Fit for Duty Podcast: Episode 10.

(0:03)

So, I'm delighted to be joined by Dr. Hemal Desai and Simon Miller for our discussion today. Gentlemen, hello. I was wondering if you could please give a bit of an introduction to yourselves and describe the work that you do at Aetna International — starting with you please Hemal.

(0:23)

Yes, sure Lorien. So, my name is Hemal Desai. I'm a GP, by background, in the UK and I look after medical affairs for Aetna International, including various different aspects across our teams, and also look after some of our medical affairs in vHealth services as well.

(0:43)

Excellent, thank you, and Simon?

(0:46)

Yes, so, I’m Simon Miller and I'm a Senior Director for Customer Proposition at Aetna International. And what that involves is responsibility for how we develop our products or services, including our well-being offerings for our clients and for our members across the globe.

(1:02)

Wonderful. So, you are both perfectly well placed to be here to contribute to our discussion today around the corporate health and wellness trends hitting the mainstream in 2021. So, to begin with, I'd like to start by tackling the changes to health care and to the benefits landscape as well. So, you're both probably aware that Aetna International has conducted some research looking at employer and employee perceptions of corporate health and wellness. So, in that research, we found that more than two thirds of employees, globally, say that the benefits provided by their employer is more important than it was pre COVID — so in 2019. So, that's for mental health and close to two thirds, say the same about physical health provision, which I think is fascinating. Those are huge, huge numbers. Now, in particular, things like weight gain, musculoskeletal conditions are high on the list of watch outs, particularly for those working from home, but across the board, things like stress as a result of financial pressures and long working hours, mixed blurred boundaries between work and family life, these are all standout areas of concern. So, with that in mind, Hemal, I was wondering if we could start with the global health care picture. So, when it comes to trends at population health level, what do we really expect to see across 2021 and beyond?

(2:38)

Well that's a big question to kick off with Lorien. So, I guess for me the first thing to say is that 2021 will bring a renewed hope that things will move in the right direction after the astonishing developments in health care over 2020. I think, unfortunately though, the global health care landscape will continue to be dominated by COVID and its consequences and repercussions. I think the exciting developments of new vaccines, accessible testing, improved treatments are all very exciting developments but will still take time to roll out across the globe, and hence I think we'll continue to see a significant impact both directly as a result of COVID, but also indirectly as a consequence of COVID on health in in 2021. I think the many health care systems have struggled during this year due to COVID by temporarily suspending or reducing non-COVID services. And this is undoubtedly going to have an effect on people's health outcomes, the impact of which I think we're likely to see for many years to come. And I think 2021 will be the next phase of that. We've already seen some of this impact in real time. An interesting piece of research came out recently from Scotland where they looked at data from their first lockdown period between March and May, which showed the 10% increase in excess deaths from strokes and heart disease and 5% increase in cancer related deaths compared to the previous five year averages during that period alone, which I think is staggering and really tragic, in terms of statistics coming out. And I think this isn't just within that health care system — I think these trends will be replicated across the globe. And this is as a consequence of people either not accessing care because it's not available, or people choosing not to access care because they're anxious or it's not available locally. And, and this trend again we've seen in many countries around the world. So, I anticipate a lag effect in 2021 of undiagnosed cancers or delay cancer treatments or deterioration in long term conditions, and this will be a trend not only next year but well into years following that. So, I think encouraging people to seek medical advice early is going to be an important message for us all to give. Another couple of areas just to touch on — firstly, the rise in prevalence of mental health. I think this will continue due to COVID, and other circumstances, in 2021 Many studies have quoted in the region of one in four people suffering from clinical anxiety and depression related disorders and higher proportion suffering from mood and sleep disturbances and other things that may indicate low lying mental illness. And I think the impact on people's mental well-being will certainly be a trend in next year and will be important, and providing support will be more important than ever in 2021. And I guess just finally for me, it's going to be important for us to monitor the longer term health trends of sedentary behaviour and decreased physical activity which people have faced in 2020 due to restrictive orders in their respective countries, and as expected the early evidence is beginning to show that this will also have a detrimental impacts. So, promoting physical activity is going to be vitally important as society’s return to some sort of normality in 2021. So, those would be the key things, or the key trends that I would anticipate next year.

