A packed agenda of speaker presentations, industry forums and networking events provided a platform for vital discussions and the sharing of information on key topics, including how the industry has been navigating Covid and how it is using this time to prepare for the future. The ITIJ team are pleased to bring you an overview of the speaker and panellist presentations, along with some of the other key highlights from the event.
As always, the ITIJ Awards took place as the culmination of ITIC Global, recognising the extraordinary efforts of each sector of the international travel and health insurance industry.
Covid-19 top of the agenda at ITIC Connected
The ﬁrst session, Coronavirus - response and impacts, focusing squarely on the coronavirus pandemic at ITIC Connected saw three expert panellists looking at industry adaptations that have been made as a result of the health implications of Covid and its related travel lockdowns – from an insurer, assistance provider and air ambulance industry perspective. Firstly, Jim Krampen of US-based insurer Seven Corners gave an insightful presentation that provided a window into his company’s thought process when it came to adapting its policy wording in light of the virus with its underwriter Lloyd’s of London.
From the company’s initial reaction to rising case numbers, which saw it halt coverage for pandemics on 1 May, in response to instruction from the underwriter, to its launch of an international travel medical policy that covers Covid-19 on 11 June, a great deal of scrutiny was carried out. After studying the nature of the virus from a number of sources, navigating changing health advisories, media coverage, and varying outpatient cost projections, Seven Corners and the underwriter ﬁnalised the new premium and beneﬁt wording, though the underwriting formula they ended up with, said Jim, was not linear and had several iterations and premium stress testing at Lloyd’s.
The future...will likely see travel insurance being as common to travellers as luggage and a passport
The future, he said, will likely see travel insurance being as common to travellers as luggage and a passport, with greater consumer demand for policies covering named pandemics.
The early effects of Covid on the insurance and assistance industry, such as initial customer enquiries around the status of their policies, cancellations, and rescheduled travel, were covered by Dr Cai Glushak of AXA Partners, who showed how caseloads changed as the pandemic spread, and how the AXA workforce was protected while maintaining service to clients, protecting brand reputation and remaining compliant. He also talked of air ambulance challenges, such as crews not being able to leave the airport, making sure larger patients would ﬁ t into the patient medical isolation units, and dealing with multiple agencies for each transport, and said AXA keeps an inventory of Covid-capable providers. As travel will take some years to rebound fully, ongoing strategies, said Dr Glushak, include an emphasis on continuing to build telemedicine offerings, the digitisation of services, and product diversiﬁcation.
A closer focus on the challenges air ambulance providers have been facing throughout Covid was explored by Dr Terry Martin of Critical Care Aeromedical Training. There are many moral and ethical issues to be taken into account with Covid cases, he explained, and assessing a provider’s essential capabilities, such as established intensive care and blood analysis capabilities, is vital. The suitability of the aircraft, in terms of size, airﬂow, and onboard equipment, as well as the willingness of staff to take part in such transports, is also important. Crews need to be fully informed, properly trained, practised and equipped, and communication between all involved teams needs to be clear and involve impeccable attention to detail.
Coronavirus – risks and lessons
During this session about the future of Covid-19 and the time after the pandemic, the virus was approached from a medical perspective.
Infection specialist Dr Vanya Gant of UCLH NHS Foundation Trust explained the spread of Covid and how best to stop it, showing data that suggests wearing masks and social distancing are the best solutions at the moment for halting the virus. He added that while ‘things are not getting better’ at the moment, discipline with wearing masks, washing hands and social distancing should keep people safe and healthy during this time. He also thinks the virus is changing, and a less nasty version might take over and eliminate the current strain.
the virus is changing, and a less nasty version might take over and eliminate the current strain.
Dr Frank Gillingham of Fairmount International then spoke about the future of telemedicine, noting that Covid-19 has sped up the development of technologies that allow for telemedicine to be wider spread across the globe. He added that, currently, the main issue with telemedicine is the difﬁ culty of writing prescriptions internationally. However, the positive impact it could have, especially in remote areas, far outweighs the drawbacks.
During the Q&A that followed these presentations, Dr Gillingham added that people are usually more forthcoming with their emotions when talking to doctors in person, which could be a drawback when it comes to mental health issues.
International Provider Network Forum
Joined by a wealth of industry peers, comprising international provider network managers, medical directors, assistance professionals and payers, Laura Hilton hosted the ITIC Connected International Provider Network Forum.
