Transcript Stuart LEATHERBY - Convention Ventures.

Addressing Global Trends and the
Increase in Demand for
International Health Insurance
October 2011
Aetna
International
Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
2
Global Trends
Increasing health
care expenditures
Growing
prevalence of
chronic diseases
 Rapidly escalating
health
expenditures in
major developing
economies
 Chronic disease
prevalence
increasing
dramatically due
to aging of
population and
lifestyles
 Health care
spending
consumes greater
share of GDP and
household
consumption
 High out-ofpocket spending
reveals unmet
needs
3
 Opportunities to
optimize
management of
existing cases,
lower health risk
and prevent
chronic disease
Economic
environment
 Global recession
resulted in a
changing global
workforce
 Re-assessment of
employee
benefits
strategies
 Increased need
for flexibility
 Governments
looking for ways
to reign in public
health care costs
Health information
technology
 Provider adoption
to increase
quality of care,
increase
administrative
efficiency and
automate
transactional
capabilities with
payers
 Governments and
private sector
exploring as a
way to better
manage cost and
quality of care
Reform as the new
normal
 U.S. health care
reform process a
reference point
 Requires shared
accountability for
health and
outcomes among
employers,
employees and
governments
 Opportunity to
create better
health care
systems
Global healthcare challenges
Cost & Affordability
Chronic Disease
 Health care spending
consumes disproportionate
share of GDP and household
consumption
 Chronic disease prevalence
increasing dramatically due
to aging of population and
lifestyles
 Increase in spending
outpacing GDP growth
 Driver of health care costs
and cause of deaths
4
Quality
 Only half of
recommended care is
received
 More costly care does
not always mean
higher quality care
Middle East health trends
Gulf Cooperation Council*
GCC
 Health care system is still developing
 Trend towards mandatory health care across the Region
(KSA, Abu Dhabi existing requirement)
 Rapidly expanding health care spending
 High rates of OOP spending
 Highest rates of overweight/obesity outside U.S. (68%
regionally)
 Highest incidence of diabetes (13% of population
regionally)
5
*Bahrain, Saudi Arabia, UAE, Kuwait, Oman, Qatar
Source: World Health Organization, IMF, International Diabetes Federation, International Association for the Study of Obesity
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Middle East challenges
Health Expenditure
$30.00
7.0%
$25.00
Projected increases
in health
expenditures will far
outpace projected
GDP growth
6.0%
5.8%
5.0%
4.7%
4.6%
4.0%
3.9%
3.6%
$15.00
3.3%
3.7%
3.1%
3.0%
2.7%
$10.00
2.4%
2.4%
2.0%
2.0%
$5.00
1.0%
$-
0.0%
UAE
KSA
Current Costs ($ Billion)
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Kuwait
Projected Costs (2011)
Qatar
Current % of GDP
Bahrain
Oman
Projected % of GDP (2011)
% of GDP
$ Billions
$20.00
 Long-term expatriate
population remain
significant
 Governments are expected
to shift more responsibility
for providing their health
care needs to the private
sector
 Governments face rapidly
increasing chronic-diseaserelated health care cost
burdens
Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
7
Direct health spending is just the tip of
the iceberg
Total Cost of Health Care
 Unhealthy workforce creates significant strain
on productivity
 Chronic disease becoming more prevalent
 Globally, costs ~$2T in lost productivity each
year
 Single costliest condition is obesity
 Presenteeism is on-the-job productivity loss
that’s illness related
Medical and
Pharmaceutical
24%
Direct Medical
Costs
Indirect Medical
Costs
Long-term
Disability
1%
Presenteeism
63%
Absenteeism
6%
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Sources: World Economic Forum, “The New Discipline of Workforce Wellness: Enhancing Corporate Performance
by Tackling Chronic Disease.” 2010 ; Harvard Business Review, October 2004
Short-term
Disability
6%
More expensive care does not always
translate into better care
Average amount paid
Quality score
for coronary artery bypass surgery
for coronary artery bypass surgery
Hospital 1
Hospital 2
$49,158
Hospital 1
$69,059
Hospital 2
86.5
85.4
• Same procedure
• Same metropolitan service area
• Same insurance plan and coverage
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Source: McKinsey, “Three Imperatives for Improving US Health Care,” December 2008; Dollar amounts based on internal mammary
coronary artery bypass graft surgery for patients admitted through the emergency room, 2006-2007. Quality scores gathered by McKinsey
from CMS.
Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
10
Governments and employers seek to
address critical issues
 Extract greater value for health spending
– Slow the rate of health spending increase
– Maximize quality of health care delivery
 Provide access to quality care
– Ensure secure partnerships with health care professionals around the world
– Confirm streamlined reimbursement and prepayment procedures with
practitioners and facilities worldwide
– Reduce costly up-front employee expenses
 Address needs of a growing globally mobile workforce
– Meet requirements of increasing mandatory health cover
– Provide flexible cover solutions
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Governments and employers seek to
address critical issues
 Impact the growing prevalence of chronic disease
– Optimize management of existing cases
– Lower health risks and prevent chronic disease
 Improve workforce productivity and retention
– Share accountability for health and outcomes
– Increase employee engagement and loyalty
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Interventions reflect multi-faceted
approach to address critical issues
13
1
Care Coordination
2
Wellness and Prevention
3
Clinical Analytics
Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
14
The Importance and Effects
of Wellness
The Need for
Wellness Programmes
Chronic diseases, such as heart disease, stroke,
cancer, respiratory diseases and diabetes, are the
leading cause of mortality in the world, representing
60% of all deaths.1
If the major risk factors for chronic disease were
eliminated, at least 80% of heart disease, stroke and
type 2 diabetes could be prevented; and 40% of cancer
could be prevented.2
1
Wellness programmes can result in a 3:1
return on investment.3
Wellness programmes save money through:
 Lower health care costs
 Greater productivity
 Reduced absenteeism4
World Health Organisation. 2005
World Health Organisation. 10 Facts about chronic disease
3 Business Insurance. Corporate wellness programs help shape a better bottom line. April 9, 2007.
http://www.businessinsurance.com/article/20070408/ISSUE03/100021545
4 Purdue University, February 2007
2
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The Effects of
Wellness Programmes
Wellness programs target lifestyle
behaviors driving costs
Characteristics of Employee Wellness Programs
Focus of Intervention
75%
Multiple Risk Factors
66%
Weight Loss & Fitness
50%
Smoking Cessation
Method of Delivery
81%
Health Risk Assessment
42%
Self-help Education Materials
39%
Individual Counseling
Classes/Seminars
Incentives
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36%
31%
Source: Katherine Baicker, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings.” Health
Affairs, Feb 2010
Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
17
What to look for in international plans
 International Community of Healthcare Professionals
– Direct-settlement and discount arrangements
– Freedom of choice of doctor and hospital across the globe to accommodate
increasing global mobility
 Care coordination for international health needs
– Assure appropriateness of medical care
– Disease and case management
– Provide health and wellness programs
 Opportunity to tailor plans to meet employers specific requirements
 Premium calculation based on the policyholders age and geographic coverage
 Cultural and local market expertise
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Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
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Our Vision Begins with the People Who Use
Our Services
Strategic Direction
To be the global leader in
empowering people to live
healthier lives by making
quality health care:
• More affordable
• More accessible
Empowering people = information,
tools and affordable benefits
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Aetna at a glance
Employees &
Customers


