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Healthcare Reform - Legal & Policy

The New Medical Exchange Journey : What and Who is Driving Newest Trends in Medical Travel

Healthcare Reform - Legal & Policy

Let me preface what’s to come by offering what I consider distinct definitions for medical tourism versus what others call “medical exchange.” The long-established trend in medical tourism is that patients travel for elective cosmetic surgeries or wellness spas and they do so in conjunction with a vacation. That is why destinations like Thailand, Costa Rica, Miami and New York City have always been popular. Hence, the phrase: “medical tourism.” By contrast, the term “medical exchange” often deals with more vital procedures including orthopedic, neurologic and cardiac surgeries delivered as tertiary care1 in an area that may or may not be in a tourist hot spot.

Both concepts have seen considerable evolution in recent years. Recession and changing healthcare laws have placed greater limitation on facilities and insurance companies and largely shifted the burden of healthcare cost to patients. Now, hospitals and surgery centers are being asked for greater transparency in their cost structures and patients, meanwhile, are more open to the idea of shopping for medical care. Not surprisingly, these two factors have contributed greatly to an increase in both demand for and expectations of medical exchange.

Along with the rise in demand and elevated expectations, the established structures around medical exchange have witnessed change and realignment, too. As the goal for medical exchange patients is to find the best treatment at the best price, regardless of location, the industry does not rely on the traditional role players associated with medical tourism in the same way it once did.

Instead, the growing trend is to rely on referral sources, which are often routed through new medical exchange programs that act as a directing entity for all participants in the process.

To understand this evolving system of medical travel and the changing roles associated with its success, this article highlights what now drives choice in medical exchange, the key role players, how insurance and bundled pricing are factored in, and the ways in which the industry will continue to evolve.

Expectation: What drives patient choice when shopping medical exchange options?

According to our research, key drivers for patients considering medical exchange options are quality, familiarity and price, all of which should be taken into consideration by medical exchange providers and referral sources.

As is always the case with any aspect of healthcare, quality is the key. The same holds absolutely true for medical exchange patients. In the case of medical exchange, evaluations of quality are usually left to a patient’s referral source because they usually have greater understanding of the available hospital or facility evaluations and applicable rating systems.

Other quality indicators that a referral source may consider include national and international accreditations, board certification for physicians and specialists and “best in class” reviews from previous patients and accrediting institutions.

Of these three drivers, familiarity can be the most challenging to accommodate. Still, research clearly shows that patients will more readily consider medical travel in areas where they have family or friends nearby.

That said, the truth is that patients are traveling absolutely everywhere for medical treatment; in part, this is what’s driven smaller, specialized facilities to advertise their willingness to work with medical travelers: the requirement that a medical destination be high on anyone’s “hot spots” list, like New York City, Miami and Boston, is almost a thing of the past, entirely.

What may surprise many is the fact that price falls to the bottom of the “key drivers” list. When considering medical travel — domestic, inter-regional or international — patients want to know they’re getting the best available deal on the highest quality service, but, in addition, they also want to be aware of all costs involved. This is where package pricing becomes important.

Package or bundled pricing is becoming more prevalent because the Affordable Care Act (ACA) has placed stringent demands on medical facilities for price transparency. At a base level, package pricing will include fees for the hospital physician and anesthesia/pathology professional.

But, what we believe is gaining in popularity, and what more and more medical exchange patients are going to look for, is all-inclusive package pricing, which typically includes all fees associated with base-level package pricing plus airfare, hotel and general transportation.

Key Players: Who’s guiding the way for medical exchange patients, and how?

Medical exchange has to be a carefully coordinated and attentive to the relationship between a patient and a broad network of participants including an impressive slew of referral sources. But, “referral source” doesn’t relate only to a referring physician; referral sources include government agencies, brokers, insurance companies, physicians, facilitators and other thirdparty administrators (TPA). Each can help serve as a patient’s eyes and ears as they navigate through their medical journey, and can be a weighty influence on the patient’s decisions.

Key drivers for patients considering medical exchange options are quality, familiarity and price, all of which should be taken into consideration by medical exchange providers and referral sources.

The challenges within this vast system of referral sources are many, particularly, when coupled with all the other moving parts inherent to medical exchange. That is why medical exchange programs are quickly on the rise.

Unlike facilitators, TPAs, government agencies and other referral sources, all of which focus on a single or niche aspect of the patient journey, medical exchange programs gather every referral source and make them part of a systematic network, which also includes a collective of partner hospitals, surgery centers and independent physicians. Directors of a medical exchange program are then able to manage all coordination relating to all aspects of the patient journey on the patient’s behalf.

There are four key benefits to working with a medical exchange program including broader geographic choice for the patient, both standard and all-inclusive package pricing, comprehensive concierge services and a cost structure that imparts no charge to the patient or main referral source.

