Salus Trust is one of the leading health maintenance organizations (HMO) in Nigeria. It is the one and only Catholic owned HMO in the country. The major player in the private sector health insurance landscape recently launched a firstclass End to End Software Solution that is deployed to address the perennial problems faced by the health insurance business in Nigeria. The Managing Director of the company, Dr. Peter Oriavwote in this interview with NETA NWOSU speaks on the Salus Trust premium and standard Health Plan, the End to End Software Solution, service delivery, 2021 year plan and other issues in the healthcare sector.
Tell us about Salus Trust in Nigeria
Salus Trust is a national Health Organisation established by the Catholic Bishops’ Conference of Nigeria (CBCN) and registered with the Corporate Affairs Commission, RC no. 692203, on May 22nd 2007. The company was initially accredited by the National Health Insurance Scheme (NHIS) in November 2008 with HMO no.054 to operate as a national Health Maintenance Organisation (HMO). Salus Trust has recently been re-accredited by the National Health Insurance Scheme (NHIS) and issued license to practice till February 2022. Currently, Salus Trust has other independent shareholders other than the Catholic Secretariat of Nigeria (CSN), some Dioceses and agencies of the Catholic Church in Nigeria
Why should one get Health Maintenance Organisation (HMO) coverage?
The advantages of enrolling with an HMO are enormous because it costs less to pay premium for health insurance plan than wait to be sick and pay huge unexpected sums of money out of pocket at the hospital. Another reason why HMO coverage is better is that HMOs register a large number of people and thus receive premium payments into pool of funds such that if any of the persons registered falls sick at any time money from that pool is used to cater for their healthcare needs at the hospital without the enrollees paying any additional sum out of their pockets, provided that care is within limit of coverage. Furthermore, HMOs ensure that enrollees receive quality care at the hospitals at any encounter.
Who are your clients? What kind of services do you render?
Salus Trust’s clients include corporate businesses, groups of enrollees within the Catholic Church (which include Priests, Religious and Lay people), Students of Secondary and Tertiary Schools, and Individuals (who enroll either on retail basis or through community health initiatives). In addition, the Company currently partners with some State government Health Insurance Agencies either as Health Insurance Agents or Third-Party Administrators. Salus Trusts offers regular health insurance and customized health plans to fit the health needs of diverse groups of people. In addition, the Company partners with Mutual Benefit Assurance PLC in providing overseas Health Insurance policies for persons travelling abroad.
How can the ordinary Nigerian benefit from these services?
You have to reap where you sow, so to benefit a Nigerian resident or group of persons will have to first subscribe to a particular health plan and pay the respective premium to enjoy the healthcare benefits of the chosen plan. However, there is another path to enjoying the benefits of a health insurance plan and that is through an adoption model. Here, some wealthy or philanthropic individuals adopt a group of individuals and purchases healthcare plan for them because they lack the capability of paying the premium or belong to the vulnerable group in society. Enrolled persons access healthcare services at designated hospitals and clinics on the network of the HMO across Nigeria.
How has the market responded so far to your services?
Generally, only about 7 million Salus Trust is one of the leading health maintenance organizations (HMO) in Nigeria. It is the one and only Catholic owned HMO in the country. The major player in the private sector health insurance landscape recently launched a firstclass End to End Software Solution that is deployed to address the perennial problems faced by the health insurance business in Nigeria. The Managing Director of the company, Dr. Peter Oriavwote in this interview with NETA NWOSU speaks on the Salus Trust premium and standard Health Plan, the End to End Software Solution, service delivery, 2021 year plan and other issues in the healthcare sector. ‘Salus Trust is rated among the best 20 HMOs in Nigeria’ persons in Nigeria have been registered under any health insurance scheme (compared with a population of 200 million people), out of which a whooping 6 million are employees of the Federal Government and their dependants who have been assigned to HMOs by the NHIS. Hence, there is low patronage by the private sector basically because health insurance has not been made compulsory in Nigeria and awareness creation has been very low. Nevertheless, Salus Trust has received patronage from the Catholic Church, Schools and some corporate bodies.
What are the unique selling points of Salus Trust Limited?
The Company has three distinct unique selling points. Firstly, assurance of quality healthcare services anywhere, anytime using trusted healthcare facilities across the country and at homes/offices of enrollees through a successful E-Consultation strategy (Enrollees either access healthcare services at home and their offices or at the hospital) Secondly, deployment of an End to End Software solution that significantly reduces waiting time at the hospital, increases to information by enrollees, and enhances claims submission and settlement online realtime. And thirdly, regular health education for enrollees to improve their health habits and lifestyle.
Last year you unveiled a new logo to reflect the Company’s repositioning in the market place aimed at achieving its set goals. You also introduced the new vision of the Company which is “…leading Health Maintenance Organisation with a difference…”. Tell us about these set goals of your repositioning initiative. What necessitated the new vision? How has this repositioning influenced patronage of your packages and corporate image?
The goal was to improve our service delivery and build brand equity and thus increase the Company’s market share. Our new logo and vision were necessitated by our strategy to change our ways of doing business to reflect the fact that our customers come first and thus we must strive towards continuous improvement in our service offerings. Our intention was to make a difference in the industry and we are gradually achieving that currently. Our repositioning is beginning to impact positively on patronage and our corporate image inspite of the negative effects of COVID-19 on the global economy. We are acquiring new corporate businesses while retaining old customers.
Salus Trust announced its plan last year to raise additional share capital of N300 million in the first quarter of year 2020 to boost its capital base. How did this scale up exercise go? Please tell us.
