The global assistance industry is an agile one, thriving on its ability to navigate the complex logistical challenges that often come with repatriating patients around the world. But nothing could have fully prepared it for the scale of the tasks that have resulted from the global pandemic. With the travel industry still on its knees, and a host of unprecedented hurdles to circumvent for the assistance cases that are still happening, it’s not been a great time for many businesses, to say the least. However, although significant challenges remain, with vaccination rollouts picking up pace around the world, international and domestic travel will see an uptick in the coming months, and, according to the assistance providers ITIJ spoke to, they will be ready to respond to a new wave of travellers who want to stay safe and well.
It’s fair to say that most people thought that Covid would have been under control by now, and international travel would be happening at a greater pace than it currently is. “We certainly thought the fall in travel volume would bounce back within a few months to a year; however, it now looks like travel at pre-Covid levels will not return before 2024-2025,” said Lara Helmi, Managing Director at Connex Assistance in Egypt. In Asia, Emergency Assistance Japan (EAJ) had been preparing itself for the expected large influx of foreign travellers for the Tokyo Olympics, but ‘that is now getting highly unlikely’ due to the ongoing pandemic, says Maki Takada, the company’s Associate Director and General Manager International Medical Network. EAJ has also noticed a marked increase in the number of European hospitals and assistance partners asking for security deposits from them – even in cases where EAJ has a guarantee of payment (GOP) agreement already set up with the hospital. Whether or not this is a direct result of the financial strains and uncertainty brought about by Covid is unclear, but it undoubtedly adds a layer of complexity to cases.
And even seemingly straightforward repatriation cases are anything but smooth in these times of border restrictions. Adding further to the complexity, though, is the ‘demand for evacuations, including for those with acute medical needs and often involving complex security considerations’, which have ‘accelerated greatly’, explains Paul Hogan, General Manager Assistance EMEA for International SOS, based in the UK.
Limited commercial flight options means that in many cases, air ambulances are required. Moving Covid patients has been a challenge in its own right, but even non-infectious patient repatriation cases require the navigation of travel restrictions and quarantine regulations, which is still being made more difficult due to constantly changing requirements in many countries around the world. “We now need our network of doctors to hold different passports and have a variety of visas to ensure we can navigate the changing travel rules and still cover our geographic area,” said Helmi.
With its ongoing hospital bed shortage issue, Canadian assistance providers face further issues yet. As Patrick Collette, Business Development Director at CanAssistance in Canada, explained: “Some Canadian insurance companies have decided to cover Covid-19, which encouraged some specific groups to travel despite the Canadian government warning to avoid nonessential travel. The impact is important for the Canadian assistance companies, namely the additional measures and steps we need to take. For example, in case of repatriation back to Canada, we have to make sure the patient has had a recent Covid test; if positive, we need to find a team that will accept the travel and transport of those patients, and an admitting hospital and MD. It was already a challenge in certain provinces in Canada to find a bed; this situation has increased this difficulty of admitting the patient in Canada.”
IT NOW LOOKS LIKE TRAVEL AT PRECOVID LEVELS WILL NOT RETURN
Not quite business as usual
Despite – and because of – ongoing challenges, the pandemic has necessitated a shift in focus for many assistance providers, and has given the industry time not only to shore up its services, but diversify its offering and create a stronger provision for the future. “As travel lockdowns began due to the global pandemic, the volume of travel assistance cases plummeted almost immediately,” said Helmi. “The first three months in particular saw very low volumes, so we had to grow our diversified portfolio of services. We focussed on growing our second medical opinion service and expatriate and local assistance services. These are now key pillars of our service portfolio and we expect them to continue going from strength to strength in future.”
Similarly, EAJ has been focusing on diversification of its service portfolio. Takada told ITIJ: “We are accelerating to expand our businesses to provide ‘preventative’ areas of assistance, such as pretravel advice, health screening, contact tracing, vaccinations, health information and counselling services.” This, said Takada, will complement the mainly ‘responsive’ assistance services provided prior to the pandemic. “It has proven too risky to have your business heavily dependent on providing emergency services to someone already in an accident or sick abroad,” he said.
