as well as back-office processes.

Digital Paradigm

The role of health insurers has evolved. The simple reimbursement of medical fees no longer drives customers’ provider selection. As outlined in our previous White Paper, insurers understand they must become a genuine care partner: and they are turning to digital to do so.

Insurers must evolve into a care partner that encourages, facilitates and informs the steps their customers can take to improve their health. This paradigm shift calls on them to:

Improve accessibility of care to improve prevention (cross-channel, digital) Transform healthcare services to improve loyalty and retention (ecosystem, connectivity) Deliver innovative and complete solutions while remaining legally compliant with protected healthcare data legislation across multiple jurisdictions

DIGITAL SOLUTIONS Although technology alone seldom provides the solution to business challenges, it typically represents a key enabler. Digital solutions are a compelling example.

Some of the key technological aspects of digital solutions in healthcare insurance are: API 1st architecture

with chatbots and other conversational tools enabling insurers to engage with customers in a human-like, personalized, proactive manner.

It is also key to be able to deliver on instant accessibility, reimbursements and claims management.

Portals for each stakeholder

Solutions need to be built on a componentbased, API First, microservices architecture with a responsive design that delivers the same experience regardless of device (e.g. tablet, smartphone, laptop). They must integrate easily with other applications providing services such as geolocation, reimbursement calculators, online payment and electronic signature.

Digital services must support Web and mobile strategies, including the digitisation of core health insurance processes and portals for retail clients, corporate customers, channel and healthcare service partners, together with online access to services such as telemedicine.

Such portals must transcend information access and enact fully digital end-to-end business processes.

Electronic data exchange and automation

The optimal solution will be solid in terms of technology, secure in terms of data, open in terms of integration and modular to evolve at the growing pace of regulation, innovation and customer expectations.

As well as readily providing access to information, customers expect interactions to be engaging and personalized. This is an area where automation can deliver value,

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WHAT DOES A DIGITAL HEALTH PLATFORM DO? The health sector is being shaken up by new entrants (e.g. Google and Amazon) looking to disrupt and leverage technologies such as AI and remote monitoring, as well as moneytizing their expertise in delighting customers. Health insurers cannot afford to ignore them and must evolve to survive. A digital health platform can enable this evolution.

providing the best solution for the (self-) service externalisation of health insurance business processes and to extend in the future to a complete healthcare solution. Compared to generic digital platforms, they provide the business functionality and technical robustness that health insurers require to seize upon the digital opportunity.

A digital health platform futureproofs a health insurer’s business, creating a new communicative and connected means of managing the entire ecosystem and all the customer’s needs, linking personalized portals at the point of delivery to core systems. As toolkits for insurers to develop their own initiatives without becoming reliant on any single vendor or internal department, digital health platforms are architected to incorporate future technology-driven needs and integrate new business-driven services,

A digital health platform captures data at each touchpoint of the customer lifecycle, providing business functionality for self-service digital business processes that cross organisational boundaries to create the joined-up experience today’s consumers expect. By turning data into information and information into action, insurers can offer a better customer experience, ensuring open connectivity with third-party services to extend the services and processes across the ecosystem.

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Benefits of a Digital Health Platform BETTER SERVICES

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Insurers need access to data throughout their customers’ journeys: from initial quotation to policy consultation, from claims management to reimbursement, from provider identification to treatment management and beyond.

Visibility of the right data at the right time is a prerequisite for insurers to gain competitive advantage. They might strive to provide more services in a more productive way, and understandably so. However, it is not just the quantity of services that matters: quality is crucial. Insurers must design services that meet customer needs and deliver them via the most appropriate platforms in a timely, personalized and engaging manner.

By enabling self-service, empowering customers to take care of certain tasks at their own convenience, as well as through connectivity and data-sharing across all stakeholders and portals, a digital health platform allows insurers to drive greater customer satisfaction and promotes retention.

PERSONALIZED ENGAGEMENT With their expectations raised by experiences in other domains, customers are looking for similar experiences from their health insurer.

For example, e-signatures can replace paperintensive processes for electronic records without compromising regulatory compliance, ensuring signed documents reach insurers more rapidly and decisions take less time and expense.

A true digital health platform allows seamless integration with conversational platforms, helping insurers overcome technology barriers on their road to increasing customer retention. Chatbots can help customers access information more easily, get support faster and undertake tasks when it suits them.

Conversations can take place via messaging apps such as Facebook Messenger, WhatsApp and Telegram, resulting in enhanced customer experience and satisfaction.

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WHENEVER, WHEREVER: ENGAGING WITH CUSTOMERS ACROSS TIME AND SPACE The World Tourism Organization expects global arrivals to hit 1.8bn by 20303 . Whether we’re sat at our breakfast table at the start of the day or in an airport lounge late at its end, we expect to be able to engage with our service providers, be it to file a claim or to check our policy details. Digital has broken down the

traditional limitations of time and space: and it has done so at a time when travel has become a commodity. Today’s insurers need to be always open for business: and, with a digital health platform, they can be.

