Aviva’s Medical Director, Dr Doug Wright, talks recent healthcare developments and how they impact you and your policy.
As the Medical Director of Aviva health, what does your role involve?
In essence it means I’m the lead doctor for Aviva health and it makes me responsible for making sure that we understand how healthcare is delivered and that we help our customers access effective, personal care.
I’m in contact with all different parts of our business including our customers and how our policy and products are working, so it’s a very interesting role.
The term Open Referral is now very common, what does it really mean?
Open Referral is a piece of jargon that’s used an awful lot nowadays but it really simply means that if you go to see your GP, they will refer you for a certain test or type of treatment but not to a single named consultant. The NHS has moved quite considerably in the direction of Open Referral because it helps them allocate patients to the most appropriate consultant.
Is Open Referral a better way for GPs to work?
Yes - I think we hold in our head an image of a GP who’s our family doctor and the person you see whenever you go to the GP surgery, but I think that’s actually very rare nowadays. There’s a lot more part- time work and GPs picking up a lot of different responsibilities, so most GPS aren’t fully aware of the range of consultants in their area who may offer different types of specialism or treatment.
How does Open Referral benefit patients?
I think the main benefit is that, whether in the case of the NHS or in the case of the insurance company, we can look at the range of options that are available and filter down complicated information around performance, waiting times and service levels so that you’re given a much more guided option of who you should see and which hospital you should go to.
How is Aviva introducing Open Referral for its 1 million Private Medical Insurance customers?
What we’ve done with open referral is really goes back to the people who are doing the work that customers are interested in - the consultants and the hospitals. We’ve developed a much more sophisticated view of which consultants are doing which techniques, which hospitals are able to perform that, and what the total cost of that is.
So we now offer open referrals to all of our customers. If a person requiring healthcare gives us a call and their GP hasn’t named a particular specialist, we ask them a few questions to find out what their problem is, or what type of specialist they need, and then we use our analysis of the data to tell us which consultant and hospital combination is most appropriate for them. We also have a specific open referral product for large corporate customer schemes – we call it Guidewell.
Our customers will often find that if they’ve called us for a new referral, we can help them find the right consultant and then transfer them directly to the hospital to make that first outpatient booking as well. So we’re making the process as simple and easy for our customers to access as possible.
My expectation is that open referral will become the way the market works over the next 3 – 4 years and as we develop experience and confidence in how Guidewell is working, I’d expect us to enable other customers to access that type of service as well.
What about other key trends in healthcare - what are the latest advancements in cancer treatment?
Cancer treatment is always advancing, I don’t think there’s ever a day that you pick up a newspaper or turn on the radio and don’t hear about a new treatment.
The ones that are headline-grabbing are always the new drug developments. But it’s not just drugs. Radiotherapy is moving on, surgical techniques are moving on - nowadays you get much more access keyhole surgery –there are also new tests available for cancer. For example, more sophisticated scanning now allows us to pinpoint the cancer and whether it’s spread, and to target treatment in a different way.
These new treatments are generally expensive, can we afford them?
There is a challenge on any healthcare system as to what the absolute level of affordability is for new treatments. That’s the reason we see decisions being made in the NHS about some drugs - while they can see that they work, they just aren’t affordable.
I think that does make people worry about what the level of cover from the NHS might be. And while the issue of cost-effectiveness hasn’t carried over into the private sector in quite the same way – one of the benefits of having private medical insurance is that they can access drugs that are over and beyond what the NHS can make available – there is a challenge around how affordable it remains.
At the moment customers often see cancer benefits under their private medical insurance policy as really valuable and for now they can afford it, but people don’t have endlessly deep pockets. So us making the right decisions and talking to our customers about what extent of cover they need is really, really important.
The Competition and Markets Authority (formerly the Competition Commission) have just completed a 3-year investigation into private hospitals in the UK. What did they conclude?
Back at the beginning of April the Competition and Markets Authority published their final report on the investigation in to how the private hospital and consultant market was working. In summary their conclusion was that it was not working as well as it should do for customers – both patients and insurers. They identified 3 main issues.
The first of them is local concentration. This is where one owner of a hospital group has such a strong presence in a particular area that to they seem to be acting more like a monopoly supplier than a competitive market. The only area in the UK that was identified as possibly working in that way is London, but there is an appeal process underway from the hospital provider in London that was identified, against that finding.
The second thing they found was that across all of the UK, private hospitals had been offering incentives to consultants to work for those private hospitals. Those incentives ranged from investments in hospitals to cash payments, and it was identified that those weren’t good features of the market because they could potentially influence what should be good clinical decision making. So there is, broadly speaking, going to be a ban on any types of those incentive schemes being offered in the future.
But the most exciting finding from our perspective is the bit that’s around information. What was missing in the market was really good information about the performance of hospitals and consultants, and there was also a little bit of lack of visibility on the fees that consultants charge for their services.
Now the CMA is looking at putting an order in place that will create an independent information organisation that will make this information publicly available on a website. The order itself will become active next year, and there’ll be a phased plan as to what information will be made available, and that will roll out over the next few years.
What benefits or changes will private healthcare customers see as a result of these findings?
I think the key thing they will achieve is making the market work in a different way. Rather than competing to attract consultants to work in their hospitals – because that’s how hospitals attract patients – they’ll be competing on what they should be competing on, which is a mixture of quality and price, just like any market.
But what really excites me for our customers is the provision of information. I think healthcare is lagging behind in the development of the appropriate information, and this is the piece that has been missing. It will for the first time allow for proper comparison between the quality of treatment that is provided by different hospitals and different consultants. So insurers can then make sensible choices around how we help our customers get to the right treatment, the right consultant and the right hospital for them - and individual patients will be able to see that information as well.
Finally, what can we expect to see from Aviva Health in the next few months?
We’re focused on helping customers get to the right care for them, and the main way of doing that is of course through continuing to work and develop our Guidewell scheme, but also through managing our day-to-day relationships. For example we’re moving things on with our contracting with hospitals so it’s much more focused on the quality, safety and experience that customers have and not just on the pricing that we agree with the hospital groups. We’ll be continuing to develop a quality experience for all our customers.