In this article Ian Youngman, Author and Publisher of the upcoming INTERNATIONAL HEALTH INSURANCE 2022 and new companion IPMI market reports, takes a look at how the demise of Aetna International, is NOT the beginning of the end, for the international private medical insurance (iPMI) market.

• Aetna’s parent CVS has decided to close Aetna International and transfer most IPMI business to Allianz.
• Before either Aetna or CVS or Allianz could issue official press releases, Aetna UK sent a memo to brokers that lead to an online magazine whisking out partial news, which led Aetna UK to push out – initially on their website- an official statement that gave some answers.
• Across the globe Aetna have several PMI/IPMI partnerships and the future of some of these is unclear but may offer potential for competitors.

Background: CVS

• Since being bought by CVS Health, Aetna in the USA has been increasingly intertwined with CVS as the vision is healthcare backed up by insurance.
• CVS has been buying pharmacies and USA health plans.
• Aetna has over 23 million US health insurance customers but CVS Pharmacy has 93 million customers.
• Aetna International has 800,000 lives covered-so numbers of policies is way below that.
• CVS/Aetna has been adding more USA health insurance customers each year than Aetna International has in total.
• CVS Health is selling off its health savings account business PayFlex to Millennium Trust,
• CVS has no business outside the USA so has been struggling to understand overseas markets and why it cannot all be dome from the USA.
• CVS wants to concentrate on the USA.

Background: IPMI market

• The IPMI market is always shifting with market exits and entrants.
• There is a global shift Eastwards as the USA/Europe axis gives way reluctantly to a China/Asia/Africa axis.
• Being no longer possible to offer IPMI offshore, due to compulsory insurance, tighter regulation and a rising rife of nationalism- global players have to invest in offices, partnerships and deciding which markets to be in.
• There is a massive rise in IPMI and PMI offerings from regional groups, local groups and single country insurers.
• Aetna and Generali may be going out but coming in or back in are Zurich, HDI Global, Vitality International, Foyer, Alan and Sanlam –to name just a few.
• APRIL and AIA are among those expanding their global presence
• The rise in nationalism means that African companies and individuals have an increasing penchant for doing business with African insurers. The same applies in Asia, China, France and Germany. The trend is not so
• USA and European groups are increasingly suffering headwinds in parts of the world due to the deeds, misdeeds and public utterances of their politicians.

Aetna International

• Aetna International is being wound down and will cease to exist with remaining IPMI business handled by Aetna.
• There will be redundancies - so there will be experienced talent available in a market where expertise is scarce.

Allianz Partners

• As yet Allianz Partners have remained silent.
• Allianz Partners is the Allianz subsidiary that specialises in assistance, international health & life, automotive and travel insurance. Solutions are available to business partners, and in some cases, are integrated into their own customer offers. They are also available via direct and digital channels under our three brands: Allianz Automotive, Allianz Global Assistance and Allianz Care plus Mondial Assistance. 
• It has 17,500 employees in 76 countries with a strong regional organisation.

Allianz and Aetna deal

• The commercial deal is contingent on certain legal processes being completed in relevant jurisdictions.  
• The deal does not apply to India, Thailand or’ The Americas”
• Exactly what The Americas means is still confused but seems to be just the USA and Canada.
• Aetna International has entered into a preferred partnership deal with Allianz Partners, a world leader in B2B2C insurance and assistance. The agreement covers all of Aetna International’s regions, with the exception of the Americas, Thailand and India. 
• Existing IPMI customers will be transferred to Allianz at renewal.
• Completion of this migration process is planned to take place before or by 31 October 2023. 
• Aetna International has been working closely with Allianz Partners to plan for a smooth handover for customers at policy renewal. 
• Allianz Partners will offer new cover with similar benefits and no additional medical underwriting. 
• More information will be shared with partners and customers over the coming weeks and also ahead of each policy renewal.   
• Aetna International, in the EMEA and APAC regions, plans to no longer provide cover for most new customers or most renewals for existing customers with policy dates from 1 July 2022 onwards for most Group business and from 1 November 2022 for Individual business.
• Aetna International IPMI customers will cease being on Aetna cover by 31 October 2023 at the latest, apart from any claims they make on their Aetna International policy.

The Americas: what is known

• Aetna International’s Americas business and operations will become part of Aetna.   
• Aetna will concentrate on the US expat business and intends to partner with Allianz Partners to explore opportunities to service its members outside of the U.S.A 
• More information on this will be provided in the coming months. 

Aetna International Thailand

• In Thailand, Allianz Ayudhya has agreed to acquire 100% of Aetna International’s shareholdings and therefore its Thailand business operations in their entirety. 

Aetna International India

• Aetna’s Indian Health Organisation is not included in the preferred partnership deal with Allianz Partners.
• A separate update will be provided in due course.
• VHealth in India has 4 million members
• It is not insurance but four health membership packages of preventative care, treatment, consultation and dental.
• vHealth services are offered in India by Aetna's fully owned subsidiary, Indian Health Organisation.

Partnerships

• Aetna International has global partnerships, some long standing and some relatively new.
• It would be usual to have a ‘ force majeure” clause so these partners will probably have the right to walk away and negotiate with other insurers.
• Sanlam Pan Africa partners with Aetna International to offer Global Health an IPMI health insurance across 20 African countries.
• Executive Healthcare Solutions in Nairobi acts as principal representatives for Aetna International PMI policies in Kenya and across Africa.
• Swiss Life uses Aetna for IPMI customers in Singapore.
• There are other local deals.

Middle East

• Some policies are written locally and not by Aetna.
• The ability and speed of transfer is down to local regulators.
• In Abu Dhabi/ Dubai/UAE Allianz policies are written by Orient Insurance
• In Abu Dhabi/Dubai/UAE Aetna policies are written by Al Ain Ahlia Insurance.
• Aetna International was appointed by the National Health Insurance Company (NHIC) of Qatar as consultant with the carrot of being a preferred provider on the about to be launched national insurance scheme for millions of expats.

