This Closed Door Executive Round Table Business Forum Takes A Look At International Medical Cost Containment Strategies, In A Post Covid-19 World.

A lot has changed since global lock downs grounded flights, halted travel and screwed up business. What a 2 years it was. Emerging from the other side, we speak with international healthcare leaders about what has changed since the pandemic, and the journey the global health insurance market is navigating to insure against future risks. As always, the dialogue and debates were highly educational.

Round Table Executives

Elena Donina Glukhman

AP Companies

Nicole Perreault

AXA Partners US

James Walker

Charles Taylor Assistance

Dr Peter Mills

Cigna Europe

Susan Yates

Falck Global Assistance

John Speers

Global Excel

Monica Rummelhoff

GMMI

Gitte Bach

New Frontier Group

Mike Rizo

Pharmcare

Sumit Gaurav

Roy Medical Assistance

Alerah Turner

World Travel Protection

How To Download International Medical Cost Containment Strategies 2022

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In this article, iPMI analyst Ian Youngman, author of the IPMI market leading report, International Health Insurance 2021 talks about how AXA has left the Middle East and why the press announcements underplay how big a deal this is.

AXA has almost completed an exit from Abu Dhabi, Bahrain, Dubai, Oman, Qatar, Saudi Arabia and all UAE states.

It still has a presence in Lebanon but a local TPA manages health insurance.

That it has sold to a local group – is huge. That the local group is part owned by a Canadian group  seem incidental until you get that Canada goes its own way from the USA and Europe in global politics.

There is a shift to local regional groups in Asia, Europe and the Middle East.

The Middle East was once the go to place for brokers and insurers in health insurance- it is being replaced by Africa and South America- and China.

With compulsory health insurance in many countries the region has almost peaked. The competition is hot and with increasing regulation and competition from local insurers, making a profit may be Ok now but not in five years time.

Expats are being replaced- often by law- with locals. Most expats are not the “white middle class Europeans and Americans" that you still see pictured in IPMI brochures – but low paid Asians and Africans- with an increasing number of professional Chinese.

Some US and European insurers and brokers also see that as the US and Europe are losing influence in the region- to be replaced by China, Iran and Russia.

That the US, UK and some European allies tried to import their democratic and business models into Afghanistan and Iraq for 20 years and dismally failed- does have a knock on effect on insurance groups.

Insurers may think they are above politics, but what your country does to other nationalities does rebound onto your company in those countries - we do not live in a bubble.

Insurers and brokers may still make money out of health insurance in the region but rising healthcare costs and increased regulation is going to make it harder.

Many Gulf countries are still trying to move away from dependence on oil to other industries but from being cash oil rich they are all – to some degree- struggling. Many saw tourism and inbound international investment as their saviours – Covid has damaged the first and there are not enough international investors to go round as they too see better long-term potential in Africa. China or Latin America.

What is certain is that other insurers will follow AXA out of the region as they look at their 5 year strategies on where they want to stay, move into, expand, or exit.

For the author it means daily work updating my country and company databases - to ensure my IPMI market reports are up to date.

Looking back at what happened in the last five years and extrapolating that forward is how many reports still work – but that process is so out of date.

RELATED READING: International Health Insurance 2021

In this exclusive iPMI Magazine interview, Christopher Knight, CEO, iPMI Magazine, meets with Steven Om, General Manager of Global Excel Indonesia. They discuss in detail the key benefits of the brand-new Hospital Express Discharge Program, designed to drastically reduce both the waiting period and the paperwork associated with the discharge process for patients leaving Indonesian hospitals.

Tell us about Global Excel Indonesia:

Global Excel Indonesia was originally an ISOS organization. Global Excel acquired the company as a joint venture in 2017. Today, as part of the Global Excel family, we offer customer-centric insurance solutions to individuals and corporations in Indonesia. Global Excel Indonesia specializes in navigating the complex processes of Third-Party Administration, comprehensive claims management, assistance, and cost containment.

What is the Hospital Express Discharge Program (HEDP), and what does it aim to accomplish?

