It would probably be an understatement to say that 2020 hasn’t exactly been the best year for travel. Having been brought to our knees by a global pandemic, the idea of planning international travel leaves most of us in a bit of a quandary. Air bridges, air corridors and travel bubbles that have the potential to expire in a matter of days have meant that making future travel plans is now a rather precarious enterprise. That is, until the travel insurance industry began looking to extend policy coverage to include Covid-19. And that’s the way advancement works and has been working for centuries. The market identifies a need, and it fills it.
It’s also the reason why digital solutions are becoming ever more prominent in the travel insurance landscape. To take Covid-19 again as a great example, Dr Sneh Khemka, Vice-President of Population Health, Aetna International, explained that there is a ‘well-documented need’ for scalable digital tools at this time. Aetna’s parent organisation in the US, CVS Health, he says, has seen an increase of over 60-per-cent in uptake of its primary care virtual health service for physical health and GP advice. “You might expect a figure like this, given the restrictions of lockdown and the potential reticence and anxiety around sitting in a waiting room during a pandemic,” he said. “However, what is really telling is that mental health requests have increased by 3,320 per cent for us – a figure that can only be described as astounding. These statistics go some way to validate both the desperate need for support, and the manner in which people are asking for it to be delivered.”
Patrick Graham, CEO - Asia Pacific and Head of Strategy, Analytics and Innovation, Cigna International Markets, told ITIJ that the company saw a six-fold increase in the use of its virtual health services between January and April this year, and added that demand for virtual health in Hong Kong in particular was up significantly this year, with 61 per cent of Hong Kong respondents saying they were likely to use virtual health services if they were an option for consultation or diagnosis, compared to 45 per cent in 2019.
“The global rise of digital engagement, combined with employers’ increasingly onerous duty of care obligations, are being reflected in an increased uptake of digital solutions,” surmised Angela Smith, Head of Propositions, Charles Taylor Specialist Claims Management.
Time is of the essence
Taking long-term expatriates out of the equation for a moment, it is important to identify that travelling for leisure and travelling for business are very different, and thus require different solutions. As any travel insurance expert will tell you, one of the major differences between business travellers and leisure travellers is their attitudes towards time. “Business travellers come to places with a very tight agenda,” Elena Donina Glukhman, Project Manager, Development & Co-operation Worldwide, AP Companies Global Solutions, told ITIJ. “Every minute is planned, and many other people are involved, while leisure travellers can afford waiting times.”
When it comes to medical issues, she explained, for leisure travellers, their main criteria is normally ‘hassle-free’ care: not having to move too far, not having to pay out of pocket, where possible – time is not a crucial factor. However, this is not the case for business travellers, who, she says, need to get things done as quickly as possible.
Expats are a different kettle of fish altogether. “They require long-term care of chronic conditions, planned medical care, check-ups, prenatal care, deliveries. They expect long-lasting relationships with their treating doctors, and a very different level of medical care. Expats are also ready to travel longer distances to be able to attend their preferred doctors,” explained Glukhman. She also noted that unlike both business and leisure travellers, who often have limited medical policies covering only accidents and emergencies, expats require more extensive policy coverage. Their expectations for medical facilities are also very different, she said, in that expats usually require doctors that speak their language and can understand their culture and background.
However, a common ground between both business travellers and expats, as Cigna’s Graham identified, is the need to pay closer attention to their health. He explained that for a frequent business traveller, it can be difficult to maintain healthy habits while on the road. “Airplane food could be high in sodium and fat, and healthy food choices may not be as readily available near workplaces while travelling for business.” Over time, these unhealthy habits can take a serious toll on the health and wellness of employees, both business travellers and expats, he noted.
Dr Khemka of Aetna reasoned that for business travellers and expats, ‘longer-term confidence in their options for healthcare’ is also key, as their visits are ‘more permanent’ and they may be ‘on the ground’ with their families. Having confidence in the quality of, and access to, care; knowing that medical advice is ‘trustworthy’; and that assistance in terms of evacuations is readily available, if necessary, can be tremendously comforting for these types of travellers, he said.
With this in mind, the evolution of telehealth as a digital solution for both expats and business travellers becomes merely a logical step in the client offering pathway. As well as providing a viable medical assistance solution to business travellers and expats that find themselves in remote locations, Glukhman reasoned that telehealth enables very busy people to avoid spending time in traffic and have consultations in the comfort of their office or home.
Scott Sunderman, Head of Assistance at Collinson, highlighted that through telemedicine solutions, ‘diagnosis and prescription appointments with a quality credentialed physician – which may previously have taken days – can now be made within minutes, often concluding an episode of care within a short call’. Perfect for the time-poor business traveller.
