The path to profitable health insurance

In reviewing the annual report of a leading Nordic insurance company, one point stood out: despite the growth in health insurance policy sales, the profitability of these products is declining.

The report attributes this to increased claims costs from surgeries and other medical treatments as more customers use their insurance.

The report leaves unanswered what the company's strategy might be to address this issue. However, I'd like to offer a solution.

Our data indicates that insurance companies often approve surgeries that may not be medically motivated, overlooking less invasive alternatives like physical therapy. The challenge lies in the sheer volume of treatment requests, making detailed reviews of each one impossible.

But what if there was a way to overcome this?

Imagine leveraging AI to sort through these requests efficiently. It could highlight the ones that potentially lack medical motivation, automatically assigning them to a claims specialist or medical advisor for a detailed review. This approach could significantly enhance the accuracy of treatment approvals.

Moreover, this system can maintain detailed records of all interactions with caregivers, enabling insurers to identify and address patterns of unjustified treatment requests.

This functionality would not only aid in managing costs but also ensure that patients receive care that's truly in their best interest, enhancing trust and customer satisfaction.

This functionality is something we've just added to Mavera DSS.

Are you interested in exploring how Mavera DSS can contribute to your health insurance's profitability and patient care quality? Just reply to this email, and let's explore the potential of this new feature together.

Best regards

Viktor Norlander, Marketing Manager at Mavera