‘We are definitely changing our model’

Priscilla Lynch speaks to the Managing Director of Vhi Health and Wellbeing, Ms Anne O’Connor, about joining the insurer from the HSE and the company’s ongoing moves into direct healthcare provision

In her previous role as HSE Chief Operations Officer, Ms Anne O’Connor became a familiar face during the Covid-19 pandemic, when she gave regular media updates on ICU bed numbers, community services, and vaccination roll-out.

So having reached the top table of HSE management after a 27-year career in public health services, it was something of a surprise when Ms O’Connor announced in April 2022 she would be leaving to join the private health insurance sector (her departure was swiftly followed by the then HSE CEO Mr Paul Reid).

It was clearly a big decision to take over as Managing Director of Vhi Health and Wellbeing. What prompted the move?

“I think for me it was a personal decision to I guess learn something new, something different,” Ms O’Connor told the Medical Independent (MI). “I had been around [the HSE] for so long that I kind of knew most people, most people knew me. So on day one in Vhi I walked in the door of Abbey Street, I didn’t know anybody, I’d never set foot inside the building. It was August so it was very quiet, and I thought what have I done?

“But very quickly I realised that it was the right thing,” she said. “I think for me it really gave me a kind of a kick again in terms of having to learn, having to think differently. Every day was a learning day. It was exhausting because it was a whole language that I just didn’t speak in terms of… the insurance world. It’s a group with subsidiary companies. It’s commercial. But underpinning that in terms of the health and wellbeing company, it’s about patients and developing services. So that bit of it was very familiar to me. And that’s what I’ve always loved.”

When people talk about the health service, they generally mean the HSE and public services, according to Ms O’Connor. However, she pointed out that in Ireland almost half the population have private health insurance.

“I’ve learned that there’s a whole world of healthcare that goes on outside the public service that I probably knew very little about in hindsight. I think when you’re in a public service role like that you’re often just so busy dealing with the stuff that comes at you that you don’t really look up and see all that’s going on, so it’s been fantastic for that really.”

The shift to care provision

Traditionally, health insurers in Ireland reimbursed and provided cover for inpatient healthcare expenses and their plans were primarily hospital-based. In recent years, the model has changed significantly, as more insurers have come into the Irish market and a wider range of healthcare expenses are reimbursed, particularly in community care and ‘wellbeing’.

Health insurance companies also started directly providing urgent care with minor injury clinics and online/phone GPs and nurses initially. Now Vhi has moved into providing a wider range of services in its larger ‘360 Health Centres’. These services include diagnostics (MRI, x-ray, and ultrasound), targeted screening, women’s health, paediatrics, orthopaedics, wound care, physiotherapy, psychology, and dermatology.

Heading up Vhi Health and Wellbeing, Ms O’Connor’s responsibilities include overseeing the 360 Health Centres, the clinical call centre, digital platforms, and the Hospital@Home service. Some 18 months into the role, these initiatives continue to expand under her leadership in terms of uptake and services provided.

By September of this year, Vhi’s Health and Wellbeing division recorded more than 420,000 interactions from its members for a wide variety of healthcare needs, an increase of 33 per cent from September 2022. This included 220,000 interactions with members across the company’s digital and phone-based services, an increase of 28 per cent on this time last year. It also recorded 120,000 healthcare interactions with members in its 360 Health Centres in Dublin (Carrickmines and Swords), Limerick, and Cork, an increase of 40 per cent.

“The reality is we are definitely changing our model. We are definitely getting into the space of early intervention, integrated care…. And I think what makes us [Vhi] different is the integrated service delivery piece,” said Ms O’Connor of the expanded 360 Health Centres.

“So it’s not just about going to see a doctor and that’s it – we actually have specialist multidisciplinary teams, specialist physios, we have a DEXA scanner… we have the whole package in terms of women’s health. Equally, we have launched our dermatology service this summer [in Carrickmines] and Dr Rupert Barry is the Clinical Lead for that.

“And what that means is you can go into an AllView centre, have your scan done, and then you will be called in for a face-to-face if you need to see a dermatologist… or if you need a procedure. That only launched in July and we’re up to nearly 1,300 consultations already since July.”

She said that for a condition such as acne, for example, there may be a significant psychological component of care and the Vhi has a psychology service available onsite.

“So the dermatologists are referring directly into the Positive Mind service for people. It is about developing that specialist pathway.”

The 360 Health Centre initiative will be expanded to Galway in 2024. Ms O’Connor said patients in the rest of the country will be able to access these services in a hub-and-spoke model through their local GP. Direct referral will also be available through the company’s online/phone healthcare team.

She also pointed to the significant number of patients being seen at the Vhi’s urgent care clinics who would otherwise be presenting to public emergency departments, minor injury clinics, or GPs.

Chronic disease management

A significant focus of Ms O’Connor’s division is, as the title says, health and wellbeing. This involves trying to prevent people from developing chronic diseases or needing acute care. The role echoes her previous work in the HSE where she worked on developing community pathways and services to try to prevent those with chronic conditions deteriorating or experiencing acute exacerbations.

