Cost containment strategies in air medical transfers
While patient welfare and continuity of care are vital in air medical transfers, cost containment is a key consideration for assistance companies and insurers alike. Experts share insights with Lauren Haigh on prevailing challenges and effective strategies for containing costs
In every air medical transfer, the priority is the patient’s safety and comfort. Increased speed and manoeuvrability compared with ground transport mean that, depending on the case and associated risk factors, air medical transport is preferable and can even be the difference between life and death. A key disadvantage, however, is increased cost. Operating costs are high, along with variable costs associated with the type of aircraft, distance travelled and staffing.
“There are a lot of factors that need to be considered before reaching a decision,” confirmed Charlotte Estipular, Managing Director of UAE-based assistance company LGA Group. “Air ambulance services are typically used for long-distance medical transportation, especially when the patient is in a critical condition and needs specialised medical care during the journey.”
From an insurer’s point of view, there must be trust that their appointed assistance provider is acting in their best interests
While patient care is at the forefront for all parties involved, cost containment is an important consideration. “Air medical transfers from the Middle East and Africa to different parts of the world or home countries present a dual challenge for insurers in containing costs while ensuring optimal patient care,” stated Estipular. Indeed, there are various challenges faced by insurers when it comes to cost containment and case management.
A foundation of trust
There are a number of strategies through which insurers can ensure value for money. The first is forging and maintaining high-level network partnerships, as Estipular explained: “Establishing strategic network partnerships with air medical service providers is crucial for reaching the highest level of cost containment. These partnerships allow us and the insurers to negotiate rates and secure preferred relationships, ensuring optimal value for money and enhancing the efficiency of air medical transfers.”
Estipular said that negotiation can be invaluable here: “We can ensure value for money by negotiating competitive contracts with air medical service providers. Establishing long-term partnerships and conducting thorough market analyses help us and the insurers secure favourable terms and pricing, ensuring they get the most cost-effective solutions.”
All stakeholders in a network will have a close eye on cost, as well as ensuring care is both optimised and suitable. Carefully vetting and selecting partners adds an extra layer of security, giving stakeholder relationships a foundation of trust. ITIJ also spoke with Dr Adrian Hyzler, Chief Medical Officer at Crisis24, who further stressed the importance of trusted networks.
“From an insurer’s point of view, there must be trust that their appointed assistance provider is acting in their best interests,” he stated. “The medical assistance provider is experienced in primarily managing cases to ensure that a patient is receiving timely, appropriate and relevant clinical care. Furthermore, the medical assistance team is also responsible for monitoring the management, investigations, and treatment to make sure that they are neither inadequate nor unnecessary.”
Estipular agreed and highlighted that pre-approval processes are important here: “Our team is composed of doctors from various disciplines and has a wide range of experience in air medical transfers. Our doctors conduct robust pre-approval processes to assess the medical necessity of air medical transfers, preventing unnecessary procedures and aligning with cost containment goals,” she said.
Trusted partnerships can also reduce the chance of unsavoury practices, as Dr Joseph Lelo, Medical Director at AMREF Flying Doctors, pointed out: “Unfortunately, inaccurate and inflated bills by opportunistic rogue service providers are seen quite frequently.”
Transparency for quality and value
Close collaboration between team members at each stage of the process is vital, Dr Hyzler stressed:
“This can usually be achieved through verbal communication between the medical teams but, ultimately, may require transfer to a facility that has been accredited by the network team to be both of a suitable standard of healthcare and also trustworthy and reputable. By using a cost containment approach with trusted networks, the assistance company is able to pass on cost savings to the insurer.”
Trust is a key word here, and Dr Lelo illustrated why this is of the utmost importance, particularly in the context of persisting fraudulent practices: “In some countries, poor regulation and enforcement of standards contributes to the difficulties insurers may face. Those engaged in dishonest practices will rarely get prosecuted and end up becoming repeat offenders. Having strong partners on the ground gives insurers a strong advantage when it comes to protecting their business and ensuring that their clients get high-quality services at great value.”
