ITIC Global Review | Malta 2019 by Voyageur Group

I N T E R N AT I O N A L T R AV E L & H E A LT H I N S U R A N C E C O N F E R E N C E

A full review of the 27th annual ITIC Global and the 2019 ITIJ Awards

CONTENTS

ITIC GLOBAL 2019 | REVIEW

Summary

Session Reviews

ITIJ Awards

Chairman’s message

Supplier fraud and abusive practices

ITIJ Awards 2019

ITIC & ITIJ Awards sponsors

Insurer counter-fraud efforts

ITIJ Marketing Campaign of the Year

Mental health coverage and assistance

Cost Containment Forum

13 5

New Attendees Welcome Reception

ITIC Global Welcome Reception

Air ambulance pricing

Short- and long-term traveller health risks

Workshop: insurtech

Medical Directors’ Forum

Insurance premiums – are they right?

22 10

Data security concerns and solutions

ITIC Running Club

New - Insurtech Initiative of the Year

Industry Supplier of the Year

Medical Provider of the Year

Cost Containment/Claims Management Company of the Year

Air Ambulance Company of the Year

Aggregator/Broker/Affinity Partner of the Year

22 18

EURAMI Members Meeting

Networking

Healthcare insurance and fraud trends

Can other countries learn from the accountable care movement in the US?

Sharp Selfie Competition

Improving the air ambulance commissioning process

Karaoke Evening

Air Ambulance and Medical Assistance Forum

International Assistance Company of the Year

International Travel & Health Insurer of the Year

Workshop: traveller security

Provider Network Forum

Medical and dental claims fraud – training for claims handlers

ITIC GLOBAL 2019 | REVIEW

CHAIRMAN’S MESSAGE I’d like to extend a huge thank you to each and every one of you who attended ITIC Global this year. More than 1,000 attendees descended upon the sunny island of Malta and it was fantastic to see so many faces, both old and new. Malta proved to be an excellent venue, with sea, sand and historical architecture, as well as the convenience of having everything on your doorstep. I sincerely hope that it was a productive and enjoyable conference for all. Across the ﬁve days, a plethora of panel sessions, workshops and forums spanning some of the most pertinent developments and challenges in travel insurance sought to captivate attendees and spark discussion. A vast exhibition space and countless networking opportunities – including an evening of karaoke! – provided the perfect

blend of professionalism and fun, affording attendees the opportunity to mingle and forge new connections in a relaxed environment. And, of course, the event concluded with the annual ITIJ Awards – and what a great night it was! This year’s Halloween theme encompassed many spooky (but nice) surprises. Well done to all of this year’s awards ﬁnalists and huge congratulations to our winners. It was a pleasure to be among industry peers and celebrate some of the year’s big achievements. Please enjoy our write-up of the event, and we hope to see you all next year in Madrid for ITIC Global 2020! Ian Cameron Conference Chairman

Thank you to the 2019

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sponsors

GROUP

International Travel & Health Insurance Journal

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The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur & Events Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or firm mentioned, is hereby excluded. Printed by Pensord Press Ltd Copyright Voyageur & Events Ltd 2019 Materials in this publication may not be reproduced in any form without permission. INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL ISSN 2055-1215

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ITIC GLOBAL 2019 | REVIEW

Sponsored by ITIJ, the New Attendees Welcome Reception – which took place at Hugo’s Terrace & Rooftop overlooking the tranquil harbour of St George’s Bay – provided a great introduction to the week’s activities for new attendees of ITIC Global. Extending a warm welcome to ﬁrst-time ITIC goers, James Miller, Head of Sales at ITIJ, detailed the history of the magazine, explaining that it had originally been launched as a means to keep attendees of the then-annual ITIC conference updated on industry news and events in between conferences. Now it its 20th year, ITIJ has come a long way since those early days! The evening was a great chance for those new to ITIC Global to meet the conference committee and ITIJ team in relaxed surroundings and learn how to make the most of their time at ITIC Global from regular attendees.

James Miller, Head of Sales at ITIJ, welcomes the new delegates to the 27th annual ITIC Global.

itic global welcome reception Pulling out all the stops for this year’s ITIC Global ofﬁcial Welcome Reception, New Frontier Group greeted conference attendees at the breathtaking medieval banqueting hall of the 16th Century Mediterranean Conference Centre. Complete with an impressive fanfare of trumpeters and drummers in traditional dress, delegates were coaxed into the former – and ﬁtting – Knights’ Hospital for an evening of drinks, canapés, and networking.

From left to right: Rob Upton, Group Business Development Director of New Frontier Group; Ian Cameron, ITIC Global Chairman; Gitte Bach, President & CEO of New Frontier Group; and Randall Condie, COO of New Frontier Group.

“ITIC has done a phenomenal job and it’s truly an honour for us to sponsor this event,” said Gitte Bach, President & CEO of New Frontier Group, during her opening speech of the evening. “What could be more appropriate then recognising that the Knights of Malta made it their mission to take care of those who needed help.” It certainly was a fitting tribute and the ITIC team would like to thank New Frontier Group for a truly memorable start to ITIC Malta 2019.

ITIC GLOBAL 2019 | REVIEW At ITIC Global, attendees congregated across four days to attend presentations and panel sessions given by their peers. A plethora of speeches, workshops and forums covering topics as diverse as the use of artiﬁcial intelligence in fraud detection, pricing structures in the air ambulance industry and solutions and innovations in cost containment, sparked industry debate and much food for thought. On the following pages, you will ﬁnd our synopses of each of the sessions at this year’s ITIC Global …

Supplier fraud and abusive practices

enior Vice-President and Chief Administrative Ofﬁcer of AIG Travel, James Page, opened the ﬁrst ITIC session of the week with a focused presentation on fraud and abusive practices in Latin America.

James Page

As people travel more, quality of care tends to improve in the regions being visited. But this uptick in travel also equates to a growing threat of fraud. In Latin America speciﬁcally, James explained that providers tend to see higher service costs and overbilling. And this is especially true in popular tourist destinations. The most common abusive practices include unnecessary procedures such as hospital admissions and tests, fabricated cases, unnecessary surgeries, and being billed for surgeries that weren’t even performed in the ﬁrst place. Elsewhere, James noted that some places take a ‘shot-gun approach’ to billing; requesting payment to different centres instead of sending bills to the appropriate department, which in some instances can cause duplicate payments. He used the example of a billing incident in Columbia in which a patient needed urgent appendicitis surgery. “If you’re not familiar with the surgery, look it up,” he advised. Often fraudulent companies take a very creative approach. “When the money goes out, you’re not getting it back,” James assured and, as such, having the right indicators in place is key to ensuring that insurance and assistance companies are able to identify and deter potential fraudulent cases.

Carol Foley

With the discussion opened up to the room, the session attendees covered the importance of screening processes to detect ransomware attached in email correspondence, as well as touching upon the annual percentage lost through fraudulent

activity (for AIG Travel, this equated to around 0.9 per cent, with roughly four to five per cent of the claims the company received being identified as fraudulent each year). James also noted that training on fraud was another important method to deter fraud – “People understand that we’re paying attention, and this helps keep the numbers down,” he said. Carol Foley, Co-Founder of Fairmount International, headed up the second part of the session, focusing on fraud in Sub-Saharan Africa. She noted that while the quality of care in Africa is improving, there are still discrepancies among the different countries in the region. She said that, in 2016, the World Health Organization cited the global healthcare spend as US$7.5 trillion. And between 2008 and 2013, the Center for Counter Fraud Studies noted that the estimated percentage of fraud was at 6.19 per cent; an increase compared with previous years. Carol explained that in Sub-Saharan Africa, fraud consists of billing for services not rendered; the misrepresentation of key claims information (including dates, locations and type of provider); over treatment; and false or unnecessary prescription of medicine. “The players are shrewd, and people need to keep alert to that kind of activity,” she warned. Carol referenced two case studies, one of which detailed an instance of fraud in Cameroon in which a claim for a 42-year-old male who was diagnosed with malaria came in on a hand-written invoice. The drugs prescribed for the case were potentially toxic and could have proved fatal to the patient. Upon a visiting analysis from Fairmount International, the team discovered that the doctor who allegedly wrote the report was long deceased. The claim was ultimately denied as the case itself turned out to be entirely fabricated, and the patient didn’t exist. A take-away point is that collaboration is extremely valuable in the fight against fraud and abusive practices, as is AI. “Medical providers, insurers and assistance partners all need to work together to minimise fraud,” Carol highlighted. Rounding up the first session of the week, Dr Sundeep Dhillon, Chief Medical Officer at MAPFRE, began his presentation with an immersive clip on medical assistance on Mount Everest, with a view to discussing helicopter fraud in Nepal. His presentation covered altitude sickness, which he reasoned can be difficult to distinguish from the general experience of everyone else engaging in mountaineering activities. Dr Dhillon explained that in Nepal 20 years ago, most of the treks were sold pre-trip by Western companies, whereas, more recently, a massive ‘explosion’ of trekking companies has resulted in local businessmen ‘over-promising’ and ‘underdelivering’ on the Everest experience. In some

cases, travellers are being offered helicopter evacuations in advance of their trip, as well as luxury accommodation after transportation. And it’s not just the air rescue companies committing fraud; trekkers and guides are also committing fraud and, as a result, insurers are blindsided due to a lack of communication. What’s more, Dr Dhillon argued that because cases are time-sensitive, insurers rushing to act quickly – due to short weather windows and air ambulances’ inability to fly at night – can further hinder the process of authenticating a claim. Dr Dhillon referenced specific types of fraud, including multiple rescues in the same helicopter, where claimants received a bill for the cost of the whole helicopter, rather than splitting the bill. Unless you have a presence in Kathmandu and know people, you are not taken seriously, he said. And, as such, Dr Dhillon explained that he has taken great pains to extend his medical network in the area, and so, offered key advice to those in the session, as well suggesting ways in which fraud could be prevented in the future. He noted that having a doctor present as part of the mountaineering team, or at least visiting the Everest ER at base camp, would help to ensure that a helicopter is called out for the right price, and that the correct medical response is provided for each individual case. He also advised placing doctors on medical flights, as well as along the popular trekking routes. Ultimately, Dr Dhillon concurred with Carol Foley’s view on collaboration when it came to fighting helicopter fraud in Nepal. “As with all fraud, if we can share this information, then we can progress. Finding a way to share best practice in fraud in a commercially effective way is key,” he said. n

Dr Sundeep Dhillon

ITIC GLOBAL 2019 | REVIEW

Insurer counter-fraud efforts

ooking at claims management in fraud detection, Moscow, Russia-based MAINS LAB CEO and Co-Founder Yury Kuvshinov explained that the different types of health fraud include over-treatment; cases that contradict the table or beneﬁt; duplication or technical mistakes; or entirely fabricated claims, where the treatment didn’t occur at all.

