How Are Expat Health Insurers Responding To Covid-19? A Conversation With Cigna Europe

Carlie: Hey there, it’s Carlie with the Expat Focus podcast. This past year has really put our health and wellbeing in the spotlight – whether it’s been dealing with a Covid-19 diagnosis ourselves, supporting loved ones, or dealing with the mental and physical health impacts of long-term lockdown and significant lifestyle change.

Health service providers have played a key role during the pandemic, and my guest for this episode is from one of our health partners here at Expat Focus – Cigna Europe.

Doctor Peter Mills is going to talk through the ways in which they’ve evolved as an organisation to support the needs of their customers and what types of services have been in demand during the crisis, and he’s going to answer some listener questions.

Doctor Peter Mills, thanks so much for coming on the podcast today.

Peter: Thank you very much, Carlie, for inviting me. It’s a pleasure to be here.

Carlie: Now, it’s no doubt been an intense year for international health service providers like Cigna Europe. How has your company been supporting expats and their families during the global pandemic?

Peter: I think that you’ve actually used the word that we have really been focused on over the past 12, 15 months. It’s been about support. Right from the beginning, we put our heads together and said, ‘How can we support our members, our customers around the world? What do they need? What can we do to alleviate some of the stress, the anxiety, the uncertainty that the pandemic was bringing?’

But not only [for] our customers and members, but also our own employees, because we’ve got thousands of employees around the world as well. So, really, our mantra was ‘support’.

Carlie: And I’m assuming you’ve been involved quite a lot when it comes to people who have found themselves in situations where they’ve needed to call on their health service providers?

Peter: Absolutely. What became very clear early on was that a number of individuals, a number of companies and their employees, they were in the dark. They didn’t really know what to do. So, the first thing we needed to provide was information and guidance in terms of, ‘Okay, where are you in the world? What’s the pandemic like there? Where can you get testing? Where can you be treated if you do get Covid-19?’

So, it really was quite a complicated endeavour, to look at the different areas of the world and to provide that initial information that people were craving.

Carlie: And so many moving targets, too, because Covid-19 hit so many countries in different ways, at so many different timescales, as well. So, I’m guessing that would’ve been quite a challenge.

Peter: Absolutely. It started, as you know, in Southeast Asia. And then the concerns at that time were, ‘Should I leave? If I don’t leave, what happens if I get unwell? Where should I go? Can you evacuate me from this location, if the worst comes to the worst?’ It really was a rolling process of assessing what was happening in different regions, and then putting together the information base that we could disseminate out to our customers around the world.

Carlie: And so many industries had to change the way that they did things over the last 12, 18 months, to accommodate how the crisis evolved, the different lockdowns, how to keep people safe … And healthcare, of course, had to really – I hate to use this word – pivot.

I know that for myself, suddenly, instead of going to the doctor’s office, I was booking video calls to see my GP and get my prescriptions and make sure I was up to date with tests. How important has that pivoting been in the healthcare industry?

Peter: I think it’s been … We will look back on this time as ‘that point in time where healthcare transformed’. I’ve heard the pandemic be called a ‘tragic innovator’. And I think one of the things that we will take from the pandemic is how it forced the healthcare industry to really think differently about how we deliver care and support to our populations.

At Cigna, we started our journey before the pandemic. We had a vision to be a whole health partner. And what we mean by that is that we wanted to move away from being just the company that paid the bills – if you like, that facilitated point of care solutions. We wanted to transform, and we wanted to transform into a health services company that is there to support and guide people in their whole health journey, all the way from staying well to managing acute conditions – and also managing chronic conditions and survivorship as well.

And we recognise that it’s not just about physical health. And I think one key message from the pandemic is that our psychological health is so important, and it really does drive how we feel in ourselves, how we work, and how we interact with others.

Our whole health strategy really recognises that health is not just the absence of disease, but actually it’s the summation of a number of different things within our life – our physical health, our mental health, our home environment, our finances, our relationships with our family, our social connections, and our place in society.

And although that’s not necessarily a new concept, I think it’s a new concept for healthcare organisations such as Cigna. So, we are really driving forward on that. As I said, we started that journey before the pandemic, but the pandemic accelerated the urgency for us to really change our relationship and what we provide to our customers.

Carlie: I think that whole health perspective is something that I know, myself, I’ve been really reflecting on over the past 12 months. [I’ve had] so much time at home to really consider what is important to me and whether I am looking after myself – not just from a medical perspective, when I’m ill, but how I’m doing, as you said, with my mental health, with my relationships, and that sort of thing.

It’s been a really big time for pause and reflection, and it sounds like Cigna Europe has been in a really good position to help people reassess their priorities and give them some solutions.

