What will it take to ensure a healthy recovery from COVID-19?
The pandemic has tested individual, societal and economic resilience over the past two years. Any talk of recovery therefore needs to tackle all three dimensions. With this in mind, The Geneva Association’s 2021 Health & Ageing Conference, co-organised with AXA, convened representatives from across the insurance industry and beyond for discussions structured into three discrete yet complementary parts: the first focused on the direct lessons from COVID-19 through the prism of society and health; the second dealt with the pre-existing forces accelerated by the pandemic to reshape health, well-being and longevity; and the final segment addressed the ‘so what?’ question for life and health insurers, with examples and insights from senior industry figures.
Opening address: Claudio Gienal
Claudio Gienal, CEO, AXA U.K. & Ireland.
Claudio Gienal set the scene by emphasising three areas. Drawing attention to the AXA Research Fund’s work, he underscored the need to strengthen preventative care, invest in new data and knowledge to strengthen care delivery and pay greater attention to the links between climate change and health.
New technology is vital to better designing and delivering health and elderly care. Virtual health consultations, technology-supported remote care management of the elderly, or even AI-powered cancer diagnosis, have been welcome innovations, but there are two critical challenges with their scalability: 1) issues of consumer trust in technology and data sharing require insurers to be more transparent; and 2) making digital health tools more accessible for hard-to-reach customer segments. Tackling these issues are a prerequisite for making technology more impactful for overall population health and well-being.
Session 1: Taking Stock of the Societal Impact of the Pandemic
(Top) Marie Bogataj (Moderator), Head of the AXA Research Fund and AXA Group Foresight; Anne Boring, Head of Women in Business Chair, Sciences Po. (Bottom) Thomas Holzheu, Chief Economist Americas, Swiss Re Institute; Kai Uwe-Schanz, Deputy Managing Director, The Geneva Association.
The pandemic has exacerbated pre-existing inequities in societies. Women, new entrants to the labour market, lower-income populations and ethnic minorities have been hit the hardest. The gender gap has widened, largely due to disruptions to industries that heavily rely on a female workforce and women having to leave their careers, e.g. to fulfill childcare responsibilities. A protracted period of social restrictions has hindered skills development opportunities and further exacerbated pre-existing inequalities.
In mature insurance markets, the loss of employment and consequently employer-sponsored health insurance created new vulnerabilities, while social safety nets also came under pressure. While the phenomenon was global, the majority of the protection gaps are observed in emerging Asia-Pacific. Globally, despite a growing perception of health and mortality risks, data show a disparity between consumer prioritisation of health and life insurance and actual purchasing decisions. As part of a Geneva Association global customer survey, 40% of retail customer respondents underscored the importance of health and life insurance in a post-pandemic world, yet only a fifth intended to buy more coverage.
Session 2: A Spotlight on Vaccines – How will they shape health risks?
Alfred Beil (Moderator), Group Chief Medical Officer, AXA; Christine Stabell Benn, Professor, University of Southern Denmark.
The polarised vaccine debate warrants a nuanced understanding of the role it plays in overall health and well-being. Professor Dr Stabell Benn illustrated how COVID-19 has motivated researchers to explore the beneficial and non-beneficial effects of vaccines more comprehensively. As a result, several ongoing trials examine the effects of live vaccines (e.g. measles or BCG for tuberculosis) on susceptibility to COVID-19 infection among adults. But new gaps have opened up and with it new risk exposures. The dogged vision on COVID-19 vaccine roll out has led to childhood immunisation programmes lagging behind, despite their favourable effects on mortality and morbidity.
There is an urgent need to broaden public discourse on vaccines and infections as well as to acknowledge the effects different vaccine technologies have on overall immunity. In particular, live vaccines, which introduce a weakened form of the disease to the body, have the potential to strengthen overall immunity in the long run. Yet the race towards the development of non-live vaccines against specific diseases may compromise a more sustainable approach to preventing infectious diseases or studying their long-term effects.
Session 3: Health and Health Systems – What did COVID-19 hurt the most?
(Top) Helen Colhoun, Professor, University of Edinburgh; Shekhar Saxena, Professor of the Practice of Global Mental Health, Harvard T. H. Chan School of Public Health. (Bottom) Joan Costa-Font, Associate Professor of Health Economics, LSE; Annabel Bentley (Moderator), Chief Medical Officer, AXA Health.
The session delved into three health impacts of COVID-19: non-communicable diseases (NCDs), mental health and elderly care. It started by focusing on the epidemiology of COVID-19 to identify segments most at risk and causes for the accelerated spread of the virus. Besides widely-known risk predictors such as NCDs, care settings themselves played a role, with the lack of ventilation in hospitals or care homes and inadequate protective equipment for staff driving infections. But instead of focusing on these factors, policy attention was often diverted to less consequential measures, such as mask mandates in schools, often with misleading public health messages.