Yury Kuvshinov

Yury rationalised that fraud detection can be split into two categories: machine learning and rules and algorithms. He noted that while machine learning can help to identify complex correlations, it can sometimes be difﬁcult to interpret and requires human expertise; and although rules and algorithms can trigger concrete fraud cases and are explainable and interpretable, they need to be constantly updated. He also stated that both these approaches are based on data and touched upon the problems and solutions associated with these forms of data. “You really need to understand the structure of fraud in your country,” Yury reasoned, referring to the different levels and types of fraud. He stated that in Romania, Poland and Russia, for example, overtreatment accounts for eight per cent of the overall claims amount. Yury’s presentation sparked a discussion on the importance of acknowledging company vulnerabilities. When it comes to ﬁghting fraud, Yury noted that it is possible to try to reduce it and keep it as a downward trend, but that, ultimately, the key is to catch trends early and adapt to deter them.

Steve Paton

Next on the podium was Steve Paton, Head of Anti-Fraud Services (Europe) at Verisk. His presentation covered the use of technology in the fight against fraud. He talked of the ‘race to zero’, with insurance industries in the US and UK making changes to see who can give the most efficient automated service. The essence of Steve’s empowering dialogue was that players in the insurance industry need to work as one to fight fraud. He asserted that sharing intelligence internally throughout the different departments was a crucial first step, and that only after organisations had implemented this system could they use other technological capabilities to their best advantages when fighting fraud.

“Fraud detection can be split into two categories: machine learning and rules and algorithms” He also said that fraud trends are increasing and that new anti-fraud technologies are therefore now necessary. In the UK alone, there is a lot of activity around detecting insider fraud and Direct Line is receiving awards for simply sharing intel internally, Steve pointed out. He added that The Direct Line Human Resources Department routinely checks its intel system before it recruits people. “Intelligence management is key. If you can share the intelligence, then that is the strongest asset that you will have,” Steve stated, adding that ‘power is collaboration’. As claims are ongoing, the fraud detection process needs to be constant and advanced anti-fraud strategies need continuous attention. Steve also touched upon AI and how this can be instated into fraud detection to help authenticate claims.

solutions for these issues have been found, including cross-referencing of an insurer’s data, arranging claims according to their fraud risk and providing insight into the underlying reasons for suspicion. Estelle went on to detail that Shift Technology has developed a denoising algorithm, called Force, that addresses errors, duplicates, typos and inaccurate entries – which databases often incur – by reconstructing entities and cleaning data. “Of course, we are using AI, but this is a human decision tool,” said Estelle, noting that, in the end, a claim will not be marked as fraudulent without the final decision of the claim manager. The audience members concurred, many of them agreeing that although technology provides ample advancements in the fight against fraud, there will always be a percentage of fraudulent cases that cannot be identified by AI and, as such, the human touch is still necessary. In a Q&A session, delegates asked who the fraudsters tend to be and whether Shift Technology had ever come across fraudulent assistance providers. Estelle responded by highlighting that, indeed, fraud could occur both internally and externally, and this was another way in which Force had helped detect instances of fraud. The discussion moved on to considering the many ways in which data could be corrupted. The session concluded with the importance of fraud detection procedures firmly established. n

Estelle Lebar

Delving into the implications of using AI to help detect and defer fraud, Estelle Lebar, Global Offering Leader, Travel Insurance & Assistance at France-based Shift Technology, began by explaining the company’s progression from providing fraud detection solutions to claim automation solutions. She explained that issues facing those working within the fraud management process are the large volume of claims that needed to be processed, limited time when processing each claim and limited information available for each claim. For Shift Technology at least,

ITIC GLOBAL 2019 | REVIEW

ITIC RUNNING CLUB

MALTA 2019 Sponsored by:

Uniting business and wellness, ITIC Global brought back its hugely popular Running Club for the third year. Sponsored by EMA Global and Life Flight International, the relaxed 5k-run each morning was the perfect way to commence busy days of networking and conference sessions. ITIJ caught up with Dexter Tan, Group Executive Director of sponsor EMA Global, for a quick chat ahead of an early morning run … How did you get involved with sponsoring Running Club at ITIC Global? Dr Winston Jong, the CEO and Medical Director of EMA Global, is an enthusiastic runner who typically starts his ITIC week with morning exploration runs of the city. As such, when an opportunity to sponsor the ITIC Asia Paciﬁc Running Club in Hong Kong came along he felt it would be a great opportunity to meet and run with likeminded people. True enough, we met a fantastic group of people, many of them avid runners, and had an incredible experience pounding the pavement of the promenade, taking in views of the beautiful Victoria Harbour. This positive experience led us to signing on as Running Club sponsors at ITIC Global, Malta. We were pleasantly surprised by the turn out and are grateful for all runners who took the time out of their mornings to run with us.

Why do you think Running Club is such a good ﬁt for ITIC? As ITIC is held at different locations each time, the Running Club is a great way to explore the local area on foot. The Running Club also provides participants the chance to get their run on with an established group in a new environment. It’s always more fun to log miles with a likeminded crew and the morning runs are a great social running experience that tend to be more community-focused and less pace-oriented. The Running Club is also a great platform to build on friendships and camaraderie. We personally love meeting new people and catching up with old friends on our runs.

What are the key beneﬁts of taking part in the ITIC Running Club? When you’re running with a club, there is much more motivation to keep going. You can chat to your running buddies to keep your mind occupied and can discover new routes you may not have explored on your own. The atmosphere on the Running Club runs is incredibly supportive and allows participants to meet people who are all there for the same reason – to get ﬁt and enjoy the process!

How did Running Club at ITIC Malta go? It was fantastic and we didn’t expect such a large and consistent turn out on all three days. We certainly hope to see the number of runners grow with each conference!

ITIC GLOBAL 2019 | REVIEW

Mental health coverage and assistance

his session provided invaluable insights into the cost of mental health conditions, globally, as well as focusing on legal requirements around mental health coverage, the Canadian approach to covering mental health, and how mental health patients are uniquely treated in Russia.

Dr Arthur Zulficarov

Dr Arthur Zulficarov, General Manager of Global Voyager Assistance Russia, opened the session with a look at some of the World Health Organization and American Psychiatric Association’s classifications of mental health conditions to show just how many there are, before showing how, in a sample of 11 insurers in Russia and Eastern Europe, all contained blanket exclusions for mental health issues on their travel policies. Explanations for these exclusions centered around the complexity and unpredictability of the diagnosis, treatment and costs associated with such conditions. However, IPMI providers offer better cover for mental health conditions, but with limits to avoid the coverage of lengthy in-patient treatment; while psychiatrists that Dr Zulficarov spoke to explained that the costs associated with treating mental health conditions are usually actually quite low. Another unique feature of this region is the strict government regulation surrounding the care of patients with mental health disorders. In Russia, all such patients must go through the psychoneurologic dispensary (PND), complete the country’s compulsory treatment protocols, and be monitored and dispatched under formal regulations. For medical escorts, strict rules also govern the determining of fitness to fly and the execution of such cases, from obtaining a recommendation from the treating psychiatrist to ensuring one of the escort team is the same gender as the patient.

Brad Dance, Chief Customer Ofﬁcer at TuGo Insurance, followed with a look at some of the reasons why mental health conditions are excluded from travel insurance policies in Australia until mid-2017, when a legal case in the country had far-reaching effects on the wider industry in terms of how it covers such conditions. A focus on extreme cases, fears over long periods of hospitalisation and an increase in the likelihood of mental health episodes increasing during travel were just some of the reasons insurers excluded mental health conditions, but the case of an Australian student traveller who cancelled her trip to New York due to a period of severe depression has changed how many insurers now approach such cover. The student had her resulting claim denied, but an appeal to the local courts found in her favour and she was awarded US$15,000 for hurt and humiliation. Subsequently, the Human Rights Commission in Victoria launched an investigation into potential unlawful systemic discrimination against people with mental health issues by the state’s travel insurance industry, and the Insurance Council for Australia called for the development of an industry code around the issue of mental health coverage, with insurers also called upon to contribute to a mental health database. As a result of this case, travel insurers in Canada sat up and took notice, said Brad, and although some of the top insurers in the country still exclude mental health conditions from their outbound medical and trip cancellation/interruption coverage, they are looking to make changes to this approach. Others have already removed language that referred speciﬁcally to mental health and now treat such illnesses like any other. The Canadian landscape is certainly evolving, said Brad, changes are in progress and although coverage and exclusions will not all look the same for Canadian consumers, they will soon have better options.

