Interview: Dr Shoba Subramanian of UnitedHealthcare Global

ITIJ Speaks with Shoba Subramanian

Ensuring quality of care is critical: Dr Shoba Subramanian of UnitedHealthcare Global can offer a unique insight into global medical treatment, assistance providing and future trends

What is your background and training in the medical sector, and how has your career progressed to where you are now?

I chose family medicine, as it offered a broader knowledge base and a chance to work in the community. During training, I would see patients from diverse backgrounds and cultures. I was later awarded a global health fellowship with the Maddox Jolie-Pitt Foundation in Cambodia, implementing health programmes in rural areas. I then joined a leading assistance company, coordinating medical evacuations and repatriations alongside a flight doctor role. I put my skills and experience in rural healthcare into action as a remote topside doctor for the oil and gas sector.

My goal was to be part of a larger organisation, so I joined UnitedHealthcare Global in 2017. I was blessed with a company award for my work on improving safety standards in medical transportation, leading to my promotion to medical director in 2019. Today, I support the Global Insurance and Assistance sectors.

What drew you to tropical medicine?

I wanted to deepen my knowledge of managing the diseases that globally mobile populations are exposed to – in particular, malaria. I had seen many cases and found it particularly challenging in an offshore environment.

Inspired, I undertook the Global Health and Humanitarian medicine course offered by Médecins Sans Frontières, providing me with in-depth coverage of disease and healthcare issues such as the management of conditions like HIV and tuberculosis. It exposed me to practical tools in microbial recognition and fundamental microscopy skills. Little did I know, but the modules on outbreak management and population health monitoring would serve me well during the pandemic. Combined, my training has made me equipped to develop strategies for managing communicable diseases in challenging environments, which is directly relevant to my day-to-day work.

Travel health is a unique sector of the medical discipline. What do you think makes it more interesting than other specialties?

The element of the unknown. Medical decision-making can be impacted by nearly anything on the planet, from a hurricane to an election, because medicine walks alongside logistics and is therefore governed by anything happening within the geopolitical landscape at any given time.

Travel medicine, as I practise it, weaves in skills from other medical disciplines. From tropical medicine and occupational health to public health and preventative medicine, it involves the identification and mitigation of specific disease risks, preparation to optimise chronic conditions and plans for any acute deteriorations. What makes it particularly unique is the appreciation of cultural impacts on disease management to drive better adherence to treatment plans, plus its reliance upon access to comprehensive and accurate healthcare intelligence to aid clinical decisions. UnitedHealthcare Global has an entire team dedicated to monitoring the globe for health risks.

Aviation medicine is also fascinating, combining aspects of preventive, occupational, environmental and clinical medicine with the physiology and psychology of humans in flight. Not many travellers realise that conditions in the air – like altered cabin pressures, sound, vibration and acceleration/deceleration forces – can impact medical conditions. My training enables me to consider these aspects when determining the safest mode of clinical transportation for members.

Business travel is known to present increased risks to employees. What does UnitedHealthcare Global do for its globally mobile staff to keep them well?

Patients put their trust in a system of checks and balances that enable providers to safely perform healthcare procedures and administer services. But around the globe, consistency varies. Perceptions of where quality care is available may be skewed.

Ensuring that quality of care is appropriate and safe is critical for all travellers. At UnitedHealthcare Global, we carefully build our international network of providers, placing an emphasis on due diligence, credentialing and assessments.

  • Due diligence consists of detailed and holistic assessments of all known risks before engaging a third-party in the healthcare industry, which is critical, particularly when expanding into less familiar and high-risk territories
  • Provider credentialing consists of vetting backgrounds and current competency levels to ensure they are qualified to deliver services that meet international standards of care. This applies to not only hospitals and clinics, but medical and emergency transport providers
  • Onsite clinical and logistics assessments involve us or one of our 30-plus in-market physician advisors to physically visit the provider and verify their capabilities.