International SOS also mentioned its delivery of services for organisations with a domestic presence as a response to adapting to Covid. “The Covid-19 pandemic has driven a fundamental change in assistance delivery,” said Hogan. “The needs of organisations, to the ways in which assistance can be delivered, have been shaped through an ever-changing landscape of lockdowns and quarantines. An agile and dynamic infrastructure has been essential to maintaining high levels of service, with the ability to pivot to client needs.” One way International SOS has done this is by shifting the focus of employee assistance programmes to help corporations ensure duty of care obligations are being met among all staff, not just travelling staff. “The pandemic brought an urgency to employers to provide the support that they had traditionally only provided to their business travellers and assignees, and extend this to their entire workforce,” said Hogan.
One of the key areas in which workforces have needed such support in the past 12 months has been mental health. As such, assistance providers around the world have ramped up their mental health service provision, and created new products that insureds can access to help improve their wellbeing.
“We have seen an increase in the need for mental health support amongst many of our clients,” confirmed Hogan. “In our recent Business Resilience Trends Watch study, it has been predicted that mental health issues will be a primary productivity disruptor in 2021. And almost one in three business risk professionals see mental health issues being likely to cause a decrease in employee productivity in 2021. Experts believe organisations could have more employees on sick leave due to mental health issues than Covid-19. While Covid-19 is seen to be creating new mental health issues, it is also seen by some as an opportunity to address what has been a growing employer concern for some time.”
Thank goodness for digital
Besides its own new online mental health support services, one of the new products AP Companies has created during the pandemic is its telehealth offering, which connects users to medical providers all over the world through teleconsultations. Indeed, telemedicine has not only been one of the key pillars of health provision during the pandemic, but due to the benefits it brings, it will be a platform that is used as standard for many more assistance providers into the future.
“Online consultations have become increasingly popular over the last couple of years, but the pandemic definitely boosted this trend and now it is becoming a rather normal way to receive consultations,” said EAJ’s Takada. “Most Japanese insurance companies had traditionally been reluctant to reimburse telemedicine expenses before the pandemic, but now they have changed their stance to allow us to even provide cashless services for telemedicine.”
Due to the restrictions on people’s physical movements throughout the pandemic, and their resultant inability to visit health clinics or make doctors appointments in some instances, together with the fact that remote consultations reduce in-person visits and, thus, reduce the risk of transmitting the virus, telemedicine has met a real need over the past year, and found a new popularity among those trying it for the first time.
The wider benefits of telemedicine have been explored fairly extensively by ITIJ, but the cost control benefits, at a time when businesses have been struggling, has certainly been a notably positive aspect of its increased rollout and uptake. With such success and, for many, a new-found trust in telehealth services, most assistance providers acknowledge its popularity is likely to persist way beyond Covid.
But with people embracing new methods of healthcare delivery from their national health service providers and primary care physicians, so their expectations of their assistance companies will increase. “As a result of Covid-19, people have learned to do everything online and the expectations in this field will be very high,” said Elena Glukhman, Project Manager, Development & Co-operation Worldwide for AP Companies. Global assistance industry providers will have to work on new digital solutions for its clients, she said. This extends beyond telemedicine and into their more general service offering. “Never before has it been so important to be agile and digital,” agreed Collette. “We had to re-scope and accelerate some of our technical initiatives to fit today’s reality.”
