Universal Health Insurance in the Emirate of Abu Dhabi. Dr. Jad Aoun Kuwait Health Insurance Conference May 28 th 2015

Transcription

1 Universal Health Insurance in the Emirate of Abu Dhabi Dr. Jad Aoun Kuwait Health Insurance Conference May 28 th 2015

2 Daman Inception The National Health Insurance Company Daman was founded in 2006 as the first and only purely health-focused insurer in UAE Market leader in health insurance in the United Arab Emirates Owned by Abu Dhabi Government (80%) and Munich Re (20%) Headquartered in the city of Abu Dhabi, branches and service points located across the Emirates of Abu Dhabi, Dubai and Sharjah Chairman: H.E. Mohammed Sultan Al Hameli CEO: Dr. Michael Bitzer 5/31/15 Visit from <name of the company> 2

3 Daman's Strengths Daman earned the trust of 2.7 million members in the UAE within only 8 years. Total membership 2.7 million Widespread local provider network and expanding global network Largest and growing branch network within the UAE All TPA functions internal More than 1,600 employees Strong team of in-house professionals with international and local experience High and increasing proportion of fully-trained Emirati employees at all levels Access to global health and insurance expertise through Munich Health and Munich Re 5/31/15 Visit from <name of the company> 3

4 Daman's Mission, Vision and Values Our Mission We deliver world-class health insurance solutions that facilitate the development of the UAE healthcare system and support Abu Dhabi in achieving its 2030 vision. Our Vision To become the most trusted partner in healthcare for the community. Our Values Trust We value honesty and integrity and are accountable to all our stakeholders. Performance We are passionate about health insurance and strive to maintain world-class performance. Customer Focus We deliver a rich customer experience that centres on quality, satisfaction and peace of mind. Social Responsibility We apply our core competencies in health to help develop a sustainable healthy society. Innovation We constantly challenge the status quo and redefine ourselves to set new industry standards. 5/31/15 Visit from <name of the company> 4

5 Roll-out of Abu Dhabi's mandatory health insurance took only 3 years until full implementation Mandatory Health Insurance Law No. (23) was issued in 2005 by H.H. Khalifa Bin Zayed Al Nahyan, Ruler of Abu Dhabi. The Implementation regulations (Health Insurance Bylaw) were issued in June Preparation & Set up Phase 1 Phase 2 Phase 3 November 2005 Kick off of project in Abu Dhabi December 2005 Signing of contracts between Daman and Munich Re 1 st May 2006 Start pilot phase 1 st July 2006 All expatriates employed in government and companies with >1,000 employees Around 250,000 Daman insured members at the end of st January 2007 Health insurance compulsory for all expatriates 950,000 Daman insured members at the end of 2007 June 2008 Compulsory health insurance for UAE citizens From 2008 onwards to today, total Daman membership increased to more than 2.7 million Basic Enhanced Thiqa Insurance products reflect the different needs and demographic characteristics of the UAE population For expatriates with salary <1,300 USD (monthly) Exclusively offered / serviced by Daman Annual premium USD 165 paid by employer Reinsured/subsidised by Abu Dhabi government All other expatriates Different benefits, limits and territorial coverage free market approach Offered and serviced by Daman and various competing insurers Daman with reinsu-rance from Munich Re Healthcare plan for UAE citizens Exclusively offered / serviced by Daman Abu Dhabi Government (self-insured / self-funded model, not premium-based) 5/31/15 Visit from <name of the company> 5

6 An effective health finance setup delivers therefore several benefits to the overall healthcare system Benefits of an Effective Health Finance Setup A B C Health System Regulator Sources of Funding Financing En4ty Good healthcare system governance Increased transparency regarding health expenditure Generation of (public) healthcare data Better value for money i.e. lean administration and overhead Sustainability of spending as health system becomes more structured and resilient Business opportunity for investment Diversification of overall economy due to health finance activities D Provider Greater investment security due to reliable / stable cash flows Build-up of health system capacity Incentives to increase productivity and quality of service delivery E Pa4ent Reduction of individual risk Better access to health services, and better availability of required services Enhanced patient experience 5/31/15 Visit from <name of the company> 6

