ITIJ 213, Assistance and Repatriations Review, October 2018
Tatum Anderson delves into the complex and fast-paced world of provider network managers
The first thing that hits you when you speak to a provider network manager is just how busy they are. “Every day is different – we may be re-negotiating pricing as our business grows in Mexico, identifying the best quality options for a student group in a remote location in Africa, working on an agreement with a new facility in China, developing a new offering like telepsychology,” said Laura Hilton, Director of Provider Relations at GeoBlue. “We could be doing a Personalised Recruitment to help an expat stay with the same pediatrician when moving to GeoBlue from a competitor.”
Network managers like Hilton specialise in building and maintaining networks of good-quality health facilities, so that assistance providers and insurers can be reassured they are sending their customers to a vetted and approved hospital, able to deal with international patients. They must also deal with other parts of their own organisations, said Geoffroy Remond, AXA Assistance’s Network Manager in charge of the Middle East, Africa and Europe. “We have very busy days,” he said. “When I get into the office, I can have up to five requests between heading for the cafeteria and taking my coffee to my desk! I can have the medical director requesting specific providers’ referral, the medical ops director requesting some evacuation options, or the nearest centre of medical excellence in one country or another or to ask us to source new providers.”
Fundamentals of the job
Care and quality of care, negotiated prices, checking credentials and operational efficiency are the most important factors network managers look for in a good hospital. As Remond explained, assessing operational efficiency means measuring the quality and speed of the provider: “Do they know how to work with a Guarantee of Payment? Are they reactive enough on a 24/7 basis? Are they able to deal with international companies? Sometimes it’s difficult, for example, to draft an invoice and make sure that good information is provided for an international company. They also check if medical facilities are allowed to function, if doctors have licenses, malpractice insurance, their diplomas are kosher and they are registered with the medical board. It’s a job that is often outsourced but must be doublechecked.”
Network managers are assessing not just the main city hospitals, but those in more remote areas with less infrastructure
But checking the quality of care is the priority, according to the managers, with Remond explaining that it’s really important to take pictures, to allow the medical and operations teams at home to have a taste of the kinds of facilities available. He assesses not only the ER, but other hospital services, from the ICU and imaging to other specialities – and that means asking probing questions. “We ask do you have a 24/7 ER department, is your ER doctor a general practitioner or is he really an emergency doctor,” he told ITIJ. “Is she physically present the whole night or is she on call and, if so, how long does it take to come to the ER to welcome our patient? If they have a specialist how long will it take the specialist to reach the site?”
It’s essential to do these thorough checks. Managers must be aware of drug stockout problems, how controlled drugs are handled, whether the hospital has its own blood banks or must source blood from a national centre in a different region. The checks are all-encompassing – they may even check if the hospital is providing laundry services, meals or the morgue itself, or subcontracting services to an external provider. The latter is important, particularly, should mortal remains need to be repatriated quickly. AXA even vets the security guards in more challenging parts of the world, such as Nigeria.
Hygiene is, of course, fundamental. “In medical facilities, you can go to a laboratory and it gives you a good taste of the level of hygiene of the medical facilities most of the time,” said Remond.
International network managers must be masters of contract negotiations and procurement rules, and establish clear points of contact: if their organisation wants to arrange an admission, who should be called and who should be sending the invoice, for example?
When looking for good hospitals, Katy Youngman, AWP Regional Medical Provider Manager at Allianz Partners in charge of the Asia-Pacific region, said that she focuses on patient health outcomes, and evidence of strong clinical governance policies and procedures. Crucially, however, she looks for a good relationship with the service provider. “When evaluating a hospital, I’m primarily looking for a willingness to work in a clinically collaborative and collegiate relationship, to ensure the delivery of evidence-based best-practice care,” she told ITIJ.
The relationship with the hospital is especially vital when the good standards seen on inspections are not maintained. Regular onsite evaluations happen every few years – but being able to work with the hospital in between these times is important too.
“Communication is key,” said Youngman. “This includes regular correspondence with providers to highlight concerns and aim for collaborative improvements.” Collaborating with other members of her own company helps her to keep up-to-date with just how well a hospital is doing as well: “I work closely with our Medical Operations teams to obtain feedback around medical outcomes with the AWP network facilities.”
Keeping a close eye
There are several tell-tale signs that indicate things are not going too well at any particular hospital. Poor health outcomes, customer feedback and clinical governance are all danger signs, warned Youngman, but so is the use of inappropriate medications and clinical practices that are totally unsupported by research or evidence. “A lack of clinical engagement with our medical teams, lack of accountability, or predatory practise leading to over servicing, is not acceptable,” she said.
Once due diligence is done, GeoBlue’s Hilton agreed that the goal is to have a long-term relationship with each contracted doctor and hospital: “It is an art, as much as a science. Clinical quality and patient experience are my top priorities, but every successful relationship has to be underpinned by win-win business terms and a solid working relationship at every level.”
