HCI Healthcare Ltd…passion for lifelong relationship with clients

Our HMO brand in focus for this edition is a notable HMO in the country – HCI Healthcare Ltd. The organisation, having commenced operations at the time the NHIS Act was passed in 1999, it still operating with impressive performance. Our team spoke with the Chief Executive Officer of the company, Dr. Abdulkadri Osumah on the company’s journey, challenges, milestones and what sets it apart from the rest. At the end, he shared with readers what to expect from the company in the coming years even as it hopes to remain a top HMO in the country.

Can you take us through the journey, the establishment of HCI? What informed the decision?

HCI was formed in 1998. That was before the National Health Insurance Scheme Act was even passed in 1999. The whole essence was to be able to pool finances for corporate organizations so that they could have access to healthcare. But it was formed as Health Care International then. So, in 1999 when the National Health Insurance Scheme Act was passed, since the company has been incorporated, we just applied for a license. The pioneer chairman was Senator Yinka Omilani, OON, who founded the company together with other corporate institutions. The company was formed with a vision to be the best in providing quality healthcare in Africa. As a company, we felt that the best way to do this was to provide access to quality managed care, which is supported by first class customer service, delivered on one-to-one lifelong relationship.

Now, people probably wonder why we set out as a company to do that. What is the linkage between providing quality healthcare and lifelong relationship? We are not a company that just wants to manage your health and leave you. That also reflects in some of our plans, where we say that we stay with you; we support you through your life journey from the period that your mum bought our plan and you were registered as a dependent to the time that you go through the university. We will give you cover while you are in the university through our tertiary institution plan, to the period that you get out of university and you get a job and we cover you with our corporate health plan, then you get married and you go into our family plan, you have your own children. Then you grow old and retire and we move you into our senior citizen plan. So, we walk with you through life.

And for us to be able to do that, we must have a relationship with you. Ours is not transactional. Some HMOs are just basically transactional. You buy a plan from them and that is it. Ours is not transactional. Ours is more of transformational. We walk with you like a partner to improve that life journey. That is our purpose. That is our message to people. Whether you are a supplier to us, that is health care provider, pharmacist, dentist or optician, we say, look, we want to be with you from the period you set up. We want to refer clients to you, to the period that you become big and have more than one branch. Same with clients. This is what we are about. That is our purpose.

Of course, we know that this may not be possible if, as a company, you don’t have guiding values that guide you on how to achieve your purpose. As a company, we have looked at what we said we wanted to do and how we said we wanted to do it and what we wanted to be known for in the market. What are those values? What are those things that matter to us as a company? What are those things that shape us? What are those things that define how we work, how we relate, how we engage? That is how we come up with our values.

Now, our values are captured in the acronym “I-CATER” where “I” stands for integrity, “C” stands for commitment, “A” stands for agility, “T” stands for teamwork, “E” stands for excellence, and “R” stands for responsibility. So we a responsible organisation. Once we tell you this is what we are going to do, that is what we are going to do. Integrity means we are quite transparent. We will be open to you. We will let you know what you will have and what you can get. We will let you know what is possible and what is not possible. For agility, we try to be flexible, innovative. Even though we are playing in the financial services sector, there is the constraint of being flexible, innovative and all that. We still believe that we need to demonstrate agility because the customer world is dynamic and it is changing at the pace that, if as an organisation does not demonstrate agility, it will become a dinosaur. So that is why it is key for us as an organisation.

Then of course teamwork. We know that two heads they say is better than one. So we understand that one person can be good, but it is better to have two people that may be fairly good. They may not be as good, but they are fairly good combining their efforts; combining their brains. It is a lot better than one person in a group because there is a limit to what one person can do. But there is so much more that people working as a group can do. That is why it is important for us. For excellence, we cannot say we want to provide quality; we cannot say we want to be the best in quality, if we don’t focus on excellence. Excellence at the medical level, excellence in terms of technology, in terms of processes, in terms of everything we do. So we need to demonstrate excellence, getting it right the very first time. So that is important for us.

