Through more than a quarter of a century Dr Doug Wright oversaw vast changes in the health insurance sector and he expects further significant evolutions in his absence.

Wright (pictured), who revealed he was retiring from his role as Aviva medical director at the end of last month, spoke to Health & Protection about the highlights of his career and huge transformations the industry has undergone since joining the insurer in the summer of 1998.

The increasing focus on clinical direction not financial control, as typified by the value-based care and pathways approach, has been a welcome development over his 27 years at Aviva.

As has been improved and tighter regulation to benefit practitioners and patient understanding, but Wright argues there is still need for better collaboration and co-ordination throughout the healthcare chain.

He also believes genomics will have a key role to play in predicting risk and reveals his post-retirement plans which include a Transatlantic crossing.

 

Clinically governed pathways

“The continuing effort to move us away from a very financially managed way of managing claims stands out over my career,” Wright tells Health & Protection.

“It’s things like excesses, session limits or other benefits and moving us into a much more clinically governed pathway where we get the certainty of the quality outcome as well as the cost management as well,” he continues.

As an example, Wright cites the launch of treatment pathways by insurers, such one for musculoskeletal (MSK).

“That gives customers a really frictionless way to access it, they don’t need to see their GP,” he continues.

“It gives great patient outcomes where we know they’re being helped where they are being improved.

“And we know the costs are being managed through that clinical governance pathway approach rather than very artificially through a financial construct.”

As a result other pathways and initiatives have followed such as condition-based networks for knee, hip, spine and cataracts.

 

Huge changes

Reflecting on his career, Wright points to “huge” changes since he first joined Aviva in the summer of 1998.

“Literally the year before I joined what was then Norwich Union, the tax relief for individuals older than 60 was withdrawn in the Gordon Brown Budget,” Wright continues.

“And that’s something that seems to have hung around ever since with the consumer market being really quite difficult to grow over time.”

But Wright also points to changes in healthcare legislation.

“The major things looking back and this was just after I joined, hospitals were still registered and monitored under the nursing homes legislation,” he adds.

“It wasn’t until the year 2000 that the Care Standards Act came in and regulated them in the more robust way that they are regulated now.”

 

Surgeon inquiries

For Wright the most significant development for clinicians was the inquiry into Ian Paterson in the early 2000s, with the surgeon subsequently suspended from practice in 2011.

This was despite there having been a serious inquiry into another surgeon, Rodney Leadwood, almost a decade earlier.

“The lessons from that weren’t really learned, even though Leadwood was struck off in 1998,” Wright continues.

“It wasn’t really until after the Paterson Inquiry that we have seen some of those more material changes coming in, looking at how you oversee what goes into the private sector hospitals,” Wright says.

“And there’s probably a little frustration, there’s a probably still a sense, and I think this still hangs over from legacy that the hospitals feel they are in the business of running hospitals and to some extent they would like to leave the clinicians, the consultants in particular, to really carry out the management and the governance of the clinical practice.

“Now we all know and we’ve said many times that delivering high quality, safe, effective healthcare is a team game,” Wright continues.

“It can’t be separated out like that.

“That’s why we’ve been really interested in the value-based healthcare agenda, moving forward with how we’re working with networks and quality guiding, because that ups the bar all around, so that not only do customers benefit from it, but the wider public benefit as well.”

 

 

CMA investigation

The 2010s brought further significant regulatory intervention with the Competition Commission (now Competition and Markets Authority) diving into the private healthcare market in 2012.

Wright explains its focus on patient literacy was a major shift for regulators and put in place the information organisation which exists today to help patients understand and make informed decisions and their treatment.

“That’s the big thing missing from healthcare generally, not just the private sector, health literacy in patients accessing and using it,” he continues.

“I would say tongue in cheek, but it’s not too far from the truth sometimes, that patients find it very hard to assess the quality of care they’re getting.

“It does need a professional overlay and more easy to understand measures and the Private Health Information Network (PHIN) is making great strides towards that, but there is still a long way to go.

“That work continues and continues to increase the pace of the delivery as well.”

 

A global pandemic

And of course the global Covid-19 pandemic has put a spotlight on people’s health and how it is delivered, with demand soaring.

“Even though it was only five years ago, we tend to forget about the pandemic and try to get back to life as normal,” Wright says.

“But that caused a fundamental change in private healthcare and was one of the key factors in uplifting the interest and the number of people that hold a private medical insurance policy.”

Indeed Aviva itself has added almost 100,000 more individual customers since 2020 with a similar size growth seen in its workplace business.

 

Challenges ahead

Looking to the future challenges the sector faces, Wright points to questions around how the sector can better collaborate to achieve better health outcomes for customers.

“The existing challenges are there,” Wright says.

“How do you have quality and customer clinical journeys as a team effort, rather than the hospitals doing their bit and the clinicians doing their bit?

“Bringing that together, getting much better oversight and collaboration between the clinicians and the facilities themselves.

“It has improved a lot, but there’s still a sense that there is more to go in that space.”

 

Value-based healthcare

But there also needs to be a focus on delivering value-based healthcare, where the most medically effecient and effective practice is followed to achieve the best patient outcome as quickly as possible, even if it may initially be more expensive.

Wright adds better collaboration is “very closely aligned to that, because you can’t really bring to life and embed value-based healthcare without it,” he continues.

“It’s about adopting a value-based healthcare approach as opposed to a pure negotiation around pricing.

“It has to be about the understanding of the clinical journey and the meaningful patient relevant outcomes.”

 

Developments in genomics

Another hot prospect is the pace of developments in the world of genomics, which Wright says the sector is already seeing a lot of value coming from.

“For instance it is already very often used to detect particular molecular targets for cancer treatments – we’ve embraced that fully and seen that increase more and more,” Wright says.

“So that sense of genomics is here and will just continue to grow.

“The bigger thing is how it is used to forecast risk predictions, and there are some things there we know are very, very well established at the moment.”

However, Wright maintains more work is needed to truly understand the potential of polygenic risk scores and if they can be used to influence underwriting and pricing decisions.

“We saw the NHS 10-year plan talk about that quite a bit and it’s potentially highly valuable at population level – almost risk stratifying the population so you target your interventions in the best value adding way,” Wright continues.

“Think about adapting that into an individual level and you start thinking about how that might affect underwriting or pricing.

“We don’t really have enough evidence around that and how to make that work, but it’s definitely coming.”

 

Missing the people

However, these will be challenges for other people to contend with and as Wright leaves office, he says it is the people he will miss most.

“I’ve worked with and have continued to work with a bunch of absolutely fabulous people,” Wright says.

“We all bring something different into the thinking around the workplace, but I think it’s bringing that diversity of thinking and people together that allows us to genuinely get the best outcomes for our customers, so I’ll definitely miss that.”

Though he adds he will be keeping a keen eye on developments within the sector.

“It will become more of a hobby,” Wright says.

“Genomics is an obvious one, but I’ll watch a lot of those emerging treatments and the use of AI and how that comes in and helps to facilitate patient care.

“That’s going to be a really interesting thing to keep a watching brief on rather than a working eye on.”

 

Setting sail

As for his immediate plans, Wright has been hitting the golf course and also plans to get back into sailing, with a transatlantic voyage already in place.

“My ambition is to lose fewer balls per round of golf; that’s probably my initial target as opposed to a specific handicap that I want to get to” Wright continues.

“And I have intermittently over the years managed to keep sailing in dinghies, but I want to get back into big boat sailing, so I’m doing a transatlantic crossing later this year,” he concludes.