Peter: Absolutely. And I think so many people have taken, from this situation, the ability or the permission to really reflect on what is important to them in life. And many people have really struggled during this period of time, and it’s not surprising, really, because pretty much all of the pillars of ‘whole health’, and all of the things that we know go towards making up our health, have been impacted.

It’s had a bigger impact on some people than others, but all of the areas have been impacted – our work life, our social life, our connections with our community, our family relationships, our finances, in many situations … People have been furloughed; people have lost their jobs – the uncertainty around it has been really quite profound.

We are on a journey as an organisation. I don’t think we are there at the end point, but what we’re trying to do is really engage our existing customers in a dialogue around, ‘How can we help you? How can we provide, for you, solutions, services, guidance, advocacy, [etc.] that will help you to become more healthy?’

Carlie: And what sorts of solutions and services have you seen increasing in popularity, particularly among expats and their families, in the past year?

Peter: So, you mentioned one, Carlie. You mentioned the telehealth side of things, which has been really beneficial during this period of time. We’ve seen a 500% increase, as an organisation, of our global telehealth solution, over the past year. And although, pre-pandemic, there were people engaging with it, the engagement level was relatively low. People were still much more comfortable with the traditional bricks and mortar approach to accessing care.

The pandemic forced many people, in different regions around the world, to actually engage with telehealth. But I think one of the great things about it is that the overwhelming majority of those people were really happy and really satisfied with it. We’ve got something like a 96%, 97% satisfaction rate – people rating it very good or excellent.

I think this has been transformative, and it’s got us thinking about how we can blend traditional care – as we say, in-person, bricks and mortar care – with virtual solutions. So, not resting on our laurels, we’re really looking at other virtual solutions that … We don’t want to replace face-to-face, but [virtual solutions] can potentially be used to augment and support face-to-face care.

So, a good example is virtual musculoskeletal care, physiotherapy. There’s been a tremendous explosion in organisations that are offering virtual solutions, and, in some ways, the digital approach is better. If you take, for example, going to see a physiotherapist because you’ve got pain in your knee …

You’ll go and see the physiotherapist, they’ll assess you, they’ll give you some exercises, and [they’ll] tell you to come back in a few weeks after you’ve done those exercises. No-one really checks up on whether you’re doing them. You can’t really remember exactly how to do them.

Research shows that at least 40%, possibly even 60%, of people who were given a course of physiotherapy, self-directed exercises … At least 40% don’t complete that course as prescribed. The great thing about the virtual setting is that you can have videos and instructions that are tailored to you.

So, if your physiotherapist says to you, ‘Okay, you need to do these four exercises,’ you can refresh yourself with them there. You can also have real-time check-ins with your physio, who can ask you, ‘Okay, what’s going on? Are you doing your exercises? How are you feeling?’

Carlie: ‘Demonstrate to me how you’ve been doing them.’

Peter: Exactly. ‘What’s your pain level like?’ And then, some of the more elaborate solutions are actually using sensors and bands that you can put on yourself. So, the physio has a record of what you’ve been doing and whether you’ve been doing the exercises correctly.

So, it’s a fascinating area of how technology can really augment what we’ve come to know and love, and actually can improve it. So, we’ve got a team within Cigna that are actively looking at new innovations that we can bring to the marketplace for our customers, again, to help them with their ‘whole health’.

Carlie: It’s really interesting, because as soon as you brought up the physio example, I thought, there’s no way … Because there are some health services where you really need to be there in person to be examined, for example. And I thought something like physio would have absolutely been one of those. But the way you explained it …

I’ve just gone through physio for a back injury, and actually, when I think about it, other than a little bit of prodding on the table, most of the time, we’re in the gym. He’s showing me some moves, giving me new things to do at home, checking my position and my posture … And so much of that – as you said, with like a sensor sort of technology – could be done virtually.

Peter: Absolutely. And like I said, that doesn’t preclude the face-to-face. I think the real opportunity and the thing that excites me is that it can add and augment the face to face. So, you may go and see a physio at the beginning and at the end, but in between, you’ve got these virtual check-ins and this virtual solution that can guide you.

Carlie: And that’s so convenient. I mean, for expats that might be living in a rural area, away from their regular doctor or specialist, it reduces the need to travel. It means that they can be accessible, without needing to really change their schedule. I think about my GP check-ups that I’ve had over video in the past 12 months. And I think, really, unless I need a physical examination, there’s no need for me to ever set foot in my doctor’s office again, because we can do so much over video now.

Peter: Indeed. I think that this is where the opportunity lies and where we, as a health services company, really are actively engaged, in terms of moving away from just being that organisation that helped you find a hospital, a clinic, or a doctor, and then paid the bills, to being your guide, your advocate, to help you make the right decisions.

