• The high – and rising – cost of healthcare has prompted the rise of new models of health insurance.
  • Whether new health insurers organize health insurance around new technologies, medical expertise, or cost transparency, their ultimate success will be determined by their ability to push patients towards healthful lifestyles.

A new generation of health insurance tech companies promises to leverage AI and machine learning to incentivize optimal preventive/therapeutic pathways, using providers that deliver best outcomes at lowest cost.

For example, Bind is a U.S. insurance tech player partnering with United HealthCare to access medical history and claims data of members as well as referral patterns, procedure costs, and outcome metrics on providers. Based on its proprietary analytical methods, Bind predicts what care a patient is likely to need and designs a “core” coverage plan with the option for on-demand “add-ons.” Premiums are kept low because members buy core coverage suited to their needs and can add further options as health conditions change. Bind also provides transparency on treatment options and pricing to help members chose their setting of care. By designing copays to incentivize the use of the most effective and lowest cost options, Bind hopes to bring down the overall system costs.

Another U.S. startup Centivo is trying to use AI-powered data analytics to steer health systems towards the three principles of efficiency: prevention, standardization, and incentivization. Members are rewarded for adhering to a health action plan (monitored through wearables and apps), supported by a state-of-the-art digital platform and dedicated concierge team. Centivo does not impose deductibles if members coordinate all their healthcare through a preferred primary care provider. This prevents unnecessary treatments and guides members to the best value-for-money setting of care for acute conditions requiring specialist treatment.

While both Bind and Centivo have attuned their business models to the U.S. market, governments in nationalized health systems and consumers in self-pay systems can make use of the same functionalities to reward people for healthy lifestyles, drive traffic to providers of cost-effective, high-quality care, and promote price transparency and choice.

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