The Health Insurance world is changing. Positioned until yesterday as simple Healthcare Payers, increasingly insurers are looking to become Healthcare Partners. Three factors are behind this evolution: (1) the epidemiological contraction of diseases, with the development of chronic diseases (2) the rising technological cost of medicine (3) digitisation.

These trends are driving: a sharp, continuous increase in reimbursement costs, placing an increasing burden on insurers, and the opportunity to achieve operational savings through digitisation.

Why implement a HealthCare Network assessment program?

  • As part of their new Healthcare Partner role, Healthcare Insurance Companies must know the quality of their Providers. This network assessment program is built upon three key objectives:

  • - Enjoy full visibility over Healthcare networks. This enables insurers to provide better advice to patients as to who is the best provider for their needs.

  • - Enable cost containment: this favours cost-effective providers and better contractual negotiations.
  • Improve customer satisfaction and loyalty: through a good advisory program, out-of-pocket expenses for patients are lowered, quality of treatment is optimised, and patient loyalty towards the insurer increased.

  • - Improve customer satisfaction and loyalty: through a good advisory program, out-of-pocket expenses for patients are lowered, quality of treatment is optimised, and patient loyalty towards the insurer increased.

What are the key criteria to assess HealthCare Network?

For an evaluation to drive value, it must measure six KPIs:

  • (1) Trust Score: linked to claims management, this provides information on the reliability of the HealthCare providers. It measures the match between pre-agreed tariffs & conditions and the actual HealthCare providers’ invoices: the higher the compliance, the higher the score;

  • (2) Equipment Score: this on-site evaluation allows insurers to list and evaluate their providers’ assets, for example technical equipment, treatment facilities and operating rooms;

  • (3) Quality of Care Score: this on-site evaluation examines the treatment provided by the Healthcare provider, and its fit with the patient’s diagnosis and international protocols;

  • (4) Patient-centricity Score: This is where insurers assess, on-site, whether the provider is patient-centric or department-centric. The more patient-centric the approach, the higher the score. This will have a direct impact on cost containment, both for the patient and for the insurer;

  • (5) Transparency Score: if the patient diagnosis is done well upfront, any pre-authorisation request should be comprehensive and accurate from the outset. This will be reflected in this KPI, measured on-site;

  • Patient outcomes Score: This leverages patient feedback and satisfaction with the HealthCare provider.

Impact of digitisation in the HealthCare network assessment programs

Digitisation in the Health Care Insurance industry can unlock three key benefits that further boost the value an assessment program delivers:

  • (1) A 360° view of all HealthCare providers, based on the Insurer’s own criteria;

 

  • (2) Real-time information: when on-site audits are performed using digital platforms, information is available instantly and can immediately inform decision-making;

 

  • (3) Communication to the end-customer (the patient): health insurers can decide to display certain scores on portals and mobile apps, providing patients with an additional service to increase their satisfaction and loyalty.

By crossing the chasm from traditional Healthcare Payer to modern Healthcare Partner, and by converting data into information, information into knowledge and knowledge into action, insurers can improve differentiation, cost containment and customer engagement – ultimately driving stakeholder value. Over the coming years, this strategic evolution will prove inevitable. So: would you rather lead from the front or lag behind?

If you are interested in this topic, the Cegedim Insurance Solutions team is at your disposal to answer to all your questions.

 Contact Us


By Cegedim