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Warba Medical Insurance Services Portfolio

Warba Medical Insurance Services Portfolio

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  • Creating an effective health and wellness program means meeting your clients wherever they are along the health care continuum. We know that each person’s journey towards optimal health is different based upon their own health status and needs. Everyone falls into one of the following health categories or stages: Healthy and low risk At risk for disease or injury Managing a chronic condition Or, experiencing a major health event.

Transcript

  • 1. Corporate Profile July 2013
  • 2. About Warba Insurance  Kuwait Shareholding Company incorporated in 1976.  The fastest growing general insurance provider in Kuwait.  Listed on Kuwait Stock Exchange since 1983; Stock Code: WINS  Capital of KD 17.4/- million. (USD 62 Million)  S&P Rating : BBB - June 2013  Operating with the support of a wide network of branches & partners located in Kuwait & across the globe
  • 3. Table of contents I. Company profile and strategy II. Affiliates & Associates III. Clinical Health Management IV. WAPMED V. Apollo VI. Aetna VII. Q&A 3
  • 4. Warba Insurance Co Corporate Profile and Strategy
  • 5. Vision & Mission  Vision an organization that formulates and implements effective policy, provides timely and accurate insurance solutions, and is capable of providing a modern, interoperable, sustainable model that can exceed customer expectation whilst maintaining conservative underwriting of risk  Mission to provide effective insurance and risk management solutions that meet the evolving needs of the clients.
  • 6. Strong sustainable operations 6  Over the past few years, WIC has strengthened its position in its home market.  Earnings growth has been satisfactorily high, driven by strong cash flows, intensive underwriting activities and an underleveraged consumer base.
  • 7. Financial track record 7  WIC has delivered well on its financial targets and is committed to improve its performance levels further whilst maintaining a conservative risk culture and solid solvency levels.  Collected insurance premiums on a comparable basis up 2.5% to 26 M from 25 M (mainly unit-linked life)  Strong business volume growth across our activities / geographic areas, generating strong commission income and offsetting impact of flattened yield curve Gross Premiums Shareholder Equity
  • 8. Financial track record 8  Profit from marking-to-markets and realised capital gains on investments signifcantly higher than 2011  Very low credit-risk provisioning (loss ratio: 0.01%) / no net impairments on the investment portfolio  Sustained sound non-life underwriting performance (combined ratio: 4%) Technical Reserves Gross Profit
  • 9. 2013 at a glance - business developments  Strengthening of long-term strategy  New group management structure along business lines (start: Mar -13)  Share buy-back programme  Enhancement of both cross-selling and cost-savings projects  Overseas expansion to further strengthen the operations 9  Streamlining of corporate identities of operations (use of WIC CI)  Integration of asset management and investment activities  Renewal of the long-term strategic distribution/associative agreements  Decision to open new branches (organic growth)
  • 10. Associates
  • 11. Partners in success Pakistan’s largest insurance provider. Serve: 9M clients globally 6k in Kuwait India’s largest insurance & investment group Serve: 100M clients globally 8k in Kuwait Middle East’s largest extended warranty provider Serve: 4M clients regionally 140k in Kuwait Kuwait’s largest passport & visa processer serving Indian & Saudi embassies Serve: 230k clients in Kuwait Northern Europe’s largest private healthcare company Serve: 10M clients globally 11k in KuwaitWorld’s leading int’l health insurer for expats Serve: 15M clients globally 16k in Kuwait US’s 2nd largest health care management organization Serve: 65M clients globally 24k in Kuwait Kuwait’s leading third party medical services administrator Serve: 22M clients globally 80k in Kuwait Private Healthcare provider with 9000 hospitals. Serve: 1.3M patients annually India’s largest housing finance group Serve: 50M clients globally 6k in Kuwait
  • 12. WAPMED Global Quality TPA Services within your grasp
  • 13. WAPMED  WAPMED is a Joint Venture between Bukhamseen Group (Kuwait) which is a very reputed business group in GCC and Family Health Plan Ltd (Apollo Hospitals Group – India)  First Licensed Third Party Administrator (TPA) established under the laws of Kuwait.  Operated by qualified, well experienced leaders in the field of health insurance TPA services  Offers a complete suite of healthcare services complementing health care plans  Casts wider spectrum of coverage of health care benefits for members and families  Administers medical benefits for organizations groups  Liaison with insurance companies to best design the product suit that fits client needs
  • 14. Worldwide Service Footprint  Over 6000 Network Providers  Spread Across 33+ Countries  & 5 Continents  & Growing…
  • 15. Full Cycle Administration  Coverage Customization  Insurance provider liaising  Enrollment & ID dispensing  Creation of Universal Health Identification UHID  Access to health network providers  Telephonic Help Desk information resources and services  Personalized Client Services  Managed Care Information System for efficacy of health plans for all stakeholders  Case Management Services to monitor quality of deliverable.