Dr Mitesh Patel

Brad Dance

Taking a broad look at the scope of mental health issues and associated costs, Dr Mitesh Patel, Medical Director UK at Aetna International, told

“In a sample of 11 insurers in Russia and Eastern Europe, all contained blanket exclusions for mental health issues on their travel policies”

delegates that over 300 million people faced depression in 2015, and expats were two-anda-half-times more likely to experience anxiety or depression than their countrymen back home. Mental health will be the number-one health concern in 10 years’ time, he said. Thankfully, the stigma attached to mental health is eroding, if more slowly in certain regions. Dr Patel gave the example of the UAE, where there are 7.25 mental health workers per 100,000 population compared to the US where there are 271.28. In terms of cost, mental health conditions not only have associated direct and indirect healthcare costs, but also costs in terms of lost productivity in the workplace. There are things that employers can do to help, however, such as offering Employee Assistance Programmes with access to mental health lines run by counsellors, offering paid or unpaid time off, and the option to work from home. Likewise, insurers can ensure they direct those in need to appropriate local care when they are travelling, offer telemedicine services allowing insureds to talk to a physician in their own language, and provide cultural training for employees pre-trip and encourage them to build local support networks. Providers can use data mining and predictive analytics to provide better care and identify any potential gaps in care and knowledge. n

“Over 300 million people faced depression in 2015 and expats were two and a half times more likely to experience anxiety or depression” 11

ITIC GLOBAL 2019 | REVIEW

Cost Containment Forum Tuesday’s Cost Containment Forum boasted four speakers: Amy Villalobos provided cost containment insights from the point of view of the health insurer; Dr Eugene Delaune spoke on behalf of the air medical transport provider; Gregory E. Marsella discussed settling tender payments in court; and Natalya Butakova spoke about the use of an automated cost containment tool to help with claims management. Amy Villalobos Head of Case Management and Assistance Services, nib

my Villalobos of nib began the discussion by talking about cost avoidance and hospital substitution. Access to medical care is expensive and healthcare systems are complex, with the average cost of treatment increasing year-onyear, she stated. Trying to navigate a hospital system can be extremely complicated, which means costs are hard to avoid. Addressing the room by relating the experience of being in an unfamiliar location, Amy conveyed how travellers and foreign nationals can inadvertently end up seeking high-cost, inappropriate treatment by presenting their case to emergency rooms (ER); having no known alternative, this is often their first port of call. Amy referenced that between 40-60 per cent of ER visits are avoidable, and although many companies have partnerships set up with these institutions that give them discounted rates for these services, a discounted rate is still a steep price to pay for unnecessary treatment. Insurers exist to pay claims, Amy asserted, and although they must do their best to achieve efficient levels of cost containment, they also need to remain focused on the fact that there is a person seeking treatment. Detailing various cases in which nib had practised successful cost containment techniques, Amy explained that case management concerns three components: enhanced clinical outcomes, reduced benefit outlay and outstanding member

Gregory E. Marsella Corporate Counsel, New Frontier Group

experience. It’s all about the right service at the right price at the right time, she said. Looking at dynamic medical case management, Dr Eugene Delaune of GMMI referenced the problems of costly medical care (particularly in the US), the high cost of medical transport and an insurer’s need to impose more effective cost containment solutions. Right from the get-go, he asserted that it was not possible to meet all of the needs of all parties involved. Dr Delaune noted that when managing the costs of medical cases, it is important to set realistic expectations early on. Specifically, he explained that informing the patient straight away that that they would be transferred home, but that that they wouldn’t necessarily immediately recover, was essential in this process. Doing so would prevent any disappointment on the patient’s side. Dr Delaune also examined the other factors that need to be considered when a case is first opened. Identifying the payer (both the individual and the insurance company), the costs that are covered (i.e. emergent care, transport, long-term care and medical costs after repatriation) and the anticipated duration of treatment was extremely helpful in ensuring that costs could be managed throughout the lifetime of the case. In the end, Dr Delaune reasoned, dynamic medical case management must always consider the ethical component – doing what is right for the patient and getting the patient home will always remain major decisive factors in the medical transport cost containment process. Gregory Marsella of New Frontier Group kicked off his presentation by hopping off the stage and taking to the floor to discuss the risks and benefits of using tender payments as a negotiation tool. He offered up a real-life example of a tender payment, analysing the claim observations, the details known about the claim and the legal principles that could be applied to the claim. A key finding from Gregory’s research revealed that when it comes to tender payments, often insurers aggregate multiple claims into one

Dr Eugene Delaune Chief Medical Officer, GMMI Inc

Natalya Butakova Business Development Manager, AP Companies Global Solutions

“Dynamic medical case management must always consider the ethical component – doing what is right for the patient” lawsuit and, that generally, cases move quickly to resolution, with the average case lasting 12 months. However, Gregory’s overall message was that tender payments are best avoided. He surmised that the process of tender payments is an extremely risky strategy for insurers, as, once in court, sympathy tends to be directed towards the provider; hospitals are often very well acquainted with the legal system; and some states even have laws that favour providers. What’s more, once in court, claims costs could increase substantially due to attorney fees and interest. For a better outcome, Gregory advised, a less dramatic approach can be employed to achieve a more favourable result. He conveyed this sentiment via the analogy of using a chainsaw for a haircut: “It may cut hair, but it’s likely to cause severe collateral damage.” AP Companies Global Solution’s Natalya Butakova detailed the key components and benefits of AP Companies’ automated cost containment tool, remarking upon the tool’s use of technical checking points, which check for duplicate invoices and services, price match claims with medical providers and apply the relevant discount for the provider. She noted that the cost containment tool also uses medical checking points. In her presentation, Natalya touched upon the adoption of AI in the cost containment sphere, with particular reference to ‘big data’ and where this information was obtained from. Conveying the results seen after two years of implementing the automated cost containment tool, Natalya noted that it simplified the process of analysing claims; the tool required minimal integration with maximum adaption, it had a customisable and ergonomic web interface, encouraged optimum engagement through its flexibility and pay-per-claim fee structure, and that the maintenance ran like a dream by providing continuous improvement via a dedicated team. All in all, the return on experience was worth it, she stated. n

ITIC GLOBAL 2019 | REVIEW

Air ambulance pricing

AAMTA’s Roylen ‘Griff’ Grifﬁn, who is Executive Director of the company, discussed accreditation in the air ambulance industry. He touched upon what an insurance company assumes is happening at an air ambulance company, in terms of accreditation and costings. He explained that if an insurance company sees that an air ambulance company is accredited, then this ups the value of the service that the insurer believes the company is providing, as well as the resources available. Referencing the cost of accreditation for air ambulance companies, Griff revealed that more often than not, these providers would put the bill under ‘Marketing’. But Griff disputed this, arguing that accreditation should be accounted for under ‘Training’, due to the demanding process involved in gaining said award. “You’d be surprised how often we walk into an organisation and they don’t have any policies and procedures,” he said, referring to NAAMTA’s common gripe when reviewing air ambulance companies. Griff also noted that, often, little value is placed upon safety management within these organisations. “When a company is trying to save money, the ﬁrst thing they cut is training and the second thing they cut is safety,” he cautioned. He then detailed the value of gaining accreditation for both insurers and air ambulance providers, explaining that accreditation is a recognised set of safety standards, and that third-party vetting also evaluates training materials and markets a company’s new accreditation to the insurance industry. “You can’t manage what you don’t measure,” he professed, before relaying the importance of partnerships in air ambulance pricing, concluding that these helped ensure patient safety was always at optimum levels. Dr Cai Glushak, International Medical Director of AXA Partners, began his presentation on air ambulance pricing by looking at drivers of cost in

the air ambulance industry. He cited key drivers as being improved medical care; consolidation in the industry; changes in the commercial air ambulance industry; weak currencies; and increased medical costs. Dr Glushak then explored how costs could be affected within areas of limited availability when air ambulance shopping; he noted that exploited pricing, reduced motivation, resource limitation and limited choices can result in high pricing, as well as resource uncertainty. To be a responsible shopper, Dr Glushak advised to go for the best price, the best quality and the best availability. Another very important factor to consider when shopping is the reliability of the provider, he added. He encouraged comparison shopping to help find options that meet all of these needs. That being said, Dr Glushak did discourage overly competitive bidding on these factors. “If you push it too far, you will be pushing price over safety,” he said. “There is a limit to what you can do when pushing prices down.” Ultimately, he argued that proper vetting is critical within the air ambulance shopping process, as foregoing this could put your company’s reputation at risk, as well as its operations. So, to conclude, is the cost related to the request (when it comes to air ambulance shopping) absolutely necessary? Yes, insisted Dr Glushak. “Ethical business practices are key to implementing and maintaining quality aviation and medical standards,” he said. AMREF CEO Dr Bettina Vadera delivered the final presentation of the session on air ambulance pricing, identifying the key components of a quality air ambulance service. She cited state-of-the-art medical equipment, a specialised medical crew, 24/7 operations and call centres, and ground ambulance support as the factors that reflected quality in an air ambulance provider. Similarly to Dr Glushak’s, Dr Vadera’s presentation also looked at cost drivers in the air ambulance industry. She explained that aviation direct operating costs (such as aircraft maintenance and fuel) and

