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The Buzz @ C-Level


Last month, at about the same time The World Medical Tourism & Global Health Congress convened in ‘Frisco Bay, we held our own Healthcare Congress of sorts ~ an August group of CEOs, CFOs and HR Directors from a variety of local companies gathered by the ‘Bay in Green Bay, Wisconsin, USA.

For the last ten years,, inc., has hosted this Congress, and invited C-Level Executives to discuss/debate the hottest issues in healthcare, and in healthcare financing.  Everything from cost to delivery to plan design is on the table at these “no-holds barred” confabs.

In addition to inviting the Evaluators and the Buyers of Corporate Healthcare Plans, select Purveyors are invited, too; Payers, Providers & Peddlers of all sorts are either on the podium or in attendance.

An Aside:  Also in the House, the Media generally attends, which is surprising because reporters are chained to their desks these days.  Their beat is email, YouTube or a satellite somewhere; their boss rarely lets them out on the streets to build relationships, develop contacts and learn what the hell is really going on!   @butler must offer something very special for The Media to be in House, en masse.

Moving on.  During a presentation by the President of a very large Payer, a conservative, well-dressed (dare I say, mousey) Human Resource Director sheepishly grabbed the microphone and politely asked, “What are you guys doing about Medical Tourism? Will you be offering plans? Is this really the trend?”

The poor Payer was perplexed.  The crutch of the corporate power point was pulled out from under her, and she went down hard, “Um, well, I’m fairly certain we’re probably looking at something?”

My take away from that little exchange is this ~ Medical Tourism is now firmly in the vernacular of CEOs, CFOs and HR.  Even in the conservative, blue-collared, Heartland of the US, questions are being raised, discussions initiated, ideas bandied about…just as they were at the World Congress in ‘Frisco!

Another Aside:  Two years ago, we surveyed 500 CEOs in the Conservative Heartland about the concept of Medical Tourism.  Back then, we were surprised by our findings.  Today, we’re no longer surprised that Medical Tourism is in the vernacular, and HR Directors are asking questions.

Actually, when it comes to healthcare financing, the word “conservative” is the proper adjective to describe CEOs in the Heartland of Green Bay, Wisconsin.  Green Bay CEOs have long been developers, beta testers and adopters of innovative healthcare financing schemes.  In the last four years, Green Bay CEOs have been leading the entire USA in adoption of HSAs and HRAs (Health Savings Accounts & Health Risk Assessments).  Our study two years ago shows Green Bay on the leading edge on Medical Tourism, too.

“Not surprising,” Dr. David Wegge told reporter Gary Mogel of the Investment News. “Green Bay is a pretty sophisticated health insurance market.”

The Northeastern Wisconsin market is home to roughly 8,000 people in the health insurance/employee benefit field:  UnitedHealthcare, Humana, and Cypress Benefit.  Administrators as well as a host of agencies and consulting firms are all successful, “home-grown” ventures.  And over the years, there has been a lot of “cross-pollination” within the various segments by innovative, creative, entrepreneurial employees seeking greater challenges and more opportunities in this dynamic market.

Wegge, a professor at St. Norbert College in DePere WI, works with Nicolet National Bank and conducts regular studies of this marketplace.  The Nicolet National Bank Business Pulse© has been conducting CEO studies in Northeastern Wisconsin for 28 consecutive quarters.  Healthcare is always a Hot Button issue for CEOs.

Wegge and Nicolet Bank have quantified the fact that Green Bay CEOs are, indeed, on the leading edge in healthcare financing.  Besides all the quantifiable data, that “leading edge” moniker is best illustrated by that mousey, HR Director standing up and challenging a Payer to get off the Powerpoint and on to her plate.  “How are we going to cut benefit costs; how are we going to access affordable and quality care; how will we remain competitive in a global market; how can we attract employees with a health plan that ships ‘em off to Timbuktu for a tonsillectomy?”

HR is no longer the Hiring, Firing and Policy Enforcement Department.  It’s the Business Competitiveness through Benefit Innovation and Creative Healthcare Financing department.   When HR gets its answers, healthcare delivery across the world will change quickly.   For now, HR is asking tough questions, ‘kicking butt and taking names.