34K Aetna employees worldwide
Customers include individuals, employer groups, health plans and
government-sponsored plans
Membership

Serve approximately 36.1M unique people worldwide

Headquartered in U.S.A.
Operations and office locations in U.S.A., United Kingdom, Europe, Asia and
the Middle East
Access to >1M health care professionals and >5K hospitals worldwide
Global
Presence


Medical
Management
Health
Information
Technology

Wide array of products and services that help improve member care and
reduce rising health care costs, including wellness programs, disease
management and case/utilization management

Evidence-based clinical rules engine (CareEngine®) identifies gaps in care
Targeted search based on clinical condition(s) identified in PHR
HIE Alliance with IBM to facilitate connectivity with providers
One of the largest clinical data warehouses in the U.S.A.



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As of May 2010
Agenda
 Global and regional challenges and trends
 Cost and access to quality care
 Critical issues for governments and employers
 Value of wellness programmes
 What to look for in international plans
 Aetna at a Glance
 Flexible solutions on a global scale
 Summary
22
Aetna International Solutions
Globally mobile/expatriates
Customers
Products
US based, Europe based, Asia Pac
based, Middle East and Africa based,
Latin America based









Individual, Small Group, Large Group
Corporate expats, Government entities,
International educators, Non-profit
organizations, Non-Governmental
Agencies
Medical
Vision
Dental
Pharmacy
Life
AD&PL
LTD
Travel
Wellness and Medical Management
Health Management
Local government medical
management services
 Data Management & Decision Support
 Demand Management
 Network Contracting &
Management
 Performance Management
 Payment Management
 Stakeholder Engagement
Cost Containment and Aetna US
Network
Local insurers
Passport to Healthcare
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Travel insurers
Suite of Wellness
Programmes and Services
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Global Access
We work with leading facilities
around the globe to establish
direct-settlement relationships.
This means we’ll focus on the
payment of your employees’ large
scale medical expenses so they
can focus on their health and
assignment.
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–
Access to over 61,000 health care professionals in
nearly 200 countries; over 31,000 of which are in
Africa.
–
Accessing our robust direct-settlement community
provides members with easier access to quality care
and reduced out-of-pocket expenses at the point of
care for eligible procedures.
–
Ability to arrange one-time direct-settlements for
facilities that aren’t currently in our direct-settlement
community. We have an over 95% success rate in
coordinating one-time direct-settlement
arrangements.
–
We partner with Joint Commission International
(JCI) and other accrediting bodies to further enhance
the quality and safety of health care in our
international community of health care professionals.
Demand for International Health Insurance
Summary
 The increase in the demand for International Health Insurance is as a
result of the increase visibility of the trends outlined in this document.
 It is no longer satisfactory for a health insurer to merely address the
issue of paying the cost of a coverable condition.
 Health insurers must continue to address the key issues of:
– Changing behaviours to increase healthier lifestyles.
– Provide mechanisms to identify conditions early and seek to manage
them more effectively.
– Increase access to high quality care, wherever that may be (and this
is not always at the highest cost facilities).
– Reduce out-of-pocket expenditure by offering the broadest direct
billing arrangements possible.
– Manage premium pricing in the long-term and help increase
productivity in the workplace.
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