Building hospital networks: Subjectivity vs experience

Earlier this year, professionals from all aspects of the travel and health insurance world gathered at the Mandarin Oriental Hotel for the ninth annual ITIC Asia Pacific conference – ITIC Bangkok 2017. Here, IHMT presents summaries of the ‘Building hospital networks: Subjectivity vs experience’ session.

Dr Zubin Daruwalla
Director, South East Asia consulting healthcare lead – PwC

It is a revolutionary time for the healthcare landscape in Asia, asserted Dr Daruwalla as he began his discussion. Tackling the challenges facing the healthcare landscape in Asia from a corporate and clinical perspective, Dr Daruwalla pointed to the three factors driving the market in Asia currently: the adoption of universal healthcare; the expansion of medical tourism; and the increasing penetration of medical devices. All three of these factors, he said, are complimented by the fact that, generally, ASEAN populations are acquiring an increasing amount of disposable income, as well as a growth in the middle classes and increasingly ageing populations. These factors mean not just an increase in public healthcare provision, but also a ‘high demand’ for privatisation.
The increase in ‘lifestyle related diseases’ such as diabetes, strokes and cancer also shows how ASEAN populations have more to spend, and therefore that there are ‘multiple investment opportunities’ to be made in these countries, especially in Thailand and Malaysia.
Digital disruption is another trend that Dr Daruwalla believes is driving a paradigm shift in the industry. Tech is empowering the consumer, he said, and this is causing shifts from health to healthcare, from hospital to home and from quality to value-based care. “We are bringing a lot of retail to healthcare,” Dr Daruwalla explained of PwC’s approach. Consumers want to participate in their care and are likely to bring in their own information from ‘Dr Google’ now, helping to deconstruct the ‘God-like’ aura around doctors. This means, said Dr Daruwalla, that the pressure is on healthcare to provide the tech-based care solutions that consumers want, and for insurers to catch up. Investing in disruptive technology can help to reduce the cost of care, while intuitive solutions will make consumers more likely to spend money on healthcare. Dr Daruwalla believes, however, that healthcare is lagging behind. “Are we ready for a hospital without patients?” he asked.
The presentation concluded by tackling the issue of accreditation. With the rapidly changing market, and the increased pressure to gain accreditation, Dr Daruwalla said that actually defining a centre of excellence is becoming more difficult. “From a clinician’s standpoint,” he said, “I think a centre of excellence would be a high-volume centre where you are getting extremely good clinical outcomes using an evidence-based approach. But whichever way you look at it, it’s going to vary.”

Tech is empowering the consumer

Dr Chatchai Arthur Yachantha
Medical network manager – AXA Assistance (Thailand) Co., Ltd.

For Dr Yachantha, building a hospital network means combining both subjectivity and experience to judge whether or not a hospital is the right provider. AXA relies on its values when assessing hospitals: ‘customer-first’; ‘courage’; ‘one AXA’; and ‘integrity’. For example, said Dr Yachantha, employees must have the courage to ‘correct hospital mistakes and make sure they are providing the best service’. With 320 JCI-accredited hospitals in the APAC region, finding out which is best for a customer is getting harder.
Dr Yachantha pointed to the ideas of yin and yang when selecting a medical provider. Though accreditation is part of this process, it is no guarantee that the treatment will be correct. On the other hand, though AXA will try to cover customers wherever they go, companies must still balance cost containment and recognise that adequate medical facilities may not be available in some areas. Pan-regional provider assessment can prove an issue, and one source is never enough, warned Dr Yachantha. Getting into a local practice and actually seeing how treatment is administered can often prove vital to assessing a centre. It can also help to avoid clinics becoming ‘a ghost’ – ie. having an address but no physical traceability.

