A conversation with Dr Avneet Kaur, Wellbeing Solutions Leader of the EMEA Health Solutions Division at AON and Prof Magda Rosenmöller, Senior Lecturer of Production, Technology and Operations Management at IESE Business School
In continuation with our COVID series, in the fourth episode of Health Tech for Businesses, we share a conversation with Dr Avneet Kaur who is the Wellbeing Solutions Leader of the EMEA Health Solutions Division at AON and with Prof Magda Rosenmöller who is the Senior Lecturer of Production, Technology and Operations Management at IESE Business School in Barcelona. They share their thoughts on the crisis today, the evolving role of the Chief Medical Officer, testing strategies, the relation between science and policy making and the importance of digital health today with DocHQ’s Marketing and Operations Lead, Gopika Sampat.
An edited transcript of the podcast follows. For more such conversations, subscribe to the series on Apple Podcasts or Spotify.
Gopika Sampat : Hello to everyone from DocHQ. I am Gopika and welcome to our podcast, ‘Health Tech For Businesses’. Here we will be talking to experts about several interesting topics from AI and data privacy to health equity and digital health solutions for businesses. In continuation with our COVID series, our podcast today will closely look at digital health and the evolving representation of health in businesses today. I am really honoured to host this panel with our two esteemed guests today. First, let me introduce Dr. Avneet Kaur. Avneet is the Wellbeing Solutions Leader for the EMEA Health Solutions division at AON. AON is a leading British global professional services firm that sells a range of financial risk mitigation products, including insurance, pension administration, and health insurance plans. Avneet is a trained clinician and has experience advising leading multinationals on health management and employee wellbeing strategies. Her current role focuses on employee health risk mitigation, cost containment and digital health strategies. So, without further ado, welcome to our podcast today Avneet.
Avneet Kaur : Thank you so much. Really excited to be here, Gopika
Gopika Sampat : Great. So, moving on to Professor Magda Rosenmöller. Magda is now a resident guest in our podcast, and we had a lovely discussion in our last episode. Magda is a senior professor at IESE Business School in Barcelona, and she studied medicine in the University of Strasbourg in France. She holds a lot of experience in European health policy and health research. So, Professor Magda, thank you so much for being with us here once again.
Magda Rosenmöller : Pleasure to me, thanks for having me Gopika.
Gopika Sampat : So Avneet, let us start with you. This crisis has affected several sectors and so far over our last few episodes, we have seen that companies have adopted different strategies and measures to handle this pandemic. So, we are curious to know how has a company as big as AON dealt with this crisis considering your employees and your clients, and what was the strategy behind it?
Avneet Kaur : So Gopika, I would say, you know, from an internal perspective, you know, let us just start looking at what AON has done for their employees. So broadly, I would say they have done a really fantastic job of handling and supporting and taking care of their employees during this pandemic. So, AON has provided really good emotional wellbeing support, financial wellbeing support. And also, you know, AON has been very invested in making sure that their people are very safe and healthy during this pandemic. Now, also, you know, there was always a regular engagement around working from home, making sure people are able to, you know, comfortably work without any issues. And also, you know, feeling connected and having a place to reach out if somebody is faced with any challenges. I would say even before the pandemic, AON was really an agile working organization. And transition to work from home was quite smooth, I would say. And another great thing was that the leadership was communicating regularly. So you know, every week we would have, you know, direct messages coming in from the CEO, going to each and every employee and really communicating what exactly is the strategy and how AON is going to take on the pandemic. Also, I would say our CEO has really led from the front. And it has been very reassuring for a lot of our colleagues that in face of this economic crisis as well, nobody will lose their jobs. That is something which was really, really clearly, I would say, outlined by our CEO. Now moving on, and touching on the client perspective, I’d say we’ve done tremendous amount of work focusing on how we can actually support clients through this pandemic, and making sure that, you know, our clients feel really supported during this time. And we have, you know, tried to really identify, and pinpoint the areas where we can really support. Any kind of requirements which our clients have, we were there to help them. And, you know, our solution capabilities or service capabilities have been really broad. So, you know, subjects like guidance and cyber resiliency, because that becomes really important with this overnight shift to a working from home model. Then there was a very, very, I would say, strategic support on business operations and strategy and also supported employers on their people strategy, and, you know, how do you actually mitigate the health risk of your population? Then we also try to, you know, get employers to understand really what exactly is the business risk of COVID-19 on their workforce, what is the impact, and how can they actually ensure safety and remain operational because a lot of our clients were really operational during the pandemic as well. Also, you know, what we have tried to do is help clients with return to work strategy as well. We partnered with some vendors to help clients in doing that, too. And alongside that, there is one thing which I would say which was, which is very, very interesting, which AON has now done is, AON in Chicago has set up a recovery coalition with a lot of other organizations. And that is our sort of an effort towards the responsibility for AON to play a larger role in really helping public and private sectors navigate the recovery during this pandemic. It started in Chicago, but this has moved to New York, London and Singapore and definitely is looking to expand to other geographies as well.
