Medical Travel. The GROWTH of. Global Healthcare Opportunities Available to Employers and Benefits Brokers: by David Boucher

Transcription

1 Global Healthcare Opportunities Available to Employers and Benefits Brokers: The GROWTH of Medical Travel as an Employee Benefit by David Boucher 28 March 2014 The Self-Insurer Self-Insurers Publishing Corp. All rights reserved.

2 I n an article published in 2012 in The Self-Insurer, it was reported that most Americans who will seek surgical destinations in overseas locations will do so for improved safety, top notch service, and significant financial savings opportunities (in that order), while most Canadians might travel for care internationally to avoid queues. For years, patients in developed countries have travelled to regional, national, and international locations for specialty services, such as transplants and cancer treatments. Now, with the significant milestone of the individual mandate of the Patient Protection and Affordability Act (PPACA) in the rear view mirror, there is increasing likelihood and evidence that medical travel, both domestic and international will continue to be adopted by self-insured employers as a benefit option. This emerging, potentially disruptive, innovation of Americans visiting their local airports rather than their local hospitals for major surgical procedures continues to gain momentum. Put aside the overzealous hype spewed at some medical tourism conferences that want us to believe tens of millions of Americans are already travelling each year for care. The fact is that an increasing number of employers are adopting medical travel options in their benefit plans. Increasing demand for healthcare will continue. As The Economist Intelligence Unit recently reported, Global healthcare spending should pick up in 2014, not just because of the U.S. reforms, but also thanks to access to better healthcare in developing markets... This growth will be driven partly by rising population, increasing life expectancy, and expanding wealth... Several countries are also trying to step up investment in healthcare provision, not just for locals but to attract medical tourism. The same Economist report also noted that 61% of respondents in their recent survey believed that, International health tourism will become a major source of competition between providers. Further, 78.1% of respondents in the same survey believed that, Developing / emerging market firms will see their share of global health and pharma markets rise substantially [emphasis added]. 1 Employers might want to consider that the most expensive medical care does not necessarily mean the best quality. Transparency is improving, but unfortunately many employees currently have limited knowledge of outcomes data at hospitals. They tend to trust wherever their surgeon has admitting privileges. To its credit, the Centers for Medicare and Medicaid posts information on US hospitals on its Hospital Compare site; however the data is limited and may not provide an accurate picture. As Dr. John James wrote in the September, 2013 issue of the Journal of Patient Safety it now appears more deaths are due to preventable harm than was previous estimated. James cited approximately 440,000 deaths due to preventable adverse events from care in hospitals which adds up to roughly onesixth of all deaths that occur in the United States each year. An October 31, 2013 HealthLeaders article by Cheryl Clark noted this was more than four times the amount estimated by the 1999 Institute of Medicine s report, To Err Is Human.2 As expensive as US healthcare is, many rational Americans might expect better. So, the table is set. That is, with 30 million insureds added as a result of PPACA, already overworked medical providers are even more burdened. Now, many overseas countries are, Programmed to Receive. From a quality and credentialing perspective, there are now almost 400 hospitals outside of the United States accredited by the international arm of the Joint Commission. Governments in Self-Insurers Publishing Corp. All rights reserved. nations such as Malaysia, Turkey, South Korea, and Thailand are expending resources to make sure that more potential travelers know they are open for business. It is not uncommon for these nations ministries of health and / or tourism to recognize the job creation potential in luring medical travelers from developing and developed countries. There is also a spike in wellness travel due to the emergence of premier wellness services that prevent and heal. Part of this increasing demand is due to the aging populations of a number of developed countries which have both opportunity (time) and resources (available funds). Some employers are including spa and other wellness services in their valueadded benefit package. It was also speculated and wellreported by the popular media way, waaaay back in 2007 that American employers would increasingly turn to medical travel as a way to help them mitigate their benefit cost curve. Many of these employers first attempted Preferred Provider Organizations (PPO) discounts, disease management programs, then wellness programs only to see their employee medical expenses increase 10-15% year over year over year. Over the past couple of years, several large marquis employers like Lowes, Wal-Mart and PepsiCo began directing their employees and dependents to a limited number of domestic hospitals. Whether their intention was to do so or not is left to be determined, but these developments signal that maybe, just maybe, the safest and most affordable surgical care might just be via an employee s local airport rather than at their local hospital! The aforementioned are not small mom and pop companies: The The Self-Insurer March

