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IHC Insider, Issue 18: Tuesday 11th August 2015

Editor’s letter

Welcome to the August issue of IHC Insider.

It’s been a busy six months in our industry, with some major takeovers making the headlines, information pills changes to the marketplace and a constant flow of new and improved products.

The insurance industry as a whole is facing some upheaval in the form of the Chancellor’s Insurance Premium Tax (IPT) proposals. During the Budget it was announced that George Osborne proposed to increase IPT from 6% to 9.5%, and the private medical insurance industry, along with many other insurance sectors, has been vocal in its disapproval of the move. The pressures PMI faces already – in the form of healthcare inflation, amongst others – mean that there is little room for additional costs. An IPT increase means some employers may need to rethink the way they approach healthcare cover for their employees, looking for lower cost options. IHC can help with that and we would encourage you to get in touch with your consultant if you want to know more.

We hope you find this newsletter interesting and informative, and, as ever, we would be delighted to receive any feedback from you.

Paul Roberts
proberts@ihc.co.uk.

Industry news

IPT increase concerns PMI industry
Chancellor George Osborne announced a proposed increase in insurance premium tax (IPT) from 6% to 9.5% in November 2015, prompting criticism from across the PMI industry. There is concern across the board that the increase in IPT will put pressure on employers and cause a greater number of patients to turn to the NHS as PMI, already faced with healthcare inflation among other issues, becomes less affordable.

AXA PPP Healthcare distribution director Chris Horlick says: “Increasing the rate of Insurance Premium Tax from 6 per cent to 9.5 per cent will potentially make the provision of private medical insurance less affordable to many larger employers – at a time when many such employers need their people to be healthier and more engaged and productive than ever, and when pressures on the NHS are increasing.”

He added: “Medical insurance is a valuable tool to many SMEs seeking to recruit and retain the very best talent in their sector and then keep them fit, healthy, engaged and in the workplace. Increasing the rate of IPT potentially makes this business critical health tool less affordable to many SME employers with a consequent impact on productivity, profitability and, ultimately, an increased burden for care that the NHS may be asked to pick up.”

Mental health causing a strain for workers
According to Canada Life Group Insurance, the number of calls to its employee assistance programme (EAP) about depression has increased dramatically. According to a report in Employee Benefits magazine, some 57% of calls about mental health involved work-related issues, while stress accounted for 43% of calls in the first quarter of 2015, a 9% increase on the same period in the previous year. However, calls about anxiety were less prevalent, making up 25% of mental health related called, a fall of 11% compared with the previous year. Depression was the cause of almost a third of calls.
Around half of those calling with mental health concerns said that they were coping poorly with work before they underwent counselling. Reassuringly, this figure fell to 5% once employees had received the counselling they needed.

Booster needed for workplace health and wellbeing
Two thirds of employees receive no workplace support for health and wellbeing, a newly-launched quarterly report by Simply Health has revealed. The SimplyHealth/Yougov Everyday Health Tracker surveyed almost 2,000 people and showed that 66% had no workplace health support, and 22% of those with no support said they would like to see their employers do more in this area.

The survey showed a general lack of confidence in health – 61% of people believed they were healthy while only 5% said they were very healthy. Of those in the 18-24 age group, only 1% said they considered themselves very healthy, compared with 6% of over-55s.
When it came to looking to the future, people were just as concerned about arthritis, joint pain and back pain as they were about conditions such as stroke and cancer.

Commenting on the new quarterly report, Romana Abdin, chief executive of Simplyhealth, said: “We’ve launched this Tracker with YouGov to help inform the debate on the future of UK healthcare. Changing demographics, increasing obesity and new technologies and treatments are demanding a new approach to healthcare delivery. To make the best decisions, our healthcare sector needs the best information.

“The Tracker shows that when thinking about their future health, people worry just as much about everyday conditions like joint and back pain as life-threatening illnesses. As our population ages, we need to have an honest discussion about how – or if – the NHS can meet the increasing demand for everyday health treatments.”

Editorial 1 – Virtual GP services: timely innovation in primary care

A new wave of primary care solutions is arriving, offering patients an innovative and efficient way to access GP advice and support. By cutting out the need for difficult-to-come-by appointment times, travelling to the surgery, and potentially facing a long time in the waiting room, online GP services can provide a more efficient way to gain advice, diagnosis and treatment.

Key players in the field of virtual GP practices are Vitality GP and Medical Solutions. They have different approaches, but they both use virtual appointments to ensure patients can be seen when they want to be, and where they feel most comfortable.

