Conceptual foundations, practical examples and specific recommendation
We’ll guide you step by step through the strategy process to consolidate your insurance services and positioning.
New technologies, individualisation, modularisation, greater transparency, the call for sustainability, changing customer needs, increasing competitive pressure – these developments demand that services be available at low cost and with low thresholds. As a health insurer, you benefit from step-by-step support through the strategy process and with major strategic decisions such as product development and services design and, accordingly, the set-up in the organisation, digitisation and other issues. We work closely with you to position your insurance services along the customer journey, consolidate your strategic positioning and future-proof your market presence.
Through our flexible approach based on interviews and workshops, our first step is to develop a strategic vision. From this, we determine areas of action and measures, and together with you give thought to opportunities for cooperation. The jointly designed roadmap shows which focus areas and specific steps are needed and when.
Whether transformation, cooperation, joint venture, reorganisation or restructuring – we support health insurers through the change. By positioning yourself efficiently and structuring yourself appropriately, you’ll maximise your performance potential in line with your strategic orientation.
We’ll show you how to proactively plan your transformation project, establish new business units, position yourself correctly, outsource activities where appropriate and get the right partners on your side. To make sure our approach is tailored to your business, we’re guided by your starting position, your goals and requirements, and – of course – best practices.
Obtaining buy-in from your organisation’s employees is critical to the success of your transformation. To this end, it’s important that we work together to simplify your project and anchor it internally.
As a health insurer, you can rely on us to help you analyse, implement and optimise measures. We keep an eye on the big picture, covering benefits and tariffs, your basic structures and outpatient processes, and your information and communication technologies (ICT). We know from experience that you have a powerful lever when it comes to tariffs, outpatient processes and the organisation of outpatient services.
Digital health enables you to build a solid bridge between strategy, transformation, process optimisation and automation, financing and change management. This means you can take into account all the needs of your stakeholders and implement them in a sustainable manner.
As digitisation progresses in the healthcare sector, health insurers are increasingly offering digital services. The successful advance of telemedicine, a wide range of health apps and the electronic patient record are changing both the behaviour of policyholders and the range of services offered by health insurers. Although digital services are in demand, they’re met with scepticism by some policyholders, who fear that the personal data collected could be used to their disadvantage and result in their exclusion from certain benefits. Particularly in the case of health apps, data privacy concerns are a major hurdle for digital services provided by health insurers.
A carefully implemented data protection policy that respects and safeguards the personal rights of policyholders builds trust – which is essential for the successful launch of digital services. We’ll help you design your digital services in compliance with data protection regulations, in order to retain the trust of your customers over the long term.
The tariff landscape in Switzerland is characterised by an evolving regulatory framework and a large number of stakeholders. With our pioneering work in core areas such as outpatient before inpatient, outpatient flat rates and additional benefits, we show you how to design your tariff projects with a long-term view and conclude them successfully. Whether a simple tariff project or a multi-stakeholder project, we’ll put our industry-specific skills in strategy and project management organisation (PMO) to work for you. We’ll also support you with our actuarial industry knowledge throughout the entire process, from designing and calibrating tariffs to preparing statistical bases and submitting tariffs to the regulator.
In terms of industry classification, the carbon footprint of the Swiss healthcare sector is higher than that of global healthcare markets. We provide step-by-step, strategy-based support to health insurers in developing an ESG transformation framework. The first step is to define a goal and a vision, and to carry out a corresponding materiality analysis. Measures are drawn up, made operational and implemented by means of a transformation roadmap. Non-financial reporting is set up so that these measures are continuously monitored and communicated to employees, patients and business partners. We also support health insurers in formulating and reporting climate-related financial risks by means of quantitative analyses that serve to measure and manage climate risks.
If the purchase or sale of a company or parts of a company is pending, we draw up lists of potential targets for you and work through these systematically. In the buying and selling process, we take care of all necessary elements such as company valuations, financing considerations, and documentation like information memorandums, letter of intent (LOI) or share purchase agreement (SPA). Our specialists contact potential investors on your behalf. We also interpret the financial and operational impact of transactions for you, for example on tariffs or sales taxes.
Finance is our profession. That means you can expect us to provide detailed quantitative and qualitative financial models (business plans) and affordability considerations of the highest quality and greatest practical relevance. You’ll need them if, for example, you’re planning an investment or a spin-off of companies from cantonal structures, or need to submit documents for potential transactions, or company or business valuations. Our financial models match goals and scope to your needs at an early stage. We’ll also evaluate your existing solutions.
We provide services for service providers (hospitals, psychiatric clinics, rehabilitation facilities and outpatient service providers), benefits providers (health insurers) and all other companies in the healthcare sector and related industries. We’ve optimised our methodology over many years, and it’s proven its worth to investors, capital providers and politicians alike.
Supplementary insurers are responsible for implementing the industry framework ‘Mehrleistungen VVG’ (additional benefits under the Swiss Insurance Contracts Act (SICA)) for Swiss supplementary health insurers, in collaboration with service providers. This leads to several questions: How should you implement these principles? What is your basic definition of additional benefits in concrete terms? How do you distinguish these benefits from compulsory health insurance? What new billing principles do you need and what are the consequences?
As a consulting company specialising in additional benefits concepts, we’ll help you create the necessary transparency in your additional benefit catalogues. We can support you in differentiating between benefits, drawing up an action plan and implementing urgent measures like developing valuation and pricing logic, establishing effective controlling, drafting negotiation strategies, adapting the model contract, designing a controlling and governance concept and carrying out mandatory reporting.
Director, Leiter Beratung Krankenversicherer & Digital Health, Zurich, PwC Switzerland
+41 58 792 77 90
Our audit process is specifically designed for health insurers. We talk with you on equal terms, because we combine the industry knowledge of our audit team with our specialists from actuarial and IT audit. This means we can support you quickly and effectively in solving complex issues.
Whether you’re a small niche player or a large market player, you’ll receive actuarial end-to-end solutions tailored to your needs. We’ll support you in meeting regulatory requirements under KVG (Health Insurance Act), VVG (Insurance Contracts Act), VORA PCG (Ordinance on Risk Compensation – Pharmaceutical Cost Groups) and UVG (Accident Insurance Act). We’ll also present the latest solutions in relation to modelling risk compensation with pharmaceutical cost groups, asset and liability management, solvency modelling, tariff strategies, product design and reserving. Our range of services is rounded off by our external role as a responsible actuary.
Director Digital Intelligence, Actuarial Services , PwC Switzerland
+41 58 792 17 91
Partner, Leiter Beratung Gesundheitswesen, PwC Switzerland
Tel.: +41 58 792 75 28
Partner, Leiter Wirtschaftsprüfung Gesundheitswesen, PwC Switzerland
Tel.: +41 58 792 26 10
Managing Director, Leiter Deals Gesundheitswesen, PwC Switzerland
Tel.: +41 58 792 15 08
Director, Leiter Beratung Krankenversicherer & Digital Health, PwC Switzerland
Tel.: +41 58 792 77 90