Another area that I think is really interesting, which we have seen a lot of interest in, is digital mental health, psychological health solutions. Without a doubt, the pandemic has had a profound impact upon people’s emotional health. And because many clinics, many hospitals around the world, have been limiting the number of people that they’ve been able to see – just because in many cases they’ve been overwhelmed with Covid-19 – the virtual side of things has really taken off.

And I think it’s an area of healthcare that really does lend itself to virtual and digital solutions, because a lot of the treatments are talking-based treatments, and increasingly, psychological health professionals are moving away from, ‘here’s some medications; they’ll make you feel better’ to ‘let’s get to the root of the problem, and let’s really talk through this, and let’s give you the tools so that you’ve got much better coping strategies as an individual.’

And we’ve seen an increase in people coming through us, as an organisation, saying, ‘Can you help me find a psychological health professional who will be able to help me? It’s really stressful home-schooling the kids, and work has got me working virtually, but I haven’t got the set up there. I’m worried about my elderly relatives back home, what’s happening with them.’

There’s been so many stresses, and we really have seen quite a marked increase in claims and requests for help around that area. So again, it’s another area that I think the virtual side of things can augment that more traditional face-to-face.

Carlie: I have read some articles, during this pandemic, about people not being able to go in to their doctor’s in-person, or that, being under curfew, being under lockdown, they haven’t necessarily kept up with important tests. For example, for cervical cancer, for women, or diabetes, or heart disease…

How is health service provider support evolving for people with chronic conditions, and how are health service providers making sure people are getting tested and staying on top of those sorts of health issues?

Peter: Absolutely. You know, we’ve heard lots of stories about health systems around the world, where the fear is that there’ll be a lot of people who’ve been sitting on symptoms that are potentially life-changing, in terms of the underlying diagnosis – cancer, cardiovascular disease, maybe their diabetes hasn’t been managed as well as it should have been…

One of the things that we wanted to make sure we did with our customers, was to reach out to them at the beginning of the pandemic – when it was clear that countries were shutting down, when it was clear that the healthcare system was not really going to be able to cope with much more than just managing acute infections with the coronavirus – we got our nurses to reach out to people that we knew had chronic conditions to make sure that they knew what to do.

[To make sure] they knew where to get their medications, that we had a telehealth service, that they had, at the end of the telephone line, a nurse at Cigna who could help them make decisions if needed. So, for those individuals with chronic conditions, it really was – even though I work for Cigna – a great solution/service for them. They had someone checking in on them, making sure they were okay.

The real problem, as you alluded to, was for those people who didn’t know they actually had an underlying condition. And one of the things that we’ve been doing of late is communicating out to our membership base around the world, saying that health services are open, or that they are open in specific regions.

If you’re sitting on any symptoms, if you are concerned about any signs or pains, whatever it is, then get in contact with us. We can find you someone who will be able to see you, or, worst comes to worst, do a virtual consultation, so that you can explain to the doctor / healthcare professional what your symptoms are.

So, what we’ve been trying to do is be proactive with these people, to support them, to help them make the right decisions if they do have underlying symptoms. But, you know, the research and the data that’s coming out does suggest that there’s going to be a significant number of people who are being diagnosed with chronic diseases later than they normally would have been, because of the pandemic.

Carlie: Now, Peter, this week, we did ask Expat Focus listeners, via social media and the Expat Focus Facebook groups, to submit their questions for you, and I have some here. The first one is from Alicia, and she says, ‘I see there are many health service providers for expats, but how do I know if they’re reliable or not?’

Peter: That’s a good question. And one of the things that we’ve been doing at Cigna has been really looking in depth at healthcare quality, because you’re right, and especially if you are abroad, you don’t really know a lot about the healthcare system where you’re at. So, an organisation like ours can help you make the decisions that are best for you.

Is this clinic/hospital any good? Do they have an acceptably low complication rate? [What about] hospital acquired infections? One of the initiatives that we’ve been running for the last two years is – what we’re calling – our provider segmentation programme. So, we’ve got a wide network of providers with whom we have direct billing arrangements, but we’re actually now segmenting these down to those ones where we are really happy with the quality and the governance of the facility.

And, increasingly, what we’re going to be doing is surfacing these to our expats around the world, within the Cigna portal, so that they can see some metrics around the provider. ‘This is the number of a certain condition or certain procedure that they do. This is the complication rate. These are the patient satisfaction metrics.’

So, we want to really be much more transparent. We’re really trying to encourage our network and our contracted providers around the world to be more transparent, because ultimately, at the end of the day, these decisions are really, really critical to individuals. Without data, people are making decisions based upon, ‘Oh, I like the fountain in the foyer’ or, ‘The espresso is really quite tasty.’

