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EF: What was Discovery’s role during the pandemic, both last year and in 2021?
RN: Our biggest responsibility was to our people, we are a big employer servicing a big community, and we feel our business as working with extended family. Our core purpose at Discovery is to enhance and protect the lives of our patients; we spend a lot of time thinking about ways of how to protect them, developing products that ensure they receive the quality of care. We are an integral part of the healthcare system in South Africa and part of that system is healthcare workers who have been heroes during the pandemic and we have put together programs to support healthcare workers. Because we are a large player in the system and feel responsible for what happens in the country we have significantly contributed to the country's response to Covid-19 working with NGOs, supporting the government, and working with private sector partners ensuring the country’s quick response to Covid.
EF: What have been the lessons learned from Managing a company like Discovery through the Covid-19?
RN: To begin with, we never know what is around the corner. 18 months ago we would have never guessed that we would have been facing this kind of situation. The clearest lesson learned is that companies that are purpose-driven deal much better with adversity and a massive change in circumstances. This has really resonated with us because we are a purpose and value-driven environment with our purpose guarding us as a moral compass throughout our response. The moment a product becomes inappropriate for the market in a company that is entirely product-focused it is very difficult for them to reposition without a bigger purpose. In our case, if one product needs to be changed the transition of the mind is easier having a purpose. Another lesson is to be nimble despite our size, managing to be both flexible and agile -notwithstanding scale- to quickly adapt our position or product to suit the environmental surroundings; I think we should never be too comfortable in what we are doing.
EF: What was the strategy you employed to keep your staff nimble and aware of the company’s purpose particularly with the new system of home office?
RN: In the long term, one of the biggest risks of being decentralised and having so many people working from their homes is that we tend to get a dissipating culture, the culture could become diluted and people get further and further away from the company values. We are very aware of this long term risk but in the short term we have seen the opposite, we have seen better productivity and higher engagement levels, we measure engagement levels and study them and our people have felt well protected and cared for and they have felt a responsibility to care for other stakeholders. This has brought our people together and at the moment we have very good alignment to our core purpose. Looking into the future we need to decide what the target operating model will be, how many people will come back to the office or where to work from and if we end up with a large virtual workforce we will have to invest in leadership to understand how to protect the culture and maintain understanding and proximity to our purpose and values.
EF: What KPIs have you been looking at this past year?
RN: Our business was founded by an actuary and we have a lot of actuaries and data scientists on the payroll. We are the biggest employer of actuaries in the country by far, everything in our business is measured and we use those measurements to manage it. During the Covid period we have developed a lot of quasi-epidemiologists all over the business, we developed people who became quick and instant experts in understanding epidemic outbreak and management of epidemics. We have developed measures and a dashboard which we now release every single day which has become visible and traveled all over South Africa in healthcare and some non-healthcare organisations. It measures all the elements of Covid with information per province, per region; we look at new infections, hospital admissions, severe illness and mortality. We are now in the phase of measuring and managing vaccination, tracking healthcare constantly, even looking at the non-Covid related healthcare because Covid-19 has squeezed out other parts of the healthcare system and we are measuring and watching that data very carefully. Aside from the usual measures of productivity and health of our people we have all these added complexities of tracking epidemic diseases which we do now on a day to day basis.
EF: In terms of allocation of resources how did you manage resources for chronic diseases portfolio in a communicable disease scenario such as Covid?
RN: When we look at visits in our healthcare system we have seen almost a 40% reduction in visits to healthcare workers by the non-Covid-19 population that have a chronic illness. We for example measure and incentivise all the females in our institution pool to have mammograms, breast surveillance, done every year and this year we have seen a 60% reduction in the number of mammograms performed in this period and we have seen quite a significant reduction in the number of cancer registrations and diagnosis. The frightening thing about this is that it is an iceberg phenomenon, cancer is still out there and breasts are still growing tumors undetected at the moment because consumers have changed their health seeking behaviours and are making different choices about accessing their healthcare system. From a resource allocation perspective, we are driving initiatives to try and encourage people at risk and with chronic illness to see the general practitioners and healthcare workers. One of the many initiatives we did in this regard was in consultations. Many general practitioners were working from home using telemedicine to consult with their patients, we analysed the data and we picked up all the people living with chronic illness who had not seen a doctor in a long time. We then provided each of those doctors a list of their patients in need of a chronic consultation and we provided across our digital health platform a booking engine and a telemedicine capability to connect the patient and the doctor. In the majority of cases, the patients were delighted to undertake a telemedicine consultation with their doctors to manage their chronic illness from the safety of their own homes.
EF: What would be your advice on enhancing accessibility?
RN: There is a big current global vaccine debate around vaccine nationalism and the rights of rich countries getting access to vaccines before developing countries. Healthcare access has become a global topic, it was featured in The Economist this week, the WHO talks about it regularly and now there is a debate on intellectual property rights related to patents of drugs. Healthcare is at the forefront of people's minds at the moment and we think it’s a great opportunity to bring this narrative forward. In our market, there is a particular need for low-income healthcare products focused on primary healthcare and in an employer-based context, the employers have an opportunity to fund primary-based healthcare for their employees with a range of cheaper products. A regulatory change is needed as is an acknowledgment that the private sector has an important role to play alongside the public sector and that people are willing to spend their disposable income gaining healthcare access. It is interesting to note that after the 1918 Spanish flu epidemic over 100 years ago the industry that did really well after the flu epidemic was the insurance industry and it grew because an event on a global scale makes people very risk-conscious and aware of their fragility and their response is to seek protection which is what health insurance provides, it gives protection in a time when it is needed.
