IHHR 4 - August 2018 by International Hospitals & Healthcare Review

Industry voice Medix Global on the future of technology and healthcare

Q&A Dr Nicolette Louissaint, Healthcare Ready

Your doctor has arrived Visiting doctors’ secrets for success

Issue 4 · August 2018

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12. Blockchain: changing 18. Industry voice the health insurance game? Medix Global on the future of technology How disruptive could blockchain be for health insurance?

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16. Q&A Dr Nicolette Louissaint, Healthcare Ready

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NEWS

Hello fellow healthcare lovers and welcome to the fourth issue of the International Hospitals and Healthcare Review – it’s nice to see you here! So, what have we got in store for you in

industry insights feature, Sigal Atzmon, CEO at Medix Global, sheds light on technological trends that are creating the future of healthcare. That should satiate your appetite for hospitals

Sigal Atzmon, CEO at Medix Global, sheds light on technological trends that are creating the future of healthcare this edition, I hear you ask! We bring you an interview with Dr Nicolette Louissaint, Executive Director of Healthcare Ready, an organisation that works to safeguard patient health by functioning as a partnership between private sector healthcare and public sector health and emergency management. In addition to an abundance of news, we present features on how disruptive blockchain could be for health insurance, the growing popularity of visiting doctor services and hospital staff shortages in the US. And last but by no means least, in our

and healthcare news for now. Happy reading and, as always, stay healthy!

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NEWS GE Healthcare and A*STAR partnering on medical innovations In Singapore, GE Healthcare and the Agency for Science, Technology and Research (A*STAR) have announced the co-development of innovative medical technologies for next-generation imaging diagnostics and patient monitoring. The technologies are expected to aid healthcare providers worldwide to deliver faster and more accurate diagnoses, improve treatment strategies, and achieve greater productivity in workflow. GE Healthcare’s expertise in medical and information technologies and A*STAR’s capabilities in data analytics and highperformance computing are being leveraged in the development of the new technologies. One of the new solutions the companies have developed improves the PET scan procedure using high-performance computing, enabling quicker scans and shorter waiting time for patients at hospitals and clinics. “After the new digital PET/CT scanner was installed at our flagship diagnostic centre last year, we were able to increase our rate of scanning patients by 20 per cent,” said Royston Lek, Country Managing Director of Fullerton Health Singapore. “Technology innovations are key to addressing the rising demand for healthcare in Singapore and Southeast Asia. We are committed to continue investing in technology to deliver world-class diagnostic services to our patients and physicians.” Further innovations the companies are working on are digital solutions that include a diagnostic

imaging system for Parkinson’s and advanced capabilities for surgery motion tracking. “Digital technology will disrupt and transform healthcare. Our partnership with GE Healthcare is a clear demonstration of how open innovation can work to develop cutting-edge solutions that have already benefited patients,” said Dr Benjamin Seet, Executive Director, Biomedical Research Council, A*STAR.

AXA partners with health startup

Global insurance company AXA has partnered with London, UK-based startup Spoon Guru to introduce the startup’s healthy eating diet and nutrition app to the corporate wellness market. The food search and discovery engine caters for individuals with multiple or complex search requirements, giving users information and guidance to match their food choices to their health and wellbeing goals. It will sit as part of AXA PPP Healthcare’s

corporate service programme, where it will assess employees and members’ health and make expert dietary recommendations. Spoon Guru will be recommended to members by AXA’s health advisors to help them stick to the programme. The standard Spoon Guru app is free to use but members will be given a special access code that unlocks a members’ area within the app where they can find additional services and diets. “We are delighted to partner with AXA PPP to offer members the benefits of Spoon Guru’s game changing technology. Sixty-four per cent of the world’s population now actively excludes foodstuffs from their diet and many are actively trying to make healthier choices. This means consumers need a trusted and accurate route to find food and recipes to suit their specific needs and help them accomplish their goals. Spoon Guru provides just that,” said Markus Stripf, co-founder and CEO of Spoon Guru.

Employees experiencing unmanageable stress A new survey by Cigna, a provider of health benefits and services across Europe, has found that unmanageable stress is the UK’s number one wellbeing issue. The 2018 Cigna 360° WellBeing Survey found that 80 per cent of people are experiencing stress, 20 per cent of whom say that it is ‘unmanageable’. According to the research, the UK ranks fifth worst for unmanageable stress in the world, behind only the United Arab Emirates, Saudi Arabia, Australia and Korea. Work was found to be the UK’s leading cause of stress, with 26 per cent of stress sufferers reporting it as the reason. In addition, the survey found that the UK trails behind other Western markets when it comes to workplace wellbeing programmes, with only nine per cent of employees saying that they have a work wellbeing programme and that they use it. This is compared to 22 per cent of employees globally reporting that they use a workplace wellbeing programme. Cigna also found that workplace wellbeing programmes are in demand, with 29 per cent of employees rating stress management as the second most desired healthcare benefit in the UK, after dental benefits (32 per cent). Although 84 per cent of people have suffered a mental health condition at some point in their lives, only one-quarter of them received support from their employer. “It’s clear employers have an important role to play in mental health. Our research shows that despite people wanting more help, the UK is lagging behind comparable countries in offering workplace wellbeing support. But

the good news is that employers are beginning to recognise the cost of poor mental health at work and the impact this can have on their employees and business,” said Phil Austin, CEO Europe at Cigna. “Cigna is helping employers tackle this prevailing issue. We were first in the UK to launch a self-referral pathway for fast access to emotional wellbeing support and early intervention care. Our proactive approach helps employers move towards an emotionally supportive culture in the workplace.”

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NEWS

Cleveland Clinic expands into China Cleveland Clinic, based in Ohio, US, has announced that it is partnering with Luye Medical Group to provide its best healthcare practices to the Shanghai New Hong Qiao International Medical Center. This is the clinic’s first foray into China and part of its global expansion. The partnership will mean that Shanghai New Hong Qiao International Medical Center has access to Cleveland Clinic treatment protocols and education materials. Patients at the Shanghai Medical Center will be able to connect to clinic specialists for second opinions via telehealth. “With strong government support, Shanghai New Hong Qiao International Medical Center is positioned to be the pilot zone for national

and Shanghai medical reform. The collaboration between Luye Medical and Cleveland Clinic is expected to pave the way in developing a premium innovation healthcare hub and a high-end medical service platform based in Shanghai that can extend to the Yangtze River Delta, and service the whole country,” said Jie Yang, Chairman of Shanghai New Hong Qiao International Medical Center Construction Development Co. Ltd. “From our patients to our caregivers to our community, we continue to have a stronger relationship with China,” said Bill Peacock, COO of Cleveland Clinic. “As China plays a more significant role in the global community, we must increase collaborations

Resource to support health technology assessment

Aetna partnering with Humanis

ISPOR, the professional society for health economics and outcomes research (HEOR), which is dedicated to advancing HEOR excellence to improve decision making for health on a global scale, has announced the launch of its new Center for Health Technology Assessment website. The website provides resources and tools to support health technology assessment (HTA), a multidisciplinary process that informs healthcare policy and supports clinical decision making by assessing health technologies in an evidencebased, systematic, transparent, and unbiased way. It also aims to bridge the gap between HEOR and other disciplines that inform HTA and healthcare decisions. “The new Center for Health Technology Assessment is designed to provide a wide-ranging set of resources and tools related to health technology assessment,” said ISPOR CEO and Executive Director Nancy S Berg. “The Center for HTA was developed in support of ISPOR’s mission to advance HEOR excellence to improve decision making for health globally. Our objective is to offer a dynamic, up-to-date and comprehensive resource that helps inform healthcare decision makers conducting and utilising HTA.”

IHHR

Global health insurance provider Aetna International has signed a strategic partnership deal with French insurance group Humanis. The partnership means that Humanis’ members can access Aetna International’s medical network and solutions. This includes better control of healthcare costs in the US for Humanis’ members, as well as a healthcare solution that meets regulatory requirements in the UAE. It is also expected to improve access to global healthcare solutions for large corporations and French expats across the globe, as well as expanding Aetna International’s reach. For example, it will increase the health insurer’s footprint in continental Europe with an expansion into the French market,

with local partners to provide world-class care. As an organisation, we are continually exploring opportunities to collaborate with great healthcare organisations worldwide.”

guided by Humanis’ local expertise and understanding of the French Government. “This strategic partnership agreement with Humanis comes at the right time. Aetna’s expertise and global presence, combined with the exceptional quality and local service that Humanis provides to its customers, will allow us to expand and improve the services we offer to our members,” said Richard di Benedetto, CEO of Aetna International. “This partnership is part of our strategy to provide local services to our members worldwide, while adapting to national and regional disparities. We look forward to working together with Humanis on improving quality and access to healthcare for our members around the world.”

