Broker Events

00.00.00
Sarah: Hello, and welcome to the first of our spotlight series here at AXA Health.
My name's Sarah Goodwin and I lead the strategy function here at AXA Health.
And today, we're glad that you can join us for a discussion about the current and future state of cardiovascular care in the UK.

This year, we'll run some of these spotlight sessions to really delve into some of the healthcare trends that are impacting employers and impacting us as a business and really trying to understand those themes and take away what we need to know today.

We've got some experts joining us today on a panel, which I'll introduce shortly.
We hope that out of this session you'll really deepen your understanding of this topic how private healthcare is transforming the outcomes in that space.
We've got a panel of those who know a huge amount about this area.

• Peter Mills, who is the Medical Director of Access Health. Thank you for joining us, Peter.
• Professor Bernard Prendegast, who is a consultant cardiologist and chair of cardiology for the Cleveland Clinic.
• And Jonas Eichhoffer, who is a consultant interventional cardiologist, and an expert in complex heart disease. And I know you work with us on some of our online outpatient services to do with cardiology.

So, thank you for joining us today. Let's get started.

00:01:19
I'm going to start with a simple one to kick us off, we hear a lot in the media about lots of different medical conditions, and you can't turn on the TV right now without somebody telling you that you need to move more, be fitter and improve your general health. What do we think is worth knowing about the state of the nation's heart health? Who wants to kick us off?

Bernard: Well, I'll have a go. I've been in the game for quite a long time. And I am old enough to remember the dark days when heart disease was a very, very major killer of very young people, whether that was patients with congenital heart disease who weren't fit for operations, whether it was patients in their middle age who were dying of heart attacks in their fifties or sixties, or even older people with degenerative heart disease.

And over the last three or four decades, it's true that we have made massive strides to improve the nation's health, but we need to remember that it's not a done deal. It's not a job done, firstly, because the statistics tell us that 160,000 people die of heart disease in the UK every year. It's still a major killer accounting for 25% of deaths. And in many ways, what we've done is that we've extended the lives of our patients so that rather than dying in middle age of heart disease, they're now often dying of degenerative diseases of the heart as well as other organ systems that they've survived sufficiently long to develop, such as musculoskeletal problems, neurodegenerative problems, dementia, frailty, and so forth.

So, the challenges are still very present and we can't be complacent.

Sarah: Really. Interesting. Thank you for that. Anything that anyone would want to add to that, that you think is important to know to kick us off?

Jonus: I think I just want to add that we have made huge strides, as Bernard said, in treating patients when they come with their medical conditions. We have been good at that. Treating heart attacks, we reduced mortality from 50% to 4% by patients immediately coming and getting their coronary arteries, which are blocked, stented and opened within 90 minutes.

Sarah: Wow. Fantastic.

Jonus:  But what we haven't done very well is making sure that these people don't get heart disease in the first place. So, our prevention hasn't been that good. And although we have had quite sophisticated care after heart attacks, only 50% of patients come to rehab afterwards. And there's a huge amount of work to be done to make sure they don't get it in the first place. And once we have spent a lot of money in hospitals, then making sure they have the benefit in the long term.
Bernard: I think the other thing to point out, and Jonas will know this more than I do, is that there's still a huge geographical divide. Socioeconomic factors are very, very important in heart disease. We used to work together in the northwest of England, but now I work in London and Jonas is working in Blackpool. There are very different scenarios, aren't there? 

Jonas: Yes. I mean, huge discrepancies. Even if we make fantastic inroads in some patient groups, we still have large numbers of patients who have limited access to proper healthcare.

You would think this isn't possible anymore, but there's a huge division between people who access care, want to access care, understand healthcare, and therefore bear the burden of obesity, diabetes, untreated hypertension.
The less you are exposed to education in healthcare, the worse you will do. We need to change that.

00:05:04
Sarah: Wow. What a direct correlation; that's so interesting to work through.
You've both alluded to huge strides, and I guess to move us on, which of those challenges do we think can be solved in the future?

Where is this going if we sit here again in five years' time? What strides do you think we would be celebrating at that point? Anybody got a particularly clear view into the future?

