Advances in genomics and clinical assessment held the key to Bupa’s launch of preventive pathways for customers with breast cancer, cardiovascular disease and diabetes.
The pathways, launched last week, guide Bupa customers based on a clinical assessment, which includes genetic risk, and offers access to diagnosis, expert support and potentially life-saving surgeries.
Speaking exclusively to Health & Protection, Daniel Sullivan, product and proposition director for UK insurance at Bupa (pictured), explained such a launch was previously not possible as it was not affordable and inefficient for the insurer to offer preventative healthcare at scale in the past.
But he adds that due to advances in genomics and clinical assessment, the insurer is now able to identify customers who face increased likelihood of breast cancer, diabetes or cardiovascular disease and can effectively target healthcare spend at this group.
Consequently, Bupa expects this launch will result in fewer claims, reduced premiums and better customer outcomes.
Though if and when pathways are extended to include other conditions will continue to be informed by a data-led approach.
Not affordable
According to Sullivan, Bupa’s latest launch relates back to the purpose of the business.
“It is the fact that we’ve got this ability with genomics, using our digital healthcare services,” Sullivan says.
“It hasn’t been affordable to offer preventative healthcare at scale before because there was a huge amount of inefficiency.
“Because of our ability to use genomics and some of the clinical assessment tools, we can spot the customers who are of increased likelihood of breast cancer, diabetes or cardiovascular disease and then target the healthcare spend on them.”
And it is this that has made the difference, Sullivan points out.
“For us, that makes a lot of difference,” Sullivan continues. “It differentiates our proposition because our mission has always been about helping customers live happier and healthier lives, so it’s really aligned to the strategy.”
Understanding and predicting claims
Sullivan maintains the pathway has made been made possible due to Bupa’s own primary care services and its pilot using genomics.
As the insurer funds and manages the healthcare it provides, it can also track healthcare outcomes which means it can see which customer cohorts are engaging preventively and its impact enabling a better understanding and prediction of claims.
“We think 200,000 customers will engage with this, and we expect to do 100,000 tests,” Sullivan continues.
“We then expect to have tens of thousands of customers in our overall customer portfolio where we’ve intervened earlier to then see the healthcare benefits come through there.”
Potential for reducing claims numbers
When asked specifically about the potential for the pathways to help drive down claims numbers, Sullivan cites the example of breast cancer.
“If you look at customers, often it can be both genders, with high-risk factors like the breast cancer gene BRCA. Between 45% and 85% of those customers will then go on to have a lifetime risk of breast cancer,” Sullivan explains.
“There is a very high likelihood – particularly if you have BRCA1. I think you’re pushing two thirds of 80% of customers who will then have breast cancer.”
Early intervention
Sullivan points out that there is a significant difference between the cost of handling a cancer claim at an earlier stage than at a later date.
“Stage one breast cancer claim versus a stage four breast cancer claim is more than 100% more expensive,” Sullivan says.
“So by that earlier intervention through that investment in preventative treatment, I am almost certain to see that claim come through. Now we’re in a much better place to de-escalate that customer away from a very expensive claim with poorer outcomes and later stage cancer treatment. So that is a really good example.”
Diabetes
But there are other treatments at the insurer’s disposal that are capable of driving down claims costs such as weight-loss drugs and the impact on patients with diabetes.
“What you see with the GLP-1 costs if you look at the studies is after about two years they bring down healthcare costs by about 6% for the customers who have been studied so far,” Sullivan explains.
“So that’s one where we know that by investing in that preventative healthcare, they have a benefit in terms of claims costs and also improve outcomes for those customers as well.”
Significant deflation
While not elaborating specifically on how premiums could fall for members on these pathways, Sullivan anticipates a “significant” deflation impact.
“We understand that incidents and the severity and claims costs will be improved and our models suggest this will have a beneficial impact on premiums for customers in the short to medium term,” he adds.
Possibility of new pathways
And when asked about the potential for pathways to be extended to other conditions, Sullivan reveals a couple of tests need to be met before this can happen.
“Clearly, we have ambitions and plans to extend these further,” Sullivan reveals.
“But I think at the moment, what we want to do is try and validate our claims costs model around the performance and the customer uptake,” he adds.
“Also, we only do them where we have access to claims costs and healthcare data that spot what the benefit is and how we can then target customers.
“That identification comes at a higher risk and then our ability to be able to track and manage the healthcare outcomes to the benefit, those tests have to be met before we expand pathways.
“And I don’t think you will see us certainly in the short to medium term, having an unstructured preventative health benefit.
“We will always say that where we know this is going to have a positive impact on outcomes, we’ll then extend the pathways.”
