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International Private Medical Insurance Magazine (iPMIM) is the ultimate Health and Medical Insurance Digital Media serving expatriate, corporate, health and travel insurance markets. 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. Combined with in depth health insurance industry analysis, best-in-class health insurance industry data, and exclusive, C-Suite Executive health insurance interviews and round tables, iPMI Magazine bridges an information gap between healthcare payor, provider and patient. Written by the health and medical insurance industry, for the health and medical insurance industry, iPMIM is supported and designed by leading international medical insurance companies and service providers.

Website URL: http://ipmimagazine.com

New Frontier Group Wins Cost Containment And Claims Management Company Of The Year At The 2019 ITIC Awards In Malta

New Frontier Group, www.newfrontiergroup.com, leader in Cost Containment and Global Assistance solutions, was named Winner of the ITIC Malta Awards 2019, for Cost Containment/Claims Management Company of the Year. 

The annual award, presented by the International Travel & Health Insurance Journal (ITIJ), was announced on Thursday, October 31st, 2019 in Malta, at the International Travel and Health Insurance Industry Conference (ITIC).

Each year ITIJ's Global Conference concludes with an award gala honoring companies for their outstanding contributions of excellence and innovation. Winners are selected by a panel of industry leaders who are experts in the area of the travel and health insurance industry.

As the recipient of the 2019 Cost Containment/Claims Management Company of the Year, New Frontier Group was selected from a large field of global competitors.  Most notably as the recipient of the 2019 Cost Containment/Claims Management award, New Frontier Group was presented this prestigious award based on recognition of outstanding achievement throughout the year.

Accepting the award before hundreds of industry associates, clients and guests, New Frontier Group President and CEO, Ms. Gitte Bach, and COO, Mr. Randall Condie, proudly acknowledged the other nominees in the category and Ms. Bach thanked and expressed her appreciation for the extraordinary performance of the New Frontier Group team which was watching the event live.

Ms. Bach states, "The last 12 months have been phenomenal for our company. I am so proud of the New Frontier Group team for its year-long dedication and commitment. Our team strives daily to provide superior client service and leverage the competitive advantage we have built using technological advancements to serve our clients, providing the very best global healthcare solutions.

Being awarded in this category at this year’s ITIC for 2019 Cost Containment/Claims Management Company of the Year and winning is extremely rewarding and we are truly grateful. We will continue our exciting journey and focus on service excellence, development, innovation and leadership."

About New Frontier Group

New Frontier Group is a global leader in Cost containment/Claims management and Global Assistance solutions. They act as first point of contact for worldwide International Insurance and Assistance Teams. New Frontier Group leads the travel and health insurance industry's global healthcare management services by providing a business suite of customized assistance, full-service solutions and cost savings for its worldwide clients.  New Frontier Group is an independently owned U.S. based International Company established in 2002.

Website: www.newfrontiergroup.com
LinkedIn: https://www.linkedin.com/company/frontier-international-group

 

iPMI Magazine Provider Network e-Directory November 2019: iPMI - Assistance - Air Ambulance - Funeral Directors - Cost Containment - Claims Management + MORE

The November 2019 edition of the iPMI Magazine Provider Network e-Directory is out now. Over 70 pages of company intelligence including iPMI - Assistance - Air Ambulance - Funeral Directors - Cost Containment - Claims Management + MORE.

    Enter full screen click the small rectangle above ↑

The IPMI industry use the iPMI Magazine Provider Network Directory to source the best information and data on international private medical insurance payors and providers. They may be searching for a new partner, looking for a contact number of a current provider, or researching the payor and provider market for future cross border network development.

Classifications include: IPMI, Assistance, Air Ambulance, Cost Containment And Claims Management, Funeral Directors, Ground Ambulance, Healthcare Insurance Management and Pharmacy Benefits Management.