Peter: It's interesting to look forward. As both Bernard and Jonas and others have said, what's happened in the last 30 or 40 years has been quite incredible, especially in managing the acute presentation of heart disease.
The challenge now is how do we get good health prevention messages into our populations? How do we encourage people to understand what their risks are and to do something about it?

The other challenge is creating a hybrid health system that utilizes digital as well as traditional face-to-face approaches to reach a greater percentage of the population.

Digital has embedded itself in every area of our life, but not so much in healthcare. That's what the future will allow us to do.

00:06:38
Sarah: Anything specific you see coming in this field that is worth calling out?
Jonas: I see that like when I drive my car, my car's suddenly telling me that there's a maintenance requirement and I'm getting a call from the garage to book something in. I really don't see why that's so different for patients.

I'm cautious about continuously telling people they should be healthy because it might turn them off. Technology needs to be more invisible, supporting rather than nagging. If you wear a watch or ring, it could communicate with healthcare systems and tell you, for example, that your blood pressure has gone up over four weeks, and suggest making an appointment or adjusting medication. Making it easier and more accessible is key. Why is it so difficult in healthcare? 

Sarah: It's interesting because we spend a lot of time at AXA Health thinking about targeted interventions backed by data, rather than broad messages like "move more," which are less effective.

Personalised, data-driven insights are more successful and build confidence in patients. Bernard, anything you'd add?

Bernard: Well, I think systems of healthcare have evolved. You know, I went to see my GP yesterday and a lot of the communication was through WhatsApp and text and a reminder your appointments. Then you go and you check in and you tap on a computer screen, and it tells you where to sit down and so forth. So, we are getting there, but Jonas makes the point that we are behind the curve compared with industry or other service providers.

You know, the health system struggles for lack of resources. It's a very complex network of hospitals, clinics, patients, people that work in health. It's a very, very big dynamic to manage. Government investment is going to be essential to really raise the level. You know, we need to be competing with the Germany and the Switzerland and so forth and really providing 21st-century healthcare and not struggling against the odds.

Sarah: This is one area where we benefit a lot from being part of a global group within AXA - we do get exposed to how healthcare is delivered in other countries that have invested in very different ways, what works, what doesn't work? Insurance systems are very different, but we spend a lot of time/I spend a lot of time really trying to learn from those other markets and see where we can shortcut some of the learning rather than needing to start and do everything ourselves.

00:10:10
Sarah: Now if we dive into cardiac care more specifically from your openings, it's clear to see there's been a huge advancing in treatment of cardiac conditions over recent years. What else is coming down the line in terms of the treatment of cardiovascular conditions when they are identified and, and perhaps when we haven't been able to prevent them, that might help some of our members in future?

Anyone got anything particularly exciting that they're reading about now?

Bernard: Well, I think that there's been lots of recent developments that are yet to really translate into everyday healthcare in the UK. I mean, cardiac surgery has been the lifesaver for many, many patients, but very, very invasive procedures are now fading away. And minimal access procedures, for example, transcatheter valve technologies where most valves can now be treated with keyhole techniques by interventional cardiologists. There's a lot of evidence emerging to compare those new steps forward with conventional surgery. But the trend is very much to go towards this minimally invasive approach.

Similarly, if we think about diseases of heart rhythm, atrial fibrillation, or needs for pacemakers, these sorts of conditions, we see the complexities of these procedures getting simpler with time, so they can be done much more quickly, much more safely, and very often as a day case. The days when you need to come into hospital for two, three days or even longer for your heart treatment are now disappearing. We've also got leadless pacemakers, and we've got virtual technologies that can communicate with the heart using new electronic media.

And the other thing that Jonas has referred to is the ability to monitor somebody's condition. So, for example, heart failure. You can have implantable devices that will monitor your blood levels of certain hormones and peptides. You can monitor the heart rhythm, you can monitor oxygen saturation, the pressure in the pulmonary artery, and all this can be communicated to a central hub and warning signals can be detected -preventative treatments can be adjusted or instigated through a virtual medium. And I know you are very connected with this world, Jonas.

