Merging healthcare and health insurance

Global health insurer AXA described at its AGM how healthcare and health insurance are merging their services, towards ‘healthcare, backed by insurance’.  Ian Youngman looks at AXA’s healthcare vision and explains why this poses a significant risk to medical tourism and healthcare facilities which are not part of insurer networks or partnerships.

Working alongside patients and health professionals, the insurer’s role has been transformed. AXA is building on technological innovation and analyses of the needs of patients, doctors and care givers, supported by increasing volumes of data to position itself as a “partner” of customers’ health.  It is becoming a health facilitator, advisor and coach.

The AXA vision of healthcare

There is no standard care pathway or pattern of behaviour followed by every patient. Even the most obvious distinctions – sick or healthy – are often more blurred than they seem, and customers are often uncertain about the seriousness of their health problems and the action they can take.

AXA says it has been seeing an individualisation of the care pathway for a while, but what has changed rapidly is the quantity of data and the channels available to analyse individual needs and provide solutions.

When the first symptoms appear and patients feel the need to be diagnosed, treated or simply reassured, finding a good doctor becomes a matter of urgency. All over the world, they talk of their difficulties including medical deserts, the cost of private treatment, and longer wait times. The obstacles are numerous, including in towns and cities, where the number of general practitioners is in decline.

AXA states that even in France, where the state reimburses a significant share of health costs, 40% of patients postpone treatment every year because they are unable to pay the costs upfront. Worldwide, 800 million people spend more than 10% of their household budget on healthcare. It is essential for patients to know how much of their treatment costs will be covered and when they will be reimbursed.

AXA believes that the first steps on a healthcare journey are a critical time in the patient experience, determining the choice of treatment and the quality of relationships with health professionals. Patients want above all to be heard and have their symptoms and feelings properly considered. They also look for clear, straightforward information on the proposed treatment and disease prevention measures, to be able to take an active role in managing their own health.

Receiving the right treatment is obviously critical to a patient’s recovery. But, AXA asks, how is the quality of treatment assessed? Is an operation that treats a problem but leaves the patient with complications a success or a failure? It is seeing more insurers working to put the patient back at the heart of care pathway assessments.

Coordinating with different medical professionals, scheduling appointments, handling administrative formalities and getting reimbursed are all tasks which can make managing treatment a real battle for both patients and care givers. Practical tools and services that help them manage (or dispense with) these formalities can provide real relief.

Previously in contact with their clients at the reimbursement stage, when it’s already quite late in the day, AXA  says it now supports patients at every health touchpoint. And that obviously changes the approach. It is not so much about knowing at which stage to act, but rather finding the right interfaces and tools to be there every time AXA customers have a problem.

This new approach has led AXA to simplify the relationship between patients and their insurer.

It is working on solutions to guarantee quick, easy reimbursements and transparent coverage. It aims at giving a preferential access to network of competent professionals with minimum upfront costs.

Customers want to have the fewest possible formalities to carry out, preferably through a single interface like AXA’s My Easy Santé app, which enables customers to manage their entire care pathways. In Asia, the Emma app provides a single interface for accessing all AXA Healthcare services, combined with disease prevention advice, such as the BetterMe coaching programme.

With telemedicine, AXA is present from the moment patients start their healthcare journey, giving them access to competent health professionals and guiding them to the right specialists for their situations and questions.   It also sees remote consultations as opening the door to a new age when the insurer can meet a patient at any time.

The increase in health data and digital tools also enable AXA to work alongside customers to prevent disease before they require treatment. The group is working alongside partner companies to improve their employees’ health. In the United Kingdom, for example, AXA PPP Healthcare offers companies’ health coaching platforms for their employees, who can follow fitness and health programmes or access health advice.

AXA states that one key question remains: how can an insurer ensure that its healthcare offering meets its quality requirements for patients? To better manage healthcare journeys, AXA has opened integrated medical centres in Egypt and Mexico, and is aiming to open 50 by 2023 to serve 1.5 million patients in key emerging markets – a new facet of its role as a partner. By offering a bundle of services that are usually provided by different companies, AXA is simplifying access to quality healthcare for customers.

Risks to medical travel and international healthcare facilities

Moving from insurance as a ‘firefighting’ backup, to ‘healthcare, backed by insurance’ is part of the ongoing trend towards an insurer offering more healthcare, advice and help to a healthy lifestyle. Insurers are now seeking to stop people getting to the point they need urgent treatment, by facilitating changes in health lifestyles.

This is a win-win for insurer and customer, although insurers vary as to whether they own healthcare facilities and/or partner with multiple providers.

This is not a win for medical tourism and healthcare facilities which are not part of these insurer networks or partnerships; it locks both out from the customer and the insurer.

The more the customer is part of a holistic healthcare/insurance offering or, in the case of the major Chinese health insurers, a health insurance/healthcare/technology offer, the less they need medical tourism agents, clinics, and hospitals.

Medical tourism businesses who are still using the “we save insurers money” approach may find this is out of date, as with this new way of working there is no need for medical tourism. Yes, insurers will send customers to other countries, but much less than before, and only if local facilities are not available.