As powerful forces reshape healthcare, health insurers should make choices now about business model changes that will position them to prosper in the future. Strategies that build resilience will focus on what is known – healthcare’s increasing drive to be value-based, consumer-focused and technologically-enabled.
To thrive in the New Health Economy, health insurers will need to embrace these trends. They will need to adopt new ways of doing business, rather than tinkering with the traditional model. PwC’s Health Research Institute (HRI) has identified five models for the health insurer of the future that balance better engaging consumers and collaborating with providers to help keep the cost of care down.
Focus on the fundamentals to build trust. Consumers and providers continue to have low levels of trust in insurers, a major barrier to overcome. Doing so will require that insurers focus on the fundamentals – delivering digital tools that are easy to use and rethinking core functions like prior authorization which have contributed to the lack of trust.
Balance technology with a human touch. Consumers want to speak to a person when making health decisions. These interactions cannot be replaced by technology. The health insurer of the future should, instead, invest in technology that supports and enhances such interactions.
Help providers focus on delivering care. By supporting and automating processes like patient eligibility and prior authorization, insurers can relieve some of providers’ administrative burdens. Doing so will help insurers establish goodwill with providers — sending the message that they are partners — and will give providers more time to focus on their most important job: caring for patients.
Hire — or borrow — the right talent. The health insurer of the future will need to diversify its workforce with people from industries such as tech, hospitality and social services. The health insurer of the future will need workers with customer service and people management skills as well as those experienced in data analytics and advanced technologies like artificial intelligence and blockchain.
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US Pharmaceutical and Life Sciences Advisory Leader, PwC US