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UnitedHealth Group Reports 2016 First Quarter Results

UnitedHealth Group has reported 2016 first quarter results.

“Our commitment and determination to constantly improve how we serve customers and consumers in health benefits and services is reflected in consistent, market-leading organic growth and strong levels of customer retention in the first quarter,” said Stephen J. Hemsley, chief executive officer of UnitedHealth Group.

Based on the first quarter results and business trends, the Company now expects 2016 revenues of approximately $182 billion and adjusted net earnings in a range of $7.75 to $7.95 per share. The increase in the outlook for adjusted net earnings of $0.15 per share is due to changes in the expected income tax rate and intangible amortization. Management affirmed its outlook for strong cash flows from operations of up to $10 billion.

OVERVIEW

  • UnitedHealth Group first quarter 2016 revenues of $44.5 billion grew 25 percent or $8.8 billion year-over-year. Growth was broad-based and reflected growing market demand for the Company’s product and service offerings. UnitedHealthcare revenues grew 10 percent and Optum revenues grew 54 percent, with revenue growth of 20 percent or more at each Optum business.
  • First quarter earnings from operations were $3 billion and adjusted net earnings grew 17 percent year-over-year to $1.81 per share. As expected, the first quarter net margin of 3.6 percent decreased 40 basis points year-over-year, due principally to an increased level of pharmacy care services business.
  • First quarter 2016 cash flows from operations of $2.3 billion were 1.4 times net earnings.
  • The consolidated medical care ratio increased 30 basis points year-over-year to 81.7 percent in the first quarter of 2016, reflecting the extra calendar day of service in the quarter. Prior year medical reserve development was $360 million, compared to $140 million in the first quarter of 2015, and first quarter 2016 medical cost trends were well-controlled and consistent with management expectations.
  • The first quarter 2016 operating cost ratio of 15.2 percent decreased 110 basis points year-over-year primarily due to changes in business mix.
  • The first quarter 2016 tax rate of 39.8 percent decreased 350 basis points year-over-year from 43.3 percent in first quarter 2015, due to the adoption of a new accounting standard. Under the new standard, certain corporate tax benefits related to stock-based compensation programs are recorded through the tax provision. This new standard, which added roughly $0.06 per share to net earnings due to the concentration of activity in the first quarter, is expected to have considerably less earnings impact in the remaining quarters of 2016.
  • First quarter 2016 days claims payable of 51 days increased 4 days year-over-year and 1 day sequentially; days sales outstanding of 16 days increased 3 days, due to increased government receivables and business mix.
  • The Company’s financial position is strong, with a debt to total capital ratio of 49 percent at March 31, 2016. The Company expects this ratio to decrease during the second half of 2016 as debt levels are reduced. First quarter 2016 annualized return on equity was 19 percent, an increase of 1 percentage point year-over-year.
  • UnitedHealth Group repurchased 4.2 million shares for $0.5 billion in first quarter 2016, at a weighted average price of $119 per share.

UnitedHealthcare continues to consistently grow as more customers choose its products and services, due to the combination of distinctive service, product innovation and integrated clinical and network value they offer. UnitedHealthcare has developed a balanced mix of business across the commercial, government and international markets, reflecting its deliberate strategy of diversifying and serving the breadth of needs in those markets.

  • UnitedHealthcare grew organically over the past year to serve 2 million more people in the U.S. medical benefits markets, with well-diversified growth across commercial, Medicare and Medicaid offerings. First quarter growth contributed 1.3 million people to this total, helping UnitedHealthcare’s first quarter revenues grow $3.3 billion or 10 percent year-over-year to nearly $36 billion.
  • First quarter 2016 earnings from operations for UnitedHealthcare of $1.9 billion were roughly even with first quarter 2015, as strong growth largely offset a 60 basis point reduction in operating margins to 5.2 percent. The year-over-year margin decrease was driven by increased quarterly costs from an extra calendar day of service and public exchange performance, partially offset by reserve development.

UnitedHealthcare Employer & Individual

  • UnitedHealthcare Employer & Individual grew to serve approximately 700,000 more people in the first quarter and 1 million more people year-over-year. First quarter growth was well-balanced, with growth of more than 300,000 people in risk-based and nearly 400,000 people in fee-based offerings, including increases in people served through the fee-based national account, public sector, mid-sized employer, small employer and individual segments of the market.
  • First quarter revenues of $12.8 billion grew $1.4 billion or 12 percent year-over-year, driven by growth in the number of people served and price increases matching medical cost trends for risk-based products.