Referencing her background as an occupational therapist, Ms O’Connor said she believes in the concept of helping people to look after their health in the first instance and “services stepping in as required at an appropriate level”.

“And in the public service it’s so complex and there’s so much demand, not enough supply. It is a constant challenge just to keep up. And the reality is the public service has to respond to the most vulnerable and the people with the highest levels of need, and people will and should be prioritised on that basis.

“And I think what is different for us is that… we are obviously in the PMI [private medical insurance] world. It’s a different demographic in some ways… we are ahead of the general population in terms of ageing, but [trying to keep people well and intervene early] is no different to what the State is trying to do.

“We are developing that integrated care pathway that supports people from wellness, staying well, through to health promotion, through to primary care, into specialist services, and then with access to acute services, and that’s our pathway.”

Increasing GP involvement

Expanding Vhi’s provision and reimbursement of primary care services is also a key focus for Ms O’Connor, with work well underway in this area. She confirmed that the Vhi is currently in discussions with the ICGP on creating a chronic disease management pathway for its members. There are existing pathways for medical card/GP visit cardholders under the HSE’s chronic disease management programmes in primary care.

“If you look at the impact of these programmes, the evidence is coming through now from the studies with the ICGP after two or three years showing the very significant reduction in costs as people manage their health, and are supported to manage their health, and then receive early intervention.

“So that’s the journey we’re on…. We would know and be very aware that people with PMI actually do not fare as well now in the space of chronic disease as those potentially with a medical card. If you go into your GP and you have diabetes, for example, the GPs now have a very clear pathway…. It’s really good….

“If you go with PMI, you know, the GP will do a bit, you’ll pay for it, and potentially refer you to three different specialists, to external dietitians, podiatrists, whatever. So there isn’t a clear pathway for people with chronic disease and we would know in terms of claims and our population that our members have the same challenges as anybody in terms of chronic disease.

“So we are looking at how we work with GPs – not replace them or take business or any of that stuff – but actually partner with GPs in respect of chronic disease management for members. We’re really trying to get into nuts and bolts of primary care, but do it in a way that adds value, not actually strip anything away from anyone.”

As well as expanded primary care service reimbursement, the next big pivot for the company is into direct provision of primary care services, Ms O’Connor told MI.

“The big gap for Vhi has been actual delivery of primary care…. It is something that we have to get in place and we are starting that this year. We are working with some corporates because we hear a lot from some of our corporate members where they have transient staff coming into the country for three, six, nine months… and have no hope of getting access to a GP. We are looking at going into corporates and providing primary care services… and in parallel we are working very closely with the ICGP.”

The payment model for members attending a direct Vhi GP/primary care service will be the same as in the community in that they can claim back a percentage of the cost of attending the GP from the insurer.

This new service is entering its trial stage and will be reviewed next year. If successful it could be expanded further, Ms O’Connor said. She added that she believes the model would be attractive for clinicians as well as patients.

“We [already] have a lot of multidisciplinary teams, very specialist staff, who have decided to come and work with Vhi for all sorts of reasons, but not least because they get to really hone-in on their clinical skills. It’s an opportunity to work clinically without the… ‘noise’ of the public system. But it’s different, it’s very different here. You can focus on patient care.”

As with the public hospital system, many patients presenting at the Vhi’s 360 Health Centres for urgent care could ideally be seen in primary care, said Ms O’Connor.

She explained recent data, particularly over the last two years, has shown that cases presenting to Vhi’s urgent care clinics “are now probably half urgent care and half medical”.

“We have many people presenting to our urgent care clinics because they cannot access the GP. And we are now at a point where we are having to look at that.”

The staff in these clinics are highly skilled in urgent care and injuries, but some people are presenting with a requirement for a different type of response, she noted.

“We are now looking at how we triage people differently in urgent care, so that we have a kind of a primary care path and an urgent care path. That’s happening by default, if you like, that wasn’t planned.”

Future plans

Looking ahead at potential additional services, Ms O’Connor said Vhi’s target model is “completely aligned” with the public Sláintecare healthcare policy.

“It is that ‘shift left’. It is about supporting people where they need to be supported, when they need to be supported and for the things they need support with. And that is our focus for our members. So it’s no different [to the HSE/Sláintecare]. We are not in competition. In the health sector in Ireland, if everybody did what they could do really well, then all boats could rise together,” she maintained.

“We want to do the things that we can do well, doing it within correct scope, doing it with the right specialists, multidisciplinary teams, integrated care, etc, and growing from there.”

There will be services that Vhi will not provide. It has no plans, for example, to enter the social care space. “It wouldn’t be appropriate to do so, or severe injury and mental illness…. I can’t see us owning hospitals.

“We have to work in a more kind of strategic way, I think, and in partnership. And that’s certainly something that we’re very committed to,” Ms O’Connor said.

Like the public system, Vhi is also looking at how to change to a value-based model, incorporating outcomes-based performance as opposed to “just paying out money for services”.

Ms O’Connor said it is a “really exciting” period. “There’s a huge wind behind us. The pressure is on us now to deliver it… we are still early in our journey. But we have a plan and certainly it’s my intention that we will continue to deliver that.”