Domestic medical tourism saving employers money and improving outcomes

Over 1.5 million Americans travel abroad each year for medical procedures.

Services typically sought by travelers include elective procedures as well as complex specialized surgeries such as cardiac surgery, dental surgery, joint replacement, and cosmetic surgeries. However, virtually every type of health care, including alternative treatments, psychiatry, convalescent care and even burial services are available.

U.S. based healthcare providers have taken notice as have self-funded employers and health plans. The reality is most people, if given the choice, would rather travel for medical purposes to Tucson than Thailand. Top surgical facilities realized they can be price competitive and have extra capacity so they have embarked on a program of domestic medical tourism. The byproduct, if you follow it to the logical extreme, is the creation of a national market for non-emergent surgery.

National Surgery Network is one of the first to identify this opportunity and has created a national network of surgical facilities that have been aggregated to offer to self-funded employers who have been frustrated with the hyperinflation they’ve felt covering their employees health costs. This is another example of the growing movement I call the Do-it-Yourself Health Reform movement such as Dr. Forrest’s Direct Primary Care model recently profiled on KevinMD.com.

That is, organizations such as National Surgery Network aren’t waiting around for politicians to fix what is widely understood to be the broken and most expensive facets of healthcare. Rather, through their own trial and error, they are refining care and payment models that are demonstrating impressive results.

I sat down with CEO and Founder of National Surgery Network, Ken Erickson, to learn more about what they are doing.

Dave Chase: How do you make the lives of patients palpably better?

Ken Erickson: Everyone wants better care and better service at lower cost.  Here’s how we deliver it for the patient:

The right healthcare providers – NSN participating hospitals, surgery centers and physicians are among the best in their focus specialties.  In addition, they are committed to delivering an outstanding overall experience for patients and their families.  NSN opens the opportunity for providers to make the case to each prospective patient why they should choose that provider for care in a competitive environment.

Personal service – Our care navigators help patients with all the non-clinical aspects of choosing, planning and arranging care.  Medical procedures are infrequent events in people’s lives so we help reduce the complexity and stress.

Better information – Choosing care is a high consequence decision, usually made with very limited information and based on anecdote (“My cousin says Dr. X is the best.”). We help patients make informed decisions.

Expanded choice – We supplement a traditional health plan network.  Nothing is taken away.

Financial: Savings and Certainty – Choosing care through NSN usually means eliminating patient deductibles and co-insurance, delivering substantial savings to the patient.  A GetWell Benefit also rewards the patient for adhering to discharge protocols and for participating in longitudinal follow-up.  The patient never receives a bill, so the worry about surprise uncovered charges is eliminated.

DC: How are you lowering overall costs?

KE: NSN can reduce self-funded employer’s cost for planned procedures by 30-50% vs. historical cost under typical major network contracts.  Looking only at the procedures we currently manage, NSN offers employers the potential to reduce current total plan cost by 6-10% with improved outcomes.

The economics driving these savings are simple:

Target efficient, focus facilities – Many studies have demonstrated that doctors who perform procedures in high volume also have the best outcomes.  Facilities and their staffs that are organized around particular specialties can deliver care efficiently and effectively.

Simplified Payment – We develop comprehensive case rates for most procedures, reducing the administrative overhead of billing and reimbursement.

Drive incremental volume to these providers – By filling beds and surgery slots, NSN patients are financially attractive at rates that are significantly lower than traditional reimbursements.

DC: How do you engage and activate the patient in their care?

KE: We establish a relationship with the patient beginning with their initial inquiry, and we maintain that relationship through the decision process, the interval of care, and long-term post-procedure follow-up.

This means patients can count on our full time care coordinators to help them select providers, schedule procedures, transfer medical records, work out travel logistics and follow discharge protocols beneficial for patients’ recovery.

DC: How do you provide rapid access to care?

KE: We connect patients with medical facilities and doctors for planned treatments and procedures.  Our care navigators streamline and accelerate all the non-clinical preparations for the patient to receive care.  We facilitate communication not just between the NSN physician specialist and the patient but also including the patient’s primary care.  We work with facility administration and scheduling to get the patient the right care as quickly as possible.