UnitedHealthcare Medicare & Retirement

  • First quarter 2016 UnitedHealthcare Medicare & Retirement revenues of $14.1 billion grew $1.3 billion or 10 percent year-over-year, due to consistent growth in services to seniors:
    • In Medicare Advantage, UnitedHealthcare grew to serve 325,000 more seniors year-over-year, a 10 percent increase, including nearly 300,000 seniors in the first quarter.
    • Medicare Supplement products grew 7 percent to serve 270,000 more people year-over-year, including 165,000 in the first quarter.
    • UnitedHealthcare’s stand-alone Medicare Part D program served 5 million people at March 31, 2016. UnitedHealthcare partially offset its planned 2016 pull-back in subsidized Part D products with an acquisition that broadened its Part D product portfolio, resulting in a net decrease of 70,000 people served in the first quarter.

UnitedHealthcare Community & State

  • First quarter 2016 UnitedHealthcare Community & State revenues of $7.7 billion grew $823 million or 12 percent year-over-year due to strong overall growth and an increasing mix of higher need members.
  • In the past year, UnitedHealthcare grew to serve 410,000 more people in Medicaid, an increase of 8 percent, including 145,000 more people in first quarter 2016. UnitedHealthcare continues to receive and implement new state-based awards, including serving 55,000 people as of January 1, 2016 under the New York Essential Plan and more than 200,000 people as of April 1, 2016 through the new Iowa Health Link program. UnitedHealthcare received a superior score on the re-procurement and program expansion serving Nebraska’s Medicaid program in 2017.

Optum is a health services business serving the broad health care marketplace, including payers, care providers, employers, governments, life sciences companies and consumers. Using advanced data analytics and technology, Optum’s people help improve overall health system performance: optimizing care quality, reducing costs and improving the consumer experience and care provider performance.

Optum’s growth continues to reflect its differentiated capabilities and comprehensive solutions for stakeholders broadly across the health care system, both domestically and abroad.

  • First quarter 2016 Optum revenues of $19.7 billion grew $6.9 billion or 54 percent year-over-year. Optum earnings from operations grew 49 percent or $364 million year-over-year to $1.1 billion, with solid operating margins from all business segments. Strong growth in pharmacy care services increased operating earnings and reduced Optum’s overall operating margin, which decreased by 20 basis points year-over-year to 5.6 percent.
    • OptumHealth revenues of $4 billion grew $709 million or 22 percent year-over-year due to growth in its health care delivery businesses, including expansion in neighborhood care centers. OptumHealth served 79 million consumers at March 31, 2016, for growth of 8 million people or 11 percent year-over-year.
    • OptumInsight revenues grew 20 percent to $1.7 billion in the first quarter of 2016, driven by growth in technology services, care provider revenue management services and payer services.
      OptumInsight’s revenue backlog grew to $11 billion at March 31, 2016, an increase of 21 percent year-over-year. Revenue backlog growth rates will fluctuate quarter to quarter, based on the timing of contract awards.
    • OptumRx revenues of $14.3 billion grew 72 percent year-over-year, driven by both acquisitions and organic growth. In total, OptumRx grew script fulfillment by 71 percent to 252 million adjusted scripts in the first quarter of 2016.
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AkesoCare Unveils New Corporate Branding

Akeso Care Management® (“AkesoCare”), a URAC-accredited international health care management company, has unveiled new corporate branding to reflect its commitment to clients.

A subsidiary of International Medical Group® (IMG®) — an administrator of global health care benefits — AkesoCare provides worldwide assistance and medical management services, including:

  • Emergency medical evacuations
  • International cost containment and Medical Concierge Service
  • Precertification and medical review
  • Wellness services and disease management
  • International workers compensation
  • Comprehensive case management

“These industry-leading services deserve a brand identity that matches the same commitment and passion shown by AkesoCare staff each day,” IMG CEO Brian Barwick said. “Refreshing the company’s brand will convey an even better sense of purpose to current and future AkesoCare clients.”

The new brand identity includes the revision of the AkesoCare logo, which reflects the company’s strong value proposition.

