Risk in the digital age - Virtual care

Increasing use of technology to monitor and manage health & wellness is a very current issue, particularly with heightened demand for remote medical consultations. Beazley underwriters Andrew Page, Carl Oliver and Kirsten Shastri discuss some of the insurance and risk management implications of virtual care and telehealth in this 10-minute podcast.

Transcript

Host:   0:00
Welcome to the Beazley Academy podcast: Risk in the digital age. In the series, we explore the fast-changing nature of risks around the world. I'm your host, Mairi MacDonald. Today we're joined by three underwriters from Beazley's London office who are looking closely at the risks and opportunities developing within the fast-growing digital health space. Andrew Page is an international healthcare underwriter and has been with Beazley for almost 10 years. Kirsten Shastri is an underwriter who joined Beazley in 2019. She has a scientific background and specifically life sciences, and Carl Oliver is a cyber underwriter within Beazley's private enterprise team here in London. Welcome.

Host:   0:40
So our topic today is virtual care and how technology is changing the healthcare landscape. Specifically, how digital technology is being used more widely to both monitor and manage health and the implications for insurance and risk management. Andrew, perhaps we can start with you, by explaining what do we mean by virtual care?

Andrew Page:   1:03
In this day and age we're more connected than we've ever been in terms of the data that we're capturing around health and wellness, which ranges from anything from a remote consultations or telemedicine between doctors and patients by video link…  It could even be cross border, across continents. But it also goes down to health and wellness apps.  Anything from heart rate data or even your scales in your bathroom that take your weight and heart rate. Some even test air quality.

Carl Oliver:   1:55
I think the main thing about virtual care is that it's tech companies that are modernising the industry, basically, so they are bringing it into the 21st century. The main thing that we look at is the risks that also brings.

Andrew Page:   2:27
The people that are the forefront of this are in the university science parks, the tech companies. They're right at the forefront of the tech and the medical frontier, but actually they're not necessarily aware of their insurance requirements. So in that sense, they're almost behind the curve, even though they're so far ahead in terms of technology and  creating this new tech world that we are seeing.

Carl Oliver:   2:59
There are two different fields that were seeing: There are  tech start-ups that are entering into the space and try to bring it forward. And there are also the healthcare companies that realise that technology is something they probably should be embracing, and then trying to embrace it. So virtual care is trying to pick up everything that those different types of companies are trying to achieve.

Kirsten Shastri:   3:24
I also think there's a challenge for all of us in insurance in the tech and medical space where we have to work together to find the right solution and that is definitely what we're trying to do, but it is a continuous conversation rather than ‘Here is a policy, please take it. You may not understand all the offering that we have,’ or alternatively, the scientific experts saying 'This is a product, please insure it. We have to work together to get the right product in place.

Host:   3:54
Thanks, Kirsten. And perhaps you could elaborate a little bit more on what's actually driving growth within the virtual care sector and how insurers are responding.

Kirsten Shastri:   4:06
Virtual care is not new. There's been a lot of products coming around where we need to be providing appropriate insurance cover for.  For example, there was a very early example of telemedicine in North America where, in order for hospitals to speak to each other, they needed some sort of linking between patients who can't get to the hospital every day, doctors wanted to check in with patients who are very far away. This was actually in Nebraska. So now medical devices are becoming more sophisticated. We have technology for diagnostic use, which also brings around additional risk to the table, which needs to be covered by insurance. So hacking is always something that comes up in the news a lot, and I'm sure Carl will talk about later. There are a lot of really amazing examples of preventative apps in the medical industry, where, for example, you can check your blood glucose levels and make sure that you aren't at risk of becoming diabetic.  We also have real time monitoring and information sharing so we can have a face-to-face conversation with a doctor via a Skype call, which is fantastic.

Andrew Page:   6:36
And so much of society now is instant. You want instant results, you want instantly be able to see a doctor and not think, ‘Oh I've got to go in and book for an appointment in two weeks’ time'.

Carl Oliver:   6:57
We need to be aware of the fact that with these technologies, there are inherently risk associated with them.

Kirsten Shastri:   7:41
And I think definitely from a life sciences point of view, understanding this cyber element as well as the health risk. So when we talk about diabetic glucose monitors, if they don't work properly, that patient could die because they may not get the right insulin levels. So I think about it from that point of view. But then, we look at the hacking exposure etc on the other side, and making sure the app is working, for example, and the medical device is working properly. There are so many different aspects of risk that maybe people didn't think about when they first created this kind of opportunity in the medical field.

Host:   8:21
It's obviously such a fast moving sector at the moment.  But, Carl, perhaps you could talk a little bit more about some of the trends that you're seeing from a cyber perspective.

Carl Oliver:   8:33
This kind of ties into the supply and demand aspect again in terms of trends. I must say, I'm wearing two wearables myself.  The trends are what people want, they want data. In terms of the data, though, that's very important and I personally want to make sure that the wearables data that's being collected on me is held securely. These things know more about me than I do myself. A massive thing when it comes to cyber is the personal health information, which is as sensitive as payment card information.

Kirsten Shastri:   9:41
Also talking about this industry, it has literally grown - it's exploded. We were looking at, I think it was about 60 billion in 2018  [pounds], which was a forecast for the digital health market which is predicted to grow to £400 billion by 2025 of which the UK will account for about 20 billion. So it's a really big market that we can't really ignore, especially in the UK. We are a centre of excellence as a country for medical development and innovation and there is a high level of investment not only from government funding, but also from private companies who are investing in us and our growth and potential. We have a lot of amazing scientists in the country. There's also great demand for equally innovative approaches to insurance.  We are the market that has to develop alongside the products that we see in order to help them with managing their risk. Another exciting thing that we've seen in the news recently is using artificial intelligence for basically deciding what new pharmaceutical drugs we could develop. So it's almost going back in time and looking at all the different active pharmaceutical ingredients there are in the world and re-purposefully making new drugs with the information that we have on the different ingredients. There has recently been a clinical trial, which is soon to go under way, which is actually using the different ingredients that were chosen via artificial intelligence instead of just people making decisions, which I think is really exciting.

