Clinically governed pathways<\/strong><\/p>\n\u201cThe continuing effort to move us away from a very financially managed way of managing claims stands out over my career,\u201d Wright tells Health & Protection.<\/p>\n
\u201cIt\u2019s things like excesses, session limits or other benefits and moving us into a much more clinically governed pathway where we get the certainty of the quality outcome as well as the cost management as well,\u201d he continues.<\/p>\n
As an example, Wright cites the launch of treatment pathways by insurers, such one for musculoskeletal (MSK).<\/p>\n
\u201cThat gives customers a really frictionless way to access it, they don\u2019t need to see their GP,\u201d he continues.<\/p>\n
\u201cIt gives great patient outcomes where we know they\u2019re being helped where they are being improved.<\/p>\n
\u201cAnd we know the costs are being managed through that clinical governance pathway approach rather than very artificially through a financial construct.\u201d<\/p>\n
As a result other pathways and initiatives have followed such as condition-based networks for knee, hip, spine and cataracts.<\/p>\n
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Huge changes<\/strong><\/p>\nReflecting on his career, Wright points to \u201chuge\u201d changes since he first joined Aviva in the summer of 1998.<\/p>\n
\u201cLiterally the year before I joined what was then Norwich Union, the tax relief for individuals older than 60 was withdrawn in the Gordon Brown Budget,\u201d Wright continues.<\/p>\n
\u201cAnd that\u2019s something that seems to have hung around ever since with the consumer market being really quite difficult to grow over time.\u201d<\/p>\n
But Wright also points to changes in healthcare legislation.<\/p>\n
\u201cThe major things looking back and this was just after I joined, hospitals were still registered and monitored under the nursing homes legislation,\u201d he adds.<\/p>\n
\u201cIt wasn\u2019t until the year 2000 that the Care Standards Act came in and regulated them in the more robust way that they are regulated now.\u201d<\/p>\n
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Surgeon inquiries<\/strong><\/p>\nFor Wright the most significant development for clinicians was the inquiry into Ian Paterson in the early 2000s, with the surgeon subsequently suspended from practice in 2011.<\/p>\n
This was despite there having been a serious inquiry into another surgeon, Rodney Leadwood, almost a decade earlier.<\/p>\n
\u201cThe lessons from that weren\u2019t really learned, even though Leadwood was struck off in 1998,\u201d Wright continues.<\/p>\n
\u201cIt wasn\u2019t really until after the Paterson Inquiry that we have seen some of those more material changes coming in, looking at how you oversee what goes into the private sector hospitals,\u201d Wright says.<\/p>\n
\u201cAnd there\u2019s probably a little frustration, there\u2019s a probably still a sense, and I think this still hangs over from legacy that the hospitals feel they are in the business of running hospitals and to some extent they would like to leave the clinicians, the consultants in particular, to really carry out the management and the governance of the clinical practice.<\/p>\n
\u201cNow we all know and we\u2019ve said many times that delivering high quality, safe, effective healthcare is a team game,\u201d Wright continues.<\/p>\n
\u201cIt can\u2019t be separated out like that.<\/p>\n
\u201cThat\u2019s why we\u2019ve been really interested in the value-based healthcare agenda, moving forward with how we\u2019re working with networks and quality guiding, because that ups the bar all around, so that not only do customers benefit from it, but the wider public benefit as well.\u201d<\/p>\n
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CMA investigation<\/strong><\/p>\nThe 2010s brought further significant regulatory intervention with the Competition Commission (now Competition and Markets Authority) diving into the private healthcare market in 2012.<\/p>\n
Wright explains its focus on patient literacy was a major shift for regulators and put in place the information organisation which exists today to help patients understand and make informed decisions and their treatment.<\/p>\n
\u201cThat\u2019s the big thing missing from healthcare generally, not just the private sector, health literacy in patients accessing and using it,\u201d he continues.<\/p>\n
\u201cI would say tongue in cheek, but it\u2019s not too far from the truth sometimes, that patients find it very hard to assess the quality of care they\u2019re getting.<\/p>\n
\u201cIt does need a professional overlay and more easy to understand measures and the Private Health Information Network (PHIN) is making great strides towards that, but there is still a long way to go.<\/p>\n
\u201cThat work continues and continues to increase the pace of the delivery as well.\u201d<\/p>\n
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A global pandemic<\/strong><\/p>\nAnd of course the global Covid-19 pandemic has put a spotlight on people\u2019s health and how it is delivered, with demand soaring.<\/p>\n