Now in orange, a combination of yellow and red, the logo evokes a sense of optimism and passion — the same traits AkesoCare employees convey as they coordinate both routine clinical care and emergency medical treatment for their members.

Additionally, the orange arrow in Akeso, a Greek word meaning “to heal or cure,” is the mark of the company’s mission to direct clients to safety, providing nothing less than the best possible medical care they can get.

As part of the rebrand, the company also launched AkesoCare Global, a new service line within AkesoCare focused entirely on providing clients the right care at the right price, globally. Established to decrease overall plan costs, AkesoCare Global uses proactive, concurrent and post-treatment strategies that help members save money and avoid unnecessary health care costs altogether.

AkesoCare Global’s proprietary cost-containment strategy provides more than 30 unique, proven cost avoidance approaches. Thus far, the strategy has demonstrated an average overall savings of 49.3% in the U.S.

“In the U.S. and many other countries, there is often no correlation between the cost and quality of care — with many providers charging bogusly inflated prices at whim,” said Andy Tibbets, vice president of AkesoCare. “AkesoCare Global is the watchdog of escalating costs, ensuring that clients and health care systems as a whole pay a fair price for the services and treatment delivered.”

These cost-containment strategies are just one component of AkesoCare’s commitment to clients. While the company’s services have expanded over the years, its focus remains the same.

“One thing that has never changed is AkesoCare’s focus on the health and well-being of its clients,” IMG President Todd A. Hancock said. “AkesoCare touches lives every day and our new branding reflects our continued commitment to serve and protect our clients.”

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Swiss Re Corporate Solutions Completes Acquisition Of IHC Risk Solutions

Swiss Re Corporate Solutions has announced it has completed its acquisition of IHC Risk Solutions, LLC from Independence Holding Company (IHC).

With this acquisition, previously announced on 5 January 2016, IHC Risk Solutions will immediately adopt the Swiss Re Corporate Solutions brand. IHC Risk Solutions' former president, Mike Kemp, will lead the North America Accident & Health Business Unit of Swiss Re Corporate Solutions.

Swiss Re Corporate Solutions offers innovative, high-quality insurance capacity to mid-sized and large multinational corporations across the globe. Our offerings range from standard risk transfer covers and multi-line programmes, to highly customised solutions tailored to the needs of our clients. Swiss Re Corporate Solutions serves customers from over 50 offices worldwide and is backed by the financial strength of the Swiss Re Group.

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Comprehensive Health Insurance Plans For Equatorial Guinea

Allianz Worldwide Care has partnered with Equatorial Guinea Insurance Company (EGICO) to create the most comprehensive group health insurance plans to date for companies employing both domestic and international workers in the country.

The plans offer the first health insurance solution for employers who require dedicated plans for their Equatorial Guinean workers and their international staff. The local plan, Salud GE, offers full domestic coverage within Equatorial Guinea. The international plan, Salud Global GE, offers coverage worldwide, outside of the United States, and is aimed at both Equatorial Guinean employees who may work abroad and expatriate staff living in Equatorial Guinea.

Susan Landers, Head of Market Management at Allianz Worldwide Care said, “Demand for comprehensive health insurance is growing rapidly in Equatorial Guinea and there was a real gap for corporate clients looking to provide their workforce with this benefit. Health insurance is a key factor in an employee benefit package. The comprehensive nature of these new plans, combined with our strong support services, will assist organisations in Equatorial Guinea in attracting and retaining highly-skilled employees.”

The partnership brings together the global reach and expertise of Allianz Worldwide Care and the on-the ground insight and knowledge of EGICO, a respected local provider. Both local employees and expatriates will benefit from a wide range of in-patient and day-care treatments together with in-patient direct settlement, while expatriates will also benefit from access to Allianz Worldwide Care’s extensive global medical network.

Michel Djimadou, CEO of EGICO said, “We’re delighted to have partnered with Allianz Worldwide Care to launch these plans, which were conceived and developed specifically for companies in Equatorial Guinea. When it comes to international health insurance, the options here were extremely limited until now. Currently, there is nothing available in Equatorial Guinea that is comparable to our partnership with Allianz Worldwide Care for local employees or expatriates.”