Dr Bettina Vadera

Dr Cai Glushak

Roylen ‘Griff’ Griffin

aviation fixed costs (such as salaries, training and aircraft financing and depreciation) were two of the top cost drivers, both accounting for about 90 per cent of evacuation costs. She also noted that medical direct costs, such as stretchers, equipment and drugs; medical fixed costs, such as medical crew training and professional indemnity; and other costs, such as call centres, accreditation, crew transport and positioning costs, were all cost drivers. High-quality air ambulance services come at a hefty price, Dr Vadera said. She noted that price competition can impact the standard of the service, just as Dr Glushak alluded to. And she warned that a price war in the air ambulance industry would inevitably affect patient care. As a resolution, Dr Vadera reasoned that contract work or related business lines can help providers to keep prices down through cost sharing. And rounding the session off nicely, she asserted that accreditation provides a systematic and independent evaluation of your own quality of air ambulance services. n

ITIC GLOBAL 2019 | REVIEW

Short- and long-term traveller health risks

r Laurent Taymans began this session with a look at some of the correlations between business travel and levels of anxiety and depression, and mental health issues and non-communicable disease such as diabetes, cancer and cardiovascular problems. Issues such as suffering from a lower quality of sleep, being less likely to exercise and being less likely to eat a balanced diet are other aspects of business travel that impact on physical health. Add this to the fact that 34 per cent of international business travellers (IBTs) are more likely to engage in risky behaviours – such as consuming more alcohol and eating in unhygienic places – when travelling on business, and that emotional exhaustion and suffering from low moods are more likely when on a business trip, and the need to look after international workers’ mental health, as well as their physical wellbeing, is obvious. The annual cost of work-related stress in the EU is estimated at €617 billion, though a Deloitte study from 2017 shows that the average return on investment in the mental health of employees is £4.20 for every £1 invested. Companies that build a culture of health, then, yield greater value for their investors, through such factors as reduced absenteeism, increased productivity and fewer errors. Focusing on other key traveller risks, Dr Charlie Easmon caught assembled delegates’ attention with his insights into future and current health risks

for travellers, which spanned road traffic accidents, tropical flu and sexually transmitted infections (STIs). Set against a backdrop of an exponential rise in travel, travel to more exotic locations, greater antibiotic resistance and more zoonosis (animal to human transmission), traveller risks are more prevalent than ever before. Some are preventable, however, said Dr Easmon, such as road traffic accidents. Insurers should be looking at how safe the roads are in specific countries, whether visitors should drive in the country, what they should drive, whether a helmet should be mandatory, and put policies in place around traveller behaviour in order to help reduce related deaths. Similarly, there are preventables related to STIs, excessive behaviours and mental health issues while travelling; but some preventable diseases such as measles are likely to return in areas where they have previously been largely eradicated due to more people travelling with communicable diseases, in some cases due to the actions of powerful antivax groups. Other risks of particular concern are yellow fever being carried in and around India by mosquitoes, the threat of a pandemic flu, bugs making their way out of the Amazon due to deforestation, new STIs that are not vaccine-preventable, blood-borne viruses, and the increased likelihood of dengue cases. Key to reducing these risks is to educate travellers on the particular ways they can best stay safe and healthy when travelling to their destinations. n

Dr Laurent Taymans

Dr Charlie Easmon

Workshop: insurtech

ith technology constantly changing how travel insurance and assistance services are designed and delivered, no conference is complete without a dedicated look at the latest innovations in this area. This workshop at ITIC Global saw two presentations that gave valuable insights into how big data is being used in the industry to deliver a range of beneﬁts to insurers, assistance providers, TPAs and customers.

Berna Ataç Ökten

Agustina Razetti

Berna Ataç Ökten, Chairman of the Board at Marm Assistance, began the session by highlighting 11 of the current insurtech trends that are making waves in the industry. These include: automation, which MCI says will replace 25 per cent of insurance jobs; chatbots, with a digital chat experience being preferred to email dialogue for many people today, especially millennials; AI and machine learning, with Digital Insurer stating that 80 per cent of insurance underwriting is likely to be done using such technology in the near future; on-demand protection; personalisation, which leads to greater customer retention; and blockchain. Next, Berna looked at how assistance companies can support insurers using insurtech through three key areas: health and safety, medical and roadside. Key points made by Berna were that when it comes to health data on employees (insureds), this can be taken with them onto different projects if kept in an interactive database, which can lead to the prevention of unnecessary costs. It can also readily highlight the fact that a pre-existing medical condition might make them unsuitable for a particular assignment. When it comes to medical assistance, smartphones and apps have proved very useful, especially with regards to patient direction, which can ultimately enhance customer satisfaction; but there is a need to be aware of app overload. Wearables, however, are becoming increasingly important monitoring devices and can be used by assistance companies to monitor insureds’ health and alert emergency contacts in case of inactivity by the wearer. In conclusion, said Berna, working with new technology is essential. The savings are signiﬁcant, efﬁciency is maximised, and errors are minimised; but the human touch is an integral and irreplaceable component.

Agustina Razetti, Data Scientist at Shift Technology, took to the podium next to give attendees an insight into how her data-driven company uses AI to automate claims and detect and prevent fraud. For each insurer the company works with, it collects data on claims and policies, which is updated all the time, as well as historical data, and tailors a solution to that company. The key beneﬁt of such a system is that it gives insurers a tool that pulls in all the company’s data and detects potentially fraudulent cases extremely quickly, whereas a human would take much longer to carry out the same tasks. In fact, the technology carries out processes that humans can’t do, such as sifting through vast amounts of data to detect similarities in different claims that might be a fraud indicator. The software maps connections between policyholders, doctors, tour companies, and so forth, and reveals networks that might be promoting fraudulent activities. It also looks for inconsistencies in meta data, so it can tell, for example, if a camera used to take a picture of a receipt is actually the camera being claimed for as stolen. Similarly, social media is integrated into the system to uncover cases of fraud; for example, if someone on holiday posts pictures of themselves participating in activities while claiming their journey was delayed due to injury. Using these elements, each case in the system gets a fraud score and lists what the suspicions are, whether that’s hidden medical tourism, a fake or exaggerated baggage loss or if a claim amount is inconsistent with the alleged treatment. The inclusion of various external data, as well as its network analysis, are just some of the things that differentiate Shift’s system from others, said Lebar. n

✓

ACCREDITED PROVIDER

ITIC GLOBAL 2019 | REVIEW

Medical Directors’ Forum The Medical Directors’ Forum provided an opportunity for industry figures to openly discuss difficult decisions they have faced during medical repatriations. Dr Thomas Buschein led the discussion, which was co-hosted by Dr Cai Glushak and involved additional speakers who depicted challenging medical repatriation cases. Dr Thomas Buschein Medical Director, FAI Air Ambulance

Dr Cai Glushak International Medical Director, AXA Partners

Dr Simon Forrington Chief Medical Officer, Capital Air Ambulance

Dr Charles Crawshaw Medical Director, ACE Air & Ambulance

Dr Yann Rouaud Group Medical Director, Airlec Ambulance

Dr Ferial Ladak Director of Global Medical Affairs, Global Excel

r Thomas Buschein began the forum by referencing a case involving a 38-yearold Nigerian man suffering from a sore throat who was eventually diagnosed with inoperable oropharyngeal carcinoma. The patient was kept in a hospital in Sarjha, UAE, where he received aggressive chemotherapy, which did little to help him. He was hooked up to a monitor, with access to a ventilator throughout the night, and placed in an ICU. Thomas explained that, realistically, the patient did not have a favourable chance of survival, and with ever-increasing medical costs, the patient’s family decided to bring him home. However, the hospital that the family chose to repatriate the patient to was inadequate. Unfortunately, the Nigerian patient had only very basic insurance, which had already reached its coverage limit, and so – the new facility being the only one that the family could now afford post-air ambulance flight W– there was little other choice. Thomas said that, upon delivering the patient, the doctor at the new treating facility assured FAI Air Ambulance that they would find a solution for the patient. But as soon as FAI left, the treating facility disconnected the patient and he sadly died. Dr Simon Forrington, Chief Medical Officer of Capital Air Ambulance, followed Thomas’ presentation, using an example of a challenging repatriation of a patient with traumatic brain injury from North Africa to the UK. The patient had fallen from a third-floor balcony, and was suffering from an extradural haematoma, which had to be drained surgically. However, the patient’s health continued to deteriorate, and after continued diagnoses, a CT scan revealed that they were suffering from ongoing bleeding from an unstable pelvic fracture, which had been missed on the original scan. The team then had to decide how to safely repatriate the patient, who desperately needed more blood products. However, the air ambulance transportation would have taken several hours back to the UK and, with no blood products available, the move would have proved extremely risky for the patient. The team decided that the best course of action was to move the patient to the nearest trauma centre in southern Spain. By maintaining constant communication with all

parties (the Capital transfer team, the assistance provider and the patient’s family), the patient was safely moved, and ultimately was able to be transferred back to the UK as soon as it was safe to do so. Simon emphasised the importance of being ﬂexible and adaptable, practising good communication and having strong working relationships between the air ambulance provider and assistance company.

“The air ambulance transportation would have taken several hours back to the UK, and with no blood products available, the move would have proved extremely risky for the patient” An incident involving a 29-year-old-male with a five-day case of malaria being treated in Songo, South Africa, was put forward by Dr Charles Crawshaw of ACE Air & Ambulance. Trying to transport the patient proved to be particularly difficult due to the rural location, with factors such as a short 900-metre runway, no local immigration facilities (the air ambulance would have had to fly in via Tete to pick up the patient), delayed flight clearance and limited flight hours impeding ACE’s rescue capabilities. Eventually, ACE had to fly in two different transport vehicles to pick up the patient – the company’s King Air Ambulance, which would fly into Tete and await a road-to-wing patient transfer from a road ambulance, as the large air ambulance could not land on the 900-metre runway in Songo. The patient was eventually transported after nine days in the facility. After repatriation, the patient’s health improved, and he eventually fully recovered. Dr Crawshaw reiterated, that as an industry, improving flight clearance into less developed or military-governed countries is integral to improving patient access to care, particularly in time-critical cases, such as those involving malaria.