IMPROVED COLLABORATION Health insurers need to seamlessly collate, store and share data within their organisation, but also with their ecosystem partners, comprising policyholders, agents and treatment providers.

By analysing customer lifecycle data, digital health platforms can facilitate decision-making and ensure it is informed by customers’ needs.

Insurers can then leverage that information to adapt their services, better address existing needs and predict future ones.

The insurers’ goal is to encourage client selfsufficiency by delivering a smooth experience, helping contain costs and drive customer proactivity. For example, a policyholder can easily request a prescription, the provider can issue it and the insurer can validate the preauthorisation request and settle the invoice.

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https://www.e-unwto.org/doi/pdf/10.18111/9789284419029

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What can a digital health platform deliver across the healthcare ecosystem?

As more data becomes available, insurers risk facing data fragmentation, resulting from a combination of increasingly mobile patients, multiple Electronic Medical Records (EMRs) and IoT technologies. To enjoy a holistic view and remain competitive, insurers must collaborate with all their partners.

Digital health platforms address this critical need. They enable digital components to be accessed and shared through interconnected portals, each delivering on the most relevant touchpoints throughout the end-to-end customer lifecycle.

INSURERS Insurers that overcome data fragmentation will manage their network more efficiently, enjoying full visibility over their partners’ operations. This represents a major change from how things were done in the past, where an insurer’s role was limited to policy and claims administration.

Insurers can now interact with their customers at each touchpoint of their health lifecycle.

The data from each customer interaction can inform insurers’ decisions, enabling them to offer improved, innovative services.

Moreover, insurers may coach policyholders to transition to healthier lifestyles. Data-driven collaboration with ecosystem partners offers insurers the path to evolve into a true care partner.

CUSTOMERS There are multiple benefits on offer for the insured population. For example, geolocalisation can help the insurer identify the most appropriate plan, or advise on the best and closest healthcare provider to deliver the treatment required; and recurring activities such as receiving quotes, processing claims and tracking prescriptions are simplified by information-sharing across providers.

Today’s customers use mobile apps to shop, manage their banking, monitor their wellness, plan travels and so much more. For many, their

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smartphone is the primary means of managing their lives. That’s why being able to connect their wellness apps and self-assessments devices (which often already benefit from data provided by wearables) can help them reach their health goals and prevent diseases. They can also actively engage with their insurer, benefitting from a relationship that they traditionally only called upon when something needed fixing. A reactive payer that customers only called upon when something went wrong is now a proactive partner that can help avoid unwelcome scenarios.

HEALTHCARE PROVIDERS A Digital Health Platform allows healthcare providers to increase levels of automation and execute administrative tasks more efficiently.

When most of the paperwork and operations can be integrated with the insurer’s systems, providers have more time to focus on their core competence: ensuring patients enjoy the best possible treatment.

With e-health services, healthcare providers can deliver treatment remotely via apps and other monitoring devices. For instance, diabetic patients can perform routine sugar

level tests and automatically send the results to the healthcare centre. By empowering patients and delivering real-time data back to providers, such self-monitoring capabilities drive greater engagement and proactivity, encouraging providers to undertake preventive assessments that may lead to early diagnoses and motivating customers to embrace healthier lifestyle choices.

CORPORATE CLIENTS Traditionally, companies would sign up for insurance plans that their staff might not understand or even take advantage of. With a digital health platform providing services to employees, real engagement is now possible.

When staff are happier with the service their insurer delivers, two distinct but key long-term partnerships are strengthened: employerinsurer and employer-employee.

Organisations also benefit from digitallyconnected services by easily accessing reports on policyholders and monitoring their plan usage to optimize savings, understanding in real-time corporate benefit consumption allowing the employer to see which services add value to the employee base and which don’t.

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How to chose a Digital Health Platform

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COMPANY CRITERIA

KEY POINTS

Solidity

Has it shown it can adapt to past seismic industry changes?

Has it evolved the services it offers?

References

Does it have a global customer base, with different insurers leveraging its systems in different legal and commercial environments and different languages?

Specialisation

Does it possess true expertise in healthcare – or is it just a side-business?

Legal Conformity

Can it seamlessly handle multiple regulatory systems?

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DHP FEATURES

BENEFITS

OPEN BY DESIGN Third party integration / Web API

Insurers don’t operate in a vacuum, rather in an ecosystem, comprising brokers, providers and, of course, clients. Your Digital Health Platform must offer interoperability and enable business improvements across your ecosystem, not just internally. Web API and connectors are a must.

IoT integration

Real-time data drives real-world benefits. Your Digital Health Platform must be able to integrate with remote medical devices and wearables to help you partner with your customers to identify risks they may be facing and inform smarter lifestyle decisions.

DMS integration

Legacy systems often leave a legacy of inefficiencies in Document Management. The more systems in the infrastructure, the greater the process improvements that a Digital Health Platform can unlock.

Multi back-office integration

Many insurers comprise a multitude of divisions, business units – and, consequently, back-office systems. A Digital Health Platform must bring them together to deliver clarity, not compound existing problems.