Jonas: Well, yeah. I find that particularly fascinating, but probably because it's right around the corner as well. There are technologies that we probably perceive as the holy grail. If we can't prevent a condition, we would love to treat it without leaving anything behind. For example, many attempts have been made already putting in stents which disappear, and the successes have been mediocre, really. But the ideal is, of course, that if we identify somebody with significant disease, we can give them any medication, any drugs, or genetic enhancements that remove the narrowing in the arteries, maybe even change the aortic or other valves in the heart and restore them to their original state.

That really is what we would love to aim for, but that truly is more than a decade away before we have proper successes there.

Sarah: Fascinating, and probably quite an interesting change in the role of clinicians in terms of really understanding that data and changing the way in which you engage with patients. Is there anything we see specifically in terms of the impact for private patients from your perspective? Peter?

Peter: I think one of the things that the increasing complexity of healthcare delivery causes is that sometimes people find it very difficult to navigate this often disparate and complex healthcare environment. And I think that’s one of the things at AXA Health, we are trying to help members with. It’s not about telling them what treatment they should have; we leave that to the experts. It’s about providing them with a pathway, a route through the often-complicated environment, to help them get the right care in the right setting.

Sarah: Absolutely. And I know Jonas, you work closely with HBSUK, which are part of our business, and that’s absolutely the ethos of what we’re trying to do. And we are developing a cardiology pathway within that space to do the very thing Peter’s talking about within cardiovascular care. Is that something you are involved in?

Jonas: Yes. I think private insurances have a big role to play when it comes to improving healthcare in this country. There’s often a misconception that private healthcare only benefits a small group of people who can afford it. That’s not entirely true, because private healthcare and the NHS work very well together. The NHS struggles with investments in modern technology, whereas private healthcare companies have been investing in these and creating products that eventually end up in NHS care. This can accelerate the adoption of new technologies across the country.

Bernard: I’d like to compliment Peter on the pathway-based approach because so often patients get lost in the maze of healthcare. Providing clear guidance, symptom-oriented if it's a primary presentation, or around their established disease, what should happen when and in what sequence, what specialists do you need to see at each stage, and how do you ensure that all these elements are joined up so that you're not repeating investigations three or four times, you're not getting conflicting opinions and you end up in the wrong place seeing the wrong doctor. It's very important that for patients, that these things are easy to navigate, particularly as we deal increasingly with elderly patients who are very easily lost and confused by the, the array of options before them.

So, I think this more, I hesitate to say protocolized, but certainly pathway orientated, and logical, clinically driven steps is very, very important for patients. 

Sarah: I think it gives them confidence, right. That they know where they're going next.

Peter: Absolutely. What we're trying to do is, is be that guide for individuals. And I think one of the things that I find quite exciting is merging the digital with the, with the face-to-face real world. How can you optimise a patient's journey through the healthcare system. By blending these two mediums be it be it telehealth consultations, remote monitoring of symptoms, you know, with rings or watches and things like that and collecting, appropriate information from them in the digital realm, which then can then pass into the real-world realm so that specialists such as Bernard and Jonas can have all of the information, they need to make those clinical decisions.

00:18:10
Sarah: Forgive me for the next one. I'm a strategist. I cannot have a single conversation now without using the term AI. I'm astounded that we've made it as far without anybody mentioning it, quite frankly. Is there anything, we've talked a lot about technology, but anything particularly exciting in terms of the application of AI or some of that advanced technology that, that you can see coming down the line that we think looking worth, worth? Calling out?

Jonus: You’re looking at me. I am very excited by the technologies that are around the corner, but in healthcare, you shouldn't be too excited about AI. Because AI we have been using for quite some time, it's not a brand spanking new thing.

We need to really distinguish between AI we've been using since the sixties and seventies which have found their way into our technologies. Every scanner, ultrasound machine, contains a certain degree of AI. And it's only since the advent a few years ago of these large language models that everybody's talking about AI, because the perception of AI is something different.

I think there's a slight misconception now that people think AI is whatever, chat GPT and anthropic, and you put something into, uh, into your chat GPT and you're getting some information. Now that is not necessarily the AI that we will immediately use because, um, we must be very, very cautious. I think AI in healthcare has to be governed properly. It requires guidance. And what really distinguishes AI in healthcare is that ultimately for the time being, AI is an advisor, and a clinician is a decision maker. And there is a huge, huge difference between these.

