Despite increasing uncertainty around global travel amidst fears of the spread of Covid-19, an impressive gathering of industry representatives convened in Costa Rica for this year's ITIC Americas event to discuss topics spanning regional cost containment, insurtech and, of course, the potential impact of the coronavirus. Here, ITIJ Editor Sarah Watson reviews the panel sessions and expert presentations that took place over the course of the 10th annual ITIC Americas conference, and gives a taste of the unrivalled networking for which ITIC is so famous.
ITIC Americas 2020 - Panel and Speaker Presentations
ITIC Americas 2020 began a very timely first panel session focused on Coronavirus and travel health risks.
A panel of expert speakers, made up of Dr Gabriela Ivankovich, Pediatric Immunologist at Costa Rica-based Hospital Nacional de Ninos, Dr Cai Glushak, International Medical Director for AXA Partners, and Dr Andres Smith, Medical Director of Emergency Services at Sharp HealthCare, explored the various ways that travel drives the spread of diseases, how the travel insurance and assistance industry learns from – and adapts to – each new health crisis, and how hospitals are approaching the admittance of patients affected – or potentially affected – by Covid-19.
Dr Ivankovich opened with an insightful look at how airports, airplanes and public transport all provide rife breeding grounds for germs and encourage the transmission of viruses, stating that this is why diseases are frequently contracted while travelling and thus why vaccines and travel insurance cover are so important. She also explained how it’s not just minor ailments that are spread through travelling, but also more serious diseases such as measles and yellow fever, although many of these are vaccine-preventable, so destination-specific immunisation advice should always be given to insureds in the pre-travel evaluation.
Dr Glushak followed by giving insights into AXA’s response to the current coronavirus pandemic and explaining that each outbreak crisis requires a slightly different response, meaning the industry learns and adapts each time there is a crisis. Covid-19 is more pervasive than anything we’ve seen before, though, so unprecedented measures have had to be taken. AXA, he explained, has been busy identifying its priorities during this pandemic, such as the health and safety of its workforce – including mental health support, maintaining its services, ensuring financial integrity and protecting its brand reputation – while taking proactive measures to ensure customers are also supported in every way possible by keeping them informed and offering advice on returning home.
Some national health service hospitals had started to refuse repatriation patients without a negative Covid-19 test result
An issue highlighted by Dr Glushak was that some national health service hospitals had started to refuse repatriation patients without a negative Covid-19 test result. The industry, he said, should put pressure on governments to prevent such denied access to care occurring.
Admitting patients who potentially have the virus, as well as those already diagnosed with it is, naturally, something that needs careful consideration and stringent protocols – both in the public and private sector. As Dr Smith explained, Sharp HealthCare has been holding bi-weekly meetings to consider its next steps and is screening all international patients for Covid-19, looking at each case on an individual basis and adhering to the constantly evolving guidelines from the CDC. Current concerns in the healthcare industry include staff shortages due to self isolation, advising cruise lines on where infected passengers can disembark, and dwindling supplies of masks and surgical gloves. For the travel insurance industry, working out which air ambulance companies will fly coronavirus cases and which hospitals will accept such cases is key.
Healthcare continued as the theme for the next session, in which Fernando Vicente Llorca Castro, Ambassador of Costa Rica to the United States, shared insights on the healthcare infrastructure in Costa Rica.
The ITIC host country has a population of just five million people, yet it receives 3.5 million tourists each year, explained Fernando. The public healthcare system, which has benefited from additional funding since the country abolished its army in 1948, receives around 70 per cent of all healthcare expenditure, and costs in this sector have remained relatively low. The private sector accounts for 10 hospitals and 250 beds.
as dental care and medical costs are around 50- to 70-per-cent lower. Costa Rica, concluded the Ambassador, is working hard to become a bilingual – Spanish and English – society and a member of the OECD.
Medical travel, especially from the US, is a growing revenue stream
Continuing on the subject of regional healthcare, Guillaume Copart, Founder & CEO of Global Health Intelligence, was next to address attendees, with an engaging presentation providing Latin American healthcare market insights.
There are three times as many hospitals in emerging markets as in developed economies, he began, and of the top 10 emerging markets, four are in Latin America. This region’s greatest opportunity is to improve efficiencies, and therefore productivity, through its institutions, including healthcare, he continued. Healthcare megatrends in the region include the fact that it has the fastest ageing population in the world, and heads the global obesity epidemic, meaning that medical providers in the region should adopt a long-term outlook with regards to care. LATAM also lags when it comes to technology adoption, including diagnostic hardware such as CT and MRI scanners and systems such as PACS and RIS; but tech helps to drive long-term relationships between medical institutions and with patients, so it’s important for the region to enhance its investment in such technologies.
When talking about medical care provision, of key concern is cost, so the next session at ITIC Americas was an essential agenda topic. This session saw Richard Loew, General Director of Best Meridian Insurancein Costa Rica, and Victor Navarro, President, Latin American Region at Global Excel Management Inc., discuss regional cost containment, providing some expert insights on how to control costs in LATAM.
This region lacks specialised care in tourist areas, began Richard, which means there is sometimes a delay in patients receiving adequate medical attention or significant transportation costs to get them to specialist care. Challenges for local medical providers include creating clear and consistent cost structures, including fair, not inflated, charges for insured patients, standardising costs across the region, and providing more bilingual staff. Local or international TPAs are vital, said Richard, for developing a network of providers with pre-established rate agreements, auditing bills and making timely payments.