Futureproof

A Digital Health Platform must be capable of enabling strategic initiatives – not just today’s, but future ones, too. It is key that it is capable of adapting to business changes in your strategy and to technical changes in your IT infrastructure.

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DHP FEATURES

BENEFITS

CONVERSATION ENABLER Social media

“Social Selling” is on the rise. Your Digital Health Platform must enable you to reach out to your current and prospective customers. If it doesn’t, your competitors’ will.

Messaging C2B and B2C

Digital touches all aspects of the Health Insurance ecosystem.

By enabling multi-channel conversations, your Digital Health Platform can facilitate decision-making and empower players to execute some of the tasks with which you have traditionally been burdened, increasing their loyalty and improving your efficiency.

Notification system

All too easily, clients, profits and efficiencies fall through gaps between multiple IT systems. Your Digital Health Platform can fill those gaps and ensure the right person in your organisation takes the right action at the right time.

Chatbot

Customers are embracing chatbots as effective sources of first-line support. Leverage them to make their life and your life easier.

Chat

Not all issues can be addressed through chatbots and VI. Ensure your Digital Health Platform helps you provide human insight and expertise through chat.

USER-FRIENDLY BY DESIGN

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Personalisation and configuration

Major digital players are setting cross-industry standards and taking customer expectations to a new level. Your Digital Health Platform must allow you to meet them.

Responsive design

You are not in control of the device through which customers will engage. But your Digital Health Platform can ensure they enjoy the same compelling experience.

CMS content management

Gathering data has never been easier. The real challenge is ensuring the right data is presented to the right people at the right time, across any channel, to drive customer acquisition, retention and satisfaction. Your Digital Health Platform should enable you to achieve this goal.

DHP FEATURES

BENEFITS

USER-FRIENDLY BY DESIGN Collaborative co-browsing

The simpler a task, the more painful it can be for both customer and agent to work through it by voice or chat.

Collaborative co-browsing makes the experience painless for your customers and boosts your teams’ efficiency.

Analytics dashboard

A Digital Health Platform can handle unprecedented levels of data. Ensure yours is also capable of transforming that data into actionable insights across your teams and your ecosystem.

COMPLEMENTARY CAPABILITIES Electronic signature

Everybody knows that paper-based systems are inefficient.

But safeguards must be put in place to ensure regulatory compliance. If your Digital Health Platform’s e-signature capabilities are not compliant, you will be stuck with paper and all its inefficiencies.

Online payment

Many claims settlements are complex, with payment flows that touch multiple insurers, brokers, providers… but none of that matters to customers, who expect online payments to be seamless, whether they are making them or receiving them.

Ensure your Digital Health Platform delivers on this pivotal customer satisfaction driver.

Geolocation

For data to be personal and relevant, it must take into account the customer’s location. When recommending a treatment provider, a network partner’s expertise is key – but their location cannot be ignored. Choose a Digital Health Platform that takes all relevant factors into account when delivering recommendations to your customers.

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Key takeaways Insurers need to identify ways of harnessing competitiveness and providing the expected customer experience. To adopt a customercentric approach, they must integrate new digital services with their existing systems and provide an omnichannel, personalized experience.

Digital health platforms enable insurers to access and share data through interconnected portals, delivering benefits to all players within the partner ecosystem: healthcare providers, brokers, corporate clients and policyholders.

This allows insurers innovate their services based on customers’ needs and journeys.

Adopting a digital health platform delivers benefits across that entire ecosystem, improving claims management, tackling restricted mobility via e-health services, enabling a more preventive approach, providing real-time data through remote monitoring and leveraging geolocation to deliver greater patient journeys.

When choosing a digital health platform, insurers must look at its provider’s reliability and expertise, its ease of integration and interoperability with core systems, its adoption of conversational apps and whether it has been future-proofed, designed to be user-friendly yet comprehensive, robust yet flexible to easily integrate other capabilities - and whatever else the future may hold.

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ABOUT CEGEDIM INSURANCE SOLUTIONS Cegedim Insurance Solutions is a global leader in software and services across the healthcare ecosystem, from insurers and social welfare institutions to professionals, intermediaries and end-users.

Its end-to-end solutions suite supports 230,000 professionals and 43 million beneficiaries, with €2.9 billion in benefits paid and 400 million electronic document interchanges (‘EDIs’) processed annually.

Cegedim Insurance Solutions is a business unit of Cegedim, whose 4,200 people generated €457m in revenue in 2017.

To learn more, please visit: www.cegedim-insurance.com.

And follow Cegedim Insurance Solutions on Twitter (@CegedimIS) and LinkedIn

CEGEDIM, Société anonyme au capital de 13 336 506,43 € 137 rue d’Aguesseau, 92100 Boulogne-Billancourt R.C.S. Nanterre : 350 422 622 Tél : 05 62 24 17 17 - Email : contact.insurance-solutions@cegedim.com - Site : www.cegedim-insurance.com Août 2018