The past year has been anything but dull in the Canadian healthcare and benefits world. As the new year unfolds, we can expect a number of key trends to continue and accelerate. Here are six areas where technology is enabling plan sponsors, advisors, third party payors and other key industry players to improve end user experiences and find efficiencies.
Trend #1: The Consumerization of Everything.
Plan members are bringing their experiences as consumers to work, and expecting their employers to respond with faster, friendlier and simpler processes and tools. Making things more complicated, we have five generations in the workplace, each with its own version of a consumer experience.
Expectations among third party administrators also show a focus on reducing complexity around processing and adjudication and an ability to customize workflows to reflect different plans and funding models. Branded by Gartner as “multi-experience,” this will show up as a shift from people who are technology savvy to technology that is people savvy.
For example, employee self-service (ESS) will need to catch up with the likes of Amazon in terms of speed and ease of use, which could be a bit bumpy since research shows that 43% of U.S. organizations that offer ESS, still use paper for their benefits enrollment and onboarding.
Automating these steps, though, will be table stakes in 2020, as employees look to an intuitive and holistic experience across the board, including how they access claims history, reimbursement status and coverage information.
Tackle the trend
Double down on user experience in 2020. From ensuring all interfaces are mobile-friendly to reducing the time and expertise plan members and administrators require to get things done.
Trend #2: More Apps Doing More Stuff.
Almost one in four Canadian smartphone users have at least one health app installed. Of these, 64 per cent track their physical activity and 41 percent keep tabs on what they’re eating. Other apps that track health history will also continue to proliferate. Increasingly, we’ll see more proprietary mobile apps that form part of the HBM ecosystem to enable efficient submission, processing and claims adjudication.
Another way to drive efficiency is the use of home health monitoring, which uses integrated devices, such as blood pressure cuffs, to share data remotely with health care teams. We can expect this highly personalized model of care to continue as an effective tool to reduce the costs of hospitalization and interventions., while improving patient satisfaction and overall quality of care.
Employee assistance program (EAP) providers and a number of insurers have been investing in application ecosystems and will focus on delivering no-cost apps to plan members.
We also anticipate a growing use of apps by primary healthcare providers to streamline clinical work, help patients manage prescriptions and improve administration tasks such as appointment booking and reminders. For example, simple automation tools can reduce no-shows by as much as 60 percent, which improves clinic efficiency and reduces costs across the board.
Perhaps the biggest impact of apps in 2020 will be in chronic disease management. About half of adult Canadians live with a chronic illness, and medication non-adherence, along with absenteeism, is costing employers and insurers billions. Apps that offer support and coaching can increase treatment adherence and help employees manage their conditions effectively. For example, cognitive behavioural therapy (CBT) apps are proving effective in the management of anxiety and depression, while others improve mindfulness and resilience. We will also see more employers using apps to track absences and leveraging that data to spot patterns that may indicate unmanaged risks, particularly among off-site workers.
Tackle the trend
Work toward creating eco-systems of mobile apps that are proven to make a measurable difference to outcomes, costs and efficiencies, while supporting a more consumer-like end user experience.
Trend #3 The data deluge gets managed.
While privacy will continue to be a key concern, AI will be put to work in synthesizing large amounts of health, behaviour and workforce data into actionable insights for benefits providers and advisors. For example, data may indicate the need for program changes to reduce absenteeism or drug costs.
Of course, automation will also be the focus of ongoing cost efficiency efforts in the industry. Certainly it will continue to improve the speed and quality of claims processing, and machine learning will be used more extensively to reduce administration costs. In fact, one report suggests by 2023 insurers worldwide will see US$1.3-billion in savings from AI.
Tackle the trend
Assess your existing reports and dashboards to identify opportunities for more data-driven insights. Consider where AI tools might be most profitably deployed.
Trend #4 Virtual Care Gets Traction.
Virtual care, which connects plan members to physicians or allied practitioners for online care and advice, will become much more mainstream and broader in its impact.
The concept is already proven to reduce costs and increase timely access to care, and two-thirds of employees say they would use virtual care if offered. While just nine per cent of Canadian plan sponsors currently include virtual care, we expect that number to increase rapidly, both because it reduces costs and it may be an attractive recruitment offer in today’s tight labour market.
Already we are seeing virtual care models that include access to pharmacists, nurses and dieticians who can offer health coaching by phone or video link, and there is encouraging data about the impact on chronic disease management. In addition to improving patient outcomes, virtual care may also improve collaboration among care team members around discharge planning and case management.
Tackle the trend
Evaluate how virtual care can work for your clients or plan members. Consider a trial for this year to test it out.
Trend #5 Pharmacogenetics goes mainstream.
Using a patient’s genetic information to customize treatment options, also known as pharmacogenetics, has been tested for the past couple of years with encouraging results, particularly in mental wellness outcomes.
As more insurers and healthcare providers test pharmacogenetics, we are seeing costs decline, while turnaround times improve. Physicians are eager for technology that will allow them to easily adopt this approach, and a number of private payors are investigating how best to incorporate it.
Tackle the trend
Plan sponsors and insurers should take some time this year to dive deeply into pharmacogenetics to understand the cost reduction and outcome implications for your organization.
Trend #6 New approaches to fraud prevention.
While AI improves processing and plan member experience, we will also see it turned loose on the problem of fraud. Between two and ten percent of all life and health insurance claims in Canada are fraudulent and it’s costing employers, carriers and employees billions.
Using machine learning, it will become much easier to analyze large datasets to detect unusual patterns that may indicate fraudulent activity. By flagging anomalies with AI, staff time can be focused less on data analysis and more on investigating suspicious claims and working on prevention strategies. Even more encouraging will be the predictive capabilities of these tools to accurately identify areas of potential vulnerability for fraud. We will continue to see insurers working together to share data and ideas for the ongoing battle against fraud.
Tackle the trend
Work with your data science team to pilot some AI solutions as part of your fraud detection strategy. Employers should continue to encourage employees to speak up when they suspect fraudulent activities.
The next 12 months offer many exciting opportunities for the health benefits industry to leverage the power of technology to reduce costs and improve health outcomes for Canadians.
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 Gartner identifies the top 10 strategic technology trends for 2020
 Paycom publishes eight key findings about employee self-service technology
 TELUS What’s app in health and wellness
 TELUS Medication adherence and productivity: summary of research findings
 Anxiety and Depression Association of America ADAA Reviewed Mental Health Apps
 Canadian Underwriter This technology predicted to save insurers $1.3-billion a year on claims administration
 TELUS 3 ways virtual care gives employers a competitive advantage
 TELUS Data mining and information sharing: two essential tools to stop insurance fraud and abuse
 Emerj AI for health insurance fraud detection – current applications