Tag Archives: continuity of care

Global Healthcare Is Not Just About The Cost

3 Million people spent $76B on care away from home in 2010.
A recent Frost and Sullivan research report on the medical travel business predicts that medical tourism will come a $100 B business by the end of 2012 and that hot spots to watch will be: the Middle East, Asia and Germany.
While most believe that cost is the main driver this is not true across the board. A McKinsey and Company 2008 report emphasizes that 40 per cent of medical travelers seek advanced technology, 32 per cent seek better healthcare, 15 per cent seek faster medical services and only 9 percent of travelers seek lower costs as their primary consideration. Click to view the full report.

As reimbursements for Medicaid and Medicare continue to decrease and increasing numbers of US doctors indicate they will cut back seeing patients insured by these government insurance plans, or stop seeing them altogether. This will fuel access, rather than cost, to the forefront of medical travel.
Inbound tourism is the flip side of the same coin – as US healthcare continues to get more expensive and more difficult to access, hospitals are looking for ways to fill the beds. Foreign patients are attractive market and also pay in cash.
As I””ve pointed out before, these market eruptions present entrepreneurs with big opportunities. Healthcare reform might change the rules, but I don””t think significantly, given the big picture patient demographic and manpower supply and demand challenges.
Global referral communications, coordination and care is a growth industry begging for talent and $100B is likely to get a lot of attention. It certainly got mine.

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The New Normal in Global Healthcare Referrals

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The model for global healthcare referrals has changed. In the old model, patients went to their doctor who referred them to another doctor or surgeon for care. These days, patients find their own surgeon and request a “reverse referral” asking the consultant to get the necessary information from a primary care doctor at home to assure continuity of care. Using transfer of electronic medical records, health information exchanges and telemedicine, patients now drive the process with increasing disintermediation of healthcare professionals.

BOTTOM LINE: The globalized, interconnected healthcare infrastructure is putting more power in the hands of patients to make choices about the value of care they receive.

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Five things will need to happen before medical travel gets real

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Despite the research reports, eco-devo white papers, industry analyses and industry marketing hype, medical travel/medical tourism is still an early stage industry looking for the right formula for success.

In my view, five things will need to happen before medical tourism and global healthcare referrals get real traction: 1) the creation of a sustainable business model, 2)global healthcare IT connectivity and integration, 3) a physician generated global healthcare referral network, 4) a global regulatory, legal and socioeconomic ecosystem, and 5) patient awareness and acceptance.

The creation of a sustainable business model
Industry players including payors, providers, partners and facilitators are still looking for the the most successful way to make a profit and scale the business. With an eye towards what happened when Expedia disrupted the travel agency business, participants understand that margins for travel arrangement services are thin and that there is high price elasticity for global medical care. Few have found the magic key that fits the lock that opens the doors to profits. Payors and employers are hesitant to accept the value proposition without a better way to reduce their risk and demonstrate tangible, meaningful cost savings to their insureds and employees.

Global healthcare IT connectivity and integration

The US national healthcare information architecture is evolving. Eventually, the network will be a portal to the world and will allow for seemless, secure, confidential transfer of personal health information thus assuring some continuity of care and quality improvement. Similarly, it will take a while for health information systems to evolve in host countries that can talk to non-host systems. Short term solutions, like personal health records or mobile health applications, might fill the void temporarily.

A physician generated global healthcare referral network

Most medical tourism models connect patients to healthcare facilities, bypassing doctors in the initial stages. Doctors will get in the game when the model feels better, and they have the resources and ability to make referrals to consultants directly, like they do now. Since MedVoy was founded by an American doctor, MedVoy connects patients directly to doctors which is unlike other facilitators. Given the rise of international members, professional medical societies should be more proactive in building global referral networks, rather than seeing them as threats to existing domestic members.

A global regulatory, legal and socioeconomic ecosystem

The barriers to adoption and penetration of medical travel are many and include liability, reimbursement, quality assurance and impediments to continuity of care. As healthcare goes global, so will the rules and regulations that facilitate or obstruct its use. How about a World Trade Organization Treaty on Medical Travel?