Research uncovers racial-ethnic disparities in end-of-life care Research led by The University of Texas Health Science Center at Houston School of Public Health, US, has discovered racial-ethnic disparities in the quality of lung cancer end-of-life care. The retrospective analysis used surveillance epidemiology and end result (SEER) data containing newly diagnosed lung cancer patients between 1992 and 2011 linked to Medicare claims from 1991 to 2013. Among patients surviving one to seven months after diagnosis, non-Hispanic (NH) blacks and Hispanics had a higher proportion of preventable medical encounters in the last month of life as compared to NH whites. Aggressive chemotherapy in the last month of life was found to be less common among NH blacks compared to NH whites, however, a higher proportion of NH blacks and Hispanics received overall aggressive care near end-of-life. The results of the study were published

in the Journal of Thoracic Oncology. “This is the first study that uses two decades of nationally representative SEER-Medicare data to examine racial-ethnic disparities in lung cancer end-of-life care. Our study found that aggressive end-of-life care management was increasing over time among lung cancer patients, with increase in the rates of potentially preventable medical encounters, delayed hospice referral, and aggressive chemotherapy provision during endof-life,” said the authors. “Our study also found considerable racial-ethnic disparities in end-oflife care quality. In particular, our study found that the racial-ethnic minorities (NH blacks and Hispanics) had higher odds of experiencing potentially preventable medical encounters in the last month of life as compared with NH whites.” The authors said that the findings indicate the need to examine the access of minority populations to appropriately trained providers during all phases of cancer care and their geographic access to hospice care.

NEWS

Health communications network McCann Health has launched the McCann Health Global Scientific Council to develop its connected global scientific community and build new external relationships. The Council is launching with around 20 of McCann Health’s top doctors and scientists. It is the first of its kind in the healthcare communication industry and will assist McCann Health in moving forward with its strategy to bring world-class, evidence-based science to pharma and healthcare clients, the medical community and scientists in government organisations and institutions. “The formation of the McCann Health Global Scientific Council is particularly exciting for me personally,” said John Cahill, Global CEO of McCann Health. “Not only does it enable McCann Health to make a real and tangible difference in key areas of need in medical science and bring added value to clients, it provides a platform for our scientists to have a meaningful voice in the global science and health debate.” The Council will be led by Global President of McCann Health Global Scientific Council Charlie Buckwell, Global Medical Director for McCann Health Dr Daniel Carucci and Executive Director and Global Head of McCann Health’s Complete Medical Communications Dr Alice Choi.

GlobalMed’s telehealth tech used by US Navy

US Navy photo by Mass Communication Specialist 3rd Class Cameron Pinske/Released

New council to advance healthcare

GlobalMed, a global provider of telehealth solutions, has announced that the US Navy recently used its technology to conduct its first ever portable telemedicine broadcast from a ship at sea. The GlobalMed technology was used to transmit vital signs and ear, nose, throat, head/neck and skin examinations from the US Navy hospital ship Mercy. The Navy also used the technology to perform its inaugural underway teleprocedural mentorship: tourniquet placement, needle thoracostomy, and cricothyroidotomy. GlobalMed recently earned the US Department of Defense (DoD) Authority to Operate (ATO) on DoD networks, becoming the first provider of Health Insurance Portability and Accountability Act of 1996-compliant

virtual health to obtain an ATO. This certification means GlobalMed can put its telehealth applications, hardware and software directly on the DoD network, which makes its solutions available to the Military Health System (MHS). “The Navy is to be congratulated for its use of portable telemedicine broadcasts while a hospital ship is underway,” said Joel E. Barthelemy, Founder and CEO of GlobalMed and a Marine veteran. “The Navy’s use of our virtual health equipment to remotely guide a hospitalman through the placement of a chest tube and the surgical opening of an airway is particularly impressive. Telehealth will help the Navy better care for its personnel as they pursue their missions around the world.”

Technology to improve the patient experience Nantucket Cottage Hospital (NCH) in the US and Aceso Interactive are working together to improve the patient experience by deploying a healthcare technology solution that will see NCH implement the Aceso Next-Gen Integrated Technology platform, an interactive patient engagement solution. It will install this technology throughout inpatient private rooms using an

interface that accesses an enterprise media repository, which stores, streams and manages the system’s content from a single source. The Aceso solution is displayed on a large-screen smart TV, allowing patients to access patientspecific and hospital information, entertainment, relaxation and wellness content. It is personalised to each patient by sourcing data from the

hospital’s electronic health record system. “We are thrilled to have been selected to implement our next generation integrated technology solution as part of the entire Island community effort to build a hospital for the future that is committed to those on their healthcare journey throughout the patient care process,” said Aceso Interactive President Geoff Fiedler.

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NEWS Partnership for patient data driven solutions for precision medicine Clinerion and the Precision MedicineHospital Information System Development Group (P-HIS Development Group) of Korea University Medical Center (KUMC) are collaborating to provide patient data driven solutions. Clinerion has signed a Memorandum of Understanding with the P-HIS Development Group of KUMC to support the KUMC’s activities in developing a patient data platform in the Republic of Korea, in particular for precision medicine. Clinerion will implement and use its Patient Network Explorer solution. “Clinerion’s established approach fits very well with the direction we have been pursuing,” said Professor Sang-Heon Lee, Head of the P-HIS Development Group and Professor at KUMC. “We are very pleased with the reliability and scalability of their solution. As South Korea has very strict patient privacy regulations, we are also happy to see their in-built protections for privacy.” “The Republic of Korea offers a worldclass stage for Clinerion which pushes the boundaries of technological possibility in secure patient data analytics,” said Ian Rentsch, CEO of Clinerion. “We are thrilled that KUMC offers us this chance to show the capabilities of Patient Network Explorer.”

Allianz launches new international health solutions

Amazon’s move into healthcare – beneﬁcial?

Allianz Care and Allianz Russia have announced the launch of a new range of international health solutions for the Russian market. The solutions offer worldwide cover and include a range of individual plans that are specifically designed to suit the needs of local and expat individuals and families. There is also a suite of group plans designed for SMEs and large multinationals. Customers of the International Healthcare Plans for Russia have access to: unrestricted access to leading healthcare facilities in Russia and across the world with direct settlement for inpatient and outpatient treatment; concierge service to arrange appointments with local providers; private ambulances; home visits from qualified doctors; and comprehensive child preventative solutions including health checks and vaccines. “It has been a pleasure collaborating with Allianz Russia to bring these world-class health solutions to the region,” said Ida Luka-Lognoné, CEO of International Health at Allianz Partners. “Our aim is to look after the health and wellbeing of all our clients, no matter where they may be in the world, and we are delighted that this service will now be available to those based in Russia.”

Digital media company GlobalData has said that Amazon’s move into the healthcare arena could benefit patients who require frequent medical products. For example, in June 2018 Amazon acquired PillPack, which packages and organises drugs in pre-sorted doses, making it easier for the patient to see what medication to take at various times of the day. It is believed that further deals may involve Xealth, a startup that helps doctors to order digital content and services to set up accessible information for patients before they are discharged from hospital. GlobalData also said, however, that there are barriers to Amazon reaching its healthcare goals, including potential insurance restrictions and concerns surrounding sharing of medical information within the company. Indeed, GlobalData’s Thematic Analysis found that 58 per cent of US consumers would have at least a minor concern about sharing medical and health information with the company. Despite this, GlobalData found that the majority of Americans approve of Amazon’s decision to enter the pharmacy market. “With the right acquisitions and deals made within the sector, Amazon, the transformed global e-commerce and tech giant – historically the online book seller – could be well positioned to emerge as a leading online distributor of prescription medicine and health services whilst increasing its consumer database in healthcare,” said Dr Edit Kovalcsik, Cardiovascular and Metabolic Diseases Managing Analyst for GlobalData.

