FICO Helps British Insurance Provider Vitality Deliver Personalised Healthcare Journeys

Vitality, a leading health and life insurance provider, is working with global analytics software leader FICO to deliver personalised experiences for its 1 million members.

Unique in the health insurance market, the Vitality Care Hub powered by FICO^® Platform offers a fully digital journey including instant authorisation, online consultant booking and integration with a GP referral. Since its implementation, fewer than 28% of Vitality member claims are now started over the phone, compared to over 90% in 2019. Consequently, Vitality’s specialist claims teams have more time to provide personal support for complex claims. 

Vitality has integrated a range of FICO tools to make data-driven decisions based on real-time insights, reducing the need for manual intervention by agents and improving the efficiency of claims processing. The Care Hub offers a fully digital journey for members to access healthcare, from GP services to physiotherapy, mental health and onward specialist treatment. As a result, Vitality has been able to lower operational costs and minimise the risk of human error during assessment and processing, while increasing its ability to scale and manage increasing volumes of complex claims, such as chemotherapy treatments.

Annabel Simmons, head of Healthcare Programs at Vitality, commented: “At Vitality we understand that no two patients are the same. Some members prefer a no-nonsense, straightforward, and self-managed approach to healthcare, while others require more handholding and empathy. We wanted to offer personalised healthcare journeys that cater to these individual preferences.

“Upgrading our system wasn’t just about moving to the cloud — it was about unlocking the potential for growth by allowing our teams to focus on what they do best: providing excellent healthcare services and improving patient outcomes. We realised we were limiting our possibilities by staying with our old system. Our upgrade with FICO is already paying for itself and will continue to drive value for years to come."

Adopting a cloud-based microservices architecture that integrates seamlessly across its various services, from life insurance to reward schemes, Vitality ensures customers benefit from tailored journeys that match their needs with full traceability of decisions made and consistent decisioning.

Care Hub complements the work of Vitality’s specialist claims teams, who are on hand to provide personal support for members, particularly when they are going through complex claims. The availability of fast, digital pathways helps manage demand, enabling Vitality to deliver strong customer satisfaction whilst driving significantly reduced operational costs when it comes to managing claims, costs that can be reinvested in other key services.

Vitality is also using the FICO^® Business Outcome Simulator to preview the outcomes of rule changes in real-time. This has been particularly crucial in understanding the impact that rule and operational changes will have on all aspects of the business and its members.

“The collaboration between FICO and Vitality has enabled the kind of personalised digital-first approach that is transforming healthcare services,” said Nikhil Behl, president, Software at FICO. “By focusing on personalisation, automation, and operational efficiency, Vitality is building a future-proof system that meets the diverse needs of its members while driving sustainable growth.”