Vitality GP is a mobile-enabled service giving people access to GP care. It has designed to be simple to use and promises to cut out problems accessing primary care. The idea is that patients download the Vitality GP app through apple’s App Store or Google Play, then can use this to book a video consultation appointment with the Vitality GP of their choice within 48 hours, at a time that suits the patient.

Through the scheme, patients will be able to discuss a wide range of health issues, upload images with their smartphones, receive prescriptions for acute illnesses, organise minor investigations and authorise onward eligible treatment.

The aim of the system is to allow patients to choose a different pathway to treatment – instead of using an NHS GP and going onto waiting lists, they will be able to have a video consultation to get quickly to the root of any problems, and, where necessary, ensure people are referred to the relevant therapists or consultants quickly.

VitalityHealth says that Vitality GP is particularly suitable for people who want to “save on their premiums and are happy to put a Vitality GP at the centre of their healthcare needs”. Clients need to use a Vitality GP in order to make a claim, and referrals will be made to consultants of therapists within the VitalityHealth network of providers.

Medical Solutions offers over the phone and virtual face-to-face GP assistance. Calls to the service are answered by an operator, who will organise for a GP to call the client at a suitable time or, in the case of a virtual face-to-face appointment, to set up an appointment via the patient’s webcam.

Medical Solutions has already built up useful experience in dealing with patients’ problems in this way, and the advice that is offered can either help immediately or allow people to decide whether they need further treatment. Successfully treated patients include a 39-year-old woman who was having difficulty sleeping and was suffering as a result. A 25-minute consultation allowed the GP to diagnose acute stress. Recommendations were given to help manage stressful situation and the woman had two further consultations which provided support and counselling. Another patient needed advice on vaccinations required for travel to south-east Asia, while a 21-year-old student with sciatica was advised to see a physiotherapist and specific over-the-counter pain relief medicine was recommended.
Online GP services promise a lot, but they have got off to a bumpy start – or rather have come to a halt – for some practices. On the island of Jersey, Babylon launched an app through Digital Jersey which was hoped to encourage people who might otherwise avoid seeing a doctor to make virtual appointments. The scheme, which kicked off in November 2014, aimed to cover 55,000 patients, offering virtual assistance through a downloadable app.

However, take up was remarkably slow – only a handful of appointments were made in this way – and the project has now been called off. Dr Phillipa Venn, a GP at Cleveland Clinic, told the Jersey Evening Post that the low take up was primarily for positive reasons. “It really proves how good the access to GPs is in Jersey,” she said. “People can see a GP very quickly over here, but in the UK it might be three weeks before people can get an appointment. It was the first launch into electronic delivery of services and in the end the app was trying to solve a problem that Jersey doesn’t currently have.”

The problem is a very real one in certain parts of the UK, of course, and, as Paul Roberts, consultant at IHC, says, virtual GP assistance could be a large part of the solution. “The idea has been around since the start of the millennium and I believe that now society is more ready than ever to embrace this approach to healthcare,” he says. “The reality is that, with smart phones, the GP will be in your hand and not at a PC desk based system. The media have told the public that there are not enough GP resources, and access is more and more of a problem, so it may just be that 2015 is the start of a significant change to the way we access primary care.”

Editorial 2 – Patient Advocate – collaborating to put patients on the best pathways

Navigating the world of healthcare can be stressful, costly and ultimately place numerous strains on both the employee and the employer. Patient Advocate is an organisation that attempts to make this easier for all concerned. Its aim is to ensure patients get consistent, high quality healthcare from start to finish, while controlling the costs of company healthcare. CEO Michael Tate explains: “The Patient Advocate model is primarily designed to work on the relationship between employer, employee and healthcare providers and ultimately will be the most comprehensive model available in the UK.”
Patient Advocate is a nurse-led service that focuses on getting the best out of healthcare, whether that means working with the private sector or NHS. Nurses manage each case individually from start to finish, profiling all the different providers and working in all areas of healthcare to work towards the best possible treatment pathway for patients. Hospitals, doctors, specific treatments, community health services, in-patient and out-patient options are all covered.

The core Patient Advocate proposition is not an insurance product – instead it works with private medical insurance that is already in place, and the idea is to get the best and most appropriate service in the right location, and at the best cost. And in doing so, Patient Advocate aims to get the right course of treatment for employees, ensuring they are soon fit enough to return to work, which is positive for the employee and for the employer.