Health costs rising due to low-quality healthcare A new report by the Organisation for Economic Co-operation and Development (OECD), World Health Organization (WHO) and World Bank has found that low-quality healthcare is increasing the burden of illness and health costs on a global scale. The report – Delivering Quality Health Services – a Global Imperative for Universal Health Coverage – found that inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices, or providers who lack adequate training and expertise prevail in all countries, and that the situation is worst in low and middle-income countries. The report states that although there has been some progress in improving quality, the broader economic and social costs of poor quality care are estimated to amount to trillions of dollars each year. “Without quality health services, universal health coverage will remain an empty promise,” said OECD Secretary-General Angel Gurría. “The economic and social benefits are clear and we need to see a much stronger focus on investing in and improving quality to create trust in health services and give everyone access to high-quality, people-centred health services.”

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The three organisations involved in the report outline the steps that are needed in order to improve healthcare quality. These require involvement from governments, health services and their workers, together with citizens and patients.

NEWS Appointment for JCI’s new safety training programme for healthcare professionals Joint Commission International (JCI) has announced the appointment of Dr Kathryn Leonhardt as Principal Consultant of the company’s newly expanded quality and safety training programme for healthcare professionals. Dr Leonhardt brings 25 years of experience in healthcare administration, leadership and research to the role. She will serve as the first point of contact for current and prospective clients for all JCI regions. She joined JCI in

2016 as a physician consultant and today her work includes tailoring education and training programmes based on an organisation’s own data to develop and implement quality programmes that produce sustainable results. “The need for global training for healthcare professionals continues to grow as healthcare evolves,” Dr Leonhardt said. “Advanced tools and methodology in improvement have enormous potential to impact patient

safety and quality of care. I am honoured to continue working with our diverse stakeholders through this unique curriculum that focuses on practical, effective results.” “With Kathy’s expertise in improvement, patient experience and education, we can help organisations stay at the forefront of healthcare quality and patient safety,” said Dr Marwa Zohdy, Vice-President of Global Consulting Services for JCI.

Antibiotics being issued without prescriptions

AHIP investigates where healthcare dollars go

The ﬁrst wearable voice-powered smart assistant

The Telegraph newspaper in the UK has reported that antibiotics are being given out without prescriptions in pharmacies around the world. This is according to a new study in which researchers from the University of Central Lancashire looked at country-level studies from 2000 to 2017 on sales of antibiotics by pharmacies around the world. “We found that the supply of antibiotics without a prescription in community pharmacies is a global problem,” said Dr Asa Auta, lecturer in pharmacy practice at the University. “Around three in four, or 78 per cent, of antibiotic requests, and 60 per cent of consultations related to symptoms of infectious diseases resulted in the supply of antibiotics without a prescription. Non-prescription use of antibiotics is often associated with incomplete or shorter treatment courses, and inappropriate drug and dose choices. This irrational use of antibiotics could have a number of consequences, including the development and spread of resistance to antibiotics, as well as delayed hospital admissions and masking the diagnosis of infectious diseases.” Dr Auta’s findings revealed that many of the antibiotics being dispensed without a prescription include critically important drugs such as amoxicillin and azithromycin, which are one of a handful of drugs able to treat several serious infections. “This poses a serious health risk, as the irrational use of [broad spectrum] antibiotics is more likely to contribute towards antimicrobial resistance,” he said.

Research firm Milliman and America’s Health Insurance Plans (AHIP) analysts examined 2014-16 data gathered from commercial health plans to investigate the dollars spent on healthcare premiums. They found that the greatest percentage (23.2 cents) goes on paying for prescription drugs, while 22.2 cents goes to paying doctors and 20.2 cents pays for all other costs at doctors’ offices and clinics. The researchers also found that 16.1 cents pays for hospital stays; 4.7 cents goes to pay federal, state, and local taxes; 1.8 cents pays for customer engagement, including customer service operations; while another 1.6 cents pays for care management, including disease management and wellness programmes. In addition, 1.6 cents pays for activities related to claims, including programmes to battle fraud, waste and abuse, while only 2.3 cents of every healthcare dollar was found to go to health insurance provider profits. “Americans value services that deliver real results – improving health and wellness, co-ordinating care with doctors and nurses, eliminating fraud and abuse. Plans use a meaningful part of premiums to make coverage more efficient and effective,” said Matt Eyles, incoming President and CEO of AHIP. “But as prescription drug prices and medical costs continue to rise, it forces premiums higher for hardworking American families. Health plans work hard to negotiate lower costs and premiums for their members. We need to come together to find new ways to provide people with the care they need at a price they can afford.”

Notable, a company working to deliver ‘voicepowered healthcare’, recently launched at the HLTH healthcare event and is seeking to transform the healthcare experience by providing the first wearable voicepowered smart assistant for physicians. The platform uses artificial intelligence (AI) and voice recognition technology to automate and structure physician patient interactions and reduce clinical administrative work. “We started Notable after my family of physicians complained about how their work had become focused on billing and risk mitigation, and less about the patient or data needed to improve outcomes,” said Pranay Kapadia, Notable CEO. “We started Notable to leverage powerful technologies such as AI, wearables and voice interface to address these challenges and to give physicians what they really want – a seamless, truly hands-free solution, not another screen to learn or computer application.” Notable automatically structures conversations, dictations and orders and recommends the appropriate billing codes, and data is automatically entered into the EHR in a secure manner using robotic process automation. Since its beta launch, it has achieved an approval rate of over 98.5 per cent, reportedly saving physicians at least an hour per day.

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FEATURE

Anthony Harrington investigates how disruptive blockchain could be for health insurance

he insurance industry is on the cusp of unleashing a spate of new applications based on the blockchain technology underlying crypto-currencies like Bitcoin. The deep technicalities of blockchain – which comes in a variety of flavours – are complex, but the general idea is simple to follow. Distributed ledger technology offers a decentralised, virtually fraud-proof way of providing a total audit trail of all the elements and actions in insurance contracts. Couple this with ‘smart contracts’, which can automate all the steps involved in accepting and paying claims, and you are looking at some seriously disruptive and transformative technology. Ken Marke, Chief Marketing Officer at the Blockchain Insurance Industry Initiative B3i, which was formed specifically to investigate and develop applications based on distributed ledger, points out that smart contracts are easiest to implement where

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the trigger points for the contract are taken from a trusted, public database. The group began by looking at a couple of simple applications and its first choice was the

met, triggering a payment, can be fully automated with reference to a trusted public database.” The B3i consortium was formed in December 2016 and developed

It is not a person at the insurance company who decides that a claim is valid and should be paid. The smart contract contains all the decision-making criteria and it triggers the payment without human intervention area of catastrophe (Cat XOL) reinsurance. “Whether or not a catastrophe contract pays out is completely driven by a specific weather event that is simply a matter of public record,” he said. “You can’t ‘game’ it, so the process of checking whether the terms of the insurance contract have been

a prototype proof-of-concept during the first quarter of 2017. More insurance company members joined, and on 23 March 2018, it became incorporated in Zurich as a legal entity, B3i Services AG, which is currently involved in funding rounds to develop further applications for

FEATURE the importance of the distributed ledger and the fact that the ledger enables smart contracts, which can automate transactions, which can be executed with very high levels of confidence.” This doesn’t mean that the insurance industry is in for an easy ride. People will always try to game the system, Ectors notes. He points out that you would have to have clauses in the terms and conditions that precluded payment where the customer had themselves caused the flight delay – by, for example, having an accomplice behaving disruptively on the inbound flight, causing it to divert. That fact would not be instantly visible to an automated process, so the insurance company will still need some investigative capabilities to look into these kinds of cases. Or, alternatively, it could take the view

Today, it might take two to five working days for a payment from the insurer to reach the user's account. Cryptos could cut this delay to seconds that such instances are statistically insignificant and not worth the cost of investigating – in which case a small fraud could rapidly turn into a big fraud. Blockchain will undoubtedly force fraudsters to work a lot harder and get vastly more imaginative, but while it may not kill fraud altogether, it >> will make it a lot more difficult for

the sector. Maarten Ectors, the Chief Digital Officer for General Insurance at Legal and General, has been looking into how to apply next-generation blockchain in insurance and financial services. “For me, the thing that is so remarkable about the distributed ledger is that different business units or different organisations can all see the same data and no one can alter their own copy of that data without others knowing. That knocks a lot of the problems on the head that you encounter when you think about how to transfer money between parties that do not trust each other and may have conflicts of interest,” he says. “Where, today, the processes for transferring high monetary values around the world tend to be very clunky, they could become instantaneous and completely auditable. For me, crypto-currencies and Bitcoin are just so much noise. They tend to obscure

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FEATURE

fraudsters to succeed. Transforming insurance processes Ectors argues that beyond the simple,

