This document provides a summary of Warba Insurance Company (WIC), a Kuwait-based insurance provider. Some key points:
- WIC was incorporated in 1976 and is the fastest growing general insurer in Kuwait, listed on the Kuwait Stock Exchange since 1983.
- The document outlines WIC's vision, mission, financial performance, business developments, and international affiliates/associates that extend its healthcare network globally.
- WIC has a joint venture with Apollo Hospitals Group called WAPMED, which is the first licensed third-party administrator in Kuwait and offers healthcare administration services across a network of over 6000 providers in 33+ countries.
Catasys, Inc. harnesses proprietary big data predictive analytics, artificial intelligence and telehealth, and human intervention to deliver improved member health and cost savings to health plans through integrated technology enabled treatment solutions. It is our mission to provide access to affordable and effective care, thereby improving health and reducing cost of care for people who suffer from the medical consequences of behavioral health conditions. Catasys helps these people and their families achieve and maintain better lives.
Catasys, Inc. harnesses proprietary big data predictive analytics, artificial intelligence and telehealth, combined with human intervention, to deliver improved member health and cost savings to health plans through integrated technology enabled treatment solutions. It is our mission to provide access to affordable and effective care, thereby improving health and reducing cost of care for people who suffer from the medical consequences of behavioral health conditions; helping these people and their families achieve and maintain better lives
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
Hosted by the United States Department of Health and Human Services and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for Kentucky small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Apollo Medical Holdings (ApolloMed) is a leading integrated healthcare company providing solutions to hospitals, health plans, physicians, and other health providers to provide cost-effective, quality healthcare. We work with providers and hospitals to coordinate care with local primary care physicians to reduce preventable hospital admissions and re-admissions, best in class patient centric care, and avoidable emergency room visits.
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
Will the Revenue Ever Return? COVID-19 and the Rise of the Insurers; the Case...Health Catalyst
As healthcare providers face the long-term revenue compression of COVID-19, they’re also navigating significant industry changes. Current challenges include horizontal competition from large insurers and digital disrupters, growing telehealth volumes, headwinds from price transparency, and growth in managed care programs, like Medicare Advantage. Without restored or growing volumes, how do health systems return to profitability?
Health systems will need accurate financial data around service line and procedural profitability, which very few have. Allocations, estimates and averages of cost, and large pools of clinical “overhead” are inaccurate, and these methods have no credibility with physicians and administrators.
Join Rob DeMichiei, Strategic Advisor for Health Catalyst and former Executive Vice President and Chief Financial Officer for UPMC, to learn more.
What You’ll Learn:
- How insurers look at their medical expenses, and their plans to reduce utilization and steer volumes away from traditional providers.
- The implications of price transparency; why a rational pricing strategy is critical to success.
- Using existing EHR data to measure and assess 100 percent of your clinical costs.
- How improved costing enables service-line management and allows for improved clinical care delivery and insight into profitability.
- How activity-based costing can help identify physician and clinical variation.
- Implications of inaccurate RVU/RCC costing on contract negotiations, resource management, and productivity reporting.
- Benefits and simplicity of activity-based (consumption) costing.
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
PYA Principal David McMillan presented during The Knowledge Congress webinar, “The Impact of Healthcare Reform in M&A,” which discussed the fundamentals and significant developments related to mergers and acquisitions (M&A) and healthcare reform and was designed to help healthcare executives and professionals avoid related, common pitfalls and risk issues. The webinar also explored hospital network alliances as an alternative to traditional M&A including.
We live in a world where our decisions are impacted by the results Google displays to us. When we need a second opinion we turn to our favorite Social Media outlet. You might not think that the world being described impacts the Skilled Nursing Facilities you run; but it does. Learn how the Best-In-Class Skilled Nursing Facilities are using Google and Social Media to position themselves for success in the age of digital marketing.