The lack of prioritisation and risk differentiation mean that health systems globally now face a mounting backlog of routine care. Policies need to adopt a more risk-differentiated approach for managing public health crises in the future.
COVID-19 has also been responsible for widespread deterioration of emotional well-being across populations, fuelled by financial insecurity, social exclusion, school closures, fear of infection, bereavement and more. The prevalence of depressive symptoms has increased three to four fold in several OECD countries, with a particularly stark impact among the young and economically vulnerable. This necessitates mental health being positioned at the core of any future pandemic response, with services being made available in schools and workplaces.
Another cohort who endured disproportionate risk exposures are the elderly, who are 13 times more likely to contract COVID-19 than their younger counterparts. Here too, policies fell short of protecting this group. For example, in Spain, over half of all deaths occurred in nursing homes, often due to factors such as occupancy rate, funding adequacy and use of temporary staff.
Session 4: Longevity and Retirement – Disruptive technologies and their influence on practice
(Top) Emma Wilkins (Moderator), Research and Proposition Manager Global Health, RGA; Volker Priebe, Member of the Board of Management, Allianz Leben. (Bottom) Steve Woh, Chief Medical Officer Claims Manager, Global Health, RGA UK; Peter Joshi, Chief Science Officer, Humanity Inc.
Genetic medicine has implications for longevity and consequently for health and life insurers. An international, RGA-led survey of insurers, however, found that just 13% followed such developments closely, 20% contemplated further investment, and 63% reported that they were unprepared. Lifespan, though somewhat influenced by genetics, is largely driven by environmental factors, and the use of genetic medicine in insurance has serious practical and ethical implications when it comes to underwriting policies. More importantly, the proliferation of genetic technology warrants insurers not only to understand how it affects their business models but also to separate the wheat from the chaff. Yet curation of such interventions has not happened in a meaningful way at scale to understand its cost effectiveness.
For life insurers, genetic advances have introduced added complexity. Germans, for example, live seven years longer on average than their parents, yet they continue to underestimate their life, health and wealth spans. Life insurers have so far successfully navigated this space; annuity tables account for rising life expectancy, as they are built on a collective model. However, with genetics, the risk could be personalised. There is little guidance on how to deal with the more granular risk differentiation introduced with genetic data, customers’ willingness to share such data as well as regulatory and ethical considerations. Similarly, while advancements in genetic medicine and in particular diagnostics can help pre-empt risks through timely and preventative healthcare, balancing this with anti-selection problems is a key concern for health insurers. The eye watering price tags of some medical interventions are of concern too for health insurers. It is therefore opportune for the industry to come together to find ways to navigate its application, with scientific, regulatory and customer considerations in mind.
Session 5: Climate Change and Health – Are we prepared?
(Top) Maria McGowan, AVP, Global Underwriting and Claims Risk Management, Manulife; Gijs Kloek, Senior Manager Group Insurance Risk Management, Achmea. (Bottom) Sam Gutterman, Consulting Actuary, Society of Actuaries; Maryam Golnaraghi (Moderator), Director Climate Change & Environment, The Geneva Association.
According to official data, overall mortality from climate change appears low – partly due to countries’ mitigation strategies but also due to incomplete data. Understanding climate change’s true impact will require going beyond the absolute numbers of deaths reported from sources such as common death or hospital registers and analysing harder-to-access information.
The longer-term and little understood effects of climate change include worsening physical and mental health, displacement, care interruption and associated risks. Wildfires, for example, pose immediate acute risks, but also chronic risks such as respiratory illnesses from poor air quality. Currently, these are not adequately monitored or understood. In the Netherlands, cold-related mortality and suffering may decline until 2050 due to milder winters in northern Europe, but heat-related events might subsequently increase. Still, variability in temperatures may make these scenarios unpredictable. Therefore, risk diversification will be important for insurers.
Session 6: The ‘So What?’ for Life and Health Insurers?
(Top) Somesh Chandra, Chief Health Officer, European Markets, AXA; Adrita Bhattacharya-Craven (Moderator), Director Health & Ageing, The Geneva Association; Hidehiko Sogano, Managing Executive Officer, Dai-ichi Life. (Bottom) Catherine Foot, Director Phoenix Insights, Phoenix Group; Margaret-Mary Wilson, Executive VP & Associate CMO, UnitedHealth Group; Jonathon Broomberg, CEO, Vitality Health, Discovery.
