Innovation in Healthcare Tourism

Innovation in Healthcare Tourism

Traveling from your home town to another world class medical facility for treatment is growing and mentioned as Medical Travel/Tourism Industry. Innovative ways are being employed to facilitate patient and match his/her needs. World is becoming flat and people are traveling across the globe for better treatment options. But some companies are employing innovative ways to cater those who don't want to go to another or distant country for medical surgery and still want to benefit from reduced cost, expert doctor and world class facility.

Mobile Surgery International(MSI) stands out in this field of providing treatment to any patient, anywhere in the world with patient's preffered US based surgical team, quality of care, reduced cost through Centers of Excellence with Global Convenience. MSI says, patient come to us, we go to the patient, or patient and surgeon meet at a mutually convenient location, we coordinate all necessary arrangements at a cost agreeable to the patient and/or the payer.

Here are the answers to our HOW?

How it works?When any patient contact MSI for surgery, MSI designs a package based on the patient's choice of destination, doctor and affordability. Patient goes to selected destination, also travels surgical team, they meet at that hospital, perfom surgery and come back. The package is currently offered at Florida, Kansas, Mexico, Panama, Trinidad in USA and Russia, China, Africa, and Middle East in Asia.

How do they cut cost?MSI cites few case examples to show when surgeon is in the decision making, you can really cut the cost.

1. There is waste in American hospitals.
An anesthesiologist may refuse to move a stable patient out of an operating room - because the patient's temperature is 35.8 C. The anesthesiologist fears that payment will be denied by a post hoc insurance review if the patient's temperature is not 36.0 C. The temperature difference is clinically irrelevant. The delay it causes wastes money by making the operating room usage inefficient and necessitating salary for a clinically irrelevant insurance clerk. If anesthesiologist, not the insurance clerk, makes the clinical decisions, it will reduce waste.

2. MSI recently visited a small hospital devoted to heart surgery. It has 60 beds and 3 operating rooms. Among its gizmos are high definition video monitors and a voice-controlled surgical robot. Their robot had been unused because a surgeon who had used it left 5 years ago. Nobody on staff knew how to make it work. Within an hour one of MSI surgeons had the robot working. Within two hours he had identified every gizmo needed for prostate surgery. MSI explains that surgical subject expertise can source prostate surgery capacity in a heart surgery hospital.

Mobile Surgery International

The above described surgeon-driven, mobile surgical model depends upon:
1. Excess operating room capacity that can be rented for little.

2. Knowledge of what is necessary and how to source it.

3. Knowledge of what is not necessary and how not to pay for it.

4. Ability to perform surgery really well

5. Mobility.

These are the packages offered by MSI.

1. Orthopedic Surgery - Total Knee Replacement includes Case Management, Logistical coordination, Operating Room, recovery room, 4 night of stay, nursing care, anesthesia and pain management, surgeon, assistant, surgical team, travel and accommodation, local and remote continuity of care, 10 days inpatient and outpatient physical therapy, FDA approved American implant.

2. Cancer Surgery - Laparoscopic Radical Prostatectomy includes Case Management, logistical coordination, operating room, recovery room, 1 night of stay, nursing care, anesthesiologist, pathologist, surgeon, assistant, surgical team, travel and accommodation, local and remote continuity of care.

Mobile Surgery International: A surgeon driven mobile service model cannot be all thing to people. However, for patients, facilitator, payer, employers, government, and the industry this model is a partial remedy to the economic and other barriers that keep patient from getting what they want and deserve: treatment choice and quality.

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Costa Rica a successful medical tourism destination

Why Costa Rica is successful bringing international patients?

Dr. Jorge Cortés is CMO in Hospital Clínica Bíblica, the largest and most prestigious private hospital in Costa Rica. Dr. Cortés has focused his work on hospital quality and patient safety, which has translated in Hospital Clínica Bíblica becoming the first organization in Central American to receive an accreditation by the Joint Commission International.

Mr Naresh Jadeja discussed with Dr. Jorge Cortés, Why Costa Rica has successfully evolved as a medical tourism destination?

Mr. Naresh Jadeja : How do you see the opportunities in medical tourism industry? What potentials does it hold? What promising benefits do you foresee in it?