  • 16. Client Oriented Discounts on Services through aptly negotiated Tariffs across the globe •Statistical Cost Tracking •Negotiated MoU Tariffs •Strict risk assessment techniques •24 Hrs Call Centre •Dedicated Helpline •Personalized services •Email services •24 x 7 assistance •Health Talk Shows •Educational Mailers •Health Checkup Camps •Completely Personalized Health Assistance Services
  • 17.  M-Care application tested for managing over 22 million lives  Capable of handling e-claims & capturing ICD, CPT & PCS codes (Master driven)  Thoroughly tested platform over 12 yrs  Exposed to handle variety of policies from international market especially Middle-East  Service Modules customized & designed to cater policies providing Out Patient (OP) coverage  Supports both single currency & multi-currency platforms to cater local & international policies Claims Processing
  • 18. FHPL – Family Health Plan Limited  Main backer of WAPMED  Subsidiary of Apollo Group of Hospitals  Licensed TPA with decades old experience in Indian Health Insurance  Only ISO & CRISIL Certified TPA in India  Offering service to over 70 million through network of 4500 hospitals  Only TPA to design and implement HMO in India
  • 19. Apollo Touching Lives
  • 20. Apollo  54 Locations  9000 beds  65000 employees  Touched 32 million lives  7 million Preventive Health Checks  Patients from 120 countries  1,30,000 Cardiothoracic Surgeries  Over 10000 Joint Replacements  First Liver Transplant in Children and Adults & First Multi Organ Transplant  Over 8400 Kidney Transplants  Over 500 Bone Marrow and 1165 Liver Transplants
  • 21. An integrated healthcare enterprise Specialties: Heart • Orthopedics • Spine • Cancer Care • Gastroenterology • Neurosciences • Nephrology & Urology • Critical Care • Preventive Health Alliances : AIG International Group • American Life Insurance Company • Vanbreda • International SOS • Seven Corners • Companion Global Health • Emergency Assistance Japan • GMC Services • International Claims Service • Prestige International
  • 22. Apollo InnovationApollo Innovation andand Quality AwardsQuality Awards Hospital services Clinical services HR practices Community service Environmental conservation Financial management Full Cycle Clinical Service
  • 23. Worldwide Footprint in all Medical fields
  • 24. Aetna Better Health Today
  • 25.  World leading global diversified health benefits company.  Serves approximately 44 million people with information and resources .  Broad range of traditional /consumer-directed health insurance products and related services, including :  Medical • Pharmacy • Dental • Behavioral health • Long-term care • Disability plans  Medical management capabilities and health care management services.  Committed to helping create a stronger, healthier global community by delivering effective health management solutions worldwide.  Health Management business collaborates with health care systems, government entities and plan sponsors worldwide.  Recently appointed by the National Health Insurance Company (NHIC) of Qatar to support development of its capabilities for clinical case management, disease management and advanced analytic reporting. Aetna
  • 26. Total Population Health Management • Cardiac Rehab. • Physical Therapy • Maternity Management • Exercise • Healthy Eating • Stress Management • Nutrition Counseling • Metabolic Syndrome • Weight Management • EAP • Smoking Cessation • Back Health • Disease Management • Behavioral Health • Wellness Coaching Improving Health and Reducing Risk Health/low risk At risk for disease/injury Managing a chronic disease Major health events 16% per year23% per year Natural Risk Migration (avoid risk save $$$$) (reduce risk save $$$)
  • 27. Global Footprint Core Business Operations Compliance Network Support Services Claims Processing Multiple Languages Multiple Currencies 24/ 7 working consultants Health Care Management Gov’t administrative services Gov’t financial services Gov’t value added services Member Services 30 Languages 24/7/365 Professional CSR service Dedicated Plan Sponsor Services Plan Setup & Implementation Billing Ongoing account maintenance Medical Directors Business Strategies International Standards Medical Care Delivery
  • 28. Fully Integrated Clinical Solution Root CausesHealthcare System Problems Data Fragmentation  Historical claims and non-claims data reside in multiple non-integrated sources Knowledge/Care Delivery Gaps  The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years Lifestyle Decisions  Unhealthy behaviors lead to increased health risk, adverse events and cost Care Team Communication Gaps  Patients and their provider(s) typically make decisions with incomplete information leading to sub-optimal coordinated care  Between 44,000–98,000 people die in hospitals each year as a result of preventable medical errors.  Medical errors for hospitalized patients cost roughly $2 billion annually.  More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, CHF, asthma, depression and chronic atrial fibrillation are currently managed inadequately.  More than 70% of cancers, heart disease, stroke and diabetes are caused by poor lifestyle.