In terms of medications, making pharmacy decisions at home can be difficult – but imagine this while stationed abroad, in another language, with a new type of healthcare system to navigate? That is why we work with OptumRx to fill and deliver prescriptions, provide clinical management, and ensure the affordability of prescription medications, worldwide.

How does UnitedHealthcare Global make the best use of technology to serve clients and customers effectively?

International travellers are on the go. They want a simplified and better experience that gives them the freedom to access care and support on their terms. We need to be where they are, using data and technology to deliver relevant services for their lifestyle.

UnitedHealthcare Global uniquely leverages another UnitedHealth Group company, Optum, to expand our healthcare and security technology offerings. Optum’s advanced analytics and artificial intelligence (AI) help us find the right care, for the right person, at the right time, and investments in mental health services in this space are yielding a more productive workforce. Optum My Wellbeing focuses on seven key areas to help individuals create and sustain positive change, right from the palm of their hand. We also offer, as part of the Employee Assistance Programme (EAP), Optum Mindful Matters. This mindfulness tool delivers evidence-based mindfulness programmes, built on 15-plus years of data-driven insights and consistent results for improving health, productivity and engagement.

Within the context of travel, duty of care is the legal obligation to research, plan and implement a strategy to mitigate the risks involved for employees travelling for business. To help our clients fulfil this obligation, we use security technology to make it easier for an organisation to prepare, plan and respond to risk. WorldWatch Monitor, our traveller and asset tracking tool, is a digital safety and security platform that keeps assets close, even when they are miles away. With destination specific, interactive maps that populate with real-time intelligence alerts, travellers receive detailed advisories, itineraries and more.

How much of the adoption of new technology was driven by Covid-19, and are there any aspects of the business you changed during the pandemic that have remained in place?

The pandemic certainly accelerated the movement from high-cost emergency care to an increased demand for home-based services and virtual assistance. In addition, there are increasing challenges related to mental health. With the adoption of healthcare technology by the masses, we learned to work with humility and use data to inform our choices. Covid morphed and changed over time, making it a challenge to track. Our in-house clinical teams decided to control what we could control, setting up systems to identify, monitor and manage cases. We offered educational webinars, developed factsheets and provided general support for Covid treatment and coverage to clients and members. In fact, the system was designed to be replicated should another outbreak impact global populations.

As a physician, how has technology changed how you interact with your patients? Has it made your life easier?

In our remote medical services division, we have used telephonic and video consultations for years to support various industries, so I am very familiar with healthcare technology for this application. What has evolved is the sophistication of monitoring kits, which can transmit data like blood pressure and electrocardiographs via satellite link, and the data security that is required alongside.

In the UK, where I’m a GP, I’ve observed that the shift towards telephonic consultation rather than face-to-face has increased access to care – particularly for working-age patients who might have otherwise struggled to get to the surgery. But I prefer to see children of any age in person, as there are certain cues that are hard to pick up otherwise. Also, a widespread introduction of secure, two-way text communication as part of consulting has greatly enhanced our ability to exchange information with patients.

But while the evolution of technology in medicine continues to delight and amaze, there are circumstances where it can never replace a human expert when someone is in distress or simply needs help. We are designed for connection, so community interaction is an essential component of health and wellbeing.

Healthcare costs are more expensive in the US than many other places. How do you encourage non-US clients to educate themselves about the complexities of its healthcare system?

Education is key. From onboarding to renewal, we work with clients to build a transparent, collaborative relationship, based on honest and open communication, trust and shared learnings. Each client is assigned a dedicated Implementation Manager, who walks them through the onboarding process. A Strategic Client Manager, or SCE, is also assigned to clients. SCEs are the day-to-day contact for clients, answering questions, sharing special intelligence reports and providing benefit utilisation reports.

Our US-bound guides and webinars help members who may be unfamiliar with the healthcare system. From how to get care at the place that best fits their condition, along with additional tools like our member portal and app, we help them navigate any situation, saving time and money. Multilingual customer care professionals (CCP) are available 24/7 via phone, chat and email, providing members with one-on-one support from a real person.