Interview: Paul Weigall and Natalya Butakova, AP Companies
Paul Weigall, Global Strategy Director, and Natalya Butakova, Business Development Manager for AP Companies, share their insights on cost containment and medical networks
As one of the leading medical TPA companies in the world, how can AP Companies help insurance companies to manage their international medical costs?
NB: to be effective cost containment company, one should be very well familiar with local healthcare systems, and with local markets of medical provider. There is no one solution for all countries which would always work. It’s rather a combination of multiple techniques and approaches – in some locations, discounts are common practice, in others, we have to watch for signs of overutilisation or overtreatment. There are some countries where discounts are just not acceptable, but there is a space for package prices or case-by -case negotiation.
PW: AP companies can and does add a lot of value to insurance companies. Cost management is the key and this can be achieved in a number of ways:
• Identify the most appropriate provider to treat insurance company members.
• Once the member is having treatment, ensure that length of stay and the procedures done are in line with protocols and appropriateness • Work with and identify new providers to negotiate best discounts on hospital costs
• Direct members to providers rather than waiting for members to pre-authorise when they are already at the provider.
What strategies do you employ to ensure your networked facilities are keeping their standards high and treating your clients appropriately?
NB: Our providers are our main assets, so selection process and maintaining a working relationship are key to best service we offer to insured members. Besides careful selection, we perform regular monitoring of our in-network providers – which is a combination of face-to-face visits, online questionnaires, quality control protocols etc. It’s an ongoing process and while new providers are added, others providers become out of network based on the quality and billing practices.
PW: I might add that it is key for AP to work with closely with insurance companies to establish where members are based in certain countries and regions and use this information to negotiate the best possible discounts if volume can be predicted.
What do hospitals have to do to join your network? Does accreditation play a part in your decision, or you do have your own criteria they must fulfil?
NB: We have our internal patented due diligence process, which every provider in our network needs to undergo before becoming a part of the network. International accreditations are taken in consideration, but are not available everywhere, hence we have to rely on our own process to determine if the provider meets our expectations and provides a good service.
PW: AP have worked closely with insurance companies to ensure that providers that the insurance companies request for their members, on the basis that they are credible and cost effective, are added to the network list
Assistance for expatriates working in remote or difficult to reach locations is a complex business. How does AP Companies’ ensure coverage around the world?
NB: I always get very skeptical when any company says that it has its own direct medical provider network globally. In my opinion, it’s simply impossible to have direct reliable network of medical providers in every corner of the world. AP Companies has a network of over 35,000 medical providers; we have providers in every single country, but in some remote locations or where our volumes are small or there is a language barrier, we still rely on our local partners as this helps us to secure best service for our members at the most competitive price.
PW: It’s important to have certain areas of specialisation and AP companies has built a best-in-class network in Europe and is building networks across Asia and the Americas. It is, however, more practical to use local expertise in certain regions and countries. The best examples of this are certain parts of Africa, where the healthcare system is complex and communications can be particularly difficult, so using local partners who understand how the system works is vital.
What do you see as being the primary challenges for international medical assistance providers in the future, and how can these challenges be overcome?
NB: I think we will see the impact of Covid-19 for years to come. This means that we will need to continue to quickly adapt to new insurance policies and conditions when it comes to benefits and coverage for travellers, cope with a restricted ability to travel even for medical purposes, new regulations and rules when it comes to vaccination, and ever-changing regulations at times of covid-19 surges. Because of this, even simple cases can become a challenge and take more time to arrange. I think we just need to be patient, flexible and open minded when facing these circumstances.
PW: The world has changed hugely since the beginning of 2020 and it is incumbent on everyone in the healthcare industry to ensure efficiency is improved and wastage removed. There is no doubt that digital communication will become the predominant mode of working and communicating in the future. It is important that insurance companies and their members can use their mobile devices to manage all of their healthcare needs. AP Companies is working hard to establish this and now has an excellent network of online consultation providers, access to the network online and dedicated provider managers to deal with local requirements. ■