7 Shareholding and Regulation Daman falls under the supervision of different regulators. Insurance Authority Regulator For Insurance HAAD Regulator for Health Insurance Dubai Health Authority for Health Insurance Munich Re Strategic Partner & Reinsurer Reinsurer 250 million AED Capitalization Management Agreement Munich Health Daman Holding** * Initially 100% Abu Dhabi government ** MedNet Holding Manager until 2011, since MHDH, a Joint Venture of Munich Health and Daman 5/31/15 Visit from <name of the company> 7

8 Munich Re Overview Munich Re is one of world s leading reinsurers Leading expertise for more than 130 years More than 7 million primary insurance clients and 4,000 reinsurance customers Present in more than 80 countries More than 5,200 health experts at 26 locations worldwide Three pillars form the basis of Munich Re s integrated business model Reinsurance Primary Insurance Munich Health Munich Re has longstanding business activities and experience in the UAE and GCC Track record of over 15 years in the Arab Markets and well established contacts Since 1995: Reinsurance and services through MedNet presence in UAE, KSA Jordan, Bahrain (present portfolio ~ members) Since 2006: Daman, JV of Munich Health and the Abu Dhabi government Regional set-up of Munich Health in the UAE in progress 5/31/15 Visit from <name of the company> 8

9 Daman's Organisational Structure Mr. Andrew Kielty Mr. Mohammed Saeed Alkhyeli Mr. Saeed Majid Mubarak Al Mansouri H.E. Mohamed Sultan Al Hameli Chairman Mr. Khaled Abdullah Almass Dr. Saeed Abdullah Al Ghafli Dr. Jamal Mohammed Al Kaabi Board of s Internal Audit vacant Chief Executive Officer Dr. Michael Bitzer Senior Management Chief Financial Officer Yousif Alkhanjari Chief Commercial Officer Dr. Sven Rohte Chief Information Officer Peter Bauer Chief Medical Officer Dr. Jad Aoun Chief Process Officer Hamad Al Mehyas Underwriting Dr. Arif Usman Sales Vacant IT & Business Services Yves de Bailliencourt Domestic Provider Relations Marion Corbet Claims Cycle Dr. Aziz Ustunel Corporate Functions Anja Helbig Special Projects Bouchra Albusaeedi Thiqa Ahmad Al Neyadi Intelligence Linda van Dijk Medical Strategy Daniel Whitehead Sales Operations Rajesh Dhomse Human Resources Dr. Nawal Khaled Finance & Controlling vacant Marketing Andrew Philips Authorization & Case Management Dr. Ali Anees Digitalization & Innovation Ingo Pischetsrieder Acting Product & Business Development Mohit Saini International Services Christoph Schult 5/31/15 Visit from <name of the company> 9

10 Daman's Organisational Workflow 5/31/15 Visit from <name of the company> 10

11 Daman's Branch Office Network Abu Dhabi: Central Branch Abu Dhabi Thiqa Branch Al Ain Thiqa Branch Mussafah Thiqa Branch Corporate Sales Center Bateen Mussafah Branch 1 Mussafah Branch 2 Al Ain Branch Western Region Madinat Zayed Masdar City Branch Dubai: Jumairah Lake Towers Dubai Capricorn Towers, Sheikh Zayed Road Sharjah: Sharjah Branch Branch serving plans: Enhanced Plan Thiqa Plan Basic Plan 5/31/15 Visit from <name of the company> 11

12 Daman's Service Points Abu Dhabi: Department of Economic Development (DOED) Infinity Services Moroor Street Infinity Services Marina Mall Abu Dhabi Immigration Abu Dhabi Chamber of Commerce Emirates Express Commercial Services Union international Tah heel ZonesCorp Musaffah Al Shahama Municipality Khalifa City A Clinic Al Mafraq Hospital SKMC Hospital Health Authority Abu Dhabi HAAD Al Corniche Hospital Al Rahba Hospital Al Ain: Infinity Services Al Wagan Municipality Mazyad Municipality Al Hayer Municipality Sweihan Municipality Al Quaa Municipality Al Ain Immigration Al Ain: Al Khaznah Municipality Al Maqam Municipality Tawam Hospital Oasis Hospital Al Ain Hospital Neima Clinic Al Muajee Clinic Western Region: Madinat Zayed, Tamm Center Ghayathi, Tamm Center Delma, Tamm Center Liwa, Tamm Center Al Marfa a, Tamm Center Al Sila, Tamm Center Other Emirates: Branch serving plans: Sharjah Immigration Ras Al Khaimah Immigration Enhanced Plan Thiqa Plan Basic Plan Visit Visa 5/31/15 Visit from <name of the company> 12

