Today’s healthcare landscape is defined by technological innovations that teach individuals working within the healthcare sector how to improve underwriting performance by using new tools to further the optimization of pricing strategies and improve risk analysis end-to-end.
Recent trends, such as the emergence of AI in health insurance modeling and the growing popularity of new transaction platforms like HPNs, have shown employers, providers, and payers the importance of harnessing disruptive technologies to streamline and improve existing care systems. To make health insurance more equitable, effective, and affordable—for both providers and the members they serve—effective underwriting is undeniably of paramount importance.
The Importance of Efficient Underwriting
Healthcare underwriting is a complex and critical process that plays a pivotal role in making informed decisions concerning how to deliver the most holistic benefits to patients, how to price insurance policies, and how to determine appropriate risk mitigation strategies to protect employers from catastrophic costs.
This is especially important for small business owners who use self-funded health plans to offer employees more flexible, cost-effective, autonomous, and customizable health insurance options than traditional counterparts. To deliver cost reduction, control, and better overall benefits efficiency, employers must deploy stringent and proactive self-funding financial planning, necessitating underwriting technologies that privilege sustainability, scalability, and proper risk mitigation.
To succeed in today’s dynamic healthcare industry, insurers, brokers, and TPAs must continually strive to improve their underwriting performance to offer their clients the most competitive benefits; the foundation of healthcare itself depends on powerful underwriting strategies designed to align the incentives of all parties involved in the process—from providers to consumers and back.
How to Improve Underwriting Performance
Learning how to improve underwriting performance is a complex and ongoing process made simpler by the transformative and emergent technology that optimizes risk assessment and effective pricing. Below are just a few of the many ways cutting-edge tools are changing and augmenting the underwriting process.
Implementing Comprehensive Risk Analysis
Risk analysis is the foundation of healthcare underwriting. It involves evaluating various factors to assess the likelihood and severity of claims that an insurer is likely to face. Data analytics and risk modeling, alongside ongoing collaborative and monitoring technologies, all contribute to risk analysis in the underwriting process.
Data Analytics and Predictive Modeling
Harnessing the power of advanced data analytics and predictive modeling allows insurers to collect and analyze vast amounts of data with ease; they can synthesize an individual or group’s medical history, lifestyle choices, and demographic information to predict future claims with greater accuracy. Whereas data analytics used to rely solely on human synthesis, new machine learning algorithms can identify trends and patterns that might not be apparent through traditional methods.
Regularly Updated Risk Models
The health insurance sector is constantly transformed by new diseases, treatments, and technologies as they continue to emerge. To stay ahead and provide relevant plan options, insurers should regularly update their risk models to reflect any new changes in the field. This ensures that underwriting remains accurate and applicable to contemporary circumstances. Health In Tech’s Stone Mountain Risk stop-loss solutions help effectively protect employers with self-funded plans from being financially inundated by any unexpected high-cost claims.
Collaboration With Healthcare Providers
Stable, long-term relationships between healthcare providers and insurers allow for better communication regarding risk analysis techniques. Both parties are subsequently better able to access medical records, collaborate on risk assessment measures, and even offer integrated wellness programs to policyholders.
For example, Health In Tech’s HI Card technology provides a standardized transaction and information-sharing platform for providers, payers, and patients so that all parties have secure, real-time access to vital information.
Monitoring Data Privacy and Security
As insurers and employers handle vast quantities of sensitive health data, it’s crucial to prioritize data privacy and security as they pertain to risk analysis. Compliance with national data protection regulations (such as HIPAA) is always essential. Many new technologies are arising to help both payers and providers keep data secure, transparent, and fortified against fraud.
Developing Effective Pricing Strategies
Once thorough risk analysis strategies are established, the next step in learning how to improve underwriting performance lies in developing effective pricing strategies. Pricing policies in healthcare insurance must balance being affordable for consumers, financially reasonable for employers, and profitable for insurers.
Tiered and Customizable Pricing Options
Tiered pricing, also known as risk-based pricing, involves categorizing policyholders into different risk groups and charging them accordingly. Advanced underwriting technology can help balance the risk pool by synthesizing health data and medical records to determine effective tiers and calculate corresponding prices.
Providing policyholders with ample customization and plan options allows them to choose coverage that best suits their needs, with providers and networks they trust. It empowers clients to choose between factors such as deductibles, co-pays, or ancillary benefits for specific conditions. Customization not only enhances customer satisfaction but can also lead to more accurate pricing on a macrocosmic scale.
Encouraging policyholders to maintain a healthy lifestyle can help reduce the financial burden of overall claims and serve to lower the risk of adverse health issues occuring significantly. Insurers can offer proactive wellness incentives by integrating features such as discounts for regular check-ups, access to fitness programs, or other rewards into their underwriting process.
Using artificial intelligence to leverage and synthesize data from wearables, electronic health records, and other supplementary assessments can inform underwriting pricing strategies. Many insurers choose to offer discounts or bonuses to policyholders who share their health data, all of which can lead to cultivating a better understanding of the insured population’s relative health. This stands to align premiums with actual risk, prevent discrimination and make the process of pricing more fair and transparent.
Regular Pricing Model Assessment
When taking a proactive approach to developing effective pricing strategies, these models should always privilege agility, flexibility, and adaptation. They should be reviewed and adjusted periodically to account for changes in healthcare costs, regulations, and other market dynamics, allowing insurers to stay competitive and to adapt to new conditions as they evolve.
Health In Tech’s Transformative eDIYBS Software
One of the most empowering underwriting technologies on the market today is Health In Tech’s Stone Mountain Risk Group underwriting platform known as the Enhanced Do It Yourself Benefit Systems, otherwise referred to as eDIYBS.
The manifold benefits of eDIYBS technology are revolutionizing healthcare deliverables across the board. This cost-effective technology completely circumvents the high opportunity cost of underwriting by allowing brokers to underwrite hundreds of groups daily instead of just a few, saving clients invaluable time and resources.
The FIRM proposals that eDIYBS creates involve 12 plans with four potential tier rates and are entirely customizable end-to-end. Clients have full autonomy to design and develop the plans that are best suited to meet their unique needs. Small business owners can seamlessly integrate ancillary benefits to offer their employees more holistic coverage, including dental, vision, critical illness, and GAP coverage.
Underwriting Made Seamless with Health In Tech
At Health In Tech, our industry-leading tools and technologies are designed to configure solutions that empower our clients to make the most of creative risk modeling and pricing strategies with ease. Helping our partners learn how to improve underwriting performance levels is what we do best; our eDIYBS technology allows brokers to underwrite hundreds of groups in mere minutes.
Quoting, binding, and administering health plans for small groups in self-funded healthcare environments has never been more accessible. Get in touch to learn more about how we can help you transform your underwriting process today.