An interest in the world is a basic requirement
That means maintaining regular contact. “We contact each contracted doctor and facility a minimum of four times per year to maintain and grow our relationships,” she said. “In the rare instances when there is a significant issue, we make sure to get all sides of the story and then evaluate the situation internally with a multi-disciplinary team (clinical, legal, provider relations) before developing a plan.”
Different levels of interaction are required too, she added, because hospitals have different needs. “Some hospitals are keen to build their business with international patients, others have been burned in the past by some company in the international space and need a lot of coaxing to actively work with a non-domestic insurer,” she told ITIJ.
That’s why travelling is such a big part of the job, not just to visit hospitals, but other parts of the organisation. “Face-to-face visits with team members and key medical providers see me travelling to varied regions throughout APAC, covering multiple countries per trip,” said Youngman.
Youngman’s team is spread across eight countries throughout the Asia Pacific region, which can be extremely diverse. Indeed, the AWP Asia Pacific region consists of 56 countries with varied standards, accessibility and costs of healthcare – and the network must accommodate very different travellers, including leisure, corporate and expatriate customers.
Such a broad range of countries with different cultures, economic conditions and ways of doing things requires a nuanced approach, she said: “For example, in Japan, our medical team often has to liaise with doctors to encourage pain relief medication when necessary. This is not reflected in other countries! Japanese patients are often very stoic and appear to be tolerant of higher pain levels than their Australian counterparts [for example]. In Japan, medical doctors are highly respected and rarely questioned by patients in regard to their decisions.” In contrast, other countries within the region are more likely to overprescribe narcotic pain relief and that leads to more complications such as delayed patient mobility, prolonged length of stay and a higher risk of hospital-acquired infections, she said.
Network managers are assessing not just the main city hospitals, but those in more remote areas with less infrastructure. “One of the great challenges is the ever more remote locations that people with significant comorbidities are travelling to – especially in ageing demographics,” said Youngman. “Locations where healthcare options are limited for patients.”
Dubai-based Jamil Juma has seen the job from various points of view – as a provider network manager himself for 12 years at International SOS, and at Oman Insurance. He said it’s a mistake to use the same criteria for an internationally accredited hospital as one in a remote or poorer country: “In some locations, it is hard to find a facility with international standards or even with acceptable standards, but management support can facilitate this mission providing the information required.”
As a result, he looks for hospitals that have put protocols in place, are well-staffed and have an interest in good communication with their clients. Importantly, he said, they must be willing to take direction from management and provide the support required for his clients.
A matter of ethos
Often, it’s not the international accreditation or lack thereof that may indicate a hospital is not up to scratch. It’s the ethos the hospital has. “If the hospital orientation is purely financial, this can be determined by their reluctance to share their price list, or you may learn that they have different price lists for insurance, cash and international clients,” said Juma.
GeoBlue’s Hilton agrees: “The most disappointing situations are those where a doctor or hospital puts financial or other interests above clinical quality and patient safety. All this makes for an extremely global and varied work environment. Extensive experience travelling or living abroad, foreign language skills, negotiation and analytical skills, open-mindedness, effectively being a cultural chameleon, is essential for Hilton: “I often think I have seen it all, but every day is still a learning experience.”
The skillset for a provider network manager is certainly diverse. Hilton told ITIJ that her foreign language and negotiating skills have been essential. “But my own experience of being hospitalised in the Amazon at 20 years old gave me insight into what is important to patients who become sick or injured abroad,” she explained.
The managers ITIJ spoke to come from wide-ranging backgrounds; starting in critical care nursing for example. AXA’s Remond said that medical operations gave him a thorough grounding in pragmatic problem-solving in different, and sometimes difficult, situations. “One thing I always look for when I’m recruiting someone is the professional background,” he said. “If they’ve worked as an operations co-ordinator or manager, it’s always a good entry to medical network management because they’ve been working with providers and they know the challenges.”
An interest in the world is a basic requirement, he added: “If you are aware of the foreign politics in these countries it’s always a plus because it makes the meetings with the providers easier. The chitchat before the meeting, it’s always important to keep these good relationships with the provider. Being comfortable with different cultures [is very useful]. It’s a job where you are constantly asking questions, but if you’re not curious it doesn’t help.”
Youngman believes that network managers must be flexible, but so must their organisations. “Flexibility is key in this role,” she said, “due to the multiple time zone differences. AWP is very supportive of flexible working, in the office and from home. Usually, I arrive at work around 8 a.m. and will likely be on calls as required between 8 p.m. and 10 p.m. at night to fit in family life in between.”
Additionally, passion for learning is vital, said Juma, who is, by training, a pharmacist. “There is no book or degree that you can obtain to become a network manager. It is a continuous development process,” he explained. “To succeed, you need to accept the daily challenges and find the right approach to dealing tactically with people. You need to accept limitation of services, language barriers, the hostility of some environments, personal interests and support the team you work with.” The key, he concluded, is to ‘never underestimate communication – any communication – even a simple SMS’. ■