DC: How are you contributing to improved patient outcomes for maintaining the health or helping with their chronic disease your patients have?

KE: Although NSN’s focus is helping patients arrange treatment for acute conditions, many people we work with are chronically sick.  One woman who had a long history of heart problems required an aortic valve replacement.  The hospitals in her local market were poorly rated for heart care.  We arranged for the procedure to be performed by one of the leading surgeons at Heart Hospital of Austin.  Although the surgery required was more complex than anticipated, the outcome was a complete success.  The patient reported that although she had been in and out of hospitals for years, this was the first time she was being cared for and not just treated.

We are committed to long-term engagement and follow-up with the patients we manage.  Our program rewards patients for adherence to discharge protocols and participation in follow-up.

DC: How will you demonstrate increased patient satisfaction and how do you measure this?

KE: Because we maintain a relationship with each patient over time, we have the opportunity to measure clinical outcomes, reported satisfaction and customer service metrics at each point of interaction.

DC: How do you demonstrate high tech and high touch?

KE: We use technology in support of personal interaction. We provide an on-line Health Information Portal to assist the patient in choosing a provider.  We also have care coordinators that establishes a personal relationship with each patient.

We use a secure on-line medical records system for easy access by the NSN physician specialist and the patient’s local/primary care.  Each patient using NSN receives their own electronic personal health record as an additional benefit.

NSN is deploying social media to help patients share their experiences and connect with one another in an environment that protects privacy and anonymity where appropriate.

DC: How do you demonstrate teamwork with other clinicians?

KE: We provide the connecting services to help specialists coordinate with the patient’s primary care.  We facilitate not just the preparation for a procedure but also the connection with surgical rehab, physical therapy, and any local specialist consult if required.  NSN creates a single point of contact around the extended interval of care.

DC: How do you increase the overall value of the healthcare services delivered?

KE: Although we aren’t a healthcare provider, we make it easy for the efficient, high-quality providers to connect with the patients who need them.  We work within the context of the patient’s existing health plan to deliver the savings to both the plan sponsor and the plan member.  We unlock the power of competition and put it to work for the benefit of all participants: employer plan sponsors, plan member patients, and healthcare providers.

DC: How do you simplify rather than complicate the process of getting care?

KE: Our care coordinators  guide patients through the complex information & decisions around a medical procedure.  NSN also eliminates the billing complexity and uncertainty around medical care. Our patients no longer worry about uncovered costs and get one letter from the hospitals and doctors after a procedure…and that is a letter of thanks!

DC: What else are you doing to scale this?

KE: We have launched our Employer Direct Healthcare initiative.  We are beginning to partner with other specialty networks, providers and services that can offer a direct value proposition to the employer.  As we grow, NSN will serve as the platform for any planned medical treatments, procedures, services, and supplies.

DC: What is the biggest obstacle to expanding what you have done more rapidly?

KE: NSN’s value could not be simpler.  We offer plan members access to better quality care, expanded choice, and better service at lower cost.  Nothing is taken away and everyone wins.

As more plan sponsors deploy NSN and we collect experience, testimonials and case studies, NSN is positioned to redefine the role of a provider network.  We are focused on finding and working with the employers and providers who share this vision and want to take leadership.

Dave Chase is CEO of Avado.com, a Patient Relationship Management software company, previously founded Microsoft’s Health business and was a consultant with Accenture’s Healthcare Practice.  He can be found on Twitter @chasedave.

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  • Anonymous

    this guy seems to be talking the talk well enough, but it would be helpful to have some evidence confirming that he’s actually doing the walk as well.  there’s a troubling lack of specifics here.  he claims to be quick and patient friendly. don’t we all?  he claims his providers are the best.  don’t they all make such claims?  I’d be willing to bet up to a dime that (a) none of his providers are academic medical centers in New York or Boston and (b) that these facilities would be quick to challenge his assertion about the quality of his preferred providers.  for a conversation that often stresses evidence and data, this item seems quite soft and promotional.

  • http://pulse.yahoo.com/_EM4LH5YBE3THRPAPEEGUMK572M russ

    Kevin .. this is really kind of limp. 

    There are other firms, trying to do the same thing (find low-usage periods). Nothing new or useful in this.

    Disappointing.