Our brand-new Hospital Express Discharge Program (HEDP) aims to simplify the traditionally complex discharge process for any type of patient admitted to an Indonesian hospital, while significantly reducing the normally lengthy wait times they experience once discharged.

How will reaching those goals help improve things for patients, payors, and providers?

For patients, the HEDP means that once they’ve been discharged by their attending doctor, they’ll be able to leave the hospital in an hour or less, instead of the usual 4 to 8 hours. It also means less paper-work – a lot less: no reimbursement forms to fill out, and no back-and-forth to figure out what’s covered and for how much.

For payers, it means an improved customer journey, in particular with the hospital claim process, whose relevance is amplified in these challenging pandemic times. This leads to higher member satisfaction, retention rates and new sales opportunities.

For providers, they’ll appreciate the simple administration process – a single complete payment from the payer rather than 2 different payments from the patient and payer for uncovered and covered amounts.  This will help with billing reconciliation and improve the overall hospital experience for their patient.

Is the HEDP unique in its field? If not, what does it do that others don’t?

Most insurance companies usually offer some sort of service related to hospital discharges. Some focus on document preparation, others concentrate on logistics while still others offer streamlined payment services. As far as we know, we’re the only company to combine all of these and more to offer a very simple, very sure, and very speedy discharge where all parties are satisfied with the win-win-win outcome.

What inspired the creation of the HEDP?

At Global Excel Indonesia, we’ve always found feedback – from members, clients, and providers – to be extremely valuable. So, we analyzed the hospital discharge process, a known pain point for all involved parties, to see where we could make improvements. From our desire to simplify and improve this process, the HEDP was born. 

Will the HEDP stay regional, or will it expand beyond Indonesia?

For now, our expertise rests upon our familiarity with the Indonesian healthcare system, so that’s our current focus. However, we’re confident in the success of the HEDP, and will certainly be open to expanding this service throughout the greater region.

Healthcare International (“HCI”), the leading international private medical insurance MGA for expats, is pleased to announce that it has been acquired by its management team led by Ian Wood and backed by Prefequity.

As part of the transaction Prefequity will provide HCI with additional capital to accelerate its growth. This will enable HCI to strengthen its management team further, expand and diversify its product range, and enhance its strategic partnerships with intermediaries and insurers.

This transaction provides a successful exit for the founders, Shane Younger, Christopher Percival and Kieran Linehan, who have retired from the business after 17 years of service.

HCI delivers a range of comprehensive, flexible and competitively priced insurance products for expatriates, globally mobile workers and travelers in over 100 countries worldwide.

HCI aims to provide policyholders and brokers with high-quality policies backed by market-leading service levels including 24-hour, 365-days-a-year assistance, wherever they are in the world.

New Management Team

HCI will be led by CEO Ian Wood, who has been with the Company for 18 months. Ian, a qualified chartered management accountant, has over 30 years’ experience in insurance and broader financial services with a proven track record of delivering both growth and robust governance. Prior to HCI Ian spent 7 years at First Central Insurance as Finance Director and Board Member as it evolved from entrepreneurial start-up to one of the leading independent UK insurers.

Supporting Ian will be Andy Kirby as COO. Andy has 30-years experience in the general insurance sector and has held many senior roles including: Head of Underwriting and Claims (GRE/AXA), Head of Insurance (Virginmoney), Placement Broker (HSBC/Marsh), and Senior Risk & Regulatory Consultant (PwC / Deloitte). Andy has recently been appointed a Justice of the Peace for the Criminal Court in Suffolk, England.

About Prefequity

Prefequity is an independently owned investment firm that provides a blend of debt and equity to support the ambitions of high-quality management teams.

Prefequity has a successful track record of investing in UK-based businesses looking to execute international growth strategies.

Ian Wood, CEO at HCI, said “We are delighted to have secured Prefequity’s backing for our growth plans. This will enable us to bring new and improved products to the market to deliver even better value and service for our policyholders. We look forward to announcing further details in the near future.”

Johnny Carew Pole, Partner at Prefequity, said “We have been impressed with the resilience and flexibility of HCI in the face of the pandemic. HCI is assembling a highly experienced and proven leadership team to drive the business forward and deliver a market-leading insurance service for expats. Ian has done a fantastic job to date and we are delighted to be backing him to execute the next phase in HCI’s journey.”

