Before talking about the challenges in supplementary healthcare for the coming years, it is worth highlighting that in August 2022, the number of beneficiaries of medical and hospital plans totaled 49.9 million. The announcement was made at the beginning of November by the National Supplementary Health Agency (ANS) and showed an increase of approximately 1.58 million beneficiaries in medical and hospital plans, compared to August 2021, the equivalent of a 3.27% increase.
The number is the highest since 2015, when the sector had 50.1 million customers. In exclusively dental plans, the number of beneficiaries reached 30.4 million, with an increase of 2.3 million beneficiaries compared to August 2021 – which represents 8.33% of growth in the period.
This is a positive scenario, considering that with the pandemic and economic crisis, Brazilian health plans have been put to the test in the last 2 years. Even so, the supplementary health sector has been managing, little by little, to grow and increase its customer base.
From what some market studies indicate, the next few years should also be challenging. And since the best way to deal with problems and challenges is by mapping them, we did exactly that in this post. Continue reading until the end to learn about the main challenges in supplementary healthcare for the coming years and start now to prepare yourself to face them.
Main challenges in supplementary healthcare:
1 – Population aging.
According to a survey by the Institute for Applied Economic Research (Ipea) released in October 2021, the change in the age structure in Brazil is “inevitable”. In 2010, the country had 194.7 million people. In the strictest scenario analyzed, by 2100 this number could decrease to 156.4 million. Furthermore, in the same period of 90 years, the proportion of elderly people could increase from 7.3% to 40.3%. The percentage of children and adolescents up to 15 years of age may fall from 24.7% to 9%.
Given this scenario, the aging of the population is a major challenge, because health plans will need to deal with more elderly patients, which in practice means more beneficiaries with chronic illnesses needing continuous care.
One way to minimize the problems arising from this challenge is by investing in awareness campaigns the importance of prevention and well-being, encouraging all customers to take good care of their health by continually carrying out preventive exams and acquiring healthy habits.
2 – (Dis)accredited professionals
Health plans depend on accredited doctors so that they can satisfactorily serve beneficiaries. The list of accredited individuals also helps guide the contracting of plans – especially with regard to individual plans. In this way, the disqualification of professionals damages the reputation of operators and helps to distance beneficiaries. Service restrictions coming from accredited professionals themselves – such as consultations and exams in specific months, days or times – also compromise the service provided.
Accreditation takes place through a partnership contract between healthcare service providers (clinics, hospitals, medical offices and laboratories) and healthcare operators/insurers. health insurance. The contract is of mutual consent and can be revoked by reciprocal or unilateral decision. If there is no longer any advantage or there is any dissatisfaction with maintaining the service provision, the contract may be terminated or recombined. A factor that can lead to the breakdown of the partnership is the delay or lack of payment by the operator/insurer or even slow service times on the part of the referenced party. In this case, the clinic, laboratory or doctor can cancel the agreement, as can the person paying for the service.
It is necessary to think and act to keep your healthcare provider's accredited network attractive in order to gain and maintain customers.
3- Cost of new technologies
With each new technology incorporated into the ANS' mandatory minimum coverage, health plan operators' expenses increase. This is one of the biggest challenges facing supplementary healthcare in the coming years.
Many treatments, such as immunotherapy, or more modern tests, are high-cost because they require a large investment from laboratories to carry out. Some have current patents, which means a monopoly on the medication. Imported items are also expensive due to the exchange rate.
A way of deal with this increase in expenses is to implement a medical audit system. With a series of automated medical bill audit routines, your healthcare provider protects itself from possible fraud, reduces disallowances by up to 95% and significantly reduces healthcare costs in the first few months of use.