As a company, we have gone through different transformation. We started out as Health Care International. The current logo that we have is not what we always have. We have maintained the name Health Care International, for a number of years until 2016/17 when we decided that there was a need to transform ourselves again. It was very easy for us, really, because in the markets even though we say we are Health Care International, our customers just simply call us HCI. HCI. HCI. We said Okay, this is the name that resonates with the market. It was then easy for us to say we are transforming to HCI. Then the logo also reflects that, which shows that we are moving from the green era, to the blue era. The blue era is when you talk about Blue Ocean, the uncharted path, the under-served market, un-served market. So those are the things we are looking at.

Of course, we have had our own share of challenges, but we have also had our own share of joy in the market, just like any other business. But here we are today, it has been over 20 years, which is a very rare milestone for Nigerian owned companies.

Talking about those challenges, are there one or two that really shook the company that maybe threatened its existence that you could recall?

Yeah, we are a health insurance company. So basically we are an insurance company. The greatest thing that threatens any insurance company is claims and sometimes the structure of the customer.  If you have a portfolio that is so big and then in that big portfolio, you actually have one customer that is responsible for 80 to 90% and then that customer decides to walk away, that is a big challenge. We had that sometime in the past where NICON Insurance was one of the biggest customers that we had as a company, and they decided to take a walk that affected the business. But of course the business was able to move out of that and learn from that experience that while it is important to still pursue some of these big blue-chip companies, it is more viable and more sustainable to get the small people in the market, the retail, the SMEs, and that has been one of the drivers that changed our focus.

Then what is your target market and how would you say your services meet their needs?

I would say our target market basically is that segment of the market that believes in quality care; that is passionate about customer service and is willing to build relationships. Now, it is not all organisations really that are focused on quality. Some just go into insurance just because they want to cut down cost. So for us, we target companies, individuals and SMEs that are focused and passionate about quality and customer service. That is our target market. So it cuts across whether it is SMEs, blue-chip companies, tertiary institutions or government institutions. What is key to us is what do they focus on? What job do they want the insurance to do for them? Is it that they just want the insurance to cut down cost for them or want insurance to grant them access to quality care? So those are very key for us as a company. That is how we also try to tailor our services. We are not where we want to be, I must confess. Perhaps, I would say we are still a little bit far from where we want to be. Our focus is really for the market to see that if you are looking for true quality healthcare, then go to this HMO. That is the perception that we want to create in the market. That is why we keep looking at our set up, our culture, our process and ask the question, how is it helping us? How is it moving us towards those things that we said we wanted to achieve? So, we are working on our services really.

What feedback do you get from your clients regarding your services? Do the services meet their needs or do they demand for more?

Well, the major feedback, I must say, has been the issue of people not getting access health care quicker at the hospital and it is quite worrisome for us. But I think it is something that I understand because there are very few hospitals that Nigerians want to go to. I will give an example. There is a hospital around Gbagada. Almost everybody wants to go to that private school. So you have this situation where 72 or 76 HMOs are working with that particular hospital and all of them, all the HMOs, have nothing less than 100 enrollees in that particular hospital. So you experience delayed service delivery. In government institutions, where there is so much bureaucracy, we have experienced it. But we keep working on our own processes and trying to engage the providers differently to see how we can cut down on those delays. Even when we know that some of those issues are probably not our fault, but we think that we can influence and work towards better service.

There are many HMO players in the market. What differentiates HCI Healthcare from the rest?

Our obsessive focus on quality and the passion for a lifelong relationship. So we have had situations where some customers say, look, we have been with you for a while, we just want to try another HMO. After trying, they come back. And we ask, okay, so why did you come back? They answer; look we have a relationship with you guys. We do not have relationship with them. Theirs is more transactional. We only talk to robots, we talk to machines, but with you, we talk to humans. We think you can feel us. We talk to you and we feel okay. You have blood flowing in you, so you can feel what I am going through. So when I am saying this thing, you understand me better. So that stands out for us. We have got a lot of that from our customers.

As you know, not many Nigerians are on health insurance just about 5%. What in your opinion is responsible for this low enrollment and how can we better drive enrollment?

Well, I think as a society, we are very religious. So religion is a major barrier. Down south of the country for instance, you have people, who because of their faith, believe that they can be healed without going to the hospital. So they really do not feel they have the need to do that. Then you have in the north, where it is the same thing for different reasons. The other one is the purchasing power. If you look at it, I mean, just this morning, I read from the news that the National Bureau of Statistics (NBS) said we have over a hundred million Nigerians living below the poverty line. So what is left? If you have over hundred million, so what is left? You then have few people that can actually afford it. We have government priority too. Government has really not prioritised health. If government prioritises health, it would have made health insurance compulsory, even though we thank the president, we thank the national assembly and the leadership of the National Health Insurance Authority NHIA. They have been able to get the president to sign the National Health Insurance Authority Act 2022.