Current Advertisers 

Click a company name below to visit their micro web site on iPMIM and learn more or download the brand new e-directory using the above link. To add your business to the e-directory and launch a micro website please write to David Bond, CIO, iPMIM on ipmi[at]ipmimagazine.com

PAYORS AND PROVIDERS IN FOCUS:

IPMI

ASSISTANCE

AIR AMBULANCE

COST CONTAINMENT AND CLAIMS MANAGEMENT

FUNERAL DIRECTORS

HEALTHCARE INSURANCE MANAGEMENT

PHARMACY BENEFITS MANAGEMENT

 

 

New Frontier Group Signs New Agreement With International Assistance Group (IAG) For US Cost Containment

New Frontier Group, the award winning US medical cost containment company has signed a new Preferred Provider Services Agreement to deliver medical cost containment and assistance support to IAG Partners who have travel and health insurance customers who require medical treatment in the United States.

Under the terms of the agreement, New Frontier Group will employ its 24/7 team and state of the art IT platform to help IAG Partner companies access the most appropriate and cost-effective treatment at hospitals and clinics across the US.

“The global travel insurance market is extremely competitive, and it is essential that insurers and assistance providers look for every advantage they can find in terms of enhanced services and cost control,” said Randall L. Condie, Chief Operating Officer with New Frontier Group. “Our job is to reduce our clients’ costs in the US, and we are confident that our IAG Partner clients will see significant savings.”

Louise Heywood, General Manager, IAG sees the recommendation of key service providers as one of the primary functions of the organisation. “By accessing and pooling the resources and expertise that we have within our network, our advisory team made up of key IAG partners are able to identify the best performing providers for the services our members need.”

About New Frontier Group

New Frontier Group is a multiple award-winning US medical claims management and cost containment company which supports some of the largest insurance and assistance groups in the global health and travel industry.

With access to the very best US networks along with outstanding in-house claims arbitration, New Frontier Group helps its clients to achieve market leading savings on their medical bills, resulting in improved loss ratios and increased bottom line profitability.

About International Assistance Group

International Assistance Group is the world’s largest alliance of independent assistance companies and accredited providers. IAG Partners specialise in worldwide roadside, medical, travel, corporate and home assistance for business and leisure travellers, expatriate workers and corporate clients. IAG Partners & Accredited Service Providers currently support over 118 million end users worldwide.

AXA To Sell AXA Bank Belgium, And Enter Into A Long-Term Insurance Distribution Partnership With Crelan Bank

AXA announced today that it has entered into an agreement to sell its Belgian banking operations, AXA Bank Belgium, to Crelan Bank.

Under the terms of the agreement, AXA will sell 100% of AXA Bank Belgium to Crelan for a total consideration of Euro 620 million, comprised of (i) a total cash consideration of Euro 540 million*, and (ii) the transfer to AXA Belgium of 100% of Crelan Insurance (valued at Euro 80 million), the insurance company of Crelan, providing protection insurance linked to loans originated by Crelan.

In addition, AXA and Crelan have agreed to enter into a long-term P&C and Protection insurance distribution partnership, extending the existing partnership between AXA Bank Belgium and AXA Belgium to the entire Crelan network.

THOMAS BUBERL, CHIEF EXECUTIVE OFFICER OF AXA comments, "This transaction is another important step in the execution of our Ambition 2020 strategy, as we concentrate on businesses with critical scale and continue to simplify our business profile.

We are extremely pleased to maintain our strong historical links through a continued partnership with AXA Bank Belgium, a key factor in this transaction, and to extend this partnership to Crelan’s network. Combining this with the transfer of Crelan’s insurance business to AXA, our leadership position in our preferred segments in Belgium will be further reinforced.

We are convinced that AXA Bank Belgium will strongly benefit from the consolidation with Crelan, leveraging on their respective scales and product offerings.

I would like to thank AXA Bank Belgium’s management team and all the employees for their strong contribution and commitment over the years and wish them every success as part of the Crelan Group."

  • This transaction is expected to result in a positive impact on AXA Group’s Solvency II ratio of ca. 4 points.
  • It is expected to result in a one-time negative Net Income impact3 of approximately Euro 0.6 billion in AXA Group’s FY19 consolidated financial statements.
  • Underlying Earnings (UE) generated by AXA Bank Belgium were Euro 47 million* in 2018.

In addition, AXA will take a 9.9% minority equity stake* in Crelan NV* and AXA Bank Belgium, investing a total of Euro 90 million, which will be fully financed by the purchase by Crelan, for Euro 90 million, of the contingent convertible bonds previously issued by AXA Bank Belgium to AXA Group.

Completion of the transaction is subject to customary closing conditions, including the receipt of regulatory approvals, and is expected to be finalized in the second quarter of 2020. 