(6:24)

Yeah, absolutely. I'm busy nodding along here. And Simon, from your perspective then, looking from an employer's perspective, rather. What can employers really do in the first instance to help support their employees? And then, in terms of those claims-related costs, comorbidities and things, how can they look at containing related costs as well? So there's a two-part question there for you please, Simon.

(6:53)

Sure. So, I think the first thing, and this was starting to happen already but I think has been exasperated through this year's events, will be the need to take a step back and look at the whole person — so a view that's looking at both the physical and the psychological. But also the social needs as well as their workforce. So, the interconnectivity between all three of those for example — between physical condition, the mental health impacts that might have and then the isolation that somebody might be going through amidst all of that, all of those will contribute to how somebody manages a condition, how somebody recovers from a condition, and also to their productivity within the workforces as well. So, I think what we're seeing is an increased focus on more of a strategic approach considering all those permitted pillars of well-being, which of course health care provision, as Hemal alludes to, is a very important part of that. But those softer, more holistic needs being met around that as well. I think the other aspect of that is then the accessibility to those services, and I think one of the things that we've seen through this year has been a real tipping point in engagement adoption and utilisation of remote health care services. Now granted, some of that has been forced through necessity. So, with telemedicine, for example, the ability to speak to a GP via telephone or video or text even, to receive a prescription — that might have been the only way somebody was able to receive the necessary medication. So, some of that has been forced through necessity. However, what that has enabled is a population that wasn't necessarily engaged with those services being delivered by those modalities beforehand. Now using it and being reassured that “hey you know what this is a comprehensive service, this is a service I can trust, it's easy, it's convenient and actual fact this is something that I might adjust to and change a habit with in terms of how I receive health care moving forward”. So, I think we've seen adoption across some of our remote health care partners, increasing from 400%, 500%, and in some cases 600%, throughout COVID. Now, that will potentially dip back down but it won't dip down to the levels it was before. I think this is a fantastic tipping point and it's a tipping point for an expectation not just around “can I speak to a GP remotely, but can I access health care in general remotely? So, therapists, nutritionists. Can I get my prescriptions delivered to my home but also maybe get treatment at home? Can I get tests at home?” And that technologically is deliverable today — that exists. But I think what we're now going to see is an acceptance and an expectation maybe of that and I think that'll be a big shift to enable providers like us to deliver those services, but I think for also for employers to make sure that it is part of that offering that they're seeking from their providers as well, and making sure that the workforce are aware that that's there. So, I think that's a great outcome for the industry, but I think it will lead to an ongoing trend beyond this year.

(10:11)

I quite agree, and then in terms of how we can really help employers to keep ahead of that rising sort of curve that Hemal mentioned there, around conditions relating to lack of physical exercise and things like that. From a preventative perspective, what are some of the key areas that employers should be looking to tackle across 2021?

(10:36)

I think the first area has got to be around, what is the duty of care as an employer, in terms of my responsibilities with the workplace? And the workplace, obviously, moving forward, not necessarily being the office. So, I think the first thing that's already starting to happen, that employers thinking about their physical environments for the people coming back into work, what does it look like in terms of the new workplace? That feels safe, both in terms of physical and psychological safety, that supports the community aspects that an employee expects of a workplace but in a safe way. But then for those not working in the office, working from home as well, what does a forward thinking, occupational health strategy look like that does support that proactive, health care provision, and prevention as you allude to Lorien. So how do we support people with their ergonomics at home, how do we help them keep active at home, understanding the very different needs of the workplace — so respecting that diversity and inclusion, that that's needed with people with very different home circumstances. So I think that's going to drive a different focus for employers in considering what does it mean to provide workplace well-being when people are no longer necessarily within the workplace. And that I come back to again things like the remote support services. And this is where things like self-help and self-care, so for example access to digital physiotherapy, which might aid that initial prevention, but also aid with early intervention with early diagnosis cues that can be then referred on to a GP for further investigation. So, thinking a lot earlier within an employer's health care journey, not just being a reactive service, being proactive and preventative, I think will be more important than ever.