Bupa has announced that James Lenton will become Bupa’s new Group Chief Financial Officer, subject to regulatory approval.

In his previous role, James was CFO of Hammerson plc, a FTSE 250 owner and manager of properties with a European portfolio. James will join Bupa later this year, and Martin Potkins will continue as Interim CFO until then.

Prior to Hammerson, James was both CFO, and a board member of AIG’s European Group, a position he held for four years, delivering new profitability and financing strategies. Earlier in his career he was a Partner at EY providing a range of assurance and advisory services including M&A, financing and external audit. His clients included FTSE 100 companies and financial services groups.

Iñaki Ereño, Group CEO, Bupa said, “I’m very pleased to welcome James to Bupa later in 2021. He brings a diverse range of experiences to the role, including an excellent track record of managing complex organisations through periods of transformation.”

James said, “I’m delighted to be joining Bupa at this exciting time in its journey, and I look forward to supporting Iñaki to position the organisation for continued success in the future.”

• More than three quarters (76%) people in the UK are currently stressed
• More than half (51%) of Brits fear for their future
• Money worries driving surge in anxiety

New research from global health service company Cigna Europe has revealed that uncertainties about the future along with worries around personal finance are the leading causes of stress amongst UK workers.

As 2020 draws to a close and the pandemic continues on, Cigna’s COVID-19 Global Impact Study unveils more than three quarters (76%) of Brits are currently stressed, more than half say uncertainty about the future is the leading cause, followed by personal finances (32%) and the amount of news/information related to COVID-19 on the media (32%).

As news of a vaccine continues to dominate the headlines, the study also shows that Brits have concerns about returning to work when rules are relaxed, with 40% concerned about catching the virus during their commute, 37% are worried about an outbreak returning when mixing in the office whilst 36% have worries over restrictions they will face in the work environment. Many workers feel financial support from their employer for COVID testing would be a key incentive to returning to the workplace.

“The COVID-19 pandemic has impacted almost every part of life across the globe and continues to play a major part in fueling stress”, said Arjan Toor, CEO, Cigna Europe. “It’s evident from our research that people are weighed down by this stress, with anxiety around income and future prospects in our new world the leading causes. This is in stark contrast to our first Impact study in April which showed that 78% of UK workers felt they had good job stability. It’s been a tough year for many, and it is naturally worrying to see so many people stressed about their future.”

The ‘always on’ corporate culture has grown rapidly since lockdown began in March, with almost 7 in 10 (68%) of workers always-on, more than half (54%) are working after working hours, 50% before working hours, and more than 4 in 10 (43%) are working on weekends. Encouragingly however, employers are remaining more flexible as the pandemic continues. The most popular measures put in place by employers are flexible working location/hours (37%) and mental health support (29%).

Toor added: “The emotional toll the virus has had on so many people, not to mention the experiences of isolation, loneliness, financial hardships and mental health trauma cannot be underestimated. As the year draws to a close, we need to look ahead to 2021 and how we, as a whole health partner, can intuitively understand our customers in this increasingly complex world, and support them in each and every aspect of their lives.”

The Cigna COVID-19 Global Impact Study is an ongoing study that has been conducted by Cigna, in partnership with Kantar, between January and October 2020, and will continue into 2021. To date, more than 23,000 online interviews have been conducted across China, Hong Kong, Korea, New Zealand, Singapore, Spain, Taiwan, Thailand, United Arab Emirates, United Kingdom and United States.

The study was conducted using an online survey, with respondents recruited from online panels and undergo rigorous quality control. Age, gender and residing city quotas were set based on the population proportion of respective markets. The 20 to 25 minutes survey was completed anonymously.

Read the full report here.

There’s no question that the landscape for international business travel has changed beyond recognition.

Recent research by the Institute of Travel Management found that 38% of corporate travel managers expect their firm’s travel plans and budgets for 2021 to be down by 25% to 50% compared to 2019. However, for many organisations that operate on an international footprint there is also an imperative to get employees moving again, and for expat workers to be located abroad. And with this requirement comes all the usual risks – as well as COVID-19.