 

International SOS Expands Investment In Northern Seas Oil & Gas And Government Medical Services

International SOS has increased its investment in its Joint Venture Partnership with Iqarus in Aberdeen and Dubai . 

This will see International SOS taking sole ownership and responsibility for Iqarus Aberdeen and increasing its investment to a majority ownership stake in the Dubai based Iqarus Global Health Services business, with immediate effect.

Michael Gardner, CEO Medical Services at International SOS commented, "The joint venture with Iqarus has successfully developed and grown both businesses since 2017, and we are now moving forward into a new closer relationship. Under sole ownership, International SOS will continue our strong commitment to driving forward the Aberdeen centre of excellence and innovation in offshore occupational healthcare. This successfully strengthens local capability and global support for Northern Seas clients in the oil and gas industry. International SOS is committed to growing its Medical Services business in the extractive and other industries from its current 1,000 sites in 90 countries worldwide."

Tim Mitchell, CEO of Iqarus, commented "From Dubai, Iqarus will continue to work in close partnership with International SOS to deliver pioneering solutions that enable supranationals, Governments, IGOs, militaries and NGOs to operate in the world's most difficult and challenging environments. We will also continue the progress we have made in developing innovative public-private healthcare initiatives to address healthcare needs in geographic markets newly opened to the global economy. This evolution of our joint venture partnership will accelerate the already rapid development of the Iqarus business going forward."

New Low Cost Business Health Insurance Plans Launched By April International Care For Singapore

In a move specifically aimed at the group and SME markets for private health insurance, APRIL International Care has added a new coverage option to their flexible MyHEALTH Business group health insurance plan in Singapore.

The new Core option offers companies an affordable level of international cover for hospital and outpatient employee benefits.

Announcing the new policy, Customer Journey and Digital Marketing Manager, Kylee Lancsar said, “Our new Core Plan now offers SMEs and Group schemes access to a low-cost alternative to traditional comprehensive private health insurance. Plans also offer new levels of flexibility to vary cover levels by seniority of staff. We believe these new options will increase the number of companies able to offer their staff the valuable benefit of private international and local health insurance.”

With companies able to structure their MyHEALTH Business plans with different levels of benefits for various levels of staff such as senior management, the new Core option provides a cost-effective way of extending international health coverage for junior staff members.

Employees covered under the new Core Plan will be covered worldwide in case of accidents. For planned hospital treatments, staff are covered within APRIL International Care’s specified network of private medical hospitals in Hong Kong or Singapore, while having free choice of any other private medical facility in the rest of ASEAN and India.

Outpatient benefits for employees with Core cover include cashless coverage for treatment in any of over 1,200 medical facilities participating in APRIL International Care’s panel network which can be found through the GPS capabilities of the Easy Claim app. Additionally, every MyHEALTH Business member can use the Easy Claim app to access Telehealth services to arrange a second medical opinion or request a call back from a doctor.

Collinson Launches New International Healthcare Solution To Further Extend Its International Insurance Reach

Collinson has launched an all-new international healthcare plan, Collinson SmartHealth™ International, in Nairobi, Kenya. The solution is delivered in partnership with Kenbright, one of Kenya’s leading medical insurance providers.

Lawrence Watts, Head of Insurance at Collinson, said, “We are delighted to partner with Kenbright to launch this new health solution to the market.  With healthcare infrastructure under pressure, especially within critical care, providing healthcare alternatives to consumers is vital. The research we carried out highlighted a strong consumer demand for international solutions; 41% surveyed stating that they would travel abroad for medical treatment if required.

“This launch, in partnership with Kenbright, means that companies in Kenya can give employees and their families access to the best possible overseas treatment through our in-house medical expertise and worldwide network of partners.”

Collinson envisages offering the plan in other countries in the region by partnering with local insurers, as well as building in its wider travel, assistance and insurance products and loyalty solutions to create a truly differentiated and holistic health plan within the comfort of a concierge travel experience.

Ezekiel Macharia, CEO at Kenbright, added, "We are thrilled to be launching this proposition in partnership with Collinson. Our team has worked hard to create an international healthcare solution that not only offers Collinson’s international insurance and assistance capabilities but will also harness local technology in Kenya, allowing our customers access to a robust network solution."