  • 29. Key Tenets  Actively facilitate patient, provider and Aetna relationship to improve health care quality and lower total costs  Meet providers and members where they are, at natural points of interaction  Apply evidence base into everything we do, to influence the way care is accessed and delivered through our networks and programs  Deliver relevant information and decision support to members and providers to facilitate improved quality and cost effective health care decisions  Reduce provider complexity and improve transparency through information sharing and innovative payment models  Enable and incentivize members to drive sustainable healthy behaviors Healthcar e Provider Plan Member Network Enhancements Health & Wellness Informatics Plan Design & Incentives Provider Payments Health Information Technology Aetna’s Clinical Strategy: “Quality and Total Cost”
  • 30. Clinical Health Management
  • 31. A Persistent Search for Value Key Players: Wide Variation in Scope, Degree of Integration, & Geographic Context Health plans – wide array of benefits and variation in provider network scope Physicians – solo practice, single specialty groups, multi-specialty groups, groups linked with hospitals, core of integrated healthcare  Hospitals – individual and system members; various ownership structures Pharmaceuticals – similar to manufacturers − In contrast w/ other components, no local barriers exist − Not addressed, for the most part
  • 32.  Full integration: Hospitals, MDs, and Insurance in one package:  Warba has 3 components available locally and a common incentive structure  Partial integration: Physician/Hospital alliances  Non integrated. Most common, insurers contract with all health care providers Provider Integration  Health Plans – national, regional & international o Consumer directed – national players  Physician Groups – mostly local, some regional o Multiple and single specialty local groups  Hospitals – mostly local and regional o Local and regional systems are commonplace − Many have a business group orientation − Tertiary component in regional systems Geographic Orientation
  • 33. Healthcare Expenditure: Recent Facts  HC (KD) = (price/service) x (services/person) x (people served)  1990 – 2010 growth accounting breakdown – 33% - general inflation – 22% - medical price rises above inflation rate – 16% - population/ demographic change – 29% - intensity of service  Growth in inflation-adjusted HC (KD) per person driven by new technology and services per person – Average - 3.6% per year since 2001 but not smooth  Not Unique to the GCC (1990 -2010) – Kuwait HC (KD) growth = GDP growth + 2.7% – Other GCC countries HC (KD) growth = GDP growth + 2.0%
  • 34. Contracts & Risk Sharing  Labor/Management Contract: Firm manages health benefits or shifts burden to employees   Company/Health Plan Contracts: Health plan defines benefit plan design/scope as well as provider network breadth  Provider/Health Plan Contracts: – Prepaid (capitation or salary) or Fee-for-Service – Fee schedules, discounts, and payment tiers are commonplace  RX/Health Plan: tiers (typically 3), formularies, & discounts – Few plans relate to value or benefit of intervention – Variety of incentives for rebates and substitution  Direct Contract: Skip health plan but not risk bearing
  • 35. Good Contracts lead to 1. Good Relationships You get what you pay for : − More choice of provider, costs more − If procedures are rewarded, pay twice for errors − Improved outcomes (pay for performance) − Short term incentives differ from long term ones − Coverage of primary and secondary prevention − Payment related to place of service and access o ambulatory versus inpatient coverage o ER coverage vs. clinic (timely access? 24/7) 2. Cost Containment Target/control specific health care components Seek increased efficiency of the delivery system (supply management) Emphasize primary and secondary prevention Provide financial incentives for patients to reduce their use of medical services (demand management) Implement administrative controls on the use of services Increase bargaining power by joining purchasing coalitions
  • 36. Total National Health Management Solution
  • 37. Questions? Thank you