Health in the Workplace: Toward Personalized Preventive Healthcare

- Profile -

Masahiro ISOBE is Head of the Healthcare Business Overseas Unit at Sumitomo Corporation. Graduated from Hitotsubashi University in 2006 with a degree in commerce and management, and in 2018 received his MBA in finance, retail and marketing from the Columbia Business School. After joining Sumitomo Corporation in 2006 he worked in various capacities and served in diverse roles, including as a junior analyst at the M&A Supporting Team, before taking on the role of Manager in the Corporate Planning Department in 2009, before moving on to the Corporate Strategy and Business Planning Department as Manager in 2015. After receiving his MBA Isobe worked as Business Development Manager in the Healthcare Business Department, before transferring to Kuala Lumpur, Malaysia in 2019. During a five-year period spent in Kuala Lumpur he worked at PMCare Sdn Bhd, a subsidiary of SC Healthcare Holdings (itself a subsidiary of Sumitomo Corporation), as Chief Strategy Officer, and as COO of SC Health Holdings Sdn Bhd. He returned to Japan and his current position in August 2024. Isobe is a Chartered Member of the Securities Analysts Association of Japan.

(1) Introduction to the lecture

Norie KAWAHARA, lecture series moderator, noted that in the previous lectures students had experienced an interdisciplinary journey that uses cancer—an experience of deep suffering—as a lens to rethink wellbeing in Asia. She noted that in the sixth lecture, the theme for the presentation and discussion would be “Co-creating a workplace-centered health ecosystem.” She introduced the speaker for the lecture, Masahiro ISOBE of Sumitomo Corporation. 

Dr. Kawahara reminded students that the lecture series explores one central question: “What does true wellbeing mean for people in Asia?” In the first session, students looked at how cancer can reveal our underlying values and how medicine reflects society and culture. The second session explored well-being through health beliefs and everyday life across Asian contexts. The third session focused on Japan’s policy innovations in response to population ageing and how these can contribute to global health. Then, in the fourth session, students were invited to examine how to assess the social and economic value of healthcare interventions. 

The fifth lecture was the first to enter the action phase of study. Students heard about international navigation models and Malaysia’s first step in guiding patients and families through the maze of medicine, information and money that begins at the moment of diagnosis, turning their suffering into effective support.

Today’s lecture’s setting is not from the hospital or medical frontline. It is the workplace, where each of us spends about one third of our entire life. Could it be that the workplace becomes the social infrastructure to prevent chronic disease and enable people to keep working even after a cancer diagnosis? 

The Asia Cancer Forum (ACF) is working with National Cancer Society, Malaysia (NCSM) to raise cancer screening awareness in Malaysia. More than 60% of cancers are found at the advanced stage. Detection is urgent, yet screening rates remain low because awareness is low, access is limited, and cultural barriers remain resistant to change.

Seeking to transform this situation, NCSM and ACF, working with in-country partner PMCare, a subsidiary of Sumitomo corporation, have started sending mobile screening buses to company sites so workers can learn the importance of screening and get tested in their workplace. Dr. Kawahara noted that Mr. Isobe would be speaking from the perspective of his headquarters role, covering how the Sumitomo Group and PMCare are using the workplace to prevent disease and control medical costs across Malaysia.

(2) Health in the Workplace: Toward Personalized Preventive Healthcare

Mr. Isobe began by with a brief introduction to Sumitomo Corporation and its work in the healthcare sector. Sumitomo Corporation is a conglomerate company doing business over the world. There are nearly 900 group companies with more than 81,000 people working all over the world. As a global conglomerate Sumitomo is involved in many domains from steel to automotive, transportation, construction, urban development, infrastructure, media, digital lifestyle, business, mineral resources, chemical solutions, and energy transformation, etc.

  There are a total of nine business groups within Sumitomo Corporation, and it is the Lifestyle Business Group that oversees the Healthcare Business Overseas Unit, which is headed by Mr. Isobe. Within the portfolio of the  Healthcare Business Overseas Unit are the countries of Malaysia, which comprises the largest share of business, followed by Vietnam, the United States and Singapore. 

  The situation for Malaysian healthcare is interesting in that there is no public medical insurance scheme like Japan in Malaysia. The Malaysian healthcare market can be divided into two – public and private. 

