Implementing Medical Tourism into Health Insurance Plans ~ Six Steps to Success
It is amazing how many insurance companies and employers have already implemented medical tourism or are in the process of implementing medical tourism. Without anyone knowing about it or hearing about it, Medical Tourism is about to become one of the biggest trends in US healthcare. The reason is simple. No other consumer driven solutions are working.
Employers and insurance companies have implemented HSA’s, moved to high deductible plans, shifted more out of pocket expenses to the employee, and basically tried every trick in the book, with the end result being that healthcare costs and premiums still keep skyrocketing. Nothing seems to be working. Medical Tourism is the ultimate consumer driven tool.
It provides the employee the choice to make an educated decision on where they will receive their care, whether overseas or domestically, based on cost and quality, and is the only consumer driven tool that actually gives the employee the tools to make that decision.
However, as all these insurance companies and employers are implementing Medical Tourism how many are really thinking it through and taking the time to do it right? Prior to running the Medical Tourism Association, I ran a large national healthcare administrator in the US. I was the first person to implement Medical Tourism into both fully insured and self funded health plans years ago, creating an affordable solution for my client to waive deductibles, coinsurance and reimburse travel expenses for the insured and a companion. This is the current trend for implementing medical tourism.
What is the real difference in how I implemented Medical Tourism and the mistakes many organizations are making today? First, make sure you really think this through, do your research and engage in due diligence. There are three ways to implement a Medical Tourism Program. First, simply put, is to implement it successfully and professionally. The second way is to implement it improperly and simply no insured or employee ever makes the choice to go overseas.
The third option, is implementing it with the wrong company, and encounter high risk of liability for an employer or insurance company. I have seen many companies implement it correctly and others do it wrong by simply picking horrible partners to communicate to employees, to the insured and to coordinate care overseas. Every aspect of a Medical Tourism program must be carefully planned in advance in order to achieve successful outcomes. Proper planning equals positive outcomes.
Six Steps to a Successful Medical Tourism Program
Step 1 ~ Educate Yourself About the Industry
One of the most important steps in any Medical Tourism Program is to become informed and educated about the Medical Tourism Industry. As an employer or insurance company moving forward into this space you need to learn which countries are providing Medical Tourism. Which are the top hospitals that are providing care in those countries, and then who are the top surgeons?
Step 2 ~ Choosing Your Middle Man or Medical Tourism Facilitator
While some insurance companies and employers are partnering directly with the hospitals, many are looking to partner with a Medical Tourism Facilitator, which is a company that coordinates all aspects of the patient journey and is the intermediary between the patient, the patient’s domestic doctor and the patient’s foreign doctor. It is very important for you to choose your intermediary carefully.
Some are focused on patient safety, quality of care, and successful outcomes, while others are strictly concerned with receiving high commissions and do not prioritize quality over pricing. Do not rest your decision on a referral from a third party, or reading about a company in a newspaper and magazine. Research and do your own due diligence, because this aspect can be the difference between a successful medical tourism program and a failure.
Does the Medical Tourism Facilitator have the experience to send patients overseas and do they have medical staff working for them? Have you done research to see how many patients they have sent overseas so you can judge their expertise and if they can handle the volume that you will send through their organization?
Do they have medical staff to check patients’ records and make sure they are good candidates for traveling overseas and to receive the proposed surgery? Also, do they even have the staff and manpower to handle a large volume of patients?
Has the Medical Tourism Facilitator actually visited the hospitals they are referring patients to, and do they have contracts in place with the hospitals, or is it a lose relationship with the hospital? Do you really want to use a company that has never set foot in the hospital they are recommending patients to go to? Without a contract in place with the hospital, pricing and services are up in the air.
Some other simple questions are: “Does the company have Errors and Omissions insurance? Errors and Omissions insurance is now very easily attainable and the Medical Tourism Association just launched and Errors and Omissions Insurance specifically for Medical Tourism Facilitators, as we recognize the importance of reducing the risk of liability for services offered by the facilitator. Without a policy, does the facilitator have the assets to defend themselves in a suit for negligence?