Development at AXA GIE, argues that current contractual processes in the insurance sector inevitably create resentment among some customers. “In

Who, exactly, will be buying medical travel insurance or other forms of cover when there are very few workers able to afford such things? straightforward applications, there are many more challenging applications that can be given the distributed ledger/smart contract treatment. Life and medical insurance could be made cheaper, for example, provided the applicant agreed to exercise, say, by running for a few hours every week, with accompanying biometric feedback. “If you decide to have a whopper hamburger and chips four nights a week, the contract could impose a monthly cash penalty until you got back to a healthier lifestyle. We are only just beginning to think through where this could go,” he says. The point is that the Internet of Things (IOT), coupled with smart contracts and distributed ledger technology can – and almost certainly will – transform a large number of processes in insurance. “With smart contracts you can build all sorts of data points and checks into the contract, so you can start calculating risk on an individual basis instead of statistically via actuarial numbers. That is a huge change,” he says. The cost of motoring insurance, for example, could be very tightly linked to the insurer’s ability to influence driver behaviour. Medical travel insurance could also benefit. “Smart watches could tell the insurer some key data points such as your heart rate, your location and your temperature. Those data points could enable me to influence your risk positively and decrease the risk premium I apply to your case,” Ectors notes. Where the insurer is working with an approved hospital the distributed ledger could capture all the processes associated with emergency treatment given to a traveller. The fact that the documents are all unalterable will help to cut down on fraud. Even close collusion between a traveller and a corrupt doctor would tend to get exposed, since the medical procedures would have to match the treatment being claimed for. Laurent Benichou, Director of Research and

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this industry, we as insurers believe in the noble purpose of insurance and to be at the service of our customers. However, we

know we have to do more as the speed and transparency with which we interact with our customers is essential to build trust,” he says. A challenge that insurers face with customers is the exclusion terms to contracts along with the time it takes to process some claims, creates resentment. One of the first applications AXA focused on to solve this problem was travel insurance, with a view to automating payment to customers if they experienced significant delays to their flights. The application is called Fizzy and it pays out automatically if a flight is delayed by more than two hours. “What made this a really practical application is the fact that whether or not a flight is delayed, and whether the delay is significant enough to meet the terms of

FEATURE

the travel insurance contract, is a matter of public record,” Benichou explains. The user simply signs up online and the signing up process creates a smart contract that is embedded in the distributed ledger, with both parties having a complete, unalterable copy. Once the contract is in place, neither side can alter any of the terms, so there is near zero opportunity for fraud. Flight delays automatically trigger the smart contract which issues a command to the insurance company’s accounting system to pay a pre-agreed sum direct to the user’s bank account. The user does not initiate the claim. It is all automatic. The smart contract records the payment with all the details of the transaction, so the fact that payment was made, and the reasons why it was made, are beyond dispute. “The key point here is that it is

not a person at the insurance company who decides that a claim is valid and should be paid. The smart contract contains all the decision-making criteria and it triggers the payment without human intervention,” Benichou notes. From the insurance company’s point of view, what it has is a fast-acting and

data, so putting medical records inside the distributed leger will have some issues. However, since distributed ledgers are virtually un-hackable, this should not be an insurmountable problem. As Willie Fleming, Project Director of the Scotcoin Project, notes, when you combine the certainty and privacy

who, exactly, will be buying medical travel insurance or other forms of cover when there are very few workers able to afford such things? fool-proof process that will immediately satisfy the terms of its contract with the customer and that involves no human action at all. It also, presumably, can count on having a satisfied customer, since they have received a cash compensation, exactly as agreed, without having to do a thing. Smart contracts With medical travel insurance, a smart contract based on distributed ledger technology could automate payment direct to the hospital as soon as the hospital raises an invoice, provided sufficient ‘solid’ data points could be crafted into the contract. It will be a lot harder to achieve such a system than was the case for travel delay insurance, but in principle it could be doable, though not without challenges, Benichou says. Similarly, if the insurance contract includes compensation for the customer, they could receive payment automatically. He points out that if the industry decided that indemnifying payouts to customers could be made using some agreed crypto-currency instead of the traditional banking system, then the payment could be almost instantaneous. “Today, it might take two to five working days for a payment from the insurer to reach the user’s account. Cryptos could cut this delay to seconds,” he says. Clearly the health and medical components in travel insurance involve far higher levels of complexity than flight delays, but he argues that switching to distributed ledger would still bring huge benefits. “For health, what is interesting is that you can store data in a very immutable way. This does not stop some clever fraud or over-charging at the foreign hospital’s end, but there will be an immutable record of the fraud,” Benichou notes. The General Data Protection Regulation imposes strict rules around storing any kind of private

offered by distributed ledger technology with smart contracts, the transformative power of the resulting applications for any sector can be pretty startling. “A smart contract is like any other business contract that is written in a codified way, but its unique feature is that the various clauses in the contract can be actioned automatically on the back of various predefined triggers,” he says. The one real difference between a smart contract and other business logic applications is that business logic generally delivers information to a human decision maker, as for instance, a claims processor, who then decides if the claim is valid or not. With a smart contract you can do away with the human in the loop. Fleming offers rather a dire warning to the insurance sector on the potential consequences of this. “It is clear to me that smart contracts and the distributed ledger will have the same impact on white collar workers that robotics and automation have had on blue collar workers. Jobs will vanish by the thousands and the hundreds of thousands. So who, exactly, will be buying medical travel insurance or other forms of cover when there are very few workers able to afford such things?” he questions. In the past, while technological change has eliminated some job categories, it has spawned new and previously undreamedof employment opportunities. Perhaps this will be the case with blockchain and distributed ledger technology, but the signs so far are not hopeful. What it will do, Fleming suggests, is to massively increase profits in the short term for early adopters in the insurance sector, who will find they need far fewer people to bring new products to market – but this could end up being at the cost of a general shrinking of the pool of people who can afford insurance. ■

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INTERVIEW

US-based organisation Healthcare Ready works to ensure patients have access to medicine and healthcare during disease outbreaks. Dr Nicolette Louissaint, Executive Director, discusses the key issues facing public health and explains how Healthcare Ready safeguards patient health What led you to the role of Executive Director of Healthcare Ready? Healthcare Ready is a special organisation because it was created by a group of leading trade associations in healthcare who believed that they could each play a stronger role in emergency response. I was drawn to the organisation because of the mission – to ensure patients have access to medicine and healthcare during a disaster or disease outbreak, and found the work (and partnerships) that the organisation sustains, to be fascinating. What aspects of your role do you find most rewarding? The most rewarding part of my role is witnessing the formation of partnerships and recent changes in healthcare and public health preparedness and response that are based on our work. We have seen a rather active two-year period with respect to disasters and disease outbreaks, which has stretched and grown the organisation in ways that we could not have imagined or anticipated. The ability to mobilise our team to respond to disasters and disease outbreaks at a moment’s notice is without doubt the most rewarding part of my role. How does Healthcare Ready safeguard patient health? Healthcare Ready works to safeguard patient health by functioning as a publicprivate partnership between private sector healthcare and public sector health and emergency management. During disasters, we work with our partners in both sectors as well as patient groups to determine patient needs during events, and we then mobilise our partners to support these patients. We work particularly closely with components of the supply chain to ensure the timely delivery critically needed medicines and medical products during and after an emergency. What do you see as the key issues

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facing public health, and which potential disasters would you say pose the biggest threat to healthcare? While there are many issues facing public health, from the current threat landscape to global surveillance and response capacity, one of the biggest threats is the ability of patients to obtain their regular and necessary medications during disasters. Based on our recent survey findings, as many as nine per cent of those in the countries polled anticipate that they would experience serious effects after just one day of going without their regular medications or medical equipment. And while the majority of respondents are satisfied with their ability to obtain medications on a ‘blue-sky’ day, they report much lower confidence in their ability to obtain life-sustaining medication during a disaster or disease outbreak. Most of those surveyed reported they were most concerned about either political/civil unrest or natural disasters such as a hurricane or earthquake. Both types of disasters pose significant threats to the integrity of the supply

to ensure they align with healthcare capabilities. Based on the results of this survey, do you believe respondents are right to have confidence in their government when it comes to responding to disasters and providing access to medications? I believe that it is appropriate for citizens to expect their governments to be able to protect and support them during a catastrophic event, both local/state and national. However, individual and community response capacity is important as well, especially because infrastructure damage may prevent emergency managers and first responders from reaching communities immediately. Governments also have to ensure that preparedness and response remains a priority, and that they are continuing to invest in the infrastructure required to support their citizens during a disaster.