So far we have not embarked on the private placement programme but we shall conclude the plans very soon to embark on the exercise.
Two months ago, your company unveiled an End to End HMO Software Solution designed to tackle health insurance business issues. What are these business issues? To what extent has the new Software Solution tackled these issues? What has been the response of the market to this new product?
The business issues that we intended to solve using this new software include but not limited to the long waiting time at the hospitals by enrollees; late submission of medical claims by the hospitals; quality assurance issues; sharp practices by some hospitals that attempt to game the billing process and over charge the HMOs and decreasing service delivery issues The new Software Solution has tackled these issues in the following ways: a. Waiting time has gradually improved as Care authorization is now done automatically through use of the software by hospitals that have onboarded b. There is now a great improvement in claims submission by the hospitals that have onboarded and now access the HMO online real time c. Quality assurance has greatly improved for enrollees as the customer satisfaction unit of Salus Trust follows up with enrollees as soon as they exit the hospital or are hospitalized. d. It has become increasingly difficult for hospitals to game the billing process as the agreed tariff and software terms apply. e. Service delivery has considerably improved through the use of the e-portal segment of the Software solution by enrollee online realtime. Both clients and healthcare providers have embraced the Software Solution and are gradually onboarding following series of clientele/provider orientation programmes and demos embarked upon by Salus Trust.
How would you position Salus Trust in the Health Maintenance Organisations sector in Nigeria? What is its market share?
Salus Trust is rated among the best 20 HMOs in Nigeria. The Company’s market share right now is below 5% the reason being that we have just recently entered into the public sector business with State Government Health Insurance Agencies.
Please assess the condition of the country’s Health Maintenance Organisations in terms of service delivery?
Service delivery has been an issue in the HMO business in Nigeria because the HMOs bear a lot of risks of huge claims settlement to hospitals in addition to serious price under-cutting by HMOs in the industry such that with continuous increases in medical tariff, HMOs begin to owe the hospitals and thus increase their inability to pay claims promptly. With tons of claims owed by HMOs, hospitals increasingly deny enrollees access to healthcare services leading to reduced service delivery. That’s an issue HMOs have to critically look into. In addition, NHIS has to really do its work of regulating the industry.
How would you describe the health insurance market in Nigeria in comparison with the markets in other climes?
First, let’s compare health insurance in Nigeria and neighbouring country like Ghana and other Africa Countries on the one side, and then compare with developed economies such as the United States, United Kingdom, and Netherlands. Now let’s take a look at the African region, the fact is that Nigeria is the most populous country in Africa for that reason, it comes with attendance problems and coupled with the fact that the Nigerian constitution prevents the Federal government from controlling the health sector in States which made the Federal government unable to make health insurance compulsory in Nigeria. The States have started setting up their independent health Insurance Agencies. This is a big problem in Nigeria when comparing health insurance in Nigeria with other countries especially with the developed countries where health insurance is adequately regulated. In our case, the Nigerian constitution is a big challenge. In summary, Nigeria is way behind in health insurance.
How can Nigeria’s insurance companies sufficiently address the issue of lack of consumer trust?
Consumer trust arises from the fact that HMOs collect premium from enrollees, and the enrollees in turn expect to receive adequate healthcare service delivery from the HMOs when they have the need to access care. But over time, some enrollees go to the hospitals and receive less than adequate care and sometimes they are denied care because they are told HMOs have not paid the health care facility. These trajectories have to change through concerted efforts of the NHIS and HMOs.
In rural areas, there are few healthcare providers, and it is hard to access care. Even in some of the cities, some HMOs transfer people to bigger cities to get them the care that they need. What is the health insurance industry doing to address this problem?
The HMOs under the NHIS are not permitted to establish hospitals. What can be done is either for the government to set up healthcare facilities or private enterprises should establish hospitals and clinics for access to care in the rural areas.
Some HMO operators have complained of abuse from hospitals and healthcare providers. It seems that providers believe they are not getting paid enough, and there is the temptation to over-service and extract the maximum payment possible from each person who walks in the door. That puts a strain on the health insurance company that might or might not pay them on time. What is your take on this?
This is a big challenge in the industry. The solution to this is an agreed tariff between Providers and enrollees, use of Software Solutions by HMOs and appropriate regulation by NHIS.
AdesimboUkiri, the Managing Director and CEO, Avon Healthcare Limited few months ago decried lack of regulation in the industry. According to her of the nearly 7 million Nigerians covered, over 6 million are covered under the federal government civil servant scheme. Noting that the current entity (NHIS) is both operator and regulator, which is a contradiction of sorts she called for transparency among sector players by ensuring audited annual accounts are publicly available for scrutiny. Let’s have your views on Ukiri’s statement.
Awareness is still very low among Nigerians for health insurance especially within the private and informal sectors. NHIS has to play its role of regulation and take control of the industry. The issue of transparency by players stated by Dr. Ukiri is valid but private entities are not under the Securities and Exchange Commission (SEC) as publicly quoted companies hence their audited accounts may not be made available for public scrutiny.
What do you consider the biggest challenges facing the HMOs and the health insurance companies?
The biggest problem is that of regulation by the NHIS. If regulation is adequate, price undercutting by HMOs and poor service delivery will be eliminated. NHIS has to focus on regulation rather than operations and thus competing with HMOs which are supposed to be regulated.
What are your growth plans for 2021?
What is the latest news from Salus Trust? We look forward to a 20 percent growth in revenue generation with respect to private sector businesses in 2021. We are making significant inroad into the public sector landscape in 2021. The latest news from Salus Trust is that we are making waves with our End to End Software solution and E-consultation strategy.