I know that AI in the past has also surpassed human capabilities when it comes to chess, when people thought it's best combined with a player. Yeah. That clearly was not true. And there is no doubt that the knowledge and the information we get out of AI is probably going to surpass the knowledge of an individual, but it is surprising how often AI does make decisions that would be potentially questionable. We don't have the right ethical borders, and I think this is where we need to as clinicians be very, very clear.  We must have the right guidance.

Any AI used in Europe in particular, has to be a medical device of some sort. It must follow the governance. And as they always say, if you don't know what it really does, and if you don't know how to switch it off, then you probably shouldn't use it in healthcare. 

Sarah: I think that’s very wise guidance. What were you going to add Bernard?

Bernard: Do you think Jonas, it can make our job easier from day-to-day; simple administration letters, just the organisation of our lives, and secondly, do you think it can accelerate our experience, our knowledge?

So, you know, we've been in the game a long time, but our younger colleagues who are learning, we learn through experience by seeing lots of patients, lots of scenarios, lots of ECGs, lots of echocardiograms. So, we learnt through experience. But do you think the next generation of doctors can learn more quickly and get their experience base up thanks to artificial intelligence?

Jonus: A hundred percent. I mean, artificial intelligence is a phenomenal accelerator. You're mentioning ECGs or X-rays or CTs. If a machine goes through a hundred thousand in an hour, even the best radiologist in the world will not ma match that. It's impossible. And what AI is very, very good at is pattern recognition. And it is faster than the human eye. And because of the increasing knowledge of data, it, it will get smarter and smarter in understanding, for example, how we can early detect certain things.

Sarah: I think that aligns very well. You know, AXA is part of a global AI index for the responsible use of AI, and I think we continually use that word responsible. I'm sure Peter, a lot of your time now is thinking about how we make the most of the opportunities that AI can bring in, in clinician efficiency in particular, and ability to spot things early, but also how we make sure we've got the right governance around it and we are doing that responsibly?

Peter: Absolutely. And I think one of the interesting things is the big AI companies are targeting health as a growth area. So Open AI have just recently launched - open AI Health I think they call it. The other big AI companies are going to go down that route as well. And their aim is to bring consumers into themselves and to be a source of health information, health advice, recommendations.

So, I think we just need to be very, very careful in that, but also recognising that people are going to be using these tools for health advice and recommendations. So being cognizant of that. How do we communicate with them in this brave new world?

Jonus: I think we must be careful not to make the same mistake as we might have done in the past and stop whatever comes our way because we are afraid of what might it bring. We can't stop AI, we can't stop companies developing things. What we can do is identify how we are using it. We have a say in where the data is kept. We can't develop large language models ourselves. We can use the technology. What we can do is we can govern where the data is stored, which data is accessed, where the output goes.

Now quite clearly, companies might love to have the information held by NHS because it is the largest database in the world for health,, but we have a say, and we can decide what ethical boundaries there are and how we govern it. All the data that we, we want to use in healthcare is stored in European servers, not all over the world for that reason.

00:25:36
Sarah: The other area that we are spending a lot of time thinking about as an insurer across the whole range of healthcare needs of our population is genomics. And again, we probably can't let this pass without talking about it. Is there anything that we should think about in this space or, or how we might approach that?

Peter: I think it's a, an interesting area. Ever since we mapped the human genome, the advances in understanding of how our genetic code can lead to or can increase your chances of disease has come on leaps and bounds. In terms of cardiovascular disease though it's not quite as interesting or exciting yet. There's a number of genes that have been found that may cause some increases in risk in things like coronary artery disease. But, but no real smoking gun.

I mean, there are organisations out there that are saying we'll do a polygenetic risk profile, we'll take data from 60, 70 different genes and then calculate your risk profile. Now, those are not very sensitive in terms of predictability. It's not to say that it won't happen, but I think some of the areas we still need to hold fire on. I don’t know what my learned colleagues have to say about that?

Jonus: Well, I think you as you pointed out, I think it's a similar situation as AI only that AI has come more recent and has advanced faster it seems than our thinking around genomics. As any technology, if it does bring significant benefits, don't throw it away. Look at how you can use it but if you don't entirely understand it, if you don't entirely understand the consequences, don't unleash it. So again, ethics, governance, a sensitive way of dealing with the data is very, very important. 

