Fit for Duty Podcast: Episode 18.

CT

I have seen quite mundane periods when we didn’t have a lot of changes in the health care industry and it was run in a certain way, to the current era right now where we are constantly challenged with changes and a lot of obstacles in delivering health care. And I’m glad that this has forced the health care industry to change the way the services are delivered. It’s of utmost importance to maintain that pace of change going forward.

LN

Hi! My name is Lorien Norden. Thank you for joining this episode of Fit for Duty, the award-nominated podcast for the global health and well-being benefits sector that’s brought to you by Aetna International. This podcast is really about helping organisations foster healthy, happy and productive people and workforces.  

So today’s conversation is all about health care trends across, not just the rest of 2022, but also those that will continue to impact us into 2023 and beyond. And today’s guest is Dr Charushilla Thadani, Medical Director at Aetna International. We’re going to be covering topics such as the ongoing impact of the pandemic, as well as Long COVID.

CT

The pandemic’s aftereffects may increase the utilisation and health care spending in 2022. Mainly due to a few reasons, one of which being the return of some care that was deferred during the pandemic, the ongoing cost of COVID-19, the increased rate that we have seen of mental health issues or substance use issues during pandemic and worsening population health.

LN

We’re also going to be looking at some mega trends such as radical flexibility that have been born out of employees’ changing attitudes to health, well-being and work-life balance and how these trends might influence benefit policy design and workplace policies going forward. So in a nutshell, we’ll be covering health-related information that organisations can take on board and apply in a practical way.

CT

It's not merely enough to provide employees with holistic well-being offerings. But it's also important for the employers to make sure that these offerings are being used by the employees.

LN

So what does the future hold? Let’s do a bit of prediction analysis with Charu and, as she’s based in Dubai, we’ll pull out some specific examples of how organisations in the emirate are adapting, transforming and responding to some of these forces.

Hello Charu, It’s fantastic to have you here today. Thank you so much for joining us. I’d like to start by asking you to give a bit of background – tell us about yourself and your role at Aetna International, please.

CT

Hi Lorien, thank you for having me. So I'm a trained physician and I have done my master's in public health. I have been working in the health insurance industry for the past 15 years. I have done multiple roles during my tenures, and I have seen multiple health care systems across the world and had the fortune to work within those systems. Currently, I work as a Director of Health Services and Medical Director for Aetna International. In my teams, I have experienced physicians and nurses. They are based mainly in Dubai and the UK.

LN

Fantastic. So where in the world are you today? And are you working from home? Or are you in the office?

CT

So I'm based in sunny Dubai. We are still working from home and I would say it has been almost two years now that we have been working remotely. And I have to say it's going fantastic. I do pop up in office as and when needed. And it gives me the freedom truly to arrange my work around my life rather than managing my life around my work. You know, so it's, it's nice to have that balance. And it's a bright, sunny Dubai afternoon. So, you know, it's as quiet as it gets.

LN

Oh, fantastic. Wonderful. And you mentioned that the model that a lot of businesses are following at the moment in Dubai, or certainly from an Aetna perspective, is working from home. Outside of Aetna, are you seeing that a lot of people are back in the office full time? Is there a hybrid situation? What's happening at the moment in Dubai?

CT

I think employers are showing a fair bit of flexibility when it comes to the working schedule, Lorien. There is no prescribed version of ‘this is how it should be done’ and I think that's, that's more unique. And that's more personalised, right. Because there is always the pluses and minuses for whether it's working from home or working from office, I have had colleagues who are bachelors and do not have families here being expats in Dubai and working from home was not that easy for them, as opposed to someone who has families and you know, enjoy that freedom or spending time with families. So, I really like that mixture of both having the flexibility to work from home on a few days and work from the office for a few days. It just means the best of both worlds together and lots of employers in Dubai are basically giving that flexibility to their employees, which is great.

LN

That is fantastic to hear. Absolutely. And so, turning our attention to the next 12 to 18 months, just thinking about health care trends. So, what do you think is really going to be the most impactful for employers and individuals? I think let's start with COVID-19. What do you really expect to be happening next?