Victor then took attendees through ‘the old, the bad and the ugly’ of local cost containment issues. ‘Old’ ongoing issues include multiple prices lists, i.e for foreign and domestic patients/ payers, knowing where the hospitals are – ‘access trumps cost containment’, and ‘being careful in tourist areas’. The ‘bad’ includes the need to check bills line by line for abuse, especially around such issues as overcharging for supplies, leased supplies charged as purchased, and GPs being charged as specialists. The ‘ugly’ includes provider and billing agency collusion. Good medical case management is essential, including the establishment of a complex claims unit, as bills from some LATAM countries are almost as high as in the US, said Victor. Steering to the right level of care and ensuring your staff know how the local healthcare systems work are also extremely important for cost containment in the LATAM region.
Challenges for local medical providers include creating clear and consistent cost structures, including fair, not inflated, charges for insured patients
Day two of ITIC Americas focused on traveller security and technology, with expert speakers imparting their knowledge on issues ranging from traveller risk perception, to apps that are boosting that all-important area – customer service. Starting off the day’s conference sessions, Mike McGarrity, who spent 23 years with the Federal Bureau of Investigation (FBI) before retiring from the role of Assistant Director of Counterterrorism and who now works as Vice-President, Global Risk Services at Global Guardian, and Brian Mulligan, President & CEO of Assist America, took us through security and safety issues in the Caribbean and Latin American regions.
Looking at some of the main security threats in the region, Mike explained that a shift in drug cartel activity from Colombia to Mexico has seen related violence shift with it. Thus, increased violence has been seen in tourist areas, such as the bar areas of Cancun; 2018 turned out to be Mexico’s most murderous year on record overall. In terms of kidnap and ransom risk to travellers, financially motivated criminals continue to dominate in every region of the world, although Mexico is where most US citizens are kidnapped for ransom. In hostage situations, collaboration between victims’ families, governments, employers and the crisis response team, said Mike, is essential – intelligence and operations have to be integrated.
But what of travellers’ approach to these risks? People approach risk in different ways, said Brian. Some avoid known risks, such as a particular destination or political demonstration; some accept the risk and go to the destination; and some work to mitigate risks, such as not displaying signs of wealth when travelling. Government programmes, such as the Smartraveller programme, are a good way of helping travellers stay safe, along with adhering to government warnings. For assistance providers, concluded Brian, ‘ground truth’ is a ‘priceless’ way of finding out what is actually happening in any particular destination.
Automation and interoperability are key to more efficiently and effectively determining coverage and allowing medical providers’ and insurers’ digital systems to function together and share data in real time
Hans Ardon, Founder of Apololab, focused on how AI is being used in healthcare to reduce medical errors – the third leading cause of death in the US, according to Johns Hopkins University – speed up diagnosis times and save associated costs. AI will never replace humans, however, assured Hans, only enhance their abilities.
And closing this session, Sandra Seminario Olivi, International Patient Office Co-Ordinator at Clinica Universidad de Nevarra in Madrid, gave a thought-provoking presentation on reducing inefficiencies in data sharing and thus saving on costs for hospitals and insurers. Automation and interoperability are key to more efficiently and effectively determining coverage and allowing medical providers’ and insurers’ digital systems to function together and share data in real time, shortening processes, and ultimately leading to better patient care and cost savings.
The next agenda topic put techology in the spotlight, with the speakers approaching the topic from their various areas of expertise. Dr Frank Gillingham, Chief Medical Officer at Fairmount International, was first to take to the podium, with an exploration of how tech such as apps, chatbots, artificial intelligence (AI) and machine learning are revolutionising the insurance and healthcare industries’ ability to offer optimal customer service and provide accurate medical results. Speech analytics, telemedicine and the digital-only Amazon model will be increasingly integrated into these industries, he said.
Concluding ITIC Americas 2020, an Industry Insights session saw two very different case studies being shared – one on how Social & Health Insurances SZV Sint Maarten worked to help insureds and locally affected people in the wake of Hurricane Irma in 2017, courtesy of Parveen Boertje, the company’s Chief Customer Officer, which provided lessons for the wider industry in how to respond to such events. The second presentation, from Ali Azeem, Operations Manager of MSH International Canada, detailed a case in which a pre-existing condition threw up questions around the cause of an accident in which an insured suffered a brain injury while travelling in Mexico. A lack of alcohol testing when the patient was admitted, said Ali, raises questions around whether all medical facilities understand alcohol exclusions on insurance policies and when it is appropriate for the assistance team to step in and request such additional tests.
The range of agenda topics on some of the industry’s most pressing issues, the unrivalled quality of speakers, and the discussions following each presentation gave plenty of food for thought.
ITIC is synonymous with networking, providing a unique platform for the global travel and health insurance industry to make vital business connections, face to face. ITIC Americas brought together payers and providers not only from across the region but across the world – all gathered in one place to do business and cement partnerships. The exhibition and networking area was a thriving hub for meetings throughout the conference, while the networking coffee breaks and lunches fuelled conversations throughout each day. Elsewhere, organised medical facility tours to Hospital Clíníca Biblica and Hospital CIMA allowed local providers to showcase their facilities and gave attendees the chance to meet the teams who provide medical care to their international patients.
Social networking also plays a big part at ITIC events and never more so than at ITIC Americas 2020, where attendees got to experience the ‘pura vida’ on a trip to La Paz Waterfall Gardens and the Doka Estate coffee plantation, catch up in the hotel bar in the evenings for networking in a relaxed environment, and bid farewell to industry friends old and new at the Farewell Party. Here’s to ITIC Americas 2021 in Cartegena!
ITIC Americas 2020 in Costa Rica - in photos!
Join us for the 11th annual ITIC Americas conference which will take place in Cartegena, 6-9 March 2021. Visit itic.co to learn more and register for the conference.