SmartHealth International will deliver a suite of new affordable health insurance products aimed at Kenyan companies, which want to protect and give peace of mind to employees and their families. Administered by Kenbright Healthcare Administrators Limited, Collinson will be harnessing its in-house insurance and assistance expertise to provide regional and international access to an extensive network of medical providers.

Designed by healthcare experts, SmartHealth International enables employees and their families to flexibly access international medical advice, treatment and support across the globe, whenever it is needed, through Collinson’s global network of health providers and in-house 24/7/365 medical assistance capability. Each case will be individually managed and assessed by Collinson’s expert medical team. The plans can include wellness, optical, dental and medical second opinion and traveller support services and can be tailored to individual company requirements and budgets.

Collinson believes that there is a significant opportunity to enhance the way international healthcare propositions are delivered. By utilising the expertise across Collinson’s loyalty and benefits capability, companies in Kenya can now offer their employees access to the best medical treatment available at home and globally. This also includes additional benefits such as digital doctor services, international medical second opinion and traveller support services accessing the Collinson global lounge network and security and medical advice when travelling.

In fact, recent third-party research commissioned by Collinson revealed that the vast majority (88%) of consumers in Kenya found the proposition to be attractive, with preventative and wellbeing and digital doctor services being rated attractive by 82% of the respondents.

 

For further information, please visit https://www.collinsongroup.com/en-meai/protect/international-healthcare

 

iPMI Magazine Speaks With Caroline Pain, Senior Vice President, Customer Proposition, Aetna International

In this iPMI Magazine industry exclusive, Christopher Knight, CEO, iPMI Magazine, sits down with Caroline Pain, Senior Vice President, Customer Proposition at Aetna International. They discuss in detail the launch of DNA testing for Aetna International European members and look at how using personalised information can spark actionable lifestyle changes.

Please introduce yourself and background in the international private medical insurance market:

I have over 20 years‘ experience in management, covering marketing and sales, analytics and digital, BPO and customer strategy. I joined Aetna International in 2012, but prior to this, I was responsible for building Aviva’s early digital self-service experience and leading the customer experience transformation programme.

Now, as the Senior Vice President of Customer Proposition at Aetna International – part of Aetna Inc., a CVS health business and a US Fortune 8 company – I lead the organisation’s global marketing, product development and customer experience. We currently serve more than 900,000 members worldwide and ensure they can stay in control of their health, wherever they are in the world.

May 2019 and Aetna International launched DNA testing for its European members as an optional part of the wellness plans. What does this mean for Aetna International?

Aetna DNA is a member-centric service, which gives each individual an opportunity to make more personal, informed decisions about their overall well-being. As a health and lifestyle test, it looks at sensitivities in four different areas; nutrigenomics (the relationship between what we eat and our biochemical response), fitness, sleep and stress. These four areas are all components that can have a substantial impact on our overall health outcomes although, as we are all unique, they will affect different people in different ways.

In the context of a bigger picture, the World Health Organisation states that noncommunicable diseases (NCDs), such as cardiovascular disease, represents 71% of all annual deaths and an estimated 80% of premature deaths1. This means they‘re by far the leading cause of death in the world. Many of these NCDs are lifestyle-based in nature and there is good evidence from a number of large, longitudinal studies that the addition of DNA insights can lead to sustainable behaviour modification. Put simply, we wanted our members to have the option of these insights.

Of course, this type of information is only the beginning of the story – it’s what you do with it that counts. But there is evidence to suggest that the positive impact from finding out more about your genetics can be truly life-changing. For example, one study in Finland tracked 7300 people over an 18 month period, after they had received their genetic risk information. It found that 88% of participants were inspired to take better care of their health and around a fifth of those who smoked managed to give up. This compares well with a control group of the general population, where only 4% gave up smoking2.

Certainly, the response to the European launch so far has been phenomenal. Our view is that our members are increasingly invested in understanding the impact of their genes on their health, and also in taking a proactive approach to managing their physical and mental health. Aetna DNA is a powerful link between both of these consumer trends.

How does the Aetna DNA test actually work?

A simple mouth swab is sent to a certified UK lab for analysis. Members register their kit online and provide their consent. They are then notified by email when their test has been processed and can log in to a digital portal to explore and download their results.