Dr Yann Rouaud, Group Medical Director of Airlec Ambulance, relayed an instance in which his team was involved in transporting a 75-year-old Jehovah’s Witness in a critical medical condition. The Airlec Ambulance was tasked with flying the patient with no blood onboard the aircraft, as per the patient’s religious beliefs. However, with acute gastric bleeding and at high risk of recurring acute gastric haemorrhage and cardiac arrest, the lack of blood proved to be tricky. Airlec organised a call with the client’s medical director in order to review the case; organised a comprehensive pre-flight briefing with the flying doctor and nurses to give an overview of possible limitations to medical care with regards to the patient’s religious beliefs; and also contacted the District Attorney to clarify the legal aspects of the repatriation pre-flight. Sadly, the patient suffered four cardiac arrests during the flight, the last of which proved to be fatal. Overall, Dr Rouaud hoped to offer up his experience so that the rest of the attendees could share in his learning. He highlighted that, although technology is an important factor, medical firms must respect patients’ decisions. In her example, Dr Ferial Ladak, Director of Global Medical Affairs at Global Excel, referenced the case of 63-year-old female who travelled to a developing country for an elective mini-gastric bypass. She explained that in her home country, the patient would have been denied the operation because she was a high-risk case. Once the treating facility had operated on her and decided that they could no longer care for her, they considered placing the patient in a public hospital, which was not covered by her travel insurance. Global Excel was eventually able to step in and transfer the patient to one of its large network of hospitals, and the woman’s insurance agreed to pay for some of the medical costs involved. The patient ended up staying in the hospital for 77 days before needing to be transferred home by air ambulance. Ferial referred to this instance as a case of ‘medical tourism gone wrong’ and discussed the importance of having full disclosure with patients, especially as the treating facility, having noted her high-risk status, should not have acted with profits in mind, rather than patient safety. Ferial concluded that it would be beneficial if the industry had an option that offered coverage for medical travellers. n

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EURAMI General Assembly and Members’ Meeting 2019 ITIJ spoke to the European AeroMedical Institute (EURAMI) to find out what went down during its board and members’ meetings during ITIC Global. Here’s their report:

t was a busy few days at Booth 14 for EURAMI – the most prominent global travel insurance conference did not disappoint, with 1,000+ participants this year. What better place to meet our valued members and interested providers? Once again, ITIC Global – serving as the ultimate crossroads of the provider and client community – was also the setting of the annual EURAMI General Assembly. Claudia Schmiedhuber, Managing Director, happily welcomed dedicated EURAMI members to discuss, debate and review the past year together. Accreditation and quality in aeromedical providers still hold a very prominent place in our industry, and it was evident that it’s not only aeromedical companies that beneﬁt from raising the quality standards for patient transportation and procedures; so do associated stakeholders such as assistance companies and insurance underwriters. With over 50 meetings held during ITIC Global, EURAMI has once again proven that there is a common interest in obtaining and accepting accreditation as the gold standard and vetting benchmark for the industry. President’s presentation On 28 October, the 34th EURAMI General Assembly was held in a room packed with members and interested guests. The EURAMI Board – Dr Cai Glushak, President; Philipp Schneider,VicePresident; Mark Chapman, Treasurer; Lisa Humphries; Franziska Hollenstein; and Sergio Abril – welcomed the membership and thanked them for their interest and participation. The presentation, led by Dr Glushak, reviewed the last year, including ﬁnancial results, new accreditations and re-accreditations, as well as an impressive list of achievements and developments. It was encouraging that the leadership actively addressed the industry’s concerns that there is a steady growth in the number of providers applying for EURAMI accreditation and that current members consistently continue to re-accredit. In particular, Dr Glushak noted that despite the

intense pressures on this highly specialised medical services field, the Board he had worked with was to be applauded for its objectivity and sole dedication to quality and safety. He also assured members that he would ensure that individual commercial interests are put to the side in favour of attention to quality care, patient safety and provider performance and reliability. This year also witnessed changes and developments within the organisation, including the official office’s move to Cologne and the change of leadership within the organisation. Claudia Schmiedhuber accepted the role of Managing Director in February 2019 after acting as Interim Manager, while Dr Mike Braida accepted the role of Chief Auditor following the resignation of Dr Terry Martin. In addition, Dr Simon Forrington was confirmed as the new Chair of the Standards Committee. The newly formed leadership, together with the EURAMI Board, is keen to further advance the organisation – becoming more inclusive and participative – in order to more effectively implement its mission and goals of improving quality and safety in the aeromedical industry. Some further key objectives for the upcoming year include the development and implementation of an updated scoring system, the increased participation and promotion of EURAMI at international conferences, a focus on the creation of a Corporate Membership and a relaunch of the institute’s website to make it more user-friendly and search engine optimised. Put to the vote The General Assembly also included some topics that needed approval by the membership, and were put to a General Assembly vote. The first vote was the approval of Dr Terry Martin as an Honorary Member of EURAMI. Dr Martin has led the organisation as Chief Auditor through many changes and has been crucial in the development of the EURAMI Standards for Fixed Wing Air Ambulances and Commercial Airline Medical Escorts. It was evident to the Board that Dr Martin should receive the Honorary Membership for his hard work and dedication to EURAMI and its mission. The General Assembly unanimously approved the request for Honorary Membership by vote. The second vote was to approve the updated fee structure that was presented to the members. The change was deemed necessary to ensure that the nonprofit organisation could further service its members, ensure long-term financial stability and promote its development initiatives. The fee structure was approved with no objections. The third vote of the day was to approve the updated and adapted Statutes, which reflect

the changes in accordance with the move of office and the legal requirements of incorporation in Germany. The Standards were approved by the attending membership. Panel discussion A first-time highlight for EURAMI members was the panel discussion that was held after the annual summary and vote. EURAMI assembled a highly respected group of panelists, consisting of Dr Nicole Bootsma of Eurocross; Dr Glenn Staples of MSO International; Dominic Rose of Capital Air Ambulance; Franziska Hollenstein of Prime Nursing Care; and Manuel Padilla of Helidosa Aviation Group. The topic was titled ‘Rest Times for Medical Crews in AA & CAME’ and the discussion was moderated by Dr Glushak. It was a lively and thought-provoking debate complemented by strong engagement from the audience. It was widely agreed that this was an important topic to be addressed in policy and best practice, but that the best approach would be to produce a publication – likely a white paper – based on available evidence. It became clear that topics like these need to be discussed more openly and that institutions like EURAMI should be proactive in promoting guidelines and best practices for such situations. The EURAMI Board would like to thank the thoughtful panelists for their contributions and insights. This was truly a successful and wellreceived premiere! That’s a wrap With the General Assembly successfully concluded and a busy week in the wraps, the ITIJ Awards on the evening of 31 October marked another highlight for the European Aeromedical Institute, as numerous EURAMI members were amongst the finalists. It is with great pride that EURAMI congratulates Air Ambulance Worldwide for winning the ITIJ Marketing Campaign of the Year Award. Congratulations also to FAI Air Ambulance and European Air Ambulance for being runners up for the Air Ambulance Company of the Year Award and, of course, congratulations to EURAMI Member Jet Rescue for winning this award! EURAMI is very proud of the achievements of its members and congratulates all the winners, finalists and the ITIC staff for once again organising such a great event. It was a truly successful and productive week for everyone in the EURAMI team and we look forward to reuniting with members and the travel community in sunny Madrid in 2020. n

ITIC GLOBAL 2019 | REVIEW

Networking

Served up in sustainable eco-cups, Global Guardianâ&#x20AC;&#x2122;s pre-conference coffees were well received.

A complimentary glass of wine or beer with lunch was provided courtesy of World Travel Protection on the busy second day of the conference.

ITIC Global remains the unrivalled event to get acquainted with the business register of the global travel and health insurance industry, and this year was no different.

AIG Travel sponsored a welcome coffee break, complete with luxury Maltese delicacies, including Cannoli, Imqaret and Pastizzi.

ITIC GLOBAL 2019 | REVIEW

Insurance premiums – are they right?