Read too: Check out the 4 technologies incorporated into the ANS List
4 – Increase in inflation
The rise in inflation, as well as the impact of the crisis on family budgets, poses major challenges. Among them is the loss of purchasing power of Brazilians who, increasingly, leave their accounts closed and choose to eliminate unnecessary expenses. Therefore, it is extremely important to keep the level of customer satisfaction high, so that a satisfactory commitment can be achieved. This can be achieved by improving processes and strengthening loyalty strategies.
The consequence of high inflation also reflects the increase in costs with purchasing materials. Highly complex procedures require the acquisition of OPME materials, which can compromise (a lot) the budget. And when these materials are purchased without any real indication of their use, the costs can be even higher. The lack of control and process audit purchasing these materials becomes one of the main obstacles in the management and control of health plan expenses.
To minimize impacts on the budget, it is necessary to improve control and process audit. In this sense, managing high costs becomes necessary for the sustainability of operators in the market.
5 – Use of data
The application of Big Data on your operator must be within what is required by the General Data Protection Law (LGPD).
This law was created to protect data that is collected, stored and used by institutions, regardless of the sector.
It requires companies, including operators, to be transparent with the data handling process that collects, the way they are manipulated and that patients and users are consented at all times.
We talk about LGPD and how operators can adapt to them in this post.
Therefore, data mapping, identifying input forms, purposes, policies and procedures, must be adapted to this law to guarantee the viability of technological evolution within the operator, making it a huge challenge for managers to get the best of both worlds. (benefits that technology generates versus regulation of laws).
6 – Investment in preventive medicine
Among the main challenges of supplementary healthcare is increasing the role of primary attention in health plans. And this could bring countless benefits to the sector.
It is primary care that organizes health care in a way that meets the needs of citizens. This means that care is not so much focused on the disease as on the patient. Thus, greater control of healthcare costs can reduce waste linked to unnecessary treatments, exams and procedures that currently occur.
Primary care is also responsible for disseminating information and guidance on disease prevention and health promotion, in addition to referring more serious and specific cases to more specialized care.
In relation to preventive medicine, operators must invest more in comprehensive actions with the aim of promoting the health and well-being of beneficiaries in a comprehensive manner, preventing diseases. To do this, the epidemiological data available from users can be used as a basis.
A Preventative medicine also usually works based on the early discovery of diseases. This is possible due to the technological resources available for diagnoses, such as modern exams for varying degrees of complexity and genetic medicine techniques. This way, it is possible to identify diseases early on, even before symptoms appear. Most health problems are more likely to be cured or leave fewer consequences when identified in the early stages.
As a result, in addition to savings for health plans in the medium and long term, patients can also benefit greatly. They are less likely to get sick and require hospitalization. They can also have a better quality of life, with targeted and qualified support.
7 – Total transparency
Finally, the relationship with suppliers and other service providers also exemplifies a challenge for supplementary healthcare in the current context. Maintaining good partnerships, based on quality and transparency, is essential to ensure good patient care, with innovation in healthcare and fair prices.
Prepare your healthcare provider to face these and other challenges!
A smart and practical way to protect your health plan provider and prepare it to face all these and other challenges is to implement a good medical bill audit software. A true ally, which helps the entire team to optimize processes, reduce unnecessary costs, mitigate losses and also ensure the best personalization of the services offered. There are several solutions available, but only one is the most awarded and requested by the largest Brazilian operators, the SAUDI – A medical audit system that assists the entire management and cost control process, capable of optimizing the audit process and ensuring a better allocation of resources.
Another very important point is being able to centralize information in one place, unify the patient journey and standardize processes. In this way, it becomes extremely viable to collect strategic indicators and check non-conformities in health management. In this scenario, for the competitive operator, it means having success in the work of managers in the health area, which in turn provides service optimization, improvements in the care offered to patients and, consequently, growth in the operator's reputation.
Therefore, knowing the challenges facing the sector and the tools capable of solving the pain is an essential task for efficient health management. It is also necessary to be aware of the best solutions to guarantee the sustainability and success of the business in the market. Count on SAUDI on the journey towards the success of your operator!