In the wider market, there are many different types of genetic tests available, from tracing your ancestry to diagnostic and carrier testing for things like sickle cell anaemia or cystic fibrosis. Aetna DNA does not test for any of these – its focus is health and lifestyle predispositions and sensitivities to food, fitness, sleep and stress.

How does knowledge about genetic predispositions and sensitivities affect the way in which health care services are designed and delivered?

We’re seeing a shift in health care becoming increasingly geared to delivering precision medicine, which means focusing on the approaches that are most effective for individuals based on genetic, environmental and lifestyle factors. We also face a situation of a chronic under-supply of primary care, so it is more important than ever that we keep people healthy, rather than waiting for them to become ill. Testing your body’s response to things like caffeine and carbohydrates with Aetna DNA plays a small part in this – it gives some personalised insight and reassurance that you‘re tailoring your approach to health in a way that makes the most sense for you.

It’s important that these insights come with the option of consultations with fitness and nutrition experts, to help people identify ways to optimise their health and reduce the risk of lifestyle-related diseases. Our members might, for example, choose to share details with one of our virtual health care nutritionists who would be able to suggest modifications – or even a different direction – to ensure they’re on target to reach their ultimate health goals. Many of our members can also consult with our clinical team, including our virtual primary care service if they have more complex questions.

However, who this information is shared with is completely up to individuals – the key to DNA testing is that it is personal. While you might be able to get more bespoke advice if you do share, people are certainly under no compulsion to do so. As an insurer, our priority is to make sure our members receive information that is as accurate as it can be. We also know we need to prove trust and integrity as an industry – this is personal, highly sensitive data, and we take our responsibilities in this area very seriously.

What are the benefits of taking a proactive and preventive approach to health care?

It helps to understand the scope of the potential benefits by considering that, in the U.S., health care spending has reached U.S. $3.5 trillion and is estimated to increase by 5.5% every year. It is set to reach $6 trillion in 2027 – nearly 20% of GDP. At the same time, the prevalence of NCDs from things like physical inactivity and unhealthy diets are on the rise.

To meet increasing demands, we know that the health care system has to be less siloed and more integrated. We need to treat people not just as patients but as active consumers of health care.

Our way of moving towards this is a vision of health care built around the P4 model; health care that is predictive, preventative, personalised and participatory. It’s a vision designed to offer individuals the right intervention, at the right time, in the right place for them, and can significantly reduce the burden on primary care as well as allowing people to live fuller and healthier lives.

This is where Aetna DNA can help. A genetic test that yields information on lifestyle and nutrition is one way of taking an active role in maintaining your health, or improving it by sparking actionable lifestyle changes.

European employers that are starting or renewing their insurance contract with Aetna International can purchase a DNA kit for employees as an add-on product. How will this work?

Aetna DNA is being offered as a supplement to the wide-ranging resources we already provide. It’s completely optional and available for schemes of 10 employees or more at an exclusive subsidised launch price of £75 per person (RRP £150). It’s a discretionary way of giving more insight into and clarity around someone’s unique nutrigenomics, fitness, sleep and stress sensitivities if they wish to engage.

What is the role of health insurers in relation to genetics?

I think the traditional role of health insurers is changing. On one hand, patients are demanding more seamless, convenient and holistic care, and on the other, we‘re facing a growing global challenge with ageing populations, increasing NCDs and massive pressure on primary care.

It means that health insurers have a duty to engage in the broader health of populations and assist in providing better health outcomes. We need to find ways to work with other health care providers and other industries, to reduce unnecessary treatments and to keep people healthy. We know that the foundations that physical and mental health are built on are the same for everyone – eating well, reducing stress levels, exercising regularly and getting enough quality sleep. But everyone is different – your tolerance to caffeine may not affect the quality of your sleep, but mine might. So genetics will undoubtedly play a part.

What are the main differentiators of the Aetna International DNA testing service VS other providers?

Our approach can be summed up in two words – responsible provision. Unlike other providers, we do not provide results in a vacuum. Instead, we are focused on putting the test results in context, with qualified clinicians, which is far more valuable than reviewing results in isolation.