(12:32)

Absolutely. And when it comes to connected care, we've obviously talked about the way in which vHealth can expedite that access to care for people. But thinking about the Internet of Bodies, we've had the Internet of Things and now we're moving towards the Internet of Bodies, where we have a lot more in the way of remote medical devices and kits. Do you see a time in the not too distant future where corporates might start adopting the distribution of those kinds of remote monitoring devices to support and enable their employees to take better care of their health?

(13:14)

So, I think that, I mean we've seen — this is not new right? Since wearables came out employers have been grasping with, you know, what's their role in providing those to employees and then, you know, what purpose does it serve? And there's a whole raft of issues regarding that in terms of it's only effective as an indicator if we have a significant proportion of a workforce actually using it. Not everybody wants to use it, not everybody trusts it and not everybody is pretty prepared to share data. So challenges in terms of that being a tool distributed by the employer. I think what we will see, though, is those being prescribed by the health care professional potentially. So, what happens if somebody is presenting with certain symptoms or risks, where that can be identified by the GP is that being a valuable tool for that individual to not only better look after themselves but potentially to provide connectivity back into the health care ecosystem with triggers with data for alerts, and onward condition management. And I think what's been very interesting is some of the data that's come out around COVID and some of the acceleration, some of these developments. Fitbit, for example, just shared some very interesting data on a study looking at respiratory and heart rate variability indicators for onset COVID risks and symptoms. But there is a fine line, you know, it's not perfect data for everybody. It doesn't mean that you've got a condition or it's a definite symptom. And we need to also be worried about creating a worried world population as well with that, so there's definitely value within the data but it does need to be used in a very responsible and a very informed way, and I think the starting point for me, is that to be part of a health care journey being prescribed as an effective tool to support a condition and a diagnosis. So, I think we'll see more of that. Meanwhile, I'm sure the curious individuals will still have an appetite to use that alongside their own activity monitoring, their own health care monitoring, and present with that data and I think we need a health care environment that is ready and accepting of that — of an individual walking in and sharing their data and saying “look, I'm concerned because I've got these indicators” and I think it requires a forward thinking primary care environment, for example, which I think some of our telehealth teams certainly are, who can look at that within the context of the bigger picture and join together the jigsaw to take advantage of all of those inputs rather than just looking at one piece of data. That's probably perhaps something Hemal might like to comment on as well from his perspective.

(15:53)

Yeah, absolutely. Simon, I think, you know, it's a really interesting time. So ,digital health services have really exploded and are now here to stay. And I think you're right that people can access, I guess, their lifestyle services, their well-being services, their health services, when they need to in the modality that they require. And I think services are developing at a rapid pace to be able to deal with the demands that some consumers have now in terms of their consumption of these types of services. And I think there are some really good propositions out there, and there's some very, very good services that can cater for the needs. I guess the thing that will start to really take this a step further, particularly in environments that we're talking about — in corporate environments or as a health care insurer — is how we and companies bring this together to meet the needs of their population. So, whether it's the employee groups or whether it's our customers as a health care insurers. And really matching that demand to a variety of trusted services that can fulfil that demand to ultimately achieve a healthier workforce, a more productive workforce, with better health outcomes in the longer term, I think, is really the goal that we're all looking for. And I think choosing the right partners and choosing the right type of services that are tailored to the needs of a particular organisation will really drive a set of benefits in the future. And I think those partners that can that can pull that together in the most meaningful way I think will deliver the best outcomes in the future. But one thing for sure is that ,you know, now, as a consequence of this last 12 months, people have placed much more importance on their own individual health and well-being and that of their family. And I think, whether you're looking at this from an employer perspective or whether you're looking at this from an individual perspective, I think that health care security or the health care protection that you now need, plays a much more important role in many people's lives. And as employees people will look at their employer to say, you know, “how are you supporting me?” and employers, on the other hand, will try to, will need to, develop the right sort of guidance in the changing workforce environment to be able to maintain the health and well-being of their workforce so that they can remain productive. And again, I come back to it, you know, understanding the needs of the population, and your employees if you're a corporate, becomes a very important determinant in what you need to be able to support them moving forward. But the tools and the services are out there.