Yet Another Side:  In one of the old “Dirty Harry” movies, Clint Eastwood’s character gets transferred from Homicide to HR because his boss was mad at Harry for shooting up The Bad Guys without regard for their benefits.  Harry crinkled his nose, scowled at his boss and barked:  “Personnel?  That’s for a…holes!”  (And your point is, Harry?  “Personnel” is even tougher today!  It’s asking probing questions because butts are on the line!  Jobs are, too!)

Unfortunately, Payers don’t have answers.  Trying to recover from the question, the Payer said, “We currently don’t cover surgeries scheduled out of the country because we don’t have the capabilities to track outcomes for physicians and facilities the same way we can in the U.S.”

Last Aside:  Surely Payers have some kind of arrangement for providing coverage or reimbursement for unexpected medical care received by companies/employees already in The Global Market?  And shouldn’t they be able to gather whatever data they already have, contract with a preferred provider or two, build a plan, set a price and go to market?

Medical Tourism: Consumers in Search of Value is a report released last month by The Deloitte Center of Health Solutions.  This study of 3,000 Americans looks at the innovations that may/will be disruptive to people, payers and providers in U.S. The Executive Summary stated,

The value proposition in a consumer transaction involves consideration about price, quality and service.  Segments of the market value the three differently based on needs and wants. In healthcare, price hasn’t been a factor to many since consumer out-of-pocket expenditures are only 19% of the total. However, that percentage is increasing and price sensitivity is soaring, especially for those with high-deductible insurance. The growth of medical tourism might be a signal as to how consumers calculate their value proposition weighing all three – price, quality and service.

So, what does that mean for Payers?  Deloitte said, “Outbound medical tourism provides health plans additional network options for cost-effective care that can be incorporated as features in group and individual products.”  (Hooray! A plan exists for the Peddlers to market.)

What else does it mean for Payers?  “Health plans may need to decrease premiums for employers who send employees abroad for major, non-urgent surgeries.”

Wait a minute.  May need to decrease premium?  Isn’t the prospect of a little cost relief the main reason we’re talking about off shoring our employees in the first place?  Is there any other reason for CEOs to take the risk of flying their valued employees 12-time zones away other than saving a couple bucks on premium?  You try selling that to your employees.  It’s not all about quality; it’s not about convenience.  Show me the money, baby!

What does it mean for The Providers?  “Outbound medical tourism means that the concept of off shoring will now hit physicians and hospitals – industries never thought to be at risk for global competition.  For example, West Virginia recently passed a bill to send state employees abroad for treatment,” according to the study.

What about the Regulators?  Deloitte reported:  “Outbound medical tourism is a complex regulatory issue: Medical liability, risk management, oversight of devices and prescription drugs, credentialing of providers, et al, are more complicated offshore. It is not likely that the government will direct enrollees (Medicare, Medicaid, FEHP) in the direction of outbound medical tourism,” [unless, of course, you’re a Regulator in West Virginia], “but it is plausible that barriers will not be created for commercial plans, employers and individuals.”

And what does this all mean for The Poor Buyers of Health Plans…those tortured CEOs and the HR Directors who, after umpteen years of double-digit rate increases, are still trying to keep their ship afloat by floating ideas like offshore medical care to their employees?  Deloitte reported:  “Outbound medical tourism will become an interesting option for employers as a cost-management hedge for services that are safe, effective and less costly.”

BINGO!  Now we’re talking…

And we’re not just talking in ‘Frisco Bay, but in Green Bay, Tampa Bay, Thunder Bay, Half Moon Bay, Murrow Bay, Coos Bay…It’s in the vernacular.  Now, walk the talk.

The Very Last Aside:  Catbert, the Evil Human Resources Director of the “Dilbert” cartoons, was addressing employees.  “We’re instituting a mandatory stretch period every day.”  One employee speaks up.  “That’s surprising because Human Resources usually doesn’t care about employee wellness.” The Evil HR Director replies, “Phase One is just to get you good and flexible.  Phase Two involves a new place to tuck your head.”

aBuzz about The Author:  He fancies himself the Dirty Harry of Insurance (Big Gun, Big Mouth, Big Deal).  In reality, Michael Bina is Inspector Clouseau.  Nearly 30 years on his beat, he’s bumbled his way to a successful career in the health insurance racket; he’s worked with charlatans, characters, geniuses – a few criminals, too.  Today, his beat is Global; his new fancy is: “Bond, James Bond.” “Dude:  Where’s I park my Aston-Martin?”

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