How about patient referrals? It would be a good idea to contact some of the patients the companies have assisted to get an idea of the quality of services offered. It will also be helpful in developing the menu of services you will expect from the facilitator. The Medical Tourism Association performs a level of due diligence on its member companies. This means that we have identified these companies as being more than a shell or a pretty website.
We provide a detailed questionnaire as a prerequisite to membership which results in transparency and provides a basis for our approval. We believe members should operate with a standard of best practices and ethics that support the tenets of the Association. Assuring patient safety and quality of care is of the utmost concern.
Step 3 ~ Understand the Different Accreditation Systems
Do you understand the different accreditation systems, such as Trent, Joint Commission International (JCI), and ISQua. Do you understand the difference between the US Joint Commission accreditation and the international version called Joint Commission International? Joint Commission International is a less stringent form of accreditation than the US Joint Commission as it has been adapted to account for cultural differences.
ISQua is the umbrella organization that accredits accreditation systems and des not accredit hospitals. Have you heard that hospitals accredited under other ISQua accredited accreditation systems may have the same, if not better quality of care as those accredited though JCI? ISQua accredits the Australian, New Zealand and Taiwanese Accreditation Systems, to name a few. This could imply that those hospitals accredited under those systems could be comparable in quality.
Have you heard of the Trent Accreditation Scheme, which is UK based and accredits hospitals in the UK and Hong Kong? Trent is expanding globally and you will be hearing more about them. Are you familiar with each country’s own specific accreditation systems, some of which may have been modeled after the Joint Commission? What are the standards you are looking for to assure you of quality?
Remember accreditation is only the first step. Just because the hospital is accredited does not mean that all of the doctors and surgeons at the hospital are “accredited” by the same agency, they are not. These organizations do not accredit physicians. Most of them do not accredit small clinics either. All doctors and surgeons are not necessarily expert surgeons with the best outcomes. How you choose the physicians in your network directly affects the outcomes for your insureds and employees.
It is important that once you have selected your hospital, you must drill down further and search out the best surgeons at the hospital and make sure your insured or employees are getting their care by only the surgeons with the most experience and best surgical outcomes for the procedures being sought. Do not leave it up to the hospital to choose your doctors for you. This is your Medical Tourism Program and you need to take charge of it or bring in a consultant or company that will take charge of it and manage it for you.
Step 4 ~ Choosing a Hospital
How are you selecting hospitals? Are you taking recommendations from third parties or choosing based upon the most impressive websites? Or, have you done your own research and due diligence and perhaps even visited the hospital personally?
Language and Culture
There are many considerations you have to look at when selecting an international hospital to send patients to, and just accepting the word of a third party isn’t the answer. First and foremost, it is important to know if the hospital has an established International Patient Department dedicated to dealing with foreigners, whether they speak the language and understand the customs of the patients you are sending.
Many patients will require religious accommodations or special dietary needs. Having those options for a patient may directly impact the overall patient experience. Then you would like to know whether the doctors and nurses also pass the language and understand the customs of foreign patients. Why is this so important? What if the patient is in pain and needs to communicate to the nurse or doctor about the pain or some other important need, and the nurse or doctor doesn’t understand them?
The language issue is probably one of the most important aspects of a successful medical tourism program, so make sure you choose the right hospital that has these processes in place.
Does the hospital have privacy regulations in place to protect the privacy of the patient in accordance with the privacy laws in their home country? Remember if you are based in the US you are very familiar with HIPAA, you will quickly notice that no other country has the privacy laws as stringent as those found in the US and many hospitals have no idea what HIPAA is, how they should comply, or if they could even put the administrative procedures in place to comply. Each country has their own definition of privacy and how they deal with medical information. Are you aware of the hospital’s privacy procedures?
