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Broomberg Shared-Value-Health
Broomberg Shared-Value-Health
VITALITY
CONFERENCE
5 November 2019
Dr Jonathan Broomberg | CEO Discovery Health, South Africa
Trends in cause of deaths, deaths (million/year) Risk-adjusted incidence rate for all cancers per 1,000 lives
2008
40 Non-communicable 2.2
1.85X
2017
diseases
30 4.1
20
Communicable diseases 2.2
10
2.02X
Injuries
4.5
0
1990 2000 2010 2020
United Nations projection for 2025 Increase in disease burden of DHMS members, age standardized
21.6%
1 billion
increase in world population by
2025
18.6%
300 million
aged > 65 2013 2014 2015 2016 2017 2018
Source: Internal DH Analysis; PWC: Emerging Trends in Healthcare; United Nations; World Health Organisation; “Chronic Emergency: Why NCDs Matter,” World Bank Health, Nutrition and Population Discussion Paper (2011)
Supply side inflation | technology, drug improvements and
02 increasing health infrastructure
Average real medical inflation rates by region (2019), %
Source: Internal DH Analysis; 2019 Global Medical Trend Survey Report, Willis Towers Watson
Data & digital technologies | proliferation of digital health apps and
03 services with significant funding available
SOURCE: CB Insights Digital Health 150: The Digital Health Start-Ups Redefining the Healthcare Industry (2019); Telehealth at Kaiser Permanente (2018)
Poor customer experience | market fragmentation, product
04 complexity and poor value for money frustrate customers
When respondents are asked about what frustrates them most in healthcare, the top three answers are:
Determining whether a
2
treatment would be covered Consumers are demonstrating a lack of trust in
traditional health systems; they are increasingly willing to
entrust their health services to non-health sectors; and
ubiquitous technology is giving them the tools to do so.
Source: Trends in Healthcare Payments Ninth Annual Report, Instamed (2018); McKinsey’s Consumer Health Insights Survey (2017); PWC: Emerging trends in healthcare
Tackling these challenges | Shared Value Health Insurance
Cost Premium Cost Care Health 1
Value = = X X X X
Member Health Care Premium Member Customer
stickiness
Results Improved growth Manage supply Manage demand Manage demand Improved growth
Positive selection inflation side inflation side inflation Lower lapses
Improve quality Positive selection
of care Lower lapses
Full set of tools and systems to support Shared Value Health
Insurance deployment
PRICING AND PROCUREMENT VALUE-BASED VITALITY ADMINISTRATION WORKPLACE HEALTHCARE
PRODUCT DESIGN ADMINISTRATION
AND NETWORK & CARE INCENTIVES & & SERVICING HEALTH SERVICE DELIVERY
SERVICING
DESIGN BEHAVIOURAL PLATFORM SOLUTIONS
PLATFORM
AI-driven pricing Procurement Personalized Behaviour change Holistic health Onsite wellness Home nursing
algorithms integrated incentive insurance claims checks services
condition programme administration and
Product and management servicing platform Executive medical
Network design programmes assessments Pharmaceutical
benefit design
distribution
Integrated software
platform New business and Onsite primary care
Product integration underwriting clinics
• Other insurance Alternative
and financial Care coordination
reimbursement HealthyCompany
services programmes Deep product
strategies AI and data-driven Employee
• Corporate integration service operations Assistance
wellness
Programme
Proven rapid Fraud analytics and ePractice Vitality brand Member and health Wellness coaching,
innovation recovery systems professional apps training and
methods advisory services
DATA & ANALTYICS Data repositories Claims intelligence Business intelligence Operations intelligence Fraud intelligence
Pricing | Advanced pricing analytics – Vitality Health UK
IFRS Gross Earned Premium, GBP
Sustained
revenue
growth
Lower
claims
ratios
Rising
profitability
1 2 3
Population Segmentation Profiling physician usage of investigations Identifying outlier hospitals
Casualty Efficiency
Hospital Efficiency
NB: Tools are categorised by most relevant use, but can also be used against multiple categories
Procurement &
network design
Live claims
risk dashboard
Procurement &
network design
Hospital
admissions
dashboard
Procurement &
network design
Example –
hospital-specific
deep dive
Value-based care | optimising throughout the value chain
Risk sharing reimbursement Value based contracts with strong Use preferred networks across
contracts including quality metrics focus on outcomes all plans
Cardio Care
Mental health
Diabetes
Vitality incentives & behavioral platform | Expanding Vitality to
members with chronic conditions
Medicine Tracker
Integration with providers
through HealthID
Healthy Food
Hypertension Risk
Healthy Healthy
Activity Activity
Reminder Queue
Cardio-Metabolic risk
Cardiovascular
See recommendations
disease
Captured
Value-based care | equipping doctors with ways to reduce member risk
Cardio-Metabolic risk
Most frequently
Lifestyle recommendations to reduce cardio-metabolic risk Reduce unhealthy purchased unhealthy Substitution
items per week item in category recommendation
45 27.5 -0.69
Captured
Health insurance plus Vitality leads to a fully integrated health
insurance and wellness ecosystem
Rich Risk profiling
member data & segmentation