 

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International And Expatriate Healthcare And Insurance

Following the huge success of the 2014 IPMI report the new edition of International And Expatriate Healthcare And Insurance now includes more countries and insurers; new information on laws and regulations PLUS countries current attitudes towards expatriates. The 2016 report also includes more details of new health insurance laws locally in various countries around the world.

"...The most complete fact filled business report is back and better than ever..." Christopher Knight, CEO, iPMI Magazine.

To order this report please click here.

Want more info? Check out the report info pack here.

 

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Report: Insurance Is Absorbing Only A Fraction Of The Economic Impacts Of Terrorist Attacks

JLT Re and JLT Specialty Limited have launched a new report – Rising to the new terror challenge. The report is a detailed look at the evolving terrorist threat and the implications on terror (re)insurance cover.

Following a series of devastating bombings and shootings around the world in recent months, including the attacks in Brussels this week, the likelihood of a major terrorist attack is set to remain high, according to the report.

Commenting on the report, Chris Holt, Head of Credit, Political & Security Risk Consulting, JLT Specialty, said, “Terrorism has evolved into a more complex threat for businesses and insurers, with both attacks and fatalities seeing steep increases since 2011.”

“But this isn’t just about an increase in activity. The rise of Islamic extremism, combined with the potential access to weapons, explosives and toxic materials, comes at a time when modern communications and technologies are being exploited by groups as recruitment tools, communication channels and potential attack vectors. This means today's terrorist threat is more dynamic with impacts that are difficult to accurately predict”.

Paul Upton, Partner, Marine, Energy & Political Risk, JLT Re, said, “Clearly all of this has implications on the provision of terror (re)insurance cover. The market has been slow to respond and the fallout from several recent attacks has reinforced the need for new products. We are working with a number of market participants to deliver new and innovative products in this area. This can be done through the development of holistic solutions or, what is more likely in the short term, a suite of products that plug existing gaps.”

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Heading For Cuba? Don't Forget Your Proof Of Health Insurance

Cuba-bound Canadian tourists are urged to update their travel insurance documents and, if necessary, re-evaluate their coverage in anticipation of a huge influx of American visitors burdening the Caribbean nation's emergency health care infrastructure this coming fall and winter season.

With the signing of an agreement granting scheduled commercial U.S. airlines up to 110 flights to Havana and nine other outlying airports each day, Canadians and other nationals can expect more competition and higher prices for all of Cuba's goods and services—including care in local hospitals and clinics.

The Cuban Tourist Board (CTB) in Toronto has re-affirmed to Ingle International that all visitors to Cuba must carry proof of health insurance that will cover them while in Cuba. This requirement will apply to Americans as it has to Canadians and other nationals since 2010, when the measure was first passed.  Should visitors lack such proof, they will be required to buy coverage from Cuban insurance companies situated at or close by the various ports of entry.*

RELATED: VISIT TRAVEL WARNING NETWORK BY IPMIM FOR MORE ON MANDATORY INSURANCE FOR TRAVEL TO CUBA, CLICK HERE.

RELATED: Cuba: Health Screening At Entry PortsRead Now

A representative of the CTB emphasized to Ingle that, although proof of Canadian provincial health insurance will meet the entry requirement, such insurance will not cover in-country emergency health care services or air ambulance repatriation, and the individual traveller would be responsible for fully paying billed charges before being allowed to leave Cuba.

The Public Health Agency of Canada (PHAC) also warns that in most hospitals in Cuba guarantee of payment (or payment in cash) must be provided in advance; the agency also advises travellers to check with their insurance company for payment/reimbursement procedures. It also advises all travellers to Cuba to purchase travel insurance from Canadian companies before they leave Canada.

Robin Ingle, CEO of Ingle International, a company that handles international insurance products for most of Canada's major international travel insurers, cautions that hospital and clinic costs in Cuba can be quite high for tourists. Consequently, Canadians should purchase travel insurance that provides a suitable coverage level and doesn't require them to pay up front. This should save a lot of anxiety—and out-of-pocket costs.

"Each year, Canadians make over one million visits to Cuba, and most say they will definitely return. With the expected surge of U.S. travellers, the Cuban infrastructure might well be tested. We can only advise that Canadians have their travel documents in good order and be fully aware of what their travel insurance covers, as well as what it limits or excludes," says Ingle.