CT

I think there is a fair number of speculations and predictions in terms of the COVID-19 status in future. A lot of scientists are continually looking for ways to predict the viruses next move and we’ve seen many new studies being published. One of such studies, which is published in the New England Journal of Medicine, suggests that the new variants are just as virulent as previous strains, and the apparently reduced virulence that we see right now of Omicron is largely due to the levels of immunity in the population. Similarly, there, there have been other studies and one of the evolutionary biologists at the University of Edinburgh, Andrew Rambaut, says that it's very difficult for us to know, based on the data that we have, what will be the future. What will be next. But there are a number of theories that he proposed - a number of different patterns that we can see this disease might progress into.

So one of the first ways that this is may progress; it might evolve into measles-like infection. So what that means is, as measles evolved, an infection or vaccination will keep the lifetime protection so if someone had infection with COVID-19, or has had vaccination, they might develop lifetime protection, and the virus circulates largely on the basis of new births. Another possible theory is the behaviour could be similar to respiratory syncytial virus, which is RSV virus infection. Now RSV largely affects people in their first two years of life and is a leading cause of hospitalisation in new-borns, but most cases are mild. So if COVID-19 follows that path, as long as we circulate vaccines that provide strong protection against severe disease, it will remain essentially a virus of kids. Now the third possible outcome could be Influenza A-like infection. So this means that this will drive seasonal flu globally, every year, because the virus evolves rapidly to escape the immunity built by the previous strains. That's why vaccines are always well matched to the circulating strain. Now if it evolves, as an Influenza B-like infection, then it will have a slower rate of evolution and it will change more slowly than influenza A. So it largely affects children, who have less immunity than adults. So this is an overall theory in terms of which way it can progress.

Now, if we are talking about long COVID, or long-haul impact of COVID, there is limited data from the previous pandemics. So, to make assumptions or predictions based on the previous data would be difficult to identify what will be the future impact of Long COVID, especially economical aspects, but the effects for individuals and countries might last for decades based on the initial findings that we have seen.

LN

Absolutely. Well, as you as you mentioned, there, I mean, influenza A, and taking a path that's very similar, is something that I have certainly heard spoken about a lot, you know, in terms of us having to have global, annual flu-like vaccinations. And that's something that I think a lot of people are expecting to come out of this. But you know, as you said, a number of other pathways that the virus could take, and it's just too early to really know with any certainty which way it could go from here. But in terms of, you know, COVID and Long COVID. What are the implications for population health managers and for health care provision in the future, according to those studies that that you've cited there? What do you think we can expect to see in the coming year or two?

CT

I think, Lorien, there will be many areas that will be impacted by COVID when it comes to the population health and the way the health care is, is provided right now. There is a study which was published by PwC to identify and explore the areas that will lead to the increase in medical cost in 2022 due to the pandemic. What that study has seen, or that study has shown us is the pandemic’s aftereffects may increase the utilisation and health care spending in 2022. Mainly due to a few reasons, one of which being the return of some care that was deferred during the pandemic, the ongoing cost of COVID-19, the increased rate that we have seen of mental health issues or substance use issues during pandemic and worsening population health. If we look at this, each component in some detail. So first, it was the care which was deferred during the pandemic. So, health care spending by employers in 2020 was lower than expected, in large part because of the deferral of care or more likely elective care as a result of pandemic. Some of this care is expected to rebound in 2022. And some of it is likely to increase the health care spending throughout 2022 and beyond. In addition to that, there is already a cost of COVID-19, which is likely to persist. So the cost of testing for COVID-19, treating patients, administrating vaccinations for the disease likely will likely continue in 2022 as well. Mental health. Now, mental health is a huge topic that has caught quite an attention during pandemic, and we have seen during the pandemic, there is a substantial increase in the demand of mental health care services. Increase substance abuse also will likely to increase the health care spending. So combining mental health and substance abuse together is likely to increase over the coming years too. Now overall population health. So we have seen a period where it was poor pandemic-era of health behaviours which is because, like we discussed, about being able to work from home, but it comes with lack of exercise, poor nutrition, increased substance use or smoking. And this led to the deterioration in the US population’s health and an increase in health care spending. Now while we are being reactive to the changes that's happening, I think the health care system is preparing itself for the next pandemic as well. So calls to prepare for the next pandemic are as certain as its eventual arrival.

