1. No category

AXA Assistance: Innovación en Salud
Digital
Semana del Seguro
Madrid, Febrero 2016
AXA Assistance
AXA Assistance – principales datos
7.523
EMPLEADOS
€1,3
BILLONES
€ 23
MILLONES
RENTABILIDAD
> 9.4 MILLONES
> 14 MIL
EXPEDIENTES
GESTIONADOS
REPATRIACIONES
ACTIVIDAD EN
200
PAÍSES
3
INGRESOS
PRESENCIA EN
33
PAÍSES
AXA Assistance – principales datos
43%
Europa
1%
Asia
34%
Francia, África,
Medio Oriente, I.
Mauricio
11%
América
10%
AXA Travel
Insurance
*Porcentaje de los ingresos por región
4
AXA Assistance España – Principales datos 2015
€
MAS DE 1.000
24/24 > 7/7
1.500.000
€147 MILLONES
EMPLEADOS
SERVICIO
SINIESTROS GESTIONADOS
INGRESOS
17.000.000
CLIENTES FINALES
Principales datos del mercado de salud en España
• Primas de seguros de Salud en 2014 ~$6,8B, con un crecimiento anual de ~4%:
• Mayores costes de siniestros:
• Crecimiento en el segmento de “colectivos”
• Mayor presión en los márgenes por el desarrollo y mayor poder de los comparadores online
• Consolidación de la industria como respuesta a la presión sobre los márgenes
• Desarrollo de modelos de negocio alternativos basados en innovación tecnológica
Innovación
Experiencia
de clientes
Control de
costes
Experiencia
digital
Calidad
Propuesta de Valor
AXA Assistance
Situación actual del mercado de salud
Un desafío para todos…
• Propuesta de valor a los
clientes
• Gestión del riesgo
• Menos tiempo disponible
• Mayor número de pacientes
Aseguradoras
• Mayores costes
Sector
Público
Médicos
Hospitales
• Mayores costes en
personal y
equipamiento
Farmacéuticas
• Medicamentos genéricos
• Poco acceso a los pacientes
Dispositivos de salud digital – de qué estamos hablando
3 grandes categorías: bienestar, seguimiento de la salud y dependencia
Oxigeno
Juegos
Temperatura
Robots
Glucosa
Tensión
Bienestar
Peso
Nutrición
Actividad Física
8 |
Ventajas y beneficios
Soluciones conectadas que optimizan el mercado…
• Mayor productividad
• Recolección de información
• Mayor frecuencia en la
•
interacción con los clientes
Diferenciación
Aseguradoras
Sector
Público
Médicos
Hospitales
• Mayor productividad
• Control de gasto
• Fiabilidad de los datos
• Fidelización de clientes
• Teleconsulta eficiente
• Mayor productividad
• Continuidad en el
tratamiento a los
pacientes
Farmacéuticas
• Acceso a venta directa de
•
medicamentos
Contacto directo con los clientes
Principales datos conectividad Móvil en España
49 MM
80% posee un móvil
38% posee una tablet
conexiones móviles vs 46 MM
de habitantes
1er país en
usuarios únicos de
móviles (87%)
Posición 8 en MCommerce
Usuarios que compran a
través del móvil
32% tráfico internet
Ya es vía móvil
2 horas al día
Conectados a internet
vía móvil
Fuente: We Are Social’s Compendium of Global Digital, Social and Mobile Data, Trends and Statistics 2016
Las nuevas tendencias nos llevan a plantear nuevos modelos de
negocio alternativos
TELE CONSULTA
TELE MONITOREO
Los sistemas remotos pueden ayudar a reducir los costes entre 10-20%, al reducir las
visitas médicas y hospitalizaciones
AXA Assistance apuesta por una propuesta con foco en servicios y en
la experiencia del cliente…
Desde una experiencia de servicios a un viaje integral de la mano de AXA Assistance
Salud conectada
Orientación a
proveedores
preferidos
Gestión de
patologías
crónicas
Coaching
conectado en
Wellness
Atención a
domicilio
Atención al cliente y capacidades clínicas
con Teleconsulta
12 |
Asistencia médica
internacional de
emergencias
Teleconsulta
TPA
Internacional
Segunda
opinión
médica
… entregando una única solución integrada
Para la monitorización de enfermedades crónicas o para Fitness Coaching
Una App “HealthLook”
Dispositivos conectados (Salud o Fitness)
Equipo médico de AXA Assistance: entrega de servicios de
monitorización, supervisión, apoyo y asesoramiento
Oportunidades en el Mercado de
asistencia de salud en España
Approach to define a value creation plan for 2020
Where are we going?
Where are we?