Patient awareness and acceptance

According to the most recent polls, 50% of consumers understand the meaning of the term “medical tourism”, leaving home for care. Social network buzz and media stories find the medical travel story sexy, particularly given all the noise about escalating healthcare costs and consumers, employers and payors are hungry for more information. Moving patients from awareness to intention to decision to action, however, will take more time and use innovative marketing approaches directed towards granular market segments.

Global medical travel is projected to be a $1B industry by 2012. While the bones are in place, it will take more time to add the flesh. Until then, to quote Karl Mauldin, people won’t leave home without it.

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MedVoy launches the Jumpstart Program

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MedVoy now offers the Jumpstart Program to quickly and easily launch our partners into the realm of medical tourism. Combining the three most necessary components – MedVoy Showcase Center, MedVoy Lead Services, and MedVoy Portal Access Services – raises visibility, channels leads and facilitates communication.

This program is designed to help consumers find the best medical travel for their needs by having the information in one-stop location. Through experience, we know providing information and enabling communication helps to mitigate against uncertainty, aids with continuity of care and improves the overall customer experience. This program is open to all types of providers in global healthcare. .

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Three Things to Know about your Doctor

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A recent Deloitte report on medical tourism predicted that outbound medical travel from the US could reach upwards of 1.6 million patients by 2012, with sustainable annual growth of 35 percent. If you are one of the many potential patients seeking high quality, affordable care outside of the US, you should know three things about your provider before boarding the plane: who they are, how and where they practice, and what are their results and outcomes.
The first question, who they are, probes the provider’s education, qualifications, experience and reputation. Most of this information is usually accessible on the doctor’s website and can be verified on accreditation organization websites or professional association resources. Check to see whether the practitioner is board certified by a reputable US or foreign specialty board and if they are a member of the national specialty society or association.

Secondly, ask how and where they practice. For example, plastic surgeons and dentists are likely to practice and operate in private clinics or ambulatory surgery facilities removed from a hospital setting. Some may even own the clinic and they should divulge that information to you. If something goes wrong during a procedure, make sure you understand how and where you would get emergency care, how you would be transported there, and who would pay for it. In addition, unlike more and more hospital facilities that are being accredited by the Joint Commission International, (click for a list of accredited hospitals) the organization responsible for making sure hospitals adhere to acceptable practices and procedures, independent, free-standing facilities frequently are not similarly examined or accredited.

Finally, and perhaps the most difficult information to find, is the outcome and results of a given procedure. Ask ” How many of these operations do you do in a week, a month or a year ?” Also, inquire about the number of cases that result in complications, the need for revision surgery or significant morbidity i.e. something that unexpectedly doesn’t work the way it should after surgery, or postoperative death. Most doctors, including those in the US, will be unable to give you an accurate answer because they don’t keep good records or have an unreliable system to keep track of results. Sometimes the best you can do is to talk to someone who has had a similar procedure.

Getting information about a doctor and his or her results in not easy, wherever they practice. The more information you know, however, the better you can determine whether surgery away from home makes sense.

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Connecting to your Doctor through your Terminal

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In our recent blog, (What’s Hot), one of our emergent trends was telemedicine. Innovations have made the world flatter and have helped with continuity of care, which is absolutely essential in global healthcare. By providing global information and communication technology networks, patients can now get a preoperative consultation and postoperative tele-care wherever and whenever they need it. While not always appropriate, in several instances, like cosmetic surgery/plastic surgery or procedures that involve mostly postoperative wound care, telemedicine image and data devices can be utilized to monitor wounds and healing while maintaining contact with the patients – regardless of location.

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The Next Wave of Global Healthcare

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The business and practice of global care is evolving. Originally called medical tourism because patients sought mostly cosmetic surgery while vacationing, the practice of seeking care away from home is now being driven by high costs, limited access, long waiting times and the availability of certain technologies not approved at home. It is morphing into a sophisticated global healthcare network facilitated by information and communications technologies and is suitable for a very small population of those who need short procedures with little postoperative risk, low followup requirements and high cost. Unfortunately, the legal, professional and business aspects of global care have lagged and continue to vex the industry.

At this point, entrepreneurs are sharpening their pencils and looking for a business model that generates cash. Facilitating care with providers is labor intensive, low margin and plagued by the aforementioned issues. Those looking to make a profit are eyeing the travel parts, insurance products and other support offerings as way to play the game. After all, more money was made servicing those traveling the Sante Fe trail, that those who actually struck it rich from mining.

