Maybe Even Diabetes Can Be Insured

The World Health Organization has published a five-year strategic plan focused on 10 major threats to global health in 2019, among which there are noncommunicable diseases, such as diabetes, cancer and heart disease - collectively responsible for over 70% of all deaths worldwide. Through the plan, the WHO wants to try to ensure that 1 billion more people will benefit from access to universal health coverage, 1 billion more people are protected from health emergencies and 1 billion more people enjoy better health and well-being. It’s a very optimistic goal, and different types of solutions are required; all means available should be employed. Where do insurers come in? They are part of the healthcare system and could do more to contribute to global health. Though it may seem perhaps altruistic to associate insurers with such a noble scope, the reality is that they, insurers, would also benefit. Forward-looking companies have understood this opportunity, so there are examples of insurers that have started to use the “Insurer as Partner” approach, which implies an active role in prevention rather than just being reactive and paying claims when an undesirable event occurs. This new potential role of the insurer has been made possible, in great part, by what we now call “connected insurance,” which encompasses IoT (Internet of Things), wearables and other monitoring devices. The re-shaping of the insurance industry has already begun, and it will continue based on new technologies. Connected health insurance can become profitable for insurers as it allows measurement of the risk for a specific client and thus allows the presentation of an improved, better-priced value proposition that may also improve general health. The insurance company can’t possibly make it on its own and will have to seek partners from both the technological innovation sphere and medical providers, keeping in mind that its role in the health system is changing from “payer” to “pivot.” Discovery’s Vitality Program To better grasp the actual benefits for clients and not just for insurers that adopt such an innovative approach, let's look at the South African insurance player Discovery, which can be considered the benchmark when it comes to engaging members and improving their quality of life. Its Vitality program has created a system that not only raises the loyalty of customers but improves their lifestyle and overall health. Discovery’s Vitality uses an "early warning" mechanism that can anticipate serious health problems and more expensive claims. It does so by using connected devices like the smartwatch. According to Discovery, Vitality Gold status members with heart disease have 41% lower risk claims than members with no Vitality membership. Vitality Gold members living with diabetes have 50% lower risk claims. See also: Security of Medical Devices Needs Care   Another claim coming from a presentation by Discovery Vitality at DIA Amsterdam 2018 deserves our attention: There is an 18% reduction of hospital and chronic claim costs for the batch of Vitality members who use the Vitality Active Rewards (VAR) alongside the Apple Watch, compared with the group of insured who do not use an Apple Watch. VAR is a smartphone application based on fitness points, which is designed to encourage Vitality members to increase their activity by setting weekly personalized physical activity goals - and then rewarding users for achieving them. (Discovery specifies that its data is based on a cross-sectional view of the relative claims experience, and it is premature to show the improvement over time given the lower frequency of health claim events.) Discovery says that Apple Watch owners enrolled in the program are 35% more active than prior to getting the watch. Since the VAR system was launched, there has been a 24% increase in physical-activity days and a 9% increase in meeting higher exercise targets. The data is telling, and the implications for ensuring healthy lives and promoting wellbeing are significant. Seen from this point of view, the transition to a “prevention-centered” approach is a pragmatic decision for insurers because, in time, the portfolio tends to change its structure, passing from a majority of “sick” clients to a majority of relatively “in good health” clients. ICS Maugeri’s Mosaic case study Let’s look now at a more specific issue within the spectrum of uninsurable diseases, that is diabetes. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. In 2014, 8,5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct cause of 1,6 million deaths, and in 2012 high blood glucose was the cause of another 2,2 million deaths. It is estimated that the number of diabetic patients worldwide will be 629 million by 2045. Diabetic patients have a high risk to develop severe complications generated by the evolution of the pathology, such as peripheral neuropathy, retinopathy, nephropathy and cardiovascular diseases. It is well-known that insurers either do not cover diabetic patients or, if they do, require a high premium. This is due to the difficulty to measure the probability of the occurrence of risks associated with these clients. Therefore, the insurance sector is leaving uncovered a market that is becoming more and more relevant. ICS Maugeri, a major group of hospitals specializing in rehabilitation medicine, has developed, in partnership with the University of Pavia, an instrument called Mosaic aimed at improving the clinical management of patients affected by diabetes mellitus type 2 (T2DM) that can calculate the risk of developing complications in different time scenarios. Mosaic uses AI and machine learning that is based on algorithms able to learn patterns and decision rules from data. Based on the results expressed in one of their published research papers, the team has been able “to predict the onset of complications (retinopathy, neuropathy, nephropathy) at different time scenarios: at three, five and seven years from the first visit. The final models are thus able to provide up to 84% accuracy in predicting the probability for a diabetic to develop the three main complications and are easy to apply in clinical practice. In insurers’ terms, this shows that risk associated with diabetes can be estimated; furthermore, given that clinical evidences show that a proper management of the diabetic patient (intensive pharmacological treatment etc.) can lead to a significant reduction in the possibility of developing complications, the risk itself can be managed and reduced. The question is: How can insurers make sure that diabetic patients follow the required therapeutic path? It’s a difficult job. Diabetic patients are required to follow a rigorous clinical, diagnostic and therapeutic path to manage and control their pathology and try to limit or slow the consequences of this chronic disease. This path involves periodic medical checks and diagnostic tests as well as continuous and intensive drug therapies, requiring significant effort for patients and their caregivers. Most of the time, the scheduling of such periodic checks must be autonomously managed by the patient, resulting in a progressive reduction of adherence to the required clinical paths. Within the Mosaic project, the patient is monitored with the help of wearables and telemedicine; this allows the team to (i) personalize and update pharmacological treatments, (ii) identify and update the diagnostic path to be performed to monitor and reduce the risk of complications and (iii) identify on-time criticalities that may require timely investigations. Therefore, this approach allows a significant risk control and, potentially, risk reduction, allowing the insurer to update the premium yearly. See also: An Easy Way Forward on Health Costs   How do Discovery Vitality and Mosaic fit in together? Discovery Vitality uses gamification, reward systems and tracking devices to steer clients toward a healthier life style. Imagine if Vitality would be integrated with Mosaic’s technology for diabetes patients. This would mean that suddenly diabetics would become insurable, and the client base would increase. Vitality has already proven that a reward-based system can help improve behavior, so probably it would also work as an additional incentive for diabetics in keeping them effectively engaged with their prescribed treatment. Taking for granted that diabetics will follow a program step by step and change their behavior toward a desired goal is not something anyone should do. Even if the real stake for diabetics is their own life expectancy, which should be motivation enough, the reward element could be a good and fun extra incentive for reaching health goals. As estimated costs with lifestyle-related conditions (including diabetes) will be 47 trillion by 2030, insurers, the healthcare systems, clinical providers and patients could all benefit in some way from such a program. We would like to see this implemented in the short term at a larger scale than the test made by Mosaic, and it would also be interesting to look at how this approach could be extended to other chronic diseases. Article based on the chapter written by Andrea Silvello and Alessandro Procaccini, “Connected Insurance Reshaping the Health Insurance Industry,” Smart Healthcare, Intechopen, 2019, DOI: 10.5772/intechopen.85123.