1. Strategic Foundation is a
robust fact base on point of
departure that drives to
strategic insights and
identifies the most important
value creation levers
Strategic
foundation
2. Bold, full-potential
ambition and target equity
value 3-5 years out
3. Clear strategic choices on
where to play and how to win
Ambition
CHOICES
Where
to play
How
to win
How do we get there?
4. Set of 5-10 critical
initiatives to increase
equity value
Priority initiatives
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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15
Approach to define a value creation plan for 2020
Where are we going?
Where are we?
1. Strategic Foundation is a
robust fact base on point of
departure that drives to
strategic insights and
identifies the most important
value creation levers
Strategic
foundation
2. Bold, full-potential
ambition and target equity
value 3-5 years out
3. Clear strategic choices on
where to play and how to win
Ambition
CHOICES
Where
to play
How
to win
How do we get there?
4. Set of 5-10 critical
initiatives to increase
equity value
Priority initiatives
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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16
Overview of health insurance market in Spain
• Health insurance premiums accounted for ~$6,8B in 2014
- Health insurances split between assistance (~88%), reimbursement (~10%) and subsidies (~2%)
• Health insurance premiums growing at ~4% p.a.; growth mostly driven by price
increases aiming to offset continuous rise in claims costs
Health
assistance
insurance
market
overview
• Cost increase in health insurance claims driven by aging population, cuts in public
spending, VAT reforms and emerging consolidation of clinics
- Most drivers likely to continue putting pressure on business margins in the near future
• Growth of “Colectivos” segment and development of online comparators also putting
pressure on health insurance margins
• As a response to margin pressure, emerging industry consolidating
-
top 3 player increased market share from 54% to 63% (2010-2014)
• Markets under similar circumstances have developed alternative business models
leveraging technology innovation (same development likely to emerge in Spanish Market)
Key
takeaways
for AA
• In order to be aligned with health insurance provider needs, AA health assistance value
proposition should prioritize services that:
- A) help insurers avoid costs or perform a better cost control process
- B) helps insurers provide a more consistent high quality customer experience; in particular a more
digital and integrated experience
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
140701_Market_Assistance_Health_V13
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Pressure on margin specially critical for small players
Smaller players have less room for margin squeeze
Profitability index: 1 minus claims
expenses as % of premiums (excluding
civil servants)
Profitability index as a function of Relative Market Share
30%
Sanitas
Aegon
DKV
ASISA
AXA
20
Mapfre
M.G.Catalunya
A.S. Colegial
Generali
Adeslas
Fiatc
10
IMQ
1,000
Millions
€
0
0.01
0.02
0.05
0.1
0.2
0.5
1
2
5
10
Relative market share
(including civil servants)
Note: RMS leader=Leader’s premiums/second competitor’s premiums; RMS others=competitor’s premiums/leader’s premiums
Source: ICEA; INESE, 2014
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Margin pressure has triggered alternative business models
in other markets (leveraging technology)
TELE CONSULTATION
TELE MONITORING
By reducing visits to doctors and hospitalizations, remote
systems can help reduce costs by 15-20%
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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19
Approach to define a value creation plan for 2020
Where are we going?
Where are we?
1. Strategic Foundation is a
robust fact base on point of
departure that drives to
strategic insights and
identifies the most important
value creation levers
Strategic
foundation
2. Bold, full-potential
ambition and target equity
value 3-5 years out
3. Clear strategic choices on
where to play and how to win
Ambition
CHOICES
Where
to play
How
to win
How do we get there?
