New thinking in private health insurance: health platform instead of service catalogue

Expectations of private health insurance have changed radically: today's policyholders want more than just reimbursement; they want support. Preferably digital, simple and personal. Traditional private health insurance offerings are coming under increasing pressure because they fail to meet the desire for a genuine health companion. But this is precisely where a great opportunity lies: insurers who focus on holistic health platforms at an early stage will be able to differentiate themselves in the long term.

From cost reimburser to health companion: a paradigm shift

Imagine you receive a medical diagnosis and need a therapy recommendation quickly. But instead of support, you encounter bureaucracy: submitting invoices, waiting for reimbursement, clarifying queries. Many privately insured people are familiar with this scenario. And this despite the fact that private health insurance claims to offer premium care.

Today's insured people expect more than just reimbursement of costs. They want to communicate digitally and easily, resolve issues independently via an app or portal, and receive personal support in complex cases such as chronic illnesses or the provision of medical aids.

But this is precisely where the problem often lies: while statutory health insurance companies are obliged to provide technical access to services such as e-prescriptions and ePA, many private health insurance providers fall short of these standards. Although doctors issue prescriptions, digital access is largely lacking. This is a damning indictment of premium care.

Even everyday processes such as submitting invoices often appear opaque: How long does reimbursement take? Will the costs of a specialised clinic be covered? Such uncertainties cause frustration among insured persons.

But this is also where an opportunity lies: those who create hybrid solutions, i.e. combine digital services with personal support, can significantly improve the customer experience. Especially in the case of complex treatments or chronic illnesses, well-managed processes not only enable better care, but also efficiency gains.

And the market? It is in flux. Noticeable differences are emerging between private health insurers in terms of digital offerings, service quality and accessibility. Those who fail to position themselves clearly here risk falling behind. The key is to offer real added value: through smart services, active health support and the feeling of being in good hands, not only when you are ill, but every day.

The health platform as a solution

What does a modern health platform need to offer? From the perspective of insured persons, one thing above all else: an overview and support in one central location. No scattered services, no searching through third-party apps, but rather a central digital home for health-related topics. This is precisely what creates trust and makes everyday life easier.

An intelligent platform can do much more than just digitise invoices. It offers digital services such as electronic patient records (ePA), doctor search, appointment scheduling and advice on medical aids, and combines these with personalised support. Case management is key to this.

Various private health insurers (such as Signal Iduna and Inter) already offer case management for certain conditions. This model can be further developed through digital and AI-supported approaches. Automated programme invitations could be sent as soon as a relevant case is reported, for example after a diagnosis or hospital admission. The platform then actively contacts the insured person, informs them about suitable offers and presents them with treatment options.

AI could, for example, recommend specialists, suggest suitable clinics or provide training plans to support the recovery process. This would always be combined with personal support, which is particularly helpful in the case of complex illnesses.

It is important that everything works in a hybrid way. Many insured persons want to start with digital services, but also want to speak to a real person if necessary. It is this combination of smart services and human contact that makes a healthcare platform truly valuable.

How insured persons and insurers benefit

An intelligent health platform not only improves service, it can also manage care in a targeted manner and reduce costs. For example, through close monitoring of chronically ill people to identify complications at an early stage and avoid hospital stays. Or through cooperation partners who provide aids and consumables reliably and at low cost.

From the insured's perspective, too, there are many positive changes: instead of hotline queues or unclear responsibilities, the platform provides a direct line to the insurance company, ideally via modern, asynchronous communication similar to WhatsApp. This allows issues to be clarified when it suits the insured. This feature is particularly helpful for insured persons with busy professional and family lives.

Digital case management ensures that insured persons receive the right information, such as recommendations or contact persons: from clinic selection and individual reminders to understandable support with questions about billing, approvals or medical reports. The insurer knows where the insured person stands at all times and can provide active support.

Prevention also becomes an integral part of the service: those who participate in health programmes can receive premium discounts, digital check-ups or exclusive services, for example. Rewards instead of lectures. The result is a healthcare offering that motivates rather than overwhelms.

The outcome: better care, stronger customer loyalty and less friction.

How adesso supports private health insurance providers in their transformation

The concept of a digital health platform offers great potential, but its implementation is complex. This is exactly where adesso adds real value for private health insurers with its in-depth industry knowledge, methodical consulting and state-of-the-art technology.

Our team combines strategy consulting, UX/UI design, software development and AI and analytics expertise under one roof.

What makes us particularly valuable is that many of our colleagues have worked in private health insurance themselves. They are familiar with the internal processes, regulatory requirements and, above all, the practical challenges. This means we not only understand the needs, but also the internal hurdles that often stand in the way of implementation.

A typical example: many insurers have well-thought-out ideas and a deep understanding of what their policyholders need. What is often missing is the appropriate technological infrastructure or the methodological tools to implement these ideas efficiently, in a user-centric and scalable manner. This is exactly where we come in. With a combination of technological expertise and industry know-how, we quickly turn concepts into tangible solutions.

Data protection and acceptance are key issues here: if you want to motivate insured persons to share health data, you have to create clear added value and trust. This can be achieved through transparency, simple language and personalised offers. We also provide technical support for integrating new solutions into existing system landscapes without rebuilding everything from scratch, but with a clear focus on user experience and scalability.

The first steps can be taken in a compact interaction format: working together to find out what vision is being pursued, which use cases are relevant and how these can be turned into a concrete plan.

Outlook and invitation to dialogue

Digital health platforms are more than just a technological trend. They can significantly improve care, make processes more efficient and offer insured persons genuine guidance. When digital solutions and personal support are combined in a meaningful way, both sides benefit: optimised treatment processes on the one hand and cost transparency and customer loyalty on the other.

The challenge remains: how can we build trust in data-driven systems while protecting sensitive health information? And how can these new services be seamlessly integrated into existing structures without overwhelming insured persons?

At adesso, we not only support you in developing individual platform strategies, but also in their concrete implementation.

From tailor-made solutions to white label offerings. Together with you, we develop solutions that offer insured persons real added value and help private health insurers strengthen their role as healthcare partners.

You have a vision – we provide the blueprint. Let's talk!

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