Preparations cost money and pandemic readiness likely will be an inflator of the medical cost trend in 2022. The US health industry is planning on embarking on investment in forecasting tools, supply chain staffing, PPE and infrastructure changes. Because this investments, payers and employers are bracing for the rising prices. And while this all is happening, the major focus that's been identified is into the digital investment. Now, the pandemic has accelerated providers’ improvements in digital experiences, so they maintain their relationships with patients through the challenge of COVID-19, while reaching new segments. Providers are also fine-tuning their “digital front door” with mobile apps that connect them to their patients, beefing up portals and intensifying use of customer relation management, or what we call it, the CRM tools. Providers are also using virtual care and analytics to not only improve the customer experience, but also create a regular touch points with patients, and also to expand their capacity to avoid frustrating and alienating patients. Now, this digital investment in patient relationship is expected to expand consumers’ access of care, increasing the utilisation and medical cost trend in 2022.

LN

So there's a lot to unpack there in terms of those, those macro trends, those macro impacts on population health and also health care providers. So I want to bring this down to a corporate or an employee basis and look from a duty of care perspective, from an employer looking after the health and well-being of their people. You know, it's part of the process of keeping them engaged in the workplace. Again, there's a lot to unpack. You touched on things like mental health, for example, which we know is incredibly important and is going to continue to be so. So I wanted to get into a little bit more detail then, you know, what do these trends and other health care trends mean for employers and the people in their care in your opinion, Charu? What do we expect to see? What can organisations do? Can you give me a little bit more of your opinion on that, please?

CT

Sure, Lorien. I think governments across the world and health regulators across the world are issuing their own regulations and guidelines in mitigating the spread of COVID-19 and how organisations should act and take responsibility, right. Depending on where you live, the actions you're employer takes could look very different. We are in an evolving situation, the world continues to be an unpredictable place. So, employers should maintain their contingency for dealing with a range of different scenarios. There is a long list of considerations. But I would like to make two key call outs when it comes to developing healthy, happy and productive workforces. So, in my opinion, the first one is the communication. The communication is key. It's important to keep an eye on open dialogue with your people around their health, well-being and safety. Employers must always take reasonable steps to protect the health and safety of their workforce, whether they are on-site or working from home. Each organisation will have to determine its own policies on workplace attendance and protecting vulnerable colleagues.

Second important point I think, would be continuing to focus on behavioural health support and ensure it gets the same airtime as physical health and the overall well-being, ensuring that employees know about the benefits and support available for the physical, mental and emotional health and from prevention through to the treatment. And harness of the power of the positives - particularly increase flexibility, efficiency, focus on health and well-being. The need for mental health support, whether it's anxiety, depression or stress is not going to go away. Therefore, the persistent efforts would go long mile for the employers.

Another important aspect I think would be to continue to provide easy convenient access to health care. Now we spoke about the virtual health care and the digital health. So the use of virtual care will continue to evolve, as do the tools and resources that employers provide to their people. So according to BenefitNews, about 70% of individual's medical complaints do not actually need an in-person doctor's visit. At-home care continues to evolve around the world with remote diagnostic tools, online therapies such as behavioural health and physiotherapy. So when it comes to care delivery, a clear direction is needed for employees, particularly expats, on how to navigate unfamiliar health care systems. For example, when should they visit the Emergency Room or Urgent Care, and when should they turn to a clinician and pharmacist.

In addition to that, I think supporting the personal needs of each employee and build a culture of well-being and equity is equally important. Our workforces reflect the communities in which we live and work. Those social determinants of health need to be considered as a part of an organisation’s health and well-being benefits for its people, no matter where they are based, or what their circumstances are. Age, gender, job, role, work patterns and locality also all have an impact on people's health and well-being. I think organisations must put well-being at the heart of their corporate agenda, taking action to support physical, mental, emotional health and cater to social, economic and environmental factors that impact individuals. I feel health is personal. So, an employee's approach to health and benefits should be personal and equitable too.