Sarah: You are speaking my language as an insurer who also manages risk. This is absolutely something that is important to us as well. And something that as a group we take very seriously.

Now, we could talk about AI all day. I've realized that this is the topic on which we could sit here for hours and talk about. But I'm going to try and bring us back to the topic of, of cardiovascular care. And we were talking before Peter, around what this means from a private healthcare perspective. What is front of mind when we think about cardiac care in the private sector right now?

Peter: I think one of the areas that is very interesting is risk factor mitigation. So, as we've heard from Jonas and Bernard, the, the days of large numbers of people dropping down dead of heart attacks in their forties and fifties are thankfully gone. It still does happen but thankfully gone. And what we have is is large populations of people with significant risk factors, often multiple risk factors. So that may be elevated cholesterol, it may be untreated hypertension, um, it may be smoking, although I think that's one of the best public health interventions we've done over the last 20, 30 years - the pricing out of cigarette smoking for most people. But also obesity, I think is one of the key areas. So how do we manage those? 

We've done a great job with cholesterol lowering. We have a variety of different statins. We've also got some newer biologics that can reduce down cholesterol in difficult to manage individuals. We've got a vast array of blood pressure medications that we can personalise based on individuals’ response to them. And now we've got the, colloquially known fat jabs, the GLP1 agonists, which I think are going to be transformative in terms of reducing down, um, uh, cardiovascular risk factors.

Um, so as we start to look at this prevention side of things, really ramping that up, getting to more people. So, it's all very well having these medications and these interventions available, but we need to get to the right people. I think as a health insurer, we have a great opportunity to, to get out to a fairly significant proportion of the population. It's not just the rich middle class who have private health insurance increasingly, across the socioeconomic spectrum people are choosing to have health insurance. So, we've got a great opportunity there.

We can also work with our employer clients as well to start to push that health and prevention message into the workplace and to layer in within our policies, preventive benefits wellness checks and other forms of prevention for individuals that are included the benefit scheme.

Sarah: Okay. So, we can think about the broader benefit in terms of how we can play that preventative role and some of those things. Anything in terms of the delivery of that cardiac care when it's needed, that anybody would call out and our role as a private insurer in particular? 

Jonus: Well, to be honest, the only thing that popped into my head when he said that is interventions or pharmacological interventions, jabs, tablets, they're fantastic tools, but really in the short term, because they are treating large groups of people that we know are in desperate need of some support, but we are treating what has happened to them instead of stopping them from happening in the first place. This is it. As I said, the holy grail is stop it from happening and maybe do something that takes it away completely. So, the tablets, the jabs, all these things are fantastic right now. They're not the long-term solution for us.

Peter: It's difficult to persuade people when they're young and immortal to change their lifestyle. And you know, some of it is genetic as well. You know, the propensity for hypertension. It is a need for both, a balance. We don't want to be continually seen as being the bad cop telling people you shouldn't do this. No, you shouldn't do that. Unfortunately, a lot of the risk factors for cardiovascular disease are from things that are quite good, you know, eating high fat foods and high salt foods and, uh, yeah. 

Bernard: But not smoking. 

Peter: Not smoking. 

Bernard: Well, I was just going to add that. I think the other thing that we may foresee with artificial intelligence and predictive models is a move towards more precision medicine. At the moment, we take very much a population-based approach. So, everyone of a certain age is on a statin. We treat a lot of patients with hypertension who will never actually have a vascular complication of their hypertension and so on. And that's the way that we practice now. But it may well be that in 10 years’ time or even sooner, who knows, we're accelerating very fast, we'll be able to identify the people who are at highest risk or those who are at risk of progressive disease.

So, for example, in valve disease, which is one of my specialties, a lot of patients have valve disease, but for most of them, it just stays still for decades, and nothing ever happens. Whereas there are other patients who progress quite fast and need an intervention within five years of diagnosis. So, the ability to predict the fast movers versus the slow progresses will, I think, become part of everyday medicine within a decade.