In response, Healix International, the security and health risk management business has developed a new suite of tools to give risk managers vital control to meet their duty-of-care obligations. Healix Sentinel brings together five solutions to provide global organisations with vital tools to stay informed of the risks their employees and operations may face and take appropriate action wherever they are across the globe. 

“This year has been extraordinary and organisations around the world are adjusting to a new way of working to ensure business continuity and productivity,” explained Mike Webb, CEO of Healix International. “But remote working can only go so far, and it is critical for many businesses that travel resumes. While COVID-19 brings a new dynamic, all the other risks associated with working abroad, such as earthquakes, terrorist activities or staff experiencing other health related emergencies, remain.

“Whether it is risk associated with COVID-19, or a country’s political landscape, we understand the importance of balance. Excessive risk management programmes can be burdensome and costly, while inadequate cover leaves an organisation vulnerable to operational disruption, reputational damage and potential litigation.”

Developed by experts in crisis management and risk mitigation, the Healix Sentinel suite of services goes beyond the traditional travel risk space to focus instead on ‘people’ risk management, whether they are travelling or not. Another refreshing way the Sentinel platform stands out is the way the client risk manager – rather than the employee - is seen as the primary stakeholder. As Mike Webb adds; “Often the client only has a small team, or a single individual, responsible for risk mitigation. That’s a heavy burden. The Sentinel platform addresses that by making their lives easier and acting as a force multiplier.”

Risk managers can tailor Healix Sentinel to fit their own specific requirements, choosing the mix of services that will complement and support existing security resources. Alternatively, Healix International can provide a fully managed 24/7 ‘virtual’ security department, delivering timely, actionable intelligence using cutting-edge technology to provide location specific insights and monitoring of incidents. In doing so, it gives risk managers peace of mind that they are providing employees with the highest level of duty-of-care.

“Our holistic approach encompasses planning, preparing and taking appropriate action as and when required. By providing a solution scalable to specific needs, this new suite of offerings allows risk managers to capitalise on opportunities in challenging environments within their own risk parameters,” concluded Mike Webb.

“As well as helping tackle an organisation’s risk management concerns and giving peace of mind, Healix Sentinel helps an organisation maintain a competitive advantage and will enhance its reputation as a secure and compliant organisation.”

The Healix Sentinel range includes:

Healix Sentinel Protect

The flagship service gives risk/security managers 24/7 access to a team of crisis and risk management experts. From travel security briefings and situation updates to incident and crisis response and evacuations, it is a virtual 24/7 Global Security Operations Centre (GSOC). Risk managers benefit from tailored analysis, second opinions and bespoke risk assessments to proactively mitigate risks before they become problematic, and expert assistance when incidents do occur. Furthermore, the service can be tailored to be, or support, an organisation’s in-house resources.

Healix Sentinel Tracker

This tool allows risk/security managers to seamlessly monitor and account for their globally mobile workforce via integration with the Healix Sentinel Travel Oracle mobile app. Security alerts and notifications are issued in a timely manner and managers can quickly locate and communicate with employees during a critical incident to ensure their safety.  With ‘Location Services’ activated by employees on their app, risk managers are provided with an accurate, real-time global view of their employees on an interactive map.

Healix Sentinel Critical Watch

Providing a cost-effective solution to extend a security team’s capabilities, Healix Sentinel Critical Watch is ideal for organisations lacking the in-house resources to monitor employees’ safety around-the-clock. The Healix International team provides 24/7 monitoring of global incidents. And in the immediate aftermath of a critical incident, the team reaches out to employees in the vicinity who could be impacted. Their safety is ascertained, and appropriate action can be taken according to the situation.

Healix Sentinel Travel Oracle App

Available on Android and iOS, the Healix Sentinel Travel Oracle app is an invaluable travel safety companion for a global workforce. Through alerts and comprehensive background travel and security briefings on over 200 countries, it provides instant access to critical insight and support before and during overseas assignments. As well as providing current travel safety information, advice and real-time alerts on breaking news, the app has a tracking function and enables travellers to share live location data or manually ‘check-in’ at pre-agreed milestones with a direct feed into the Healix Sentinel Tracker platform.

