保険業界におけるデータを活用したエコシステムの形成

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2021/04/04
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Alternative data sources would provide insurers with additional data that complement internal organizational or policyholders’ information. It would allow for extended insights that can translate to strategies for customer-centric insurance products. Alternative data resource will increase accuracy and provide more up-to-date and varied data, aside from structured historical data. Unstructured data can include biometric and IoT sensor data, along with medical sound and imagery.

Integrated Electronic Health Records for Health Insurance

Health data sharing has been discussed in Celent report, Health and Insurance: Health Informatics, Internet of Things, and Integrated Electronic Health Records (October 2020), and we presented Human API. Human API is a consumer-centric health data sharing platform, which allows consumers to share their information with trusted third parties across the US. This forms a nationwide network where information can be shared digitally and increase innovation across healthcare to related industries such as insurance.

A recent development in Singapore shows a 3-pronged strategy by including health data with insurance, with support from government and healthcare providers. The General Insurance Association Singapore (GIA Singapore), Life Insurance Association (LIA Singapore) and Integrated Health Information System (IHIS) are working together and calling for proposals to develop an end-to-end health insurance claims platform. The concept is to have a nationwide platform that allows policyholders to connect with both healthcare providers and insures.

For privacy control, patients can use the nationwide digital identity–Singpass–to authorise the release of their medical records and insurance policy details to insurers and healthcare providers. This platform goal is to speed up claims processing process and allow healthcare providers to submit claims digitally to insurers on behalf of patients.

As an integrated platform, healthcare providers can provide billing information and details about patients, such as health status and length of hospital stay, to both patients and insurers. Healthcare providers can also retrieve details of patient’s relevant policy coverage information, which include the government-supported health insurance scheme–the Integrated Shield Plans–and group hospitals and surgical insurance, to determine if hospital admission deposit can be waived. For the insurers, by obtaining billing and medical data from healthcare providers directly, insurers can provide faster updates on the estimated claimable amount.

Current claims process and information exchange is largely paper-based due to the fragmentation of multiple systems of various healthcare institutions and insurers. This separation of systems can be a consequence of legacy conditions and a cyber attack on Singapore’s largest healthcare institution group–SingHealth– in June 2018 which compromised the personal information of 1.5 million patients. The penalty was fines by the Personal Data Protection Commission (PDPC) to IHIS and SingHealth for failure to secure confidential patient data. This cyber-attack disclosure was the nations’ worst breach and involved subsidiaries related to the government. The breach has prompted stronger enhancement to cyber-security governance, management, and cyber-defence systems. As a vendor for healthcare systems in Singapore, IHIS is transforming its cyber defence capabilities and put in place new safeguards through lessons learned from this incident.

Data and Security Safeguards for Customer-centric Services

Today, the vision for the conception of an integrated ecosystem is to digitalize information exchange, speed up processes and reduce costs incurred, which will bring about greater convenience and better customer journey to patients. Policyholders/patients will benefit from timely support for their healthcare needs, with the insurance industry having the ability to provide an end-to-end hospitalization experience.

From the polls conducted during the live insurance session of Celent Innovation and Insight Week 2021, we see customer-centrism and customer journeys as the focus of respondents. The above initiative highlights the importance of putting customer at the heart of design and to have a conscious effort to educate and build strong cyber defence for data systems, which is becoming a priority for insurers and organizations alike. As we look towards an integrated ecosystem of service, we have to bear in mind the key role of data and the safeguards needed to protect this digital asset.

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To learn more, please pick any publication you like (list of recent reports here) and we can discuss over video calls, walking through any reports/blogs, exhibits, provide additional insights or perspectives. Email me at mang@celent.com.

Below are related reports/blogs to this blog:

Health and Insurance: Health Informatics, Internet of Things, and Integrated Electronic Health Records

Integrated Insurance Ecosystem: The Next Generation Insurer

At the Heart of Design – Care for Customers

At the Heart of Design - Adopting Machine Learning with a Data-focus Design

Insight details

分野
生命保険, 損害保険
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保険, 生命保険, 損害保険
種類
ブログ
拠点
アジア, 北米