Aetna International – educating health consumers through innovation
The health insurance industry is undergoing a rapid transformation. Escalating healthcare costs amidst a diverse global demographic has presented a multitude of challenges for insurers in meeting member needs on a global scale. Moving towards a consumer-centric healthcare model, patients are demanding increased control and cost transparency, as well as services which are further connected and accessible through the implementation of new technologies.
One of the industry's largest and most prominent international health benefits providers, Aetna International has developed world-class health management solutions for governments, corporations and providers worldwide, providing health benefits to more than 800,000 members. Part of Fortune 100 company, Aetna, the business has stepped up its game in the development of products, services and programmes to cater to its international market.
Running the company’s evacuation service, Medical Director, Mitesh Patel remains passionate about providing exceptional member support, which includes keeping abreast of all new health trends and technologies. Still practising in emergency medicine, he explains that its evacuation services remain a unique selling point for the business.
“Our evacuation business is completely in-house and decisions are made in real time. I also oversee the care management programme, ensuring that members get the right treatment, at the right place and at the right time,” he says.
“Through the care management programme, we have a particular focus on people with chronic diseases, such as diabetes and high blood pressure, but also the more serious end of the spectrum, such as those with cancer or chronic high-cost conditions. Our programme ensures there is a dedicated nurse where members are then able to establish an ongoing relationship. They are able to navigate members through a complex healthcare pathway, but also act as a point of support through the process.”
Many members, particularly in developing countries are still unable to gain essential information surrounding long-term conditions, such as cancer, or if they are in the final stages of life. Patel explains that having a dedicated person that patients can speak to inhouse at Aetna International is therefore essential in enabling the ability for difficult conversations to be had in place of a medical professional who may remain reluctant to discuss.
“It starts with the basics: trying to find out what they've heard about their condition and what the doctors have told them and sourcing ways in which to help. Giving people time is important once that conversation is had. After a couple of days to reflect, we will then call back to see how they're feeling and if they've got any questions,” he explains.
“Often, customers don't want to hear this kind of news from an insurance company because that should be the doctor's role. However, we’ve often found that once members have got over the initial shock, they are very appreciative. Once they know what's happening, they can then plan the rest of their lives.”
Through its pre-authorisation process, the insurer also works to help identify medical conditions, cases and treatments with members in collaboration with medical professionals to source the right solution. The aim of Aetna International is to undertake what is best for its members, making sure they're not being over-treated or having unnecessary surgeries in ensure a higher quality result and increased member satisfaction.
However, the number of people affected by lifestyle diseases, such as atherosclerosis, obesity and diabetes are also placing significant pressures within health insurance and rising member costs. Tackling this head on, Aetna’s Care Management Programme has sought to identify these members and appointing nurses to outreach, provide advice on disease management, how to be compliant with medication, as well as assess member diet and lifestyle choices. The number of people with diabetes, for example, has increased from 108mn in 1980 to over 420mn in 2014 – a figure which is significantly rising. The World Health Organization (WHO) has even projected that diabetes will be the seventh leading cause of death by 2030.
“We provide general health and well-being advice so that people who are at risk of potentially getting diabetes or are developing conditions can take action to modify their lifestyles,” says Patel. “I think the biggest value for money long-term is taking this right down to school level. This would have to be done by governments, where we could definitely advise. Teaching children to lead a healthier lifestyle, where children will inform their parents, will become full circle.
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“Take for example, alcohol consumption in the United Kingdom. It has been stated that quarter of 18-25-year-olds are now teetotal. Obviously that's not just due to education, but also financial pressures, et cetera, but that message is getting through and is enabling a healthier society for the future.”
Whilst education remains central in addressing the rise of lifestyle diseases, it has also been proven to be vital in halting the rise of antimicrobial resistance worldwide.
Although this can occur naturally over a period of time, the misuse and overuse of antimicrobials is accelerating this process, threatening not only the industry’s ability to treat common infectious diseases, but also leads to higher patient costs and increased mortality rates, according to the WHO.
“In the US, in the domestic part of the business, we've had success on tackling this, where we've identified people who over-prescribe and written letters saying ‘Your prescription rate for antibiotics is above the trend of what your peers are doing.’ We've had a similar approach in the UK. That in itself has had a notable success,” notes Patel.
“Both members and providers need to be educated that taking antibiotics is not the best solution all-'round and often can do more harm than good. Antibiotics have got their place and they're extremely useful, but they are for diagnosed bacterial infections only.”
The need in tackling lifestyle diseases is also being explored by non-traditional healthcare players. Companies such as Fitbit, Apple and Amazon are all continuing to develop consumer health wearables and fitness trackers, enabling users to harness greater interest and control over their healthcare. Following from the launch of Bluetooth in the early 2000s, the number of connected wearable devices worldwide is predicted to jump from an estimate of 325mn in 2016 to over 830mn in 2020.
“This is a Penicillin Moment, basically,” observes Patel. “Technologies in healthcare have got the potential to save more lives than some of the biggest inventions of the last century. There are mainly two fronts: machine learning and artificial intelligence (AI) capabilities. As this gets better and better and better, it's going to augment the physician role. Rather than the physician spending a lot of time on diagnostics, machines can interpret scans, CT and MRI images. This trend is going to evolve.
“Secondly, the ability of the machine to collect and interpret large amounts of data and find correlations and causations that we might not even be aware of. That will give us a different perspective on diseases. Once we find out exactly what's going on, that's when you have positive interventions being made for that specific individual. It's tailor-made medicine.”
Such technology is already having an impact on conditions such as heart failure. Through advanced data analytics, providers can predict hospital admissions and illnesses before they occur and intervene and increase the dosage of a drug to prevent a hospital admission where required, therefore developing a personalised model of care.
“This is going to be the biggest movement of the century. The ability for the algorithm to analyse huge sets of data which we as humans simply can't do and to create a personalised plan for every individual,” says Patel.
This revolution is already underway with many partnerships established in 2018. From Amazon, JP Morgan and Berkshire Hathaway joining forces, to vertical integrations of providers and insurance companies such as Cigna, Express Scripts and CVS Health’s US$69bn acquisition of Aetna, the industry is set to undergo tremendous growth.
“The main aim of all of this is going to be to build a healthier world and to benefit our members by offering a local solution. We need to have a personal relationship with our members at their time of need. By doing that, we're touching upon the vulnerable, yet we’re delivering a phenomenal service,” adds Patel
“It's not just being a pure health insurance company, but to be seen to be bringing effective care directly to the member and making them engage with us, to lead a healthier life and actually change behaviours. It's a combination of doing what we're really good at doing, but also a focus on improving the member experience.”
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.