IN­TER­VIEW

Sunday Independent (Ireland) - Business & Appointments - - FRONT PAGE -

IT may be the rar­i­fied high-tech at­mos­phere in the brand new in­no­va­tion hub, but Ir­ish Life Health manag­ing direc­tor Jim Dow­dall has no prob­lem hap­pily imag­in­ing a fu­ture that oth­ers might just see as Or­wellian. The builders, in­te­rior de­sign­ers and trendy light­ing spe­cial­ists have barely left the Exo Hub — the beau­ti­fully-de­signed blue-sky-think­ing fa­cil­ity for the wider in­sur­ance and in­vest­ment group at its sprawl­ing of­fice cam­pus off Dublin’s Abbey Street — but Dow­dall is al­ready en­vis­ag­ing a brave new world of dig­i­tal in­no­va­tion for the health in­sur­ance provider he leads for the PLC.

Exo Hub is the phys­i­cal man­i­fes­ta­tion of Ir­ish Life’s de­ter­mi­na­tion to place tech­nol­ogy star­tups and dig­i­tal in­no­va­tion at the core of all of its busi­nesses, not least the health in­sur­ance arm that it cre­ated through ac­qui­si­tions and a merger two years ago.

Draw­ing on this techy vibe, Dow­dall paints a pic­ture of a world where health in­sur­ance cus­tomers don wear­able de­vices to po­ten­tially trans­mit all sorts of de­tailed and sen­si­tive med­i­cal data so in­sur­ers can mon­i­tor the health and ac­tiv­ity sta­tus of clients from afar.

“One of our prob­lems with the Ir­ish health sys­tem — and par­tic­u­larly with in­sur­ance — is it has re­mained the same as it was 20 years ago. It hasn’t evolved,” he says.

That has to change if the en­tire sec­tor is to re­main sus­tain­able, he says. Wear­able tech­nol­ogy is just one of the many in­no­va­tions he says can help. It is of par­tic­u­lar in­ter­est to the health-in­sur­ance in­dus­try, given 50 mil­lion of the de­vices will be in use glob­ally by 2020. Step coun­ters, for ex­am­ple, could al­low in­sur­ance com­pa­nies to give dis­counts to cus­tomers who hit ac­tiv­ity tar­gets and clin­i­cal level data can be used to pro­tect the vul­ner­a­ble from afar.

“You can have much more mon­i­tor­ing of peo­ple’s health and well-be­ing,” says Dow­dall. “You can pre-empt and iden­tify po­ten­tial risks and ex­po­sures. That can be fed back into the health sys­tem where some­one can in­ter­vene and ad­dress is­sues be­fore they be­come an in­ci­dent.”

For now, he says, reg­u­la­tion here does not al­low an in­surer to use data for these types of pur­poses. No doubt many con­sumers would be ini­tially hor­ri­fied to see those rules change. But Dow­dall says fears that in­sur­ance com­pa­nies would use this sort of data against peo­ple rather than for them are mis­placed.

“I think it comes down to trust. The part­ner­ship I would love us to be able to have with cus­tomers is that we can work with you to de­velop pro­grammes and pro­vide you with tools to let you track your own health con­di­tion and we can re­spond to the im­prove­ments you are mak­ing,” he says.

“Our vi­sion is about help­ing our cus­tomers live health­ier lives and if we can do that through new tech­nolo­gies I don’t think we should be afraid of do­ing that. This is not about try­ing to catch peo­ple out. It is about de­vel­op­ing pro­grammes that are shaped for you to im­prove the qual­ity of your health and well be­ing.”

The abil­ity to se­ri­ously con­sider these types of in­no­va­tions is one of the great ben­e­fits that Dow­dall sees from the ac­qui­si­tions and then merger that brought Aviva Health and Glo­health un­der the Ir­ish Life um­brella two-and-a-half years ago. “We have scope now to in­vest in new things,” he says.

Dow­dall has been in­volved in just about ev­ery health in­sur­ance up­start that has come in to take a slice of a once closed mar­ket in the last 15 years — ever since he threw in his lot with for­mer VHI chief ex­ec­u­tive Oliver Tat­tan’s Vivas Health in 2004.

“We cre­ated some­thing from noth­ing. Since start­ing from zero in 2004, our com­pa­nies com­bined have paid in ex­cess of €1.5bn for health­care for our cus­tomers. We have grown a suc­cess­ful busi­ness that now em­ploys over 400 peo­ple,” he says.

“The health in­sur­ance busi­nesses I have been part of have led the way in terms of in­no­va­tion be­cause they had to, be­cause they were small startup busi­nesses. We now have an op­por­tu­nity to ac­cel­er­ate the pace. It means we can do things in the years ahead that we could never have done on our own.”

Dow­dall ac­tu­ally be­gan his ca­reer in the Ir­ish Life tech­nol­ogy depart­ment straight out of school, where he worked for 14 years be­fore mov­ing to US multi­na­tional Am­dahl in 1996. Then in 2004 he met Tat­tan and Vivas co-founder Stephen Lough­man, who were plan­ning to set up Vivas to take on the might of VHI, and Dow­dall de­cided to join forces with them. “I knew noth­ing about health in­sur­ance, but I had the am­bi­tion to do some­thing dif­fer­ent,” he says.

The gam­ble paid off and Vivas was ul­ti­mately bought by Hiber­nian Aviva.

But Dow­dall still had the startup bug and he and Lough­man de­cided to step away and set up an­other new player, Glo­health: “It was deja vu but we had so much more ex­pe­ri­ence and we brought a prod­uct to the mar­ket that was all about tai­lor­ing and per­son­al­i­sa­tion.”