WE NOW NEED OUR NETWORK OF DOCTORS TO HOLD DIFFERENT PASSPORTS AND HAVE A VARIETY OF VISAS TO
ENSURE WE CAN NAVIGATE THE CHANGING TRAVEL RULES
AND STILL COVER OUR GEOGRAPHIC AREA
Another of the great challenges of the pandemic has been the global shift to home-working – a challenge that was swiftly overcome, and is now welcomed by many. In the assistance industry, although many companies were already set up for remote meetings and conference calls, and had business continuity plans in place that included remote site working, nothing on the scale of the global pandemic had tested the ability of entire businesses, and the businesses they serve, to move to an entirely home-working model. But this shift has been embraced by many due to myriad benefits hybrid working models can bring. “The majority of companies have been forced to discover working from home, and medical assistance companies are no exception,” said Glukhman, who is based in Spain. “For most employees, working from home has proved to be very efficient and companies have been able to save a lot of costs at a time when this has been absolutely vital. There is no reason to go back to a 100-per-cent office-based model again.”
International SOS explained to ITIJ that it has established a hybrid working environment that is sustainable in the long-term, while Bagoes Hakim, Head of International Technical Operation for Across Asia Assist in Indonesia, explained how his company’s move to home working has created a shift in habits that will likely persist for a long time to come, including online meetings and hands-free access to the company’s physical offices. And this shift certainly hasn’t stopped businesses from continuing with their operational plans.
AN AGILE AND DYNAMIC INFRASTRUCTURE HAS BEEN ESSENTIAL TO MAINTAINING HIGH LEVELS OF SERVICE, WITH THE ABILITY TO PIVOT TO CLIENT NEEDS
Connex Assistance and AP Companies both told ITIJ how they have been using their time working remotely to grow their medical networks though virtual audits, both with great success. Helmi also explained that her company’s entire non-medical team underwent online training ‘to be better informed about infectious diseases in general and how to deal with them’. “We are certain this new way of conducting our business remotely will be around for years to come,” she said.
This said, for some, the operational challenges that working from home can bring are continuing to cause some issues. “The move to working remotely from home in all the countries where we have offices has not really affected the quality of our services in general but has undoubtedly affected our call centre capacities and therefore increased operational costs,” said Federico Tarling, Chief Service Officer for ASSIST CARD in Argentina. Capacity, he explained, can be affected due to unstable internet connections and electricity fluctuations, meaning there are fewer staff members available to handle calls. Face-to-face discussions, as opposed to online meetings, are also something Tarling believes are often better when it comes to talking about the kind of business often carried out by the assistance industry. “Though I think home office working will be more common in the future, I don’t think our operations will stay remote in the future, or at least not to the extent they are today.”
For those fortunate enough to have had fairly unproblematic transitions away from a purely office-based environment, the work-from-home model looks set to be as entrenched in the assistance industry as it is in the wider working world. “By and large, the work from home ‘experiment’ has been a great success for many, making remote working and online meetings the norm of doing business,” said Helmi. “It will be some time before the business world goes back to its old travel volumes due to this success, as it is not only safer for the moment, but also a lot cheaper for companies.”
A new preparedness
Now that the assistance industry has learnt the intricacies of operating from its staff’s homes, it is without doubt better prepared for any future events that warrant the near-abandonment of office spaces, even for a prolonged period of time.
Many companies have created new protocols for working from home and have enabled secure remote access to any of the resources staff members need. AP Companies did exactly this, and says it is now confident of moving to a working from home model on a mass scale again in the future if needed: “[Working remotely] seemed like an interim measure; now we can see that this model is absolutely viable and it now forms part of our business contingency plan for pandemics and natural disasters,” said Glukhman.
Naturally, the working from home model requires operational agility, thorough organisation, and effective communication strategies – all essential for businesses to continue operating to their normal standards. “The pandemic has brought business continuity planning to the fore for the assistance industry and their clients: the flexible approach adopted by many companies in 2020 will need to be retained and developed, as they analyse the dynamic threat environment and build actionable plans to enable their business to thrive in uncertainty and be prepared to respond nimbly when the situation necessitates,” said Hogan. At a time when the distinction between opinion and fact is often blurred, however, obtaining timely, apolitical, verifiable and actionable information, he added, is a vital part of informing organisations’ strategic and tactical decisions and to ensure business continuity.