One woman who was referred to Patient Advocate in May this year was given support her after a diagnosis of a possible secondary metastatic breast cancer tumour. She had been treated for breast cancer some years before and was thought to be in remission. She was facing conflicting medical opinions from two different consultants – each proposed a very different course of treatment. One suggested cyber knife treatment while a second opinion from another specialist suggested a triple chemotherapy regime for up to a year.

A dedicated nurse case manager from Patient Advocate carried out an early intervention assessment with the patient within 24 hours of referral, established her medical history and explained the services Patient Advocate could offer. The patient gave full written consent and from then on the nurse case manager was able to intervene and coordinate her treatment pathway, working collaboratively and minimising any delay in her care.

The patient was keen to access her chosen consultant oncologist and receive the most effective treatment, and Patient Advocate was able to liaise with the consultant and his secretary and establish that NHS treatment for an almost identical chemotherapy regime to the privately-proposed one was available, with no change to her long term health outcomes. One issue she faced was that a drug on the NHS regime was different to one that was available privately, and was harsher with the potential for worse side effects. The Patient Advocate nurse worked with the medical team to have it written into the care plan that the alternative, privately-available drug should be made available on the NHS if the patient was not able to tolerate the standard drug.

By liaising further with the patient’s GP and coordinating referrals for tests and treatment, the nurse case manager was able to ensure that the patient’s treatment plan could start promptly – almost as quickly as the private treatment – and with a cost saving of more than £100,000. Being a qualified nurse, she was able to understand the procedures, the order in which they should happen, as well as the inner workings of referrals and communication between GPs and hospital departments. For the medical staff, having an advocate to coordinate helped the process go smoothly, and for the patient, it was reassuring to have expert guidance on hand to get her on the right treatment pathway without delay.

For businesses, too, Patient Advocate can offer support and significant savings on private treatment by finding NHS options that work well for the patient. One large security firm working with Patient Advocate saved thousands by working with Patient Advocate. Some £3,000 was saved on wisdom tooth removal by opting for the NHS, a urology case with a potential cost of £8,000 was referred to the NHS with a diagnostics cost saving of £2,000 and £7,500 was saved through NHS employee-elected treatment for muscular skeletal problems. And it’s not just cost savings – Patient Advocate intervened to reduce an eight-week NHS waiting period to one week, and when waiting times with were estimated at three to four months, the organisation successfully managed to reduce the waiting time so that the employee was treated on the NHS and back at work within three weeks.

The organisation aims to bring down costs, improve waiting times and work with existing PMI and NHS structures to get the best results all round. “Patient Advocate creates a valuable bridge between public and private health programmes and services, providing individuals with greater choice to get well, whilst importantly providing significant and measureable benefits and savings to the employer,” says Michael Tate.

For IHC consultant Paul Roberts, Patient Advocate is an important addition to a range of services that help patients get the treatment they need. “The service provides a vital link to the NHS, using the best of the NHS treatment whilst using waiting lists information intelligently,” says Paul. “Patients can be fast-tracked to NHS centres of excellence with spare capacity, making the best use of resources available and with public funding. Should a condition prevent a worker performing their duties, then Patient Advocate can discuss the options and costs with the corporate client so they can make a business decision. What’s more, this relatively new service comes with a good pedigree and well known team behind it.”

A review of the past six months

In this section, we take a look at some of the stories we at IHC have covered over the past six months. It has been a busy time for the industry, with plenty to discuss, and here we round-up articles on some of the key issues affecting our industry.

Screening: the benefits are clear
Identifying and treating health issues in the earliest stages is hugely beneficial, and simply taking time out to discuss lifestyle, habits, nutrition and exercise can be extremely positive both for individuals and their employers. According to Screenetics, a leading provider in health screening as an employee benefit, screening has been proven to improve productivity, reduce time off work through illness and the costs involved, reduce the risk of stress related illness at work, and reduce injuries and compensation claims. The IHC team discovers what screening is all about. Click here for more information »

International PMI – a sector that continues to fly
As many as a quarter of British people living overseas have no international private medical insurance (iPMI) policy. Many fail to buy policies because they don’t think they need them, while others are put off by the cost. But the costs of living or travelling abroad without insurance can be far higher, as a Canadian woman and her husband discovered when their baby was born early during a holiday in Hawaii. An in-patient spell and a helicopter ambulance, among other elements, left them with almost $1m in medical bills – costs that her travel insurance would not cover as she had been treated for complications. A lesson learned the hard way.