we are very concerned about the next pandemic. This threat is truly a matter of ‘not if, but when’, and it can be difficult to keep threats like disease outbreaks and even pandemics on policymakers’ radar chain and the ability of both local and international actors to respond to a crisis. Like many of our partners in the field, we are very concerned about the next pandemic. This threat is truly a matter of ‘not if, but when’, and it can be difficult to keep threats like disease outbreaks and even pandemics on policymakers’ radars when there are often more immediate threats. This is one of the reasons we included a set of questions in our poll asking patients what they would do in the event of a pandemic – because while it is important to know the capabilities of hospitals and healthcare facilities that would respond and care for patients during a pandemic, it’s just as important to have an idea of the actions patients would take,

A common saying in the field is that ‘all disasters are local’. This points to the notion that no matter national capabilities, local communities and local governments will always be the first to respond. Following this logic, it is imperative that local communities and governments are resourced. It is important to note that governments are increasingly investing in emergency preparedness measures, such as strategic medical stockpiles, surveillance capabilities, and institutional capacity. The work of the international community in pushing for improved health security capacity is clear in the voluntary participation of many countries in the Joint External Evaluations under the Global Health

INTERVIEW Security Agenda. There is clearly still room for improvement, but the international community is certainly taking the issues of preparedness and response seriously. Do you think government responses to disease outbreaks are improving? There is a cycle of response and complacency well known in the entire disaster field, which is also true as it pertains to responses to disease outbreaks. The fatigue experienced is often framed as ‘donor fatigue’ or ‘response fatigue’. When a serious outbreak hits, there is an immediate surge in funding and research that lasts for a while, and then slowly subsides as no new outbreaks occur. Eventually, another outbreak strikes, and the cycle starts over again. Generally, there is a global recognition that government response must improve, and we have seen some countries begin to invest more in improving their ability to prevent, detect, and respond to crises, including through the Global Health Security Agenda. The World Health Organization (WHO) has also invested more in its pandemic response capacity; capabilities that will prove vital during a large-scale disease outbreak. While there is a long way to go, we have seen some recent improvement in preparedness efforts. In terms of responding to outbreaks, we are currently seeing a decrease in funding from the US Government, but at the same time we’re hearing encouraging discussions to increase public health preparedness and response funding (and broader infrastructure). Ultimately, time will tell in our next response to an outbreak if we have improved our response capabilities and procedures since the last pandemic. Why is it that patient perspectives on obtaining medication and care, preparedness, and health security tend to be unmeasured and overlooked, and what are the repercussions of this? This is a function of how we have viewed preparedness and response for many years. Much of the preparedness and response infrastructure has been housed within government, and in some countries, the private sector and NGO community have been able to contribute to supporting health security and disaster response initiatives (there has been an incredible body of work in this space over the past 10 years). So, in many ways, the focus has been on the systems that are expected to support patients, without much emphasis on the patient perspectives. In addition, systems-level inputs have often been used to determine the readiness posture, which is critical and requires inputs from health systems and

emergency management infrastructure in country. These approaches are not bad or problematic, but the opportunity to also incorporate the voice of the patient can help to gain additional insights into anticipated impacts from a disaster. Every patient perceives their risk and preparedness for disaster with their own calculus of exposure and perceptions of preparedness, which may or may not be the same as the calculus used by researchers and governments studying systems-level data. If we accept that a person’s calculus of risk will, at least in part, determine their response to a threat, then we are missing the information we need to understand how the system will be utilised by those who need it during a disaster. However, it can be difficult to poll the high number of

the importance of the work that we do, especially as we facilitated transport of product and conveyed status information that made the difference in the lives of many patients. During this time, we responded to 1,000 patient pleas, facility needs, supply chain demands and pharmacy status inquiries, and worked with more than 30 NGOs, private sector partners and government agencies during the four different hurricanes across eight states and territories.  Looking ahead to the next five to 10 years, what are your professional goals and future hopes for public health and health policy? As far as professional goals – who knows! This is an ever-changing field and I just

it is my hope that partnerships and cross sector co-ordination become the norm in public health and health policy people needed to obtain a clear picture of the public’s risk perception and confidence in their abilities to obtain medications or treatment during a disaster or outbreak. This is part of the reason we were motivated to do this work. Even as an organisation that has worked on a wide range of responses, we were surprised by the reported answers that patients are satisfied with their ability to access healthcare during normal times but anticipate experiencing serious vulnerabilities during a crisis. Another important aspect of this work, collecting patient perspectives provides a timeframe. Based on the survey results, patients would begin to experience negative health impacts much sooner than anticipated, so time is truly of the essence during a crisis. Which of Healthcare Ready’s achievements are you proudest of? I am incredibly proud of Healthcare Ready’s response to the catastrophic 2017 hurricane season. We were activated for 81 consecutive days, which was far more expansive than our previous responses. We found our organisation focused on disaster response in three distinct geographical areas across the US and Caribbean, which brought unique challenges. While our focus is to ensure that patients are connected to healthcare, we accomplish this by supporting the healthcare supply chain in resuming operations. The 2017 hurricane season activation demonstrated

hope to continue to contribute to it in meaningful ways. Ultimately, I hope that the healthcare and public health infrastructure is so strong that groups like ours are no longer needed, but I think we are quite far from that. The field has become more collaborative, which is important, and it is my hope that partnerships and cross-sector co-ordination become the norm in public health and health policy. I am also hopeful that the investments from today will build a strong global health security infrastructure, as we know that there will be future disasters which require it. As a country and as an international community, we must continue prioritising disaster preparedness and response so communities across the globe can become more resilient in the face of disaster. Because we know that it’s ‘not if, but when’ until the next disaster strikes. ■

BIOGRAPHY Dr Nicolette A. Louissaint serves as the Executive Director of Healthcare Ready. Prior to this, she served as a Foreign Affairs Officer at the US Department of State in the Bureau of Economic and Business Affairs. As the lead officer for health intellectual property and trade issues, she advised the State Department’s leadership on issues related to public health, technology transfer and biotechnology. She also worked on policies related to pharmaceutical counterfeiting, pharmaceutical trade, supply chain, climate change and other science and technology development issues.

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INDUSTRY VOICE

Sigal Atzmon, CEO at Medix Global, sheds light on technological trends that are creating the future of healthcare People are living longer. Thatâ&#x20AC;&#x2122;s the good news, but longer life spans are bringing with them a number of chronic diseases, placing a significant strain on healthcare systems around the world. Driven by a public funding crisis, patients are spending more on private health insurance and healthcare services; yet overworked doctors, a fragmented system and nontransparent practices are often leading to misdiagnosis and over or under-treatment. However, despite the difficulties just listed, we are actually living in one of the most progressive eras of healthcare. Thanks to the exponential growth of technology in the last decade, we are on the cusp of an opportunity to provide advanced, personalised healthcare that will improve the lives of people all over the world. From hacking our own DNA through genome editing to AI and bio-printing replacement

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organs, the healthcare industry is going to be given the means to radically re-create what we think of when we talk about medicine. This is not technology that will create and apply itself. Everyone from practitioners to insurers to the patients themselves will be responsible for making sure this technology is used to create the future of healthcare. Data and AI In the future, existing healthcare institutions will slowly be crushed as new business models, with better and more efficient care, emerge. Big data giants (Google, Apple, Microsoft, SAP, IBM, Tencent, Alibaba, etc.) are trying to revolutionise healthcare by analysing vast amounts of medical data and reaching conclusions on how to treat disease, and ultimately prevent it. One of the advantages technology companies have is their ability to capture this data through wearables. 24/7 feedback on biometric signals will offer patients a

running data model of their own health, offering the chance to receive live advice and preventative measures. Helping make sense of all this will be a AI, which will analyse big data to find patterns,

we are on the cusp of an opportunity to provide advanced, personalised healthcare that will improve the lives of people all over the world associations, insights and ultimately make predictions, based on algorithms. AI can help doctors reach the right diagnosis faster and suggest to doctors and patients the correct course of treatment.