4. Set of 5-10 critical
initiatives to increase
equity value
Priority initiatives
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Health assistance claims can be divided in two groups:
clinical services and non-clinical services
CLINICAL
SERVICES
Hospitalization
External consultation
NON-CLINICAL
SERVICES
Patient
management
Cross border
healthcare
• Medical helpline, triage &
teleconsultation
• Second medical opinion
• Authorizations
• Elite concierge services
Corporate and
individual mobility
• Travel for treatment
International claims
management
Major surgeries
• International TPA
• Corporate mobility/
Individuals mobility
Day hospital
Emergencies
• US PPO
Emergency medical
assistance
• Medical staff/Medical
transportation
Home healthcare
• In-Home healthcare/
Telemonitoring
Note: Insurance premium include Health Assistance and Reimbursment
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Non-clinical services account for ~5% of the overall health
insurance claims expenditures
DIRECTIONAL WIP
Total =
€5,668M
100%
€5,384M
€284M
Emergencies €481M
Day hospital €192M
Emergency medical
assistance €76M
Major surgeries €485M
80
Second medical opinion
€16M
External consultations €947M
Corporate and
individual mobility
€37M
60
Home healthcare
€23M
Authorizations
€45M
40
Hospitalizations €3,279M
Medical helpline,
triage &
teleconsultation*
€88M
20
0
Clinical services
Non-clinical services
Note: Includes medical assistance and reimbursement; *teleconsultation currently not offered by insurance companies
Source: ICEA; DBK; Ministerio de Sanidad, Servicios Sociales e Igualdad; Bain analysis
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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22
Non-clinical services landscape highly fragmented
PRELIMINARY
Internalized services
Other players
Source: LitSearch; Expert calls; Bain analysis;
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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23
Clearly defined criteria used for markets prioritization
PRELIMINARY
HABILITY TO WIN
MARKET
ATTRACTIVENESS
Criteria
Weight
• Expected market
size in 2020
• €0M-€25M
• €25M-€50M
• €50M-€75M
• €75M-€100M
• €100M+
• 30%
• Profitability
(% EBITDA)
• Negative profit
• 0%-5%
• 5%-10%
• 10%-20%
• 20%+
• 30%
• Strategic value
to capture other
segments
• Initial CAPEX
investment
• Available IT
Platform
• Competitive
landscape
• Access to
clients
• Very low
strategic
importante
• Very high
investments
• Some
strategic
importance
• High
investment
• Medium
strategic
importance
• Medium
investment
• High
strategic
importance
• Low
investment
• Key
strategic
choice
• No additional
investments
• No existing
platform
• Basic platform, large
changes
• Platform
needs several
changes
• Platform
needs minor
changes
• Platform fully
developed
• Very high
competition
• High
competition
• Medium
competition
• Low
competition
• No
competition
• Some access
• Good access
• Differentiated
access
• No access
• Exclusive
access
• 40%
• 25%
• 25%
• 25%
• 25%
Source: Bain analysis
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Proposed health assistance markets prioritization
HIGH
80.0%
Priority 3
Priority 2
Authorizations
€45M
Market attractiveness
60.0
40.0
Emergency
medical
assistance
€76M
Second medical
opinion €16M
Priority 1
Medical
helpline, triage
& teleconsultation
€88M
Home
healthcare and
telemonitoring
€23M
Corporate and
Individual
Mobility €37M
LOW
20.0
€50M
Estimated
Market
Size 2020
0.0
20.0
40.0
60.0
80.0%
LOW
HIGH
Ability to win
Note: *International claim management, Travel for treatment and concierge services market size not to scale
Source: Bain analysis
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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SP among top EU markets in Tele-Health readiness rankings
COUNTRY RANKING BY TELE-HEALTH
MARKET READINESS SCORE
SPAIN PERFORMANCE IN SOME
KEY EVALUATED DIMENSION
• Most favorable legal framework to develop
Tele-Health
- In some countries, such as Germany or Austria, remote
assistance is forbidden or only used for emergencies
- Regulation and acceptance of electronic prescription
- Regulation and acceptance of medical remote assistance
• Active population in terms of digital
background (mostly in public sector)
- Doctors likely to prescribe electronically
- Doctors likely to share information with other
professionals across devices and electronic networks
• Lack of awareness of positive ecosystem
among key stakeholders
• Low development of potential Tele-Health
market
- Low market size compared to market potential
*Market readiness score - average of the scores in 5 categories: eHealth adoption, level of digitalization among population, Tele-Health market
potential, ease of starting Tele-Health business, Tele-Health regulatory frameworkValues of the scores are between 0 and 1, where score 1 represents
country which has the highest value in all criteria; Source: research2guidance - EU Countries’ mHealth App Market Ranking 2015
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Tele-Health emerging in the public and private sector
• Between 19931994, 1st pilot
to introduce
Electronic
Health Record
in 3 healthcare
centers in
Andalucia
1990-2000
• In Spain since
2004, Tunstall is
a leading
provider of TeleAssistance,
introducing TeleHealth services
(TACTIO)
• In 2005, the
Spanish
Government
launches
electronic
prescriptions
• By 2010, ~95% of primary healthcare
doctors had used Electronic Health Record
• In 2010, ~250M electronic prescriptions
were sent to pharmacies, and in regions
where electronic prescriptions were used,
achieved up to ~15% reduction of primary
healthcare visits
2001-2005
• In 2007, Hospital
Virgen de la Poveda
(Madrid) opens its TeleHealth unit, TeleConsultation for
dermatology services
2006-2010
• In 2010, Telefonica
launches its Global
E-health unit for
Tele-Health
services
• In 2015, development
of 'Receta Médica
Online‘, online
platform that
connects doctors and
pharmacists with
patients to renew
private prescriptions
2011-2014
• In 2015, Hospital Virgen de la
Poveda creates Sociedad
Iberica de Telemedicina y
Teleconsulta (SITT)
- 250 professionals and health
companies in Spain and Portugal to
promote and contribute to the
development and knowledge of TeleHealth
Public sector
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
2015
LON
Private sector
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Recap: Approach to define a value creation plan for 2020
Where are we going?