  Looking at these two sectors by expenditure, the public healthcare system spends approximately US$6.9 billion, and private sector spending amounts to US$6.6 billion, making them almost the same. In terms of primary care, in the public sector there are approximately 3,000 clinics nationwide, compared to 8,000 in the private sector. The costs to the patient are very small in public clinics, but are more expensive in the private sector. It could be said that public clinics are working as a safety net for the country. Sixty percent of primary care is conducted in the public sector, with the remaining 40% being dealt with in the private sector. In terms of secondary and tertiary care, which is done largely in hospitals, 77% of care is in the public sector, and only 23% is in the private sector. However, there are considerably more private hospitals (208) than public hospitals (135) providing this secondary and tertiary care. As these figures suggest, the public hospital system in Malaysia is overcrowded and entails significant waits for patients. 

  Another issue seen in the Malaysian healthcare system is the increasing number of cases of non-communicable diseases (NCDs), including cancer. Eight out of 10 causes of death in Malaysia are NCDs, the top being ischemic heart disease. The issue facing Malaysia is how to cope with chronic, long-term disease and how to prevent such NCDs in the first place. 

  Looking at obesity rates, Malaysia ranks as the most obese nation in ASEAN, with 16% of Malaysians being considered obese, contrasted to just 2.1% in Vietnam and 6.1% in Singapore. Obesity causes many diseases later in life, including hyperlipidemia,  diabetes and other chronic conditions. Tackling obesity is therefore another major challenge for Malaysia, as it is also a cause of significant healthcare cost inflation in the country.

Looking at healthcare cost inflation figures, since 2021 the inflation rate has continued to increase, standing at 13.8% in 2023, much higher than the general inflation rate. 

In response to these various challenges, in June 2023 the Ministry of Health of Malaysia issued a health white paper, aiming to reform Malaysia's health system over the next 15 years. The white paper covers a vast number of topics, but basically there are four key pillars (Fig. 1).

Pillar one covers “transforming healthcare service delivery,” and the aim is to shift primary healthcare to be the first point of contact. Another part of this pillar is managing chronic and transitional care at the community level, to alleviate overcrowding at hospitals.

Pillar two covers “advancing health promotion and disease prevention.” The focus is on preventive care, with a move away from sick care toward healthy living. 

Pillar three covers “ensuring sustainable and equitable healthcare financing.” The Malaysian government has pledged to gradually raise public health spending to 5% of GDP. 

Pillar four covers “strengthening the foundation and the governance of the health system.” The aim here is to transition the Ministry of Health to become primarily a regulator and the policymaker. Other parts of the healthcare provision system will be delegated to other autonomous stakeholders. 

The key question for the private sector, therefore, under the action area of pillar four is to identify solutions that can be quickly started in the private sector. One of these is managed care solutions for corporate workers and their dependents.

(3) Introduction to the managed care concept

The concept of managed care was created in the U.S. It is basically a healthcare delivery system organized to manage cost, utilization and quality. This approach is primarily seen in health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Key characteristics include: 1) provider networks, 2) emphasis on prevention, 3) gatekeeping, 4) cost control, 5) quality oversight, and 6) restrictions on coverage.  Overall, the goal of management care is to provide quality care in a cost effective manner, but it can sometimes result in tension between cost savings and the provision of comprehensive care.

Approximately 30 years ago, this concept was imported to Malaysia and several managed care companies were born. Sumitomo acquired one of those companies in order to enter the managed care sector in Malaysia in 2019. Today, PMCare, a subsidiary of Sumitomo Corporation is active in this field. 

The managed care ecosystem in Malaysia comprises providers and payers. Providers means people or organizations providing medical care. Payers may not necessarily be the patient themselves, it could be the government or another organization. Corporations and insurance companies can also be payers in the corporate workplace. Many companies provide medical benefits to their employees to support their lives. In order to attract the best employees the trend is for companies to increase medical benefits for employees. The majority of companies today have some form of medical coverage for employees and their families, including reimbursement of medical fees. The increase in coverage and claims has resulted in a demand for third parties to support the companies in providing services to employees. This is where managed care comes in, to support companies in managing healthcare systems and costs.

In the case of Sumitomo Corporation, three managed care organizations (MCO), including PMCare, act as a bridge between payer and provider. The companies provide access to providers for cashless treatment, offer wellness programs, providing population health analytics, and promoting digital health. These services result in the collection of a great deal of data (Fig. 2) Data collected includes diagnosis data, cost data, and laboratory information.

