For an assistance company with a patient to repatriate, the choice of air ambulance provider to fly the mission is not to be taken lightly. Simply taking the first provider that accepts the mission would certainly save research time. Equally, making a few calls and then accepting the lowest-priced offer would save money. But what if (taking the extreme case) that ‘provider’ is just a chancer with a flashy website throwing a mission together for the first time using an unchecked, rented aircraft and untrained, freelance medical crew? Not the ideal choice for the assistance company that wants a reasonable probability of getting the patient from A to B in good condition. Rather, the conscientious purchaser will do their homework to make sure the air medical providers they work with are of a good standard. But what does that entail? What do they look for in a potential partner – is it low cost, high quality, availability, capability, certification, or a mixture of all of these?
While it might be unwise to choose a provider based only on price, it would be disingenuous to suggest that cost does not factor into the overall equation
Let’s first tackle cost, which may be the most obvious differentiator between providers, at least for the purchaser faced with a number of quotes for a mission. While it might be unwise to choose a provider based only on price, it would be disingenuous to suggest that cost does not factor into the overall equation. Federico Tarling, Chief Service Officer at travel assistance firm ASSIST CARD, stated: “Price is also a key factor when deciding to go on this kind of mission, so we work with partners that understand this and offer us the right kind of aircraft for every mission and not just the one that they want to use.”
Speaking at ITIC Malta in November 2019, Dr Cai Glushak, International Medical Director at AXA Partners, suggested that when appraising potential air ambulance partners, the responsible shopper should compare three key factors: quality, reliability and availability. Although price is also a factor, Dr Glushak warned against a race to the bottom: “If you push [competitive bidding] too far, you will be pushing price over safety. There is a limit to what you can do when pushing prices down.”
Ready to respond
A provider could be a perfect fit for an assistance company’s needs in every way, but if they take too much time to accept a mission, they may fall to the bottom of the call list. Mark Rands is Commercial Director for International Medical Group (IMG) Europe, which provides international medical insurance products, and its subsidiary Global Response Ltd, which offers medical assistance and claims management services. “IMG operates and evacuates clients globally and by the nature of the business, often from remote locations in conflict zones,” said Rands. “On a functional daily basis, a responsive air ambulance provider is essential to our operation.” While some air ambulance services may take days to plan, added Rands, many are urgent. In time-critical cases, he said that in order to ensure optimal clinical outcomes, ‘we would expect to have indications of mission cost and timings within an hour of a request’. He continued: “This responsiveness goes hand in hand with effective communication between the transferring medical team and the IMG medical team at the planning stage and throughout the mission.”
On a functional daily basis, a responsive air ambulance provider is essential
Note that this requirement is for a response with initial mission information within 60 minutes, allowing the company to choose which provider will get the mission. Time to wheels-up may be longer, as the provider needs to assemble the appropriate crew and prepare aircraft and equipment. Time to reach the patient depends on the above as well as the locations involved; the type and number of aircraft in a provider’s fleet also have a role here.
Daniel Durazo is Director of Marketing and Communications at Allianz Global Assistance USA, a consumer speciality insurance and assistance company with operation centres in 35 countries. He commented: “Location and aircraft fleet are two key factors we examine when selecting air ambulance providers. For location, we ask if the provider’s location will help us serve our customers better and faster.” Regarding the fleet, Durazo continued: “We consider if the provider’s fleet will provide us with additional capabilities, such as the ability to transport more than one patient at a time.”
Federico Tarling also highlighted the importance of aircraft availability. This is, though, just one component of a reliable provider, he said, adding: “By reliability, we mean that they stick to schedules and there are no surprises. We’ve encountered situations in which an air ambulance provider committed to a schedule without having the aircraft available and they made changes later on that made us look bad in front of our clients. Therefore, we ideally work with companies that own their fleet and not with ‘brokers’.”
Commenting on assessing an operator’s safety culture, Rands stated: “External accreditation in this area cannot be underestimated, as this complements our own credentialing processes, and underlines the provider’s investment in operational safety.
An example of a provider that holds accreditation is AMREF Flying Doctors of Kenya. Speaking at ITIC Malta in November, former CEO Dr Bettina Vadera noted the value of accreditation as a quality mark, saying that in order to gain accreditation, providers have to undergo a systematic, independent evaluation of the quality of their services.
Accreditation is not the only form of third-party vetting. Take, for example, the 3AT system from Generali Global Assistance, which is an auction tool that allows the company to select from pre-approved air ambulance providers bidding on a mission. Dr Eugene Delaune, Chief Medical Officer at Generali Global Assistance, told ITIC Malta delegates that this appraisal process looks at which providers offer the best value for money, as well as how reliable they are.
We would only collaborate with an air ambulance provider who has a proven track record with effective safety procedures
Overall, what the various aspects sum to is an essential element in the relationship between payer and provider: trust. Rands commented: “Trust is a key element of a successful relationship, both for the air ambulance provider and IMG. Trust at a clinical level, where the air ambulance provider and IMG have a clear plan and execution to ensure a positive outcome for the patient; trust at an operational level to ensure any logistical issues that may arise are effectively addressed; trust at a commercial level to ensure missions are executed with efficiency and at a cost that is fair to all parties responsible for delivering a cost-effective supply chain.”
Naturally, trust is best built through working successfully together over a period of time. Durazo discussed this in relation to the decision of choosing a provider for a given mission: “We review business history, we look to see if we have completed missions previously with this provider – and we also review their reputation within the repatriation community.”
Tarling touched on the same aspect, saying that he looks for professionalism in an air ambulance provider: “By professionalism, we mean that they will only accept the job when it is in the best interest of the patient and not just an opportunity to make money. Having a very professional medical team is a key element of the partners we work with so we can make sure that when they take on a mission, they do it after they have thoroughly analysed the patient’s medical condition and they are confident the mission will be a success as much as that can be ascertained.”
Location and aircraft fleet are two key factors
ASSIST CARD prefers to work with providers with which it already has a relationship, said Tarling, adding: “Of course there can be missions in parts of the world that we have never had a case before, so we need to rely on new partners, but for the most part, we try to work with companies we have worked in the past so that we know ‘who we are getting in bed with’.”
External accreditation in this area cannot be underestimated
And so it comes back to relationships again. Finding the right partner means someone who cares about the same things you do, and when it comes to air ambulance and assistance companies, experts are united in their opinion: quality, price and reliability are what matter. Companies that can prove their worth in these fields, whether through accreditation or their own track records, will remain the providers of choice for the global travel and health insurance sector.