13 Daman Provider Network Daman offers coverage Worldwide with more than 2000 providers in UAE and more than 9000 providers internationally. The UAE network doubled since UAE Providers Count Intl Provider Network CAGR 96% /31/15 Visit from <name of the company> 13

14 International Expansion Daman s main focus is on the UAE market, Munich Health Daman Holding s, a Joint Venture between Daman and Munich Health, focus is to expand regionally. Munich Health Daman Holding 5/31/15 Visit from <name of the company> 14

15 Statistical Overview 5/31/ million members million received claims in ,000 1,600+ managed calls in 2013 employees, 51 different nationalities Visit from <name of the company> 15

16 Daman s Lines of Business Insurance Plans and Thiqa Programme Basic Enhanced Portfolio Thiqa For Expatriates residing in the Emirate of Abu Dhabi with a monthly total salary package less than 5,000 AED per month. Subsidized, standard policy of 600 AED p.a. Products with different benefits: Core, Enhanced and Care. Risk-based pricing (individual and group policies). For all UAE Nationals. Daman is the exclusive Third Party Administrator (TPA) for the Thiqa plan. Risk Carrier: Abu Dhabi Government. 5/31/15 Visit from <name of the company> 16

17 Basic Plan Benefits, Challenges and Membership The Basic Plan for Expatriates with a monthly salary less than 5,000 AED with accommodation or 4,000 AED without accommodation, including housing is supported by the Government. Key Benefits All expats have guaranteed access to affordable healthcare Premium paid by employer Broad provider network across the Emirate of Abu Dhabi (same as for Thiqa and Enhanced) 1.3 million Challenges Since 2006 premium of 600 AED Coverage extended in various dimensions without raising premium Burning Cost* higher than Net Risk Premium** Membership October 2014: 1.3 million Development since 2006 * Burning Cost: Total medical cost for an (average) at risk member. ** Net Risk Premium: Risk Premium covers the insurance risk including safety margin. 5/31/15 Visit from <name of the company> 17

18 Enhanced Plans Benefits, Challenges and Membership A wide range of Enhanced plans are available with different benefits, policy limits and geographical coverage. Key Benefits Individually tailored products Trustworthy brand (with the backing of Munich Re) Market leader Branches and Service Points across the UAE Challenges Medical Inflation Increasing competition from now more than 40 competitors Daman mainly in competition with multiline insurance companies 534, ,000 Top Up Membership October 2014: 534,000 plus 110,000 Thiqa Top Up members Development since /31/15 Visit from <name of the company> 18

19 Thiqa Program Benefits, Challenges and Membership Thiqa is among the most comprehensive health programs in the world. Key Benefits Extensive branch network Only state-of-the-art Disease Management program in the region (Diabetes, Obesity, Asthma) 3 years coverage now High Emiratisation rate in Thiqa branches popular with members 741,000 Challenges Medical inflation Long-term risk of significant increasing cost due to diabetes and obesity and aging population Increasing over serving of patients due to increasing provider overcapacity 50% co-pay for pharma + dental in the private sector unpopular Membership October 2014: 741,000 Development since 2008 Thiqa membership increased by approx. 30% between 2009 and /31/15 Visit from <name of the company> 19