It’s an intricate establishment, but proving to be the most successful means of finding medical travelers the best treatment, for the best price, in the smartest location.

But how does it work?

Because patients are decreasingly concerned with the snazziness of their medical destination, the facility and physician networks associated with a medical exchange program are key components: they provide freedom of choice in both geographic location and, depending on the procedure needed, present multiple clinical options. This freedom of choice puts patients more at ease because rather than being told where to go, they are given an opportunity to weigh in on which options they feel are right for them.

In conjunction with this, because medical exchange programs have direct relationships with the facilities and physicians in their network, they can negotiate package pricing options that keep cost structures transparent and assist in patient budget planning.

Depending on patient need, package pricing options may be standard, with procedure and professional fees only, or all-inclusive, to account for airfare, accommodations and general transportation.

Perhaps, one of the more unique benefits to working with a medical exchange program is the availability of comprehensive concierge services. The overarching goal of a medical exchange program is to make medical travel possible, affordable and accessible. Concierge services go a long way toward achieving each of those.

These services revolve around a patient coordinator who delivers personalized service to patients and assists in all communication between patients, physicians, providers and other participating parties (government entities, insurers).

Generally, this service-oriented architecture is built around a scalable health information website and comprehensive medical travel booking portal that also tracks and facilitates follow-up care.

Numbers: How people manage medical exchange costs and where does insurance factor in?

Cost is a curious topic when it comes to medical exchange. Perhaps, it’s because even though package or bundled pricing, as previously mentioned, is crucial to offering patients the best deals and winning their decisions, it’s a feature that so many facilities fail to offer.

Focusing just on the United States, facilities are scrambling left and right to determine package pricing options for both their traditional and exchange patients because the ACA is demanding transparency on all fronts. For those who want to capitalize on medical exchange as a growing trend, package pricing is not an option — it’s a must.

To offset costs associated with medical exchange, which are already offered at a discount when working through a program, insurance companies, government agencies and even self-funded employers are now offering incentive and assistance for medical travel.

Select government agencies have funds specifically allocated for what they consider “special needs cases” and these reserves are often directed toward medical exchange, particularly, when the needed services are not offered in a country.

Many self-funded employers are learning that sending employees out of state, or, in some cases, out of country for medical care because of sharply reduced rates is in their best interest.

Many self-funded employers are learning that sending employees out of state, or, in some cases, out of country for medical care because of sharply reduced rates is in their best interest. Just last year, ABC News reported on a company that claims to have saved nearly $10 million in a five-year period by outsourcing medical care through medical exchange.12

As for insurance, major U.S. carriers are now offering coverage for medical travel, and even dental providers are starting to offer benefits for procedures carried out overseas. According to a January report in Corporate Wellness Magazine, as select carriers expand their coverage options to include medical procedures overseas and across borders, others will follow suit so as not to lose their competitive edge.23 I certainly agree with that prediction.

Future: How will this industry continue to evolve, and how should providers evolve in response?

The bandwagon effect is reaching full swing for medical exchange, and if the recent past is any indication of the immediate future, medical exchange is going to grow. Not only that, it’s going to grow exponentially as patients continue to demand borderless healthcare options, medical exchange programs continue to expand their networks, and insurance providers continue to expand their coverage of cross-border procedures.

For those looking to play a key role in the industry, now is the time to become knowledgeable of and practiced in the requirements and expectations of both exchange patients and their referral sources. Plus, the networking and alignment practices associated with medical exchange programs also mean new opportunities for physicians and healthcare leaders to learn from one another, further benefitting every nation’s patient community.

At its core, medical exchange, and even medical tourism, is about satisfying every global patient’s desire for efficient, effective, affordable healthcare, while generating new opportunity for those providers willing to heed the call.

So keep your ear to the ground and stay aware of the trends. Your opportunity to take part is here, because the newest wave of healthcare is unlimited by borders, driven by patients and dependent on those who are willing to redefine sustainable healthcare.

About the Author

As president of Nueterra Global Alliance (NGA), David Miller has created a culture of dedication, drive and efficiency, and grown the company’s provider network to include almost a dozen international and domestic partners.

In 2010, Miller was instrumental in creating the initial vision for NGA and since then has driven its success, compelled by his role in granting healthcare access to a global population.

Before NGA, Miller worked with Nueterra as a research and development leader and helped the company establish countless new departments, overseas partnerships and opportunities for growth.

In 1990, Miller entered the healthcare industry as a dental insurance salesman, but carried with him an intrinsic ability to relate to others and understand what motivates them — a characteristic that led him to quick success. In 2006, he became president of Humana and, in just two years, led his team to become number one within the entire Humana family.

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