Those factors and the perception that has been created by the regular insurance before now with payment of claims have created the moment of truth. In that moment of truth, you have a number of people that have been turned back that cannot make a claim or something happened. So that has created mistrust for anything insurance. Putting health to it is not going to change that perception. So people are feeling like, look, these guys are going to take my money and they are not going to provide services. Then of course, there is the attitude of our providers wanting to maintain the status quo is a very big challenge.

The recently passed NHIA Act, how much do you think it can drive enrollment?

Law on its own is not going to drive people to buy insurance. However, it is going to facilitate it very quickly, particularly if the government agency that is responsible for implementing that law is able to put in place framework that will make almost everybody have access to social amenities; to certain facilities if they have one form health insurance or the other. So that needs to be created.

Now, let us talk about innovation. It has been said that it is a driver of business sustainability. How is HCI adopting innovation in driving it business?

Hmmm…that is quite interesting. Innovation is something that a lot of companies talk about, which for them, it is more about talk. Innovation is very critical for us as a company. It is one of the things that we said, if we must beat the market; be the leader of the market, we must be innovative. That is why we have a unit that is responsible for innovation. The unit looks at the market, looks at how we can improve our customers and our current products. The unit looks at how we can create new product that targets new markets at affordable price. The unit also looks at how we handle claims differently compared to our peers and how we make sure that the entire premium work for them. So these are areas of innovation that we think about. Like I said earlier, we still operate in a financial services sector. Those innovations require investment and they ensure that we are more innovative than our peers. Part of the investment is in information technology (IT). As we speak, as a company, we have digitally transformed and we are on top. We are still looking at different operation processes that we can digitally transform so that we will become more efficient. We are applying analytics to get more insights, business intelligence, that can help us to innovate our products, our process and our approach in general.

Many of the companies that started the same time with HCI have gone out of business for various reasons. So has HCI been able to survive different business climates that we have had since the return to democracy in 1999.  So how have you been able to achieve this?

Glory be to God for that. I will say that God has been faithful and the leadership of the board has also been very supportive for the business. I must thank the past management of this company. They really weathered the storms during those periods that you mentioned from 1999 to 2019. Kudos to the past management led by Mr. Tosin Awosika (former MD/CEO). They did great things to keep the company afloat. Maybe because he had a background in insurance, so he probably understood what needed to be done, what needed to be looked at and what needed to be set aside. I think that has helped the business till date.

Talking about universal health coverage, how do you think the country can achieve this?

Well, while universal health coverage is desirable, generally you cannot say there is a particular country that has achieved it although you have those that have achieved it 90-95%. I think Nigeria is on the right path with the passage of the National Health Insurance Authority Act. What we need to do is to continue to on this path. The law has been passed and it has made provisions for what we are supposed to do. It has made allowance for the vulnerable groups. You will recall I said that the statistics released by the NBS that says that over 100 million Nigerians are poor. If you want to achieve universal coverage, you must think about those people. Because that is a critical mass. How do you fund the universal health coverage? Like I mentioned earlier, the law has made provision for all that. It is for the leadership of the country and the key stakeholders in the healthcare industry to begin to lead and define how they can mobilise fund. It will not be a bad idea really if we create a tax net just to be able to get more money to be able to fund healthcare for those vulnerable people. They constitute a significant number. Then of course there must be focus on excellent customer service, prompt payment of claims so that the perception created by the regular insurance can be eliminated in the market.

As a major player in the industry, what is your view about the NHIA? What impact do you think the law will have on the industry?

The National Health Insurance Authority Act is good but a little bit controversial. However, it is going to help the industry in the long run. Like I said, it is a step in the right direction. No law is passed anywhere in the world that is perfect from beginning. Now, the onus is on the industry players to have continuous engagement on how those parts of the law that are not working can be modified. That law has defined function of everybody. It has also defined different schemes for different segments of the market. If fully implemented, healthcare is going to be a boom in this country. You can imagine how much will be available to hospitals to be able to manage people that will come to them. It can still be improved upon. There are some grey areas but largely, it is a step in the right direction.

