How digital health ecosystems promise a new era for group benefits insurers

With increased strain on the Canadian healthcare system and the rise in demand for virtual healthcare post-pandemic, more group benefits insurers than ever are recognizing the value of digital health ecosystems.

“Today, group benefits insurers are rethinking traditional business models and looking for ways to engage plan members more holistically as healthcare partners,” explains Mathieu Beauchesne, Strategic Advisor and expert leader in Life and Health Insurance – Individual and Group Benefits at GFT Canada, a leading IT solutions provider.

“Digital health ecosystems have a lot of advantages for people, but also for insurers. By giving individuals access to a technology platform that provides them with an entire ecosystem of healthcare services that they can easily and proactively interact with, insurers are handing control back to plan members,” Beauchesne says. “By working with partners in an ecosystem, insurers not only respond more holistically to the needs of plan members, but evolve their risk management business model towards one that focuses on health prevention,” he adds.

GROWING IMPORTANCE

GFT Canada’s recently released report, Health in a Virtual World, which was authored by Beauchesne, highlights key emerging trends that have led insurers to consider digital health ecosystems as a means to address a “perfect storm” in Canada’s traditional healthcare.

First, the Canadian public healthcare system is at a tipping point, rated one of the least accessible systems. “Coupled with the lack of accessibility is the increased demand for services, as well as a lack of interconnectivity between healthcare providers,” Beauchesne adds.

Healthcare is also increasingly expensive and fragmented, with the system becoming more difficult to navigate and patient satisfaction worryingly low, Beauchesne writes in the report.

Second, the pandemic exacerbated these issues, not only leading to longer wait times and delays but sicker people – and a spike in the demand for virtual healthcare, Beauchesne adds, giving digital health ecosystems more prevalence than ever.

“As the pandemic swept in, there was a sudden and acute need to enable remote healthcare services when in-person appointments weren’t possible,”  Beauchesne says, “And this new way of consuming healthcare services has continued beyond the pandemic.”

Between 24% and 42% of Canadian healthcare services have been delivered virtually since the start of the pandemic, depending on the province, the report notes. In addition, the number of online mental and physical health and wellness platforms and apps have grown significantly, whilst globally, consumers are much more willing to share personal health data in exchange for discounts, promotions and personalized preventative healthcare services.

Third, insurers continue to face pressure to reduce claims costs and improve the client experience, whilst building brand loyalty and remaining profitable, Beauchesne says.

Last year, insurers paid a record $40.8 billion in total health claims – an increase of 11% compared to 2020, the report highlights. Mental health-related claims increased a staggering 75% between 2019 and 2021.

DATA-BASED SOLUTION

One of the biggest advantages of a digital health ecosystem is its ability to turn enormous quantities of data insights into a personalized wellness experience and preventative healthcare – thus also leading to less claims, Beauchesne says.

“For plan members, this means more customized care and increased wellness – for example through preventative health tips relevant to their habits, encouragement to participate in health challenges, and even suggestions for preventative medications or services,” Beauchesne says, adding that these ecosystems can also be linked to public health providers for a more interconnected, holistic patient experience.

“For group benefits insurers, digital health ecosystems represent an opportunity to strategically position themselves to increase and diversify their revenues. Insurers can play several roles in building virtual healthcare ecosystems, from orchestrators to contributing partners depending on their capacity. A digital health ecosystem also helps insurers improve customer engagement, satisfaction and loyalty, whilst the preventative model proactively helps them avoid more complex claims.”

EXPERTISE YOU CAN TRUST

Insurers have been trusting GFT Canada’s technology solutions to help them implement a digital health ecosystem effectively, affordably and securely.

“At GFT, we understand that systems integration is key to a successful implementation. We are able to design and architecture core systems, such as policy administration, which can easily and affordably integrate with external partner systems,” Beauchesne says.

GFT also knows that data security is non-negotiable. “When an insurer works with us, they can trust that the sensitive data they’re dealing with will stay secure within the ecosystem, and their plan members can trust their personal data is protected and used for only the reasons they permitted,” says Beauchesne.

Finally, GFT specializes in data and analytics, making their expertise essential in setting the infrastructure in place to gain greater insights, which ultimately, leads to a better, more personalized experience for plan members.

For more information visit GFT Canada.