There is an abundance of comprehensive, easy to access and professional advice available after people take the Aetna DNA test. The written results reports are intentionally user-friendly, and members can book a consultation appointment to talk to about changes they may like to make. Our follow-up assistance can be accessed from a number of our well-being resources, including health coaching, our employee assistance programme and vHealth, our virtual health care service.

At Aetna International, we’re striving to move from a paradigm of ‘sick care’ to ‘well care’ to help people stay healthy and live long and fulfilling lives. We firmly believe that personalised health and wellness plans are key to disease prevention, and can also expedite diagnosis and treatment, often negating the need for invasive treatment. This is clearly good news for the individual’s health, but it also reduces pressure on health care systems and ultimately has a positive impact on national economies. It can also encourage behaviours which ultimately lead to healthier communities and workplaces. We are privileged to be able to join our members on their health journeys – and with that privilege comes a responsibility that we take very seriously.

RELATED READING: Aetna International Announces Launch Of Health And Lifestyle DNA Testing

References

1 https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

iPMI Magazine Speaks With Scott Rosen, CEO, MDabroad

In this iPMI Magazine interview exclusive, Christopher Knight, CEO, iPMI Magazine, sits down with Scott Rosen, CEO, MDabroad. They discuss in detail a new on-demand insuretech assistance solution, First Click Assist™.

Please introduce yourself and background in the international medical insurance market:

In 2000, I founded MDabroad as an international provider network to linked insurers to medical providers, globally. Since that time, we have contracted with some of the largest providers and insurers to meet their evolving needs. The observation I’ve made time and time again is that the players within the value chain – providers, TPAs, insurers, reinsurers and even members – are not connected to the extent they should be given that the success of our business relies upon relationships with medical providers and how we interact with them to keep losses at bay. During my twenty years in this industry, I’ve seen very little done to standardize the way in which we work with providers, either in the exchange of information and on the way in which we treat them regarding payment. To address that, MDabroad offered both network services to insurers and another controversial service, which was “Provider Services” where we offer tools to medical providers with the purpose of standardizing their revenue cycle management.

The network model has been extremely successful for us and is the cornerstone of MDabroad’s longevity, which is attributable to our keen focus on Latin America, a trouble spot for many insurers. As time goes on, we are finally seeing insurers and large TPAs acknowledging the fact that developing a network inhouse on a hospital-by-hospital basis is not practical, and the most successful companies have outsourced services to networks and boutique assistance providers, like us. While this model has been accepted by the sophisticated insurers, our providers services model has been widely misunderstood and underappreciated by many payers. If I may, I’d like to elaborate.

Our goal was to help providers, and consequently payers, by processing their claims on our proprietary CRM, where we can check which discounts we can proactively offer to international insurers, justified by us making the lives of providers easier. Some of the less sophisticated insurers resisted, and still do, arguing that we actually increase the cost of business. This simply is not true and I’d counter with a few points (1) MDabroad brings value to providers by giving them the chance to effectively outsource processes and integrate them by default into its network; (2) MDabroad pays cases in advance to medical providers and takes credit risk. MDabroad first operated as a network to standardize access to providers. For the larger and sophisticated insurers, it has been a great model as they understand that they cannot possibly have the critical mass to engage providers in relationship where anything is accomplished except for a superficial discount. In our view, the quality of a network relationship is based on payment, as good as your last missed payment, it has worked towards becoming a clearinghouse of sorts.

As you can probably see, I took the road less travelled. I and it’s because I’m in it for the long haul and have a vision. As a result, we are the largest and most established network in the Americas, and we launched a full-service assistance company that is now managing tens of thousands of cases per year.

You are launching a new on-demand insuretech assistance solution, First Click Assist™. Can you walk us through the idea of First Click Assist™?

Over 90% of cases we see in the assistance capacity are outpatient and typically require an extensive network in order to effectively service members by delivering a direct pay network. For the cases falling outside of any payer’s direct pay network, members are forced to pay upfront and file for reimbursement. We all agree that this isn’t the most ideal service experience. To add insult to injury, you are hit with the cost of processing pay and file claims that leave something to be desired in terms of pricing.

What First Click Assist™ does is to provide an entire network to our clients, resulting in direct pay access, reduced medical expenditure and an unprecedented member experience. The First Click Assist network will start by offering Telemedicine with a Purpose: visiting physician services, urgent care/walk-in clinics. We even offer pharmacy delivery. The best part is that there are no case management fees.