(18:44)

Absolutely. I agree with you Hemal. I think one thing brought through is also just recognising the diversity of those needs. It's not about one solution fits all. And I think that the strategies, the well-being strategies, effective ones moving forward, start with that listening exercise and really understanding the needs of your population. And technology is really an enabler to deliver that. Technology isn't necessarily the solution, it's the enabler and I think what we've recognised through even some of our own data, right Lorien, is around the different needs across the different demographics. 88% of 18-to-24-year-olds feeling severely affected by the mental health needs, but perhaps in a different way to those with children at an older age group and are different to those with frail and elderly parents that they're caring for as well. And how as an employer do I cater for all of those different needs within that? But I think first step is listening and recognising those, and then you can start building a strategy around it. Whereas I would say we're certainly seeing in some instances, maybe through the last couple of years, maybe brought on by the fact that there are loads of technology-enabled and digital solutions out there that we've almost been coming at it from a solution angle, and then retrofitting it into a workplace and well-being framework rather than necessarily from that, sort of, that pain point that customer need or employee need point of view, and then building upwards. So, I think there's been a good injection, a good shot, to sort of say “hey let's take a step back and let's understand the needs that build strategically in a way that caters for all those different populations within our workforce, and then we go shopping for the solutions” in a way that sort of connected and brings it all together.

(20:26)

Yeah. Quite right. I think in terms of everything you've just said that about the changing workforce environment, the need segmentation across populations and then organisations need to simplify that whole user journey, if you like, and signpost people in the right direction, is critical. And that really brings me nicely on to the next area of discussion that I wanted to talk through with you, which is really focusing on remote working. And a lot of organisations, understandably, are having to look at adopting a long-term policy of versatility and remote working. There are there are numerous obvious implications in terms of infrastructure and culture, how we collaborate, you know, financial implications, data security, as well as obviously benefits rewards and incentives. So, one of the questions that I have in mind is, really, Simon, you know, do you expect compensation and benefits strategies to change across 2021 in response to this? And, also, do you think that there'll be a time when working from home is considered a disadvantage or, it's not a benefit?

(21:36)

Yeah, I mean, I think the first thing to recognise is it has very significant and different implications for different people. Right? Some people will be thriving off of a work in home environment, and may thrive now but might not thrive later. May thrive in certain seasons, certain circumstances, certain life stages, when the children are at home — when they're not at home might be one of those for example. Others may be really, really struggling and almost in crisis mode, you know. If you're an individual with living in a small flat with no access to garden areas, for example, living with housemates, lodgers in and out. I mean, this would be potentially a very, very stressful and anxious time being forced to work from home. So I think the first thing is thinking about it as a strategy that obviously recognises those very different needs and I think that's an obvious thing. But then in terms of, you know, having flexibility within your policies to support that and I think that's the biggest thing it's not one size fits all, and it will need that flexibility. I think, building on the trends and the impacts of it, I think probably we touched upon the need for remote health care support and I'm glad to see much greater adoption, even within our own world of things like our access to our mental health digital resources, our virtual GP resources and digital physio, and that's indicative of both people having a need, but I think also, a little bit of downtime or clear time to also explore those. I think we're seeing more cut through with some of our messaging now — when people aren't in the office when they are maybe able to reflect and take in some of them be aware of the resources that are available to them. But I think the biggest perhaps concern that I'm seeing come through at the moment — I think people are grappling with that fatigue and burnout risk, that separation between home and work, that perhaps was always going on, slightly for a certain part of the population in the background anyway but perhaps is more visible now or more noticeable now. And this really sort of manifesting itself and having severe consequences I think in terms of absenteeism, in terms of presenteeism, and particularly where that load is on some of the executive level, in the real pinch points in the organisation where maybe the there is some real key points of dependency. So, it'd be interesting to see how employers start to develop their strategies to recognise that, to provide for flexible working arrangements, to maybe use data. It was interesting to see some talk about Microsoft starting to build sensors into the use of their office platform, that starts to pick up on cues around stress and hours in ways that could be, presumably anonymously reported back into the business to pick up on trends as to when people are using the systems but also trigger behaviours are exhibiting, how quickly they're responding to emails, maybe even picking up on facial cues within web calls, who knows. But it'll be interesting over time as to how people start to build data to understand when people are approaching fatigue and burnout, in addition to of course the training of line management, to understand and pick up on those human cues and triggers as well. So, I think that's probably one of the key things. Yes, we've got solutions but how do we get ahead of the game and start picking up on the cues as well.