20 Daman Medical Quality and Performance Assurance Strategy Clinical Performance Metrics, e.g.: Increasing number of clinical KPIs based on current international literature and expert opinion Measurability based on the claims data and additionally coded and shared clinical information is essential Financial Performance Metrics, e.g.: Bottom-up costing studies conducted on behalf of Daman by independent consultants with local network providers Average cost for bundled inpatient and outpatient service packages in comparison to international benchmarks Average cost per member with chronic conditions in comparison to the national average Structural Performance Metrics, e.g.: Uniqueness, innovation and location of specific clinical services Daman audit outcome Staffing levels and qualifications of clinicians International quality accreditation status of the provider Voluntary sharing of input and cost data Coding and billing accuracy of the provider based on findings of independent external auditors 5/31/15 DAMAN CONFIDENTIAL 20

21 Medical Investigation and Audit Our goal is to protect health care funds by preventing and detecting health insurance fraud, abuse and misuse. We focus on deterring potential perpetrators from indulging in organized and/or opportunistic health insurance fraudulent activities through: Routine scheduled audits Specialty focused audits (based on our data analysis) Investigations into individual cases based on information from internal departments and external entities (HAAD, general public or press) Whistle-blowers from members, policy holders & provider staff Mystery Shopping 5/31/15 Visit from <name of the company> 21

22 Daman Intelligence & Analytics Daman actively drives the development of the healthcare market by delivering state-of-the-art information and decision making tools for internal and external stakeholders. For Daman Automate medical decision making by transcribing internal knowledge into system rules to support consistency & efficiency Implement integrated performance management, incl. indicators, targets & reporting cycles to power operational excellence Provide data-driven business decision support to improve agility For Medical Professionals Release provider profile reports to support individual performance feedback to facilities and/or physicians Publish Adjudication Rules on Daman coverage to increase transparency on payment Develop and benchmark medical (quality) indicators to stimulate health system quality improvement For Stakeholders Forecast and monitor future healthcare spending and trends to power [political] debate Release tailored utilisation reports for key customers Develop advanced statistical methods to prove fraud, waste and abuse Develop price- and incentive structures to evolve healthcare, incl. running impact- and sensitivity analysis to ensure cost control 5/31/15 Visit from <name of the company> 22

23 Key Information Tools Provider / Medical Ul4mate Truth(including MIS) Policy / Sales Contracting Tool Tracker Group Tool Sales Dashboard Provider Dashboard Policy Performance Report Investigation Tool external internal Clinician Profile Member History (Provider/Clinician/Group/Activity) 2 March 2015

24 Daman Community activation initiatives Our ActiveLife community mobilization initiatives provided a well accepted platform for employees and their families to perform a healthier lifestyle 1 Get aware 21,000 Facebook followers representing a strong community platform over last 18 months 2 Get active 3 Perform 90,000 people got active in our events since ,000 people performed in our events since /31/15 Visit from <name of the company> 24

25 Customer Experience Since 2012, we have observed changes in our customers perception and witnessed the progression on how Daman adopts to the changes and implements necessary improvements to address customers biggest concerns. Customer Satisfaction Index Target 4.20 Very Good Despite strong competition in an industry like the health insurance which is also driven largely by government regulations, Daman s customer satisfaction scores are increasing over the years In line with Daman s mission to become the leading health insurer in the region, ongoing efforts and further customer experience enhancement initiatives are set to reach the Excellent standing /31/15 25

26 Our Growth Timeline and Achievements 5/31/15 Visit from <name of the company> 26

27 Our Growth Timeline and Achievements 5/31/15 Visit from <name of the company> 27

28 Key learnings for Kuwait - Success Factors Key learnings for Kuwait on how best to launch a mandatory health insurance scheme successfully in the GCC include: 1) Only one insurer to manage all insurance plans, which are funded/subsidised by the government (i.e. for nationals and for low-income guest-workers). 2) Plan for yearly premium alignment with medical inflation and increases in utilisation 3) E-claims right from the start: don't even start with paper claims 4) Importance of waste, fraud and abuse readiness right from the start 5) Importance of intensive stakeholder messaging and involvement: a) Benefit of ensuring access for everyone and enabling choice of provider b) Explaining how HI improves quality of medical care as well as service quality c) Explaining members entitlements and processes of how to get them d) Involving members in waste, abuse & fraud prevention 6) Importance of strategic alignment with the regulator 5/31/15 Visit from <name of the company> 28

29 Thank You! For more information visit 5/31/15 Visit from <name of the company> 29