The Americas

• United Nations geoscheme for the Americas
• Northern America—the northern region of the North American continent, including Canada, the United States, Greenland, Saint-Pierre and Miquelon, and Bermuda.
• Latin America and the Caribbean-extending from The Bahamas and Mexico to Argentina and Chile.
• Whether Aetna means this or just the USA and Canada is not clear but probably is just the USA and Canada.
• Aetna International has a Canadian office in Toronto with other local offices.
• Aetna International has an office in Tampa, USA, serving the Caribbean, Central America and South America.
• Aetna sells LatAm products via US agency VUMI- that has offices in Ecuador and Panama.
• Neither CVS nor Aetna has any physical offices across the Americas.

China

• Aetna partners with China Life and Huatai Insurance to offer IPMI within China
• Allianz Care has a local office in Shanghai. It offers international healthcare plans for China, created in partnership with sister company Allianz China General Insurance. These healthcare plans have been designed to appeal to both international and local Chinese companies.
• The theory and practice of transferring from Aetna to Allianz may be full of difficulties, and the Chinese authorities are not known for speed.

UK

• Aetna International serves the UK and Europe and Russia from offices in Farnborough
• Sanctions means that no Russian business can be renewed.

Conclusions

• The leak of partial information before the two insurers could issue a joint statement could mean that regulators, brokers, partner companies and others may have learned about the deal second hand. This may just be an annoyance for brokers but insurance regulators and stock exchanges take a harsher view.
• Insurance regulators globally are becoming tougher – witness the way they effectively killed the AON/WTW merger.
• The above analysis shows that transferring from one global insurer to another is not a simple exercise.
• It also shows why being a global IPMI provider is not easy unless you have a myriad of local offices and partnerships – and keep regulators sweet.
• Latin America, Central America and the Caribbean are growth areas for PMI and IPMI- Aetna never stood a chance of really growing this business just from Florida.
• To sell to Latin America, Central America and the Caribbean you now need local offices or partners.
• For Allianz this is a major coup – at probably a lot less than CVS wanted last year.
• The IPMI is not dead or dying- it is growing but in a myriad of different ways and is no longer a market any insurer can dabble in or control from offshore as it did decades ago.

About The Author

Ian Youngman is a writer and researcher specialising in insurance. He writes regularly for a variety of magazines, newsletters, and on-line services. He publishes a range of market reports and undertakes research for companies and has London market management experience with brokers and insurers. Read Ian's reports here.

In this exclusive iPMI Magazine interview, Christopher Knight, CEO, iPMI Magazine, met with Global General Managers from Aetna international. The group interview focused on international health and medical insurance regional trends; the impact of COVID-19 on iPMI; plus predictions for the coming year. As always the interview raised some excellent points for the international private medical insurance market.

Have you recognised any notable trends in health insurance from your region over the past year?

Damian Lenihan, Executive Director - Operations and Distribution, Europe, Aetna International: The COVID-19 pandemic has amplified the importance of good physical, mental and emotional health for employees of all ages across Europe. This translates directly into employees having greater expectations for health insurance benefits from their employers. This is what we discovered in our research. Our ‘Polarised Perceptions of Corporate Health and Wellness’ study shows that in global business, 70 percent of employees feel that their mental health is most important and that they have been negatively affected during the pandemic. They expect employers to provide comprehensive mental health and well-being services as standard. Research also shows that these services are more important to employees now than previously. A real desire for digital services was also communicated. Results show that employers need to carefully choose the best comprehensive plans for their valued workforce. Plans that cover everything from health support, advice and guidance through to telemedicine services and the latest digital tools.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

Damian Lenihan, Executive Director - Operations and Distribution, Europe, Aetna International: The health insurance market has clearly evolved from helping people to recover to supporting prevention. Empowering people is much more of a focus. It is vital for individuals to manage their own physical, mental and emotional well-being and this should become a daily routine. The “well-care model” as we refer to it comes with an excellent set of tools and resources that we provide for members which supports them to lead happier, healthier lives. Prior to the pandemic, we were determined to provide mental health support. We invested in product enhancement and innovation. For example, our members have access to the award-winning chatbot app, Wysa, access to doctors via our sophisticated telemedicine service, vHealth, and to counsellors through the Employee Assistance Programme (EAP). To put all of this into context, we know that corporate and SME clients want to be cost efficient and are less likely to want to switch insurers at the moment. Preferences are for continued long-term relationships with a trusted health insurer.

What are your predictions for health insurance trends in your region over the next year?

Damian Lenihan, Executive Director - Operations and Distribution, Europe, Aetna International: Many of the trends from the past 18 months will continue for the next year. Health insurers will continue to offer all-round health care. We’ll see an acceleration in the roll-out of digital services, such as telehealth. This will be driven by members’ demand for services, which will be due to convenience and safety. Also, it goes back to people feeling empowered to self-manage health concerns. Preventative measures that will reduce the need for in-person medical care and potentially the number of claims and therefore costs. That being said, the continuing degree of global uncertainty indicates that we will likely work in an agile way for the foreseeable future. The investment will be in efficient operations.

Have you recognised any notable trends in health insurance from your region over the past year?

David Healy, CEO EMEA, Aetna International: COVID-19 has increased expectations from employees about health insurance benefits packages. Recent research we conducted found that 76% of UAE employees believe comprehensive health insurance is more important now than before the pandemic. A further 66% said their employer should be spending more on health benefits. Two thirds of UAE-based HR professionals also agree that there’s an expectation for employers to take more responsibility for their employees’ health. Consequently, plan sponsors are balancing workforce expectations with budget restrictions and are working with health insurance providers that offer holistic plans.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

David Healy, CEO EMEA, Aetna International: COVID-19 has had a negative impact on mental health and well-being. This ‘second curve’ of the pandemic is likely to be relevant for some time as people grapple with uncertainty. We believe we have a duty to champion change and our commitment is to ensure that mental and physical health are prioritised equally. We have made several product enhancements to meet the health needs of our members in the short and longer-term, regardless of location. For example, enhancements have been made to Focus, the health insurance product designed specifically for UAE small- and medium-size enterprises (SMEs). This includes inpatient and outpatient psychiatric treatment and psychotherapy for patients with non-emergency medical conditions.