INDUSTRY VOICE

Genetics and personalised medicine Ten years ago, it cost US$1 million to have your full DNA sequenced. Today it costs $1,000 and soon this will drop to $100. Genome sequencing and machine learning will allow us to better understand the root cause of many of the most debilitating diseases today. With the abundance of information that could be stored in the cloud, we will be able to diagnose illnesses and identify the best treatment through personalised matching. Nanomedicine Nanobots, robots that enter then repair or monitor designated parts of the body, aim to bring about medical breakthroughs at the most microscopic scale. As part of this trend, researchers are developing solutions which include: a nanoparticle that can combat the ‘superbug’ bacteria, a solution to avert a crisis that was long considered unavoidable; improving drug delivery of existing medications, using nanobots to help guide drug molecules towards specific cells in the body; and nano-sensors for a range of diseases to aid the early detection and treatment of medical conditions at a molecular level.

Genome editing Genome editing is a way of making specific changes to the DNA of a cell or organism. Enzyme cuts the DNA at a specific sequence, and when this is repaired by the cell, a change or ‘edit’ is made to the sequence. Genome editing can be used to add, remove, or alter DNA in the genome and therefore change the characteristics of a cell or an organism. The implications

a future of efficient, high quality, personalised and accurate healthcare awaits of this are huge as we will be able to remove parts of our DNA that cause specific diseases Gene therapy and stem cell therapy One issue that has always been around is the lack of suitable organ donors. Through regenerative medicine and bio-printing we

will be able to regrow a heart, liver, lung or kidney without anyone else involved. As well as being able to grow new organs, advancements in stem cell research will allow for previous incurable diseases to be tackled though modifying genes. Robots Finally, another exciting development for the future of healthcare comes in the form of robotic surgeons able to carry out autonomous, consistent surgical procedures perfectly. Linked with AI and augmented reality (AR), robotic surgery will be a game changer. A day in the life of the future These exciting and disruptive technologies mean that healthcare implications for individuals are infinite. Consider this scenario: 1. A patient’s genetic data, blood tests and scans are uploaded into the cloud. They immediately receive highly personalised genetic profiling, risk profile and cloud medicine. 2. Their diagnosis is made via big data analysis. Supported by multidisciplinary discussions with specialists across the world, big data and AI will predict what treatment will work best for the patient. 3. A world-leading surgeon in New York City remotely controls a robot to perform a complex surgery on a patient in London. 4. The patient recuperates at home with wearables transmitting vital signs and alerts in real-time to the hospital catching complications on time. Technology is not a magic bullet and the above certainly won’t appear from nowhere. To ensure that it’s used correctly, everyone must play their part. But once this is done, a future of efficient, high quality, personalised and accurate healthcare awaits. ■

BIOGRAPHY Prior to founding Medix, Sigal held diverse management roles in the finance and investment sector. In 2006 she founded Medix, a global health services group of companies which develops and offers innovative and disruptive health management services that make a difference in people’s lives around the world. For Sigal, Medix is much more than just a business; it’s a passion to make a difference in people’s lives.

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FEATURE

With visiting doctor services gaining popularity in the global medical assistance industry, Christian Northwood ďŹ nds out how cost savings are one of the keys to their success

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FEATURE

f an unexpected medical issue arises when abroad, the first port of call for travellers and expatriates is too often the emergency room (ER), as travel and health insurers know only too well. Otherwise, such travellers often take themselves to the nearest clinic or urgent care centre, whether or not it is in-network. In both scenarios, cost is a serious issue. The US National Hospital Ambulatory Medical Care Survey estimates, however, that one-third to half of all ER visits are for non-urgent care; while the New England Health Institute said 56 per cent of emergency room visits are ‘totally avoidable’. “The simple answer,” says Alex Sanchez, Director of Global Excel Management, “is that not every case requires a patient to be seen in a hospital.” And with the average cost of a US ER visit totalling around US$1,917, according to a Health Care Cost Institute report, and an urgent care trip costing around $375, Dr Jose Gardens – whose US-based visiting doctor company Doctors @ Your Home has been active since 2008 – presents a strong case for why a home visit doctor service could be a positive addition to the arsenal of any travel or IPMI insurer: because a visit costs, on average, significantly less, he says – at between $150 and $200. First impressions Like other forms of primary medical evaluation, the way that visiting doctor services manage to so effectively contain costs is that they act as a gatekeeper, keeping the patient from immediately heading into expensive secondary care and ‘making an ill-informed decision off their own back’, according to Dr Mitesh Patel, Medical Director at Aetna International in the UK. “It’s a control mechanism,” he told the International Hospitals & Healthcare Review. What differentiates a home visit doctor from a ‘bricks and mortar’ operation like a pharmacy or General Practitioner's surgery is the ability to pre-assess a patient before a health professional is contracted to take a more in-depth look. Dr Gardens stresses the importance of this when his company is utilised by an insurer. When contacted about a patient, a medical professional evaluates the case, before speaking with the patient. They are then able to arrive at the patient’s home or hotel within one to two hours, knowing more or less what they are treating. Sanchez’s company also uses preevaluation, coupling this with StandbyMD, its directional care programme. “StandbyMD was built on a risk assessment algorithm that effectively

identifies the best medical care, taking into consideration multiple factors such as location, age, symptoms, time of day, availability of services and more,” said Sanchez. “The most important element of our service is first call resolution. We aim to provide the right service to the member on this first call. Because we track

are travelling to and, as such, are generally unaware of cultural or financial differences in hospital systems. For example, someone heading from the UK to the US would not just be confronted with a different billing system within the country’s hospitals but would potentially also not know the differences between an emergency room and an urgent care centre. Throw in a possible difference in language and medical culture, and the personal touch of a home call doctor could greatly improve a customer’s experience. “In general, travellers are not familiar with local healthcare systems, may not speak the language, and may not even know how to find their way around,” Sanchez asserted. His company uses telemedicine, house calls and clinic networks combined to keep patients out of expensive emergency rooms. “A win-win situation for everyone,” he concluded. Dr Patel echoes these sentiments, saying that having an independent healthcare professional on your side could also help a patient to properly navigate a foreign health system more effectively, and not be over billed for unnecessary treatment or consultations.

Why contain on the back end and pay fees on the savings, when you avoid on the front end and make the member journey a better one? the complete claim from first call to final resolution, we know if the member needed and received additional services or not. Our algorithm is continuously learning from each outcome and we deliver real resolution rates higher than 80 per cent.” From the point of view of a traveller or expatriate, a visit from a doctor at their accommodation can be comforting. Tourists rarely research the nuances of the healthcare system in the countries they

Expanding horizons Unsurprisingly, a majority of the emphasis for companies providing this service is on the US, infamous for its expensive healthcare. However, the market is growing elsewhere. “Outside of the US, discounts on medical bills are less prevalent, and a greater focus is on assuring quality and cost-effective care,” said Sanchez. Global Excel Management, a cost containment company based in Canada, has also made business acquisitions to increase its global reach for these services – including Choicenet International in Mexico, ChargeCare International in Europe and Prima Sarana Jasa in Indonesia – and has handled home visit cases in over 100 countries. The market for home call doctors is clearly growing. Dr Gardens has seen an increase in demand for his company’s services in tourist hotspots, near beaches and in cities. Sanchez also says that he has seen a ‘dramatic increase in the utilisation of these services’. He puts this down to the changing face of global healthcare: “Traditionally, our industry has >> focused on ‘containing’ costs after a

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FEATURE healthcare event has occurred. However, with global healthcare inflation rates averaging over six per cent, costs continue to rise dramatically, and this traditional way of thinking needs to change. We are convinced that the only way to truly manage healthcare risk is to intervene much earlier in the process. We want to avoid costs first (while providing a better patient experience) and contain costs second. In other words, why contain on the back end and pay fees on the savings, when you can avoid on the front end and make the member journey a better one?” Like most areas in the insurance industry, customer education is one of the biggest hurdles facing a visiting doctor system, no matter where you are in the world. Dr Patel stresses the importance of understanding a

technology is giving home call doctor services a bright-looking future

customer’s home culture as part of this. For example, he explains, in the UK the idea of having a primary care lead is not too alien, meaning a client would be more trusting of a GP visiting them in their hotel room or holiday destination. In the Middle East, however, the expectation is that to receive proper medical treatment, you go to a hospital, see a specialist and are prescribed medication on the spot. Dr Patel says that changing these cultural attitudes will take ‘a lot of marketing, a lot of education and you may have to end up using mechanisms by which you steer [patients]’ – including altering policy wording to give customers

X-ray, ultrasound, prescription refill, dental services, physical therapy and, in some areas, even veterinary services.

