Health insurers: How an industry doubly impacted is making strides

Health insurers: How an industry doubly impacted is making strides
By Vijay Madyastha
Vijay Madyastha
Partner, Healthcare
May 29, 2020

Health Insurers faced multiple challenges and played a key role in the aftermath of the COVID-19 crisis. Here’s how they met the pandemic head on and what’s in store for an industry adapting more quickly than ever.

As the COVID-19 pandemic stretches into the summer, the crisis’ ripple effect continues to reach almost every virtual shore of our lives. Industries around the globe have been impacted in myriad different ways, now taking stock and picking up the pieces for some semblance of a recovery. The healthcare industry was forced to embrace an impact of tsunami-like proportions that no one could have predicted just a few months ago. Health insurers in particular have withstood a deluge of challenges from all sides, many of which show no signs of receding, and whose impact will undoubtedly shape the insurer landscape for years to come.  

Answers and information on the frontlines

At the outset of the crisis, health insurers were looked to as a source of information and guidance in dealing with an unprecedented set of circumstances and questions. They were on the front lines, helping individuals navigate the pandemic while also catering to employer groups that were scrambling to adjust their health benefits and communicate these changes to employee populations. Health insurers made critical benefits—such as the testing and treatment of COVID-19—quickly available to meet the needs of the pandemic.

The speed and scale of change required health insurers to communicate differently in order to get new information out in a hurry. Although speedy communication was a requirement, it was also a major challenge for such a highly regulated industry: health insurers had to figure out how to navigate a robust approvals process to disseminate information quickly and efficiently. This was true of both internal and consumer-facing communications, whether managing employees’ needs or mitigating how operations were impacted, like the handling of claims or spikes in call volumes. Core activities such as reimbursement and delivering quality care to members presented significant challenges, especially given the sheer level of remote processing required to address claims in this new environment.

Digital pathways and roles redefined

The pandemic has impacted the patient delivery ecosystem as well, fast-tracking once slow-to-implement changes to the customer experience. For example, with limited in-person access to doctors and healthcare providers, telehealth, which allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and even remote admissions will become significantly more commonplace and its use heightened among certain demographics.

Digital engagement overall will be even more critical as well as perhaps more prevalent among populations that have historically not been as comfortable with digital experiences. Insurers are responding quickly, standing up digital channels to facilitate getting care while at home. They are launching new apps to allow members to get personalized guidance about their health and connect with a doctor via text, chat, or video. Consumers who previously preferred in-person doctor visits will adapt and their preferences will evolve to fit this new environment. Whole swaths of the patient population are quickly becoming more digitally-oriented than ever before, requiring the industry to ramp up new engagement pathways at scale.

Engagement with employers is changing, too, as health insurers have been increasingly sought after for guidance in this time of crisis. By advising employers on how best to manage their populations, make benefits available, and provide key information to employees or members, some health insurers have stepped into a consultative role. This type of advisory input may become more prevalent as the pandemic continues to unfold.

The need for speed

COVID-19 has demonstrated the need for agility among health insurers. At the enterprise level, the ability to adapt quickly is central to being able to address and implement changes in just a few short months. But the highly regulated healthcare industry is required to adhere to established processes, procedures, and laws and cannot make changes on a whim. This is where Agile processes, frameworks, and ways of thinking can be of service, providing the tools for the industry to adjust its day-to-day processes and prepare for the unexpected at a much faster, more responsive—but still responsible—clip.  

This need for speed extends to the care members receive as well. For example, the healthcare industry has had to pivot to supplant physical check-ins with video consults to ensure that patients are still getting the uninterrupted care they need, albeit in a different form. Through actions like these, the industry is able to assure members that the care continuum is resilient—able to withstand this crisis and all future disruptive events—which is a vital message to send. This is true of not just front-end experiences, but back-end ones as well. By deploying automated technology, health insurers will be able to manage a multitude of routine or administrative processes and allow for higher touch interactions and more seamless experiences.

Redefining participation in a legacy space

The healthcare industry has often viewed participation through the preventative lens of behavior and life choices. For insurers in the individual market, there's been a consistent focus on capturing the uninsured population. The current crisis has added fuel to the fire, as the sharp rise in unemployment has led to a dramatic rise in uninsured or underinsured individuals. Insurers now need to address this growing population and foster participation on the healthcare continuum—inspiring a traditionally hard-to-engage population to participate for their own protection and coverage.

Participation doesn’t end at enrollment; it extends to care engagement as well. It’s easy to posit that pre-COVID, care wasn’t top-of-mind for certain segments, when going all the way to a doctor’s office to sit in a crowded waiting room was the pinnacle of the healthcare experience. But health insurers and providers now have an opportunity to activate an otherwise dormant population through digital means, demonstrating to this suddenly captive audience the value of digital care engagement. At this moment, it’s helpful to remember that digital activation isn’t only advantageous to the member—a healthy patient benefits everyone on the care continuum.

Converging challenges will chart a new normal

Health insurers have been hard hit. On the one hand, insurers are themselves employers, with tens of thousands of employees nationwide, and while they are heroically responding to the pandemic, they are simultaneously dealing with the same challenges that all other industries are facing. Whether that’s going through furloughs or layoffs, figuring out how and when to return to work, or simply fostering remote work for large parts of the employee base, they’re facing the same tough decisions as other industries. On the other hand, there are macro and microeconomic factors that affect their business – both individual and employer markets.

We can’t predict with certainty what the lasting impact will be for health insurers post-COVID-19. And it’s hard to say if legacy processes will be replaced with agile practices full-stop, if digital ecosystems will become an even greater focus for enhanced patient and member experiences, or if artificial intelligence and investments in infrastructure will become the breeding ground for technological advancements. What is clear, however, is that we’re already beginning to see the industry adapt and accelerate to meet the emerging consumer landscape.

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Meet the author
  1. Vijay Madyastha, Partner, Healthcare

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