After 17 years with rival firm Cigna, what prompted your move to Bupa Global?
Up until 2011, I was managing director of Cigna Global in Europe and the Middle East. That year, I joined Cigna’s headquarters in Philadelphia, where I was chief commercial officer of the North American business for nearly five years.
In late 2015, I joined Bupa Global and moved back to the UK. The chance to lead the company into its next phase was too good to miss.
The cross-border business falls into two segments that are split roughly 50/50: consumers who come to us through intermediaries and our corporate business. We operate across five regions and the intermediary market is incredibly important to us.
We have standard terms of business with intermediaries that are tailored to local markets, so a Latin American broker does not have to fight their way through a European-style insurance company set-up.
Roughly three-quarters of our business comes through intermediaries, so making ourselves easy to do business with is key.
What are Bupa’s biggest regions and where is the greatest growth?
We have aligned our regions so they have scale, so all of them are significant and growing. In Europe, our office is essentially based in the UK and Copenhagen, where we have a service centre.
In North America, we have a partnership with the Blue Cross Blue Shield Association. We have traditionally been strong in Latin America, where we have facilities as well as extensive network capabilities.
The Middle East is by far the largest part of the Africa, India and the Middle East region, but there is growth in Africa and potential in India. Then there is Asia Pacific, which is centred around Hong Kong and Greater China, and then south-east Asia, where we have an office in Singapore.
What is the rationale behind having a partnership in US versus an exclusive presence?
North America is a high-growth market and that is because of the partnership with the Blue Cross Blue Shield Association. We structured it as a partnership because North America is such a complex legislative environment for healthcare, not least because of what president Donald Trump might do with Obamacare or, to give it its proper name, the Affordable Care Act.
North America is very dependent on provider networks. When we entered into the joint venture with the biggest national provider of healthcare in 2014, we wanted to achieve two things.
We wanted a strong footprint so that we could be at the forefront of legislative and regulatory changes and we wanted a partner to offer the very best network access we could, which is critical.
That joint venture involved purchasing a stake in a company called Highway to Health, which is an established healthcare provider in the US.
Via that network, we have seamless global programmes for multinationals that want all their expats, whether they’re Americans or otherwise, in one environment.
Whether our customers are in the US on assignment or for any other reason, they get seamless access to healthcare at the same rate a US national would pay.
It is highly efficient and convenient, and it also ensures that global multinationals in particular have an Obamacare-compliant programme. And, whatever ‘Trumpcare’ or whatever comes next looks like, we’ll ensure that that’s the case as the situation evolves.
Does the replacement of the Affordable Care Act concern Bupa?
It is a highly fluid scenario. The legislation that goes some way to repealing Obamacare, the American Health Care Act, was only just passed last month. The promulgation of regulation will take longer. We are keeping a close eye on it.
For us, it splits into two elements. One is access to the care system, which is divorced from the Obamacare debate because that’s a right accorded to us via our joint venture with Blue. So, we are not worried about our clients’ access to care in the US.
The other element, and the one we and everybody else will have to react to, is if the repeal of Obamacare means we have to start changing benefit structures. We suspect there will be some changes but those regulations and interpretations have yet to be made. The one thing we are confident about is that the whole market will have to respond. Our position is secured via the joint venture with a domestic provider.
Obamacare, which was introduced when I was at Cigna, had never been envisaged before in the US, so we are less worried than we were about Obamacare.
The original development of Obamacare focused on domestic healthcare and ignored travellers from and to the US. This created structures that were difficult for foreign insurers to understand and respond to.
Having figured that out and responded to it, we believe we will be able to cope with whatever comes next.
What types of products does Bupa offer?
There are varying tiers of product but the principle is to apply global capability to local relevance. Depending on the region in which the products are bought, the range would be tailored to the typical needs of individuals and companies.
This is particularly the case for larger multinationals where we have to be flexible to match their buying criteria. We have completely refreshed the benefits in the past 18 months to meet local market trends.
The best example of that is the Middle East where certain benefits must now be provided to employees. We tailor products to those markets so that our customers can be confident they are compliant.
Dubai is probably the most advanced in terms of developing an all-encompassing visa with healthcare requirements. Nothing focuses the mind of the human resources community more than if a senior individual can’t take up their assignment in Dubai because the healthcare formalities have not been sorted out. Abu Dhabi has pretty similar requirements, as does Saudi Arabia.
We fully expect that trend to continue across the region. Our aim is to be at the forefront of making sure that emerging regulations are built into the products and advise intermediaries
outside the region what those requirements are, should they be engaging with customers or corporates sending their people there.
On one hand, we are making sure our products are compliant, and on the other hand we’re making sure we have got the tools and resources available so that an intermediary in the UK, or elsewhere, can understand those obligations and advise their clients accordingly.