Graham told ITIJ that Cigna Hong Kong’s WhatsApp service chatbot, which is powered by artificial intelligence (AI), allows customers to find a doctor by name, location, and specialty instantly. It also allows customers to book appointments and obtain clinic information such as opening hours quickly – all of which provide hassle-free claims processes for local group customers. Similarly, Smith detailed that Charles Taylor’s automated claims channel provides both a fast and hassle-free process to customers, maximising customer choice, accelerating the claims journey and minimising operating costs.
Meanwhile, Glukhman noted that in the case of expats, chronic disease management is one of the most sophisticated parts of a virtual medical proposition when living abroad. “Being able to continue the treatment with the preferred physician, when changing the country of residence, may result in a huge relief for the patient,” she said. As such, digital tools that take into account extensive medical history, and medical reports that reflect years of treatment, while also allowing patients to maintain a familiar patient-doctor relationship, will be integral for expats, said Glukhman. And teleconsultations for business travellers, she added, will allow them to avoid unnecessary stress, looking for medical providers, and having to deal with a doctor in a foreign language.
“Ultimately, through innovative telehealth services, we are delivering on our promise to enable our customers to improve their health and wellbeing,” Graham told ITIJ. “At the heart of telehealth is equalising the quality of healthcare. This means that regardless of where our customers live or travel to, they will have peace of mind knowing that there are similar quality of healthcare services anywhere they travel to.”
Mental health support
There’s no getting around the fact that stress is also a major factor in business travel – probably thanks to all that rushing about – and if Aetna’s figures are anything to go by, it’s also a major factor for anyone living through the Covid-19 pandemic.
“Travelling for business can be taxing on the body and mind,” said Cigna’s Graham. “Between red-eye flights, getting ready for an important presentation while on the road, shifting between time zones, poor sleep and navigating unfamiliar locations, all could be stressors that are disruptive to one’s routine.”
What’s more, global events such as Covid-19 have proven to be a massive stress factor – and Dr Khemka of Aetna notes that expats may be particularly vulnerable to the uncertainties surrounding this. He said that in this case, the main benefits digital solutions offer are the security and reassurance that support is available quickly and easily when needed, through the channels that work best for members. “This is why it’s important to offer a variety of routes to healthcare, particularly at times of crisis,” he stated. “We’ve seen the demand for behavioural health support increasing, especially with Covid-19, and a ‘second curve’ of mental health challenges is coming to fruition as we progress through the pandemic.” Dr Khemka explained that in order to address this, Aetna has invested significantly in digital behavioural health applications recently and has accelerated further developments, including giving members access to the wellbeing and resilience app myStrength and the Wysa app – a conversational wellbeing AI chatbot that can lead to human coaching.
Wearable health devices can also be a saving grace when managing stress and chronic conditions, allowing employees to track their own health and ensure they’re not rundown, stressed or overtired.
What’s more, as Collinson’s Sunderman noted, digital access to healthcare, including telehealth and wearable device technology, improves the concept of a centralised and portable medical record, access to care standards, language barriers, early intervention and continuous quality care, even for people for whom travel and living abroad is a way of life. “This can be particularly important if travellers are in locations where the standards of care available in the local economy are low,” he said. “Wearables and connected devices, feeding into the central digital health record, create the ability for users to manage chronic conditions proactively. AI is also improving, and medical data repositories coupled with machine learning have enabled chatbots to converse with patients to diagnose primary care issues with an accuracy of up to 90 per cent.”
Duty of care
Having established that health and wellbeing are two of the most important factors to consider when developing innovative digital solutions for expats and business travellers, a concern that Sunderman argues the employer is wholly responsible for, it seems pertinent that digital solutions that enable the effective management of these are also accessible to the employer. And Sunderman also pointed out that in a post-Covid world, businesses need to go beyond their usual duty of care responsibilities to ensure optimum safety of their travelling employees, and this includes taking into account the variable landscape of traveller risk.
Charles Taylor’s Smith explained that risks include the threat of infectious diseases (not just Covid-19), unstable political situations, terrorism, unsuitable medical provision, natural disasters, and much more. And she noted that risk mitigation measures include pre-travel health, medical and security risk assessments and employee-training and education: “But,” she added, “truly effective duty of care means ensuring that employers and employees have a constant awareness of real-time health and security risks, before and during an employee’s assignment abroad – and that expert medical and security advice and responses are easily accessible.”
As such, both Smith and Sunderman recommend digital risk assessment tools. Used in conjunction with digital solutions that provide medical assistance, Sunderman noted that digital tools can help determine how safe the travel destination is; whether the traveller is in a high-risk group, potentially has an underlying health condition that could make them more vulnerable; and if there are adequate, 24/7 support and response services for those who are away.