As patients, providers and payors seek global solutions to high costs, the global care networks will evolve and barriers will be eliminated. It will happen faster if everyone works together to provide a business model that provides value to everyone.

Arlen D Meyers, MD, MBA

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Healthcare Open Enrollment Period

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It’s that time of year again… open enrollment for your health benefit plans. Most Americans are frustrated because their healthcare care bill is increasing… yet again… and this is exacerbated by the global recession and the confusion surrounding healthcare reform. Colorado is projected to see a healthcare increase of 14.4% in 2010 – slightly higher than other states due to the large number of small businesses in the state.

Large employers with 100 or more employees will often receive utilization and cost data and are in a much better position to manage their health care cost through aggressive plan management strategies and tactics. Small employers (and individuals) generally do not receive utilization and cost data plus often rely on the pooling of risk since they have a higher probability of costing the system more than the dollars they contribute through premium payments – since “everybody pays for a few”.

The misperception in healthcare is that cost and pricing for the same clinical procedure is relatively the same from provider to provider yet clinical costs vary significantly from zip code to zip code, state to state, and country to country.

Domestic and international medical tourism introduces transparency and helps to lower healthcare cost. There are scores of articles on lowering your out-of-pocket healthcare cost in 2011 that may help marginally. However, MedVoy is in a position to help individuals, employers and employees save real money on healthcare – contact us for details.

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Medical Tourism Terms

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For the average patient seeking care, there is a confusing array of terms describing who participates in the healthcare referral process. Here are some terms and what they mean.

Medical tourism: Seeking care away from home, either in the same country (like across several state borders in the US and sometimes called domestic) , outside the home country (leaving the US to go to Mexico) or to a home country (coming from the Caribbean to get care in Florida). Many industry participants are trying to get away from the term “medical tourism” since it tends to minimize the serious medical issues and risks associated with getting care away from your home location or region. Evolving terms are global or international healthcare referrals or sourcing, global care or transnational care referral. Also, how does traveling a few miles from your home, even if it means crossing a state border or a country border (Canada or Mexico) for care differ from domestic medical tourism? This lack of specificity contributes to the confusion about how many people actually seek care in different regions and that leads to inflated numbers of “medical tourists”

Facilitators: Facilitators are those individuals or companies that help patients identify providers and make travel or care arrangements for a fee. They do not actually provide care. Facilitators can be country specific, regional or global and sometimes promote themselves as exclusive (the only company that represents care providers in a given country to inbound potential patients) or non-exclusive (multiple people or companies that can source providers in a given country).

Transnational providers: These are, usually, large domestic providers with brand recognition, like the Cleveland Clinic , Johns Hopkins and Harvard, that have affiliation arrangements with hospitals outside of the US, for example, Panama,Dubai or Abu Dhabi.

BOTTOM LINE: If you decide to seek care away from home, do your homework and understand the role of the different members of the chain of care.

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Medical tourism redefines continuity of care

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Continuity of care traditionally means a physician follows a patient throughout the course of their epidode of illness. For example, when someone presents to a surgeon for a possible operation, the surgeon does a preoperative evaluation, performs the procedure if necessary, and the sees the patient in follow up to be sure there are no complications or requirements for further care. Medical tourism is forcing a change in the paradigm.

First, patients no longer expect their doctors to do the surgery when they are looking for another treatment option away from home. The new model proposes that the home doctor assist the patient with finding the best place for care at the most reasonable cost and assist with preoperative assessment, records transfer or communcation with the operating surgeon. Likewise, after surgery, the patient will expect their doctor to help with any postoperative complications or needs for further treatment.

Second, continuity of care may be an obsolete model that needs to be replaced with connectedness of care. The one-on-one face-to-face doctor appointment is an unsustainable business model given the changes in healthcare financing and systems. Medical tourism events will be just one of many possible points of care that need to be integrated into a patient health record or healthcare information exchange. The impact will be a need to reassess how we train doctors, how we define the doctor-patient relationship and its responsibilities, and how we reimburse providers for patient encounters using other than face-to-face appointments and visits.

Medical tourism will continue to challenge our traditional notion of how we deliver and pay for care. Some will ignore the changes and fade away, others will adapt and thrive.

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