Tips to generate revenue in Payer Industry

Tips to generate revenue in Payer Industry

Regulating a revenue for an industry is not a cake walk job as each of the industry has its own advantages and disadvantages. An organisation’s revenue is based on various decisions that it makes. Informed decisions can be made based on how effective data is stored and used. There are platforms that can help making informed decision in an industry. Underwriting contributes a significant portion to an organisations revenue and it is a typical process that happens in every insurance industry and healthcare is not an exception.

 

Below are the few basic parameters contributing to underwriting factors in Payer Industry,

  • The Group Size – Larger the size of the group with similar kind of members, greater the costs spent.
  • The Group’s Composition – The group should consists of people from varying age group, gender, geographies to keep the costs spent low.
  • Level of Participation – Population heath plan tries to keep people of diversified factors engaged in insurance plans, to reduce the costs spent. Traditional group health insurance is designed and priced based on the premise that most members of the group will participate in the group insurance plan and only a few avail the policy claims.
  • Level of Benefits – Benefits based on the insurer’s choice and dependant group plan member’s health considerations based on associated risks. Members do not make decisions on benefit limits.
  • Occupational Hazard – Certain occupation might be hazardous to health. Many Insured from the similar kind of occupation might increase the costs of an insurance company. The members participating in group insurance policy should come from a diversified portfolio.
  • Geographic Location – Geographic location also plays an important role, few diseases might turn epidemic in certain geographic location and people in few geographic locations might have certain conditions due to weather conditions.

 

Having considering the challenges and data analysis, DMA (Disease Management Analytics) as a platform helps the underwriter in designing the revenue generation pattern in payer industry.  Payer can claim advantages from the outcome of the platform about an insured pre medical conditions and history. DMA considers family history, previous conditions, lifestyle habits, occupational effects of the policy holder. It also helps underwriter to make informed decisions in setting the premium costs and the expenditure spent on the policy holder, if he falls ill due to chronic conditions. An easy approach for Payer to attract lot of young age adults at a lower premium costs and whose probability of falling sick due to a chronic condition is very less. Disease Management Analytics being an AI enabled platform drives decision making not just for the providers but also for the payers.

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