\u201cEven though it was only five years ago, we tend to forget about the pandemic and try to get back to life as normal,\u201d Wright says.<\/p>\n
\u201cBut that caused a fundamental change in private healthcare and was one of the key factors in uplifting the interest and the number of people that hold a private medical insurance policy.\u201d<\/p>\n
Indeed Aviva itself has added almost 100,000 more individual customers since 2020 with a similar size growth seen in its workplace business.<\/p>\n
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Challenges ahead<\/strong><\/p>\nLooking to the future challenges the sector faces, Wright points to questions around how the sector can better collaborate to achieve better health outcomes for customers.<\/p>\n
\u201cThe existing challenges are there,\u201d Wright says.<\/p>\n
\u201cHow do you have quality and customer clinical journeys as a team effort, rather than the hospitals doing their bit and the clinicians doing their bit?<\/p>\n
\u201cBringing that together, getting much better oversight and collaboration between the clinicians and the facilities themselves.<\/p>\n
\u201cIt has improved a lot, but there\u2019s still a sense that there is more to go in that space.\u201d<\/p>\n
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Value-based healthcare<\/strong><\/p>\nBut there also needs to be a focus on delivering value-based healthcare, where the most medically effecient and effective practice is followed to achieve the best patient outcome as quickly as possible, even if it may initially be more expensive.<\/p>\n
Wright adds better collaboration is \u201cvery closely aligned to that, because you can\u2019t really bring to life and embed value-based healthcare without it,\u201d he continues.<\/p>\n
\u201cIt\u2019s about adopting a value-based healthcare approach as opposed to a pure negotiation around pricing.<\/p>\n
\u201cIt has to be about the understanding of the clinical journey and the meaningful patient relevant outcomes.\u201d<\/p>\n
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Developments in genomics<\/strong><\/p>\nAnother hot prospect is the pace of developments in the world of genomics, which Wright says the sector is already seeing a lot of value coming from.<\/p>\n
\u201cFor instance it is already very often used to detect particular molecular targets for cancer treatments \u2013 we\u2019ve embraced that fully and seen that increase more and more,\u201d Wright says.<\/p>\n
\u201cSo that sense of genomics is here and will just continue to grow.<\/p>\n
\u201cThe bigger thing is how it is used to forecast risk predictions, and there are some things there we know are very, very well established at the moment.\u201d<\/p>\n
However, Wright maintains more work is needed to truly understand the potential of polygenic risk scores and if they can be used to influence underwriting and pricing decisions.<\/p>\n
\u201cWe saw the NHS 10-year plan talk about that quite a bit and it\u2019s potentially highly valuable at population level \u2013 almost risk stratifying the population so you target your interventions in the best value adding way,\u201d Wright continues.<\/p>\n
\u201cThink about adapting that into an individual level and you start thinking about how that might affect underwriting or pricing.<\/p>\n
\u201cWe don\u2019t really have enough evidence around that and how to make that work, but it\u2019s definitely coming.\u201d<\/p>\n
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Missing the people<\/strong><\/p>\nHowever, these will be challenges for other people to contend with and as Wright leaves office, he says it is the people he will miss most.<\/p>\n
\u201cI\u2019ve worked with and have continued to work with a bunch of absolutely fabulous people,\u201d Wright says.<\/p>\n
\u201cWe all bring something different into the thinking around the workplace, but I think it\u2019s bringing that diversity of thinking and people together that allows us to genuinely get the best outcomes for our customers, so I\u2019ll definitely miss that.\u201d<\/p>\n
Though he adds he will be keeping a keen eye on developments within the sector.<\/p>\n
\u201cIt will become more of a hobby,\u201d Wright says.<\/p>\n
\u201cGenomics is an obvious one, but I\u2019ll watch a lot of those emerging treatments and the use of AI and how that comes in and helps to facilitate patient care.<\/p>\n
\u201cThat\u2019s going to be a really interesting thing to keep a watching brief on rather than a working eye on.\u201d<\/p>\n
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Setting sail<\/strong><\/p>\nAs for his immediate plans, Wright has been hitting the golf course and also plans to get back into sailing, with a transatlantic voyage already in place.<\/p>\n
\u201cMy ambition is to lose fewer balls per round of golf; that\u2019s probably my initial target as opposed to a specific handicap that I want to get to\u201d Wright continues.<\/p>\n
\u201cAnd I have intermittently over the years managed to keep sailing in dinghies, but I want to get back into big boat sailing, so I\u2019m doing a transatlantic crossing later this year,\u201d he concludes.<\/p>\n
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