John Armstrong

Will McAleer

n the first of two panel sessions addressing this topic, John Armstrong, Head of Actuarial at Allianz Partners, started by explaining that an oversupply of providers and a competitive, costfocused marketplace has resulted in a downward pressure on premiums, and gave a list of possible drivers for medical inflation, which is significantly in excess of general inflation. At present, he explained, we are at the bottom of an underwriting cycle, with insurers providing comprehensive products with rich benefits. However, this may not be sustainable, and we will likely see a move to lighter benefits and higher premiums. Looking at key trends in global health insurance, John talked about how these are driving the way the industry will move over the next five years. Such trends include the increased blurring of local and global markets, stakeholders becoming more expert

in using their data, increased regulation, investment in new technology, changes in population dynamics – including an ageing workforce, new delivery of care patterns, political and economic uncertainties, and wider medical innovations that are likely to lead to more cost pressures for providers. It’s difficult to see any of these trends not having inflationary impacts for the industry and therefore consumers, said John. It’s also not clear whether existing pricing models can accurately predict, beyond crude means, the impact of these trends. This will lead to significant challenges for underwriters, actuaries and, in general, planning. The questions for insurers, though, said John, is ‘what should our products be covering as we move forward?’. Insurers and providers need to work together, concluded John, to manage cost pressures, through aligning benefits to meet but not exceed needs, managing costs prior to treatment, managing individual treatment costs, and embracing technology to manage risk. Will McAleer, President of World Travel Protection, followed with an insightful look at some

of the pressures currently affecting premiums, beginning with a review of some recent highcost remote evacuation cases carried out by his company, including a group from Everest. Travellers expect cover for such eventualities on standard policies, he said. However, travellers are changing. We face an ageing population with multiple and complex medical conditions; an increase in the use of illicit drugs, promiscuous activity, and other risky behaviours such as cliff diving; and the instant response/threat of social media focusing on travellers’ plights – and we are living in an increasingly dangerous world. Other premium pressures highlighted by Will include the cost of regulatory intervention and reputational risks for large underwriters, climate change putting pressure on assistance companies to respond and also on insurers to deliver ﬂight delay and cancellation cover, and technology demands. More people are buying insurance, said Will, as they are more aware that they need cover. Younger travellers need cover to meet their needs and enable them to do the things they want on their trip, so insurers need to make sure prices are right for all sectors of the market. Essentially, insurers need to deliver more value to customers, concluded Will – potentially pre- and post-travel, so they feel that buying travel insurance was worth it even if they didn’t need to make a claim. n

Insurance premiums – are they right? Continued

Michael Tauber

Pawel Sieczkiewicz

n the second panel session looking at factors affecting premium pricing, attendees heard about the various insurer behaviours that affect pricing and learnt about methods of reducing costs through telemedicine and reclaimables. First up, revealing the good, the bad and the ugly when it comes to pricing inﬂuencers, Michael Tauber, CEO & Managing Director of International Rescue Services, began by sharing the good things he has witnessed in the Australian market and beyond, including technological advancements and the use of big data. Parametric insurance now sees the likes of cancellation and medical claims being paid globally in minutes and is revolutionising the marketplace. At the same time, insurers are making use of AI to enable chatbots to deal with claims and customer questions. Such methods of providing and servicing insurance require fewer resources in the back end and can increase an insurer’s net promoter score. Further innovations that fall into the ‘good’ category discussed by Michael include proactive pre-trip advice for travellers that is speciﬁc to their destination, policy customisation around limits and excess ranges, medical underwriting for pre-existing conditions, effective cost containment methods, and options around pricing; including lead time pricing and offering a range of excess options. On the other side of the coin, some of the not-so-

Sabrina Chisholm

good things Michael has noticed include schedule of beneﬁts that obscure sub-limits, undisclosed depreciation allowances on covered items, cover declined for bookings not made on the ‘right’ type of credit card, and cancel for any reason cover, including time limit clauses. And the downright ugly, according to Michael, includes insurers refusing to cover mental health issues and other broad exclusions. In summary, said Michael, the best advice is to follow the words of Mark Twain and ‘Do the right thing. It will gratify some people and astonish the rest.’ Next, giving insights into how his company’s software can be integrated with that of any doctor in order to help bring down the cost of doctor visits for insurers, Pawel Sieczkiewicz. CEO of Telemedico, began by telling attendees about the Telemedico Medical Booth. This is a portable cabinet that can be installed in the workplace for employees to use instead of making a ‘stationary’ doctor visit, i.e. a visit to a doctor’s ofﬁce. The booths are equipped with telemedical devices and software that allow live patient monitoring and connection to a doctor through a video monitor. Whether using your own doctors or Telemedico’s doctors, the company’s software is available in web format and in an app, allowing medical consultations from anywhere. The system also gives

physicians recommendations, using its data, based on the symptoms provided by the patient, offering treatment advice or more information about the diagnosis. The benefits of the system include that the usage time of a doctor has been decreased by 22 per cent per consultation; the symptom checker makes it easier to find the right physician for each patient and can determine whether a stationary visit is necessary; and there is 88-per-cent accuracy via AI-based triage. With physical clinics offering their services between set hours and having potentially long wait times, the benefits of cheaper, faster, alwaysavailable telemedicine services are clearly beneficial for patients and insurers alike. Concluding this session, Sabrina Chisholm, Director of Travel Salvage, gave an insightful presentation on how her company can recover costs for insurers related to holiday cancellations. With such claims making up 34 per cent of all travel claims and costing insurers £145 million per year in the UK alone, recovering costs in this area is something insurers should consider carefully if they don’t already. Refundable cost elements, explained Sabrina, include concealed taxes, fees and charges related to flights, accommodation and holiday bookings – such as airport departure tax and tourist taxes – though around £4 million per year remains unrecovered in the UK. Travel Salvage boasts a 50-per-cent successful recovery rate, amounting to an average of £83 per claim recovery for UK trip departures and 70 per cent and £50 respectively for international recoveries. The recovery process necessitates exploiting travel and consumer regulations to increase recovery proceeds. To save any negative impact on the customer journey, Sabrina recommends settling a claim and then using the policyholder’s rights to recover cost elements on their behalf. n

ITIC GLOBAL 2019 | REVIEW

ITIC Malta marked the fifth annual Sharp HealthCare #LookingSharpITIC selfie competition. Attendees embraced the creative challenge to show ITIC life through a lens.

Thank you to everyone who took part! Now, we are thrilled to reveal the winning entry â&#x20AC;&#x201C; as voted for by fellow ITIC Global attendees Inez Dijkstra, Commercial Manager, AirLink Ambulance.

ITIC GLOBAL 2019 | REVIEW

Can other countries learn from the accountable care movement in the US? Data security concerns and solutions

pencer Livingston, COO of Global Guardian, discussed cyber threats and how they can affect travelling employees. He focused specifically on the communications aspect of cyber security, referencing the ways in which a business can be exploited by hackers through company email accounts. Spencer cited that the cost of responding to a cyber threat has risen by 60 per cent year on year over the past five years. He detailed a case study in which a cyber-attack on a Dubai-based manufacturing company took place. Hackers who had been monitoring the emails of the accounting department sent a payment request for around $800,000 – which ended up being transferred across.

“Travellers should be wary of public Wi-Fi networks and instead use phone data wherever possible” He concluded his presentation with an ABC of what travellers can do to protect their phones when travelling abroad. A good VPN is key, he said, as this helps monitor and prevent phishing. He advised that travellers should be wary of public Wi-Fi networks and instead use phone data wherever possible. Finally, turning off location settings and being aware of how search history is tracked can also help deter cyber-crime. With these measures, he insisted, 60 to 70 per cent of these forms of cyber-attacks can be thwarted at the onset. n

Spencer Livingston

“[Healthcare] waste is being driven by excessive use of diagnostics, poor prescribing, errors and misaligned incentives” Michael Frank

Healthcare insurance and fraud trends

ichael Frank, Founder and President of Aquarius Capital, began his presentation with a brief overview of the history of healthcare in the US, with specific reference to healthcare laws that have been passed, as well as the health insurance ‘food chain’. He listed some of the more common healthcare provider fraud schemes, including billing for services not rendered, misrepresenting claims information, incorrect reporting of diagnoses, and procedural corruption. Michael revealed that, in his studies, it had become clear that fraud was greater in countries that had a higher healthcare GDP. Michael also noted that, with insurers moving towards more quickly resolving claims, there was a larger window for fraud, and that though healthcare inflation sat between eight and 12 per cent, price inflation in healthcare had only really increased by one or two per cent a year. Therefore, he reasoned, the remaining six to 10 per cent was likely coming from fraud. Michael cited an increase in the number of large claims; as per the Tokio Marine HCC announcement that was released in April this year, there was a 28.3 per cent average annual growth rate of claimants in excess of $1 million. Divulging his own experience of fraud in the healthcare system, Michael noted that the implantable device industry is a huge player in fraudulent healthcare claims. He spoke about his two-hour hip replacement procedure, which required him to stay in the hospital for under 24 hours. Within the hospital in-network bill, he pointed out that he had been billed at 47 times the cost of the service that the hospital had paid for his care, essentially having been required to pay for 11 hips. Michael recommended that health insurance be redesigned to ensure that technology can be increasingly implemented to help monitor the care that individuals receive; and said that tracking member utilisation of healthcare services would help detect anomalies in data and, as such, help prevent fraud. n

ohn Lee, Executive Director of Aetna, addressed the beneﬁts of implementing an accountable care ethic in countries across the globe. Accountable care, he explained,involves maximising value for patients, reducing the cost per capita, and overall, improving access to healthcare. John detailed that with a rise in ageing populations, spending is increasing, but value is not going up at the same rate, and so accountable care would be a viable solution that would address this imbalance.

In the US, there are currently about 75 accountable care organisations, but waste in the health system is estimated at 25 per cent of the total spend. John extrapolated that this waste is being driven by excessive use of diagnostics, poor prescribing, errors and misaligned incentives – all of which affect patients. As a solution, John suggested changing the incentive structure to prevent and share risk, which in turn would improve the quality of care, create sustainable savings and engage the workforce. Creating a culture to catalyse change empowers patients and families and ensures that incentives are aligned between both the provider and the payer. “The size of the price is really worth driving for, but the journey isn’t easy,” he said. n

John Lee

ITIC GLOBAL 2019 | REVIEW

Improving the air ambulance commissioning process

r Eugene Delaune, Chief Medical Officer at Generali Global Assistance, provided an overview of the air ambulance commissioning process from the consumer health perspective, detailing the development of Generali’s global 3AT tool, an air ambulance auction tool that supplies the user with a pool of air ambulances to choose from.