“Online risk monitors and intelligence and tracking apps can provide the organisation and traveller with risk information about each destination and send real-time alerts concerning developments or changes to the situation,” Sunderman explained.
Tracking – through a Passenger Name Record (PNR) and/or physical tracking through a mobile app or GPS device – has, for a long time, been key in managing duty of care agendas, Sunderman explained: “A watching brief on emerging global risks, overlaid with traveller patterns and locations, enables employers to communicate quickly with staff and offer assistance proactively should they be within a geo-fence of an impactful event.
“Travelling employees need to be informed and have planned responses in place before they become stranded in quarantine, or worse, in the middle of a wave of infection. Travel risk apps can help with this and, where GPS tracking is used, can also potentially help with contact tracing to show if people have been in a ‘high-risk’ zone, although individual privacy and consent must always be a consideration for employers.”
Smith said that Charles Taylor utilises Intrinsic Assistance as part of its wider digital solutions. Developed with the company’s security partners Solace Global, Intrinsic Assistance provides a single platform for travel risk management and integrated medical and security assistance. “It incorporates the Itinerary Travel Tracking app, which is accessible via mobile devices and wearables, and provides seamless medical and security intelligence, response and assistance services via a single point of contact.” Smith added that the app provides instant alert communications to managers and employees, informing them of potential threats, and allowing them to delay travel, if needed, or provide medical / security assistance ‘at the swipe of a screen’.
In this instance, digital solutions such as wearable devices and mobile apps offer support for the business traveller and expat, providing the user with both a means to manage their own healthcare, connect to a healthcare professional and also deliver up-to-date health information, as well as security risk tracking, to their employer, who can use this data to provide immediate informational, medical or evacuation support, should a user need it
An augmentation rather than a replacement
Still, Glukhman reasoned that for all their worth, digital channels don’t always equate to an increase in customer satisfaction. Cigna’s Graham explained that ‘technology anxiety’ plays a large role in discouraging people from using telehealth, for example. “On-site medical consultations have long become the norm and transitioning to virtual health services can be a drastic step for some people,” he said. “As such, changing social habits that are as old as the medical practice itself will take time.”
But Smith mused that digital solutions also have a role to play in reducing traveller anxiety, as they give travelling employees the reassurance of knowing they have access to health, medical and security assistance without delay.
Moreover, ‘flexible digital solutions’, as identified by Smith, which offer ‘accessibility and convenience’, as noted by Dr Khemka, provide a comprehensive and holistic approach to the management of healthcare and wellbeing, and are a crucial response to real-world situations such as Covid-19.
“Technology should be used smartly to directly address the needs of the customers,” said Graham. “At Cigna, we view technology as a strategic enabler that allows us to create more meaningful connections to our customers during moments that matter. Leveraging innovative technology such as AI has allowed us to use data and analytics to deliver fully personalised healthcare for our customers based on their exact needs.”
Collinson’s Sunderman noted that in most cases, digital solutions do in fact equate to an increase in customer satisfaction, but only when used appropriately: “For example, spending five or 10 minutes going through 30 AI questions with a health chatbot about non-urgent symptoms might be much more accurate and, ultimately, more helpful than using Google, but not appropriate if your symptoms are chest pains. Sometimes, picking up the phone and calling your assistance provider is the best option.” Digital solutions, he reasoned, are there to quickly respond to the right issue, if the technology works. However, giving people the option to speak to a human right away is critical. “When it comes to the use of technology, it is crucial to remember that it is not a solution by itself, the digital and the human element must always come together,” Sunderman told ITIJ. “Offering the right solution, through the right channel and at the right time, is key, and speaking to a human in the most urgent cases can never truly be replaced by technology.”
He also noted that as with the majority of technology-focused solutions, issues like data protection and cybersecurity, or low rates of adoption, are always a concern – as is potential misdiagnosis. “Therefore, the digital element will always be an augmentation rather than replacement,” he said. “Keeping up with the digital-native and tech-savvy business travellers and expats and constantly improving the abilities of new technologies, such as AI or chatbots, is always something to take into consideration.”
Understand and respond
Digital solutions, it seems, are fast becoming a lifeline for expats and business travellers – as has been demonstrated by the Covid-19 pandemic, and most businesses recognise the importance of digital transformation in effectively solving problems within their service offering. Ultimately, the key to identifying the most effective digital insurance and assistance solutions may well lie in shifting the focus of the traditional business model and putting the needs of the customer at the forefront of the journey, identifying solutions that adequately improve the customer experience while also addressing business needs and processes. “Each solution has to reflect a deep understanding of your customer and their needs,” concluded Sunderman. ■