LN

Yeah, no, that's such a such a good point. And just, you know, going back to some of the points that you raised there, Charu. In terms of communication and the fact that the world continues to be a very unpredictable, uncertain place. I think from a corporate perspective, you cited some studies there yourself, you know, such as BenefitNews. But if you start looking a little bit more widely at other studies, it really shows that organisations that communicate on a regular basis about what the organisation is doing for its people, where it's headed, making sure that you're continually listening to what your employees need and taking action, whether that's on increasing personalization, increased access to those virtual tools, increasing support for that mental and that emotional health care as well as the physical you know, making sure there's a parity there, and making sure it's accessible to all is, you know, it's incredibly important. So I just wanted to say thank you for just highlighting all of those.

And then coming back to your points around technology and advances in technology. So, you know, in terms of treatment journeys, chronic disease management, as well as the delivery of some of those benefits, you know, you touched on I think physiotherapy and also mental health. Behavioural Therapy, I think you mentioned earlier. What are some of the areas that we expect to see becoming more of the norm, as far as health care delivery is concerned, Charu?

CT

Sure, Lorien, I think, you know, the new way of service delivery is quite exciting. So a recent report by McKinsey & Company found that there is an estimated $265 billion worth of care services that could potentially shift from traditional facilities to the home by 2025. Now, this is this is quite powerful. The report further explains that “as eager as Americans may be to leave their homes after close to two years of COVID-19 pandemic, one prevailing sentiment has become clear: when it comes to health care, many consumers would prefer options that allow them to remain out of the hospital or facility.” To meet that demand, I think health care systems are re-engineering themselves on how care at home ecosystems may evolve. Even before pandemic, care at home was one of the fastest-growing provider growth segments because of the favourable demographic and regulatory trends. So I feel the COVID 19 pandemic has underscored the potential of improved care quality, clinical outcomes and superior patient experience. Care at home is evolving as an indispensable component of health systems' efforts to position themselves for success now, and most importantly, in the future. Aetna conducted its own research and found that the traditional post-acute home-health segment remains the largest. But the new emerging home-care sub-segments - such as home infusions, home based dialysis, primary home care and hospital homecare - these are some of the rapidly growing sub-areas under home health care. And at home and virtual therapy, whether physical or mental, is another area experiencing substantial growth.

LN

So that home-health segment is really fascinating how that is continuing to develop and how a lot of systems and processes that were already in play have really been expedited, and are continuing to be expedited, and will continue to grow incredibly quickly in the coming years. So, you know, I wanted to again, you mentioned that Aetna has conducted his own research and from an Aetna international perspective as well, the business looks at global studies on an annual basis, and they really look at the health and well-being benefits and how they're changing, the balance of power between employees and employers, if you like, as well as the wants and expectations of employees with regards to their health and well-being benefits. So most recently, at the end of 2021, 25% of employees said that employer support for mental health was good. So that's, that's pretty low, and was less than half the number of those that said that it was good in the previous year. So we can see already that there's a perceived return to pre-pandemic levels of focus on mental health. That's what employees believe, and employers don't think that that's good enough, whereas physical health seems to be continuing to be given the same levels of priority, which have been consistently rated as good for the last several years, according to this study. So, for example, upwards of 77% of employees would rate physical health support by their workplaces as good. So, you know, this, this is from an employee perspective, it is about perceptions, but why do you think that those employees have been perceiving a reduction in focus on mental health and well-being?

CT

So there could be a lot of reasons, Lorien. It may be that the topic of mental health has had less airtime in communication because a lot of organisations were busy managing the evolving pandemic situation, tackling subjects such as equity and inclusion, and all while keeping the business moving forward. That doesn't mean that the understanding, support and resources for mental health are no longer there. Rather, it highlights the need for thoughtful, consistent, impactful communication around mental health. That includes not just communication about available benefits - industry experts say that it's imperative that employees are not only aware of offerings, but regularly encouraged to access and use them and also receive regular communication about employer strategies and plans. During times of crisis, conflict and confusion it's apparent that employees need employers more than ever, and employers should deliver.

