The online consumer presents both an opportunity and threat for the typical health insurer. This document highlights the changing landscape in terms of consumer, B2B and technology trends. It discusses how health payors with a progressive e-commerce program can make the most of the emerging opportunity.

1. The eCommerce
Opportunity in Health Care
Insurer Best Practices
Sanjay Chatterjee

2. Payors- today’s realities
 Pressure on revenue drivers
 A zero-sum market for new members
 Member churn – poor economy, changing
demographics
 Price sensitivity in all market segments
 With limited relief on costs
 Cost of health care growing faster than economy
 New mandates and regulations to implement
 Silo systems, costly integrations, manual
processes
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© Sanjay Chatterjee, 2010

3. Online consumer (B2C) trends
 Seek
 140 million+ US online health information searchers and
surfers
 Buy
 Online comparison shoppers
 Transact and Engage
 Adoption of online service channels
 Health and wellness content consumption
 Deeper provider-consumer relationships
 Preventative net-initiatives
 Mediate: emerging net intermediaries
 Online brokers
 Content portals and communities
 Marketing, advertising and technology service provisers
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© Sanjay Chatterjee, 2010

4. Online B2B trends
 Use of web and voice e-channels for cost savings
 B2B self-serve gateways
 Inter-plan transactions
 Call avoidance
 Workflow automation
 Auto-adjudication
 Cost and security management
 Pharmacy authorization
 Employer portals essential to closing and doing
business
 PHR initiatives
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5. Online technology trends
 Highly scalable and flexible web services
 B2B trading gateways
 Personal health records
 Voice recognition technology
 Mobility
 eCRM and contact management
 Heterogeneous data management
 Cheaper, scalable infrastructure and development
 Robust and flexible user security management
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6. Online trends - opportunity or
threat?
 An opportunity for first movers and a threat for
laggards
 Net-savvy consumers use online in all facets of their lives
– they will expect and value emergence of online health
care services
 Net-savvy payors and intermediaries can gain share of
mind and wallet by listening to customers and looking to
be a key part of the online health care value chain
 A sound, dynamic, e-business strategy and roadmap
must be part of every payor’s corporate goals
 At 15% of GDP going to 25%, investment in the online
channel isn’t a luxury, it’s a necessity to compete and
grow
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Confidential: Sanjay Chatterje

7. Best practices for insurers
 Common online channels
 Unified approach to branding and services
 Cross constituent support
 Prospects, members, providers, brokers, employer-
administrators
 Requirements grounded in constituent research and
feedback
 Online solution capabilities
 Basics – shopping tools, enrollment, accounts, claims,
eligibility, billing and payments, etc.
 Advanced - e-Prescribing, care management, clinical
information, cost management tools, configurable products,
etc.
 Content and community – original, syndicated or partnered

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Confidential: Sanjay Chatterje

8. Best practices for insurers
 Governance
 Executive buy in and ongoing engagement with e-business
initiatives
 Grounded in business case framework in partnership with
finance
 Strong business sponsorship, possibly co-owned by IT and
Business
 Early adopter customer forum for feedback and validation
 Technology architecture
 Scalable design, infrastructure and cost management
 Tiered architecture to separate channel and business
transaction layers
 Open web services, trending towards services oriented
architectures
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9. THANK YOU
©Sanjay Chatterjee
Questions and feedback:
Sanjay Chatterjee
http://www.linkedin.com/in/chatterjeesanjay
chatterjeesanjay@yahoo.com

10. THANK YOU
©Sanjay Chatterjee
Questions and feedback:
Sanjay Chatterjee
http://www.linkedin.com/in/chatterjeesanjay
chatterjeesanjay@yahoo.com