Interview: Damian Lenihan of Aetna International

Damian Lenihan
Not enough hours in the day

ITIJ caught up with Damian Lenihan, Executive Director – Europe at Aetna International, to pick his brains about providing healthcare for an ageing population, technological revolution, challenge and opportunity

How did you first get started in the insurance industry, and how did you come to be in your current role?
I fell into it by happy accident. In 1993, I was selling office equipment, and a friend who was working in insurance suggested I come and give it a go. I intended it to be for six months but ended up staying at the company, Bupa, for nearly 22 years, having done a variety of roles across different sectors. 
After that, I did a brief spell at a private equity business before I was approached by Aetna International, with an exciting offer to head up distribution for the UK. I’ve been here for just over four years now, and am the Executive Director for Europe, as well as CEO of the UK regulated entity, Aetna Insurance Company Ltd (AICL) and Aetna Global Benefits (AGB). 

One of the biggest issues facing global health is our ageing population. How does this issue affect your approach to healthcare provision at Aetna? 
The biggest challenge about living longer is ensuring those added years are spent in good health. Disease and disability might seem to be automatic consequences of ageing, but that’s not always the case – decisions made earlier in life can have a profound impact.

No matter what happens, we’re in a state of readiness and have been for some time

To accommodate this, we’ve deliberately shifted from being a health insurer to a health and wellness partner, focusing on ‘well-care’ in the long and short-term rather than just ‘sick-care’. One of the major drivers for us at Aetna is adherence to the four Ps of healthcare – preventative, personalised, predictive and participatory. We know lots of our members are increasingly proactive about their health, and we want to support that. It can be as simple as information and education, or as cutting-edge as offering the latest scientific advances. Aetna DNA, a health and lifestyle genetic test that can give members personalised insight and then coaching if they choose to act on it, is a case in point.

We’re always striving to offer individuals the right intervention, at the right time, in the right place for them. This is what will significantly reduce the burden on primary care, ensuring customers are treated as active participants of their own healthcare so that they can stay healthier for longer. 

Being based in the UK but dealing with business in Europe, Brexit must be on your mind – obviously the situation keeps changing, how is Aetna preparing for the various potential eventualities of the UK’s exit from the EU?
Well, we planned and keep planning for the worst but, of course, we are hoping for the best. No matter what happens, we’re in a state of readiness and have been for some time – for example, we have an overseas entity in place in Dublin should we need to passport into Europe. Now, it’s just a case of preparing and waiting.

What technological solutions are going to have the biggest impact on the delivery of healthcare insurance and health-related services over the next few years, in your view?
Virtual healthcare, in all its forms, is set to grow and grow. It has the potential to be a true gamechanger, especially in emerging economies where access to primary healthcare either doesn’t exist or is out of reach for financial or geographical reasons. As well as delivering access to an integrated healthcare system, it can offer more efficient monitoring and management of chronic diseases and conditions such as diabetes via virtual check-ups, which may help with the ageing population situation. Since we launched virtual health for our members two years ago, there are great examples of individuals receiving a full diagnosis of chronic diseases virtually, often including prescriptions and medications. The key advantages we have found have been remote access and that the majority of members don’t go on to make further claims, as they resolve their issues over the phone. 

Taking that a step further, I can imagine a day when a surgeon in one country will be able to operate on a patient in another. We’re already seeing moves being made in that direction – at the beginning of the year, a surgeon in China performed the world’s first remote operation using 5G technology, controlling robotic arms in a remote location 30 miles away. It’s a very exciting prospect and could have far-reaching consequences when it comes to clients in remote locations who need first-class care more quickly than an evacuation could provide. 

How has your previous experience in the industry prepared you for your current role?
Excellent industry knowledge and an understanding of the drivers of claims costs obviously helps, but it’s probably people management skills that are the most important. Having worked in healthcare for over 25 years, I’ve also built up a pretty extensive network and know lots of people in lots of places. It’s one of the many great things about healthcare – people tend to stay in the industry and it’s always fun to catch up with old faces at events and award ceremonies. 