Healix Sentinel Intelligence Portal

This portal is designed to provide risk managers with up-to-date intelligence on global risks that could impact their operations. The dashboard displays a concise summary of information relating to ongoing incidents, risk levels and trends. Alerts are updated to the platform in real-time by our risk analysts who monitor, verify and assess the impact of incidents as they happen.

The Intelligence Portal also has detailed intelligence summaries on every country worldwide, providing risk managers with in-depth contextual information. A number of different reports can be accessed such as a weekly forecast, evacuation watch and threat report.

Healix International is a global provider of travel risk management and international medical, security and travel assistance services. Working on behalf of multinationals, governments, NGOs and insurers they look after the welfare of expatriates, travellers, offshore workers and local nationals in every country of the world. Healix provide a comprehensive, integrated range of solutions to help safeguard the health and security of their clients’ employees, providing a single point of contact to access the expertise and help they may need, wherever they are in the world, 24/7.

For more information about Healix Sentinel please visit: www.healix.com

AM Best has affirmed the Financial Strength Rating of A+ (Superior), the Long-Term Issuer Credit Rating of “aa”, and the Mexico National Scale Rating of “aaa.MX” of Allianz México, S.A., Compañía de Seguros (Allianz Mexico) (Mexico City, Mexico). The outlook of these Credit Ratings (ratings) is stable.

The ratings reflect Allianz Mexico’s strategic importance as a subsidiary of Allianz SE (Allianz), which on a consolidated basis has a balance sheet strength that AM Best categorizes as strongest, as well as strong operating performance, very favorable business profile and very strong enterprise risk management.

Allianz is one of the world’s largest insurance groups, with superior diversification by geography and business line, and leading positions in many developed and emerging markets, offering a complete range of life and non-life insurance products, as well as asset management services. Its competitive position is supported by its scale, strong management capabilities, dynamic strategy and strong brand.

Allianz Mexico specializes in offering insurance coverages across a broad spectrum of categories in life, property/casualty, and accident and health. It is focused solely on Mexico’s market, and the insurance portfolio, as of December 2019, was composed of life (52%), property/casualty (33%) and accident and health (15%). The company operates life administration funds in its life business segment, consisting mainly of investment and savings products.

Allianz Mexico forms part of the IberoLatAm division of Allianz, and is identified by the group as one of the key regions of future insurance growth outside its core European markets. Allianz Mexico also is integrated in all core processes of the group, as well as in the ongoing strategic initiatives.

Operating performance is characterized by positive bottom-line results, derived from the company’s well-diversified business portfolio, and financial flexibility in terms of size, capital and reinsurance use. Underwriting practices are sound, and further benefit from the synergies provided by the group through the rest of its financial entities, which has enabled the company to contain operating expenses.

The group’s consolidated risk-adjusted capitalization remains at the strongest level, as measured by Best Capital Adequacy Ratio (BCAR), which fosters underwriting growth and provides financial flexibility. The company also is supported by an appropriate reinsurance program, placed mainly with Allianz, and has an adequate liquidity profile.

If there are positive rating actions on the main operating subsidiaries of Allianz, as a result of a sustained improvement of operating performance, the ratings of Allianz Mexico likely would move in tandem. Likewise, if there are negative rating actions on the main operating subsidiaries of Allianz, as a result of weakening in risk-adjusted capitalization below the level required for the strongest BCAR assessment, or a sustained deterioration of operating performance, the ratings of Allianz Mexico would mirror those same actions. A change in AM Best’s perception regarding the strategic importance of Allianz Mexico to the group also could impact Allianz Mexico’s ratings.

iPMI Magazine's CEO, Christopher Knight, speaks with Mary-Jo McDonald, Managing Director for Europe at Global Excel Management. They discuss in detail how COVID-19 has affected the industry, life after lockdown and the impact on the travel industry for leisure, business and student travel markets.

Broadly speaking, can you tell us what steps Europe is taking towards life after lockdown?