This session explored how health and life insurers are leveraging data and innovation to do things better and differently – for their customers and their businesses.
Digitalisation and big data bring many opportunities for insurers. Discovery, for example, has moved beyond conventional insurer functions to deepen and personalise consumer engagement and promote healthier lifestyles by analysing health behaviours through data. Big data has also helped to deepen their understanding of healthcare provider behaviour and actively steer them towards efficiency and evidence-based practice to deliver better outcomes. This has enabled them to generate surplus from the risk pools and share rewards with consumers (lower premiums) and providers (higher reimbursements).
The health ecosystem developed by AXA and Microsoft highlights the value of joining up different tiers of care. Together they were able to integrate AXA’s digital health tools (e.g. apps, telehealth) and physical care to reduce episodic care. The platform has become a one-stop shop, with an improved curation of solutions to guide customers throughout the care journey and giving insurers better control of managing and monitoring outcomes through data.
The three pillars of Dai-ichi Life’s strategy – preparedness, protection and prevention – illustrate the important role of insurance in improving healthy life expectancy and lessening its longevity risk exposures. The strategy prioritises financial and health literacy, expanding coverage by leveraging data and artificial intelligence to better understand risks, and timely preventative interventions.
The UnitedCare Group emphasises the role of primary care at the heart of any future health insurance sustainability strategy. Eighty percent of the factors that influence health status and outcomes relate to community and home settings as opposed to clinical settings. The Group is therefore recalibrating care in three ways: 1) designing simpler referral pathways to seamlessly meet care needs in a diversity of settings, including virtual, physical and closer to home; 2) focusing on care quality and outcomes over volume; and 3) replacing episodic, fee-for-service payments to providers with value-based payments to incentivise better care management and outcomes.
Keynote speech: Andy Briggs, CEO, Phoenix Group
Andy Briggs, CEO, Phoenix Group.
The convergence of longevity and health presents several opportunities for life and retirement insurers. Harnessing them means challenging the longstanding doom-and-gloom view of longevity risk and making dramatic changes in attitudes, structures and approaches to healthy living. Retirement is “no longer a cliff-edge experience but a clear-cut, predictable and defined one”, with a quarter of people born today living until the age of 100. But increase in life expectancy, though cause to celebrate, is not enough on its own. The industry now needs to support new ways of working, saving and living to enable not just longer but happier lives.
Three of the company’s priority focus areas were detailed: 1) increasing awareness about the importance of financial planning and related interventions such as mid-career ‘check-ups’; 2) enabling people to save by offering age-inclusive work; and 3) pairing its longevity mission with the company’s net-zero ambitions, for example by ensuring that housing for the elderly meets standards for both well-being, such as adequate insulation, and sustainability.
Session 7: The Role of Data – The good, the bad and the ugly
(Top) Leena Johns (Moderator), VP Global Healthcare & Head of Health and Wellness, MetLife (MAXIS GBN); Stacy Borans, Founder & Chief Medical Officer, Advanced Medical Strategies; Alessa Quane, Chief Insurance Officer, Oscar Health. (Bottom) Timothy Shakesby, Head of Conduct of Business Oversight, European Insurance and Occupational Pensions Authority (EIOPA); Nigel Acheson, Deputy Chief Inspector of Hospitals, Care Quality Commission.
The final session discussed the role of data, bringing together the perspectives of an insurer, data analytics provider, health regulator and insurance supervisor. It was discussed how big data could be harnessed to support more intelligent purchasing of healthcare.
For Oscar Health, simple interventions, such as offering customers virtual consultations based on their app activities (e.g. researching services), reduced emergency care by 13%. Other types of nudges promote preventative and primary care, and algorithms help direct customers to quality providers at affordable costs, thereby mitigating the risks of catastrophic health expenditures.
Real-time data plays an important role in monitoring clinical standards and detecting early signs of deviation, but regulators face a two-fold challenge: the quality of data collected varies and the siloes between health, social care and socio-economic datasets make it difficult to paint a comprehensive picture of health outcomes. The ambition of the Care Quality Commission, an independent U.K. regulator, is to address this through an integrated, real-time data repository. But to ensure equity in the era of digital health, regulators also need to monitor the ‘data black box’ for algorithmic biases.
Insurance supervisors need to strike a balance between allowing data innovations to flourish and giving consumers the protection they need. Encouraging data-led innovations in risk prevention and mitigation strategies in health and life insurance could allay concerns about fairness and ethics that have often marred discussions in digitalisation in this space. Ultimately, however, while technical discussions with the supervisory or regulatory communities is a welcome start, societies need to decide how far they are willing to go with digitalisation and data to protect them from future risks.
Presentations and speakers booklet
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