Hospital Management Business Plan Powerpoint Presentation SlidesSlideTeam
Introducing our Hospital Management Business Plan PowerPoint Presentation Slides to help you build a firm foundation for the public health system. Select our professionally curated health administration PPT templates to provide an understanding of key demand and supply drivers like consumer demographics and geographics. Highlight the global medical spending statistics on crucial trends like robotics companions, ingestible health sensors, health technology, smart nutrition technology, and mobile applications through this PPT slideshow. You can employ our hospitality PowerPoint layouts to elaborate on building blocks of optimized health systems like technical content, management skills, operational and finance systems. Highlight the structure of important stakeholders and the importance of effective healthcare administration using these hospital sector PPT visuals. Showcase the framework of corporate and hospital tie-ups with our hospital network PowerPoint presentation in a well-organized format. Click the download button and make this healthcare management PowerPoint deck your source to educate the audiences about the essential public health services. These content-specific slides effectively convey the importance of proper medical care comprehensively. https://bit.ly/3tNrHhU
Johan Vendrig
GM Information Services – healthAlliance
Andrew Terris
Programme Director, Patients First
Darrin Hackett
GM HIQ, Acting CIO Waikato DHB
Martin Wilson
GP, Sexual Health Physician, Clinical Leader
Pegasus, executive NICLG
Tony Cooke
Manager Health Systems Investment and
Planning, Information Group, NHB
(Thursday, 4.15, Panel)
we promote preventive care ,Wellness and create access to smart care . Our advanced e-health platform simplify health record keeping , offer personalized health , fitness and insurance solution for all our members .
We help our members experience the wired health and fitness world . At UAH we offer fabulous local and global “All discount” deals .
An introduction to PruProtect looking at their product evolution, growth and their financial strength and stability along with Discovery's 2011 claims experience.
Catasys, Inc. harnesses proprietary big data predictive analytics, artificial intelligence and telehealth, and human intervention to deliver improved member health and cost savings to health plans through integrated technology enabled treatment solutions. It is our mission to provide access to affordable and effective care, thereby improving health and reducing cost of care for people who suffer from the medical consequences of behavioral health conditions. Catasys helps these people and their families achieve and maintain better lives.
Catasys, Inc. harnesses proprietary big data predictive analytics, artificial intelligence and telehealth, combined with human intervention, to deliver improved member health and cost savings to health plans through integrated technology enabled treatment solutions. It is our mission to provide access to affordable and effective care, thereby improving health and reducing cost of care for people who suffer from the medical consequences of behavioral health conditions; helping these people and their families achieve and maintain better lives
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
Hosted by the United States Department of Health and Human Services and Small Business Majority. This webinar focused on what the new healthcare law, the Affordable Care Act, means for Kentucky small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
This webinar focused on what the new healthcare law, the Affordable Care Act, means for small businesses. It focused on both federal and state provisions to help local small business owners understand how the law will affect them.
Apollo Medical Holdings (ApolloMed) is a leading integrated healthcare company providing solutions to hospitals, health plans, physicians, and other health providers to provide cost-effective, quality healthcare. We work with providers and hospitals to coordinate care with local primary care physicians to reduce preventable hospital admissions and re-admissions, best in class patient centric care, and avoidable emergency room visits.
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
Will the Revenue Ever Return? COVID-19 and the Rise of the Insurers; the Case...Health Catalyst
As healthcare providers face the long-term revenue compression of COVID-19, they’re also navigating significant industry changes. Current challenges include horizontal competition from large insurers and digital disrupters, growing telehealth volumes, headwinds from price transparency, and growth in managed care programs, like Medicare Advantage. Without restored or growing volumes, how do health systems return to profitability?
Health systems will need accurate financial data around service line and procedural profitability, which very few have. Allocations, estimates and averages of cost, and large pools of clinical “overhead” are inaccurate, and these methods have no credibility with physicians and administrators.
Join Rob DeMichiei, Strategic Advisor for Health Catalyst and former Executive Vice President and Chief Financial Officer for UPMC, to learn more.
What You’ll Learn:
- How insurers look at their medical expenses, and their plans to reduce utilization and steer volumes away from traditional providers.
- The implications of price transparency; why a rational pricing strategy is critical to success.
- Using existing EHR data to measure and assess 100 percent of your clinical costs.
- How improved costing enables service-line management and allows for improved clinical care delivery and insight into profitability.
- How activity-based costing can help identify physician and clinical variation.
- Implications of inaccurate RVU/RCC costing on contract negotiations, resource management, and productivity reporting.
- Benefits and simplicity of activity-based (consumption) costing.
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
PYA Principal David McMillan presented during The Knowledge Congress webinar, “The Impact of Healthcare Reform in M&A,” which discussed the fundamentals and significant developments related to mergers and acquisitions (M&A) and healthcare reform and was designed to help healthcare executives and professionals avoid related, common pitfalls and risk issues. The webinar also explored hospital network alliances as an alternative to traditional M&A including.
