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Why hospitals should fear outbound medical tourism

Posted Nov 16 2010 5:49pm

by Maria K. Todd , MHA, PhD

Two weeks ago, I began describing why hospitals need to start worrying about outbound medical tourism. This continues that discussion.

With some new health plan offerings, the employer may designate which services may be covered under the arrangement, per IRS rules. They may offer choices of where (for example, location, provider, narrow network) the money may be spent and provide incentives such as companion travel expense contribution, copay and deductible waivers. This is the first phase, which we anticipate will be followed by full global benefits as an option.

Another part of this phase is a revision of their expatriate benefit program, away from fully-insured supplements that "top up" what local health statutory coverage plans offer, to bring them to matching U.S. benefit levels in parity with their domestic workforce managed through their self-insured captive plans--those insurance companies that are started by large self-insured employers in offshore locations for the tax benefits.

This reconstruction will redefine which foreign healthcare providers will receive their business in exchange for data, outcomes, pricing and other redefined market expectations. The expatriates won't be able to use just any provider in the marketplace if they want the richest benefits.

At the same time employers will use these encounters and utilization data to monitor outcomes, collaboration, and employee satisfaction with primary data that is and has been previously unavailable to them through the expatriate fully-insured plans. As the tipping point approaches, medical tourism, which was previously a rare phenomenon, will become dramatically more common.

Employers are using this plan to test receptiveness by employees, outcomes, and bottom-line performance. They are very concerned with the fiduciary liability as the plan administrator because they could bring tort liability on the company if they choose providers injudiciously on the basis of costs alone.

Because of their concern for quality and safety transparency, they are also closely monitoring how challenges such as medical records in different languages, case management, and claims processing and re-pricing of claims submitted in different currencies and coding systems will be managed by their third party administrators, who process the claims made against employer health plan funds.

Because of the added liability mentioned above, they are concerned about credentialing and privileging, and vetting and site inspection processes according to long-adopted National Committee for Quality Assurance standards. With all the focus on outcomes monitoring, measurement and reporting, they want to know how the data will be migrated with their domestic-sourced care into one globally integrated, statistically valid data set. Finally they want to know how privacy, security and other U.S. regulatory compliance issues will be addressed.

If American healthcare providers think these challenges will take years to overcome, think again. Currently, we’re meeting all those challenges at Mercury Healthcare. The company currently collaborates with four TPAs on each of those touch points and continues to add relationships weekly.

In addition, more than 1200 licensed and authorized producers, or insurance agents or brokers, are able to meet with self-funded employers with whom they have long-established and trusted relationships. These producers can offer an employer a fully-insured plan renewal with a 60 percent premium increase to continue to receive all care from U.S. providers through these high-cost, low-value plans. Or they can offer to convert the employer to a complete solution that offers:

*a globally integrated provider network in the U.S. and over 25 countries
*wellness and health risk assessments,
*cost avoidance programs that effectively slow disease progression,
*plan administrator fiduciary insurance, health travel complications insurance,
*reinsurance for excess claim losses,
*and for high net worth executives, kidnap and ransom coverage and financial health-to-wealth planning to influence behavior choices.

Globally integrated health delivery by design is here to stay. American hospitals and healthcare providers can choose to be a part of that integration or remain on the outside looking in.

[In the next part of this series, I will look at what U.S. hospitals and providers can do to become part of the global integration and National Expert Initiative that seeks to double inbound U.S. medical tourism over the next five years.]

Related Article: Why competition from medical tourism is sure to grow

Maria K. Todd, MHA PhD, is (www.mariatodd.com) is the president and CEO of The Mercury Healthcare Companies, headquartered in Denver, Colorado and a Director at Mercury Healthcare, LIMITED of London, England. She is also the author of The Managed Care Contracting Handbook, 2nd Edition, and Handbook of Medical Tourism Program Development, and seven other health administration industry books. Email her at mtodd@mercury-healthcare.com .

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