I’ll explain how it works: Insurers, TPAs and assistance companies simply log in to our CRM online, where their agents may enter the patient location, actually see pricing by service type and request service. Transparency is a big deal for us.

Here is what makes First Click more than just a tech play: we know how to help contain costs. A local physician will call the patient within minutes of the request, which is what we call "telemedicine with a purpose" irrespective of the service requested. Why? First, to a patient, a call from a doctor sends an important message about how seriously the insurer takes its clients. Second, since most of these cases can actually be diagnosed by phone and prescriptions delivered to the patient, the cost and time associated with. While telemedicine isn’t for everyone and each case, many patients prefer getting it done as quickly as possible.

Geographically speaking, where will the First Click Assist solution cover?

US, Mexico and Costa Rica. We’re trying to address some region-specific challenges. For example, in the US, we think that the value proposition of making the Aetna network available for all users in a tremendous offering that will be adopted without question. In all locations, we will have pharmacy delivery.

In some areas of the world, for example Costa Rica, telemedicine is not a heavily adopted solution. How will you accelerate adoption rates?

We chose Costa Rica since, outside of San Jose, the country can be characterized as mostly rural. In a rural environment, one factor that we need to consider is that we don’t find 24/7 pharmacies throughout most of the country, specifically the tourist enclaves. So, think about it, the difference between a telemedicine consult at 2PM and a visiting physician at 6PM can mean getting in one or two doses of an important antibiotic that will both shorten the duration of an illness and get the patient on his/her feet.

First Click Assist’s goal approach is to allow our clients to steer members into telemedicine, get treatment started and to refer the patient to a local doctor if medically necessary or even if the patient feels more comfortable in a more traditional care setting. In a rural environment, this is vital due to the fact that getting care and necessary medications, can take several hours to even a day, depending on the day and time a patient falls ill. Costa Rica fits the bill: lots of cases, rural, expensive care. First Click Assist™ can make an impact here.

No contracts. No provider networks. Transparent pricing. No billing – payment at point of care. No large amount of investment required. Improved medical loss ratios. Quick and easy case management allowing cases to be opened and closed very quickly therefore reducing case management costs. What's the catch?

That’s pretty much it. What is a network? It is a list of providers to whom insurers try to send their patients when they have the chance to direct their members. The value to the provider is a little more confidence than normal that they are going to be paid. Payment equals good faith. Good faith means that the provider will work with the payer on a credit basis if the need arises. Still, providers charge more to international insurers and are within their rights. Now, by First Click guaranteeing payment within a matter of a few days, providers are willing to charge a significantly lower price and pay a premium to First Click to guaranteeing that. This is the basis of our economic model. First Click has created a network based on the tangible value that no single-payer can offer. In my experience in assistance, it can take up to 120 days to square up on a bordereau, something that will affect provider payment. Let’s be realistic, it’s not fair to a provider. First Click is fair, and this is a network built on real value.

We are also in a position to ask the provider to do the heavy lifting that payers need in order to justify a claim. Those tasks imply obtaining every piece of information needed to adjudicate a claim. It is only once those fields and information are submitted that we will charge our clients’ credit cards. The biggest push back we have faced is the payment at the time of service…. I’m okay with that. Let payers be the ones to extend credit to reinsurers and stop expecting providers to take blind risk if we want to have real networks that achieve access and fair pricing. Additionally, we collect data, which we share with clients.

We are talking about the overwhelming majority of the small cases that translate to low margin and a much higher cost of doing business than justified by fees. We developed the infrastructure over many years, we have network relations in the most common tourist areas. We have found that by aggregating volume of the rest of the industry, paying providers quickly with insurers paying by credit card at the time of service and getting cases open and shut, it’s a no-brainer. The question that I want to answer proactively is “where is the cost”? Well, there is a platform usage fee to have access to our CRM, on a case by case basis. Providers will pay those fees and I can assure you that it is reasonable and does not raise the cost of claims. I will also reduce the cost of administration for so many obvious reasons.

So, the First Click Assist solution gives any insurance company access to the Aetna provider network in the USA?

Yes. First Click is democratizing access to large networks in the US. This is the feature we are so excited about. I can’t think of anything more disruptive in the industry during my 20-year career in this market.