There is still much room for education, but the iPMI sector is nonetheless doing well –and has the potential to do even better. Independent analysts McGrigor Group said that the iPMI market has trebled over the past decade and was worth some US$9.8bn at the end of 2013 – a figure that is set to grow. Click here for more information »

Why engaging in staff wellbeing is crucial
When two bankers at the pinnacles of their respective careers cited stress-related issues as their reasons for leaving top City jobs, it became clear that this was a problem that required more than just acknowledgement. Lloyds chief Antonio Horta-Osorio and Sir Hector Sants, former head of global compliance at Barclays, have both taken time out of their careers in the past few years because stress had taken its toll on their health. And while this many have showed that those in the financial sector needed to take a look at how working practices affect their staff even at the highest level, the message should have been clear to all sectors of industry. If the human aspect didn’t drive that message home, then the commercial aspect might. Once the markets got wind of what had happened, shares at both Barclays and Lloyds dropped sharply – stress was bad for business. Paul Roberts takes a look at the importance of well-being in the workplace – for staff and for employers. Click here for more information »

Shared parental leave: flexible options for new families
Parents of babies born after 5 April 2015 will be able to choose to divide childcare between them in the first year after birth. Based on the mother’s entitlement to maternity or adoption leave allowance of 52 weeks, new parents will be able to share the care of their new baby so that one or both may take time off to look after their new addition. We take a look at how the new measures may benefit, and challenge, businesses. Click here for more information »

Mental health week – a time to think
Mental health week has been running for 15 years, and there is no doubt that in this time there have been changes in attitudes to mental health. The stigma around the matter is constantly being challenged and communities and workplaces are growing in their understanding of what mental health really means. But the results of an AXA PPP healthcare survey, published in April, revealed that companies have a very long way to go when it comes to dealing positively with mental health. Click here for more information & raquo;

Check4Cancer – how employers can help
Everyone knows someone who has been affected by cancer, whether they have faced a diagnosis of their own or are caring for a loved one. According to the cancer charity MacMillan, some 2.5 million people in the UK are currently living with the disease, and the charity estimates that around 50% of the UK population may contract the disease at some point in their lives by 2020. But survival rates are improving and early detection is playing a huge part in this.

Cancer has a serious impact on employees and the businesses they work within, but there are ways to build in an approach to HR planning that can help. We take a look at the benefits available and the measures businesses can take. https://www.check4cancer.com/media/2015_pdfs/1504-annual-cancer-report.pdf

AXA PPP powers ahead in PMI
AXA PPP bolstered its presence in the private medical insurance (PMI) market with two notable acquisitions in a month. The company has announced that it is to acquire both Simplyhealth’s and the Permanent Health Company’s (PHC) private medical insurance (PMI) businesses, subject to approval from the relevant bodies. Click here for more information »

IHC’s managing director Nick Lipczynski said: “Following the deals, AXA PPP will become a larger business with a greater market share, potentially making it a better competitor to Bupa. We believe AXA PPP will capitalise on this and look to see product development and innovation to give improved customer value. However, there is no doubt that the reduction in the number of insurers in the marketplace restricts customer choice.” [link]

Health Shield: making claims paperless
Cash plan provider Health Shield has announced the launch of a new online claiming service. The new system means that all valid receipt-based claims can be paid within 24 hours. It speeds up the process by removing the reliance on the postal system, as well as doing the environment a favour by saving paper, a move made possible by “significant investment in the IT infrastructure” at Health Shield.

The not-for-profit Friendly Society, whose premium income and membership numbers reached record highs in 2014, said that 97.4% of claims on 2014 were paid, and 93% of those were paid within two working days. It hopes that the launch of the online claims system will ensure even better results. Click here for more information »

IHC News – Project Propeller!
Each year, a very special reunion takes place, bringing together more than 150 veteran pilots who flew in World War II. The pilots deserve to arrive in style, and they are all flown to the reunion in light aircraft by a group of dedicated volunteers. These elderly gentlemen, many of whom were little more than boys when they flew in the war, get together annually to remember those days.

Nick Lipczynski, IHC’s managing director, has been involved in the event for five years. Nick has a huge respect for those pilots who fought in the war, a passion for aviation and a particular interest in Spitfires and Lancaster Bombers, all of which make him a perfect fit for the job. Each year, Nick offers his help in flying veterans to the reunion.

Nick is a qualified pilot and has long been fascinated by aviation and classic aircraft, so he was delighted to be able to participate in Project Propeller. “I was approached by the charity through other pilots, and I was delighted to be a part of this. It is a real honour for me to be able to combine my interest in Lancaster and Spitfires with helping the people who actually flew in them. To meet these people and to listen to their stories and their modesty is incredible,” says Nick. “They are inspirational and this is the least we can do.”

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