(25:17)

Yes, some definite short term and long-term implications there for organisations to think about. And Hemal, I wanted to speak to you about the fact that a number of countries around the world have implemented remote working programmes, specifically to attract freelancers and potentially students or high net worth earners or people that are no longer confined by boundaries, whose organisations have said, you know, “we don't mind if you're working in Chicago or, you know, in Barbados, as long as you're able to do your job”. But this obviously has a number of implications in terms of tax and Social Security – you know who pays that? Compliance implications for both parties. So, I wanted to ask you, Hemal, if individuals are, as full time employees, able to go and work remotely around the world, work from home or in the country of their choice, what role does international private medical insurance play in that scenario?

(26:21)

I mean these are really interesting opportunities that people have in front of them, and as you described there, they're quite complicated from an employer point of view but actually could be quite attractive to a number of people either working in the organisation already or even as part of a recruitment drive that organisations may have. So, people that may not have commitments in a particular location, and are relatively mobile. These could present really, really interesting opportunities. So, I certainly think that, you know, global organisations in particular, but even other organisations should look at how they construct the right policies around this type of approach. But one thing is important to note is that many of these areas that are promoting themselves or countries that are promoting themselves around the world have quite stringent visa programmes and requirements, particularly around health coverage, so that people who may move into those countries have access to health benefits, should they become ill during their time and during their stay. An international PMI will play an important role in that, particularly where this is likely to extend beyond the traditional realms of travel insurance, usually two to three months into a particular stay. So, I think there's an important role for PMI and also IPMI to play in this — IPMI in particular, offers some particular benefits generally within their policies and particular expertise on the on the back end, that can be more attractive for people. In some countries actually IPMI is the requirement. But some of those benefits and capabilities I think could be an important part of people's consideration when they're looking at health coverage with these types of initiatives, particularly around flexible products, dental maternity, screening vaccinations, good primary care offering, having services that could be virtual as Simon talked about. And certainly, you know, what we have a virtual primary care services like vHealth would play an important role within that because it would provide that first element of care for people who may have moved into unfamiliar surroundings, but also making sure that, you know, IPMI traditionally, and particularly if we look at one of our, you know, our capabilities, having strong provider networks across many different countries, having well designed emergency care benefits that should, should the worst happen, that you have access to and can be taken to a place where they could provide you with the necessary care if it's not available locally, you know good understanding of local regulations. I think all of those things are quite important and IPMI providers tend to bring that in abundance. So, I think there's an important role for IPMI to play in these types of initiatives.

(29:14)

And just to pick up on that as well with Hemal. We are seeing, we already saw instances of the increasing sort of global nomad demographic as we refer to it — the people who do have that flexibility in their work to be able to relocate themselves in different places overseas, and that sort of led to individuals taking out their own cover. So their company might provide them with cover within their home country, and the individual would then purchase international private medical insurance to cover them in their location of choice. So, that's something we've been used to in the past. And I think perhaps we might be seeing more of that at the moment, but I think maybe an interesting product development area, and I was only speaking to some colleagues about this the other day, is when employers start to say well, “is that something we should be encouraging, supporting? And should we be providing a cover option for that, or at least the top option?” Where, for example we provide cover in the US, but you might be able to pay as an employee for the extra bit that covers you to go and live in the Bahamas or whatever it is and still be insured with your private medical insurance from us as a company. So, yes, that might force, a little bit of product development, as we see some more flexibility with people's location of choice for work.

