Building co-operation between assistance companies and cost containment providers has far-reaching benefits for the wider travel insurance industry. Mark Rands gives his insights
Assistance organisations, cost containment companies and healthcare providers in the travel insurance industry are intrinsically linked, and working well together benefits end customers and insurers. Assistance providers’ focus is to ensure that patients receive the right care, at the right time whilst ensuring and enabling the right price for the insurer. Partnering with cost containment companies and building collaborative relationships helps to facilitate this, and, done well, benefits all parties involved. A trusting working relationship between assistance providers and cost containers is vital to ensuring the best quality treatment is always provided without losing sight of the economics. Laying a solid foundation for a collaborative partnership will require efforts from both parties but when done well, can be rewarding for both and benefitting for the travel insurance industry as a whole.
Delivering valueManaging medical incidents to deliver the best value is a complex process. Gone are the days of ‘evidencing’ savings with a percentage discount off an invoice. Today’s assistance providers deliver value through efficiency, customer satisfaction, management of clinical care and practices, as well as negotiated costs. Understanding medical risk in international territories, coupled with a keen knowledge of the local healthcare and regulatory systems across countries are integral to ensuring that customers and insurers get the best experience and outcome when it is needed. Ensuring appropriate medical treatment, at a fair and reasonable price, is the duty of assistance companies. This is where the right relationship between an assistance company and a cost containment organisation can further enhance the overall case management. Having clearly defined roles that complement each other drives efficacy and manages costs for all parties involved.
Finding the right partnershipChoosing the right partners from the start is fundamental to building a constructive relationship between assistance providers and cost containers. Ensuring that the selection process establishes that you share the same values, visions and principles gives the foundation to a mutually beneficial, long-term partnership. If the companies involved do not share the same values, visions and principles, it can be challenging to nurture the relationship in the long run.
robust medical case management … is not only intrinsic to effective cost containment, but more importantly to better patient careCritically, price should not be the overriding factor. Assistance providers should give equal consideration to an array of factors in their selection process. They need to understand the political and social environments in different regions and demonstrate that understanding when selecting cost containment partners, asking questions such as ‘how do cost containers manage relationships and negotiate with hospitals?’, and ‘how do they demonstrate the value they can bring?’. It is important for assistance companies to know the fundamental cost of treatment received in order to ensure bills charged are fair and reasonable. Healthcare systems, care pathways, and services available vary across the world, but so do cost containment approaches. Working with the right partners, an assistance company can be informed – and able to inform – about current practices and trends and, as such, manage the value chain globally. Communication and transparency are key to maintaining and strengthening the working relationship. Regular appraisals and review of existing account management practices in light of changes in customer volumes, new healthcare market trends and product developments should be agreed before the start of the contract. Similarly, parameters and standards to measure against and compare should be clear and transparent, and best practices should include data sharing and data benchmarking.
Working side-by-sideCost containment is a much more sophisticated practice than it was 20 years ago, when companies tended to simply pay whatever bill was presented to them, and only negotiated on particularly expensive ones. Assistance companies, when not undertaking the cost containment themselves, will want to make sure that cost containers have practices in place to identify and challenge unwarranted and unsubstantiated provider fees, to ensure procedures and treatments were medically necessary and invoices are billed appropriately. In addition, overcharging and overtreatment can be common, especially in tourist areas. This again changes with wider social and economic challenges; for example, hospital revenue in some tourist areas could be hit where travel destinations are shifting because of terrorist concerns. Assistance providers need to work closely with cost containers to identify practices and exploit potential to contain costs still further in high-volume tourist areas.
cost containers will continue to be a crucial partner in helping assistance companies deliver cost-effective, high-quality medical care to patientsIn addition, telemedicine will play an increasingly important role in delivering medical and healthcare services. This will give assistance companies more flexibility in managing their costs by giving patients alternative access to healthcare. Instead of sending people to hospitals, for example, mobile diagnosis or a doctor outpatient visit can spare patients from having to travel to healthcare facilities and provide them with the right level of support that serves their needs. The relationship between the assistance company and cost container shouldn’t be seen in a purely transactional context; sharing data, information and adopting a pro-active approach is a pre-requisite and an investment that will benefit all parties. In the pursuit of best value, assistance companies and cost containers must not neglect the importance of being fair and reasonable to healthcare providers. If healthcare organisations are being pushed too hard by overly aggressive pricing pressures, this might have a further adverse effect on cost transparency and treatment quality. Cost cuttings should not be obtained at the cost of patients’ welfare and an open, receptive dialogue needs to be maintained with care.
Active medical case managementWhile close and productive co-operation with cost containers is essential, it is only one side of the coin. Another vital aspect to controlling costs is active and robust medical case management, as making the right medical decision can be instrumental to avoiding costs from incurring in the first place. This is not only intrinsic to effective cost containment, but more importantly, to better patient care. That means assistance companies need to have experienced medical case managers to proactively manage incidents. They need highly trained and skilled people who have medical expertise and proper understanding of hospital administration, as well as local regulations and billing structures. International clinical experience and medical backgrounds enables the team to competently and confidently evaluate different situations and direct patients to the right facilities for appropriate treatment. Not only will this help to avoid unnecessary medical costs, it can also provide a much better demonstration of patient care.
the right relationship between an assistance company and a cost containment organisation can further enhance the overall case managementEvaluation of all circumstances is needed to identify the most appropriate way of handling medical cases. For tourists, the aim is often to get them home as soon as possible, a corporate traveller may need an alternative care pathway to be able to fulfil their assignment, and those with an international health insurance policy may need to have all treatment needs met locally. Assistance companies that can build a network to deliver for all client needs, work with the right partners and take a proactive approach in case handling according to varying requirements and situations, will further drive forward effective cost management.