Gopika Sampat : So, what we have realized during this pandemic is that companies are looking at health very differently now. I was reading a Wall Street journal article that said that Tyson Foods, the meatpacking company, has created a Chief Medical Officer position now. And it plans to hire 200 nurses only as part of its COVID-19 monitoring program. I mean, can you imagine this, previously, mostly tech companies were transitioning into the CMO model because of the increasing investment in health tech. And by CMO, I mean Chief Medical Officer. But now everyone is suddenly looking at a Chief Medical Officer. So, Magda, what do you think about this?
Magda Rosenmöller : I find it a very interesting development. I mean, if we look into where health and safety comes from, it particularly came from risky work. So that is where it started. We’ve looked into health and safety at work that as employers, you’re responsible for it and you have to make sure that you minimize the risk, but from there it has, even before the COVID crisis, has developed to looking into the health issues. So, if you were working in in in a copper mine for example, we knew that this has a respiratory risk. So how can we help to minimize these risks that we know that will occur? So that was the concept behind a Chief Medical Officer or medical unit or the health and safety unit in in any company. But then there are two things. Companies would work very closely with work accident insurance companies to see to minimize those risks. But on the other side, many companies and that is particularly in the US but also in many systems in Europe – the health insurance of workers is very closely related to the employer. So, they have started to see how they can increase the health of the workforce. So, employers have taken a very active role – gyms ,healthy food, smoke free environment etc. COVID is an additional aspect. It is like we are in a crisis. So yes, companies do feel responsible for their workforce. But companies also know that if they do not do that, if they do not make themselves responsible for the safety, non-infection of their workforce etc, they might be out of business, as Avneet just said. So, we have seen many companies that took this more public role of doing the testing, but it was rather like looking into how we can actually create the COVID free environment here. We have done that at IESE Business School as well. Working from home is fine but our main job is education. So, we have to see how we can bring students back to the classroom in a safe way. It is imperative similar to what Avneet mentioned earlier about AON, that companies look into how they can bring the workforce togethe. So, they can create committees where they have executives from multiple functions and then also have the Medical Director or CMO, as you call it in addition to a representative of the workforce. I have been looking at several companies. And they said one of the important factors is the involvement of the of the CEO or at least someone from the board. They said that they had someone from the board every time with this risk committee or however you want to call it and I have learned that it is important to involve everyone. So that would be kind of maybe a longer response, but the CMO today, to fight COVID, I think it is a very important thing and we have to see how will we be developing this in the future? What would be the new normal of the Chief Medical Officer function? And that is something we should be looking into.
Gopika Sampat : So, I would like to delve into this a bit more with you Avneet. Dr. David Agus, one of the world’s leading physicians, said that we should not call this role ‘Chief Medical Officer’ because the term “medical” denotes dealing with medical issues. He is saying that this role should be bigger, it should be renamed to Chief Health Officer because the term “health” is your state today – it is effectively the lack of disease. So according to him, companies should have a program where they think of employee productivity and health every day. Just like how a Chief Environmental Officer looks at whether buildings are certified and waste management protocols, the Chief Health Officer should look at measures like whether the airflow in the building is optimized to reduce viral spread, stuff like that. So, Magda, like you said earlier, this role is ever evolving. You need to look at operational aspects, you need to be able to integrate a culture of healthcare in the business. So Avneet, what is your take on this, especially now in the context of COVID? Do you think this is more relevant?