As always, the forum began with a game. In this one, players paired up and were made to partake in charades-style antics. After this, talk turned to Covid and how the industry had adapted to the challenges presented by the global pandemic, including the increasing use of telemedicine.
since the advent of the global pandemic, there has been a ‘quantum shift’ in customers’ attitudes towards health and healthcare planning
As the panellists astutely noted, since the advent of the global pandemic, there has been a ‘quantum shift’ in customers’ attitudes towards health and healthcare planning, which has paved the way for the uptake of telemedicine and other technology within the healthcare space.
Panellists discussed the challenges and opportunities presented by telemedicine, as well as addressing the issues associated with providing prescription medications in different international destinations. The topic of data security within digital healthcare solutions was also broached, as was the move to remote working and the beneﬁ ts that this could bring to people’s work-life balances. “This year has shown the resilience of the industry,” concluded Jane Hegeler. “Let’s hang in there and hope for the best.”
This session at ITIC Connected focused on the impact of Covid-19 on the global cruise industry, and how assistance providers can use this time where few ships are sailing to shore up their networks and work with cruise operators to enhance collaboration and make sailing safer for travellers once routes open back up again.
The panel session was opened by Natalya Butakova of AP Companies, who began by showing how the global cruise industry had gone from one that was blooming, with more than 30 million cruise passengers last year, to one that ground to a halt due to the no-sail orders put in place. Natalya’s company, she said, was then faced with new types of request from the cruise industry, such as assisting crewmembers still working onboard, telemedicine services, and testing. PCR swab testing will likely be the norm when sailings resume, she said, but issues remain around what can and can’t be done with onboard positive cases as rules vary in different countries. A return to normal cruising will be a slow process, concluded Natalya.
Gaby Hosea of On Call International agreed that the future of cruising is certainly occupying the assistance industry’s thoughts, and said it’s a good time to revise and reﬁne procedures around dealing with cruise patients and identify resources that will help with future cases. Where disembarkation is necessary and permitted, you need to know what local resources you have and how to navigate them.
Now is the time to identify historically challenging areas for disembarkations and look at new opportunities
Now is the time to identify historically challenging areas for disembarkations and look at new opportunities. Communication between all parties – including cruise ship doctors, port agents, and airport handlers – needs to be started early and carried out effectively, and relationships with these parties need to be Gaby also agreed that telemedicine and tele-pharmaceutical services had been a great help to the cruise industry, closing the gap for some remote services and paving the way for new resources and options for cruise lines, going forward.
Infectious diseases were already an important issue for cruise lines, began the ﬁnal panellist Dr Bruno Sicard of MedSSIS, due to the conﬁned environments of cruise ships. Other systemic challenges related to cruising include the remote areas visited, and the fact that onboard medical care is never as good as on land, so passengers expect to be evacuated for better medical care, he said, before looking at some of the current and ongoing operational challenges faced in helping those on cruise ships. Medical challenges also persist, with Dr Sicard wondering why some cruise ships have such large swimming pools instead of a helideck.
Going forward, he said that better communication is needed between crews and assistance providers, and that agility, ﬂexibility and transparent processes need to be developed to address current and future issues.
Regional trends in fraud
a lack of price transparency, especially in the US, is a breeding ground for fraudulent activities
A topic that we come back to often at ITIC is fraud, and it’s one that will always be an important issue to discuss. From an air ambulance transport that was wrongfully billed at several hundred thousand dollars, to individuals faking documents online, the speakers each went through case studies and discussed ways of preventing fraud in the future.
Ian Jones of AXA Partners spoke about how easy internet fraud can be, which means insurers should be extra vigilant about doublechecking documents and asking for secondary proof of purchase or loss. He added that fraudulent cases can come from professionals, from criminal groups or even individuals. Since, these days, documentation often comes from the internet, source codes can be easily manipulated to create fake documents, which is something insurers should be aware of.
Simon Cook of Charles Taylor added that fraudsters can’t be stereotyped, as they include all types of people: high earners and families, as well as low earners. He also warned that while regular audits of providers are important, insurers should be careful not to hurt important relationships when considering accusing someone of fraud. However, some providers tend to overprice their services, and this has been especially prevalent during the pandemic as economic difﬁculties continue to arise.
To round off the session, Soraia Lynch of GMMI emphasised that a high level of awareness is key for preventing fraud. She spoke about a few case studies, including one where an air ambulance transport was wrongfully billed at $827,000. By being aware of the overly high pricing, the insurer managed to get the bill down to $120,000. Similar cases happen all the time, she said, especially in the US, where most of the healthcare system is privatised. She mentioned that a lack of price transparency, especially in the US, is a breeding ground for fraudulent activities.