Dr. Cortez : Absolutely remarkable, I think it's a growing industry and to continue with we must clarify some untouched issues particularly the legal aspect. But along with it we must also have this in our mind that the medical services available globally are almost same if not better then developed countries. That is because treatment is related to technology and technology is related to knowledge, which is universal and that means technological advancements are also universal. This leads to expectation of having the same quality outcomes in any place. It means that the matter to be addressed here are cost management and qualitative medical services.

Mr. Naresh : What extra advantage does Costa Rica has over other countries?

Dr Cortez : Well, proximity is obviously the first one, as Costa Rica is geographically the closest medical travel destination to one of the major market of industry that is United States. Secondly Costa Rica has a reputed history about its quality medical services since seventy long years. Costa Rica has very well established social security system, as is the most ancient democracy in Latin America.The country does not posses army and is a peace full place to be.

Mr. Naresh Jadeja : What issues does Costa Rica as a medical travel destination face in attracting more patients?

Dr Cortez : The very first thing to overcome is to let insurers believe that the quality of surgery is same as they experience back home in United States above being low cost. Also, it is hard to achieve confidence of the people. I mean this is a new industry and people are still experiencing this carefully. But I think in the matter of Five to ten years this will be something as normal as domestic travel, I mean take a regional airline or international airline will be the same.

Mr Naresh. Jadeja : IWHTA is raising awareness about one of the major fear for an international traveler - transparency in quality data reporting. What initiatives do you offer right now?

Dr Cortez : The fact here is to have the equivalent results and to be so comfortable with the quality that we can bring those moderators to our hospitals. Along with comes the transparency for which we are recognized as 1 out 132 JCI accredited hospital worldwide and ranked fifth in Latin America by the financial analysis news magazine: American Economics. Clinica Biblica is one of the most prestigious in this region and we have a history of giving best medical services to the population of Costa Rica since 1929.

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Three key factors promoting Medical Tourism

Dato' Mohr revels factors promoting Medical Tourism

Dato' Mohr, Masters in Healthcare Administration from Minnesota Public School. He is a Fellow of American College of Healthcare Executive and has been the CEO & CFO for various hospitals in California, Kansas, Tennessee, & Michigan, USA. Besides developing several medical science companies Dato' Mohr soulely carried the recovery of two bankrupt hospital in 1990's. From 1997 onwards he is CEO for Penang Adventist Hospital in Malaysia and on board of many hospitals in India, Philippines, Thailand, Cambodia, Nepal & Singapore and On July 2005, the Governor of Penang awarded him Dato' Ship for service to Malaysia.

Mr. Naresh Jadeja : What according to you promotes an individual to consider crossing his home country borders for healthcare?

Dato' Mohr : Precisely following three issues can be the deciding factors

Availability : Availability means the surgery is either not at all available at home or the queue is too long to wait for, or even in the absence of queue, the price is so high that it's not affordable for an individual. By either ways the non availability or the in accessibility of healthcare promotes to healthcare tourism.

Quality : Is the other factor. But quality could be defined as a cloud, for everybody approaches it differently. It varies for a person coming from Harvard versus what could be the view of a man from Kansas or Burma or even India for that matter. Well again in India one can experience tremendous variations depending upon the geographical presence. Thus quality is a variable and defining factor for buyer considering surgery abroad.

Price : The third and most mitigating factor is price. People from New York won't fly to Penang Adventist, were I live, for heart surgery although our outcomes are identical to that of United States. Unless we offer them something which is unavailable in New York City at an affordable cost like Stem Cell, which we do a lot and are at an advantage? Secondly its non affordability in New York City which could cost them out of pocket surgery expenses of $ 80,000 could divert them to us where they can get it done for $ 7,000. Hence price is and will remain the mitigating factor for medical travel. Also a very interesting factor is variable quality. For example A heart surgery abroad could mildly differ. Mild variation here means that they have to believe we are as good as New York City where the chances of dyeing on the table are very low, almost nil. Now if the difference is about 10 % versus that of New York City they are probably not coming for surgery. Similarly if we are doing Tummy Tuck and there is little variation one can live with it, as it saves me a lot of money. So these are the possible factors and people end up with availability, then with a crisp cross negotiation between quality and price.

This depicts that a bit varied quality could be considered for better cost, but we don't do so at Penang Adventist. We have to realize that basically we are in a commodity market and we are selling a commodity be it Open Heart Surgery, a face Lift, new knees its all based on all three factors.

