A combination of factors, including demographic changes, evolving consumer preferences, and regulatory and compliance mandates, were already spurring change in the health insurance industry. Enter 2020 and the COVID-19 pandemic, which is having sweeping implications for the industry. At the peak of disruption, the focus was on ensuring business continuity, but new initiatives are cropping up to tackle the challenges as the industry adapts to the new normal. Furthermore, some changes are here to stay, and it will be prudent for the industry players to be resilient to the market shifts by being agile, improving member centricity, making processes intelligent, and embracing the open ecosystem. Read our Health Insurance Top Trends 2021 report to explore the strategies insurers are adopting to manage the external pressures.

1. 1© Capgemini 2020. All rights reserved |
Health Insurance:
Top Trends 2021
November 2020
Link: https://www.capgemini.com/top-trends-in-2021/

2. 2© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: 1World Health Organization, “Ageing and Health,” February 5, 2018; 2New York Post, “Humans are living longer — but they’re also getting sicker,” January 26, 2018; 3 4Capgemini | Efma, World Insurance Report
2019, 2020; 5Capgemini Research Institute, “COVID-19 and the financial services consumer,” April 2020; Capgemini Financial Services Analysis, 2020.
Customer demand for health insurance has increased by 10 percentage points compared with pre-COVID-19 levels
The global pandemic has intensified external pressures on the health insurance industry

3. 3© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
Health insurers must
pivot fast to ADAPT to
market shifts

4. 4© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Check for auto-
adjudication
Run through rules
to determine if
the claim can be
auto-adjudicated
Flag fraud
Identify outliers or
suspicious claims
and filter them for
further
investigation
Document
pre-processing
Ensure provider submits
all the information
Fast track payouts
To offer greater
convenience to
members and providers
Trend 1: Insurers are leveraging AI-based solutions to improve claims processing
Artificial intelligence can help insurers improve claims management to enable real-time claims processing
Real-time claims processing in health insurance

5. 5© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 2: Cognitive digital-automation powers intelligent, personalized member engagement
Health insurers are leveraging cognitive automation to power emotionally intelligent,
real-time interactions with members
How cognitive automation empowers
intelligent real-time customer interactions
UrgentNon-urgent
Faster resolution
Customer service request
Cognitive chatbot/ service
portal
Refer to human
representative
Recommend a solution
Recognizes customers’
emotions/urgency
Cognitive digital
assistance

6. 6© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 3: Pandemic catapults health and wellness into the global spotlight
COVID-19 changed the way people led their daily lives in 2020 – insurers are responding with
member-centric wellness initiatives
Fitness
tracking and
management
Health tips
Incentivizing
healthy
behavior
Community
connection
Health and
wellness initiatives
by health insurers

7. 7© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 4: Data interoperability enables seamless, coordinated care delivery
Benefits of healthcare data interoperability
Value
propositions:
healthcare data
interoperability
Seamless
data sharing
Turn-around
time reduced
Better health
outcomes
Personalized
healthcare
recommendations
Actionable
insights
Eliminate
redundant
procedures
Interoperable healthcare data will give insurers and providers a holistic view of members’ health,
enabling them to deliver faster, more accurate, and coordinated care

8. 8© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini | Efma, World InsurTech Report, 2020; Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 5: Customer-centric BigTechs enter health insurance
As tech giants step into the health insurance ecosystem via investments and partnerships, they are
driving innovative solutions to improve CX
Policyholder interest in purchasing insurance from BigTechs is on the rise
17% 30% 36% 44%
2016 2018 2020
JAN
2020
APR

9. 9© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 6: COVID-19 accelerates telehealth adoption
Leading health insurers quickly scaled up telehealth operations during the 2020 pandemic to ensure seamless care
delivery and experiences that mirror in-person care
What’s driving telehealth adoption?
Social
distancing
mandates
Relaxed
regulations
Scarce medical
resources due
to COVID-19
Convenient
care delivery

10. 10© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 7: Insurers are stepping up digital capabilities to offer virtual care services
Health insurers are launching quick access to care management and
risk assessment via digital channels
Benefits of virtual care management services
Digital care
management
Personalized
health guidance
Reduce strain on
healthcare system
Cost control with
less ER visits
Preventive
healthcare
services

11. 11© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: HealthyPeople.gov; Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 8: Recognizing social determinants can improve health outcomes
Insurers are expanding coverage to address social determinants that impact members’ health
to gain insights and improve outcomes
Five key areas of social determinants of health (SDOH)
SDOH
Economic
stability
Education
Social and
community
context
Health and
healthcare
Neighborhood
and built
environment

12. 12© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
Top Trends in Health Insurance for 2021 by Capgemini
Source: Capgemini Financial Services Analysis, 2020.
TA D A P
Trend 9: Insurers guide members’ healthcare journey to coordinate care, control costs
Payers are collaborating and vertically integrating with providers to offer members
streamlined and coordinated care ‒ cost-efficiently
Why is member steering important for health insurers?
Drive adoption
of network
providers
Deliver
coordinated care
Reduce
healthcare costs

13. 13© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
A strong focus on trends with high business impact will help insurers build business
resilience and will separate future frontrunners from laggards
Priorityofadoption(2021)
MediumHighSignificant
Business impact (2021)
Medium High Significant
1 9 4
8
3 2
5
TREND 1
TREND 2
TREND 3
TREND 4
TREND 6
TREND 9
TREND 7
TREND 5
TREND 8
Insurers are leveraging AI-based solutions to improve claims
processing
Cognitive digital-automation powers intelligent, personalized
member engagement
Pandemic catapults health and wellness into the global spotlight
Data interoperability enables seamless, coordinated care delivery
COVID-19 accelerates telehealth adoption
Insurers guide members’ health care journey to coordinate care,
control costs
Insurers are stepping up digital capabilities to offer virtual care
services
Customer-centric BigTechs enter health insurance
Recognizing social determinants can improve health outcomes
Source: Capgemini Financial Services Analysis, 2020.
6 7
 Priority of adoption refers to the urgency of adopting a particular trend to maximize value creation in 2021. This rating is based on the identified trends for an insurer operating in the current environment.
 Business impact represents impact of an identified trend on an insurer’s business in 2021. The impact could be on customer experience, operational excellence, regulatory compliance, or profitability.
 This matrix represents the view of Capgemini analysts for an insurer working in the current operating environment:
‒ Low interest rate environment
‒ Operational disruption due to COVID-19
‒ Uncertain regulatory environment
‒ Highly competitive environment and increased focus on customer centricity due to new-age players
‒ Emerging consumer preferences.
The factors above will vary by insurer depending on business priorities, geographic location, and several other factors. For specific requirements, please contact insurance@capgemini.com

14. 14© Capgemini 2020. All rights reserved |Health Insurance Trends 2021 – November 2020
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