(30:35)

Absolutely, and I still think there's another dimension to that as well which is the opposite way around, because actually now you can start to attract across many different countries so, you know, that that workforce that an organisation that may be based in a particular country can now recruit from all over the world as these types of working from home practices come in, whether on the short term or whether in the longer term. And those types of companies and organisations who are looking to grow their talent or recruit new talent from different parts of the world that are now open to this remote way of working, and now understand that this can work, and lead to a very productive workforce environment. We'll now be looking for solutions as well from their benefits providers to be able to cover these types of working arrangements in the future.

(31:23)

Absolutely. And I think the other dynamic with it as well is whether it's short term travel insurance or whether it's comprehensive private medical insurance provided by your employer I think there's going to be a greater focus on reassurance of what I am covered for and not covered for if I and my family are being moved overseas in light of what we've gone through now. You know, what does my evacuation cover look like should the worst happen? How does this support me with visa access and COVID requirements for testing for access, as Hemal alluded to? So I think this will cause a lot of people to pay a little bit more attention perhaps to exactly what they covered for and maybe realise, for example, their travel insurance doesn't support them as extensively as they thought it might do and it might drive more of a need for sort of short term health insurance coverage for people on assignments who perhaps might have relied on travel previously. So, I think as we start to see travel opening up again, it’s going to lead to a number of dynamics for us to consider and for an employer to consider how they sort of reassure and support their employee in that travel that they're now asking of or requiring them to do.

(32:34)

And you've both actually covered off the questions that I was going to ask which is, you know, bringing up the subject of a broadened talent pool and looking at various compensation and benefits design, as well as expanding what a lot of employers are actually offering and bringing the family into the fold, so to speak. Which really brings me on to kind of the next area of discussion nicely. So, in another of our recent studies of expat families, we found that 35% of expats have actually added family members to their current insurance plan or have taken out a new policy to cover their family member, or members, as a result of the pandemic. So our surveys also revealed that there's a lot of uncertainty, the pandemic has made people look at health care abroad and reconsider their position, living outside their country of origin as well, which is another sort of interesting result of the pandemic. So, do you want to comment on that Simon?

(33:44)

Yeah, I think it's driving a couple of dynamics, I mean, one, as you say is certainly people reconsidering and revaluating, you know, their situation overseas whether due to work or work requirements or just through lifestyle choices — is it the time for me to repatriate, you know, what's important to me right now? So, in one sense, you've got people moving back home, perhaps, and therefore sacrificing some of their international cover. But on the other hand, as you say, we're also seeing a significant increase in cover from people who are remaining in location, and that we're putting down to a few different factors. One, I think, is realising perhaps I can't be as reliant on the state health health care system where I am as much as I might have been previously, for myself or my dependence. Secondly, perhaps I was overly reliant on the cover being provided by my organisation locally, and actually realising that that might be fairly limited or restricted. And it may not even cover my dependence and might be only myself as an employer. So you know I think there's people better evaluating and understanding what they've got and maybe realising that that isn't enough for peace of mind, amidst these heightened needs. So, there's a few different dynamics going on there but I think we've certainly got a much more health aware, and health conscious population out there to serve. And that's great, not only for demand for the products but also scrutiny of the products to make sure that that's really meeting their needs and understanding some of the limitations and why cheapest isn't always necessarily the best answer in these situations. And that's good because we need to avoid commoditizing health insurance. This is hugely, hugely important and valuable. And you don't want at any point of need to realise limitations of your cover due to that commoditization.

(35:37)

Quite right and Hemal, do you have anything that you would like to add there?