Avneet Kaur : So, in terms of you know what Magda mentioned, I think this is something which we have also been thinking about. Typically, the Health and Safety officer or the Chief Medical Officer or Medical Director in the past, used to be somebody, exactly like Magda pointed out, in high risk industries, coal mines, asbestos work or any kind of construction sites, because there’s very, very high risk involved there. But now, I think, you know, what organizations are realizing is that health is very important, and I think COVID-19 has very, very clearly outlined that. Because if you do not have your people’s health, you really cannot run your business. And everyone has been thinking, you know, in terms of what exactly is the role of the Chief Medical Officer and how the value they add to businesses is changing. Now, at this moment, like right now, under the pandemic, the role is very clear, almost all organizations need some sort of a health and I would say ‘over the shoulder’ guidance in order to make certain decisions, because the questions which are being asked by governments or the requirements which have been put in, put on organizations by the government are very difficult for I would say, HR or even Health and Safety or business leaders to really make a decision based on that, because the health aspect is very, very strongly involved. But I would say once even COVID-19 moves out, you know, I’m hoping that happens very soon, I think it becomes a thing of the past – I would say, we do feel that there would definitely be a higher interest in the role of a CMO. A CMO would be somebody you know, who would be really driving the agenda of people’s health, making sure that you know, they are very clearly defining what is an business’s health policy, of course in line with business requirements and business objectives. And also making sure that leadership is engaged, to make sure that employee health is at the centre of the business strategy and optimize that health agenda. In my role, I have been interacting with clients, what happens is that you are interfacing with the HR or sometimes health and safety. But getting that point across and via employee health is important. I think a CMO or Medical Director role definitely would be able to do that. And also, another thing which we have been thinking about is that the CMO or Medical Director role typically in larger organizations, you know, they have budgets to hire a full time CMO , have somebody there. But AON is also thinking about different delivery models to make sure that CMOs are available to even mid-cap clients. Because somebody, you know, having somebody full time on your payroll might not be very, very valid or cost effective for them. So, I would say thought process around this is definitely evolving and it is an area definitely to keep an eye on.
Gopika Sampat : That’s a great point that you made there Avneet. I think this evolving representation of health in businesses today is definitely something to look out for. So now let us focus on the other approaches that companies are adopting at the moment to deal with this crisis. One of those measures is of course testing of employees. Companies and countries have had different approaches to testing. In most countries, testing remains restricted to people who show symptoms whereas in countries like say South Korea and Japan – they tested asymptomatic people as well. With companies for instance, Tyson Foods that I mentioned earlier is testing even those without symptoms. And this program involves screening employees daily, an algorithm-based process will select a number of employees to be tested on a weekly basis. And they plan to test thousands of workers every week. So, Avneet, my question is to you, what do you think of this approach where most government testing is all about testing symptomatic people and it’s more of a reactive approach versus a combination of proactive testing, even considering asymptomatic people, surveillance, etc? So, what do you think is best suited for companies?
Avneet Kaur : I would say, you know, there is, it’s a very good question, because there is no clear answer and the reason for that is that science is not advanced enough to actually help us to definitely decide and say ‘this method is better, you have to pick this one’. But having said that, you know, always being proactive is usually a better thing than having a reactive approach. But despite this, you know, it is very important to understand that testing is just a part of the puzzle. Like, it is not the whole picture. And organizations, have been coming to us asking about testing methods and guidance on implementation because it is very tough. Which tests do you want to pick? How frequently do you want to test somebody? Which employees do you want to test? AON has been helping clients on this. But alongside this, we also insist that they look at it strategically, like do not get stuck on the testing word. Be smart about it, look at the combination of health risk assessments, understand what is your people’s risk, think about symptomatic involvement or some sort of a surveillance from a symptomatic basis rather than you know, just using testing for that purpose. And also, I would say personal hygiene methods are very important. Anybody who knows anything about infectious diseases will definitely tell you this is the most important thing. And we want to make sure that all of this is used in a combination, in a good strategic manner, instead of, you know, focusing on just one bit of the puzzle. The other thing, which I think organizations definitely need to consider is around, what is their operational setup like? So, for example, a strategy or return to workplace or testing strategy for an aviation sector would look very different from somebody who is working in let us say, the food handling sector, or from white collar employees. So, yeah, I mean, there are so many factors to consider and there is no short answer is what I will say. Magda, would you agree with me?