With 320 JCI-accredited hospitals in the APAC region, finding out which is best for a customer is getting harder

AXA, said Dr Yachantha, also has its own certificate of accreditation, which it awards to clinics to show they are a ‘trusted partner’. But the process does not stop there, he said, and the big question after a site has been visited and awarded partnership is ‘how can we make our partners grow in the future’. Insurers, however, look for consistency and transparency when choosing a provider, a member of the audience pointed out, and differences in prices can often come not from facilities, but instead from individual physicians.
Dr Yachantha asserted that he had indeed worked with regulating single providers and inconsistent charges from specialists. To tackle the issue, he said that AXA has created a general tariff, and that if they see something above the tariff, they go direct to the doctor. The tariff system was just one of many systems that Dr Yachantha characterised as necessary when judging hospitals. “Quality is an act, not a habit,” he said, ending his presentation quoting from Aristotle.

Dr Eric Fleischman
International medical director – Bumrungrad International Hospital

Dr Fleischman started by putting the topic of accreditation into perspective, looking at how patients, insurers and assistance companies choose hospitals. As he pointed out, patients rarely use a hospital’s accreditation to pick their destination, instead looking for peer reviews, word of mouth and a hospital’s branding. However, accreditation is far up the list for insurers and assistance companies – but there are still several other factors in play.
So, asked Dr Fleischman, if there are so many other factors in play, why accredit? Though later in the session Julie Munro would assert that ‘accreditation has had its day’, Dr Fleischman said that when his own hospital, Bangkok-based Bumrungrad, gained accreditation, it meant it became the standard for hospitals in the area, which helped it to compete in the market. But does accreditation actually mean a better outcome for patients? “As it turns out, in a number of fields – trauma, pain management and a few other subspecialities – it has been shown that the processes and the quality of treatment improve,” asserted Dr Fleischman. From this information, an assumption could be made about whether this could create better outcomes for patients.
However, when several hospitals have similar accreditation, it can be hard to ‘stand out from the crowd’, said Dr Fleischman. A thorough and in-depth set of statistics can help an institution to stand out, with possible statistics to offer including: hospital infection control rate; surgical infection control rate; re-operation statistics; and days in ICU following procedure.
Dr Fleischman concluded his presentation saying that although accreditation and certification are important, achieving customer confidence and trust is essential. And in the discussion that followed, he said that accreditation is not a barrier for new hospitals – instead it is a target, and should be an ongoing process for hospitals.

A thorough and in-depth set of statistics can help an institution to stand out

Julie Munro
President – Medical Travel Quality Alliance

After the statement in the previous presentation that accreditation had ‘had its day’, Julie Munro again stirred up debate with her assertion that the culture of a specific country could often overcome the medical infrastructure put in place. Julie began by explaining the Medical Travel Quality Alliance’s (MTQUA) own accreditation and certification processes. The international global standards setter and best practices organisation has certification for non-clinical processes, and said that in some internationally accredited hospitals, issues such as peer management can be found to be below par.
The hospitals that are accredited by the MTQUA are not technically a medical network, but instead a ‘circle of care’ that ‘surrounds and supports clinical excellence’, according to Julie. Julie then addressed why she believed international accreditation was not as useful as it used to be: “In the nineties or eighties … an international infrastructure made sense to overcome the chaos of culture … but we are now finding when we work with accredited hospitals that in fact local culture tends to trump the international infrastructure in hospitals.” This idea, that culture beats infrastructure, stirred up debate. Julie gave an example of a US patient who had been locked in their room overnight, because that was what was done at that hospital, despite the patient’s need for attention during those hours.

If the leadership of a hospital is committed … then gaining outcomes outside of accreditation will be easier

Many APAC doctors spoke up after, however, and claimed that this was a one-off and, in fact, their hospitals and the other hospitals they knew would not do this. Julie asserted in her presentation her belief that ‘when it comes to the crunch’, many doctors may make judgments due to culture, not the international infrastructure. However, the way to combat this issue, she said, is by putting care support and care systems in place of international accreditation. This will give a stronger opportunity for better patient experiences. There are four pillars to focus on for this approach, said Julie: care, communication, comfort and collaboration. This last pillar includes not just the networks built between different medical providers and insurers, but also focuses on the team within the hospital. If the leadership of a hospital is committed, she concluded, then gaining outcomes outside of accreditation will be easier.

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