We live in a world where our decisions are impacted by the results Google displays to us. When we need a second opinion we turn to our favorite Social Media outlet. You might not think that the world being described impacts the Skilled Nursing Facilities you run; but it does. Learn how the Best-In-Class Skilled Nursing Facilities are using Google and Social Media to position themselves for success in the age of digital marketing.
Hospital Management Business Plan Powerpoint Presentation SlidesSlideTeam
Introducing our Hospital Management Business Plan PowerPoint Presentation Slides to help you build a firm foundation for the public health system. Select our professionally curated health administration PPT templates to provide an understanding of key demand and supply drivers like consumer demographics and geographics. Highlight the global medical spending statistics on crucial trends like robotics companions, ingestible health sensors, health technology, smart nutrition technology, and mobile applications through this PPT slideshow. You can employ our hospitality PowerPoint layouts to elaborate on building blocks of optimized health systems like technical content, management skills, operational and finance systems. Highlight the structure of important stakeholders and the importance of effective healthcare administration using these hospital sector PPT visuals. Showcase the framework of corporate and hospital tie-ups with our hospital network PowerPoint presentation in a well-organized format. Click the download button and make this healthcare management PowerPoint deck your source to educate the audiences about the essential public health services. These content-specific slides effectively convey the importance of proper medical care comprehensively. https://bit.ly/3tNrHhU
Johan Vendrig
GM Information Services – healthAlliance
Andrew Terris
Programme Director, Patients First
Darrin Hackett
GM HIQ, Acting CIO Waikato DHB
Martin Wilson
GP, Sexual Health Physician, Clinical Leader
Pegasus, executive NICLG
Tony Cooke
Manager Health Systems Investment and
Planning, Information Group, NHB
(Thursday, 4.15, Panel)
we promote preventive care ,Wellness and create access to smart care . Our advanced e-health platform simplify health record keeping , offer personalized health , fitness and insurance solution for all our members .
We help our members experience the wired health and fitness world . At UAH we offer fabulous local and global “All discount” deals .
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MoCI Ministerial Decree 412 FY13 with regards controls and instructions regul...Warba Insurance Co Kuwait
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MoCI Ministerial Decree No 412 FY13 with regards controls and instructions re...Warba Insurance Co Kuwait
Kuwait Ministry of Commerce & Industry Ministerial Decree No 412 FY13 with regards controls and instructions regulating the working of insurance companies brokers and agents especially with regards combating money laundering and terrorism financing
official pdf enabled corporate governance compliance forms documents for periodic submission to Capital Markets Authority Kuwait CMA 10 days after end of each fiscal quarter
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the what'sapp information for my personal pi vendor.
+12349014282
Seminar: Gender Board Diversity through Ownership NetworksGRAPE
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2. Elemental Economics - Mineral demand.pdfNeal Brewster
After this second you should be able to: Explain the main determinants of demand for any mineral product, and their relative importance; recognise and explain how demand for any product is likely to change with economic activity; recognise and explain the roles of technology and relative prices in influencing demand; be able to explain the differences between the rates of growth of demand for different products.
STREETONOMICS: Exploring the Uncharted Territories of Informal Markets throug...sameer shah
Delve into the world of STREETONOMICS, where a team of 7 enthusiasts embarks on a journey to understand unorganized markets. By engaging with a coffee street vendor and crafting questionnaires, this project uncovers valuable insights into consumer behavior and market dynamics in informal settings."
Abhay Bhutada Leads Poonawalla Fincorp To Record Low NPA And Unprecedented Gr...Vighnesh Shashtri
Under the leadership of Abhay Bhutada, Poonawalla Fincorp has achieved record-low Non-Performing Assets (NPA) and witnessed unprecedented growth. Bhutada's strategic vision and effective management have significantly enhanced the company's financial health, showcasing a robust performance in the financial sector. This achievement underscores the company's resilience and ability to thrive in a competitive market, setting a new benchmark for operational excellence in the industry.
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the what's app number of my personal pi vendor to trade with.
+12349014282
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
where can I find a legit pi merchant onlineDOT TECH
Yes. This is very easy what you need is a recommendation from someone who has successfully traded pi coins before with a merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi network coins and resell them to Investors looking forward to hold thousands of pi coins before the open mainnet.
I will leave the what'sapp contact of my personal pi merchant to trade with
+12349014282
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
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)
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
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
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
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”
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
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.