Looking at the challenges facing the industry, the brain drain and all of that, do you think the industry is prepared for the change that will happen to the industry through the NHIA?

I think a lot of things are reshaping the industry as it were. As an industry, we never imagine a time will come where we have to ask some of our staff to work from home. COVID-19 brought that change upon us and as an industry, all of us have been forced to change. So we have started investing in technology platforms that will allow our people and suppliers to be able to work from home. We engage through digital platforms now. Nothing says people in the UK and Canada cannot work for you. We have digital platforms now. If you want to “Japa” (migrate) and you arequite useful to us, we can saywhy do not you keep working for us and keeping the money here? After all, we do not even need you to come to the office in the first instance. So those are the things that will happen. So it is already shaping the industry positively.

Let us talk about the poor service delivery in the industry. What do you think is responsible for poor service delivery?

Hmmm…asymmetric information. Health insurance came to Nigeria because the law was passed and not because service was being provided that people felt there is need. So you have a situation where a law forced two parties with different opinions and view of things. You have the law forcing them to come together. Healthcare providers believe that they should continue with retainership. HMOs believe that no; let us pool resources as that is the way to go. Then on the client end, they do not understand anything. Like I mentioned, our attitude to health is poor. How many Nigerians read what malaria is all about? Yet, we keep saying, oh, I have malaria but you ask the person this thing that you have every day, what have you learnt about it? Nothing. So people do not look into that leading to asymetric information, a situation which somebody at the lower end to be managed out of that information and then the person gets angry!

Then, I think the lack of customer experience specialists in the industry is also major issue. Like my company, we have promised you the client that when you get to the hospital within four to six minutes, you will be attended to. But we all know that there are some hospitals you will get to, due to the crowd, you may not be attended to and you are angry. So at that point that you get angry, you put a call through. So you need a specialist that can manage your expectations but we have a dearth of specialists right now. The other thing is maybe delay of claims and then the hospital tariff too. It is not helping matter. When hospitals increase their tariff, it is difficult for health insurance companies to do same to customers. Then you have a challenge because there is a mismatch. So you are covering the same services at the higher cost using the same (old) premium. So it gets to a point where you start shuffling some payments. I pay you, I owe you, I pay you, I owe you; you pay one hospital and owe another.   Those things backfire because you do not dictate where customers go. The customer may then go to the hospital that is not in your schedule of hospitals. Then the hospital starts turning the customer back because the HMO owes. These are issues.

So players within the industry must be bold to educate the customers. The customers do not have the kind of knowledge that is at the disposal of the operators. To engage the customers, let them see reasons, empathize with them but be bold enough to tell them the truth. Endeavour to tell them the way it is. Let them know what they can get. Setting those clear expectations will clear off anything that has to do with poor service. It is basically poor management of customer expectations. If these expectations are properly managed, there will not be anything like poor service.

Looking at the future now, what should the customers, the suppliers, even the staff, all the stakeholders, be expecting from HCI Healthcare?

HCI Healthcare is already looking into the future. The customers should look out for an organisation that is going to transform how healthcare is delivered in Nigeria. Our intention has always been to be known for providing quality of health care in Africa. So we are obsessed with that. As part of the big steps toward realizing that future, we are in partnership with some internationally-recognized medical institutions that provide us with the most recent approach, methods and tools to handle different disease conditions. So with that in our possession, we have the tools that help us to engage all parties-customers and providers.

We have our blog. We are working to improve our blog. So we want our blog to be the best healthcare blog in Nigeria that people will go to get medical information, medical news, medical interactions and medical engagement. Our blog is something that will create a community that drives quality healthcare. So it is a future where we are trying to transform customer experience, which is the reason why we are investing in different technologies. And we will not stop. We keep looking at the market. We keep looking at how can we delight and excite our customers beyond what we are currently doing.

So, looking into the future is an exciting moment, it is an exciting moment for our customers, for our partners and providers. It is a future that our shareholders cannot wait to see because it is a promise of not only profit but fulfillment of the purpose for which we were set out as a company, which is to give people that fulfillment of investing in their health, their life through a company that they see as a trusted partner. So that is the HCI Healthcare of the future.

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