what challenges will health insurance face? by rafael senen ceo at coverontrip digital insurance
TRANSCRIPT
WHAT NEXT CHALLENGES WILL HEALTH INSURANCE FACE?
WILL ONLY INNOVATION BE ENOUGH?
Rafael Senén CEO & Co-Founder
priv
ate
and
conf
iden
tial
| c
over
ontr
ip d
igit
al in
sura
nce
s.a.
| 2
017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS-AGING
72.3years
73.3years
Population aging is accelerating rapidly worldwide.
Life Expectancy
20142019
People aged 65+ worldwide to over 604 million 10.8 %
20.8 %
“Contrary to common assumptions, aging has far less influence on
health care expenditures than other factors, including the high costs
of new medical technologies.”
Worldreportonagingandhealth, World Health Organization, 2015
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS-CHRONICANDCOMMUNICABLEDISEASES
Increased Life Expectancy
Proliferation of chronic diseases
Obesity CV Diseases Hypertension Dementia…
Challenging Health Systems
Drugs and treatments
The current number of people with diabetes globally is 387 million and that number is expected to increase to 592 million by 2035, according to the International Diabetes Federation.
private and confidential | coverontrip digital insurance s.a. | 2017
Diabetes is a global threat with prevalence rates, which vary from region to region from 5.1% the lowest, to 11.9% the highest.
Source: Juvenile Diabetes Research Foundation International (JDRF)
DEMOGRAPHICS-CHRONICANDCOMMUNICABLEDISEASES
DEMOGRAPHICS–CONSUMERENGAGEMENT
q Consumers are more informed, involved in, and financially responsible for their healthcare decisions
q Consumers now are more actively involved in their personal health rather relying only on doctors’ expertise
q Consumers increasingly value online and mobile information exchange with their provider and health plan
Consumer behaviors drive health management
Patient Empowerment
Consumer Engagement
private and confidential | coverontrip digital insurance s.a. | 2017
q Preventive healthcare is becoming widely known as consumers are increasingly concerned about health related issues and healthcare costs
q More people are adopting digital health apps to manage their care when and where they want it
DEMOGRAPHICS–CONSUMERENGAGEMENT
feel comfortable consulting with a provider via email or phone
of consumers would like access to technology that enables review of quality
and satisfaction rankings
of consumers have no concerns about using mobile technology to
pay their medical bills
Deloitte’s 2015 Survey of U.S. Health Care Consumers.
61 %
36 %
52 %
(*) Health purposes include learning more about and/or sharing personal experience with a specific illness, injury, or health problem; specific prescription medications or medical devices; specific doctors or hospitals; the health care system in general; health technologies that can help you diagnose, treat, monitor, or improve your health; or other health -or care- related purposes. Source: Deloitte 2015 Survey of US Health Care Customers.
Use of social media for health purposes(*)
28%
37%
22% 21%
22%
18%
6% 8%
2013 2015
Millenials (18-33 years)
Seniors (70+ years)
Gen X (34-50 years)
Boomers (51-69 years)
DEMOGRAPHICS–CONSUMERENGAGEMENT
private and confidential | coverontrip digital insurance s.a. | 2017
Proper environmental conditions are critical for healthy living and can help to prevent diseases.
by 2050, 66 per cent of the world’s population is projected to be urban. Cities usually grant better access to
healthcare services but are sources of pollution (air, water, soil, sound, ...)
URBANIZATION 54%
World population lives in cities
DEMOGRAPHICS–ENVIRONMENT
WATER 748 million people
remain without access to an improved source of water
The number of people whose right to water is not satisfied is even greater, probably in the order of 3.5 billion.
private and confidential | coverontrip digital insurance s.a. | 2017
Climate change affects the social and environmental determinants of health –
clean air, safe drinking water, sufficient food and secure shelter
CLIMATE 250.000 additional
deaths and millions of chronical diseases per year
DEMOGRAPHICS–ENVIRONMENT
private and confidential | coverontrip digital insurance s.a. | 2017
Breathing PM is associated with increased risk of heart attack, stroke and other
cardiovascular disease; respiratory illnesses such as emphysema; and cancer.
