+++ Health management is a strategic component that enables private health insurance companies to position themselves against the competition +++ Customers’ perceived fulfillment of the value proposition as a central success factor +++ Development of health management requires structured development of the services on offer and of the organization. +++
The topic of health is taking on increasing importance in our society. In parallel to this, customer expectations with regard to the services and benefits included in their health insurance are also growing. Rising competitive pressure – not only between private health insurance companies (PHI), but above all in competition with statutory health insurance companies (SHI) – requires ever-greater differentiation through specific services. Each private health insurer must ensure an attractive contribution level which competes with statutory health insurers and other private health insurers, by actively managing performance expenditure as part of health management. At the same time, a private health insurance company needs to meet its customers’ expectations and function as a holistic healthcare provider with (digital) services in the areas of disease prevention, diagnosis and information, treatment and monitoring as well as administration. Successfully creating this balance between cost reduction and customer expectation requires clear strategic goals and medium-term implementation planning that includes development phases.
Though the pressure to act is growing for all private health insurance companies, each is starting out from a very different point. Larger insurers are already developing into health managers in many fields of action along the entire supply chain, while others are lagging behind the market. Many insurance companies are still in the early stages of expanding their services to become health managers, and some have no discernible strategic direction or master plan, even though this is absolutely key to being successful. Above all, medium-sized and smaller private health insurance companies must have a clear idea of how they are uniquely positioned. A “me too” approach does not set a company apart from the competition, and for some companies is simply not possible due to a lack of available resources. Some insurers are trying to position themselves in individual fields of action – for example SDK, which is building up its own health advice service specializing in complex topics.
However, the following applies for all insurers: Customer focus is a key success factor. Who is my customer? What do they need? What do they want? How much are they willing to pay? These and other questions must be answered before a health management system can be developed. Apart from comparable rates and the lean, fast processing already implemented in many companies – for example with invoicing apps, digital health records and medication management – the customer must also experience services that inspire enthusiasm. These might include, for example, the private health insurance employee as a “carer” who focuses on the needs of the customer. After all, it is only in times of difficulty that the value of health insurance as an intangible good becomes visible to the customer. The customer’s perceived fulfillment of the value proposition is decisive in ensuring a positive attitude and resulting willingness to recommend the company. Any expectation created by marketing, sales promotion and sales must be met, from the customer’s perspective, at the point of need. “Much promised but little delivered” inflicts serious damage to the relationship, which is almost impossible to repair. Strong quality management when it counts is therefore critical to success.
The benefits of health management can be perceived all the way along the customer or patient journey. For insurance companies, the focus objectives are primarily competitive positioning, medium- and long-term service cost reduction and customer willingness to recommend the company. However, analog and digital services which reduce service costs through prevention, diagnosis and information, as well as support with customer treatment and recovery, first require investment, for example in the areas of data provision and analysis. In this context, the overall business case throughout the customer lifecycle is the right perspective from which to monitor and evaluate the contribution to profits of health management services.
Furthermore, as well as enabling competitive positioning, successful health management is an asset for Sales in terms of customer contact and supports new customer business.
However, it is not possible to establish professional health management in a private health insurance scheme in the short term. Instead, such a development requires strategic decisions, clear implementation planning and the application of resources in development stages right through to professional case and disease management. Target and existing customer analyses are required to determine which medical topics are included in the services, in which order and at what level of detail. The development period must have a wider scope than merely the development and marketing of offers and services relevant to the customer target groups, such as the treatment of mental illnesses or the treatment of chronic diseases like multiple sclerosis. During this phase the organization must be fully oriented towards its role as a health manager – with the involvement of external service providers if necessary. Lean processes with omnichannel capabilities for fulfilling the value proposition, practice-oriented data analytics, sustainable digitalization of services, knowledge management and the right mindset in employees at customer contact points are just a few examples of hygiene factors relevant to successful implementation in the growing organization of a private health insurance company.
Strategic analyses and the devising of a medium- to long-term, quantified strategy for setting up or improving health management should be supplemented by a critical inventory or self-analysis of the company’s own personnel, technical and financial performance along the entire value chain.
Based on this information, a clear concept and implementation plan can be developed, and this must then be checked and approved in terms of content and financial feasibility. This step includes the analysis and decision on whether to develop and provide services in-house within the company’s own organization or through the integration of service providers.
The success of health management is determined at the customer contact points, from the case worker to the health manager. These services must prove their value at the point of delivery, or “moment of truth”. Content, speed, and empathy in customer contact across all channels – from telephone calls or live chats to written information – as well as the lasting, uniform quality of services provided internally and externally must fully deliver on the customer promise.
Constant monitoring and continuous improvement of health management are not a task only for Controlling; the performance of health management has an impact on the image and competitive positioning of the entire company, and as such this is a function that must unite strategic, product-oriented, procedural, technical, and financial perspectives. The combination of the various perspectives in an institutionalized responsible body ensures long-term success, including economic success.
In our view there are six must-haves for the successful transformation of a private health insurance company into a modern health partner:
We would be happy to meet with you in person to discuss the core issues as well as the possibilities for setting up or further developing your health management. Get in touch!
Stumpf, F. / Leitzmann. C.
