During the 5th World Medical Tourism & Global Healthcare Congress ( WMT &GHC) Randy Moon vice president International HR Benefits & HRIS for Lowes Companies Inc. shared a case study of how this mainstream home repair store has successfully implemented medical tourism into their healthcare plan for employees.
Lowes currently has 1750 stores located in the U.S. Canada Mexico and Australia employing 250000 employees. Out of the 250000 156000 are eligible for benefits with 114000 actually enrolled in a health insurance plan. Lowes offers two self-funded healthcare plans to employees one with Blue Cross Blue Shield of Alabama and one with Aetna.
In 2010 Lowes made the decision to enter into an agreement with the Cleveland Clinic as a way to provide their employees with the best healthcare they could offer featuring complicated cardiac procedures.
The project began by taking a look at the challenges to overcome to make this program successful. The challenge realized was that surgeries for life threatening conditions are expensive sometimes unnecessary and are low in quality.
After gathering data the results showed that there was a significant challenge with the high cost complicated cardiac procedures and that the best surgical results come from the most experienced surgeons and only a small number have the level of experience required for the most complicated surgeries.
In particular we wanted to focus on less invasive procedures for the complicated surgeries so we could have quick recoveries for the families and employees that are in the program said Moon.With the challenges at hand Lowes considered three options to increase quality and/or reduce cost in self-funded medical plans.
- Out of the country surgery it had lower cost but it didn really meet the quality enhancement requirements that Lowes was looking for. Additionally Moon shared that many of their employees and families didn travel very often so for them to consider leaving the country would have been intimidating and they wanted this to be a benefit that they wanted to take advantage of.
- Broad centers of excellence networks they had some cost reduction and some improved quality but it still did not have what Lowes was looking for.
- So finally they looked at a single center of excellence where the cost would be neutral but the quality would be very high. They researched a number of the best hospitals.
After considering all the options it was decided to pilot with a top quality provider at a break even cost. The focus was on high cost complicated cardiac procedures.We wanted to provide an option to employees to shift complicated cardiac surgeries from community hospitals to a hospital with top quality care said Moon.
Lowes selected the Cleveland Clinic as designated surgery partner for high risk complicated cardiac surgeries they were chosen for many reasons and some of them are:
- Ranked #1 in cardiac care
- Culture of quality: published outcomes
- Highly specialized physicians
- Magnet Nursing Status
- EMR with portable patient health record
- Experience with traveling patients
Its a recognition that healthcare no longer has to be local and not all facilities need to or can develop the capability to handle all surgeries and we felt strongly that quality trumps price said Moon.
As part of the partnership they worked out a simplified bundled payment case rate paid by Lowes for all clinical care in Cleveland. It was not the standard fee for service payment type approach.
For the employees this is a voluntary program with minimal cost for the beneficiary. Details of the program include:
- No one has to do this program several other health plan options are available they can receive local care or go to Cleveland
- Deductible co-pay coinsurance waived (subject to limitations of HAS plans)
- All travel cost to and from Cleveland and expenses in Cleveland will be paid by Lowes for patient and companion
- Patients and family members receive concierge-level support
Support and prescreening for the patient:- This program has separate full administrative and travel support for the employee and companion (TPA). The TPA works with the patient and clinic to prescreen patients to coordinate eligibility perform medical necessity reviews and make sure information is properly flowing from home doctors to the clinic and the same process is done when discharging patients they also coordinate aftercare.
The TPAs also process bills capture data related to the patients surgery and then send the information into Lowes data warehouse. Once all the information is gathered the Cleveland Clinic reviews this data to see if the patient would benefit from their services. For example there were 10 cases where they find out that the patient was originally diagnosed wrong and they actually do not need surgery.
So far this program has had positive outcomes but only for a small number of people. The main reason for the small number of participants is because many of the employees do not want to travel.From the beginning through September 30 2012 60 surgeries have taken place this is a mixture of:
- 51 employees eight adult dependents and one child from 24 states have traveled to Cleveland
- Mitral valve repair has been the most common procedure so far others include aorta surgery coronary bypass and pediatric open heart surgery
- Industry benchmarks predicted 3.4 percent mortality or two patients should have passed away out of 60 completed cases based on patient clinical characteristics
- Cleveland Clinic has achieved 0 percent mortality since beginning of the program in 2010
Moon shared a comment from an employee: My family and I know that I would not be here today if Lowes had not created this benefit.Re-admissions eliminated in year two
- 17 percent re-admission rate in year one it is at 0 percent re-admission in year two. Post-discharge calls to patients to reinforce plans and drive ongoing education and physician to physician communication were highly effective in reducing re-admissions so local physicians knew they could call on the Cleveland Clinic doctors.
Quicker return to work
- On average patients undergoing coronary artery bypass surgery (CABG) returned to work 10 days (21 percent) sooner than national guidelines
- Satisfied employees- 94 percent out of surgery responded I feel I had much better care than I would have had if I had had surgery at my home hospital
Lessons learned and changes made since initiation
- Supportive partners and coordination to hotels are important
- There is now an accolade to triage calls with insurance companies so when patients call into the insurance company instead of getting a company representative they get representatives that are clinicians.
Moon provided an example of a call that saved the patient a lot of trouble. An employee called the insurance company and asked an accolade when he could get his insurance card the accolade answered the question but then followed up by asking if he needed it sooner.
The employee said I need to go to the emergency room the accolade described to the caller how to treat the wound and determined that he didn really need to go to the emergency room. By the time the call was over there was no ER visit and the caller had a choice of two doctors to call the next day.
- Lowes is now expanding the program with Cleveland they are implementing a spine surgery program and because they learned there are many unnecessary surgeries they also started a program for chronic pain
- Post-op follow-up visit by doctor the day before the patient is discharged to home significantly improves recovery
- Physician to physician communication both before and after surgery is key
- Focus on hand-off/ communication with local insurer case management is important
- Benefit design is powerful motivator
Information from this article came directly from Randy Moons presentation at the 5th World Medical Tourism & Global Healthcare Congress.