Tag Archives: telemedicine

How to make money investing in the medical travel industry

By now, you’ve heard all the hype about the potential growth of the medical travel industry and how US patients are fleeing the country to get affordable care. Unfortunately, the experts agree, that there are few reliable statistics about the size and growth of the market, there are no common definitions of a medical traveler, comparisons of revenues and costs are hard to make, and there remain persistent, nagging barriers to widespread adoption by patients, payers and physicians.

That said, investors are still clinging to the promise of big returns fueled by patients losing their health benefits because of high unemployment, the aging population requiring more units of care and exploding costs of healthcare. If you think the medical travel industry is set to explode, there are some areas of investment to consider:

Foreign Healthcare infrastructure

Hospitals and systems
Ambulatory surgery centers
Clinical labs and imaging centers
Disease specific treatment facilities like cancer centers, stem cell centers, etc

Foreign Travel and hospitality infrastructure

Hotels and Surgical Hotels
Spas
Airport development

Tools and support companies

Players in global healthcare information exchange
Data analytics and business intelligence
Quality, price and value determinations
Companies offering alternative pricing mechanisms

Supporting global healthcare insurance and travel products

Trip cancellation
Follow up care
Emergency evacuation
Professional liability
Infectious disease management
Geopolitical risk insurance

Firms in the medical travel supply chain

Travel medicine clinics
Medical travel facilitators and specialty travel agents
Medical concierge ground operators
Currency exchange risk managers

Expatriate retirement health cities and communities

Like other industry sectors, gold, for example, you can invest in the product itself, the people who create the product, or investments that pools risks, like mutual funds or exchange traded funds.

Look for companies in markets where the supply of care does not meet the demands of a growing middle class, that provide products and services delivering low, cost high volume care, and that provide platforms and infrastructure designed to reduce transaction costs for billing and collecting and value-based information.

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Medical Tourism Evolution

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Medical tourism used to be tiny and only for the wealthy. Now it’s ‘Medical Travel’ and it’s growing, fast.

Leaving home for care is nothing new. People have been traveling around the world for treatment since the beginning of time. Now we call it medical tourism, and it is growing quickly.

Patients seek care away from home because it is cheaper, unavailable in their home location, can be accessed without waiting for a long time, can be combined with a travel experience and can be kept secret. Despite the talk of healthcare reform, patients and employers are paying more for care with no forseeable decreases and they are looking for safe, affordable alternatives to care in the US.

There are several serious barriers to adoption and penetration of the notion of leaving home for care. In fact, we’re not even sure what to call it these days. “Medical tourism” has morphed into global healthcare referral or medical travel, underlying the fact that we are talking about healthcare in a different place, not sipping Margueritas by the pool. The growth of the industry is being fueled by mostly medical outsiders who see the commercial potential of opportunities that have resulted from medical cost inflation, globalization and cheap information and communications technologies.

There are lots of opportunties for physicians in the medical travel industry. Substantial challenges to the traditional notions of face-to-face care, continuity of care, itinerant surgery and global healthcare information exchange are but a few of the issues that the medical provider establishment will have to confront as medical travel continues to grow around the world.

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What's hot

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By now you know that the landscape of medical tourism changes on an almost monthly basis. Geopolitical eruptions, natural disasters or the latest headline about US healthcare reform changes the industry on a dime. Here’s what’s hot this week:

1. The person sitting next to you on the plane is your surgeon-off-shore health communities are looking for US- based surgeons to participate in foreign offices to do surgery, and bring their patients, for less cost in the host country. Grumpy doctors in the US are interested.

2. The person you see on your computer is your doctor- information and communications technologies are providing a way to deliver follow up care at minimal cost

3. Click to see your record anywhere in the world- global healthcare information exchanges are growing as more doctors around the world adopt and connect electronic medical records.

BOTTOM LINE: Global healthcare referral coordination is more about moving information than moving people.

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Enrollment in High Deductible Health Plans Increased in 2010

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According to the survey from Benefit Research Institute, the 2010 EBRI/MGA Consumer Engagement in Health Care Survey showed that enrollments in high deductible health plans increased in 2010 – from 13% in 2009 to 14% in 2010.

