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Joe Hornyak
Former editor of Benefits and Pensions Monitor and founder of Joe Hornyak Communications
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Insurers moving to prevention model
The growth of virtual health care is going to allow group insurance companies to switch from simply paying claims to interacting with health care providers and plan members to prevent medical problems.
The ‘Health in a virtual world ’ report from GFT Canada, a global digital transformation company, shows as society becomes increasingly data-driven, Canadians expect proactive, data-driven, and personalized experiences in all aspects of their lives, including healthcare. It highlights the role group insurers can play in building digital health ecosystems and how they can support the Canadian healthcare system.
Mathieu?Beauchesne, GFT’s strategic advisor and expert leader in personal insurance, said it has been working with the group benefits insurance industry for several years to build a vision for 2030. Currently, most pressure from the market is about healthcare. That's what's causing group insurance companies problems in terms of profitability and that's why they want to switch to a prevention business model mentality instead of just paying claims.
This is where virtual health care changes the environment. “What we’ve seen in the market is basically more attention is being paid to the virtual part. It started a couple of years back and the pandemic only accelerated that trend,” he said.
Since then, insurers have added digital health care services because of the growing interest from plan members.
However, he said this should be done more strategically to build a healthy ecosystem for the benefit of plan members and sponsors. Using an ecosystem strategy means insurers can help plan members take charge of their health and wellness by using technology platforms that provide them with relevant information about their health and access to services.
This is the opposite of the public health ecosystem model which is now replicated by the industry. “Basically, we're replicating the same model of a set of services not so well interconnected between each other. Insurers can do a better job and offer better integration through digital health services for the plan members, as well as simplify their experience,” he said.
Since the pandemic, the growth of virtual healthcare has been tremendous, he said, especially for services that were not expected.
While telemedicine before the pandemic was practical as it meant plan members just had to call a doctor for some minor things, for mental health, “we were not expecting plan members ? and especially professionals, psychologists, and health professionals ? to be so open to providing therapy online,” said Beauchesne.
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There has also been an increase in virtual care for physical treatments. “Most people think you have to go to see a physiotherapist for rehabilitation therapy. But now, there's online technology that can show if the angle of your arm is doing the right things when you do certain movements. So with technology, and more open minds from the plan members, we've seen those kinds of digital services getting a lot of attention,” he said.
Other areas of health care are also going virtual.
ePharmacy is one. No-one really needs to physically go to a pharmacy to pick up their prescriptions. Not only is it more convenient to use ePharmacy from a cost perspective, it's cheaper because these come from warehouses where the orders are picked and delivered to a plan member.
The key benefit of virtual health care is the potential to prevent illness. For group insurers, this can result in fewer claims which is better for them from a cost perspective, “but it also lets them get in touch with the plan members. They are getting more interaction and engagement because in group benefits we're kind of losing interactions with the final client. For example, if you go to the dentist or the pharmacy, you only pay your coinsurance. You don't go to a portal or web application to send your claim so there's less and less contact. So that's kind of the motivation ? to get more contact and interactions with plan members and switch to a prevention mode,” he said.
For plan members, they are able to get more services easier. “Sometimes it's kind of tough to get into the Canadian healthcare system. Once you're in, it usually goes well, but sometimes it's the accessibility where we have problems,” said Beauchesne. Virtual healthcare can provide access to services easier and faster.
This could also evolve into a more transparent or integrative system. “Everything is fragmented, at least in Quebec. You go and see a healthcare professional and they don't share information with each other. You basically have to retell your own story every time,” he said. Virtual healthcare is helping provide better integration between health professionals.
And for plan sponsors, they will see their employees more productive, with less time off work for healthcare and less absenteeism from employees on the job, but thinking about health issues.
“We're going to be doing more with digital health in the coming years so as insurers position themselves in a market where margins are only going smaller and smaller, they need to think ahead. They're sitting on a gold mine if they can better integrate into it,” said Beauchesne.
For details on these stories, visit www.bpmmagazine.com