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incentives to use these services. One way in which Doctors @ Your Home tries to intercept patients before they head to an ER is by partnering with hotels and concierge services, whereby these establishments advise guests to call the company when seeking advice regarding where to receive medical care. The company is also able to provide a range of services for patients to supplement and support a home visit doctor, including in-house

The bot will see you now Like other areas of medicine, and insurance, technology is giving home call doctor services a bright looking future. Sanchez says that Global Excel hopes to integrate ‘new innovations such as artificial intelligence, voice recognition, and blockchain technology’ into its already existing systems, meaning that not only will the depth and breadth of its home doctor services improve, but also that

its continuously learning StandbyMD algorithm will be able to pick the most effective solution for a patient every time. Dr Patel, however, acknowledges that the luxury of a home visit doctor may not be the most cost-effective method of primary healthcare in the future. “With the globally ageing population and the demand for global healthcare increasing at such a rapid rate, we’re simply unable to train the number of doctors needed, so virtual healthcare is the future. Whether that is actually having a physical doctor at the end of your phone is yet to be seen, but artificial intelligence’s growing intelligence means a bot could basically make a diagnosis for the simplest conditions using an algorithm.” A technology-based method is far more scalable, and though he believes

that the technology could combine with a home doctor or other primary care service provider, exploring this technology may not only benefit the insurance industry, but may also enable better healthcare access to those in countries where such access is poor. The personal approach is not something that is likely to go away in healthcare, however, Dr Gardens concluded: “I think the future is in house calls. Every day, there is new technology in this marketplace, like telemedicine, robotics, and so forth; but there will never be a substitute for handson patient care.” ■

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Centro M_dico Bournigal

Samaritano Botafogo Hospital SBIBAE - Programa Einstein na Comunidade de Paraisopolis Serviço de Referência Nacional em Filarioses - SRNF do Centro de Pesquisas...

Centro M_dico Punta Cana Grupo Rescue Hospital General de la Plaza de la SaludÊ Hospital Metropolitano de Santiago

Sociedade Beneﬁcente Israelita Brasileira Albert Einstein - SBIBAE

La Unión Médica

Total Care AMIL - Botafogo

Adam International Hospital

EGYPT

Sociedade Beneﬁcente de Senhoras Hospital Sirio-Libanes

Total Care AMIL Unidade Barra da Tijuca Total Care Unidade Jardins

As-Salam International Hospital Hassabo International Hospital

International Medical Center

City Clinic Varna BULGARIA

DOMINICAN REPUBLIC

Real Hospital Portugues de Beneﬁcencia em Pernambuco

website: hptu.org.co

ACIBADEM City Clinic Tokuda Hospital EAD

Clinic Km 42,Cairo Ism. Desert Rd., Cairo Near To El Sherouk City, Gate 2 Cairo, EGYPT

bul. “Nikola Y. Vaptsarov” 516, 1407 Sofia, BULGARIA tel: (+359) 2/403 4000

website: tokudabolnica.bg

tel: (+20) 224 775 902

website: imc.org.eg/imc

Luxor International Hospital

Greenberg Medical Centre International Medical Center Vita Hospital

Cl’nica El Rosario

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Cl’nica las Américas >>

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HONG KONG

GREECE

Sharm International Hospital

INDIA

EGYPT

INTERNATIONAL HOSPITALS DIRECTORY

AMC Aseel Hospital for Medical Care

Narayana Multispeciality Hospital, Jaipur

CrossBorderMedCare

National Institute of Ophthalmology

Rajagiri Hospital

Euromedica General Hospital of Rhodes

Matilda International Hospital

Chunangamvely Aluva â&#x20AC;&#x201C; 683 112 Kerala, INDIA

41 Mount Kellett Road, The Peak, HONG KONG

tel: (+91) 484 66 55 000

website: matilda.org

Satguru Partap Singh Hospital

Apollo Gleneagles Hospitals, Kolkata

SevenHills Healthcare Private Limited

Apollo Hospital, Chennai

Sri Ramachandra Medical Centre

Apollo Hospital, Hyderabad

Wockhardt Hospitals Ltd Unit: Adams Wylie Memorial

Apollo Hospitals Enterprise Limited, Navi Mumbai

Awal Bros Hospital Batam

Apollo Hospitals International Limited

INDONESIA

INDIA

Narayana Hrudayalaya Pvt. Ltd.

Awal Bros Hospital Bekasi

Apollo Hospitals, Bangalore

Awal Bros Hospital Pekanbaru

Artemis Hospital (a unit of Artemis Medicare Services Ltd.)

Awal Bros Hospital Tangerang

Asian Heart Institute and Research Center Pvt Ltd

Dr Kariadi General Hospital

Aster Medcity

DR Sardjito Hospital

Care Institute of Medical Sciences

Dr. Mohammad Hoesin Hospital, Palembang

Columbia Asia Referral Hospital, Yeshwanthupur

Dr. Wahidin Sudirohusodo Hospital, Makassar

Continental Hospitals Limited, Hyderabad

Eka Hospital

Fortis Hospital Limited, Mulund

Eka Hospital Pekanbaru

Fortis Hospital, Bannerghatta Road

Fatmawati General Hospital

Fortis Hospital, Cunningham Road

National Cardiovascular Center Harapan Kita

Fortis Hospital, Mohali

RS Pondok Indah - Puri Indah

Indraprastha Apollo Hospitals

RS Pondok Indah - Pondok Indah

Maharaja Agrasen Hospital, Punjabi Bagh

RS Premier Bintaro

Max Super Speciality Hospital (A Unit of Devki Devi Foundation)

RS Premier Surabaya - PT AfďŹ nity Health Indonesia

Medanta - The Medicity

RSUP Dr. Hasan Sadikin Bandung

Moolchand Hospital

RSUP Sanglah

26 IHHR

website: rajagirihospital.com

RSUPN Dr. Cipto Mangunkusumo Rumah Salit Pusat Angkatan Darat (RSPAD) Gatot Soebroto

ISRAEL

INDONESIA

INTERNATIONAL HOSPITALS DIRECTORY

Tel Aviv Medical Center The Baruch Padeh Medical Center Poriya

Siloam Hospital Bali

The Chaim Sheba Medical Center

Siloam Hospitals Kebon Jeruk

The Jerusalem Princess Basma Centre

Siloam Hospitals Lippo Village

The Lady Davis Carmel Medical Center ITALY

BIMC

Centro Chirurgico Toscano Srl

BIMC Hospital Kuta

Via dei Lecci, 22 52100 Arezzo ITALY

Assuta Hospital Tel Aviv

tel: (+39) 0575 3335

Augusta Victoria Hospital Barzilai Medical Center

Fondazione Poliambulanza

Edith Wolfson Medical Center

IRCCS Centro San Giovanni di Dio Fatebenefratelli

Elisha Hospital

Universita Campus Bio-Medico di Roma

Galilee Medical Center

UPMC San Pietro FBF - Advanced Radiotherapy Center MALAYSIA

Hillel Yaffe Medical Center Kaplan Medical Center

website: centrochirurgicotoscano.it

Gleneagles Penang (Pulau Pinang Clinic Sdn. Bhd.) 1, Jalan Pangkor 10050 Penang, MALAYSIA

Loewenstein Hospital Rehabilitation Center Mayney Hayeshua Medical Center

tel: (+604) 2229 111

Meir Medical Center - Clalit Health Services

website: gleneagles-penang.com

Pantai Hospital Penang

Rabin Medical Center/Beilinson & Hasharon Hospitals (Clalit Health Services)

Prince Court Medical Centre

39 Jabotinsky St., Petah Tikva ISRAEL tel: (+972) 3 937 6363 Rambam Health Care Campus

The Tun Hussein Onn National Eye Hospital

website: clalit.co.il

MEXICO

ISRAEL

Fullerton Health Indonesia

Centro Oncologico de Chihuahua Clinica Cumbres Chihuahua Global Doctors International Medical Clinic

Red Crescent Hospital Jerusalem Schneider Childrenâ&#x20AC;&#x2122;s Medical Center of Israel Shaare Zedek Medical Center Soroka Medical Center

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Calle Adolfo Rosado Salas No 999 entre 85 av y 85 av .bis, C.P. 77670 Cozumel, Q.Roo, MEXICO tel: +52 (987) 869 55 55

Hospital Amerimed Cozumel Islamed Sa De Cv

VieCuri Medisch Centrum

PORTUGAL

MEXICO

INTERNATIONAL HOSPITALS DIRECTORY

Centro Hospitalar Cova da Beira, E.P.E.