Large deductibles mean that patient will pay out-of-pocket for many of their medical expensive. As more and more Americans are tightening their belts, they will be looking elsewhere to lower their medical cost. This will raise demand for diagnostic tests (colonoscopies, endoscopies, CT scans, MRI), overall health screenings (Executive Wellness Exams) as well as other procedures, such as orthopedics, ophthalmology and others. Global healthcare can help to fill in the gaps to provide solutions to help families struggling with rising healthcare costs.

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South Korean Hospitals – World Class Physicians and Modern Technology at Great Value

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Arriving at the pristine airport and being efficiently whisked through customs gives visitors the first inkling why medical tourism in South Korea has achieved so much in such a short period of time – receiving over 60,000 patients in 2009, 40 percent of which are from the US. Global healthcare being a key economic driver led to the establishment of The Korean Health Industry Development Institute (KHIDI) to oversee this sector and to support international patients. KHIDI ensures that participating hospitals are registered, medical outcomes are reported and there is even a multilingual medical call center specifically to help foreign patients, if needed.
South Korea does not stray from its reputation as a technological leader with “slip-less hospitals” that are paperless, chartless and filmless, using rather, RFID chips, completely electronic medical records (EMR) and telemedicine. When hospitals commonly utilize the third generation of da Vinci Surgical System, fourth generation of CyberKnife and where 64 slice CT scans are de rigueur, surgeons pride themselves on using a laparoscopic solution first. Even Dr. Kim of St. Mary’s Hospital was a pioneer in this arena and published his initial findings about minimally invasive options for colorectal cancer seven years before this method received the nod from The New England Journal of Medicine.
Significant inroads have been made in living donor organ transplantations for not only the liver, but also kidney, pancreas and bone marrow transplants since it is important in Confucian culture to preserve the body whole. Highly specialized developments have also been made for cancer treatments and outcomes for stomach, liver and cervical cancers are higher than those in the US. Other areas of specialization include spinal treatment, joint/rheumatism treatment, health screenings, dental care, infertility treatments and integrated traditional Korean medicine.

Cancer 5 Year Survival Rates
Site	Korea Percentage (2003-07)	USA Percentage (1999-2005)
Stomach	61.2	25.7
Liver	21.7	13.1
Cervix	80.5	70.6
Colon and rectum	68.7	65.2
Thyroid	98.8	96.9
Breast	89.5	89.1
Lung	16.7	15.6
Pancreas	7.6	5.5

(Source KHIDI/ December 2010)

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Removing the barriers to global care

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While more and more patients are accepting the idea of leaving home to get care, the main questions in their minds have to do with quality, continuity of care, global information exchange, and liability. Enterprising entrepreneurs are rushing in to fill the gaps by providing value added services that address these market needs.

For example, take continuity of care. By providing global information and communcation technology networks, patients can now get a preoperative consultation and postoperative tele-care wherever and whenever they need it. While in some cases this does not meet the standard of care, in several instances, like cosmetic surgery or procedures that involve mostly postoperative wound care, telemedicine image and data devices are perfectly acceptable to monitor wounds and healing.

BOTTOM LINE: Entrepreneurs will rapidly fill markets in global healthcare referrals and care where there is an unmet need.

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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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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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Online care is coming to your neighborhood

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If you have not already noticed, online care is coming to a hospital near you. That means that you will be able to communicate with any doctor or provider in the world using a computer. Hospitals ,doctors , payors and vendors are rushing to get these systems in place because they are convenient , they can be used to improve the quality of care and the quality of service, and because patients are demanding them.

Using global information and telecommunications technologies to perform clinical (e. g. follow up care, second opinions, telemedicine, consultations for medical tourism) and business processes (e.g.billing and collection, making appointments, transferring documents) will eliminate waste and reduce costs of care.

BOTTOM LINE: Healthcare power is continual shifting to the patient. Look for an Office of Online Medicine to come to your hospital soon.

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