What are your predictions for health insurance trends in your region over the next year?

David Healy, CEO EMEA, Aetna International: Arguably the biggest trend will be health insurers’ continued focus on providing their members with accessible telehealth services. There are a few drivers that make telehealth a key cog in the primary care model. The first is convenience — across the Middle East, telehealth services afford ready access to experienced doctors and some services take it a step further by combining primary care with concierge-style diagnostics and prescription services, where patient samples are taken, and medicines are delivered, to the office or home door.

Second, telemedicine doctors provide the full range of primary care. They take patient histories and either prescribe treatment plans or arrange specialist referrals, after considering the physical and mental effects of a range of afflictions. This approach is vital in a post-COVID world where we have seen an increase in the number of patients with comorbidities.

Third, is the treatment of extant comorbidities. Through 2020 and beyond, the pandemic made it harder for patients with chronic conditions such as diabetes to keep up with their medication and regular check-ups. Telehealth played a vital role in delivering uninterrupted care including diagnosis, treatment, home blood-monitoring, delivery of prescriptions and consultation when needed.

Last but not least, telehealth has the potential to drive down premium costs. While the economic recovery is well underway in the region, businesses are still watching costs. Data from our vHealth service shows that the more employees use telehealth services, the bigger the potential reduction in claims. Around 75% of vHealth users completely resolve their condition without the need for onward care and over 90% admit they would have gone to a hospital if a remote consultation hadn’t been available.

Have you recognised any notable trends in health insurance from your region over the past year?

Hemal Desai, Global Medical Director, Aetna International: The most significant trend over the past year has been the increased acceptance from people to consume multi-channel health care. People can choose how they interact with their health and well-being providers whether it be via chat, voice, video or physical services. This has resulted in a significant uptick in telemedicine and other digital health services.

One area that has benefited most from this multi-channel approach is mental health care, which has traditionally been difficult to access in the past. As a consequence, it is a greater part of the health insurance agenda than it ever was before. We have seen a major push for mental health and well-being provision which wasn’t something actively discussed in previous years. Corporate insurers across the board have seen that the COVID pandemic has triggered mental health concerns. With this, insurance providers are organically becoming health partners offering holistic solutions to drive positive health outcomes. Primary care is central to the health and well-being of individuals. Whilst the global trend is to live longer due to improved preventative care, people need to be able to have the resources to self-manage their health concerns.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

Hemal Desai, Global Medical Director, Aetna International: Many people avoided seeking health care when they needed it during the height of the pandemic. In some cases, people that actively needed treatment could not access it as hospitals were full dealing with COVID-19 patients. Those with mild symptoms or well-controlled long-term conditions hesitated to consult with their health care provider, which has led to accumulating burden of illness.  We’re seeing chronic conditions like hypertension and diabetes that are less well managed, resulting in longer-term complications or an increase in undiagnosed or late presenting cancers leading to poorer health outcomes and costlier treatments. Insurers may have seen an initial lag on claims as people avoided or could not access their health care settings, but this is more than likely to result in more disease complications and higher-value claims in the future. Many people think it will come back harder due to undiagnosed illness.

What are your predictions for health insurance trends in your region over the next year?

Hemal Desai, Global Medical Director, Aetna International: The impact of technology on the health sector is going to be profound over the next year and beyond. Artificial Intelligence (AI) together with remote patient monitoring will create a huge step change in how people access and are managed within virtual health care settings. It will enable new methods of diagnostic support for clinicians, new options in digital therapeutics and allow people to be more engaged in their own well-being. Accurate remote diagnosis of eye, skin conditions and heart arrythmias have already been achieved. The combination of AI and remote diagnosis and telemedicine will be game-changing for health care.

Digital health care is stickier than before - people now trust telemedicine, and this provides a platform for further growth and adoption. Accessible, consumer centric health care is appropriate for modern lives. Additionally, AI will continue to revolutionise remote diagnosis. The challenge for insurers will be developing the right funding environment to accommodate these newer technologies.

One such area of rapid advance is gene and cell therapies. A significant pipeline of exciting new therapies is due to come on to the international market to treat previously untreatable health conditions. 

COVID-19 has also potentially accelerated vaccination production for other illnesses such as malaria, HIV, and some cancers. It is very exciting that COVID-19 has accelerated this by improving vaccine technologies, such as mRNA, but also the vaccine development process and regulatory approval cycles. Preventing illnesses is really important from a health insurance perspective.

The impact of post-acute COVID syndrome (or long COVID) is also an area that health insurers will need to monitor closely. The impact and extent of long COVID may be significant but is not yet fully understood and extremely hard to predict. Long COVID potentially presents a significant challenge for health care systems, payors, employers and, most importantly, those suffering from the illness.

Have you recognised any notable trends in health insurance from your region over the past year?

Derek Goldberg, CEO APAC, Aetna International: There is an increased need for mental health support and services due to the toll the pandemic has taken on mental health in the region. We’re also seeing ‘flight to safety’ behaviours whereby customers are choosing to purchase insurance from more established insurers.

Driven by the prevalence of work-from-home and a reluctance to venture out into a physical health care setting when avoidable during a pandemic, there has been an increased demand for digitisation of customer processes. Telemedicine is one of the key capabilities required to support this demand, and we have seen an increase in both registrations and utilisation across our telemedicine programmes.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

Derek Goldberg, CEO APAC, Aetna International: Many insurance providers are removing their pandemic exclusions or developing dedicated products to cover pandemic risks. Unique to this pandemic, insurance may be used as an incentive to drive vaccination, for example new regulations allow Singapore employers to exclude unvaccinated employees from COVID-19 coverage under their health insurance plans.