Users (company employees) of the system use the system on a cashless basis and then send in a claim to PMCare, which then pays the medical bill to the provider. The interesting and useful point about managed care is that we know who is visiting which providers, and what medication is being given for what cost. This data is very useful for managing payer-side costs going forward. 

Sumitomo’s main data set is claims data, and efforts are being made to gradually expand data coverage to health and medical data, including blood test results, digital wellness data, and electronic medical records (EMR). Based on the claims data set, Sumitomo is able to analyze various aspects of healthcare spending of a particular organization, such as the condition/disease on which most money is spent for treatment, etc. With this information it is possible to devise intervention or prevention programs, with a view to lowering medical costs in the future. 

  Population health analytics based on data help to categorize employees as high risk, growing risk or low risk. Possible solutions include chronic disease management programs and patient navigation to appropriate doctors for high risk patients, and health improvement programs for the growing risk group. Sumitomo holds a large number of health awareness events and webinars from this preventive aspect of healthcare. 

  Sumitomo also provides health screening to employees of client companies, and analysis reports are provided for the individual employees themselves. In addition, cross-organizational analysis is also provided to help employers see the overall status of their workforce. 

  Sumitomo, through PMCare, is also conducting a cancer screening program in collaboration with the Asia Cancer Forum (ACF) and National Cancer Society Malaysia (NCSM), which is being implemented at workplaces in Malaysia. 

  Digital health is another important tool to provide care to patients, including teleconsultation or ePharmacy. Sumitomo has developed a mobile app which can take care of administrative, digital health and self-care/preventive care functions. This app is therefore a one-stop portal for employees to manage their own individualized health management program.

  KAMICare is an employee assistance program powered and secured by PMCare, which aims to provide comprehensive care for client organizations. KAMICare has data on the NCD burden in Malaysia, and the figures extrapolated from KAMICare data are generally more severe than the data published by the Malaysian government. It is these data that provide the basis for the KAMICare program, which is comprised of the following elements: health assessment, fitness and nutrition, digital health coaching, KAMICare Community, and rewards.  

  In terms of the health assessment element, based on blood testing results Sumitomo provides all the personalized results, including lifestyle management recommendations. The individual reports are AI generated. For fitness and nutrition and digital health, these elements are implemented online, including mental health assessment, fitness and nutrition advice, and digital wellbeing. 

  Physical activity is very important for health and in Malaysia the KAMICare STEP CHALLENGE has proved to be very popular. It is important to incentivize people to change their lifestyles and behaviors. The first such incentive is monetary incentive, and a second one is peer pressure, which is why KAMICare STEP CHALLENGE is proving to be so popular, as people become competitive in terms of their activities in the step challenge. 

There is also a KAMICare FITNESS CHALLENGE in place too, which measures muscle and body fat and functions on the same principle as the Step Challenge, based on the assumption that people will become competitive with each other to improve their personal statistics. 

In terms of medical and the nutritional support, in-house doctors and nutritionists at PMCare provide medical support online or via live chat. 

For engagement and education KAMICare Hub provides a variety of webinars, health libraries and virtual fitness programs to complement the activities of people on the KAMICare program. The stages of the KAMICare program in the workplace are implemented over a six-month period (Fig. 3) to guide employees toward better health and wellness outcomes.

The activities of Sumitomo in Malaysia through PMCare and its various programs have demonstrated the potential for government-private sector collaboration. One concept is for government private sector collaboration to establish accredited “Health Workplace” designations that may help to accelerate the shift from sick-care to more holistic well-being of people in Malaysia. 

One possibility could be to export the concept of “KENKO Investment for Health” which has been developed by the Japanese government. This concept could then be applied locally in Malaysia by the Malaysian government, which could be accredited as a program, and private sector companies then accredited as official proponents of this program. The designation of “healthy workplace” companies could help to differentiate companies seeking to attract talented people. As a managed care company, PMCare is well-placed to support those companies who want to make their workplace healthier.

(4) Assignment to students

Mr. Isobe gave students the following assignment: 

The Ministry of Economy, Trade and Industry (METI) of Japan has been promoting a program called KENKO Investment for Health, which is basically to make workplaces healthy and to gain more productivity and optimize costs.

