IT Modernization, The Key to Success in the Private Health Plan Market in Brazil

Brazil has undergone significant political, economic, and demographic changes over the years, and today faces historic transformation with regard to its healthcare system. While Brazilians have free access to healthcare through a public system – the Unified Health System or the Sistema Único de Saúde – the private healthcare system is growing at a rapid pace.

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today’s post:

Individuals are increasingly seeking care in the private sector. Over the next few years, Brazil expects that more than 20 million additional individuals will purchase insurance through a private health plan, bringing the total number of participants in the private system to more than 75 million. This projected growth presents significant opportunity for private health plans, but are they ready?

Brazil’s budding economy, up-and-coming middle class, and progressive policies toward managed care make it a high-growth market, and the public system is struggling to keep pace. The private system, by and large, operates much more efficiently, with shorter waits and quality care. As the population becomes wealthier as the result of economic growth, more Brazilians – approximately 55 million individuals totaling a quarter of the population − are choosing to enter the private healthcare system.

The influx into the private healthcare system opens significant opportunity for Brazil’s health plans. It also presents several challenges:

  • Healthcare payers must deal with regulatory and contractual complexities that are unique to the sector, such as waiting period requirements, co-pays, and the negotiation of in-network versus out-of-network agreements.
  • They must also have the scalability required to process a much higher volume of claims than in life and P&C lines of business.
  • Healthcare payers can expect to handle dozens of claims per member, adding up to tens of millions of claims annually, and they must do so rapidly and cost effectively.
  • Processing these large volumes of transactions can place tremendous strains on payers who continue to adhere to manually intensive systems.

Healthcare payers – which for the most part employ decades-old core technology – have limited business process scalability in a fast growing market, and struggle to keep pace with change. Payers seek greater agility to address their specific business requirements and adapt in real time to ever-shifting market conditions.

By consolidating legacy systems onto a single health insurance-specific platform, payers can support core business processes and emerging opportunities in the private sector, while establishing critical flexibility in their IT infrastructure that increases visibility, reduces operational costs, and drives innovation within the business.

For this reason, Brazilian payers need flexibility as a central IT platform design component. They require applications that support core business processes in Brazil’s increasingly blended public and private systems, in which people may choose a private plan as a supplement to, or in lieu of, public insurance – ultimately supporting business innovation and rapid growth.

Payers need to do three things to be successful:

  • Get Agile - Invest in an IT infrastructure that can respond to the rapidly changing market
  • Amplify Business Intelligence - Business intelligence and analytics will make the difference for payers. It will aid in determining risk, provider effectiveness, fraud, market trends and more
  • Help Members Help Themselves - Employ self service options that make it easy for members to sign up, pay premiums, obtain information

While Brazilian healthcare payers’ challenges are complex as they seek opportunities in a growing market, they are not unique. Oracle Health Insurance is focused on helping healthcare payers around the world with their modernization challenges by providing applications that support payers’ business processes, enabling them to implement changes and provide consumers with tailor-made products while using uniform administrative processing.

Learn more by reading the strategy brief, Prescription for a Healthier Tomorrow: Considerations for Health Plan IT Modernization in Brazil.

The Oracle Health Insurance suite of applications have proven their scalability at customers with sizes ranging from 100,000 to 4,200,000 members (with approximately 10 million product enrollments) in a single instance. In addition, Oracle offers engineered systems or hardware, software, and storage tuned to address specific health insurance challenges including high availability, performance, and scalability.

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