This pandemic has taught the industry a lot about preparedness for global events that can affect all areas of business. Better stockpiling of PPE and medical supplies are just one of the ways many will be better prepared for future outbreaks. And everyone who has lived through this pandemic will have at the back of their mind the absolute knowledge that global pandemics live not just in the imaginations of sci-fi writers, and the nearcertainty that this will happen again. “We need to listen to the science and try and identify potential risks that would have a similar, if not more severe global impact,” said Helmi. “Some examples would be an even more deadly virus, or the global risk posed by climate change; both of which many experts have warned could be our next global catastrophe with even greater impact than the coronavirus pandemic.”
“The light at the end of the tunnel that we are already seeing is the awareness of the need to travel protected,” said Tarling. “This has increased already, and we expect it to increase even more when travel becomes normal again, so we hope to see our industry grow at a faster pace than before.” This sentiment is echoed by assistance providers around the world, most of which have seen an increased awareness in their local populations of the importance of adequate medical coverage for their trips. “They have seen how important it is to be protected and make sure they will be taken care of if needed,” agreed Glukhman. “This will result in a considerable increase of volumes both for travel insurance and assistance companies.
Unfortunately, this beautiful future will take at least two to three years to come, as the pandemic will not allow frequent unlimited business and leisure travelling around the world for some time yet.” When it does, though, assistance providers will be prepared. Corporates are already reaching out to the assistance industry for their expertise in travel risk management – a concept that is very much front of mind for those with responsibility for ensuring the safety of their travelling workforces.
“During the pandemic, we have seen organisations’ willingness to engage and invest in employee health and wellbeing only increase,” said Hogan. “As the complexity (of reviewing an organisation’s risks for its employees) has grown, independent unbiased health and security advisors – including those working in global assistance – have played an increasingly important role, helping organisations to make decisions based on their profile and needs, while not spending above their means and avoiding being seen as taking a political stand on Covid-19 measures. Ultimately, their role will be to help organisations anticipate the next health challenges, beyond the current pandemic, that they need to start addressing now.”
WHILE COVID-19 IS SEEN TO BE CREATING NEW MENTAL HEALTH ISSUES, IT IS ALSO SEEN BY SOME AS AN OPPORTUNITY TO ADDRESS WHAT HAS BEEN A GROWING EMPLOYER CONCERN FOR SOME TIME
Lasting, positive changes in the assistance industry will also be seen in other ways. With assistance providers having had to work more closely with port and border authorities, as well as government health ministries, during these times of border closures and restrictions, such relationships have been strengthened, bringing lasting benefits for all parties. As Reine Jong, Chief Human Resources Manager at EMA Global in Singapore, told ITIJ: “This increase in communication and collaboration across the globe is an improvement to the current industry, and a change that is here to stay.”
The adherence to the strict standards of hygiene and health protocols that have come with carrying out patient transfers during the pandemic has also strengthened the industry, believes Jong. “Strict industry standards for safety and hygiene are something that will stay in the industry for a long time,” he commented.
As a sector that is used to dealing with logistical hurdles around providing assistance to travellers in all parts of the world, and at all levels of medical complexity, the assistance industry has called on its vast experience to navigate these difficult times, pooled its resources in some areas, and will emerge from Covid stronger than ever.
The world may be a little different for a while, but the industry is prepared: “The core of the business of our industry – in assisting travellers or expats – we think will remain the same; however, we will have to be more flexible to identify their needs and to broaden our service options to meet them, as the way people travel will be very different than pre-Covid,” said Takada.
Indeed, Covid may have changed the way the industry conducts its business, and some of these changes will last well into the future, as the industry adapts to meet changing traveller and patient needs and uses its experience of the pandemic to make its offering stronger and broader. But, at its heart, the industry will remain the same.
As Helmi summarises: “[Covid] has changed the way we do business, but the core of our business will always remain the same: to come up with innovative, rapid and effective solutions to achieve results in some of the most challenging situations.” And it will certainly be better prepared than ever before to do this.