(35:41)

I completely agree with Simon. I think people are reassessing their health benefits, they're identifying the gaps now, they're paying much more attention to what they have or what they need, they're evaluating it against their, sort of, family needs if have family with them. They're assessing the local health care provision and really taking note of, you know, what's available and where, and whether that's enough should they require services. So, I think people are looking at these things with more rigour than ever before, I think, and certainly those discussions and that sort of internal decision that people will have as individuals or as family is really taking a much, much higher level of importance than probably previously it did for many. I think people are not just looking at you know their health benefits partner and their insurer just you know managing their claims, they're looking at their insurer to manage their health, and I think that will become increasingly valuable over the coming months and years, as Simon describes. And I think, you know, for me it starts to highlight the need for some of the things that we've already talked about — the access to trusted and convenient health and well-being support in extension to you know the management of claims when you're ill, giving access to you to a good network. I think things that support people's needs, either their well-being needs or when they're ill — their health care needs, in a modality that they can access conveniently in unfamiliar surroundings or in places that might be away from their home countries, I think will become increasingly important. And this is particularly important for experts. We know this through many of the surveys that we've done, and giving people access to these types of services, whether it's, you know, similar to our vHealth telemedicine service that we've already touched on, or whether it's our, you know, well designed employee assistance programmes, or our access to our 24 seven assistance for medical emergencies or security challenges. I think those sorts of things become much more vital for people, and I think as Simon says, looking into what your benefits partner provides or, you know, trying to search for these things separately is becoming more and more important. Our vHealth service, as Simon said, has seen multiple hundreds of percent increase in consultations, where we provide GP services, we provide the diagnostics in people's homes or offices, we provide treatments that are delivered to them, whether it's medications or through digital means. You know, we're starting to open up partnerships with diagnostics providers and others that really start to treat people in their own homes or in their own offices and I think that starts to give people reassurance that they have the right support when they need it wherever they are in the world. And I think over the coming months, more and more of our members will have access to vHealth services as well as many of the other plethora of digital health services and the employee assistance programmes that we have. And, and this will only become more increasing value to them as we move forward.

(38:48)

Yeah, and from what I understand the dependants of the primary insured are three to four times more likely to access virtual health for the sniffles or for concerns or symptoms, than the primary insured themselves. So, it just shows how valuable it is to the extended family. And so, we've talked a little bit about workplace locality, you know, in terms of geography or remote versus office-based working. I wanted to also touch on different strategic approaches that organisations should be considering depending on the size of the organisation. So, the reason I bring this up is because, you know, we've discovered again through our survey that employees at small businesses are more susceptible to being stressed or as a result of long working hours compared to employees or counterparts at larger corporates. They're also being more likely to be negatively affected by budget cuts putting more pressure on resources which means that potentially they're being called upon to sort of pick up the extra load. So, Simon I wanted to ask you, you know, when it comes to the size of an organisation, what's really going to move the needle for small business in terms of that sort of holistic employee well-being and cost containment versus big business, for example?

(41:38)

Yeah, it's a real challenge here, Lorien, because I think even in the larger organisations, there are significant pinch points right. There's been people working at 200% of their capacity throughout all of this, but there's probably been other people at say 50%. So, you've still got that challenge within a large organisation and I think large employers are having to think about that and moving forwards and thinking: “well how do I create more agile workforces that enable people to adapt and evolve in their roles and deliver across functions?” You know, that you're not pigeon holed by job title, that you are multi skilled. And that requires quite a cultural shift as well, to enable people to be resilient and adapt to that change. To recognise that they might have to pivot themselves and their career, so I think it's not just an SME challenge, I think in large corporates, there's certainly a big leadership organisational piece to come out of this and rethink about workforce role design and organisational structure. But coming back to your question around SMEs — yes, significant pinch points for an SME. And I think the important thing is here, I mean if you've only got three or four people in your organisation and the work needs to be done then the work needs to be done. However, how can you be flexible and adaptable to not just lead to that sort of burnout and fatigue that we sort of talked about previously. You know, that adage that I'd much rather, you know, you work for four days hard and take a day off and recover, rather than, you know, end up to the point of view that sort of breaking. So, how do you provide and build recovery into your work pattern and into work, just like an athlete would after a heavy training block, how do you build that recovery into your work environment. Not as an exception, but just as part of organisational design. If that's the type of workforce that we have if we are a small workforce if everybody is a pinch point – how do we build that flexibility into how we preserve the wellness of our employees. So, I think that becomes as much around policy and working flexibility and approach, as it does around, necessarily, the wellness solutions per se. And I think if you're an organisation, a small organisation, and you think “well I simply can't do that”, then you have to ask yourself well is that viable then? Is this a viable and sustainable business model, both as a business and for the individuals? If we can work in no other way than this, at 150% capacity for everybody. And I think there'll be a lot of individuals that come out to this questioning – what are things all about? What's important to me? You know, what's my purpose? Do we have a shared purpose in our organisation? Am I willing to commit 150%, 200% in a long-term way? If I don't feel that sense of community, if I don’t I feel and share that same purpose and those values to be driven in that way. So, I think organisations that do that, and don't have that connection, I would question how sustainable they're going to be in their long term and how well they retain that talent in their organisation.