He explained that the tool considers providers that are the most economical (not necessarily the cheapest), of the best quality, and the most reliable (in that they could be trusted to deliver when they say they will, and will be available even in times when services are limited). Dr Delaune said that the Generali team conducted its own primary research when selecting the air ambulances listed in the tool. For providers, Generali’s tool is convenient, as they know that Generali will pay them on time, and that they will be fair in how they commission the services, said Dr Delaune. For Generali, the tool provides pre-negotiated prices that providers can come in lower at if they’re experiencing low business. It’s a win-win for all, he surmised.

commissioning process. She explained that discerning certain pieces of information at the quote stage helps ensure resources are not wasted and costs can be better managed. Determining the route can enable the provider to choose the best airports and flight options; identifying the age and gender of the patient allows the provider to employ the right medical facility (paediatric teams are more expensive, elderly patients may have more complications and there might be additional gender considerations); and providing a correct diagnosis should not be undervalued, as this could also help determine what kind of transportation the patient requires – either bed-tobed or tarmac can be determined with the aid of the operator on the line. In addition, information about the sea level is paramount in determining the amount of fuel needed, while additional ground transportation can inflate costs if it hasn’t been included within the initial quote, Eva said. She added that further information, such as the patient’s passport and visa information, the specific address of both the start and end hospital and a current medical report can prevent any unhelpful delays. All of this information will not only ensure that the patient receives the most appropriate care, but will also help the air ambulance provider to better practise cost containment. Seek advice in aeromedical matters when you’re not sure, she reiterated; communication is always key in ensuring a smooth service.

Eva Kluge, Chief Commercial Officer at Air Alliance Medflight GmbH, discussed how providing detailed information at the point of quote when choosing an air ambulance provider is integral to improving the air ambulance

Looking at misunderstandings, communication pitfalls and ways in which related challenges can be overcome, Patrick Schomaker, Director, Sales & Marketing, European Air Ambulance, detailed the air ambulance commissioning process from the

Dr Eugene Delaune

Eva Kluge

Patrick Schomaker

“Communication is always key in ensuring a smooth service”

“The ground ambulance is often something that is underappreciated and underestimated” point of view of the air ambulance team and the medical provider. Similarly to Eva, Patrick also highlightd the importance of discussing options with the medical provider in advance. “The ground ambulance is often something that is underappreciated and underestimated,” he said, noting that ground ambulances are often neglected in patient transportation plans and, as such, are unable to provide the level of assistance that they could potentially give. Patrick reasoned that cost savings come down to successfully combining services, such as running two missions back to back and the use of empty leg offers. Again, he emphasised that it is important to ask about combination possibilities as early as possible. To summarise, Patrick explained that it is best to let the air ambulance company choose the airport, that the medical conditions of the patient should be discussed as early as possible with the air ambulance provider, that hospitals on both ends should also be informed as far in advance of the situation as possible, and that choosing a ground ambulance familiar with the transportation route were all considerations that would ensure the best patient outcomes and the best methods of containing costs. n

ITIC GLOBAL 2019 | REVIEW

Air Ambulance and Medical Assistance Forum The second Air Ambulance and Medical Assistance Forum was held at ITIC Global and moderated by Andrew Lee of Rescue Wings Malta. Delegates – assistance companies and operators alike – presented a variety of informative case studies. Dr Winston Jong Group Medical Director and Group CEO, EMA Global

Mike Asimos Managing Director Aspen Medical International

Eva Kluge Chief Commercial Officer Air Alliance Medflight GmbH

Dr Franz Bernhardt Physician, RMSI

Alex Veldman Medical Director, Jet Call

Melanie Veloso COO, MSH International/Ingle International

irst up was AMREF’s Dr Bettina Vadera who presented a case study on a known substance abuse patient. The decision-making process was based on poor communication from the treating hospital. The suitability and capability for transport had to be assessed using insufficient medical information before a delayed air ambulance was arranged.

“It is common practice in some areas for air ambulances to be pushed when travel insurance is involveld” Next, EMA Global’s Dr Winston Jong covered how to deal with unscrupulous local providers and how to optimise a critically ill patient’s suitability for a medevac transfer, while having a suitable back-up plan. Dr Jong explained that many challenges were encountered in Hilsa, Kathmandu and Malaysia. The first air ambulance was a noshow, he said, and a land ambulance was planned but ended up being delayed by a further day due to an alleged road accident. Two helicopters were used to transport the patient and family members to Kathmandu, but were delayed due to bad weather, necessitating a further hospital admission. After four days, the patient finally made it to Kathmandu, where a wing-to-wing transfer to Malaysia took place. The next case study was presented by Aspen Medical International’s Mike Asimos and Air Alliance Medﬂight’s Eva Kluge. They recounted the story of a 22-year-old Libyan female in need of treatment for a ruptured giant basilar tip aneurysm requiring an urgent transfer. Challenges faced included the absence of functional banking facilities in Libya, a problematic visa process in Tunis and Germany, the closure of the receiving hospital’s international department at the weekend, and the fact that neither guarantee of payment or

Dr Bettina Vadera Chief Executive & Medical Director, AMREF

cash were accepted by Hamburg Hospital. All of these factors led to a lengthy delay. RMSI’s Dr Franz Bernhardt took to the podium next to present the interesting case of a patient handover dilemma. This involved a 59-year-old male contractor working at a remote site where medical care did not meet appropriate standards. There were a number of challenges, including a possible discrepancy between the medical report and the patient’s condition. Dr Bernhardt discussed how communication between the referring clinicians and the air ambulance team could have been improved. JETCALL Air Ambulance’s Alex Veldman discussed the early discharge of a premature baby in Barbados. The fascinating case study raised a number of questions. One interesting discussion point was whether the surprisingly early discharge to a hotel room from NICU could have been more actively managed. In addition, whether a regional air ambulance to the US shortened the time to appropriate medical care. A successful conclusion was reached, with a long haul aircraft air ambulance flight to the UK. Last, but by no means least, MSH Assistance’s Melanie Veloso presented the case of a 26-yearold Canadian lady who was travelling in Belize on vacation with her partner. Whilst hiking in a forest a branch fell and hit her in the right eye. She was rushed to the nearest medical clinic where a diagnosis was given: severe oedema of the eye with hyphema. Following a number of difficulties, the patient was eventually transferred by air ambulance. The findings

post-case review were as follows, said Veloso: the air ambulance to Bascom Palmer Florida was unnecessary. On arrival to Florida, the patient was found to have mild laceration of the right eye. She was discharged with instructions to rest and apply medication; no intervention or major treatment was needed. The conclusion is that it is common practice in some areas for air ambulances to be pushed when travel insurance is involved. This is because air ambulance representatives, treating doctors, facilities and so on are involved in receiving kickbacks/commission. The case studies were well delivered and made for interesting debate from the floor. An insightful forum! n

ITIC GLOBAL 2019 | REVIEW

Networking

NETWORKING LOUNGE The specially curated Networking Lounge hosted by Commercial Medical Escorts formed a central hub for organising important business meetings, forging new connections and rekindling old ones.

Elaine Yturralde, CFO, and Blake Yturralde, President, Commercial Medical Escorts.

ITIC GLOBAL 2019 | REVIEW

Workshop: Traveller security

n the Wednesday afternoon workshop, panel members from Healix International, beTravelwise and WorldAware discussed how both individuals and companies are managing the risks of corporate travel. Bruce McIndoe, President and Founder of WorldAware, took to the podium to describe the environment in which his organisation is currently operating, in terms of conflict and travel risks. He highlighted existing areas of conflict in the world, explicitly referencing the prominent regions of Europe and Asia. He explained that areas in which active kinetic conflict is happening on a global scale are those that pose a high risk to travellers, and touched upon the territorial disputes in the South China sea, affecting areas such as Vietnam, the Philippines and Taiwan. Reflecting upon the risks of global terrorism, Bruce presented an insightful yet alarming view of projected security threats coming up in the next few weeks based on current world affairs, predicting a terrorist response to the actions of the US in Syria. “Warning is foreknowledge of terrorism,” he said. What can and should be done? Bruce advised that organisations protect their operations and clients through the use of a continuous risk management programme and continuous monitoring of potential risks such as protests and strikes. Determining which assets may be impacted – including people and locations – certainly helps, as does determining who is responsible and if you can act on the intelligence, he said. Finally, Bruce cautioned, be sure to learn from previous instances; an improvement plan in place that evaluates policies and procedures, and includes training, is paramount to success. “If you’re not evaluating the outcomes … then you are not improving,” he warned. Offering a view of pre-travel risk briefings, Juan Peña Núñez, Business Development Director for Healix International, looked at the provision of medical assistance in challenging environments from a corporate business travel perspective – fitting for the ITIC setting. He analysed what businesses can do to help staff prepare for safer travel. He noted that, although many companies purchase a corporate business policy, not all employees necessarily know how to access them, or are trained on how to use them. Juan insisted that, in difficult travel environments, the biggest challenge faced by an assistance company is setting and meeting client expectations. Especially when troubling situations arise, Juan noted that for Healix International, not being able to pre-plan how to respond can be frustrating, and so the company will provide a reactive service,

gathering information and providing support as the situation unfolds. He explained that how well prepared a company is can play a major role in the support that Healix can provide, but if a company has not briefed the employee in advance, this task can become much harder. When it comes to the provision of medical assistance in challenging environments, even the most thorough plans can go awry said Juan. Director of beTravelwise Saul Shanagher discussed global risks for solo travellers. He highlighted that, as a corporate manager might not necessarily know each employee’s lifestyle choices, it is integral that companies do not make assumptions about certain individuals, but instead ensure all travel information is available to every individual corporate traveller. For LGBTQ+ employees particularly, Saul noted, this technique can enable them to make a risk assessment of their own based upon information that they may choose not to share with their employer. Saul went on to present a series of ‘risk maps’ from different providers, including International SOS, AIG Travel and Falck Global Assistance, as well as identifying some of the more common risks solo travellers faced such as traveller’s diarrhoea, petty crime and road traffic incidents. Saul also detailed the countries that have imposed rigid antihomosexual laws and highlighted the risks faced by LGBTQ+ travellers in these regions. He ended his presentation by exploring the ways in which technology could be used to help mitigate risks. When opened to the floor, the discussion centred around the potential risks associated with LGBTQ+ travellers. Delegates highlighted that as programmes mature, these risk mitigations improve, and that technology has proven to be an invaluable resource in helping manage and prepare for these travel risks. Bruce reasoned that although the LGBTQ+ demographic has increased as a risk profile, it still only makes up a minority of incidents for WorldAware. And Juan expounded this view, detailing that in his 20 years of operations he has only come across two homophobic cases (although this is arguably two too many). The discussion then shifted to a focus on motor accidents as one of the highest risks for travellers. The panel covered the rules and regulations of different countries and the fact that travellers are often unaware of these. Overall, the panel concluded that businesses should do all that they can to provide employees with the resources required to stay safe, but, ultimately, the onus is on the individual traveller to practise safe and responsible travel. n

