Vitality partners with FICO to offer personalised digital care

Techday NZ

26-05-2025

Vitality has partnered with FICO to provide personalised digital healthcare journeys for its one million members.
The collaboration sees the implementation of the Vitality Care Hub, which is built on FICO Platform and aims to streamline and personalise the process of accessing healthcare services for members, from GP referrals to physiotherapy and mental health support. The Care Hub enables digital claims submission and management, resulting in a marked shift from telephone to online claims initiation.
Vitality reports that fewer than 28% of member claims are now started over the phone, compared to over 90% in 2019. The shift toward a digital-first process has allowed specialist claims teams to dedicate more time to complex cases requiring personal support.
The insurer has integrated a suite of FICO tools to facilitate data-driven decisions using real-time insights. This has reduced the need for manual intervention by agents, improved the efficiency of claims processing, and lowered operational costs. By minimising the risk of human error, Vitality can handle a higher volume of complex claims such as chemotherapy treatments, while also supporting scalability as claim volumes rise.
Annabel Simmons, Head of Healthcare Programs at Vitality, explained the rationale behind the move: "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."
Simmons added, "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."
The adoption of a cloud-based microservices architecture, which integrates across services such as life insurance and member reward schemes, allows Vitality to offer tailored journeys for members. The system also provides traceability of decisions and consistency in outcomes.
Care Hub is intended to complement the work of Vitality's specialist claims teams by enabling fast digital pathways for customers whose needs are more routine, while reserving human resources for complex cases. The insurer states this approach manages demand efficiently, helping to maintain customer satisfaction and drive operational savings that can be reinvested into key services.
Vitality is also using FICO Business Outcome Simulator to test and preview the likely outcomes of rule changes in real time. This enables the business to understand potential impacts before changes are implemented, both at the operational level and for members.
Nikhil Behl, President, Software at FICO, commented on the project: "The collaboration between FICO and Vitality has enabled the kind of personalised digital-first approach that is transforming healthcare services. 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."
FICO Platform provides open architecture and integrated capabilities for organising data, generating insights, and executing operational actions. FICO was recently recognised as a Leader in the IDC MarketScape: Worldwide Decision Intelligence Platforms 2024 Vendor Assessment.