EF: When you close your year in June, without going into specific numbers, what do you expect that presentation to look like?
RN: Healthcare is a very defensive sector because of the basic human acknowledgment that people always get sick and regardless of what happens with the rest of the economy they will always need healthcare of some sort. Healthcare offers a defensive option relative to other financial services stocks, for people trading in equities having a healthcare investment balances the funds risk should there be economic volatility in the rest of the markets. As far as results are concerned the first obvious consideration is swollen healthcare insurance risk pools which have grown enormously over this period and on a worldwide level -not depleted during the crisis. The increase in the need for healthcare during the pandemic has offset the drastic reduction in non-Covid related healthcare with the results showing much bigger capital reserves and bigger profits in health insurance systems. This is a short-term situation, in the medium term there will be a catch-up of all the deferred healthcare needs, all the delayed elective surgeries will all come through quite significantly once people are vaccinated and there will be all the undiagnosed diseases manifesting, some in advanced forms. It might even consume more of the reserves when the deferred catch-up happens. Administration costs of delivering healthcare are up at the moment, we have had to ship in new resources for increased communication and support, we have sent people to work in all parts of the country so it has been from a healthcare administration perspective an expensive period of time quite different to what the healthcare insurance risk pools usually look like.
EF: What do you think the future healthcare company will look like, what will be the skill sets needed?
RN: There has been a trend over time on the relevance of data –data and digital- at the centre of healthcare systems which has been accelerated by Covid becoming even more exaggerated than ever before. We are struggling to find skills and over the next 4 or 5 years there is a great opportunity in terms of career trajectories for data scientists, data engineers, data government experts, system and digital developers, customer journey experts that design outstanding customer journeys as all these digital fields with data at the centre have exploded. It has been a long-standing trend and Covid has in a matter of 18 months achieved ten years of gains. We have leaped ahead 8 to 10 years in a year.
EF: How will this digitalisation affect such a regulated industry?
RN: Covid has opened up the regulatory ambit, regulators all over the world, including in South Africa became much more permissive of telemedicine and digital healthcare. We mustn’t go backward after Covid and embed this regulatory environment. It is our responsibility, we need to analyse the data and demonstrate to the regulators that this open environment has been good for patients and healthcare systems, availing greater affordable access and is not doing any harm. In medicine the first part of the Hippocratic Oath is “do no harm”, we must prove that telemedicine won’t harm and will broaden access to quality healthcare for this open regulatory environment to survive. We are investing a lot of time and effort in measuring and understanding the experience to put together definite proof and evidence of these benefits for the regulators.
EF: What about behavioural patterns – will they have a big impact on your vitality programs and projects?
RN: Practically the whole Vitality program had to change because of Covid and a much more robust program has emerged. A big part of Vitality was providing access to people to gyms, but with gyms closed, we had to develop physical activity at home, remote gym classes, and develop a different way to measure activity using wearable devices and digital connectivity and as a result a much nimbler Vitality program emerged. I think people are becoming fatigued, I see a restlessness and Covid fatigue in our market, people tired of working from home and from wearing a mask all day every day, and as a result, I am seeing a reversion to the pre-Covid behaviours which pose a severe risk to infection transmission and I am hoping people can maintain discipline and behaviours.
EF: What do you expect the outcome and roll out of the vaccine to be like, do you foresee many bottlenecks and problems to solve?
RN: Vaccination for Covid-19 is probably the single most important public health imperative of the last century, it will save lives, open economies and reestablish lifestyles. The economic harm and the damage to people’s mental health and social development at the moment should not be underestimated. We are just about to kick off our mass vaccination campaign in South Africa and it must be done with speed. As a developing country, our constraints have been the procurement of vaccines, accessing a sufficient downstream supply of vaccines, and its pricing –a difficult process to accomplish for an African country. Discovery has played a big part in supporting the government and I am pleased to say we have managed to procure sufficient doses at a highly affordable price on the global benchmark to vaccinate the entire country and get to a herd immunity threshold. My biggest worry is vaccine hesitancy. In developing countries we are learning that vaccine hesitancy is significant, materially higher than in developed countries and we will have to run pervasive education campaigns to ensure we dispel the myths around vaccination and that we can attract the majority of the population to be vaccinated. Our epidemiologists have calculated that we need about 67% of our society vaccinated to achieve herd immunity in South Africa and we must try and achieve that target by February 2022. We have the supply and there is some execution risk as the mass vaccination sites are going to start running next week and we need to make sure they run efficiently, protect against wastage and theft but as long as we can execute I think our biggest challenge will be vaccine hesitancy.
EF: A few years down the road when you look back on these last couple of years -the Covid years- what would you like your 2020/2021 tenure to be remembered for?
RN: This is I think the biggest learning curve I will ever go through, it has been a challenge on every level, a challenge from a leadership perspective, from a product perspective, and an economic challenge. With the whole economy under pressure, it is more difficult for our customers to afford insurance. I would like to be remembered as having an inspirational optimistic leadership approach that helped to protect employees, doctors, and customers and as part of the solution to the country's successful response to Covid-19. I would also like it if people thought I brought stability through a calm approach, focused on the right things with relevant products and services. Aspirationally, I would love people to say Discovery helped vaccinate the nation with its incredible partnerships with Vodacom, with the Department of Health, the Solidarity Fund. It would be great for our brand to be considered central to the country's response to Covid.