Air pollution only in California kills 25,000 people per year and costs $200 million
worth of medical expenses.
AIR 1 year
is the life expectancy decreased in the European Region by exposure
to particulate matter (PM).
DEMOGRAPHICS–ENVIRONMENT
Smog glows in the sunset in Shanghai, China. (Matt Mawson/Corbis)
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
FINANCIAL-GOVERNMENTSPENDING
HEALTH CARE IS ONE OF THE LARGEST INDUSTRIES IN THE WORLD
9.9% GDP
10.0% GDP 17.1% GDP
9.1% GDP
Source: The World Bank 2014
Governments
Universal HCS
Optimizing their supply chain Revenue cycle, using bulk purchasing Reducing labor expenditures Improving clinical efficiency
private and confidential | coverontrip digital insurance s.a. | 2017
FINANCIAL-ALTERNATIVEMODELS
Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity.
There are different VBC models that are currently been implanted by different governments, but also big payers.
Shared Risk
Shared Savings Bundles
FFS
• Full-risk arrangement with provider receiving PMPM payments regardless of services used and bearing the full impact of any upside or downside
• Could be condition- or population-focused models with risk across multiple populations
• Requires mature capabilities
• Paid under FFS until year-end reconciliation. Upside bonus paid if cost and quality goals met within a pre-determined corridor; downside risk for portion of spending that exceeds cost containment targets
• Typically multi-year risk- sharing contract with integrated systems or large physician groups
• Arrangement with predetermined reimbursements for clinically defined episodes/bundles of care instead of separate payments to hospitals, physicians, etc.
• Includes upside potential and downside risk
• FFS until year-end reconciliation plus gain-sharing or bonus contract with physician groups for attributed members based on overall quality and medical cost versus target. Savings come from better coordination and population health management (e.g., using PCMH)
• Volume-based, low-risk model where a set fee is paid for each service or procedure provided
Increasing level of risk and capabilities required
Capitation RANGE OF PAYMENT MODELS
private and confidential | coverontrip digital insurance s.a. | 2017
In more basic terms, value-based care models center on patient outcomes and how well healthcare providers can improve quality of care based on specific measures, such as:
• reducing hospital readmissions, • using certified health IT • and improving preventative care.
FINANCIAL-VBC
Last year, US HHS announced that 20 percent of Medicare payments in 2015 were made through a value-
based, alternative payment (30%/2016 – 50%/2018)
20% Medicare payments
VBC payments
VBC payment models helped reduce hospital readmissions in Medicare beneficiaries by eight
percent in 2015 (12%/2016 – 20%/2018)
8% Medicare hospital
readmissions down
Other Big Payers private and confidential | coverontrip digital insurance s.a. | 2017
Amid the reform-driven shift to outcomes-focused and value-based payment many countries are instituting reform-driven drug price
controls.
FINANCIAL-DRUGPRICECONTROLS
U.S. health plans try to control pharma costs through reference pricing, formularies, and co-payments Germany moved to a highly regulated pricing regime from a free pricing market in 2011 China, the government mandates that all public hospitals procure pharmaceuticals through a provincial, centralized bidding system U.K. uses quality-adjusted life years to evaluate the cost-effectiveness of treatments.44
private and confidential | coverontrip digital insurance s.a. | 2017
Generic drugs will continue to gain market share as both public payers and health plans seek to reduce costs.
FINANCIAL-DRUGPRICECONTROL
84 % Is the generics’ share in the
United Kingdom of the pharma market in 2012
11 % Is the yearly growth rate
of generics sales in Brazil
80%
by April 2021 is the target of Japan’s government for
generic use from 60 percent by the end of April 2018.
70% of the pharma market
by volume comes from generic drugs in USA
Development and sales of biosimilars, biologic products which are similar but not identical to reference biologic products — and less expensive — are accelerating, as well.
In EU more than 700 biosimilars approved or nearly.
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
The healthcare ecosystem is a complex one with differentiated groups of key players having relationship each other.