00:34:18
Sarah: It's a fascinating conversation. So well over 80% of the private healthcare provided in the UK is funded through an employer, that is an enormous part of our market, be that a very small business right up to the very largest businesses in the UK. My team spend a lot of time now thinking about that shifting role of the employer. There's a very strong government narrative now with Keep Britain Working with the review saying to employers, you have a real responsibility to manage the health of your workforce and keep them productive and keep them healthy. If we think about that in the space of, of cardiology and cardiovascular care now, I'm sure some of those who might watch this will be those who are responsible for putting in healthcare solutions for a workforce. Is there anything in this space that you think that they should take away from this in terms of this space and, and to make sure that what they do put in place to your language that Peter is successful and really does deliver that value? 

Any advice to employers in terms of how they can take all this insight and turn it into something that really makes a difference?

Jonus: If companies are investing in their healthcare and wellbeing of their own staff, then that is on one hand because they want to be good to their people, but clearly, it's also good for the bottom-line productivity. It obviously is worth it to have a healthier, more enthusiastic workforce, who's living or working in an area that supports them. 

Peter: Absolutely. And there's plenty of research evidence over the last 20, 25 years, that shows that organisations that invest in health interventions and health promotional initiatives within their workforce, and as long as it's done well, and, and as long as there's good uptake, do show that people are not only healthier but more productive, less time away from work. So, there's good evidence to back that up. 

Each workforce is different. Each workplace is different. 

One of the things that AXA Health does is help organizations understand what sort of health initiatives they can put in place to really have an impact on their employees and improve how they're performing. One of the things I've done when working in this area with employers is to encourage them to put together a workforce health strategy. So, what are your goals? What do you want to achieve through a health promotion and improvement program within the workforce? Once you're clear about what you want to achieve, you can plan how to do it. Different workforces and workplaces vary, so there's no one-size-fits-all solution. You can include simple activities, structured programs, competitions, online assessments, offline health measurements, gym memberships—depending on who the end user is. And AXA Health can support with these. The first step is to define what you want to achieve and how to progress with targeted interventions. 

Sarah: So, we see a huge amount of success in solutions that we offer to workforces that have coaching associated with them. And I think it links to our conversation earlier, right? Rather than send out an email to all employees saying, you should all take some more steps, a coaching relationship that says, what do you want your health outcomes to be? What do you want to be able to do that you can't do now? What's the opportunity? We see the real tangible evidence of having had that personal interaction that says, why are you doing this? Speaking to a coach and really understanding why you are doing that rather than, as I say, sending out a blanket email every Tuesday and saying, you should all really get up from your desks and, and move more. 

If I look to the panel who are really, really focus on cardiovascular care, AXA Health and other private insurers in the UK look after a huge amount of the population all in. Is there anything specific you would say to employers or, HR leads who are looking to put benefits in place specifically about your area of care?

Jonus: Well, I'm not sure, I'm not necessarily wanting to address the individual employers here. I would address the insurers. So, I think you are in a pivotal role here. You are a broker between healthcare expertise and the end user. So, the companies and the employees. And you are in this unique position that you can bring together these three groups and really get the best out of everybody to provide the best care for the individuals to the benefit of the insurers and the employers, and ultimately also to the benefit of the healthcare providers. Because healthcare challenges are massive. We are looking desperately for solutions that are more efficient and better for everybody. 

I think the other point is that healthcare investment is very cost-effective. Most interventions, they prolong life, but they also sustain the quality of life. And as an employer, you know, absenteeism from the workplace because of ill health costs your business, your organisation, whatever it may be. So, keeping our patients healthy, keeping the population healthy, but keeping your employees healthy is a very cost-effective investment and intervention. 

Sarah: I think it particularly makes sense to our earlier conversation, people living longer with some of these conditions and how do we therefore keep them in the workforce, in productive work is something we've got a real opportunity and alignment of incentives on. That's why we are here today talking about this in terms of our options and our ability to work together. 

It sounds like from all our conversations today, improving the heart health of the employee workforce is absolutely something that is possible and is doable with everything that we've talked about if we continue to make those strides forward that we've talked about.

It's been a fascinating conversation, so thank you all three of you for joining us today. I know the topics that we could talk about for hours, and I really appreciate your time. So, thank you, Peter. Thank you, Bernard, and thank you Jonas. And thank you for joining us today on our first of the Spotlight series, really focused on cardiac care, and we hope that you'll join us in the future.