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Blue Cross Blue Shield on global healthcare travel

Blue Cross Blue Shield approach for Medical Tourism

Mr. Ariza is the Director of International Marketing at BlueCross BlueShield of Florida which is one of the biggest Health Insurance Companies in USA. He is currently working in the Strategy and Insight group, as Director of Market Strategy and Innovation, and is in charge of long-range strategic forecasting and market planning, also he manages the Innovation team for developing new solutions for both the sustaining and disruptive spaces.

Mr Naresh Jadeja: What is Blue Cross Blue Shield's strategy regarding Medical Travel ? What opportunities you would like to explore ?

Carlos : At Blue Cross Blue Shield we are looking at the opportunities for both inbound and outbound medical tourism. Also we are observing other providers and trying to figure out and understand how a business can be formulated and how better services can be delivered. At Blue Cross Blue Shield we are looking at what benefits do these providers see in terms of building a business around medical tourism or healthcare travel, considering the fact that we have initiated with the process and also are keenly interested to be a part of this growing market.

Mr. Naresh Jadeja : Being an insurance company how would you justify the necessity of medical tourism and how will you get involved in this market?

Carlos : I think, from a US insurer's perspective and from the employer's perspective, BCBS is definitely interested in reducing the healthcare cost so as to get better outcome overseas which is always affective. Also this is more of a matter of creating awareness and evolving services around it which makes it convenient and easier for the customers/patients at the end.

But given the current scenario there is another bigger market of people travelling for equal care without necessarily having insurance or being connected to an employer, this uninsured individual are self paid patients and forms a huge market which is growing in both directions in and out of United States.

Considering this cases that are relatively routine it is understood that they would go overseas, but there are also people from overseas who come to US for health care because they can't get new experimental or specialized treatment in their home countries. In either case thats an opportunity for Blue Cross Blue Shield.

Mr. Naresh Jadeja : With your view point towards the medical tourism industry, what according to you could be possible barriers for US patients while travelling abroad for surgery?

Carlos : One of the most obvious and biggest barriers would be cultural, for the level of comfort that people going abroad would have, a fear of never being visited before, doubts about its quality assurance or inability of speaking the local language.

But there is an opportunity, if we concentrate on people that are here in the US but are internationally experienced, be it second generations or children of immigrants should travel for health care as they are comfortable going to their home countries and could better understand and compare quality more precisely. You have those kind of pilot markets and you can grow those.

Also there isn't enough work done in health insurance benefits and how health benefits get structured to incentivize people who would like to consider medical tourism. For example if I go overseas for treatment, I will be going out of network and I will get hit. But some insurance companies started to offer these benefits of no deductibles and low premiums and that will definitely create growth in this industry.

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Is Wal-Mart considering medical tourism

GENE ANN STILLWELL-MASON, Senior Director, Global benefits design of WALMART STORES discuss with MR. NARESH JADEJA, President of IWHTA about medical tourism as coverage plan for Wal-Mart employees.

Gene plays a critical leadership role in the design of leading-edge benefits programs and health care initiatives for Wal-Mart's over 2 million associates. Her 20 years of experience has equipped her to identify innovative solutions for complex benefits challenges around the globe. Gene serves on Global Health Benefits Institute Board and is a member of American Benefits Council and the Council on Employee Benefits. Internationally Wal-Mart operate in 15 markets, serving 49 million customers weekly.

Mr. Naresh Jadeja : What do you think are challenges and barriers for Medical Travel industry's growth ?

Gene Ann Stillwell : The major factor would be fear. Fear of unknown, fear of surgery, fear of being away from home country, which is scary enough by it self.
For an average consumer going to an unknown place could make it worse, its only if he/she is familiar with international or domestic travel then that fear of unknown vanishes.
Other fear they have is that they don't have their family members and their family doctor with them.

Mr. Naresh Jadeja : Wal-mart has its offices in 22 countries and its US employees are travelling to different destinations. In case of emergency, do these associates get treated in respective countries facility? Does this means that Wal-Mart is aware about the world class quality treatment provided by these facilities? If yes, will Wal-Mart consider these medical facilities for its associate's medical travel?

Gene Ann Stillwell : Yes we could consider from benefits perspective, but when you think about our associates, if we know certain hospital abroad and consider it better, that does not necessarily means that our employee also know the quality of the hospital. But for emergency situations before sending our associates to these world class medical facilities we are partnering with Medex and other agencies to figure out
What are these world class facilities?
What quality of treatment they deliver?
Where can they provide emergency service to our associates?
For all these and other necessary data to judge the medical facilities, we rely on our in country experts as this also assures comfortably managing emergency situation.
But in medical travel the scenario is completely different.