HEALTHINDUSTRY
private and confidential | coverontrip digital insurance s.a. | 2017
HEALTHINDUSTRY
• Contradictory reward system stressing efficiency pressures but still paying doctors based on number of visits.
• Physician’s role changing from an undisputable expert into a therapy prescriber/guide
PHYSICIANS AND CAREGIVERS
Percentage of physicians who say they feel responsible to control healthcare costs
38%
82% 81%
9 years ago
4 years ago Today Source: Bain Front Line of Healthcare, January 2015; Bain Physician Attitudes Survey, January 2011
private and confidential | coverontrip digital insurance s.a. | 2017
• The rise of big data predictive models and consumers’ growing comfort with tracking their daily habits have accelerated the adoption of wearable technology, health apps and other high-tech digital applications.
• Many technology and data based companies such as Google and Apple are developing long interests in health and life science
HEALTHINDUSTRY
TECHNOLOGY AND DATA PROVIDERS
(1) The State of the Art of mH
ealth App Publishing. (2) D
ISYS.
private and confidential | coverontrip digital insurance s.a. | 2017
HEALTHINDUSTRYTECHNOLOGY AND DATA PROVIDERS
ProjectBaseline
Anini.a.vetodevelopacompletemodelofthechemistryofahealthy
humanbody
Currentlydevelopingasmartcontactlens,solarpowered,thatcollectsdiagnos.cdatausingsensors
CuringHeartDisease
EnteredintoapartnershipwiththeAmericanHeartAssocia.ontodrop$50millionintofundingasingle
projectbeginningin2016
SmartContactLenses
HealthKit
PlaHormwhichallowsthedevelopmentofhealthandfitnessapps
tobeusedingatheringdatafromindividual
AplaHormforresearcherstobuildmedicalappsandrecruitpa.entsfor
clinicaltrials
ResearchKit
CareKit
Aframeworkfordeveloperstocreateappsthatwillenableyoutomanageyourownwell-beingonadailybasis
UsingthesmartphoneAlexaapp,EchoownersenableKidsMDfromBostonChildren'sHospital
Introducedanappwhereconsumersuploadanimageoftheirprescrip.onandgetquotesfromnearbypharmacies
Asaresultofits“Organ-DonorStatusIni.a.ve”,organdona.onsign-upincreased21-foldoveraverageonthe
dayitrolledout
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
REGULATORYÐICS
Muchofhealthcare’sregulatoryfocusisonpa.entanddrugsafety.Regulatoryagencies
con.nuetoexertpressureonpharma,biotech,andmedtechcompanies,withincreasingemphasisonoff-labelmarke.ng,failurestodisclosesafetyrisks,andconcernsabouttheclinical
trialprocess.
PATIENTANDPRODUCTSAFETY
CIBERSECURITY
RegardingCloud-basedcompu.nga\acks;medicaldevicessecurityconcernsandcontrolofprivileged
access.
FRAUDANDABUSE
AnimportantpartthefightagainstfraudandabuseistheIndustrybeableof
trackingandanalyzingtherela.onsand
interdependenciesthatexistwithinHCEcosystem.
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
MEDICALADVANCES
NANOTECHNOLOGY STEAMCELLTREATMENT
REJUVENATIONRESEARCH
TELOMERASE
MAINTENANCEOFCONSCIOUSNESS
BIONICLIMBS
GENETICMAP DNAMANIPULATION
NEWCHALLENGESregardinganewperspecNveaboutinmortality
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
TECHNOLOGY&DATA
MAINDRIVERS
according to a recent research by Gartner
3DPRINTING
of people in the developed world will be living with 3D-printed items.