3 three corporations noted above are representative by over 1.5 million members. And an increasing number of American employers feel comfortable about having their employees consider overseas hospitals as well. For a specifi c demonstration of this trend, direct your attention to a Facebook page entitled, Kevin s New Knee. This single traveler s testimonial/ blog illustrate why he decided to travel abroad for surgery. His employer s benefi t plan waived his > $4,000 personal health plan out-of-pocket fi nancial responsibility, so he was all-ears when it came to considering leaving the United States for a total knee replacement. Kevin took his time spending several months and considering many options before he selected Ramsay Ara Damansara / Sime Darby Medical Center in Kuala Lumpur, Malaysia for his care in October, A medical travel facilitator was engaged to coordinate all of his medical travel plans... and off he went. He saved his > $4,000 personal out-of-pocket expense, his self-insured employer saved at least $10,000 on the procedure, and he s back to biking long distances only months after his surgery. Kevin s New Knee chronicles the rest... on Facebook! There are a lot of examples like Kevin s. The process of Americans travelling abroad for surgery with their employer s assistance is, in fact, happening... and it will occur with increasing frequency if patient wait times elongate in the U.S., local supplies of medical services struggle to keep up, and expenses mount. Travel abroad (or to a distant American city) is not for every employer, nor every employee. To meet this domestic demand, many medical travel facilitators began offering domestic surgical options as well. The compass, of course, goes in all directions! The opportunities for benefi ts brokers and human resource professionals in this market abound, but some level of due-diligence is required as the self-insured employer considers a medical travel benefi t. There are few barriers to entry for medical travel facilitators. Some prospective facilitators see an exciting opportunity to travel the world, while they may have limited knowledge in the provision of medical services and are neither licensed nor experienced travel agents. Many facilitators do not visit their network hospitals and can offer limited response when glitches arise. In an effort to offer employers members a quality door-to-door experience, employers should really consider a facilitator which handles the vetting of international hospitals and conducts on-site visits. For ethical and other reasons, employers and brokers should only consider facilitators which do not accept marketing/referral fees from their providers. The facilitator will then works directly with the consumer to assist in their destination selection and this is where there is some level of heavylifting involved; it can take as many as twenty (20) communications with the traveler before they reach the decision point to actually book plane tickets. Most prospective medical travelers have questions that need answers. Some facilitators try to handle their customers travel itineraries; others utilize experienced travel agencies like Well-Being Travel, a trusted and time-tested premier travel vendor. Air travel is indicated most of the time and well over 90% of travelers have a companion accompany them. Hotel bookings are involved in 100% of cases as almost all discharged patients remain in the in-country destination for at least a full week for rehabilitation purposes. But employers fear not! This only minimally delays an employee s return to work. Remember that even when your employees have a hip replaced locally, they rarely return to work the same day. And it is very common for travelers to seek day excursions; most medical tourism facilitators recommend that patients considering such excursions before their care, however their companions might consider at least half-day outings once most patients are a couple of 30 March 2014 The Self-Insurer Self-Insurers Publishing Corp. All rights reserved.

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6 Waive out-ofpocket costs for select procedures at select hospitals Wave out-of-pocket costs, PLUS cover travel costs for patient and companion Waive out-of-pocket costs, cover travel costs, PLUS cover the cost of an individual medical travel policy (e.g. $200,000 coverage) Wave out-of-pocket costs, cover travel costs for patient and companion, cover an individual medical travel policy, PLUS share savings with beneficiaries (e.g. share up to $500 in Savings with the employee) Conservative Aggressive days post-surgical. Normally by the time the employee returns to the US, he or she often will have much of the rehabilitation completed. When additional physical therapy is recommended, this can easily be completed after the employee returns. Employers and brokers may be wondering how to structure this benefit option. As discussed in the example of Kevin above, it makes sense to offer an incentive for employees to consider traveling to certain hospitals. Above are several considerations beginning with the most conservative moving to more aggressive from left to right. It s no secret that employers are struggling to control costs. Many companies working diligently to maximize bottom line results and provide a productive workforce, so offering options for several episodic, medically necessary procedures makes sense. Medical travel offers one of the very few opportunities for employers to effectively expand coverage while reducing costs, not to mention the opportunity to possibly improve quality and experience. As we are into the well-discussed Experience Economy many JCI-accredited hospitals offer additional value well-beyond the excellent care provided via the core surgical service which includes outstanding patient rooms, food, and all of the amenities. Employees and their companions can have unique travel opportunities and return with improved health and wellness. A number of patients that facilitators have assisted had never previously traveled abroad or had only limited experience traveling. Medical travel provides that additional value and can improve satisfaction among employees with their employer, potentially even reducing turnover and Your Bottom Line is our bottom line Self-Insurers Publishing Corp. All rights reserved. The Self-Insurer March

7 attracting quality employees. With all of the talk about Value-based Benefit Design realizing real value may be as simple as finding the right terminal and gate! Finally, for stakeholders who inquire about who and how to sue when something might not go according to plan with the member s surgery, there is at least one solution. Individual medical travel insurance is available such as that offered by Global Protective Solutions. In the unlikely event of something going wrong, regardless of fault at medical traveler can be made whole. So 2014 offers exciting times for employers and benefits brokers in the medical travel arena. Happy contrails!! The sky s the limit! n Since October, 2012, David Boucher has served as President and Chief Operating Officer of UCI Medical Affiliates, Inc. UCI Medical provides management services to 53 urgent care and employer on-site centers under the Doctors Care brand and 21 Progressive Physical Therapy rehabilitation centers in South Carolina and Tennessee, as well as the Doctors Wellness Center in Columbia, SC. Beginning in 2008, David Boucher served as President and Chief Operating Officer of Companion Global Healthcare, Inc. Over the past 7 years, David has been able to examine firsthand the best practices in hospital care in over 25 countries. Over the past few years, David has been quoted in over 250 national publications including US News & World Reports, Business Week, Fast Company, The New York Times, Wall Street Journal, The Economist (x3), Good Housekeeping plus NBC Nightly News and Fox Business News. David has made presentations on medical travel to a number of audiences including Harvard Medical School, Harvard Business School, Yale University, AARP and AHIP. References Scary-Things-About-Healthcare-Quality Assistance for Stop Loss Coverage At BenefitMall, we know that some employer groups benefit most from treating their medical plan as an investment rather than an expense. Our self funded team of experts represents numerous direct writers of medical stop-loss. We can help you succeed by offering: Marketing Billing & Premium Collection Licensing, Commission & Bonus Programs Claims Expedition Compliance Services (888) BenefitMall. All rights reserved. BenefitMall, the BenefitMall Logo, the BenefitMall ALL TOGETHER, BETTER Logo, the ALL Logo, ALL TOGETHER, BETTER, CompuPay and Self Funded Products and Services are trademarks or registered trademarks of Centerstone Insurance and Financial Services, Inc. d/b/a BenefitMall or its affiliates in the U.S. California License # *All other trademarks are the property of their respective owners. 34 March 2014 The Self-Insurer Self-Insurers Publishing Corp. All rights reserved.

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