"You don't want to be stranded in Cuba or any other country facing demands for a medical bill that far exceeds your credit card limit. And if you have appropriate coverage from a major Canadian company, you won't have to go through the trouble of paying the hospital, clinic, or doctor up front and then seeking reimbursement once you get home," says Ingle.

He notes that Ingle International has worked with Asistur, Cuba's primary travel medical assistance company, for over twenty years. The two companies have developed a strong relationship during this time and have fine-tuned their approach to providing and coordinating assistance. Ingle works together with Asistur to transport people with emergency medical needs to appropriate facilities quickly, to monitor their care, and to facilitate payment requirements on behalf of their international insurance clients. 

* Travel insurance purchased in Cuba from private companies provides far lower benefit levels than those available under Canadian plans. Canadian travel insurance plans cover up to $10 million for medical expenses, including air repatriation home when medically necessary. Cuban insurance, available at various ports of entry for approximately $4.50 per day, covers up to $25,000 (USD) for accident/illness costs and $15,000 for repatriation—not enough cover an air ambulance trip from Cuba to Canada.

 

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Consumer Distribution Trends in UK Insurance

Consumers from the 'millennial' generation (defined here as adults aged up to 34) are more likely to buy insurance online using a tablet or mobile phone than their older counterparts. That is according to new UK-focused research just issued by Finaccord.

Covering a range of different insurance products commonly acquired by individual customers – including household, life, motor, pet and travel insurance – the research established that 16.2% of all online purchases of these policy types in the UK in 2015 were originally made via a mobile device with the remaining 84.8% acquired online through a laptop or desktop computer.

"These findings are important for both underwriters and intermediaries marketing insurance products to consumers", commented Alan Leach, Director of Finaccord. "Online sales now constitute the interface most commonly used for buying most types of insurance, even for those traditionally sold by phone or in person such as life and health insurance. However, there is an apparent shift among 'millennials' towards utilising mobile devices for this purpose and while use of laptop or desktop computers to buy insurance online remains dominant at present across all age groups, this change in behaviour is sure to perpetuate in future years with the emergence of another new generation of insurance buyers that is even more at ease with buying different products and services online via tablets or mobile phones."

Among consumers aged up to 34, 20.3% of policies bought online were purchased using a mobile device, segmenting between 13.9% using a tablet and 6.4% a mobile phone. In contrast, among those aged from 35 to 54 and those aged 55 or over, a respective 14.2% and 14.3% of online insurance sales in 2015 were concluded via a mobile device, which tends to prove the greater propensity of the younger generation to use tablets and mobiles phones to buy insurance cover. However, within these two older age groups, those aged from 35 to 54 were slightly more likely to use a mobile phone than a tablet in this context, relative to those aged 55 or more.

Furthermore, by type of insurance, the research established that the breakdown of online sales by type of device used does not vary greatly. Perhaps surprisingly, use of both tablets and mobile phones to conclude transactions online is most prevalent in the case of accident and health insurance – a class embracing forms of cover such as dental, personal accident and private medical insurance plus health and hospital cash plans – given that a respective 18.5% and 7.6% of online purchases of these products were reportedly made through these device types. In contrast, propensity to use them was found to be least advanced in the case of motor insurance which is, simultaneously, the form of cover most likely to be acquired online.

 

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Become A Global iPMI Health Care Insider

International Private Medical Insurance Magazine (iPMIM) is the ultimate International Private Medical Insurance (iPMI) online platform and health insurance magazine, serving global expatriate, corporate, health and travel insurance markets. Become A Global iPMI Health Care Insider with iPMI Magazine.

Due to the nomadic nature of the international healthcare industry iPMI Magazine is an internet based news service for worldwide healthcare professionals, who need to understand the impacts of healthcare and insurance policy, regulatory, and legislative developments. iPMI Magazine is the leading international industry voice, of the international travel, health, expat, assistance and private medical insurance market.

iPMI Magazine details private medical insurance providers; the advantages and disadvantages of private medical insurance; international private medical insurance Vs travel insurance; private medical insurance comparison; iPMI Magazine acts as a worldwide guide to private medical insurance, with the most up-to-date news and views from leading providers of private medical insurance plans, including international private medical insurance (IPMI) companies like APRIL, Globality Health, Aetna International, Generali Global Health, Cigna Global IPMI, Globality Health, ALC Healthcare, GeoBlue, Integra Global, Expatriate Healthcare, Strategic Insurance Services and many more.

