Traditional risk modelling approaches are now insufficient for the level of cost management required to tackle healthcare waste, says David Frankenfield, Chief Data and Analytics Officer at health insurtech Amplify Health, with loss ratios seeming like a “never-ending battle”.
The way that most insurers in healthcare model risk isn’t sufficient to manage every penny that gets spent by insureds, Frankenfield said during a panel at InsureTech Connect Asia 2025 held on Wednesday (June 4). “The people who work for payers hear today, your loss ratios seem like it’s a never-ending battle to bring them into double digits.”
Asia Pacific is expected to experience the world’s worst medical inflation rates in 2025, according to a WTW 2025 global medical trends survey, with more than three-quarters of regional insurers forecasting elevated or substantially elevated medical cost trends through the next three years.
Amplify Health, which supports five of the largest payers in the Asia-Pacific region with fraud detection solutions, has developed comprehensive member risk profiling systems that integrate claims data, wellness data, and practice management data to achieve more granular risk assessments, said Frankenfield.
It’s the granularity of this data that has allowed the insurtech to build an intimate model of insureds in their member risk profiling. “We’re looking at either partnering with reinsurers or some of our payer clients to get down to the intimate level [and look at] how that modelling can support almost your entire business ecosystem,” he added.
Veera Ramsing
Chief Operating Officer, Digital Solutions at Munich Re(Re)insurers and insurtechs have to look at the data to diagnose issues, said Veera Ramsing, Chief Operating Officer, Digital Solutions at Munich Re. While generative AI will be a helpful tool, understanding the data and the insights they provide will be important.
“You can start looking at data insights, making operations efficient for the people who deal with claims assessment on a day-to-day basis,” Ramsing said. “But the key thing is, once you have these insights, how do you implement them? We should really focus on the use cases and look at the tools we have available.”
Moving to underserved markets
Previously overlooked market segments have proved to provide significant expansion potential, said Kim-Fredrik Schneider, CEO of virtual care provider Abi Global Health.
“We’re seeing a shift towards processes to manage their risk, and this is where digitalisation, the integration of services, allows opportunities to provide support for those with chronic diseases, for example, in order to reduce the risk in these populations, rather than to simply exclude them from insurance products.”
Local insurers should begin developing products for the mass market within their own countries, Schneider said, before large global insurers take up this space. “If you don’t do it, the global international insurers will do it because we are working with them to develop products specifically for the mass market,” he added.
Telehealth and virtual care — which provide a very high value for a relatively low price point — is a service that can be adapted to the low resource context, said Schneider. [They] are very well suited to be attached to mass market insurance products.”
The virtual care provider recently received investment from the HSBC FinTech Venture Capital Fund to expand its presence to underserved segments in Asia, Schneider said. “We’re super in that space, and we’re very delighted to be involved in some of those processes.”
Kim-Fredrik Schneider
CEO of Abi Global HealthAI necessitates a complete redesign
(Re)insurers and insurtechs who want to implement AI will have to consider how they can maximise its impact, said Schneider. “There’s this tendency at the moment to kind of sprinkle AI fairy dust on top of whatever you were doing before, and then now it sparkles with AI, and you can pretend like it’s something new.”
But a comprehensive redesign is needed, he said, and that comes back to the tendency for insurers to think about cost containment as an exercise of “getting the customer less”.
“I would like to propose that all of us rethink that, that AI can be something that enables this rethinking of: ‘how can I contain costs by giving my customers more, how can I give them a better experience, faster access to a doctor’,” he added.
In giving insureds a faster, more convenient option, insurers can actually reduce costs. “We have data showing that we’re able to have a 30% reduction on value of claims by giving people easier access to healthcare professionals, faster access to healthcare professionals,” said Schneider. “I think that’s really where the power of AI and technology generally comes in.”
Should reinsurers share data?
Reinsurers sit on a wealth of data within their portfolios, and while sharing this data can help improve industry insights, privacy constraints limit public access to valuable claims information.
“There are challenges in terms of the ways we can use the data,” said Dhiraj Goud, Vice President and Regional Head of Technical Oversight and Digital Underwriting Solutions in Asia for RGA. “We can predict the trends, we can make this available to others.”
“Regulators obviously would be on your back,” said Munich Re’s Ramsing. “You can’t just do what you want with the data.”
Still, reinsurers have been actively partnering with carriers to use generative AI to improve underwriting, customer journeys, and claims.
RGA partnered with Prudential in Hong Kong to create a solution that digitises medical reports and converts them into structured data named MedScreen, allowing underwriters to speed up the underwriting process, said Goud. “We try to customise, develop solutions that are required for each market, each client, and that’s how we build our portfolio.”
Ramsing said that Munich Re is focused on implementing automation and AI solutions — especially on management. “[We’re] making sure that we’re writing a business that we price correctly,” Ramsing said. “But our whole thing is, how have we actually added value to the end customer, to the insurer and create solutions.”
