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CEO Insights: Personalized Health Insurance Is Coming

In the face of major challenges over the past year, the health care industry mobilized and adapted quickly. But what’s next?

In a recent interview, Eugene Sayan of Softheon, a private exchange technology provider, sat down with Oliver Wyman partner, Martin Graf, to discuss the possibilities of where the industry may be headed in the next five to 10 years.

Eugene emphasized that consumer empowerment coupled with data aggregation will shift how consumers access care: “Rather than building products for masses, I think we’re going to start seeing products finding their consumers through careful curation.”

Key Insights

On the influence of AI in health care:

“I think we are a few years away from true transformation. … We are seeing an unsupervised learning or deep learning being deployed more on the care aspect [whether that’s in] oncology, pharmaceutical, topography, demography. … We see AI becoming the deep learning AI. … It’s ultimately a computational algorithm detecting an anomaly, for instance, in X-rays or MRI/CAT scans.

On the administration side, we don’t believe there’s going to be a lot of room for true disruptive AI other than automation. … In a nutshell, the administration side is going to be going down the path of supervised learning … [on] the care side the unsupervised learning or deep learning could truly change how the care is delivered, measured and enhanced.”

On the shortcomings of health insurance:

“The biggest problem or opportunity for health care is that … health care has to get out of this two-transaction business — that is enrollment and claims and nothing in between. … Every invoice is a tool — is a communication opportunity — with that individual.”

On the future of health insurance:

“We’re going to start seeing more and more personalization of health care. There’s a great opportunity to break down this macroeconomy around health care under the pillars of Medicaid, Medicare, the marketplace and commercial. What we’re going to start to see is consumers, individuals, empowerment taking so many different shapes.

My personal prophecy is that within five to 10 years, we’re going to have one umbrella policy. … Under there, you’re going to have health insurance for your elderly mom and dad … your wife may have a slightly different version of a policy.”

On the personalization of health plans:

“Conventional wisdom is being challenged through these micro plans. [I came across] a recent health plan focusing on the LGBTQ community — so health plans custom tailored for that particular population.

As we get into the genomics aspect of it, I think we’re going to start picking up different trends. I am a Middle Eastern Turkish descendent. I am sure that somewhere in my genealogy I have some mutations that are going to cause me and people with my background to develop certain diseases, and I can see, within 5-10 years, some insurance company [says] ‘hey Turkish people … I know exactly what you’re going to go through’ and I have this special program that is catered for me.

Rather than building products for masses, I think we’re going to start seeing that products are finding their consumers through curation [and] reaching out to individuals.”

Martin Graf

Partner, Health and Life Sciences at Oliver Wyman

With a background in aeronautics and a Ph.D. in mechanical engineering, Martin is a former rocket scientist.

Today, Martin works with health insurers and providers to improve their strategy and operations. He has 20 years of executive-level leadership and management consulting experience in health care and has worked with many of the largest players in the industry. He’s directly improved their businesses, and he focuses on driving major transformations.

Eugene Sayan

Founder and CEO of Softheon

Since 2000, Eugene has led Softheon in its mission to develop innovative solutions for health care payers, providers and government agencies. Prior to Softheon, Eugene led big data and process management initiatives for Fortune 1000 companies at IBM.

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