10 %
of surgical procedures requiring prosthetic, implant devices or organs will use 3D
Printing as a critical tool
35 %
by 2019
private and confidential | coverontrip digital insurance s.a. | 2017
TECHNOLOGY&DATA
MAINDRIVERS
mHEALTHDiagnostic tools will be used both for preventative / decision support and
treatment compliance purposes
HealthcareWearableDeviceShipmentsandRevenue,WorldMarkets2015-2020(1)
(1)Source:Trac.ca
private and confidential | coverontrip digital insurance s.a. | 2017
Wearable developments based on new materials and miniaturization allowing implantation into the body’s various parts and systems Wearables are backed with decision support capabilities
TECHNOLOGY&DATA
MAINDRIVERS
BODYINTELIGENTIMPLANTS&PROSTHESIS
private and confidential | coverontrip digital insurance s.a. | 2017
Applications may go from early detection – action strategies, to support
AI systems to interact with persons Current data processing capabilities
allow to analyze data which was impossible to process years ago,
running more complex analysis and using data in depth
TECHNOLOGY&DATA
MAINDRIVERS
PREDICTIVEMEDICALDATAMODELS
private and confidential | coverontrip digital insurance s.a. | 2017
TECHNOLOGY&DATA
MAINDRIVERS
COGNITIVETECHNOLOGIESANDAIBASEDHEALTHCARE
DecisionMakinginHealthcare:TheGrowingGapBetweenAvailableDataandHumanAbility(1)
(1)IBMW
atsonHealth:CapturingtheValueofBigData:BigChangesAhead
private and confidential | coverontrip digital insurance s.a. | 2017
TECHNOLOGY&DATA
MAINDRIVERS
AUGMENTEDREALITYANDVIRTUALREALITY
TELEMEDICINEANDREMOTEROBOTICSURGERY
HEALTHINTELIGENTDOMESTICOBJECTS
private and confidential | coverontrip digital insurance s.a. | 2017
DEMOGRAPHICS
FINANCIAL
HEALTHINDUSTRY
REGULATORYÐICS
MEDICALADVANCES
TECHNOLOGY&DATA
HEAL
THCONDITION
ISSUESIMPACTINGTHEGLOBALHEALTHCARESECTOR
private and confidential | coverontrip digital insurance s.a. | 2017
BUT WHAT ABOUT THE HEALTH INSURANCE INDUSTRY?
BIG CHALLENGES, FAST CHANGES AND NEW TRENDS?
IS IT READY?
priv
ate
and
conf
iden
tial
| c
over
ontr
ip d
igit
al in
sura
nce
s.a.
| 2
017
WHERETOFOCUS?SHOULDWESHOOTANYTHINGTHATMOVES?
AGING CHRONICAL DISEASES
AIR – WATER CLIMATE – URBANIZATION
PUBLIC HC SYSTEM MEDICAL ADVANCES
PATIENT AND PRODUCT SAFETY
FINANCIAL MODELS DRUG PRICE CONTROL
GENERIC AND BIOSIMILAR CYBERSECURITY
FRAUD AND ABUSE TECHNOLOGY AND DATA
PREVENTION CARE UNITS
CONSUMER BEHAVIOR PATIENT EMPOWERMENT
WECANDOORWECANUSE
private and confidential | coverontrip digital insurance s.a. | 2017
1
2
3
4
FOURGOODSTARTINGS
private and confidential | coverontrip digital insurance s.a. | 2017
1
private and confidential | coverontrip digital insurance s.a. | 2017
HEALTHLITERACY PATIENTCONTROL PATIENTPARTICIPATION
LinkbetweenpaNentandhis/her
understandingofhealthinformaNon
RelaNonshipbetweenthepaNentandthemanagementofhis/
hercondiNon
RelaNonshipbetweenpaNentandhealth
professionals
MEANINGFULPATIENTINVOLVEMENTINHEALTH
private and confidential | coverontrip digital insurance s.a. | 2017
private and confidential | coverontrip digital insurance s.a. | 2017
TOP THREE SERVICES AVAILABLE TO PATIENTS ELETRONICALLY
(1) Accenture. Doctors Survey. (2015)
private and confidential | coverontrip digital insurance s.a. | 2017
2
private and confidential | coverontrip digital insurance s.a. | 2017
private and confidential | coverontrip digital insurance s.a. | 2017
private and confidential | coverontrip digital insurance s.a. | 2017
Membersengagedinhealthyac.vi.esexperiencedfeweradmissionsandlowercoststhanothers.