Students were asked to: 

1) summarize the key features, goals, and the implementation strategies of the KENKO investment for Health program.
2) Analyze and discuss how this concept could be applied or adapted to companies or organizations in other countries.

(5) Discussion

Dr. Kawahara noted that it must be very difficult to establish a system for collecting medical data, covering the multi-ethnic population of Malaysia. She asked what were the hardest challenges to overcome. 

Mr. Isobe responded that there are many challenges in creating such a system, but one of the greatest challenges from a workplace perspective is to convince employers of the importance of investing in health. In Japan it is mandatory for employees to take a health checkup every year, and it is taken for granted that people can have access to screening. However, in Malaysia, there is no mandatory implementation for annual health screening. The recognition of health screening or preventive care is not as high as compared with Japan. The most challenging aspect for PMCare, therefore, is to convince company HR divisions to make an investment in preventive care.

Dr. Kawahara noted that the healthcare field is highly sensitive in terms of patient confidentiality. She asked how PMCare works to build consensus across different Asian countries and gain consent for data use. 

Mr. Isobe responded that laws and regulations pertaining to data differ from country to country, but most countries have private data protection legislation in place, and it is imperative to comply with such legislation and receive appropriate consent from patients. When making analysis of data on a global basis all the data will be anonymized and generalized. It is also important to protect the human rights and ethical aspects of data, and endeavor to eliminate discrimination too, such as discrimination against people who receive a cancer diagnosis, from both their colleagues and possibly from their HR department. It is essential to provide appropriate education to all persons concerned. 

Dr. Kawahara noted that human mindsets are changing and that the concept of self-care is likely to become increasingly important in Asia. She asked if Sumitomo perceives any regional trends—such as challenges in self-management or the growing role of digital technologies—that are influencing this movement toward self-care. 

Mr. Isobe responded that there is definitely a trend toward self-care. In more developed countries people have more access to health information and the time and access to regular exercise and health food options. On the other hand there are countries in Asia where the concept of self-care has yet to develop fully. As a private sector company it is important to be flexible and start from education in the lesser developed countries in Asia, including such screening as BMI measurement, etc., and in so doing introduce the concept of self-care gradually. 

A student noted that healthcare of employees actually requires the outlay of certain costs, and asked how companies can protect employee healthcare while also pursuing their profits? 

Mr. Isobe noted that in Malaysia companies are paying their employees’ medical costs, whereas in Japan, the government bears 70% of medical costs. Making a good balance between profit and employee health is a very important trade off that companies have to solve. PMCare is promoting the concept that preventive care makes a good return on investment, moving from sick care to preventive care as a more cost-effective option. 

Dr. Kawahara noted that Mr. Isobe has a great deal of non-healthcare businesses in the course of his work at Sumitomo. She asked how those diverse experiences have shaped the healthcare work he engages in today. 

Mr. Isobe responded that he worked in the fashion business previously, and it is the case that the management of the 170 clinics all over Malaysia is in some respects quite similar to retail chain management experience, with a headquarters defining the policies and KPIs, which are then implemented by the clinics. 

Dr. Kawahara asked about the unique value that citizen-sector partners such as ACF and NCSM bring to corporate projects like those of PMCare.

Mr. Isobe responded that NPOs have different agendas to private sector companies and are not required to seek to make profits, therefore they are well positioned to focus on initiatives such as preventive care, where the visualization of ROI may be difficult. NPOs can also use their organizations and networks to obtain data for the public good and academic analysis, using the knowledge gained to make further value propositions and implement preventive care or wellness services.

Dr. Kawahara reminded students that their final assignment will be to write a policy brief for the international conference to be held in Malaysia in September using what they have learned in this lecture series to propose concrete ways to enhance wellbeing across Asia. 

She noted that the assignment from Mr. Isobe would be very useful in concentrating students’ thought towards the compilation of their final assignment. 

Dr. Kawahara asked Mr. Isobe, as someone who is working to expand Japanese healthcare throughout Asia, what he thinks is the single most important consideration when designing a solution for other countries. 

Mr. Isobe noted that Asia is an incredibly diverse region, and healthcare is very localized. It is therefore imperative to understand the local context. Healthcare is also very complex. It is important to be patient and you need to have continuous passion to solve the various complexities involved. Local understanding, local respect, passion and perseverance are the most important elements to make an impact in the Asian healthcare sector.