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Impact Valuation of the French Health Reform

Sia Partners supports its clients in the valuation of the impacts in regards to the French health reform (100% Santé) by using the existing models, and by exploiting more complex models with the use of machine learning, notably to enhance predictive accuracy.

The Health sector is regularly subject to regulatory changes. Insurers must initially assess the impacts they can generate from their portfolio, make the best use of the available data, adapt their prices and their product range accordingly, and then finally make sure their contracts are compliant. Sia Partners supports its clients during these three fundamental stages, for all regulatory developments (responsible contracts, ANI, intra-annual cancellations, etc.):

Building a modeling database:

Reading and exploiting data from data centers is an extremely important step in modeling risk and predicting its evolution. This phase is divided into four parts.

1- From management data to a modeling database

Reconciliation of exposure and claims files, database formatting, and data quality control.

 

2- Understanding data

Improvement of risk knowledge and identification of the specific features of the portfolio available (overall analysis of the portfolio, analysis of data and their influence on the model, etc.).

 

3- Development and audit of models

Selection and development of models by business constraints.

 

4- Delivery of the final solution

Delivery of a product that is be perfectly integrated into business processes (assistance with the implementation of the solution, writing of technical specifications, and implementation of data visualization tools for the communication of results).

 

Our proposed approach to measure the impact of the implementation of 100% Santé and for the compliance is as follow:

The "100% Santé" reform aims to regulate the Health product features causing an increase in number of people canceling or delaying healthcare for financial reasons. Three product lines are then created, the lowest cover includes a commitment to access care and have full reimbursement. Thus, how can the players anticipate the costs generated by behavioral changes of the insured in the portfolio?

We can clarify these impacts for our clients, as well as using machine learning tools that can refine the prospective vision. Traditional pricing techniques have certain limits because they are based on linear links between variables, while certain behavioral effects can be more complex. This approach can be broken down into six stages:

Preliminary phase: Integration into an existing environment

Ensure overall consistency, logic in changes, as well as the respect of strategic, financial, and commercial decisions.

Phase 1: Establish a framework along three main pillars (actuarial, risk, compliance)

  • Analyze available data and the classification of information centers/IS management
  • Assessment of the optimization of existing tools and the necessary developments
  • Definition of monitoring indicators: risks/impacts (risk appetite / tolerance, written policies, financial communication, etc.) with funding options when necessary
  • Compliance: ensuring proper compliance with regulatory rules/constraints in the delivery

 

Phase 2: Perform preparatory work

  • Building the modeling database
  • Building/optimization of the necessary tools (pricing, risk monitoring and impact of the reform)

 

Phase 3: Analyze

  • Definition of impacts (using databases and impact tools)
  • Provision of funding related to the strategic plan

 

Phase 4: Make the necessary changes (questioning the technical balance requires a new pricing framework)

  • Re-pricing
  • Definition of new contractual conditions/features
  • Definition of risk monitoring breakdown (management settings consistent with customer reporting needs)

 

Phase 5: Lead operational implementation

  • Set new contractual documents (primarily for new business)
  • Taking into account migrations (for portfolio business)
  • Preparation for management (contracts/claims)

 

Phase 6: Supporting change

  • Training of sales teams on technical aspects and financial issues
  • Technical support and assistance with changing/developing commercial activities (commercial teams are often intermediaries between management and technical monitoring)

 

The objective of this compliance is to find a technical balance while facing challenges and the new regulatory frameworks.

For this, additional studies can be done, for example, to measure the changes in underwriting behavior caused by the implementation of the reform (for example, to adapt the commercial strategy and optimize acquisition costs).