What are your predictions for health insurance trends in your region over the next year?

Derek Goldberg, CEO APAC, Aetna International: Employers will continue to be conscious of budgets as the economic outlook remains uncertain in many countries, and, as insurers, we’ll be called upon to work collaboratively and creatively with our clients to devise health benefit programmes that manage costs and meet their financial objectives. Digitisation will continue to accelerate across all industries including health care. Long COVID (symptoms of COVID that persist long after the initial infection has cleared) and its implications for longer-term support and follow-up treatment will be an emerging part of the landscape.

The Global Health plan addresses the needs of the local market in 19 countries across Africa, and expats across the region, by giving them access to quality, cost-effective healthcare.

Aetna International, a leading provider of global health benefits, has announced that it has partnered with Sanlam Pan Africa, a premier pan-African financial services group, to launch the Global Health plan — a unique health insurance offering that addresses the healthcare needs of both local and expatriate nationals, on an international basis, across all market segments in 19 countries^[1] in Africa. Fully compliant with regulations in all local markets, the plan offers a broad range of benefits, an extensive direct billing medical network, flexible payment options and an enhanced member experience with local in-country service.

“In recent years we have seen employers across Africa pivot from traditional offshore international medical insurance providers to local ones. However, few local providers have the capacity to offer international cover, which in Africa, where certain forms of treatment are not always available locally, is essential,” commented Antony Brown MBE, Head of Africa, Aetna International. “Furthermore, as a result of the global pandemic and greater availability of skilled resources in country, we are seeing companies on the continent make more local hires. What this means is potentially less demand for the traditional, high-cost fully international plans and an uptick in demand for plans that are more focused on regional cover, with comprehensive yet affordable benefits. This is exactly where we position Global Health; fit for today’s market and yet future-proofed for the changes ahead.”

RELATED READING: iPMI Magazine Speaks with Antony Brown MBE, Head of Africa, Aetna International

The Global Health proposition provides four plan levels — Value, Essential, Plus and Premium — with coverage ranging from US$100,000 to US$5,000,000. Depending on the tiers, the plans offer all levels of employees a host of health and well-being benefits, including cancer care, inpatient psychiatric treatment or psychotherapy, HIV or AIDS treatment, terminal care, medical evacuation, dental, optical and emergency treatment outside the area of cover.

With pre-authorised inpatient care across all of Africa and outpatient direct billing across the 19 Africa markets, Global Health offers members access to 8,000 directly contracted providers in Africa and over 1.3 million health care professionals globally, as well as a 24/7 multilingual call centre for emergency and evacuation immediate assistance. For plan sponsors, premiums can be invoiced centrally in USD, or in the local currency of each respective country, with all mandatory tax requirements included. 

“Not only is there a vast difference in the health insurance requirements of companies from one country in Africa to another, but the diversity of the countries in terms of language, currencies, cultures, and service expectation adds additional layers of complexity. By bringing together the Africa-specific experience of Sanlam Pan Africa with the global health insurance expertise of Aetna International, I have no doubt that Global Health will deliver Africa’s most comprehensive and locally compliant health care solution with broad international access,” added Ilham Lahlou, Head of Healthcare at Sanlam Pan Africa.

About Sanlam Pan Africa

Sanlam Pan Africa is the Sanlam Group Business unit responsible for managing and developing General Insurance business. Sanlam Pan Africa have more than 2,700 employees, working in 30 countries and operates in 3 areas of activity: Insurance & Reinsurance, Assistance and Third Party Management (TPA).

As the undisputed pan-African leader in insurance and a leading continental player, Sanlam Pan Africa has unique multi-business experience in the African market. In addition, it’s the preferred entry point to support its clients on the continent, thanks to its extensive presence in Africa, which gives it an unparalleled geographic dimension. In addition, there is a complete product offering dedicated to all its customers, whether they are individuals, professionals or corporate.

For further information on Sanlam Pan Africa, visit: www.sanlampanafrica.com.

About Aetna International

Aetna International is committed to helping create a stronger, healthier global community by delivering comprehensive health care benefits and population health solutions worldwide. One of the largest providers of international private medical insurance, Aetna International serves more than 800,000 members worldwide, including expatriates, local nationals and business travelers. Its global benefits include medical, dental, vision and emergency assistance and, in some regions, life and disability. Aetna International also offers customised technological and health management solutions for health care systems, government entities and large employers to improve people’s health, enhance quality of care and contain costs. Aetna International is a subsidiary of Aetna, a CVS Health company, which serves an estimated 34 million people with information and resources to help them make better informed decisions about their health care.

For more information, see www.aetnainternational.com or LinkedIn.

^[1] Global Health covers local nationals and expats in 19 countries across the continent including Angola, Benin, Burkina Faso, Cameroon, Congo Brazzaville, Gabon, Guinea Conakry, Côte d’Ivoire , Mali, Madagascar, Morocco, Niger, Nigeria, Senegal, Togo, Kenya, Rwanda, Uganda, Zambia.

In this exclusive iPMI Magazine article, Damian Lenihan, Executive Director for Europe at Aetna International, talks about how telemedicine is positively impacting access to high quality healthcare, during a global pandemic.

With record numbers of employees working from home and facing new and evolving health pressures, employers have also begun to embrace telemedicine as a way to roll out effective health and well-being strategies.

Telemedicine is easing the burden of new employee health pressures

A survey we conducted with 4,000 global office workers last September shows just how much workers’ mental health has been impacted by the pandemic. From worrying about juggling work and home-schooling, to concerns over being furloughed (not to mention fears over contracting the virus or caring for those who have), lockdown truly tested our emotional resilience.

