The supplementary health sector in Brazil is going through a decisive moment, where digital transformation in supplementary health is emerging as an inevitable - and extremely promising - path. The combination of technological advances, changes in regulations and the growing demand for more efficient services has put pressure on health insurance companies to reinvent themselves.
Allied to this transformation, the movement towards value-based models represents a break with traditional remuneration and care paradigms. The focus shifts from the quantity of care and procedures to quality, clinical outcomes and the patient experience.
In this article, you will understand how this technological and conceptual revolution is profoundly impacting the management of operators, what the challenges and opportunities are, as well as the best practices for your organization to remain competitive.
What is digital transformation in supplementary health?
Digital transformation in supplementary healthcare goes far beyond digitizing processes. It represents a structural change in which technology, data and artificial intelligence become strategic allies to offer more efficient, transparent and patient-centered management.
The operators leading this transformation are investing in:
- Intelligent management systems;
- Predictive data analysis;
- Automation of auditing and billing processes;
- Telemedicine and remote monitoring platforms;
- Integration of clinical and operational data in real time.
In addition to improving internal operations, these technologies promote a better experience for beneficiaries and have a direct impact on reducing healthcare costs.
Why are value-based models the future?
The traditional model, known as fee-for-service, pays providers for the number of procedures carried out, regardless of the results. In addition to being inefficient, this model generates rising costs and does not necessarily improve patient health.
Value-based models, on the other hand, reward service providers and operators for the results they achieve in terms of patient health:
- Reduction of unnecessary hospitalizations;
- Effective control of chronic diseases;
- Increased quality of life for beneficiaries;
- Patient satisfaction.
This means that financial incentives are aligned with delivering more efficient, person-centered care, as well as reducing waste and fraud.
The main pillars of digital transformation in supplementary healthcare
1. data intelligence and analytics
The basis for any modern operator is data management. Big Data, Machine Learning and Artificial Intelligence tools make this possible:
- Anticipating health risks;
- Monitoring patients with chronic diseases;
- Predict claims;
- Directing preventive actions;
- Reduce costs with unnecessary hospitalizations and tests.
2. Process automation
Solutions such as SAUDI, for example, automate critical medical bill auditing tasks such as:
- Error detection;
- Fraud prevention;
- Reduction of disallowances;
- Agility in reimbursement processes.
This frees up teams to focus on more strategic and less operational analysis.
3. Telemedicine and Remote Monitoring
The pandemic has accelerated the adoption of telemedicine, which is now essential. But the next step is the use of wearables, devices that monitor vital signs in real time, feeding operators' databases and enabling early interventions.
4. Data Interoperability
The ability to integrate information from different systems - clinics, hospitals, laboratories, occupational medicine and the operator itself - creates a 360º view of the patient. This improves decision-making and resource management.
Digital transformation challenges for operators
Despite the benefits, the journey of digital transformation in supplementary health is not simple. Among the main challenges are:
- Organizational culture resistant to change;
- Low level of digital maturity in many operators;
- Data fragmentation and lack of interoperability;
- Regulatory challenges in data protection (LGPD);
- Need for continuous investment in technology and training.
Overcoming these challenges requires visionary leadership, strategic planning and the choice of solid technology partners.
Direct benefits for operators
Operators that have already adopted digital transformation practices and value-based models are reaping significant benefits, such as:
- Reduction of care costs;
- Decrease in claims;
- Greater control of fraud;
- Improved beneficiary satisfaction rates;
- Corporate customer loyalty;
- Competitive edge in the market.
How to implement value-based models in practice
- Map the patient's journey: identify critical points that impact costs and outcomes.
- Implement population health management programs: especially for chronic diseases such as diabetes, hypertension and obesity.
- Establish performance contracts with providers: pay for quality, not quantity.
- Use predictive data: anticipate risks and act before high-cost events occur.
- Automate operational processes: especially medical auditing, reimbursement and billing.
- Empower the team: prepare professionals for the new digital and value-driven mentality.
The impact of NR 630 and the new era of supplementary healthcare
ANS Normative Resolution No. 630, which updates the Operator Accreditation Program, reinforces the need for continuous improvement in management, with a focus on quality of care, governance and financial sustainability.
Operators who adhere to the accreditation criteria will have competitive advantages, such as:
- Lower requirement for technical reserves;
- Differential in attracting customers;
- Market recognition as an operator of excellence.
This further consolidates the urgency of digital transformation and the adoption of value-based models.
Count on SAUDI for digital transformation
Digital transformation in supplementary healthcare is no longer a trend - it's an urgent necessity in order to guarantee financial sustainability, control costs and deliver more value to beneficiaries.
In this scenario, having robust, intelligent and secure technologies is essential. SAUDI is Brazil's most award-winning medical auditing system, adopted by dozens of operators across the country, precisely because it offers..:
- Complete automation of medical bill auditing;
- Significant reduction in disallowances, fraud and errors;
- Predictive analysis to improve risk management;
- Intelligent reports for decision-making;
- Increased operational efficiency and reduced costs.
More than just a system, SAUDI is a strategic partner in your operator's digital transformation, helping to build a sustainable, agile management model aligned with the value-based models that are the future of the sector.
🚀 Is your operator ready for this new era? Count on SAUDI. Talk to our experts and schedule a demo!