We know that European countries’ response to this pandemic has varied in intensity – from closed borders to domestic travel restrictions. Overall, Europe is pulling together, and many countries are moving towards opening internal borders before the end of June. This first step will have a refreshing impact on travel, hospitality and education – a variety of industries will be operational. There will be limitations though, in this “new normal”, which we are gradually settling in to. Social distancing, protective face coverings and hand washing are already accepted at large in European society. Travel corridors or air-bridges are being considered, ground transportation will be permitted, and non-essential travel will be allowed.

We’re optimistic, as many clients and partners are preparing for this first step – continental Europe will be open for business very shortly. We remain realistic, knowing COVID-19 won’t disappear overnight. What we expect is that many Europeans will be asking questions and looking for reassurance, especially concerning their health as they travel, first within Europe and then abroad.

Has Global Excel seen a significant increase in assistance requests during this pandemic? What changed and how did you adapt to this unprecedented situation?

We have seen an increase in assistance requests, from business travellers having to modify schedules, expatriates worried about being able to keep their appointment with a physician, students needing to quickly access care and many wanting to speak with a practitioner in a “virtual” environment rather than face to face. One key concern was being able to respond within a reasonable amount of time. To do so, we quickly shifted to providing information, support and guidance online either via chat, text or email. This significantly reduced call wait-times while responding to requests. We prioritized different request-types – medical emergencies remain our top priorities. We also deployed a COVID-19-specific version of our digital health solution, StandbyMD. This is a self-serve virtual assistant which enables travellers to quickly self-assess their symptoms, then select the best care option. Responding with minimal down time, in several languages, across several time zones was a big challenge, but our team made it work, to the satisfaction of our clients and their members.

How has Global Excel Europe weathered this pandemic?

Early in February this year, we started reaching out to our clients with regular updates on measures we were taking as a response to developing situations. At that time, many countries reactions and directives were varied.

Our concern was two-fold: to ensure we could quickly respond to members returning to their homes – business travellers, tourists and students – but also to respond to medical emergencies and answer concerns while directing them to the best care available in their area. Our second priority was our own employee health, with over 95% of them working safely from home. Transferring our staff and ensuring our systems were up and running within only a few hours is a testament to our leadership’s agile planning and to the commitment of our team members. We were even able to outsource our services to other companies struggling with the sudden increase in volume and complexity.

As the gradual exit from lockdown is being coordinated, what should business and leisure travellers expect and how can they best prepare themselves?

As travel restrictions are loosening up across Europe, we expect that travellers in general will have to focus on low risk areas, seeking information from governments and using “travel bubbles/corridors”. This means additional wait times at airports for screenings and decontamination processes, with physical distancing and face coverings which will likely remain a requirement. Many vacation areas, educational institutions, restaurants and airports have already adapted to these new directives, as well as places of worship, offices and government buildings.

More than ever, we believe that travellers’ best protection is research – being aware of government advisories and looking closely at their travel and health policies, knowing and understanding the limitations, but also reaching out to travel experts to discuss options. An ounce of prevention is worth a pound of cure.

Has access to healthcare for students, travellers and others changed? If so, what are some must-haves going forward?

Polls across different countries indicate that many students and travellers have accessed healthcare using some form of digital solution. In some countries, telemedicine was used, and in other countries a mix of video, text and email communication to engage with physicians has been preferred.

We’ve seen a greater demand for our own digital health tool. Many members appreciate that they can self-serve and choose the type of care they prefer, wherever and whenever. Digital healthcare and choice will be key to responding to needs during a pandemic, but also during any cautious recovery period. These solutions ensure that physical distancing directives are met, minimizing infection risks while reducing wait times. The future is digital, and having a great solution that combines flexibility, personalized care and cashless billing options with worldwide coverage will be the new norm.

How can Global Excel help insurance and assistance companies and their members (business travellers, expats, students, etc)?

Global Excel combines four elements to ensure our clients and their members consistently benefit from the best available care options, no matter where they are: flexible, comprehensive healthcare solutions; world class costavoidance and cost-containment services; FastTrack, our cashless out-patient solution; fully customisable networks across Europe.

As a global enterprise, we can easily assist travellers, expats, international students and those seeking major medical treatment anywhere in the world: a unique, reliable and proven offering from your trusted partner – Global Excel.