Learning from the past and looking to the future

How did the pandemic influence the way you work, if at all? 

The most obvious change has been that shared with virtually all customer service organisations – shifting to a largely work-from-home mode. We are far from unique in that respect, but having to make this transition while remaining fully responsive as a 24/7 emergency provider was especially challenging. 

Having survived through a number of global ‘mini-pandemics’ – SARS-1, H1N1, Ebola and MERS – I’ve come to recognise the early signs that will affect our operations and made sure we’ve enacted and updated our pandemic response at the first signal.

Hence, I think we were able to adapt quite early and effectively to the unprecedented pandemic starting in 2019. However, the challenge of the new normal is still a struggle. Training new staff and establishing close working relationships remotely is a trial, and places heavy demand on experienced leaders. But I’m proud that we managed to maintain the quality of our emergency medical support throughout the entire saga and have even learned new strategies – perhaps indicative of the native adaptability of emergency providers.  

How did the pandemic influence air medical transport as a whole?

I can speak both from my assistance as well as my EURAMI perspective. At the peak of Covid-19, getting clearance to transport and finding properly equipped providers was extremely difficult – it forced us to rebalance our decisions to opt for ongoing treatment onsite versus early evacuation or repatriation. Since restrictions have abated, we face an aeromedical industry that is struggling to meet demand as a result of workforce and supply chain issues. Hence, availability of flights is often fleeting and we are having to make decisions much faster to move patients with certainty. We are now much more attentive to potential highly infectious disease threats, and practising meticulous hygiene precautions has become de rigueur. In fact, EURAMI scaled up its standards to this aspect of transport for all providers.

How are payers seeing the value of air ambulance repatriations change?

Fortunately, we are not seeing reluctance to resort to air ambulance use when clearly indicated. However, I see ongoing confusion and consternation about the significant rise in prices. In theory, payers appreciate that global inflation has affected AA costs as much as any other industry. However, these are high-cost services by nature and the individual missions can still seem to stun some payers. We know the reasons that have especially affected the AA industry and I am often asked to help explain these factors to our clients. 

The opportunity to enhance our online presence has become an opportunity for less handling time and a higher degree of self-management

Have insurers become more cautious about commissioning air ambulance flights due to rising costs?

We have not been especially pressured to avoid air ambulances, but clients do expect us to make a cost-benefit analysis weighing risks of remaining in place versus early transport by AA. As medical costs in many locations have risen as significantly as for AA flights, it may make sense to fly the patient home as a more cost-effective option despite the higher costs of AA flights. In that regard, we have been more actively searching for empty legs to reduce costs and AA providers are very happy to have both legs filled.

What do you think are the major challenges right now facing international insurers?

Since Covid-19, travellers’ awareness of risks both for cancellation and emergency situations has heightened and increased both demand for protection along with their expectations. In a sense there is more adverse selection.

Along with that, use of social media has placed a broad microscope on our response to patient requests. Insurers and assistance providers are increasingly exposed to public pressure by customers and their associates, whether justified or not.
It is an uncomfortable, generally one-sided process, since we are reluctant to engage with customers publicly, especially where private medical information is involved. This makes navigating a serious medical situation even more complicated. On a more positive note, customers expect less dependence on telephone exchange and to move to expanded and rapid online resources. The opportunity to enhance our online presence has become an opportunity for less handling time and a higher degree of self-management. It does not, however, change the level of personal support for complicated medical situations that we provide.

We do everything possible to avoid leaving our insureds in unsafe circumstances, even if it means at times going beyond contracted exceptions of force majeure

How are current geopolitical events influencing medical assistance providers? 

For the most part, our organisations are obliged legally or by logistic obstacles to respect restrictions on response to areas of active conflict or sanction. At AXA, we always seek a solution for our insureds and employees caught unexpectedly in a geopolitical crisis. We immediately warn customers against travel to those locations. For those needing to exit urgently, whether medical or not, we typically source private and governmental resources to intervene emergently. We have increased our emphasis on effective relations with our main client country government agencies to be able to make use of any national responses and diplomatic engagements. We also work with a select group of security and aeromedical partners who are willing to take on high-risk missions if at all possible. The bottom line is that we do everything possible to avoid leaving our insureds in unsafe circumstances, even if it means at times going beyond contracted exceptions of force majeure (unforeseeable circumstances).

How can medical assistance providers improve the support they offer for their staff if they are dealing with a particularly traumatic case?

Advance training is key and we now place significant emphasis for our agents on how to deal with emotionally fraught customers – whether it is anxiety, sadness or anger. Our medical teams are experienced clinicians, so are arguably more practised at handling patients and their families, but they can provide much needed support and buffer for frontline agents. We help our staff understand they are not responsible for a customer’s situation or their anxiety and we offer debriefing and even counselling if necessary for really trying situations. It may come as a surprise how personally many staff take these cases when they have been helping a family through a personal catastrophe, even though they will never meet or see their clients. It takes strong and special people to weather through.