Payers are assuming a member health orchestrator role to tackle rising healthcare costs

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Across the globe, healthcare costs are escalating at alarming rates. In fact, the anticipated increase in medical-plan unit costs in 2019 (net of inflation) was 7.8%, which is 4.9 percentage points higher than the 2.9% annual worldwide inflation rate.*

These skyrocketing costs are acting as a catalyst for health insurers to take measures and approaches that improve efficiency. Enter the preventive model of care, which encourages early identification of potential health issues so that proactive steps may be taken before diseases become catastrophic. Preventive care models work to keep people healthy and include services such as annual physicals, well-woman checks, and dental cleanings that defend against health emergencies.

The result? Reduced healthcare costs and more satisfied patients. No wonder insurers are responding by leveraging technology to achieve preventive healthcare models. Let’s take a closer look at how technology is enabling payers to reduce healthcare costs.

Predictive analytics to target care intervention

Payers are leveraging predictive analytics to detect potential health concerns and take preemptive action. Similarly, consumer analytics and journey mapping are being used to coordinate member interactions and to make recommendations about next steps.

Healthcare spending is not exempt from the 20–80 rule, and a smaller number of members often contributes to a more significant proportion of spending. Therefore, identifying members most likely to become seriously ill can go a long way to control costs.

NextHealth Technologies, a Denver, Colorado-based InsurTech, created a SaaS platform that integrates predictive and prescriptive analytics, behavioral economics, and multichannel consumer engagement solutions for health plans to reduce medical costs. The platform bolsters member risk identification and engagement to improve health and financial outcomes by using personalized data and optimized action recommendations.[1]

With offices in New Jersey and Silicon Valley, InsurTech startup Clover Health offers health coverage to senior citizens across seven US states. The firm uses machine learning and data analytics to continuously monitor and identify patients at the most risk – and then provides preventive care intervention. The firm’s strategy has cut healthcare costs, reduced hospital admissions, and improved clinical efficiency.[2]


Insurers are turning to telemedicine as another useful tool to combat ever-increasing costs, according to the Top-10 Technology Trends in Health Insurance 2019, a report from Capgemini.

Remote diagnosis is convenient, and also offers cost benefits to all healthcare ecosystem members by reducing on-site visits and enabling patients to avoid travel and costs associated with a trip to a clinic or physician’s office.

In addition to cost savings for stakeholders, telemedicine offers members (even those in isolated or remote areas) access to physicians through video consultations enabled by an app on their mobile phone or tablet.

Therefore, it’s not surprising that more and more payers are providing telemedicine services. Aetna and Blue Cross Blue Shield Association offer general medical care for routine and common illnesses through partnerships with Teladoc, a New York-based telemedicine firm. Diagnosis and treatment for flu, allergies, sinus infections, rash, sore throat, and more are offered, along with prescriptions for necessary medications.[3]

Medication and treatment adherence

Medication nonadherence in the United States has been reported to cost $300 billion annually.[4] Consequently, payers are working to simplify the healthcare journey, provide drug rebates, and increase meaningful interactions to encourage their members to fill and take medications as prescribed.

French multinational insurance firm AXA launched AXA Health Solutions as a one-stop coverage option for members in Italy. Services are designed to consider the country’s aging population and long wait times for consultations. Features such as video consultation, remote prescription orders, and home delivery as well as home health and well-being services, are provided all from a single platform.[5]

United Health, the largest health insurer in the United States, passes drug manufacturers’ rebates directly to consumers to improve patient adherence to medication. The trial program began in January, and by March had resulted in an average savings of $130 per eligible prescription. According to an analysis from United Health, when there are no sizeable out-of-pocket drug costs, patient adherence to a medication plan improves by 4% to 16%.[6]

Health startup Reflexion Health launched VERAHome and VERAClinic platforms to encourage patients to stick with their physical therapy plans. VERAHome also offers educational features that help members prepare for surgery while VERAClinic provides clinicians with data-based insights that can be used to review patient progress and identify members that might require additional intervention.[7]

The World Insurance Report 2019, available in May, explores the more proactive role in customer risk management that insurers will be required to take going forward.

Rapid technological advancements combined with customers’ increased digital adoption and openness to data sharing have set the stage for unprecedented transformation for payers as well as the healthcare industry. With a focus on the future, payers are already beginning to digitally transform and assume a new member health orchestrator role to cut costs and boost customer loyalty and retention.

[1] NextHealth Technologies website,, accessed March 2019.

[2] Clover health website,, accessed March 2019.

[3] FierceHealthcare, “With 89% revenue growth in 2017, Teladoc looks to deepen partnerships with large insurers,” Evan Sweeney, February 28, 2018,

[4] Healthcare Finance, “Patients who skip medications cost healthcare $300 billion annually,” Jeff Lagasse, May 14, 2018,

[5] AXA website,, accessed March 2019.

[6] Fortune, “UnitedHealth Expands Drug Rebate Program to Consumers,” Erik Sherman, March 12, 2019,

[7] Reflexion Health website,, accessed March 2019.

*AoN, “2019 Global Medical Trend Rates,”, accessed April 2019.

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