Thinking outside the box

ITIJ 192, January 2017
the insurance industry is more volatile than most. You never quite know what is around the corner
Christiane Burniston
CEO and chairman
ChargeCare International
ITIJ spoke to Christiane Burniston, CEO and chairman of ChargeCare International in the UK, about the management of provider networks, enabling technology, and the evolution of the cost containment industry
How long have you worked in the cost containment industry, and can you describe the career path that has led to your current role?  
I started focusing on cost containment more than 20 years ago. My career started with Europ Assistance in the UK. I learnt everything there was to know about medical assistance. It was a big part of my life, exciting and so fulfilling. I moved away from assistance to insurance, joining Home & Overseas (H&O) some 11 years later, expecting a more regular type of life. H&O was anything but that, and it turned out to be the best school I could have joined to learn about the vibrant, wild, successful world of UK insurance. 
ChargeCare was founded in 1995, and one of its early aims was to exploit the potential of web-based technologies, something that could be considered quite ahead of its time. Has it been a challenge keeping pace with technological developments over the years? 
We have always been up there, right on the edge of new technology, developing our own systems. We have created new systems with a high level of automated processes and minimal touch points. Many years ago, we made the choice to be transparent with our clients and medical providers, giving them real-time access to their claims. Sharing information, giving feedback, providing benchmarking reports is part of our philosophy. ChargeCare is a tough negotiator for medical providers, with years of statistics on costs, treatments and trends. Our IT vision is backed up by an experienced, forward thinking and security minded IT director who embraces our ambitions.
How does ChargeCare maintain its provider network to ensure quality care for patients at the best price for clients, and what unique benefits does ChargeCare offer its networked medical providers?
We use all sorts of touch points, to ensure quality and best price. As much as possible, we have local doctors working for us, who know the facilities and the costs. We regularly visit doctors and hospitals. We manage our relationships professionally and maintain excellent communication channels from the UK but also from our local offices, which are a great asset.
Patients have always played a significant part, giving us their feedback on quality of care. 
More recently, we have sent undercover patients to selected surgeries, comparing first hand the treatment and handling of the insurance process with the final information contained in the invoices and medical reports.
Not only do we use our auditing process to gather elements to detect fraud, overtreatment, overcharging and identifying new trends, we also create a unique opportunity to make patients more aware of what is happening to them, on the ground, at the time of treatment. 
ChargeCare provides cost containment services on a regular basis in more than 12 countries. There is not a one-size-fits-all solution. Our expertise goes way past quality of care and costs, as many other aspects play a vital role in assessing and controlling a provider in a fair and objective way: local logistics, local competition, domestic healthcare, culture.
We aim at pointing new providers to the ‘correct’ way, through our technology and knowhow. We post useful instructions and information on our medical providers’ portal to facilitate their tasks and maximise efficiency.
Many of ChargeCare International’s patients are already at a doctor’s surgery or in a hospital when a new claim notification is received. The majority of hospitals will deliver good care. However, when there is an opportunity of directive care, ChargeCare International offers its clients the use of its database to direct patients to a hospital of their choice. With private medical health insurance, where treatment is often not an emergency, we can pick the most suited provider at the best price. 
How has the cost containment industry, and companies’ approaches to cost containment, changed over the course of your career?
Our main focus in cost containment has traditionally been in Europe. Insurers have certainly increased their level of interest in cost containment in this region. They are taking a much more proactive and direct involvement in cost containment in Europe. Cost containment, or procurement teams in charge of cost containment, are now common features in insurance or assistance companies. We work with them closely to complement what they are doing in-house.
Medical providers are reacting to cost containment much more seriously. Cost containment in Europe is very much driven by the British industry and, as a result, medical providers’ attitude to British patients in some key destinations in Europe has changed quite considerably. It is important that ChargeCare International manages costs in a way that is not detrimental to the patients’ welfare.
With an increasing number of companies involved one way or another with cost containment activities, medical providers are consciously creating an elite group of cost containment companies with whom they are prepared to work. They look for integrity, reliability, expertise and technology. ChargeCare is one of the companies in that small group. 
In terms of a different approach to cost containment in Europe, the biggest has been the increasing practice of directing patients away from private clinics to state hospitals for treatment under the EHIC.
What would you say are the biggest challenges currently facing the global cost containment industry? 
Regarding cost containment in Europe, one of the biggest challenges will be managing the ‘Brexit’ effect. Will some sort of reciprocity agreement replace the EHIC card, will the status quo remain or will it be a free for all?
The destinations for mass tourism are shifting, often determined by uncontrollable world events. Thinking ahead, we are researching new ways of controlling the patient journey, ensuring good quality care, reducing hospital admissions and medical costs whilst balancing management costs versus medical savings. 
What do you enjoy most about your role – and what would you say are its most challenging aspects?
I particularly enjoy thinking outside the box, finding solutions and being innovative and creative in terms of new products, new technology, new set-ups. I like to make things happen and work. 
Many of my clients and contacts have been around as long as me, and it is always a good feeling to catch up with them at the International Travel Insurance Conference (ITIC) or elsewhere, and reflect on the good old days and what we have achieved together or separately in this industry. 
I have been extremely lucky with the people I have met along the way, especially the teams of people behind me who have believed in ChargeCare International and worked consistently with me to make the company what it is today. We have great and lively interaction despite the miles between us. This is also the right job for travelling and meeting people, which I love.
A lot of responsibilities come with running your own business and the insurance industry is more volatile than most. You never quite know what is around the corner. The travel industry is very much connected to what happens in the world, and that is not in our control.
If you could do any other job in the world, what would it be and why?
Toughest question of all! I wouldn’t know! It would have to be a job that allows me to work in an exciting and beautiful environment, to create a happy and motivated team. I am an organiser and a planner. It would have to be a journey of discoveries though!
What are you most proud of – both personally and professionally?
Personally and professionally go together when you are so intensively involved with your own business. I am proud of making a big and happy life in the UK for myself, surrounded by loving, brilliant, kind and genuine people. I am originally from France, but being in the UK has been the best springboard ever into the world. I love Britain, the bulldog spirit and the eccentricity of this country.  

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