It’s crazy, isn’t it? We spend more time researching where we are going to go for dinner than we do deciding which doctor or which facility we’re going to use. One of the things that we’re bringing to the table is much more transparency around that. Let’s help you make a decision based upon your needs, your individual requirements, and what it is specifically that you need doing – because some places are good for some things, and other places are good for other things.

Carlie: And let’s face it, when you look at reviews and ratings online, a lot of the time, people only take the time to give their opinions when they have had a negative experience. So sometimes it can be hard to get an accurate gauge of, ‘Was that clinic, or was that surgeon, any good?’ or, ‘Did they provide adequate care?’

Another question we’ve got here is from Simon, and he wants to know, ‘Is Covid-19 treatment covered by health service providers?’ Here in France, for example, they’re giving out the Covid-19 vaccinations for free. I’m sure that’s the case everywhere else in the world, unless I’m mistaken. But what about if you do have Covid-19 and need to be treated, worst case scenario, with a hospital stay?

Peter: One of the things that we did, really early on in the pandemic, was communicate out to our customers and our employer clients to say that the treatment of Covid-19 or testing – if there’s a medical suspicion that someone has the coronavirus – is completely covered. ‘There are going to be no co-pays or any any out-of-pocket expenses for the testing and management of Covid-19.’

I think that’s really important, because a lot of people were really concerned, and it gave them that little bit of peace of mind, in terms of, you don’t have to worry about costs. For many expats, their healthcare policies are very rich and very robust, but in some areas around the world, such as the United States, even rich policies have co-pays and deductibles within them. So, we wanted to make sure that we completely levelled the playing field, so that the people didn’t have to worry about that.

Carlie: Now, we’ve received quite a few questions about coverage, eligibility, and where to get certain treatments in particular countries. That’s probably a bit too specific to get into in this conversation, but what can you suggest for those listeners who are interested in that sort of information?

Peter: The thing I would encourage people to do is talk to their health insurer. So, if you’re covered with us at Cigna, you will have a helpline, an email address, a portal, etc. Other organisations probably have a similar solution. Talk to your insurer to get some help and advice, in terms of where to go, based upon your location and what your particular need is. They should be able to provide you with some good information.

Carlie: And if you’re not with Cigna, but you’d like to know about what this health service provider can cover, I’m assuming there is a lot of information on your website, as well?

Peter: There’s a lot of information online, information about our network of providers. Just go online and do some searches. I’d like to say that we are a lot better than our competitors, but I think, in terms of the public information that’s available, it’s quite similar.

Carlie: My final question, for expats and their families that may be looking to change or upgrade their international health insurance, particularly in the wake of the pandemic and what they’ve been through in the past year … Many may have decided their current coverage is not quite adequate for what they need, or, as we talked about, in light of whole health, they’re looking for more out of their policy. What would you suggest is key for them to look for when they are considering a new policy?

Peter: So, that is a broad ranging question, I must admit. I think people need to take time when they’re thinking about the coverage and the solutions that they need for their own and for their family’s health. It is a complex area, and I think one of the things you need to do is sit down and right out what the things are that are important to you.

Now, clearly, access to care is one of the key areas. So, you would need to be confident that whoever is providing your health services solutions for you, which includes the insurance, can provide you with good access to care in the regions around the world where you are. That’s the first thing.

But then, as you said, what are the additional areas that are important to you, in terms of your own health and wellbeing and that of your family. That’s where you can start to think about that whole health concept.

Additional psychological health support … One of the things that we often see with expat families is that the main member on the policy is an expat with a major corporation, and they bring along the family, the spouse, children, etc., and often we see problems that occur with – what we colloquially call – the trailing dependants. So, it’s really worth thinking about that, as well. What’s the coverage and what’s available for those individuals?

I think the psychological health side of things is really important. It’s really stressful going out on an expat assignment. You are in a new country, possibly with a new culture, and without that support network that you were used to back in your home country.

So, there are so many different things to think about, but I would encourage people to sit down and think through things, and take their time to do it, as well, because it’s not just as easy as booking your restaurant and where to go. It really does require some thought.

And look around, as well. If you are an expat, you’re most likely going to be employed by an organisation that is providing you with your healthcare services. Talk to the benefits people, and ask them questions about what it is that the organisation is going to deliver. What are their unique selling points, etc.?

Carlie: Well, Peter, thanks so much for your time today. It’s been a pleasure chatting.

Peter: Thank you very much, Carlie.

Carlie: That’s it for this episode. If you’d like more information about Cigna and the services they provide, head over to their website – it’s cignaglobal.com.

If you like what we do here on the Expat Focus podcast, please follow or subscribe to the show, however you like to listen. Remember, you can contact us at any time on social media – we are “Expat Focus”; our website is expatfocus.com – and I’ll catch you next time!