With social restrictions limiting access to sports facilities, as well as eliminating the commute, most employees have also been moving and exercising less. Add to this the fact that most hospitals and health care centres have been overwhelmed with Covid-19, and businesses are facing a perfect storm: their employees’ health is under more pressure than ever before, but regular health tests and screenings, and even treatment appointments, have largely been postponed unless crucial.

That is why employer-provided access to virtual consultations and health and well-being support during this time has been so important. It has helped to address a clear gap, giving people the much needed opportunity to speak to their GP or other health care professionals, all from the comfort and safety of their own home.

Virtual health for a new type of workplace

As hybrid and flexible working models become a more permanent fixture of working life, employers need to be mindful of the impact this could have on employee experiences and expectations. Our ongoing research into the views of global employees and HR Directors indicates that 3 in 5 UK HR decision makers recognise that expectations around employer-provided health support have changed dramatically since the beginning of the pandemic. For instance, employees say they now want access to more digital health solutions.

Although not completely new, the provision of health benefits through virtual means has accelerated and employee usage is increasing as well. At Aetna International, for example, we saw a 180% increase in global utilisation of vHealth, our virtual telemedicine service, between April 2019 and April 2020, with some regions more than doubling their usage during this time. More generally, the use of virtual health platforms has increased by 200-300% across the globe, showing the increasing demand for such services.

As many firms announce the implementation of hybrid working models, providing health support for teams through digital means, underpinned by a clear internal communications strategy, will be key to ensuring employees can take care of their health and well-being – no matter where they are. 

Employee appetite for digital health solutions in the workplace

The role technology has played in keeping the world connected over the last year has shown just how easy it is to take care of everyday tasks virtually, whether conducting meetings via Zoom or participating in virtual events.  

Previous research we conducted found that 69% of global workers think access to physical health services through their phone would help them better manage their physical health, whilst over three quarters said the same about convenient access to exercise or health appointment options online. It’s clear that even though our lives have been dominated by technology during the past year, employees view health and well-being services through technology as a positive and are keen to see more of it.

Harnessing digital solutions, including telemedicine, will allow employers to more easily cater to the hybrid workforce, as well as help them tackle the long-lasting mental and physical effects caused by the pandemic. In addition, anonymised employee health data could help companies to adapt their digital health benefits and make them more personalised. In fact, our research found that 80% of people would willingly share their anonymised health data if it would help to improve their health and well-being benefits at work. Of course, employees must also feel reassured that their data is secure and won’t be used for purposes outside their consent.

Building the future of virtual solutions and telemedicine

Although telemedicine has been available for some time, the pandemic has helped to establish it as a practical and convenient health care solution. The increased use of telemedicine has changed the way people think about access to health care, and people are now more likely to expect easy digital access to general health information, e-prescriptions in some cases, as well as convenient appointments and quick advice about condition management, for example.

The benefits of telemedicine go beyond this though, and as its role in our everyday lives increases, so will awareness of the benefits it can bring. For instance, dealing with health issues can be stressful and scary, but services such as Aetna International’s vHealth give patients the opportunity to store and access all health documents in one place, making communications between the patient and health care professionals more streamlined and connected. What’s more, employers with workers based in various locations needn’t worry about a service only benefitting some employees, as many services are offered around the world, and in multiple languages.

Telemedicine will never be able to fully replace traditional health systems (and nor should it) but it will certainly be an essential part of them; increasing their scope and easing the burden on currently overtaxed systems. As we move into the next normal, I’m confident that digital health solutions are here to stay, and will only become more embedded in day-to-day life. Employers will need to ensure these are part and parcel of their health and well-being strategies, to help their employees achieve the best possible health outcomes.

• 35.5% of expats added family members to their current insurance plan due to the COVID-19 pandemic;
• 24.5% of expats took out a new policy to provide cover for their family members;
• 82.6% of expats developed healthier habits during COVID-19 crisis.

The data has been revealed in the 'Expat Family Wellness Survey 2020: The Impact of COVID-19', published by international health benefits provider, Aetna International. The report, which surveyed 1,000 expat families in the UK, US, Singapore and UAE, explores the effect of the COVID-19 pandemic on expat family health and well-being. It investigates how expats managed both their own and their children's health and well-being during the pandemic and subsequent lockdowns. 

The survey found that in response to COVID-19, a quarter of expats (24.5%) took out a new insurance plan to provide cover for their family members. Adding to this:

• 35.5% of expats added family members to their current insurance plan 
• 15.9% didn't buy extra cover for their family members, but did consider it
• 7.3% didn't buy extra cover for their family members but would consider it for the future
• Only 16.8% did not buy extra cover for their family members

Overall, 60% of respondents either added family members to an existing insurance plan or took out new cover so their immediate relatives could be added. Globally, 33% of expats already had health insurance to cover themselves and their family members. 

iPMI and improved access to health care

With access to health care a key issue for many expats, it is unsurprising to learn that 60% of our respondents added family members to an existing insurance plan or took out new cover so their immediate relatives could be added. A further 23.2% said they have or would consider buying additional cover due to the COVID-19 pandemic.

45% of expats with health insurance in the U.S. added their family to their current health care plan due to the COVID-19 pandemic. While in the UK, 33% said that they took out new plans. These figures are higher than in the UAE and Singapore, although this is probably due to higher rates of cover in these regions, insurance being mandatory for most expats in UAE — and 45.2% of respondents from Singapore already had cover for the whole family.

While expat concerns around health care access have grown, insurance has offered many families peace of mind. As well as providing members with the insurance safety net, international private medical insurance providers, such as Aetna International, can help to improve physical and mental health by offering well-being resources such as mental health apps, fitness membership discounts and virtual health services.

Speaking in our video on virtual health and its benefits for expats, Richard di Benedetto, President, Aetna International, said: “It helps when you are an expat and you’re not familiar with the environment.