Host:   11:38
Andrew, you’re a healthcare liability underwriter. How much is digital technology impacting all of your clients right across the book?

Andrew Page:   11:52
I think it's impacting clients across the board. As we have said the digital aspect of wellness is almost expected these days. Certainly in the private space, it means you're not keeping up with your peers. So there's a competition there as well that you know you want to be the best in your field. It definitely impacts across across the board. It's a pretty fast moving  area, and whole new sectors of healthcare and wellness, are not quite being created overnight but it's not far off it. I think regulation is also going to increase over time. And it's really important you have a policy in place that actually can adapt and grow with you as a company. Those growth figures, they're enormous.  Potentially if you're if you're the company at the peak of your powers, your policy needs to be able to grow with you as well. So it's really important the insurance aspect matches your company's growth and the growth in potential exposure as well.

Host:   13:28
So as we're sitting here, we're in the midst of a global pandemic that will be directly impacting some of the organisations within this space. Can you explain how some of them are going to be feeling the impact of the moment?

Carl Oliver:   13:52
There is obviously going to be a real increase in their demand for their services. I think that the virtual care entities that we've been talking about here can really help step in at this point and help ease that disruption.

Kirsten Shastri:   14:42
I agree with that, and also having the opportunity to do a remote consultation is not only safer for the doctor, but also safer for the patient and  a lot of people  probably, originally when that kind of new technology came in, probably people were reluctant, maybe from the medical side of view to get on board with remote consultations. But I think right now people are probably really happy that that is an option. But also it means you can get non-emergency situations out off the GP kind of surgeries and the hospitals. You know, if I wanted to call and get a repeat prescription, I can do that through an app rather than going on waiting in a doctor's surgery where I could potentially be someone who could have coronavirus and I could give it someone else. So I think we're mitigating the risk.

Carl Oliver:   15:50
I just want to caveat that again, obviously, by saying it's great that these tech companies and healthcare companies can help at this time, but the companies themselves need to be aware of what they're doing. The exposure they're putting themselves into and the people that consume their services also need to be aware of the exposures there in terms of giving their information away. It's a case of making sure they've got the proper policies in place when they need it.

Host:   16:28
You have highlighted quite a number of the clear opportunities that virtual care, digital health, can bring. But what about when things actually do go wrong? What are some of the claims trends that we're already seeing within this sector?

Andrew Page:   16:48
Because it's an emerging industry,some businesses, because they are so new and start-up, and so forward looking that they're not really aware about the risk landscape. Healthcare providers that are long established and in the typical healthcare structure, you know, physical surgeries  seeing patients face to face, they're really aware of their healthcare risks. You have got a medical malpractice in place, they've got their general liability for trips and falls, But the additional exposure that come from the virtual care arena - the virtual healthcare and wellness arena - I think that these clients aren't fully aware of their risk landscape.  At is constantly emerging as well.

Carl Oliver:   17:55
I'll let Andrew own the bodily injury med-mal aspect of it. From my point of view, on the cyber side, it's definitely that, like I said earlier, it's personal health information. That's what we're seeing exposed or as quite an attractive proposition to hackers or the wrong sort people unfortunately. Personal healthcare information is obviously inherent within the virtual care arena. So that’s where we're seeing the biggest exposure on the cyber side.

Kirsten Shastri:   18:39
Also talking about the medical malpractice, obviously, sometimes you're going to be having a consultation to the phone with the doctor, and obviously there is room for error there. But if we look at it from a products liability point of view, people are trying to bring technology into the home and give medical devices to people who are not trained medical individuals so that they have the opportunity to take some kind of control over, checking their insulin levels, like I spoke about before, or using their phones to take photos of a mole that they were slightly concerned about. Maybe the picture quality was quite poor. And there is room for error of that picture being taken and then being sent to a medical professional and the idea and everything around that product being put in place  - the app,  if it's a medical device that’s attached onto your phone, to the actual conversation with the doctor and the doctor reviewing the picture that you've sent. That may not always go perfectly to plan as anticipated, so there has to be room for error there, and there has to be insurance in place for when it doesn't go properly.

Host:   20:14
There are a lot of themes that we could pick out for a whole series of podcasts on virtual care. But to draw things to a conclusion for today and maybe you could each share a final thought with us.

Kirsten Shastri:   20:29
So I think one of the main things from my point of view is that this is ongoing education. Like I said before, it's a constant communication and constant conversation. We just need to form strong partnerships with the kind of client to ensure that the insurance continues to meet the needs of the virtual care sector. We are very actively going to events and learning more and more about new and amazing products are that coming our way.

Andrew Page:   21:19
My takeaway is that it is a constantly evolving space and I've said this before. It's really important that we partner with people and we evolve together in terms of both the services they're offering and the insurance products. They need to grow together and I think we're definitely able to do that.

Carl Oliver:   21:43
Lastly I would say obviously virtual care's great. It's a revolutionary area, which, as I say, some might say it's necessary, maybe overdue. It's there to make our lives healthier but there are risks that need to be considered.

Host:   
Thanks, Kirsten, Andrew and Carl for joining us today. And thank you to you all for listening. I hope it's been an enjoyable podcast. To learn more about this topic and others, please visit www.beazleyacademy.com for an extensive library, videos, podcasts and blog posts. I'm Mairi MacDonald. This has been a Beazley Academy podcast for Risk in the Digital Age.