Again, this was echoed in our proprietary research into communications that employees want. They want more frequent communications. They want clarity on what's available and where, and more importantly, how to access it. They want a single central point of access and information to all their benefits. Of course, every organisation will need to engage with its own people to find what they want, so they can respond with a customised plan.

Employers may be taking longer to implement all the changes required to eliminate stigma, ensure mental health is given the same recognition as physical health than originally estimated or communicated, and making significant changes to an organisation culture takes time, as does finding out exactly what your employees wants, and need and taking appropriate action.

Another important point we need to consider is while employees were told about mental health resources, tools, programmes and company policies in the early days of pandemic, they may well have forgotten what's available and how and where to access it since then. Again, highlighting the need of consistent communication is important. Historically, employers aren't as tuned in to what is available to them as employers think, or hope they are. Another important point to consider is mental health days and time off for burned out employees may have been part of the agenda in the two years after pandemic. But are they still on this table this year? So that's important consideration - the ongoing support for mental health conditions and the challenges. I think mental health conditions existed long before the pandemic came along. Workplace stressors that may have been causing employees anxiety, stress or depression could still be there. Employers that get in the habit of taking regular pulse checks about the employee's health and well-being will learn where they need to make internal changes and bolster their support for mental health.

So to reiterate my points earlier - workforce specific communication, integrating well-being into the culture, making it easy to find and access care benefits, and behavioural therapy, are going to remain key for next 12 to 18 months, if not longer.

LN

That was fantastic. There was so much that you covered there, so I'm really glad that you were able to summarise it at the end there for us as well. So just building on some of those points, what are some of the areas the other areas of health and well-being that you think employers and benefits providers in particular should be focusing on in the coming years? And if you could bring this round to your experience of Dubai, for example, where do you get the sense that demand by employees will be coming from in the future? So just again, just thinking about communications, mental health support, benefits, behavioural therapy, making it easy to find and access care? What are other areas that you can build on top of that and where do you get the sense that demand is coming from in Dubai?

CT

Sure Lorien. I think going forward that employees are going to be more aware of their needs, and therefore there would be a high level of expectations from employers. In a study by Gartner a few areas came out as the most important for employees. One of these areas is deeper connections. So employees do expect help from their employers in strengthening their connections with their family and community, and not just the work ones. Another important point is the radical flexibility that you even mentioned in the introduction. I think giving employees flexibility of where, when, how much, how, and with whom they work is going to be important. Many organisations allow for remote work at least some of the time. Employees can and should be granted more control of their schedules. Now, far from providing covers for loafers, Gartner finds that the adoption of radical flexibility raises the number of employees defined as high performing by 40%. Employees want to be treated as whole individuals, the researcher emphasises on this point and the employees do want to feel deeply connected to their company. Though considering today's tight labour market, which might be fuelling a spike in organisational attention to these concerns, the researchers say that it would be a mistake of an organisation if they do not see this as a long-term investment and consider it as a passing trend. Leading employers should take action to write new rules for their relationship with their people.

While employers are focusing on this aspect, there is also a demand or a need from employees to provide opportunities to grow as people, and not only from a professional perspective, but also in a holistic way. And talking about holistic, a holistic well-being is an important aspect of the employers’ demand too. It's not merely enough to provide employees with holistic well-being offerings. But it's also important for the employers to make sure that these offerings are being used by the employees. Now, most large firms offer a variety of well-being programmes, but few employees take advantage of them. Companies can start to address this by recognising that needs vary from person to person, and most importantly, it changes over time. To quote one example from Dubai, Mashreq, a leading Middle Eastern financial institution, encourages its employees to assess their well-being across six dimensions, such as family well-being and financial well-being. And it helps them to create and hold themselves to an action plan that leverages the organization's offerings. Leaders can also talk candidly about mental health and provide managers with do's and don'ts because it's very important when it comes to mental health. To give an example, do ask your employees how they're doing and guide them to resources if needed, but don't necessarily try to be their counsellor.