“If you are in Singapore, or in Africa, and you think that you have fever or a cough you can immediately consult with less than a half hour waiting time, a doctor through a video call. And he will see all your medical conditions and he can give you advice, or he can give you a diagnosis.”

Regional differences

Expats in Singapore and the UAE were most likely to already have health insurance for themselves and their family members, at 45.2% and 37.2%. This is higher than the global average of 33%. 

Only 21.6% and 28% of expats in the UK and U.S. already had health insurance for themselves and their family members. However:

• 45.9% of expats in the U.S. who said that they already had health insurance, added their family to their current health care plan due to the COVID-19 pandemic
• 33% of expats in the UK who said that they had health insurance bought a new plan so that family members would be covered

An increased awareness of health

These findings suggest an increased awareness of health and health care and the value of health insurance during the COVID-19 pandemic, which is strengthened by the fact 82.6% of expats developed healthier habits during COVID-19 crisis.

Of the 82.6% of expats that developed healthier habits during COVID-19 crisis, 69.5% did so because the pandemic made them aware of their own health. Adding to this:

• 27.5% of expats said that they have been meaning to improve their health for a while
• 3% of expats developed healthier eating habits because they are an at-risk group 

The UAE and Singapore have the highest percentage of participants that have developed healthier eating habits (89-90%), since the onset of the pandemic, closely followed by the U.S. with 84%. The UK has the lowest number of participants who have developed a healthier eating routine due to COVID-19 at 67%. 

Dr Hemal Desai, Global Medical Director, Aetna International says, "The health crisis has clearly made people more aware of their own health. It's heartening to see that people have been developing healthy habits to keep themselves well. Private medical insurance has become increasingly important for expats as a means of protecting one of their most valuable assets – their health and the health of their families. Organisations like ours are more than just an insurance provider. At Aetna, we are a health and wellness partner helping people access health care solutions for physical and mental health in a way that suits them, both online and in their local community. As the impact of COVID-19 continues it is more important than ever that people protect their own health and that of their family."   

The full report can be seen here: https://www.aetnainternational.com/en/about-us/explore/living-abroad/expatriate-life/expat-family-wellness-survey-2020.html

Nothing has accelerated the take-up of virtual health services more than Covid-19, so are we looking at lasting changes in consumer health care behaviour? asks Dr Sneh Khemka, VP of Population Health, Aetna International.

With the legacy of lockdown still fresh in our minds, many simple tasks have suddenly become much more complicated. Activities that we previously took for granted in the western world, such as visiting the doctor to access everyday treatments, are now clouded by concerns around social distancing and the risk of infection.

Fortunately, we live in a digital age. The world may have suffered a serious setback, yet technology is providing the health and well-being industry with more options than ever before.

Putting technology to the test

Telemedicine has been around for some time now but, ironically, it was only when Covid-19 brought the world to a standstill that individuals and businesses started to realise the true value of this provision. With the help of smartphones, virtual health services allow people to book consultations and speak to doctors as often as they like, by telephone or video call. In some cases, they can also get prescriptions, referrals and treatment plans sent directly to their phones too.

Rather than postponing appointments or delaying treatments, telemedicine means that people have been able to continue to access the health care support they need, without ever leaving the house. For anyone living alone through lockdown, dealing with a chronic illness or worrying about a family member, this will have been a route to a much-needed lifeline, offering a great deal of reassurance during a difficult time from the comfort and safety of their own front room.

Moving forward

In my experience, when people do give telemedicine a go, they rarely look back. It’s something I’m starting to see more and more with our own customers. Last year, for example, we had a young woman arrange a video consultation after having a dry cough for several months. This was prior to Covid-19, so there was no need to be too alarmed, but she was getting increasingly worried because the symptoms weren’t going away. To put her mind at ease, she booked a video consultation.

After asking a few medical history questions, the doctor discovered that she’d been to several physical clinics about the same complaint before. She wasn’t a smoker so had been prescribed a number of medications, including a high dose of steroids, which hadn’t worked. When the virtual examination showed no signs of respiratory or ENT problems either, it led the doctor to correctly diagnose her with gastro-oesophageal reflux – a common condition for young people.

Remember, the assessment was all done by video call. But by asking the right questions and conducting a thorough virtual examination, it was possible to diagnose a condition that previous doctors had missed. The woman was prescribed new medication, which ultimately resolved the problem. And when she next had a health worry, it won’t surprise you to learn she turned directly to a virtual health consultation again.

Holistic Approach

What’s particularly interesting here is the holistic approach of the doctor. By taking the time to ask detailed questions and review the symptoms thoroughly, she was able to find a solution that had eluded so many others. In many ways, this is what makes telemedicine unique. Doctors are encouraged to take as much time as they need to fully understand the symptoms, and it seems to be paying off.

However, when you’re dealing with health and well-being, it isn’t easy to alter habits. People find it hard to believe that the same quality of care is possible without being physically in front of a GP, which can lead to reticence in booking virtual consultations. Nonetheless, when you see the meticulous process that virtual doctors go through, you start to understand how they can be so precise.

Embracing the new normal

When Covid-19 was categorised as a pandemic in March, many health care organisations started to promote their telemedicine services as a viable alternative to face-to-face consultations. The need for no contact provided a whole new perspective, and proved to be a real turning point in terms of usage and attitude. For some, it was also a source of comfort – we received many calls from members in rural areas of India, for example, who were lacking reliable information and therefore felt very scared. A call with a professional medical practitioner who could relay the latest guidelines on hand hygiene and social distancing offered some much needed reassurance.

We also received calls from people concerned that they had coronavirus symptoms but were stuck abroad due to lockdown measures, and were either not familiar with the health care system or were too scared to leave their accommodation. In these situations, virtual health consultations could assess the likelihood of the virus or diagnosis other illnesses – a case in point is a 62 year old English woman, trapped in Italy, whose breathlessness was actually acute bronchitis for which inhalers and other medications were required.

