ITIC Global 2024 | Cost containment – global hotspot case study review

The ITIJ team have been reporting live from ITIC Global in Vienna this week (November 2024) sharing the discussions that took place at the conference. Read all reports

David Broderick, Head of Global Medical Provider Management, Allianz Partners

Broderick took a look at Greece, which attracts 36 million visitors each year, three times its resident population and “by any stretch of the imagination … a phenomenal number of tourists”.

“If you look at the ratio of tourists to local population, it is actually one of the highest in the world,” he said, underlining the pressure on infrastructure this creates.

The country has 4.2 hospital beds per 1,000 people, compared with a European average of 5.3. Issues are more around availability and access to care, rather than quality, he said, although beyond the top four or five big islands, the available services become “significantly less”.

As well as this “huge demand” and “limited supply”, other challenges affecting Greece are its geographical spread across hundreds of islands, and climate change, with more frequent and longer heatwaves leading to faster and more dangerous wildfires. And, when a heatwave hits, said Broderick, there will be a certain number of tourists needing help.

Broderick shared data from some real-life case studies, and explained that the “levers” pulled were a combination of the global and the local, public and private infrastructure.

Global centres of excellence have strong medical and provider management expertise; they set the tone with benchmarking and shared platforms through a large organisation such as Allianz.

“But … you cannot replace local expertise,” he said. Local relationships and knowledge of conditions on the ground are “priceless”. “A huge element of cost containment comes down to relationships, the people – making sure you’ve got the availability,” he said.

Buying power is also important, he added: “How much spend you can bring to providers, that can help you with negotiations.” Knowing domestic rates, “what we should be paying”, is also crucial: “We know what the benchmarks are.”

When asked by moderator Ian Cameron, ITIC Chairman, for one final thought, Broderick called for providers to focus on long-term partnerships and strategic relationships. “Invest with us, partner with us, and the money will flow,” he said.

Helen Calderini, Head of Global Medical Network, APRIL International

Calderini turned the spotlight on cost containment in Singapore, one of APRIL International’s 18 operating countries. “Singapore is viewed as a model for high-quality, innovative and sustainable healthcare,” she said. “However, it does come at a cost.”

Medical technology, an ageing population and prevalence of chronic illnesses are all driving cost rises, she explained, along with medical tourism, and private medical providers pushing up prices.

The Singapore Ministry of Health has in place a usual, customary and reasonable (UCR) benchmark of all procedures that will happen in its facilities, she said. It is also currently investigating insurance fraud among healthcare providers and insurance agents. When it finds fraud has been committed, it names the providers and suspends their local licences, Calderini said.

The medical inflation Singapore has seen in recent years is happening for a variety of reasons, she explained, citing an increase in outpatient visits, which is affecting APRIL’s international private medical insurance (IPMI) policies.

Other cost difficulties are coming from doctors using “the upper part of the benchmark”, overcharging, or telling patients they need to have elective surgery within 24 to 48 hours. This is where APRIL’s IPMI policies come into play, Calderini said, with a five-day pre-approval time built in for discussions with doctor and provider.

The vast majority – 90% – of the work is done before admission is needed, she explained. As well as product design, this includes communication, provider negotiations, and network steering.

Calderini finished by sharing figures reflecting the value that this can represent for payers. She cited a case where early detection of pricing that was outside of the Table of Surgical Procedures (TOSP) coding resulted in US$15,000 of savings. She also described a paediatric transfer to France for surgery, which, beyond saving money, meant the patient received care from a more experienced surgeon than would have been available locally. “It’s just making sure that absolutely everything has been looked at, every possible solution has been thought about,” she said. “We’re looking for that solution that’s been adapted to the situation.”

Ted Jones, Chairman, NGS – Northcott Global Solutions

Jones took a look at cost containment in volatile regions such as the Middle East.

Security evacuations in these regions are often time-critical, high-risk operations, he said. Costs can escalate quickly due to rapid response needs, logistical complexities, and unpredictable security situations.

Lack of available assets can also be a problem, with air assets in particularly high demand. “Very often in more difficult, challenging parts of the world, aviation flicks on and off,” he said. You need alternative routes by sea, and “don’t have one maritime option; have dozens”.

Emergency evacuations by their nature happen at short notice, and with a limited time window in which to operate. It’s therefore “not good enough to have a system that relies on funds being cleared … It needs to be done now, [otherwise] it’s not an emergency response”.

However, it doesn’t have to be an expensive exercise, Jones said: “The non-medical elements don’t cost much.”

These challenges are best mitigated through pre-emptive planning and risk assessment, including proactive risk mapping – conducting detailed country and regional risk assessments to identify potential evacuation scenarios before the need arises.

Costs can be shared through multi-client solutions, Jones explained, such as evacuation clustering – grouping multiple clients in the same region, reducing per capita costs. Leveraging regional networks enables multinational organisations to share transport and security resources.

Jones said that technology could create efficiencies, and building strong relationships was also crucial.

It was a matter of balancing speed and cost, and continuous adaption, he said. Evacuation plans and cost containment strategies must be regularly assessed, and adapted to the evolving security landscape in the region.

Finally, he concluded, simplicity was key. “In a complicated region, if your plan is complicated it will fail. If your plan is simple, it will be robust and it will work.”