Health insurance cover and risk protection for expatriates, business travellers, tourists, mobile and remote workers and multinational corporations managing global mobility programs and frequent corporate travel plans.

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Health Plan Member Satisfaction Climbs to Highest Levels Since ACA Implementation

Critical factors of health plan member satisfaction are highest in areas of the country that have more competition between different health plans according to the J.D. Power 2016 Member Health Plan StudySM .

On a nationwide basis, member satisfaction with their health plans improves nine index points in 2016, scoring a total of 688 on a 1,000-point scale. This follows a 10 point improvement in 2015. Member satisfaction with health plans reached a low point in 2014, following the introduction of the health insurance marketplace as part of the Affordable Care Act (ACA).

On a regional basis, the J.D. Power 2016 Member Health Plan Study found that member satisfaction in cost and information and communication is significantly lower in areas where one carrier holds a majority (more than 50%) of market share. Satisfaction is higher in competitive markets than in markets dominated by a single plan in cost (610 vs. 606, respectively); customer service (743 vs. 740); and information and communication (646 vs. 641).

“Competition among health plans is good for members in that it forces carriers to fight for market share, and the best way to do that is with satisfied customers,” said Greg Hoeg, vice president of U.S. insurance operations at J.D. Power. “In today’s health insurance markets, with increased legal restrictions on profitability, carriers are shifting toward member satisfaction.”

Hoeg noted that the one factor in which member satisfaction is higher in markets with less competition than in more competitive markets is provider choice within their plan (759 vs. 748, respectively). “Sometimes, having fewer, simpler plan choices makes it easier for the member,” said Hoeg. “Having dozens of plan options—such as deductibles and coverage levels—to choose from can be overwhelming.”

The Affordable Care Act (ACA) imposition of a minimum medical loss ratio has forced health insurers to compensate for slimmer margins by focusing on increasing their market share, often through mergers and acquisitions.

“Carriers are paying particular attention to cost management and economies of scale, and one way to do that is to combine with other carriers,” said Hoeg. “Competition is good for the market, but how that narrowing of the market will affect member satisfaction remains to be seen.”

The traditional plans like Blue Cross Blue Shield plans merging with other Blue plans, national deals like Aetna/Humana and Anthem/Cigna, and major market-driven acquisitions for UnitedHealthcare/Optum are all with an eye toward increased economies of scale and market power. Many have speculated that Anthem’s proposed acquisition of Cigna will harm competition and consumers by reducing the ability of other health insurers to compete with Blue plans. It appears that cost isn’t the only factor impacting member satisfaction, as satisfaction with information and communication and customer service is also significantly lower among members in less competitive markets.

Now in its 10th year, the study measures satisfaction among members of 135 health plans in 18 regions throughout the United States by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service.

Overall member satisfaction averages 688 in the 2016 study, up from 679 in 2015 and 669 in 2014. The increase in satisfaction is driven by improved performance across all factors, most notably in coverage and benefits (+12 points); information and communication (+11); and customer service (+10).

 KEY FINDINGS

  • Integrated Delivery Systems Dominate the Rankings: Health plans that utilize an integrated delivery system (IDS)—a network of healthcare and health insurance organizations presented to members as a single delivery organization—are poised for success as healthcare and health insurance become more focused on member satisfaction. Integrated plans have an average overall satisfaction score of 746, which is 63 points higher than that for non-integrated plans.
  • Premiums Declining: There is a slight decrease in the monthly premiums members pay. On average, the monthly premium for a family plan is $355 in 2016, down from $374 in 2015, while individual plan premiums are $207, down from $216.
  • Health Plans Evolve into ‘Wellness Partners’: Among the 20% of members who say they “strongly agree” that their health plan is a trusted partner in their health and wellness, satisfaction averages 837, which is 200 points higher than among the 7% who say they “strongly disagree.”

- See more at: http://www.jdpower.com/press-releases/2016-member-health-plan-study#sthash.WvKwyWet.dpuf

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Expatriate Health Insurance

Compare Expatriate Health and Medical Insurance Plans, Coverage, Quotes and Companies, with iPMI Magazine. iPMIM represents leading providers of expat medical, health and travel insurance plans. Find the right and most appropriate Expatriate Health Insurance for overseas travel, global mobility and relocation