According to the World Health Organisation the biggest issue globally in health care is non-communicable diseases (NCDs) such as cardiovascular diseases (i.e. heart attacks and stroke), cancers, chronic respiratory diseases (i.e. chronic obstructive pulmonary disease and asthma), and diabetes. These diseases cause 70 percent of deaths worldwide and it is estimated the cost to fight these diseases will surge to $47 trillion by 2030 (WEF).
Studies have shown that there are factors such as lifestyle, genetics, social circumstances, medical care and environmental exposure that can directly impact the prevention of NCDs. Lifestyle changes has the largest impact of all these factors, representing 40 percent of the impact (Source: Mcinnis et ai (2002). The Case For More Active Policy Attention To Health Promotion. Health Affairs, 21 (2): 78-93).
Ultimately, citizens’ health is at stake. But the impact of NCDs is not one dimensional. NCDs effect the cost of healthcare. And, the medical claims’ burden associated to NCDs is an astronomical number that has a large impact on financial reserves. These reserves could be used for further research and/or to help fight these diseases vs. being used to pay to treat them.
If one thinks about how healthcare plans currently work, the insurer calculates insurance premiums for the insured using a set formula based on historical data collected by the actuaries.
A new approach to healthcare
Oracle and dacadoo take a different approach to healthcare and insurance. The tech companies are collaborating to help healthcare insurers provide their insured an opt-in tool that uses data to encourage them to get into a preventative health program. dacadoo uses the 300 million person years of clinical data (data collected during medical trials and/or patient care during a formal clinical trial program) to calculate accurately a person’s HealthScore. The HealthScore, which has 98 percent accuracy, is a representation of the person’s health on a scale of 0 to 1000. This HealthScore can be calculated with a minimum set of data and then more accurately calculated when more data points are provided. Once the HealthScore is calculated dacadoo’s platform then engages the person to improve on their HealthScore through gamification, social networking and direct feedback on any activity. For example, a division in a company could challenge all other divisions for some fitness or sleep challenges and even quizzes about nutrition. Coaching is used to assist people in areas in which they may need assistance such as nutrition, mental health or fitness. The HealthScore may also indicate if the person has a health factor that is a danger to their health such as a probability of developing Type 2 Diabetes and in this case, a “triage” is activated to address immediately the issue. This triage approach hopefully prevents the person from developing the disease, and saves the health care cost associated with any treatment that might have occurred.
Through the dacadoo platform a person is engaged on a continual basis to ensure health improvement is an active goal. By the person becoming healthier, or staying healthy, the reduction in potential medical treatment and claims is a direct benefit.
Oracle Health Insurance is integrated with the dacadoo platform for enrollment, insurance premium calculation and repricing if needed, and claims calculation across diseases – which is then directly correlated against the dacadoo HealthScore. This allows the health insurer or “payor” to get direct insight into the effectiveness of the HealthScore on various disease groupings, highlights the claims expense savings and allows for improved business alignment for interventions on diseases which in turn impacts the specific claims categories. The savings realized through this process can then be redistributed to the insured or used for investment purposes to reduce claims reserves.
There direct benefits for both the insured and the insurers are clear.
The insured have better health, a longer lifespan and in some cases additional health-plan benefits, depending on the reward system introduced by the health insurer or payor. For the health insurers or payors, they can reduce the cost of claims, be more profitable and provide better health plans for the insured.
But the greatest potential benefit is bigger than those combined – a healthier global population.
Visit oracle.com/healthinsurance to learn more about Oracle’s modern, innovative technology for core health insurance administration, either on-premise or in the cloud.