Escala Vila Franca - Sociedade Gestora do Estabelecimento, S.A.

website: amerimedcozumel.com

Hospital Beatriz Angelo - SGHL

Hospital CMQ

Hospital da Senhora da Oliveira - Guimaraes EPE

Hospital de Especialidades (Baja Medical Response)

Hospital de Cascais Dr. Jose de Almeida

Hospital Galenia

Hospital Lusiadas Lisboa

Hospital Mexico

Hospital Lusiadas Porto

M_dica Sur S.A.B. de C.V.

Hospital Sao Goncalo de Lagos - Aljezur

Obesity Control Center (Cyntar SC)

Hospital Sao Goncalo de Lagos - Odemira

Salud Digna Para Todos I.A.P.

Hospital Sao Goncalo de Lagos - SÜo TeotÑnio

Luz Saúde SA

Grand Med hospital

Rua Carlos Alberto da Mota Pinto, 17-9.º 1070-313 Lisboa, PORTUGAL

Intermed Hospital

tel: (+976) 7701 11 11

website: intermed.mn

SOS Medica Mongolia UB International Clinic

tel: +351 213 138 260 RU

United Famili Intermed Hospital Chinggis Avenue 41, Khan-Uul District 15, Uildver 17040, Ulaanbaatar, MONGOLIA

Euromed Clinic

SINGAPORE

MONGOLIA

Tropicana Medical Centre

NETHERLANDS

Centro Hospitalar de Leiria, E.P.E.

Fullerton Healthcare @ Ocean Financial Centre

website: www.luzsaude.pt

Gleneagles Hospital - Parkway Hospitals Singapore Pte Ltd (Network)

UB Songdo Hospital

Infectious Disease Partners Pte Ltd (Farrer Park Medical Centre)

Acibadem International Medical Center

Infectious Disease Partners Pte Ltd (Mount Elizabeth Novena Specialist Centre)

Amphia Ziekenhuis

Institute of Mental Health

International Health Center The Hague

KK Women’s and Children’s Hospital

Isala

Mount Elizabeth Hospital - Parkway Hospitals Singapore Pte Ltd (Network)

Groteweg 5, 8191 JS Wapenveld, NETHERLANDS tel: (+31) 38 424 50 00 SGE International Healthcare Services

28 IHHR

website: isala.nl

National Cancer Centre of Singapore Pte Ltd National Healthcare Group Polyclinics National Heart Centre Singapore National Skin Centre National University Hospital

Parkway East Hospital - Parkway Hospitals Singapore Pte Ltd (Network) Rafﬂes Hospital

TURKEY

SINGAPORE

INTERNATIONAL HOSPITALS DIRECTORY

Acıbadem Healthcare Group Fahrettin Kerim Gökay Cad. No:49 34662 Altunizade İstanbul, TURKEY

Singapore General Hospital (SGH) SingHealth Polyclinics

tel: +90 530 976 8398

SPAIN

Tan Tock Seng Hospital

Hospital Clinica Biblica

Anatolia Hospital AVENIDA 14, CALLE 1 Y CENTRAL, SAN JOSÉ, SPAIN

tel: 506 2522 1000

Caybasi Mh 1352 Sk No 12 , 07100 Antalya, TURKEY

website: clinicabiblica.com

tel: +90 242 249 33 00

Best Doctors

tel: +34 91 308 56 22

Istanbul Florence Nightingale Hastanesi A._. Medipol Mega Hospitals Complex Memorial Ankara Hospital

Özel Medicabil Hastanesi

website: bestdoctors.com/spain

Medical Response International

Fethiye Mahallesi, 1/A Mudanya Yolu Küre Sok Fethiye Mahallesi, 16140 Nilüfer/Bursa TURKEY

Quironsalud Hospitales USP Hospital de Marbella

tel: (+90) 444 8 112

Hospital Clinica Benidorm UAE

Hospitales San Roque Maspalomas

THAILAND

Bangkok Dusit Medical Services 2 Soi Soonvijai 7, New Petchburi Rd., Bangkok 10310, THAILAND tel: +66(0)2-310-3000

Vejthani Hospital

website: medicabil.com

Al Amana Home Health Care LLC

Belhoul European Hospital

Vithas Xanit International Hopsital

Samitivej Sukhumvit Hospital

website: anatoliahospital.com

Gayrettepe Florence Nightingale Hastanesi

C/ Almagro, 36 1ª planta 28010 Madrid SPAIN

Bumrungrad International Hospital

website: acibademinternational.com

PO Box : 4674, Dubai, UAE tel: (+971) 4 345 4000

website: belhouleuropean.com

website: bangkokhospital.com

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USA

Saudi German Hospital

USA

UAE

INTERNATIONAL HOSPITALS DIRECTORY

Cancer Treatment Centers of America

Seha Emirates Hospital

Children’s Health (Dallas)

Sharjah International Holistic Health Center

Children’s Hospital Colorado

Sheikh Khalifa General Hospital

Children’s Hospital Los Angeles

Sunny Specialty Medical Centre

Children’s Hospital of Philadelphia, The

Tawam Hospital

Children’s Mercy Hospital

Thalassemia Center

Children’s National Medical Center

Thumbay Hospital

Cincinnati Children’s Hospital Medical Center

Trust Medical Laboratory

City of Hope

Umm AlQaiwain - Primary Healthcare Centers in Umm Al Quwain-Ministr...

Cleveland Clinic

Universal Hospital - Al Ain

Cook Children’s Health System

Universal Hospital LLC - Abu Dhabi

Duke Medicine Global

University Hospital Sharjah

Emory Clinic

UpToDate Medicare Centre

Florida Hospital

York Diagnostic Laboratories, JLT

Flywire

Zabeel Health Center - Dubai Health Authority Primary Healthcare Service Sector

Health Brand Group

Zayed Military Hospital

Helvetic Credit Solutions

Zulekha Hospital Sharjah

Henry Ford Health Systems

Ann & Robert H. Lurie ChildrenÕs Hospital of Chicago

Hospital for Special Surgery

Atrium Health

Houston Methodist Global

Baptist Health International

Indiana University Health

Jackson Memorial Hospital International

Baylor St Lukes Medical Centre Boston Childrens Hospital

1500 NW 12th Avenue, Suite 829 East, Miami, FL 33136, USA

Brigham and Women’s Hospital (Partners HealthCare International)

Broward Health International 1608 SE 3rd Avenue, Ste 503-B, Ft Lauderdale, FL 33316, USA tel: +1 954 767 5587

Bumrungrad International

30 IHHR

email: Sbaig@browardhealth.org

tel: +1 305 355 1211

James Cancer Hospital (OSU), The Johns Hopkins Medicine International Kennedy Krieger Institute Lahey Hospital & Medical Center

website: jmhi.org

Massachusetts General Hospital (Partners HealthCare International)

USA

INTERNATIONAL HOSPITALS DIRECTORY

Sharp Global Patient Services

Mayo Clinic

8695 Spectrum Center Blvd., San Diego, CA 92123, USA

Medstar Georgetown University Hospital Memorial Healthcare System

tel: +1 888 265 1513

Memorial Hermann-Texas Medical Center and TIRR Memorial Hermann

website: sharp.com

Memorial Sloan-Kettering Cancer Center

St. Joseph’s Hospital and Medical Center/Barrow Neurological Institute

Minnesota International Medicine

Stanford Health Care

Mofﬁtt Cancer Center

Texas Children’s Hospital

Mount Sinai Medical Center

UC San Diego Health System International Patient Program

Navigant Consulting

136 W. Dickinson Street, Suite 109, San Diego, CA 92103-8222, USA

Nemours Children’s Health System NewYork-Presbyterian

tel: +1 619 471 0466

Nicklaus Children’s Hospital Northwell Health

Uchicago Medicine

Northwestern Medicine

UCLA Health

NYU Langone Health

UCSF Medical Center

Ochsner Health System

University Health System (San Antonio)

Ohio State Uni Comprehensive Cancer Centre

University of Cincinnati Cancer Institute

Penn Global Medicine

website: health.ucsd.edu/internation

University of Colorado Health

3400 Spruce Street Philadelphia PA 19104 USA

University of Michigan Health System

website: pennmedicine.org

UPMC

University of Pennsylvania Health System University of Southern California

Philadelphia International Medicine

USCSF Health

Princeton HealthCare System

Yale International Medicine Program

Ropes and Gray Roswell Park Cancer Institute Rush University Medical Center Scripps Health

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Seattle Children’s

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