Flexibility for backend systems of private health insurers

Currently, there is a lot going on in the German healthcare market. Through "Gematik", the German Federal Ministry of Health is forcing the healthcare industry to digitalize. It includes, for instance, the "eRezept" (electronic prescription), the electronic certificate of inability to work, and electronic patient files. Furthermore, the coronavirus pandemic is posing organizational and financial challenges to the healthcare system. Every day, we are bombarded with various new messages related to healthcare, more than we have been in a long time.

adesso insurance solutions and the Insurance Forums Leipzig are actively participating in the open discourse as well. For instance, they do so via the joint study regarding the role of private health insurance in the health insurance system of the future or through the FlasHED event, the digital expert talk on healthcare trends in Germany. The study points out specific areas of activity for private health insurance, based on comprehensive surveys and interviews.

Fields of activity for private health insurance

One important finding of the study is that private health insurers must see themselves as a guide or partner for the insured. To achieve this goal, the following areas of activity are defined:

• Adaptability to changing market conditions, medical and technological advances, and growing customer expectations
• Collaborations with players in the healthcare system.
• Flexibility in products, processes, and IT systems.

What can "greater flexibility" specifically mean for private health insurance?

Modularly adaptable products and rates

Over the past several years, policyholders' requirements regarding rates have changed, and this is not only proven by the study's surveys, but also by the new rates that have been brought to market. Rates must be made modular and adaptable so that they can meet individual needs. Furthermore, from an actuarial perspective, some insurers already have originally non-health insurance services in their offerings. For instance, they can be services related to operational health management, such as assistance in looking for preventative care, or a dedicated contact person for policyholders from a customer company in the field of company health insurance.

This is actually a challenge for insurance companies. If such additional services are to be "booked" modularly during policy creation or as a follow-up, then there needs to be the option of expanding the attribution of the affected categories accordingly. This type of classification is not only required for operational management but will also become indispensable for downstream cost consideration and assessment. Particularly with preventative care, insurers expect that high benefit payments in the future can be reduced by an investment today. This information must be available in the companies' data warehouses for retrospective contemplation in controlling.

Easily configurable processes and systems

Now we wish to cover the flexibilization of processes and systems according to the aspect of flexibility through personalized products and rates. What do we mean by that? Processes should be as easily configurable as possible. In other words, depending on the selected configuration, processes should run light, i.e. semiautomatically or manually, or dark, i.e., without human intervention (straight through processing). The exact meaning of "as light as possible" depends on the particular company. With well-positioned application development and a well-conceived service section, a workflow machine can provide fully adequate flexibility with access to configurable parts. Other companies may see the use of business rules as a solution, although it mostly requires departments that are savvy in logic in order to extensively utilize their advantages.

These kinds of processes require IT systems that are designed to respond accordingly from the ground up, whether as the actor which is called up or is doing the calling up in the processes. Going back to the point regarding light and dark processing: An underlying system (business layer) must operate irrespective of whether, e.g., a clerk uses a GUI or process to call up this system for the same purpose.

In order that systems can become more flexible as set forth in the study, they must be or become connectable and scalable. Connectability must be considered using entry via the processes. Scalability is an issue that cannot be solved with more hardware alone. For instance, a 3-layer architecture is useful, because every layer can be scaled in its own right. Since many companies use systems whose architecture was partially designed with entirely different premises decades ago, the challenges from this field of activity alone will sooner or later require in-depth adjustments to legacy IT.

In other words, modernization must take place in the backends of insurance companies. Achieving this will lay the foundation for the required flexibility to offer the innovations and services demanded by policyholders.

Would you like to learn more? We are happy to personally advise you on the issue of modernizing legacy IT in private insurance companies. Book an appointment with our expert Karsten Schmitt today.