Column: Argus & Medical Practices Partnership

[Opinion column written by Peter Lozier & Dr. Basil Wilson]

The Argus Group recently took the next step in our plan to deliver a positive impact on Bermuda’s healthcare system, by entering a Better Health Partnership with Island Health Services and the Family Practice Group.

While various forms of accountable care or patient-centred clinics have been long-established in many countries worldwide, we understand this is a new partnership for Bermuda and that the community has many questions.

Track record

Argus has been a dedicated part of Bermuda’s healthcare system for 70 years, and we are still committed to improving wellness in the community. Our position has allowed us to monitor significant trends over time, and our conclusion is that healthcare costs are continuing to rise while more people contend with chronic and crippling illnesses such as diabetes.

In 2019, Argus became the only health insurance provider in Bermuda to own an overseas care coordinator when we purchased One Team Health in Canada. This allowed us to leverage data and resources to improve access to quality, affordable overseas care for all of our clients. Like any business, we make investments to diversify and expand our operations, but we don’t just want to invest overseas. We are reinvesting in Bermuda.

Why now?

Rising medical costs continue to be an issue with the global average medical trend rate again far outpacing the average general inflation rate [7.8% vs 2.8% in 2019 ] and Bermuda typically experiences greater healthcare costs due to our high prevalence of chronic disease and utilisation of overseas care.

With healthcare costs increasing, Argus and the medical practices recognise we have a responsibility to help contain or drive down these costs while continuing to focus on improving patient outcomes.

We believe that change is necessary to ensure everyone has access to quality healthcare and that we need to work together to solve the challenges with all stakeholders aligned behind the goal of helping to improve the system. Combining insurer knowledge with the expertise of trusted and long-serving primary-care physicians in Bermuda is a natural step to achieving this goal.

We are not trying to take control of healthcare in Bermuda. We are simply the first to take this step here. We aim to support all our patients and give them greater value by finding a better balance between the quality of care and its affordability. Having healthier patients will curb the growth in health insurance premiums in the long term.

A new system

Medical practices around the world have traditionally provided care on a fee-for-service model that compensates doctors for each patient visit. Increasingly, insurers and health systems are shifting to a value-based reimbursement model that compensates healthcare providers for the quality of care they deliver, which can be measured by monitoring people’s long-term health. Our partnership will help deliver this model in Bermuda where, for the first time, doctors and insurance companies are aligned around their members.

An innovative partnership

This is a progressive physician-led venture that prioritises care and patient outcomes. It focuses on how the practices can educate people about preventing illness by changing their diet, exercise and lifestyle, and emphasises the importance of collaboration between all of a patient’s care providers. If we focus on their care, wellness and long-term outcomes, the financial rewards will benefit the entire healthcare system in terms of increasing investment and passing on potential savings.

What happens next?

For the practices and our patients, it is business as usual. You can continue to see your doctor as scheduled regardless of what insurance you have.

For Argus policy holders, there are no immediate changes to your benefits. We will continue to honour the benefits outlined in your policy regardless of your primary care provider.

Non-Argus insureds will continue to have access to the Island Health Services and Family Practice Group as per usual.

We are now working with stakeholders and other healthcare providers in Bermuda and abroad to create the Better Health Partnership ecosystem by:

• 1] Investing in health information technology [HIT]

• 2] Building more care teams

• 3] Emphasising wellness and overall population health

• 4] Building new health insurance products where the terms and benefits are aligned to the goal of healthy living

• 5] Delivering innovative partnerships to help improve Bermuda’s health system

We will also introduce several new initiatives to reward healthy behaviours.

Lastly, we will work alongside government and other stakeholders to support the Bermuda wide healthcare reform initiative. We are here to help.

Legality and confidentiality

We would like to alleviate any concerns over the legality of the acquisitions by saying that we complied with all current laws and regulations, and that all the required regulatory bodies were notified of the transaction.

We also know that there have been concerns expressed about patients’ data being shared with an insurance company without their knowledge. Argus and the practices are highly regulated entities and are legally obliged to respect data privacy. No new data will be transmitted between Argus and the practices in either direction. In the long term, however, the voluntary sharing of data, only when pre-authorised by the patient, will help predict, treat and curb incidences of chronic disease.

A brighter future

Bermuda’s economy is contracting, but we believe this investment will help build a better healthcare system.

For too long, medical costs have been allowed to spiral out of control; the customer has been seen as the sole driver of these increases; and the focus has been on making people better rather than preventing them from falling ill. For too long, insurers and medical providers have been working in silos. We can do better, but we can’t do it alone.

• It’s about getting better value for money by reducing healthcare costs through transparency and efficiency

• It’s about getting better access to health and wellness services by blending the provision of care with comprehensive insurance in a dynamic alliance

• It’s about getting better at representing the needs of the entire population by developing flexible partnerships across the community

• It’s about getting better health outcomes through active participation in wellness programmes to reduce drug dependency and medical interventions

It’s about getting better together.

- Peter Lozier, Chief-Executive Americas, The Argus Group & Dr. Basil Wilson, Physician and Director, Island Health Services

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