A related element is the importance of transparent pricing models, ensuring that everyone is on the same page with cost and has a comprehensive understanding of what to expect. Estipular explained:
“Developing transparent pricing models enhances understanding of cost structures, promoting trust and accountability between LGA Group, insurers and air medical service providers. Fast payment is also an option to reach the highest cost containment, reaching an additional 10–15% saving value on top of proactive discounts in the contract.
“When seeking medevac services, it is crucial to trust local assistance companies that understand the intricacies of the market, especially in terms of pricing.”
This knowledge can prove invaluable for fair and accurate pricing. An important part of transparency is quality and control checks.
“Insurers can ensure value for money by having continuous control checks on invoices to ensure that they are accurate and charges are customary,” said Dr Lelo. “Quality checks by visiting and auditing the medical service providers will also ensure that the insurer is getting value for money and also helps to increase business intelligence. IT solutions based on artificial intelligence (AI) can also monitor trends specific to a city or region and pick out anomalies whenever they arise.”
Estipular agreed, emphasising the importance of continuous monitoring and reporting: “Regular monitoring of efficiency and costs allows LGA Group and insurers to make real-time adjustments to the cost containment strategy, ensuring ongoing value for money in air medical transfers.”
Quality checks by visiting and auditing the medical service providers will ensure that the insurer is getting value for money and also helps to increase business intelligence
The correct treatment and travel plans
Considering the challenges faced by insurers when it comes to cost containment and case management, Dr Hyzler reflected on how working with an independent assistance company can be advantageous.
“When it comes to the eventual evacuation or repatriation of the patient, there is once again a reliance on sourcing the best options for the patient but also seeking comparable quotes from a range of recognised providers,” he told ITIJ.
“An independent assistance company has the capacity to source the best quote from an open and competitive market of air ambulance providers and can thereby provide the best value to the insurer.”
Estipular agreed, pointing out the importance of effective decision-making related to the case in hand. “Some insurance plans can only cover a portion of air ambulance costs. Our team, with the help of our medical director and our trusted medevac provider, can assess whether the patient can be transferred via commercial flight or air ambulance,” she said.
“It’s important to note that the cost of air ambulance services can be very high, sometimes reaching tens of thousands of dollars or more. Commercial flights are generally more cost-effective for non-critical patients travelling longer distances. LGA Group always ensures that correct treatment and travel plans are recommended.”
Another key challenge relates to lack of communication, as Dr Lelo highlighted: “Poor, delayed communication and reporting is a common challenge.”
Estipular agreed that effective communication is absolutely essential for avoiding roadblocks. “Effective communication between local medical personnel, aircrew and ground-based healthcare providers is crucial. Language barriers or poor communication infrastructure can impede the flow of essential information. LGA Group is deploying our local representatives who are also native in the country to ensure that the case will be managed without any delays or problems. In the Middle East, it is essential to deploy native speakers, especially in Saudi Arabia, for example.”
The rising cost of care and increasing incidences of fraud only exert more pressure on the insurance industry
Fraud is a prevailing concern that has huge ramifications throughout a network. “Medical insurance fraud is very common, especially in developing countries where systems and fraud risk management practices are not mainstream,” said Dr Lelo.
“The rising cost of care and increasing incidences of fraud only exert more pressure on the insurance industry.”
Estipular has also encountered this and stressed that having effective preventative measures in place is paramount. “In areas where fraud is rampant, we are proactively informing the insurers that our client relationship medical team will be sent to check the patient’s condition, [and] to also assess if the case is subject to peer-to-peer review, spearheaded by our medical director, treating doctor, and insurer’s medical director,” she said.
Medical assistance companies, air ambulance operators and insurers all play a role in mitigating costs while prioritising patient welfare, and, with the right connections, robust strategies and effective communication, costs can be successfully contained while prioritising patient welfare and continuity of care.
“Addressing challenges requires a multidisciplinary approach involving the medical assistance company, aviation providers, insurers and logistical support teams to ensure the safe and efficient transfer of patients in critical medical situations,” concluded Estipular.