Ir­ish Life came on board as an in­vestor and then in 2016 the PLC ac­quired both Aviva Health and Glo­health and put the two to­gether to cre­ate Ir­ish Life Health.

The com­pany now has just over 20pc of the health in­sur­ance mar­ket — about 450,000 cus­tomers, up 30,000 since the merger.

“When we started out in health in­sur­ance the em­pha­sis was on hav­ing cover when you were ill or in hos­pi­tal. Ba­si­cally, sick­ness in­sur­ance. Com­pe­ti­tion in the mar­ket has moved that to­wards health in­sur­ance.” But it’s not all good news in the sec­tor, he says. “Af­ford­abil­ity is the sin­gle big­gest chal­lenge that we have. A lot of in­di­vid­u­als are not see­ing the ben­e­fits from the eco­nomic re­cov­ery and health in­sur­ance costs have in­creased over the last num­ber of years. So it is in­cum­bent on all of us to find ev­ery op­por­tu­nity to keep our costs down.”

De­mo­graph­ics are also prob­lem­atic. In 10 years’ time there will be more than 200,000 more peo­ple over the age of 65 than there are to­day. “We need to re­spond to that. We will need to build three more Beau­mont Hos­pi­tals just to main­tain the health sys­tem where it is at to­day,” he says.

Ever-grow­ing obe­sity and chronic dis­ease lev­els take up 40pc of Ir­ish hos­pi­tal bud­gets an­nu­ally and this is an area where he be­lieves tech­nol­ogy can help most.

“You can’t cure chronic dis­ease. You can only pre­vent it. And the sin­gle big­gest in­ter­ven­tion we can make is around phys­i­cal ac­tiv­ity. So my view is that we should have an op­por­tu­nity to in­cen­tivise peo­ple to take con­trol and im­prove their health and well-be­ing. That’s be­cause it is in their in­ter­ests, but it is also in the in­ter­ests of the over­all health sys­tem — whether that is through dis­counts to their pre­mium or some other mech­a­nism, reg­u­la­tion should let us do that be­cause mo­ti­va­tors like that can work.”

An Ir­ish Life Health study in con­junc­tion with DCU sports sci­ence ex­pert Niall Moyna has found that a third of 16-year-old girls and 40pc of 16-year-old boys don’t meet the min­i­mum fit­ness lev­els for chil­dren.

“The im­pact of this is that un­fit tran­si­tion-year boys have the same heart health as a 69-year-old. We are see­ing an obe­sity cri­sis com­ing at us that we can­not af­ford. Pre­vi­ously the health­care sys­tem was con­strained by peo­ple as they got older and sicker. Now we have pres­sures com­ing on the health sys­tem from the younger pop­u­la­tion, and we have to in­ter­vene.

“We need to put a break on some of the in­creases that are com­ing through from pri­vate hos­pi­tals that just drive up the cost of health in­sur­ance. We don’t have an op­por­tu­nity to ne­go­ti­ate with the pub­lic sys­tem — we are a price taker, all health in­sur­ers are. But we need to en­gage with the Depart­ment of Health and the Minister to ensure that pol­icy de­ci­sions they are mak­ing aren’t go­ing to im­pact on peo­ple opt­ing to have pri­vate health in­sur­ance on the back of what they have al­ready paid for in the pub­lic sys­tem.”

In 2014 then Health Minister James Reilly changed the reg­u­la­tions which has led to a sit­u­a­tion whereby if a pa­tient with pri­vate health in­sur­ance at­tends a pub­lic hos­pi­tal and signs a form to waive their right to be treated as a pub­lic pa­tient then their health in­surer was li­able to pay, even if they ended up on a trol­ley. Pre­vi­ously, their in­surer would be only charged for ad­di­tional ser­vices, for ex­am­ple, a pri­vate room.

“That has been the sin­gle big­gest driver of health in­sur­ance in­creases over re­cent years. There are so many chal­lenges in our health sys­tem but one of the im­por­tant ones is to put some in­tegrity back in the sys­tem. Peo­ple go­ing in, be­ing asked to sign forms that are not be­ing ex­plained but which waive their right to be treated as a pub­lic pa­tient. As a re­sult of that, their health in­surer is pick­ing up sig­nif­i­cant ad­di­tional charges for no ex­tra value. That needs to be fixed be­cause it is in­equitable. Peo­ple who have al­ready funded the pub­lic health sys­tem through their taxes and have opted to take out care, which al­le­vi­ates de­mand on the pub­lic sys­tem, are now be­ing pe­nalised by be­ing dou­ble charged for a ser­vice that they have al­ready paid for. It is some­thing that should be looked at by the Minister and the Depart­ment of Health.”

Dow­dall says Ir­ish Life Health cus­tomers have been told by the com­pany that if they are in a pub­lic hos­pi­tal and they are asked to sign a waiver that they should first ask what ad­di­tional ser­vices they will get.

“If they are given ad­di­tional ser­vices such as a pri­vate or semi-pri­vate room they should con­sider sign­ing the form if they are get­ting some­thing for it. If they are re­ceiv­ing no ad­di­tional care or treat­ment they should ques­tion whether they should sign it be­cause it is just putting up the costs of health in­sur­ance. We have had a very strong re­sponse from cus­tomers when they were ed­u­cated about this. We have seen cases in dif­fer­ent hos­pi­tals where peo­ple have been ha­rassed through­out

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