What in your opinion are the biggest challenges and opportunities that lie ahead for the international health insurance industry in the coming years?
I think the whole role of the industry is changing. We have a responsibility to engage in the broader health of populations, so we need to find ways to work with other healthcare providers and other industries to keep people healthy. An increase in local contracting is one example, in order to broaden access to the best facilities all over the world. After all, in 2018, Aetna paid claims in 193 countries, which represents around 98 per cent of the countries in the world.

When global healthcare costs are rapidly rising, how we stem that increase is both a challenge and an opportunity to do things differently. Our strategy is to focus on seamless, holistic care for our customers and use value-based approaches to address costs, clinical inefficiency and the duplication of services. However, as I said, in order to meet increasing demands, the healthcare system has to be less siloed and more integrated, so I think we’ll see more vertical integrations offering people much broader health services, such as our own with Aetna-CVS.

Aetna has recently received honours at the International Investment Awards, the Health Insurance and Protection Awards and the International Adviser Awards. How does it feel to win these awards?
One word – awesome! Those two days in October were the most successful we’ve ever had and, added to the WSB award that we won in September, represent an amazing series of accolades in 2019. I think it shows how keenly we focus on our customers and reflects well on the exceptional internal teamwork that ensures we’re always delivering the best service and products we can. It also demonstrates the amazing support we get from brokers, which we are very grateful for. After all, they are the people who place their trust and clients with us. Of course, occasionally things go wrong, but I’m a firm believer that how you resolve these issues is the true test and we have a great track record here. We always make sure that we respond to broker and member feedback – when they ask, we listen and do what we can to implement any changes. 

One of the major drivers for us is adherence to the four Ps of healthcare – preventative, personalised, predictive and participatory

Can you describe a typical day in your role?
There isn’t really a typical day. If I’m travelling, I might be up at 5 a.m., but otherwise it’s 6.30 a.m. If I’m at home in Manchester, I’ll hit the gym first thing and if I’m away, I’ll make time for a run, usually in the evening. In any case, I tend to hit 13,000 steps most days as I can’t sit still – something my kids tease me relentlessly about.
During the middle of the week, you’ll find me in either our London or Farnborough offices, where the days are largely taken up with meetings – everything from checking in with my team, to discussing developments with customer proposition and operations. Then, in the evening, I might meet a broker partner or colleague for dinner. I do try to prioritise sleep, but it can be difficult when you’re staying in unfamiliar places. Luckily, six to seven hours is about right for me and is usually achievable. 

Which aspects of your role do you enjoy the most, and which are the most challenging?
The most challenging aspect of the role is maintaining focus as we grow – currently 20 per cent per annum – and mirroring that growth with resourcing. With ambitious plans, sometimes it feels as though there aren’t enough hours in the day, especially as we’re an international business so you have to factor in time zones for other people. 

The most enjoyable is the interaction with clients, customers and members, both long-standing and prospective. I get a real kick out of picking up issues and resolving them, and a great sense of satisfaction when I know we’ve made a tangible difference to someone. I genuinely love what we do – as a company, we are always looking to do the right thing, and that’s what, I think, makes us stand out from our competitors. 

If you were lost in the mountains, which three people – from any historical era – would you want to have with you?
Firstly, Richard Branson. He’d be up for the adventure and I’d love to learn more about how he developed and grew his businesses. My impression is that he’s a fantastic motivator of teams, balancing fun with getting the job done. 

Secondly, Christian Horner. He might not be on a winning streak at the moment, but his passion and mindset mean his is the team I’d want to work for. He personifies the work hard, play hard mentality.

And thirdly, Joanna Lumley. She’s exceptionally well-travelled, a champion for good causes and a comedienne. She’d bring a little light-heartedness to the situation, as well as being fascinating to spend time with.