Aetna has been such a terrific partner for us on so many fronts. Noam Baruch is forward-thinking, and they have gone out of their way to accommodate this product launch. Imagine all payers lowering their loss ratios on 90% of the cases... we see ourselves as the solution for outpatient care in the US for all providers, not just those with tens of millions of dollars of claims in the US. This truly levels the playing field. Plus, the technology behind this allows us to send electronic Aetna IDs to patients, send VOBs to providers automatically and all providers know how to handle Aetna members. The member experience is simply superior. The insurers experience much better rates and do less work on the claims that traditionally represent the hugest headache in the industry.

Telemedicine, house calls and outpatient services all feature within the First Click Assist solution. Can you give us further information how it will all work?

First Click offers insurers the chance to have a local physician call the member directly prior to activating any house call service or sending the patient to an outpatient provider. Could you think of better service than a local doctor calling the patients within minutes of their request to see a doctor? No. Why not coordinate the patient the requested visiting physician or the walk-in clinic visit right away? First, your call centre has an option to skip that part, but you have to realize that a call directly from a doctor has gravitas: patients tend to be very receptive to the advice of the physician. If our telemedicine providers boast 70%+ success rates, we should put them to the test. If we see, based on chief complaints and other factors we will see when patients or the call centre of payers pre-register, that our telemedicine providers think there is a high chance of resolving the case by phone, we do it, plus, we have prescription medications delivered. If that’s not enough, we program physician-to-patient courtesy calls. If, and when resolved, the payer only pays the telemedicine service. If the case isn’t resolved or the patient isn’t completely satisfied, we coordinate that appointment as per the recommendation, but we do not charge the telemedicine fee. Again, it’s a no-brainer.

Cost containment remains a key feature of the First Click Assist solution. How does First Click Assist deliver cost containment?

There are two types of cost. 1. Medical Expenses. In the US, it’s obvious. In Mexico, we negotiate flat rates with our providers and keep them out of the hands of nasty referral patterns. Look at the before and after numbers six months into the program and you should see the difference. 2- Administrative Expenses. The cost of collecting claims, vetting them to have all information necessary to pay the claims and then the transaction cost barely covers the case management fee. On top of it, cases can stay open for many months. How does First Click address this? The provider, on our online CRM portal, needs to submit all required documentation in order for funds to be released. You get a full invoice, medical notes, a copy of the patient ID and passport, and a receipt for payment, which is all you need to approve the case. Case closed within hours of requesting service.

Finally, I’d like everyone to think about the effect of one standard across the board for our operators. We can increase the number of cases handled per agent and the admin teams. Again, use us for six months, look at our reports and look at your own reports.

Overcharging, kickbacks and unnecessary treatments can all feature in international medical claims. How does First Click Assist fight international medical insurance fraud?

Strong contracts with providers and the leverage of a patient referral source. We publish the rates on First Click Assist, and we sit and stand behind those amounts. If a physician exceeds the scope of the VOB or bills above and beyond our agreed rates, payers only pay the published rate and we fight with the provider... then we exclude them from the network.

Now, by having the first point of contact as an agnostic physician, your patient will not be guided to providers of the ‘concierge cartel’ where things always go sideways. The network is key. Paying claims direct is a major plus because member fraud like submission of inflated charges is obviated through our tight-knit network and very strong agreements.

By its very nature, the market is nomadic. How does First Click Assist deliver cross border healthcare services to travellers and expats?

No contracts needed. We depend on insurers doing their job enticing patients to call the insurer at the onset of a medical episode. We also have a great tool to make it easier for members to communicate with insurers. We actually integrated WhatsApp into our CRM, which is an industry first. Live Person and WhatsApp had us come on as early adopters and a case study will be appearing soon online. To give your readers an idea of how successful it has been: over 80% of our cases involve WhatsApp and 70% are fully resolved using WhatsApp only. First Click may offer this solution to clients for a nominal fee, something we suggest once payers are sold on the First Click solution.

How can First Click Assist improve payors medical loss ratios?

How can’t it?

How can potential clients and partners learn more about First Click Assist?

We will be at the ITIC in Malta and available to discuss First Click Assist™. You can contact me directly at +1 646 644 9747 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it..




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