(44:55)

Yeah, I guess, you know the principles are the same whether you're big or small. The only thing really I would add is that prevention is better than cure. And so, when employers are looking at whether you're big or small, and looking at, you know, how do you create employee well-being during these uncertain times? How would you support your employees, through this difficult time and uncertain times for not only the employees but also for organisations as a whole? You know, investing in services that can support people's well-being before, there is an impact on people's health, I think is really important. And as a primary care physician, I've been trained in prevention rather than curing but I've also been trained in curing as well. And we know that there are a whole host of benefits in prevention, and designing the right workplace or you know wherever that may be and however diverse that is now, having the right policies in place, as Simon describes, having the right insurance to give the right comfort when health care is required. Having the right digital services in place to help both in prevention and to help when things are not quite going your way, and to have those other bits of security out there, like your emergency benefits — all of that becomes really important for big, as well as small. And the smaller you are, the more important, you could argue that these elements are for you as an organisation to maintain your employees’ health and well-being. And so, I would urge you to choose the right partner to help you through that journey, and to understand what can be provided to support your employees.

(46:36)

And just reflecting on that as well Lorien, I think what the small employer does have a huge advantage in terms of its proximity to its people. You know, not necessarily in the physical but the metaphorical sense as well. And I think one of the biggest challenges in the largest corporate organisation, larger organisations, throughout COVID has been that remoteness, you know. Some people simply gone missing. You know, and it's been very hard to pick up on cues and clues as to what those individuals might be going through. For example, and I'd say a smaller organisation is much better place to be having those frequent conversations, to build that close knit community and those real pillars of well-being around contact, shared purpose, sometimes than necessarily a larger organisation. So, done in the right way, an SME may be well positioned to pick up on those cues for prevention and intervention, as Hemal describes, and sort of foster a real sense of purpose and well-being, that maybe is a little bit tougher in a larger corporate organisation to sort of filter through across all the many levels and many geographies and in many teams.

(47:41)

Absolutely and I think that, in what I would say is that this entire year 2019, 2020 in fact, has shown us how fast paced and fluid these, these changes are. How quickly we need to continue to respond and adapt, and that's not going to go anytime soon. But I really feel that in the points that you have raised in the conversation today, it's given people a lot to think about in terms of how to set up sustainable strategies to look after the future well-being of their employees and the organisation as a whole. So, thank you both very, very much, and I'm looking forward to inviting you both back to join the podcast at some point in the future.

(48:32)

For those of you who don’t know us, Aetna International is a global health and wellness benefits provider. But we're more than just an insurance safety net, our skill lies in delivering the tools, services and resources that can help drive health care costs down, and people's overall health and well-being up. That's something that's important to not only our corporate clients but our self-funded members, and that's why we serve almost 900,000 people around the world, from Shanghai to Seattle. Ultimately, we believe that when people thrive, their work and their personal endeavours thrive as well. For more information about us, you can visit Aetnainternational.com.