Mr. Naresh Jadeja : Does Wal-mart health plan gives its associates the liberty of getting treated anywhere?

Gene Ann Stillwell : The current health plan offers complete liberty to our associates for getting treated whenever and wherever they want.
The protocol remains the same be it for check ups or whether to get second opinion or treatment, our associates are free of all restrictions. We also have our transplant coverage with John Hopkins, Mayo clinic and other facilities and Wal-mart is using them as center of excellence but that is limited to transplants, for rest of the treatment and elective surgeries we are aware that some people are going out of their home town to get treatments but other then that we don't promote medical travel.

Mr. Naresh Jadeja : Is Wal-mart considering Medical Travel as an option to reduce healthcare cost and to provide better coverage ?

Gene Ann Stillwell : We at Wal-mart are thinking it as an option . We are trying to find ways to keep employees and our cost low but provide the best coverage at the same time. It is certainly one of the strategies Wal-Mart is considering but it is not what we are offering right now.

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Medical Travel opportunity under MBGH

Mr. Larry Boress, CEO of MBGH, on medical travel opportunities

Mr. Larry Boress, President and CEO of Midwest Business Group shares his view on medical travel opportunities with Mr Naresh Jadeja, President, IWHTA.

Mr. Bores: Is Presidnet and CEO at Midwest Business Group of Health one of nation's leading coalitions of private and public employers. MBGH's 75+ members employ over 2 million workers, spending greater than US $ 2.3 billion on health care benefits. MBGH offers employers a variety of health benefit educational seminars, networking opportunities, quality and community initiatives, demonstration projects and group purchasing programs. Members of MBGH includes top employers like Boeing, United Airlines, Abbot labs., Pfizer, J & J, Caterpillar, BMS etc.

Mr. Naresh Jadeja : Your members are big employers and you help them design their own benefits and how they can get more value for the benefit dollars they are spending, how do you see medical travel industry from an employer's perspective ? What do you have to say about opportunities in medical travel industry and what do you think are major barriers and obstacles for it's growth ?

Mr. Boress : Medical travel is an intriguing industry. It offers promise for giving world class quality treatment at one tenth of the cost, opportunity to get treatment from US trained doctors and English speaking health care professionals and to experience new culture and new country. There are opportunities as well some barriers and problems. Current situation is that big employers don't cover medical travel into their health plans, employees are not very educated about it, Unions are not asking for it. For many years there are many center of excellence but employers can't get their people to go outside their own town. The reason is they want to be next to their friends and family, they tend to be surrounded by ancillary people, they are more comfortable with the people they know. Also employers are thinking that how do I get my people to get back to work quicker and they have fiscal responsibility for the coverage they are offering. Unions are not supporting it because they think this is just a way to cut cost. Also we even don't know the quality of US hospitals so how can you show equal quality compared to US hospitals. Accreditation doesn't mean anything, even within a single hospital quality varies dramatically, the care varies, so there are no. of factors and barriers why employers cannot consider Medical travel as part of their benefit program. However there are number of employers who has center of excellence for year, where they send people for transplants, for specialty treatments, cancer care, bariatric care, and I think there is a value in that, it comes from knowing the data, outcome, and cost and how that compare with what is in you plan. So if overseas hospitals can show equal quality compared to the US hospitals, and it is accepted by health plan then there is a big opportunity. Health plan is very important because they are the one who decide who is in the network and who is not, it's not the employer, even self employed people relies on the available health plan. So I think it comes down to what is the outcome, what is the quality and cost compared to what they have locally.

Mr. Naresh Jadeja : What is necessary for the growth of the Medical Travel Industry ? Is there any successful strategies that can be applied to convince employers to take advantage of Medical Travel benefits ?

Mr. Boress : You got to have poster boys for the people who are going there, find a CEO who has gone overseas for medical treatment, it is interesting that we find many of our members, they do things because their CEO says he want them to take a look at it or he want them to do it , it started out with HMO's, it started out with the consumer driven program, it started with employee incentive programs, It's always a CEO, who has an experience or has read about some new benefit strategies and approaches and who said yes, I want my company to do this. You got to find some champions who can do this or a spouse of CEO who has gone there . You need to tell these companies to talk publicly to their employees and other employers about how good quality is there at overseas facilities and their experience and how they saved money . You have to get the unions and other employees to say this is what we want, we want this part of our coverage, when I am at the negotiation table, this is one pieces I want to negotiate on. So you should have demand from the bottom and demand from the top people and then you have to convince health plans to include you in the network and say that we are comfortable with the quality of care and cost and we will cover it.

