Health Advisory, Analytics and Technology Solutions

We help health insurers to:

• Segment their customer base to understand attractive profit pools in the market and identify untapped subsegments
• Better understand the profitability and lifetime value of their customers
• Develop and optimise propositions and products targeted at attractive market segments and subsegments
• Predict lapse with greater accuracy, stratify customers according to value and proactively intervene to minimise lapse risk

We equip health insurance pricing and underwriting teams with:

• Advanced predictive analytics that deliver more accurate risk assessment, deeper customer insights and sharper risk segmentation
• Real-time scenario testing to understand financial impact and make quicker decisions
• Integrated end-to-end pricing and underwriting platforms that cut manual work and improve accuracy
• Powerful rating engines that deliver fast rating deployment using modern cloud technology
• Strong governance with full auditability and clear approval workflows

We help healthcare payors to:

• Identify, monitor and address emerging claims inflation trends using predictive analytics
• Understand variation in provider performance and value
• Strengthen reimbursement, contracting and preferred-provider strategies
• Transition funding models from fee for service to activity-based funding to value-based healthcare

We have a comprehensive end-to-end solution encompassing hypotheses development, clustering, real-time prevention and retrospective detection, and levers to prevent and recover. This enables detection of anomalies sooner, enabling healthcare payors to reduce financial leakage by strengthening governance and claims management more effectively. From identifying suspicious activity, developing models to uncover the underlying drivers of fraud, waste, error and abuse, to analysing variations in member, provider and treatment patterns, we flag triggers for early intervention and action.

We help healthcare payors to:

• Identify population health risks and intervention opportunities
• Model propensity for hospitalisation
• Identify gaps in care
• Proactively prompt health actions and recommendations
• Identify and refer to prevention and care management programmes

We help health insurers with:

• Operational efficiency initiatives
• Direct selling cost management
• Broker and aggregator cost management
• Data and coding strategy and operations
• Claims operations efficiency
• Back-office functions

From supporting granular reserving and stress testing, to refining capital frameworks and board and regulator communication, WTW’s health sector specialists help insurers improve compliance, control and long-term strategic planning.

We assess the impact of structural reforms, pricing controls, incentives and new purchasing models. Our teams combine deep health system expertise with advanced data modelling to show what will work, what it will cost and how it will improve outcomes. Our health experts provide clear evidence, practical recommendations and actionable insights that help decision makers build stronger, more sustainable health systems.