I think besides the this regular arsenal of benefit choices, employers have been getting more creative to help employees during COVID-19. Examples of benefits include emergency time off and online tutoring for employees’ kids, as well as collective time off trend - when companies shut down operations for a week to give employees a break all at once. Others embraced company-wide mental health days. I think the last point I would make for this agenda is the shared purpose. I think it's important to recognise the shared purpose, it's important to recognise the need of employees. But at the same time, it's really pivotal to take actions on societal and cultural issues and not just make statements about the purpose.

LN

That’s absolutely fantastic. I couldn't agree more and I think, just looking back to some of the things that you’ve mentioned there, the Mashreq example, for example. Looking at those social determinants of health and how the way in which we live, we work, we grow, how all of those things impact our health and our well-being, how our family relationships are impacted by that and how we can’t focus, be productive and be on an even keel emotionally if some of those things are out of kilter. So it’s fantastic to hear that process being described by such a well-respected financial institution so thank you for highlighting that.

I wanted to ask you, in terms of your experience of Dubai as well, just getting a bit more into what’s happening on the ground. The Great Resignation is well recognised and talked about the world over. We talked about the tight labour market, you referenced it there. So in terms of that talent attraction and retention, how do you see organisations in Dubai flexing to meet the needs of their people? Are you seeing any radical flexibility? Are you seeing those personal growth opportunities? And are you seeing organisations really focussing on their shared purpose and developing their culture? What can you tell me about that please?

CT

I think, Lorien, UAE has always been exceptional in recognising the population needs and implementing agile solutions, whether it’s investment in digital health or implementing new working week patterns. I think many private firms in UAE have recognised that it is of upmost importance, that they should put employee’s needs first – so when it comes to designing the future of the workplace, at the centre of designing their work culture in the future, it is important for them to recognise the needs of their employees and, with that in mind, many companies have implemented all of the things we have spoke about, whether it is hybrid work models or including mental health and overall well-being in their health benefit offerings apart from physical health benefits that they offer to their employees.

I think it has been done and definitely there is room for improvement going forward and room for more employee-focussed culture to be developed for the companies. Focus on the complete well-being of the employers rather than only the physical and the mental – both are equally helpful, so focussing on the complete well-being of employees,  I think it will be effectively leveraged as a tool for talent attraction and retention in UAE in the coming days.

LN

Well thank you so much Charu. Do you have any final insights on the situation in Dubai or even your own personal reflections on what you hope to see from an organisation’s perspective and how they look after the health and well-being of their people in the coming years?

CT

Absolutely Lorien. I think, being a millennial, I am so blessed because I feel that I have seen the best of both worlds. I have seen quite mundane periods when we didn’t have a lot of changes in the health care industry and it was run in a certain way, to the current era right now where we are constantly challenged with changes and a lot of obstacles in delivering health care. So, I would say that while the world is changing rapidly, it’s important for us to understand the health care needs and trends of the population. And I’m glad that this has forced the health care industry to change the way the services are delivered. It’s of utmost importance to maintain that pace of change going forward, whether it is in terms of digital or virtual care or home-health care options, as we identified, or equal focus on mental health along with physical health and overall well-being of employees. While all this is happening, it would also be important for us to maintain that personal connection with our consumer, whether it is a patient, whether it’s employees. It would be equally important to maintain that personal connection with our overall offerings and virtual offerings that we would be getting into.

LN

Yeah, I couldn't agree more. And with that, I would just like to say thank you so much for all the rich insights and data sources that you’ve brought to the conversation today. I think it’s given people a lot to think about and a lot to consider and also, hopefully, an understanding that Aetna International has an awful lot that they can do to support and to guide people in these areas. So again, it just remains for me to say thank you Charu. I’ve thoroughly enjoyed the conversation and I hope you have too.

CT

Thank you, Lorien. Thanks a lot for having me.

LN

For those 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 help drive health care costs down and people's health and well-being up. And that's something that's important to not only our corporate clients, but also our self-funded members, and that's why we currently serve almost 900,000 members around the world from Shanghai to Seattle. Ultimately, we believe that when people thrive, their work and their personal endeavours strive as well. For more information about us, you can visit Aetnainternational.com.