With the service more accessible, people are starting to realise that video consultations are both more convenient than face-to-face appointments and just as effective or in some cases, even more so. When you think about it, of course, technology is being used effectively in all aspects of the modern world so there’s no reason why health and well-being should be any different. Covid-19 has simply been the catalyst that that made people sit up and take notice.

Progressing in the right direction

Perhaps the biggest endorsement of telemedicine is that, when people finally get round to using the service, they choose to stick with it. There are plenty of plus points for businesses too. Any company that’s looking to reduce absence, increase productivity and cause minimal disruption to its working schedules, only has to look at the numbers. Our latest figures confirm that 86% of employees who use virtual consultations save themselves time away from the workplace – with an average of almost 4 hours saved by every appointment.

If the last few months have taught us anything, it’s that, in the interest of our health and well-being, we sometimes have to change and adapt to the situation around us. Telemedicine is a prime example of how digital innovation can give us more options. It’s already proving an invaluable tool to help people navigate Covid-19 and giving us a glimpse of how health care might look in the not too distant future. And in my opinion, we’re looking at a change that will be long-lasting in consumer health care behaviour.

Majority of employees are worried that sharing personal health data with an employer could lead to it being used as a criteria for promotion or as a means of establishing salary.

The majority of employees think businesses should provide more physical and mental health support through technology, with apps, wearables and online services high on the list of demands, according to new research published today by Aetna International. However, there is also clear concern around the use of personal health data by employers on an individual basis, according to the global survey involving over 4,000 employees in the US, UK, UAE and Singapore.

The study, designed to assess the impact of technology on health at work, found that 71% believe their employer can help them manage physical health better through technology, while 61% say the same of their mental health.

Over two thirds support the provision of a smart watch or fitness tracker to benefit mental and physical health and three quarters use or would use an app to help manage mental health. Additionally 69% believe access to physical health services (provided by their employer) through their phone would help them manage physical health better, with that figure rising to 75% for mental health services.

However, the findings also highlight employee concerns around personal health data being used by employers or shared with third parties. Over six in ten worry it could one day be used as a criteria for promotion and a similar number that it might be a means of establishing salary grade (64%).

Most employees surveyed had concerns about their employer sharing their personal health data with third parties (67%) or government agencies or institutions (57%).

Richard di Benedetto, President at Aetna International, said: “Technology has not only revolutionised how we collaborate, communicate and work, but also how organisations help support and improve employee health and well-being. In the current climate, high-tech, high-touch corporate well-being strategies that include apps, devices, and virtual access to care services are high on the list of employee demands. Businesses have a significant opportunity to embrace technology and innovation and fundamentally change their values, culture and approach to employee health.

“Of course, with more digital innovation comes more data, and a greater need to alleviate employees’ concerns about the use of their health data. All employers are responsible for the privacy and protection of their employees’ health data, ensuring that individuals retain ownership and control.

“Interestingly, our research shows that when data is used responsibly, many people are open to sharing anonymised health data. This suggests employees understand the powerful role technology can play in enabling and informing a business’s strategies. If handled correctly, it presents an incredible opportunity for employers to foster trust, and for all parties to help shape the corporate culture and approach to workforce health and well-being.”

Circumstances where employees indicated they would willingly share their health data include helping to improve health and wellness benefits offered across the business (80%) and helping their business to offer more personalised health benefits (74%).

Over two thirds also said they would share personal health data if it helped to improve company culture (69%), while 75% would do so to help improve workplace policies. 

Despite over a third (40%) of workers globally revealing they are worried about their long-term health, 40% admit they haven’t had a health check in the last year and a significant number have no idea about simple measures of health, such as cholesterol levels, according to new research published today. Inflexible and long working hours are compounding the problem, as employees feel unable to take time off to manage their health.

The findings are revealed in the second of two new Business of health 2020 reports, How organisations can overcome employee health inertia, from Aetna International, a leading global health benefits provider, which explores the attitudes to health of 4,000 office workers in USA, UK, UAE and Singapore, focusing on the health fears of today’s workers and probing the gaps in their own health knowledge.

Despite the fact that 96% of those surveyed think about their health at least some of the time, 40% do not go to the doctor to get health issues checked, even if they are concerned, and nearly a quarter (24%) say they are too scared to get a health check.

To compound this, very few know basic indicators of their own health – only 1 in 3 (33%) people know their cholesterol level or body fat percentage (29%). Although, overall, employees in the UAE and Singapore have a better knowledge of health measurements like blood pressure, cholesterol and body mass index (BMI) than those in the US or UK.

Most workers globally acknowledge they could do more to improve their health, with over half (55%) admitting their diet needs improvement and nearly three quarters (72%) saying they need to exercise more. When people do feel ill, however, 40% say they tend to look up symptoms online and self-medicate rather than seeking out a doctor.

Dr Sneh Khemka, President, Population Health & vHealth, Aetna International, said: “While the majority of workers are aware they need to do more to improve their health, fear and worry is causing a huge number to avoid the situation. More should be done to empower people to manage their own health, with a focus on changing company cultures to promote prevention and early intervention. It is not only the responsibility of the employee but that of the employer to ensure people are equipped to lead healthy lives.”

Increasing pressure in the workplace is having a significant impact on how people prioritise their health. Almost half (47%) of those surveyed admit that they often feel stressed because of work but don’t see a health care professional about the issue. Long and inflexible working hours may be to blame, as a third say they don’t have time to be ill at work and nearly a quarter (21%) cite lack of time off from work as the reason behind their health inertia.

Results also indicate that employers could play a bigger role in encouraging people to look after their health, with over a quarter (27%) of office workers admitting they would go to the doctor if their boss told them to. Nearly half (46%) also said the ability to take time off work to go to the doctor would encourage them to make an appointment.