Bruce McIndoe

Juan Peña Núñez

Saul Shanagher

ITIC GLOBAL 2019 | REVIEW

KARAOKE & NETWORKING Karaoke provided the perfect opportunity for delegates to let their hair down and channel their inner Madonna. Hidden talents emerged as delegates took to the mic to belt out their favourite songs. The night, hosted by Commercial Medical Escorts (CME), afforded delegates a great opportunity to network in a relaxed and fun environment. Blake Yturralde, CEO of CME, said of the event: â&#x20AC;&#x153;Many of us attend these conferences for networking opportunities and what a better way to get the attendees together than a fun night of karaoke, singing, laughs, dancing, drinks and still exchanging business cards. Thanks so much to the ITIC team for assisting us in making this event a success. We look forward to many more years of singing together with our friends from the industry.â&#x20AC;?

Mid d le: Bla k e Ytur r a ld e, CEO a nd Ela ine Ytur r a ld e, Dir ector of CME

ITIC GLOBAL 2019 | REVIEW

Provider Network Forum

osted by Laura Hilton, Co-Founder of Fairmount International, and Rory O’Gara, Vice-President, Medical Provider Management, Allianz Partners, the forum began with an informal Family Feud-style gameshow, in which payers and providers went head to head answering a series of ITIC-related questions.

“Negative customer experience is something that insurers desperately want to avoid” Laura then opened up the discussion, drawing upon a number of different issues affecting hospitals, clinics and insurance partners. The forum’s first topic identified particular factors that hinder providers’ operations, including insufficient communication about coverage, particularly when it comes to preexisting conditions, and the differences between travel policies and health plans. The medical providers highlighted that having a table of benefits – which could be accessed on the website, for example – would be particularly helpful in clarifying the coverage included, as geographical delay in email or phone communication can hinder patient assistance and claims clarity. However, payers noted that there is sometimes

a reluctance to share exactly what is covered in a policy as this could encourage fraud through overtreatment and exploiting of benefits. Instead, providers suggested that standardising definitions within policies, such as categorising different treatment needs, would help tackle cost discrepancies. The second topic explored the growing challenges surrounding medical provider billing in Mexico, with providers in Mexico increasingly leaning towards US cost structures. Some medical providers in the region will refuse to treat patients without a guarantee of payment (GOP), then after treatment, will inflate the cost to three times the original agreed GOP, and harass the patients for this cost. This negative customer experience is something that insurers desperately want to avoid, but they also need to balance this with reasonable medical costs. The panel asserted that hospitals were likely discriminating against patients based on their nationality. It was suggested that many Mexican hospitals were not honouring the national agreement to allow a central organisation to do their hospital billing – one which was originally instated to ensure fair medical pricing. Instead, hospitals will get the patient to sign a disclosure agreement saying they are happy for a different company to do the billing for the hospital, and so the medical costs are extremely high. Moreover,

“There is sometimes a reluctance to share exactly what is covered in a policy as this could encourage fraud” although the Procuraduría Federal del Consumidor (Profeco) exists to put some legislation in place, the organisation is conciliatory and exclusively represents the consumer, and so insurers are not able to file a complaint to Profeco. As a solution, the panel discussed instating legislation making it difficult for organisations in Mexico to carry out these activities, but more importantly, they highlighted that communication with both Mexican hospitals and travelling insureds is key to tackling the conflict. And so, the forum came round full circle, highlighting the importance of enforcing positive relationships between providers and payers as one of the key solutions to ensuring fair prices for all. And though both teams performed spectacularly, not everyone can be a winner. With two rounds and 174 points, the international provider team came second, while the payers were crowned the victors of the Provider Network Forum, with three rounds and 255 points. n

Medical and dental claims fraud – training for claims handlers

n entertaining presentation from Phil Peart, General Manager of Travel Claims Investigations for MJM Corporate Risk Services, gave clear insights into why training for call handlers is very important and highlighted some of the key indicators to look for when identifying medical, dental and major accident claims. There are many opportunistic, repeat and organised fraudsters in the travel insurance sphere, said Phil, including those who put in claims just to try and get back the cost of the airfare they’ve forked out on. Besides using such tools as voice stress analysis and conducting link analysis to check for connections between claims that could highlight fraud, there are some key red ﬂags to look out for that could indicate fraud, Phil warned. These

include: claims for surgery where this has been carried out on the same day as an alleged accident, handwriting or signatures on medical documents and receipts that are the same, and receipts lacking vital information. Insurers need to look at medical and X-ray records, especially on high-value claims, to validate the timeline of events; validate that the staff signing the receipts actually work at the medical facility; and even where ofﬁcial hospital documents are used, make sure the patient was actually treated at that facility. Concluding, Phil said to make sure you validate your providers and that they’re qualiﬁed to do the work on the receipt. Insurers also need to be aware of trends that attract fraudulent activity, such as when a new iPhone is released. n

Phil Peart

ITIC GLOBAL 2019 | REVIEW

Networking

RECHARGE LOUNGE A new addition to ITIC Global, UnitedHealthcare Global’s Recharge Lounge and Oxygen Bar proved to be extremely popular with attendees. A place to ‘refresh, energise and inspire’, the Lounge offered a comfortable area to hold relaxed business meetings and garner a little ‘clarity of mind’ from the on-tap oxygen. Throughout the conference, anyone who downloaded the Optum My Wellbeing app and registered to use it was entered into a draw to win an Apple Watch. UnitedHealthcare is pleased to reveal that the winner of this prize is Amy Villalobos of nib!

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL

INDUSTRY AWARDS 2019 The 17th annual ITIJ Awards took place on the ﬁnal night of the conference at the Finale Dinner of ITIC Global in Malta. Hosted by ITIC Chairman and ITIJ Editor-in-Chief Ian Cameron and ITIJ Editor Sarah Watson on 31 October, the event boasted a suitably spooky theme. It was a fantastic evening of celebration designed to recognise and celebrate excellence in the industry. With live music and dancing, delicious food and drink and, of course, the hotly anticipated announcement of this year’s winners, it was a night to remember.

The Judges

“Thank you everyone who attended the ITIJ Awards. You are a fundamental part of making the night what it is – a vibrant event where the global travel and health insurance community is all under one roof. I’d like to personally congratulate this year’s winners – a huge well done! And I’d also like to extend my congratulations to the ﬁnalists. We received an extremely high quality of entrants, which is testament to the level of innovation and excellence within the industry. It’s been a fantastic year and I wish you all a wonderful 2020,” said Ian Cameron.

The ITIJ Awards judges consist of a panel of men and women from across all sectors of the global travel and health insurance industry – from underwriters to insurers, and from air ambulance professionals to consultants – including those currently active in the industry and those with a rich career history in it. The ITIJ Awards judging is carried out conﬁdentially and, as such, many of our judges prefer to remain anonymous. However, the core panel includes: Dennis Peckham, a travel insurance consultant, formerly with Mondial Assistance; Steve Wilcox, a chartered insurer, formerly with AXA; Louis Wright, Director of Sales & Marketing for Calastone, formerly with Luxembourg Air Ambulance; Ernie Jones, an industry consultant, formerly with Mercury Insurance/Assistance; and Milan Korcok, ombudsman, journalist and founder of the Travel Health Insurance Association of Canada. Many thanks to all the 2019 ITIJ Awards judges!

You can watch the 2019 ITIJ Awards on demand at: www.itij.com/awards

2019 ITIJ Awards Finalists

Thank you to the 2019 ITIJ AWARDS SPONSORS

Thank you to nib for the evening’s entertainment

Thank you to Sharp HealthCare for the evening’s photobooth

ITIJ MARKETING CAMPAIGN OF THE YEAR SPONSORED BY

ITIJ MARKETING CAMPAIGN OF THE YEAR AWARD WINNER - Air Ambulance Worldwide Congratulations to the runners up in this category: Marm Assistance & New Frontier Group

Air Ambulance Worldwide is a world-class medical transport company with bases in Clearwater, Florida and Washington, Pennsylvania. Our reputation as a leader in the critical care transport ďŹ eld comes from the fact that we consistently combine uplifting care with outstanding support on every air ambulance mission we ďŹ&#x201A;y.

Thank you to our colleagues who we were working with on this campaign, and also to Mike Vallee, Vice-President of Business Development for Air Ambulance Worldwide. And thank you to ITIC for a great conference and to the Award sponsor Rescue Wings Malta, I appreciate it.

Lauren Dulin, COO, Air Ambulance Worldwide