Where are we?
1. Strategic Foundation is a
robust fact base on point of
departure that drives to
strategic insights and
identifies the most important
value creation levers
Strategic
foundation
2. Bold, full-potential
ambition and target equity
value 3-5 years out
3. Clear strategic choices on
where to play and how to win
Ambition
CHOICES
Where
to play
How
to win
How do we get there?
4. Set of 5-10 critical
initiatives to increase
equity value
Priority initiatives
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Telemonitoring approach should have attractive economics
for both Axa Assistance and insurance companies
Private sector
Insurance company
Axa Assistance
TM fees lower than
physical consultation fees x
TM avoidance rate*
Cost of providing TM services
lower than
TM fees charged to insurers
Attractive economics for both parties
Note: *% of physical consultations avoided due to use of TC
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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~1M people with chronical conditions in the private sector
Private sector
Condition considered for Tele-Monitoring
• Chronic
obstructive
pulmonary
disease
• Diabetes
• Type of obstructive lung
disease characterized by
chronically poor airflow
Prevalence
(1)
Number
people with
condition
Avoidable
cost per
patient (2)
• 2.2%
• ~198k
• ~€3,600
• 4.6%
• ~410k
•
~€150
• 8.0%
• ~720k
•
~€113
• 0.4%
• ~32k
•
~€300
• Monitoring of blood pressure,
blood oxygen, pulse…
• Group of metabolic diseases
in which there are high blood
sugar levels over a prolonged
period
• Monitoring of glucose levels
• Hypertension
• Cholesterol
• Different metabolic or
coronary alterations that
require medical supervision
• Obesity
• Monitoring of blood pressure,
weight, cholesterol levels,…
• Pregnancy
• Monitoring of pregnant
women weight, blood
pressure, oximetry, etc. and
mobile solution for pregnancy
management
Total
• 1,361k
Note: (1) Prevalence: % people with a given condition in the entire population; (2) Avoidable cost per patient: Emergency consultation and
hospitalization cost could be avoided by using telemonitoring
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Maximum TM fee for insurer vary by type of condition
Private sector
ANNUAL COST PER MEDICAL
CONDITION FOR INSURANCE
DIRECTIONAL
X
AVOIDANCE RATE
TELEMONITORING
=
MAXIMUM FEE THAT COULD
CHARGED FOR TELEMONITORING
Note: Number are direction, actual number might change +/- 10%
Source: Bain analysis
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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AA able to offer TM below threshold price across conditions
Attractive margins could be charged to insurers
Private sector
~300 CHRONIC OBSTRUCTION PULMONARY DISEASE
Price limit
Cost
DIABETES~6K PATIENTS
~€1,080
~€45
~€22
~€71
HYPERTENSION/CHOLESTEROL ~8K
PREGNANCY~3K PATIENTS
~€90
~€38
~€34
~€22
~30% mark-up on cost assumed for pricing to insurers at roll-out phase
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Potential approach for AA tele-monitoring solution
Tactio solution could be used as platform to provide tele-monitoring services
Solution based on of the shelf SaaS tele-monitoring platform
Patient side
Cloud infrastructure
Medical team side
• Smartphone
•
Measuring
device
• Tablet
Main requirements
Main requirements
Main requirements
Connection of devices
agnostic to brand
Secured data transmission
(SSL encryption)
Tracking of medical parameters
Process for patient
identification
Secured data storage
System of automatic alerts
Process for confidential
data use consent
Embedded data traceability
System to notify patients if required
Upload medical measurements
(e.g. glucose levels)
Connectivity to 3rd party systems
(public clinical history platforms)
Upload files capability
(e.g. education pamphlet)
Read access to clinical history
Connectivity to 3rd party actors
(e.g. pharmacies)
Write access to clinical history
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Potential approach for AA tele-consultation solution
Tactio solution could be used as platform to provide tele-consultation services
Solution based on of the shelf SaaS tele-consultation platform
Patient side
Cloud infrastructure
Medical team side
• Smartphone
• Desktop
• Tablet
• Desktop
Main requirements
Main requirements
Main requirements
Video capability
Secured data transmission
(SSL encryption)
Video capability
Process for patient
identification
Secured data storage
Process for Doctor/Nurse
identification
Process for confidential
data use consent
Embedded data traceability
Triage
capability
Upload files capability
(e.g. images)
Connectivity to 3rd party systems
(public clinical history platforms)
Upload files capability
(e.g. prescription)
Read access to clinical history
Connectivity to 3rd party actors
(e.g. pharmacies)
Write access to clinical history
This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent
LON
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Healthlook