Magda Rosenmöller : Yeah, I agree with what you are saying. It is a difficult question, and there is no one answer to that. You have probably seen this in the news – Germany just started to test everyone that returned from holidays. So, they actually identified this as a high-risk group. And while they said initially that it would be voluntary now it looks like they will make it compulsory for all those that come from at least one of the risk areas. But definitely I see a big advantage in doing a proactive approach, on testing non symptomatic people, on groups that look like that they may have a higher risk and I think that is the way to go. And if we look into healthcare, we do everything based on evidence. So, if we do a health technology assessment now, we would definitely look into what would be the cost, definitely in terms of life, of the mortality rate. We see increasingly from COVID people who faced severe illnesses and those that even had a lighter version of it. So, there is a risk there. So, the cost in terms of further illness, further morbidity, further mortality, but also in terms of cost to the health system – we had to look into all aspects. If we only take the last one, the cost of the health system, and Avneet, you work with health insurances, that’s very familiar to you – then probably there’s a very good trade-off between the price I have to pay for a test of particularly those risky groups with comparing it to the cost that they would have had on the health system, if they weren’t tested. And yes, we have been actually looking into that. What is the cost of a company being closed down due to an outbreak? And what is the cost of testing all the workforce? At IESE, all our MBA students would get tested. And we tell any visitor to get the tests done in order to keep the campus free of infection. So, this is a case of testing of all those people even before they have symptoms. We have chosen that approach and that would be the right way to go in order to be on the safer side. And let me just add one point to it, COVID-19 is a public problem. Being a public problem, it is important that we join forces. This is a role that private companies can play – they can closely collaborate with the public authorities so that they know who has been tested and who not. This can help reduce the damage and the risk of a second wave.
Gopika Sampat : Magda, it is interesting that you bring that up because this whole interaction between science, companies and policymaking has become so relevant now. You spoke about Germany – Germany’s COVID strategy was driven by science. The National Health Institute was of course extremely involved in crisis management and generally speaking, they do a lot of research to support policymaking and the government. So, this interaction has become so relevant now. But, you know, in several other countries, politicians do not listen to scientists, as Professor Mike Rosenberg from IESE rightly asked you in one of your webinars. If that is the case, how can we expect companies to listen to scientists?
Magda Rosenmöller :Well there are several aspects to it, I think it is a very difficult moment now where this pandemic is just chaos. In a chaos, we do not know what to expect. We do not know this virus. So, if you look at science, we do not have that much knowledge about COVID-19. We do not know how it will develop. So, what is happening now is that each day, I have a little more knowledge and there is a lot of exchange of knowledge between the epidemiologists and virologists, but also among clinicians. But for the policymakers, it is very difficult to react to something that was said yesterday. And today I know more and that could change. So, then companies will ask well, why would we do that, why would we change? No. And then we have some cases where countries were more driven by science or at least had a Chief Scientist running it. And others would kind of say, well, actually, we do not want to listen to science. We only make it a political issue, and this is a minor thing. It is just a minor flu as the Brazilian President said and therefore, we have seen that particularly those countries and the US, unfortunately, and maybe to some extent, the UK, also, we have seen a neglection of science. And they might take decisions that might not be the correct. So that is definitely an aspect that we see here. Well, we see that there is this continuous interaction between science and policymaking actually driving this forward. There are a lot of sides or other aspects to it. One is, will science develop a vaccine quickly. We want to have better treatment. But things might be overseen as well. There was a Lancet article based on bad data. And it was only identified afterwards that it was a non-existent database, and someone had just invented the data. So that is one aspect that if we have this speed, in this uncertainty, the speed might be questionable. And then on the other side, we usually have a collaborative process in science involving peer reviews and critiques. But so far, we have only seen situations where there is one critique and a political statement is made out of it. I think we should really think and lean on those scientists that make a very good analysis of the different ideas. I think we will get into a new way of interaction then. We have just heard of a very interesting development of how a new respirator was developed as a result of an interaction between Medtronic and Boston Scientific. They said they put aside everything and went for very quick development. Thermo Fisher collaborated with Pepsi and said that they wanted to better understand how to deal with plastic that Pepsi used for its bottles. So, we would now see probably more collaboration and I would like to see how we can learn to speed up processes in companies that have an old hierarchic structure where maybe some more speed maybe even beneficial. So good and bad sides on that, like this is normally how life works, but I hope we really learned from this crisis. And yes, define a new normal, in a different way, in the future and a way of collaboration.
Gopika Sampat : Speaking of science and technology and this goes to my last question, and that is for you Avneet. Digital health is playing a big role now. For example, telehealth and digital therapy programs offering evidence-based therapies for mental health issues have a unique potential for scalability. But of course, they come with their own share of issues, – issues with good quality customer engagement, workflow integration issues, etc. And this can of course, hamper this scalability during this crisis. So, what do you think of this and how do you think tech can accelerate the delivery of care at scale?
