Personal Health Pathways Qorus-NTT DATA Innovation in Insurance Awards 2025 - Winner

Personal Health Pathways (PHP) is an AI-driven product devised to address the global challenge of escalating non-communicable diseases through enhanced habit formation.

a) Global challenge of increasing non-communicable disease

Healthcare systems and insurers worldwide are facing the dual pressures of aging populations and rising chronic disease prevalence, compounded by the escalating costs of new treatments and technologies. This creates significant strain on the sustainability of healthcare systems. Within Discovery Health Medical Scheme (DHMS), for example, members with chronic conditions incur, on average, 3.8 times higher annual costs than healthy members, and spend 32.7% more of their life expectancy in poor health. This

impacts both individual health outcomes and healthcare costs, driving long-term increases in insurance premiums.

b) Healthy habits lead to better health outcomes and reduced cost

Habits play a crucial role in shaping health outcomes. By coupling healthy lifestyle behaviours, such as regular physical activity and a balanced diet, with proactive health seeking actions specifically tailored to the individual, such as medicine adherence, regular health checks, and screenings, individuals can significantly improve their health trajectory, enhancing their chances of living healthier and longer lives. Leveraging Discovery Health and Vitality’s extensive dataset, combined with advanced causal inference methodologies, has led to a breakthrough in understanding the direct impact of healthy habits on both mortality and morbidity.

Results from the study “Optimising shared-value through Personal Health Pathways” shows that improving one’s clinical and physical activity habit from a poor habit to a strong habit, results in a 13% and 16% reduction in in-hospital costs respectively. The impact of habit formation is thus significant. This paper shows that incentivising the formation of clinical habits generates R2.50 of actuarial surplus, and the formation of physical activity habits generates R3.90, for every R1 invested in a chronic member base.

c) Precision and personalization improves healthy habit formation

While the evidence of healthy habits improving health outcomes and reducing healthcare costs is clear, the challenge lies in driving targeted and sustained behaviour change. Preventative care is both medically and economically beneficial, reducing disease risk and lowering healthcare costs. However, navigating healthcare is complex, and individuals often struggle to determine which actions to take and when.

Although the benefits of healthy habits are well documented, achieving sustained behavioral change presents a challenge. Personalisation is critical; by delivering precise, individualised recommendations and

communications at just the right time, using the member’s preferred communication channel, Personal Health Pathways assists members in navigating complex healthcare decisions, thereby fostering improved engagement and health outcomes.

d) Personal Health Pathways as the platform for personalisation and healthy habit formation

Developing personalised health recommendations for a large population, optimised to reduce morbidity, mortality, and healthcare costs, requires extensive data, advanced analytics, and machine learning, alongside expertise in behavioural science and health economics. Leveraging Discovery’s rich data, data science, and behavioural science capabilities, on the 1 January 2025, Personal Health Pathways was launched, delivering customised healthcare journeys for over 2 million adult members of Discovery Health Medical Scheme. Powered by an intuitive and gamified digital platform, Personal Health Pathways delivers personalised health and lifestyle actions, communication, and rewards that foster engagement and lasting behaviour change, driving better health outcomes.