The often-revisited ITIC topic of industry challenges in Mexico and the Caribbean began this year with a case study from Allianz Partners, presented by Rory O’Gara. Rory introduced a case of a high-risk patient needing assistance for a suspected brain aneurism in Acapulco, and the subsequent challenges that the region posed for this.
Logimedex’s Salvador Belity Haro then discussed hospital consolidation and approaches to cost containment that can be taken effectively in Mexico, as well as looking at how Covid-19 affected medical services in the country, including the fact that the enormous patient load this year caused the cancellation of more than 15,000 surgeries.
Finally, Robin Ingle of Ingle International looked at how the global pandemic had created a need for integrated web and mobile technology in the travel and health insurance sector, and for collaboration across the industry. Key topics that arose in the discussion included accreditation of facilities in Mexico and the Caribbean, and that while it is important to modify ‘Western expectations’ of care in these regions, it’s still important that these facilities uphold a quality of care that is acceptable for that region.
quality of care, and options for medical treatment and repatriation, vary widely in Mexico and in the wider Caribbean island region
Further noted by participants and panellists was the fact that the quality of care, and options for medical treatment and repatriation, vary widely in Mexico and in the wider Caribbean island region. Overall, the takeaway point was that while issues with billing and access to care continue in select regions of Mexico and the Caribbean, the global pandemic has effected a massive shift in the expectation that governments have of their healthcare facilities as key centres of support for the travel trade – and of the role that international insurance and medical assistance services have to play too. As Robin put forward, ‘collaboration is key’. “It’s an opportunistic time for us all,” surmised Rory.
Medical Directors' Forum
AXA Partners’ Elyah Oulad-Mehdi and Dr Cai Glushak detailed a ‘hellishly complex’ repatriation case that called for the single air transfer of a tour group in Patagonia who were covered by five different travel insurance companies – some members of whom had tested positive for Covid-19. Elyah recounted how the team divided a Boeing 737 into three separate sections in order to safely transfer the various insureds, and Gant commended the team for managing to ensure that no secondary infections occurred during the operation.
Introduced by Dr David Farcy, REVA Medical Director, and Steve Williams, REVA Director of Medical Operations, case number two looked at an air medical transport from April, in which the team transferred 16 crewmembers from onboard a cruise ship. Using a Boeing 737, a Hawker 800 and a Learjet 35 to transport the many patients, REVA worked with the aircraft engineering team at Miami Air to generate negative airflow pressure within the cabins, as well as creating separate compartments within the aircraft to hold patients – the toilets and galley were assigned to the Covid-19 patients and, surprisingly, these turned out to be the cleanest area of the plane upon testing after the operation concluded.
Case number three, presented by AMREF Flying Doctor’s Dr Joseph Lelo, detailed the difficult repatriation of a 45-year-old male being treated for Covid from Sana’a, Yemen, to Belgium. Working against a multitude of challenges, including an insufficient healthcare system in Yemen that saw the ground ambulance run out of oxygen, and an emergency intubation of the patient pre-flight, as well as demanding in-flight oxygen requirements, Dr Lelo recounted what Gant described as a ‘no-win’ satiation. Sadly, the patient passed away during the flight, and with a do-not-resuscitate agreement, the team was forced to turn around. Reflecting upon the troubling situation, panellists agreed that, where possible, avoiding invasive ventilation techniques such as intubation leads to much higher chances of survival. It was also noted by many participants that PPE can be very challenging for air medical crews, particularly in hot climates.
PPE can be very challenging for air medical crews, particularly in hot climates
Lastly, Global Excel Management’s Dr Ferial Ladak presented the case of a 50-year-old woman who travelled to Cancun in Mexico in March and developed Covid-19 symptoms that AXA were similar to pneumonia. The assisting provider encountered numerous problems, including a husband that needed enhanced assistance and support, and a concerned family that needed continuous communication. The patient was transferred back to the UK, where she passed away. This resulted in criticism from the accepting doctor, who later understood that the company’s ‘mercy flight’ had been in the best interests of the patient. The forum noted the importance of the medical team being present for all ‘doctor-to-doctor’ conversations, and that there were definitely some ethical issues at play when it comes to informing patients and their families of the risks of repatriation.