private and confidential | coverontrip digital insurance s.a. | 2017
3
private and confidential | coverontrip digital insurance s.a. | 2017
OSCAR´s PROPOSAL IS BASED IN: 1. SIMPLICITY IN THE OFFER (ONLY THREE PLANS) 2. DIGITAL AND SIMPLE CUSTOMER RELATIONSHIP 3. PREVENTION AND ENGAGEMENT THROUGH WEARABLES
private and confidential | coverontrip digital insurance s.a. | 2017
4
private and confidential | coverontrip digital insurance s.a. | 2017
ANDTHEELEMENTSAREALREADYTHERE…
DIGITALTRANSFORMATION INTERNETOFTHINGS
BIGDATACAPABILITIES TECHNOLOGYWELLUSED
private and confidential | coverontrip digital insurance s.a. | 2017
SANDTHISISWHATINDUSTRYTHINKS…
private and confidential | coverontrip digital insurance s.a. | 2017
Concept
InnovaNon
FoundingYear
GeographicScope
• Thecompanygiveswearablestoitsmembers,whogeta$20rewardformee.ngac.vitygoalseachmonth
• Oscarclaimsthatpeopleiskepthealthierthroughthesemonthlygoalsandbyusingwearables
• USA(star.nginNY,NJ,CA,TX,butexpandingna.onally)
• TechplaHormwhichhelpsemployerstooffer“healthbenefits”totheiremployees
• Collec.veHealthhelpstocustomizeindividualhealthplansforeachemployee
• USA
• 2013 • 2013
• USA
• 2013
• USA
• 2012
• Anadvisor/conciergeonhealthinsuranceplans
• Basedon38factorshelpstocompareandfinetherightplanforeachcustomer
• Alifeinsuranceproviderwhichchargeseachcustomerbasedontheirspecificphysicalac.vity
• Throughappsandwearables,thecompanymonitorsusers’ac.vityandassiststhemtoaccomplishtheirgoals
INNOVATIONISHERE…
private and confidential | coverontrip digital insurance s.a. | 2017
INNOVATIONISHERE…
private and confidential | coverontrip digital insurance s.a. | 2017
Dr. Allianz • Digital house calls-that
leverages mobile technology to monitor vitals in patient’s home
• Patients can contact Dr. 24/7; if needed, Dr. will come to them
Ask a Nurse 24/7
• Users can call a
telephone number to get immediate answers to non-emergency health questions from a registered nurse
LiveHealth Online
• Uses the video capabilities of members' computers to have a face to face virtual meeting with a doctor- on demand.
Digital Underwriter
• Insurance applicants can apply from anywhere and get instant decisions on their smart-device
• The aim is to be paperless for both parties
INNOVATIONISHERE…
private and confidential | coverontrip digital insurance s.a. | 2017
INNOVATIONISHERE…
private and confidential | coverontrip digital insurance s.a. | 2017
ASWELLASFUNDINGFORSTARTUPS…
private and confidential | coverontrip digital insurance s.a. | 2017
BUTITISNOTENOUGHTOOVERCOMETHECHALLENGESTHEINDUSTRYHASTOFACETOWITHINTHENEXT5YEARS
FINANCIAL MODELS DRUG PRICE
CONTROL GENERIC AND BIOSIMILAR
CYBERSECURITY FRAUD AND ABUSE TECHNOLOGY AND
DATA PREVENTION CARE UNITS CONSUMER BEHAVIOR PATIENT
EMPOWERMENT
CUSTOMER/PATIENTCENTRICMODELSSTABLISHINGVBCPAYMENTSNEWPROVIDERSMANAGEMENTRELATIONSHIPCREATINGNEWPLANNSLINKEDTOPHARMACOSTSFUNDINGSERIOUSLYPREVENTIONCAMPAINGS,RETHINKINGCAREUNITSNETWORKSamongothers…
HCINSURANCEINDUSTRYHASTOWORKHARD
private and confidential | coverontrip digital insurance s.a. | 2017
THANK YOU
coverontrip.com
Rafael Senén CEO & Co-Founder
priv
ate
and
conf
iden
tial
| c
over
ontr
ip d
igit
al in
sura
nce
s.a.
| 2
017