Additionally, better access to online health consultations would encourage nearly a third (31%) to get regular check-ups, while over a third (35%) would like the use of an app or online service.

Dr Khemka continued: “Expanding access to health care is imperative to ensure today’s time poor workers prioritise their health. Technology can undoubtedly play a role here, but businesses also need to ensure they create a culture where people can talk about and take time for their health needs.”

Aetna International, the global health benefits provider, is launching a ‘vHealth at Home’ service for London-based customers, enabling a doctor to visit you at a location of your choice, such as work or home, within four hours of being booked – and often quicker.

Initially available to Aetna members within London Zones 1 to 4, ‘vHealth at Home’ improves ease of access to GP assistance, saves time spent travelling and in waiting rooms, and acts as a complement to Aetna’s existing digital primary care doctor service, vHealth.

During your appointment, the visiting primary care doctor – who will be both GMC-registered and NHS-trained – will be able to provide everything you’d expect from your regular GP consultation, including the assessment and treatment of minor illness and injuries, providing prescriptions and sick notes, and making referrals when appropriate.

Being able to have a fully qualified GP come to you and consult face-to-face addresses a well-documented gap in the current marketplace. A recent survey revealed that two in five employees are worried about their long-term health but haven’t had a health check in the last year, and almost a quarter (23%) cite a lack of time as the reason. There has also been a 15% increase year-on-year in patients waiting a month for a GP appointment.

“Health care consumers want convenience. In an era where professionals are increasingly time-poor, it can be challenging to schedule an appointment with a GP at a time and place that works for you, let alone set aside time to travel to the surgery and spend in waiting rooms,” comments Dr Anushka Patchava, Global Proposition & Strategy Lead, vHealth, at Aetna International. 

“A review of our existing digital virtual health provision showed that our members report saving an average of 4.5 hours per appointment – a substantial amount of time from both employees’ and employers’ perspectives.  However, there are still occasions when someone might prefer to see a medical professional face-to-face. As a high-tech and high-touch solution, ‘vHealth at Home’ provides this, and ensures our customers have increased access to high quality, personalised, round the clock, primary care. In essence, it takes the hassle out of health care.”

In partnership with Qured, a revolutionary health care company specialising in delivering doctors and physiotherapy services to the consumer, ‘vHealth at Home’ will be available between the hours of 8.30am and 9.30pm, seven days a week, 365 days a year.

Bookings are made online and, during doctors’ working hours, the assigned doctor will phone within 10 minutes of this booking for an initial assessment (triage), to provide reassurance and ensure it is not a case for emergency services. It’s also possible to book an appointment for the next-day, ensuring not only convenience but flexibility.

Damian Lenihan, Executive Director, Europe, at Aetna International comments: “We’re always looking for ways to lead positive change and deliver the best health outcomes for members by merging new tech, new business models and new partnerships. Introducing the ‘vHealth at Home’ service to our London-based members is a case in point, and a further step towards engaging people with the care they need, when they need it.  Above all, it underlines our commitment to innovating with our customer at the forefront, in order to create a more accessible and patient-centric health care system.”

Brokers will be informed today about the launch of ‘vHealth at Home’ at Aetna International’s bi-annual Health Matters Forum event, held at the Bulgari Hotel, Knightsbridge.

Leading global health and wellness benefits provider Aetna International has released a paper Bespoke health promotion: How personalisation is transforming health, which examines the importance of bringing together health and lifestyle data with advances in genetic profiling and technology to help tackle the rising global disease burden. The organisation believes the future of health care lies in the worldwide adoption of a more predictive, preventative, personalised and participatory approach to health; one that enables people to be more actively involved in their own health and well-being.

Highlights:

• 40 percent of premature deaths are the result of individual behaviour, with obesity and smoking as the leading causes of death.
• Genetic predisposition and social circumstances are also important factors.
• Advances in science and technology can help curb the rate of premature deaths, by predicting and preventing health episodes before they happen. 
• Aetna International explores a holistic approach to individual health, partnering technology with expertise from health care professionals.

Global increases in lifestyle-related diseases are placing significant strains on health systems around the world. An increase in chronic diseases, coupled with the fact that people are living longer, is resulting in the need for more expensive and longer-term treatment. Recent research has shown that 40 percent of premature deaths are the result of individual behaviour, with obesity and smoking leading the way; other contributing factors are social circumstances like poverty and genetic predisposition. Although genetics are a lesser factor than scientists once thought, they, along with individual behaviour, must be taken into consideration when determining the best approach to reducing the rising global disease epidemic.

Aetna International maintains that the examination of both sets of an individual’s data - their unique biological identity and their lifestyle behaviours - can help to provide insight into their future health. Such insights can be used by health professions to empower individuals to make appropriate health and medical decisions.  However, Aetna warns that whilst results can be enlightening, a genetic pre-disposition for developing a certain disease is also no guarantee that the disease will ever develop.

Caroline Pain, Senior Vice President, Customer Proposition, Aetna International says: “We are extremely interested in the potential to use genomic data as part of an overall appraisal of a person’s health status. That way, we can work with them to agree the best care pathway and hopefully prevent the onset of inflammation or disease.  A critical step in determining the best treatment is an holistic view of the patient - their symptoms, family history, circumstances and biomarkers – combined with expert guidance from a geneticist and the provision of genetic counselling for the patient. Technology such as wearables can also support a pre-emptive health approach by helping individuals make healthy choices. However, it is important to recognise that while some individuals will respond to a chat bot, others will respond better to social and physical intervention.”

The organisation argues that delivering hyper-personalised health journeys will help to increase healthy outcomes at an individual level and will make disease care radically more cost-effective at a population level.

“It’s important to meet people where they are. If we are to engage people in their journey to better health, we need to make health care more personal, more local and more integrated into the technology they use every day. If we can meet people where they are, and if we can offer health care that is tailored to them, the chances are high that they can live longer and healthier lives,” concludes Caroline.