Avneet Kaur : Very very relevant question Gopika. So, definitely in COVID, we have seen this acceleration. But if you look at towards the end of 2019, a lot of governments had really started to focus on digital health because access to care and affordability of care has always been a really big challenge globally, because, you know, there are a few doctors and there are so many who need access to care. And digital solutions can really, you know, help to alleviate these pain points. But adoption has really been very slow. Now, what COVID has done, as I say this, this has been a time capsule for almost a lot of different things and definitely digital health. We have seen that, you know, uptake has increased. I was reading an article the other day that said that in China, in Ping An Good Doctor, the consultations have increased 900%. In UK there is a provider called eConsult – their consultations shot up from 300 per month to 3000 per hour, which is close to 3600% increase. Similarly, if you look at LATAM, Latin America – in Brazil, we were seeing, you know, one provider who has seen an increase of 2,000% in e- consultations and also interestingly, probably, you know, Magda would definitely know more about this, even in Germany, what we have noticed is that doctors are also more, you know, engaged with the platforms and they’re open to offer their services digitally. And the reason is because, you know, this pandemic has really forced people to engage via the digital route, as there are so many challenges in in-person engagement, and the burden of disease has increased so much like, you know, hospitals were overflowing, so it was very difficult to actually access care otherwise. So that has been the key driver of this adaptation. Definitely there is a significant opportunity with regards to digital health. Whether it be you know, the items you mentioned, whether it be, you know, preventive care or case management or remote monitoring or, you know, while recovery, let’s say, you know, instead of people staying in wards, you can send somebody home and you can remote monitor somebody on what their conditions are. I would say the challenges, which you mentioned, are very, very crucial. One definitely is having that ease of access for users. And second is having that sort of continuous engagement across the healthcare continuum. And when I look at my clients or AON’s clients, it becomes very relevant for them because at the moment, a lot of organizations offer piecemeal digital health solutions. Now, in order for these things to work, you need a connected offering, right, where if you are speaking to a GP, you don’t need another platform to speak to a specialist like it should be all very, very transmissible plus I was reading some EU regulations and what they are doing is they also check for adaptability in between digital health solutions, so that these platforms could be merged if needed. And, you know, there is also some development going on in digital health integration space, which I would say is very important. Also, when it comes to looking specially from, from a client perspective on what they’re offering to their employees via employee benefits – so the traditional sort of medical plan is usually, you know, typically offered, but with the current scenario, employers definitely will need to have more strategic view about, you know, what exactly is their role in virtual care provision as a part of employee benefits and there are actually quite a few pieces to have alignment on this area. So, for example, you know, what is the expectation of an employee from an experience perspective, and how do you make sure that those employees are engaging with it? And then even if you have implemented something, it needs continuous review and adjustment, right, you cannot just implement and leave it. So, you really need to make sure that employers are having a stronghold on this and you know, they are making things available, employees are feeling comfortable. Plus, you know, that sort of a trust employees need to have, because you know, the switch, I would say COVID-19 had made that switch, but now making people stay on that platform and not going back to the in person model, I think that will be that will be really, really important as well. And, you know, of course, there are, I would say a lot of issues with any new thing which comes in, but definitely I think this is the way forward. No doubt about it.
Magda Rosenmöller : Maybe just to add on that, I agree with you, Avneet, it is important that the way we take this forward now is really looking into what is this new normal. Because the new normal is not this extreme of doing everything online but is the combination of we need the kind of caring aspect for particularly chronic diseases and home care. Much of the surveillance can be done through telemedicine and we are seeing the increasing usage of apps too which I think is great. But we actually need some one that is responsible behind it to show what the app is for, how can we activate the app, how can I have people really see the usefulness of it etc. So the new normal would be a combination of all these aspects but I would say definitely there’s a lot of things that don’t need to be inside the hospital – surgery and radiology treatment needs to be inside and we need the patient and the doctor to be there physically but there’s so many others where it isn’t needed. But I think it is important we look into how to use these technologies; how does it respond to patient needs etc. I think that will make the future of healthcare successful.
Gopika Sampat : Dr.Avneet and Professor Magda, thank you so much for joining us today. This was quite an engaging discussion and it definitely highlighted the importance of healthcare in a business and policy context and the need for digital transformation today. Thank you so much.
Avneet Kaur : Thank you for having us.
Magda Rosenmöller : It was a real pleasure, this discussion, I learnt a lot from you Avneet, thank you.
Avneet Kaur : Good to meet you Magda.