Mr. Naresh Jadeja : Many big employers like Walmart or Boeing has offices outside USA and they are providing world class health benefit packages to those employees in their home countries in Europe or Asia. Do you think it will be easy for them to understand and adapt medical travel as an option ?

Mr. Boress : I think you are right, lot of our members have their offices or factories outside US or employees from overseas offices are coming to US for projects. They are more comfortable going back to their countries for the treatment and I think the challenge for the medical travel industry is to get the stories of these people, say if someone is from Malaysia but works for Boeing in Seattle, talk to them and put up their stories, let them tell about their good experience and put them into company employee news letters, there is no doubt that people in south would like to go to central America, Mexico or where they are from. They are more comfortable with the culture and language so they will be interested in Medical Travel option. There is no doubt that many changes that comes in employee program are result of peer to peer discussions and pressure, one example is if employer cannot enroll their employees in the their wellness program yet they find some employee who were benefited from it and started talking about that program with colleagues, then people will start taking advantage of it. This peer to peer networking is great so if your co worker talks about how good the quality was and how interesting the culture is then more and more people would like to take advantage of it and employers will definitely work towards the interest of their employees.

Mr. Naresh Jadeja : What is your personal opinion about medical travel industry ?

Mr. Boress : As I said medical travel industry is intriguing, the opportunity that you can get same quality treatment at one tenth of the cost with US trained doctors at good accredited facility and you get to experience a new culture and new country is very hard to ignore. If I was exposed to it more, then I would be definitely interested in seeing it or may be I would have taken a group of US employers over to see by them selves and talk about it and when they come back to US they can take Medical Travel into consideration. I think this is an opportunity that employers cannot afford to not to take a look at it.

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IWHTA shares healthcare tourism industry experts voice

Sharing experts voice
Following IWHTA's mission, we are going to start a new series from next week' news letter issue. In every newsletter we will ask one industry expert about their views on Medical Tourism Industry. They will be top US employers, Top US health Insurance executives, Facilitators, Third party Administrators and Travel Insurance experts. This move will educate and inform all our subscribers and medical tourism industry stakeholders about the upcoming trend and development in the industry world wide.

If you have specific questions for these experts then you can e-mail us on info@iwhta.org and we will get you in touch with the expert.

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IWHTA participates in The healthcare globalization summit

IWHTA participates in The healthcare globalization summit

As Washington searches for ways to rework the country's health care system, U.S. and international leaders gathered in Miami November 10-13, 2009 for the Medical Travel Summit of the Americas presented by MedicaTree International .

Opportunity at Miami summit
The Miami summit gave domestic and international providers, U.S. employers, health insurers, consumers and third party administrators their first opportunity to examine the legislative impact and recommended courses of action to comply with legislative reform. Distinguished panelists and keynote speakers examined the results and implications of 2009 legislation and the economic impact on U.S. and international healthcare stakeholders. Always consider your audience. Who is the primary target of this press release - reporters, investors, partners or customers? Make sure that your words are pertinent to your audience.

Visitors at Miami summit
Summit was a great chance for individuals to meet hundreds of healthcare leaders from around the world and proved to be a great networking opportunity. Insurance executives, Hospital CEO's, Facilitators, Government officials, Third party administrators were present at the summit along with Mr. Jorge Woodbridge, Costa Rica's minister for competitiveness and Hon. Dr. Arthur T. Porter from Canadian Healthcare system. "It was a great event and I was very happy to meet leaders of the medical tourism industry who helped shape this industry," said Michelle a medical travel facilitator from Brazil.

'Medical Alliance of the Americas'
On 11th November, 2009 a big step was taken towards betterment of US citizens when 14 organizations joined their hands to form 'Medical Alliance of the Americas'. These organizations include universities, hospitals, research institutes, and government officials. Representatives from these organizations supported this alliance through their announcement of support. They signed a proclamation and declared their support for contributing towards the health care issue of America. During the summit Healthcare leaders from around the world found IWHTA's mission and goals truly unique and expressed their best wishes for the success of its 'Donate a Surgery' program. Many executives offered their services and assured their support for the upcoming IWHTA events.

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