Transparency in Quality and Pricing
Hospitals should undertake protocols to provide transparency in quality and pricing. Are patients provided with prices that are bottom line prices, or are their hidden costs that a patient could not anticipate before they arrive? Does the pricing include transportation, meals, aftercare such as rehabilitation and a hotel or recovery resort for recovery? Some hospitals are allowed to change prices within 24 hours notice.
In the area of quality, hospitals with policies in place to disclose quality information, outcomes and experience will find patients more receptive than hospitals that do not disclose. It is imperative that any hospital you work with be open and honest when it comes to quality and pricing or it will lose the trust of the patients, employees and insureds.
Step 5 ~ Aftercare
Where the patient will recover after surgery and what happens when the patient returns home is directly related to a positive patient experience. Does the hospital have an aftercare program in place? Has aftercare in the home country been pre-arranged? How long is the recovery time?
For recovery directly after the surgery, each hospital has their own policies, so you need to be aware of country specific practices. For example in most hospitals in India, patients recover in the hospital, specifically because the costs of hotels are too expensive. Decent hotels can cost $400+ per night, which are unaffordable for many patients and the price of the extended hospital stay is usually included within the hospital package.
But in other regions, such as Latin America, after the appropriate recovery time in the hospital the patient is moved to a hotel or recovery resort where they will continue rehabilitation before they return to their home country. The costs for the hotel or recovery resort are normally not included within the hospital package price for the surgery.
So, then you need to ask the question of what hotel or recovery resort are they recovering in and what procedures are in place? Does the recovery resort or hotel have nurses and rehabilitation services available?
Once you deal with aftercare within the country of surgery, one of the most important aspects of the patient experience is follow-up care when the patient gets back to their home country. In reality, this issue needs to be resolved before the patient ever steps onto a plane. Prior to an overseas journey, the patient or a third party should get involved to assure their local, domestic provider understands where the patient is traveling to, what procedure they are getting, and clears the patient for travel.
It would be best to have the physician agree to treat the patient upon his return. If this is not in place, patients should not be traveling overseas! Also, this is not something that can be coordinated when the patient is in the foreign country for their surgery or just before their return, it is a necessary detail to be resolved prior to departure from their home country.
Step 6 ~ Communicating to Employees
One of the most overlooked aspects of any successful medical tourism program is how will you communicate the program to your employees and their dependents? Most organizations have absolutely no idea, and to not think this through before implementing a medical tourism program can be a waste of time.
Simply put, you can’t hand an employee a brochure showing a pretty picture of a hospital and expect that now they will be convinced there is high quality of care available overseas and that they will jump at the opportunity. You must educate the employee or their dependent about the quality of care overseas.
One of the major aspects that most employers or insurance companies do not think about is an ethnic insured patient. This refers to an insured or employee who is from another country or a descendant of another country, meaning their parents or grand parents are from another country. Currently under most insurance plans this type of employees or insureds are forced to get care in the country they live in, when in reality they would rather go for care to their “home” country and recover with extended family.
This segment of employees or insureds does not need convincing of the quality of care available in their home country. This is one of the biggest opportunities in Medical Tourism. A Filipino, Mexican, Indian, Colombian, Costa Rican, Vietnamese, or Salvadoran (for example) employee or insured would jump at the opportunity to go to their “home” country and, if they had an incentive such as waiving deductible, coinsurance and travel, they would not hesitate to travel overseas.
Don’t just rely on third party. As an employer or insurance company, you have a duty to educate yourself, understand the issues and come up with solutions and answers.
Your employees or insured are assuming you have done the due diligence for them, and that if you are recommending a hospital, you have done your research on the hospital and on the actual doctors as well.
Don’t disappoint them. They are looking to you to put together the whole package, and a package that they as the end user can use without complications or problems. A successful medical tourism program is easy to implement, but needs proper planning and strategic analysis.
Jonathan Edelheit is President of the Medical Tourism Association with a long history in the healthcare industry, providing third party administration services for fully insured, self-funded and mini-medical plans to large employers groups.