THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL

Volume 2, Issue 10

Dear Colleagues,

A new trend has emerged in the domestic medical travel space: Small to mid-size employers are taking advantage of direct-to-provider contracts with bundled pricing.

Mark Kendall, senior partner, Hub International Midwest Limited, reiterates that while many large employers - 25,000+ employees - have already begun to implement a medical travel offering for planned surgeries, the small to mid-size employers are working to receive the same benefits.

Kendall details the challenges that small to mid-size employers face as they try to offer a medical travel benefit to beneficiaries, as well as how he is working to help the employers provide access to high-quality, affordable care.

Additionally, I had the privilege of conducting a "Meet & Greet" with Michael Thompson, the new president of the National Business Coalition on Health. Read on to hear what initiatives Michael has underway for the group.

Self-insured employers of all sizes are re-evaluating the size and scope of their networks to ensure that individuals are accessing quality care at the most cost-effective sites. This new trend will be on my mind when, once again, I chair a panel presentation at SIIA's upcoming Annual Meeting in Austin, Texas, September 25-27, 2016.

Judging from the turnout and enthusiasm at last year's event, I am certain that this year will be even better.  Take a look at the speakers - high profile leaders who are positioned to make these decisions for the marketplace.  http://www.siia.org/

Whether you are an employer, provider or intermediary, you will want to attend. Look forward to seeing you in September!

We're starting to hear from many hospitals, independent surgi-centers and provider groups that want to be better positioned to serve self-funded employers offering medical/surgical travel options.  If you have a good story to tell us, please be in touch!  We want to boost opportunities for Centers of Excellence nationwide. 

Tell us:
What distinguishes your service offering in terms of cost, patient experience and satisfaction, outcomes, or other quality indicators. 

Send us your descriptor, including photos or charts, and we will evaluate for publication in this newsletter.

"Rising health insurance premiums, lack of transparency and increased awareness of how varied medical costs and quality vary dramatically between hospitals and across regions, have pushed consumers right into the arms of international and domestic medical travel. The growing industry provides the perfect solution for patients to receive the high-quality, cost-effective care that they need AND rightfully deserve!" - Laura Carabello, Executive Editor and Publisher, Medical Travel Today and U.S. Domestic Medical Travel.

READERS: I invite you to send quotes relevant to domestic medical travel to editor@usdomesticmedicaltravel.com to be featured in upcoming issues of U.S. Domestic Medical Travel.

Thank you for your interest in this exciting, growing market space. Please be in touch with your comments and editorial contributions, which can be sent directly to: editor@USDomesticMedicalTravel.com.

Laura Carabello
Editor and Publisher

 

SPOTLIGHT: Mark Kendall, Senior Partner, Hub International Midwest Limited

http://www.hubinternational.com/

About Mark Kendall
With 30 years' experience in the corporate employee benefit industry, Mark has a proven record in consulting corporations. His core competencies include alignment of strategic and tactical objectives of Fortune 500 corporations to enhance their own future financial position with their total rewards plans and with the insurance carrier. Starting his 16th year in consulting, Mark has created over $150 million in documented savings for large corporations and their employees relative to their plans.

Mark is a senior partner at Hub International located in their Chicago office. Hub International is the largest privately held brokerage in the U.S. with over 8,500 employees serving customers in North America. Mark has worked with many of the Fortune 500 companies over his consulting career, including Accenture, W.W. Grainger, Gannett, HCR ManorCare, HSBC, JohnsonDiversey, ArcelorMittal, Presence Health, United Airlines, Union Pacific Railroad and Reyes Holdings.

Prior to his consulting career, Mark's carrier background includes leading the Chicago operation of Unum and leading Prudential Financial's Midwest operation. Throughout his career, Mark's experience also includes extensive training to the industry, product innovation and development specifically directed towards national account sized multinational companies.

About HUB International
HUB International was formed with the merger of 11 privately held Canadian insurance brokerages in 1998. Today, we are ranked among the largest insurance brokers worldwide.

The entrepreneurial spirit that formed HUB is evident today in the way we do business. Our company is organized around large regional offices with over 330 satellite locations. Our structure enables us to be proactive in addressing local market needs while centrally managing the growth of our business with consistent standards.

While global, our strength lies in our commitment to the communities we live and do business in. We are here to help you evaluate your risks and develop solutions that are tailored to your needs.

 

U.S. Domestic Medical Travel (USDMT): Direct contracting between employers and providers is clearly a trend. What are your perspectives?

Mark Kendall (MK): First and foremost, we have to start any strategy with creating a ‘member-centric' approach.  Every entity involved in the delivery of healthcare needs to put the member in the center of the strategy and build it out from there.  We don't do a good job of that right now.  Employers, hospitals, carriers, TPA's, consultants, brokers, Rx, vendors - all have a responsibility in creating a better solution in the coming years. We can't sustain these continued year-over-year increases, can we?

From an insurance carrier standpoint, it can be difficult to create a platform that allows for employers to offer employees a plan benefit that can help them manage costs for "planned surgeries." Such as knee and hip replacements, spinal fusions, and heart bypasses. It should not be this difficult.

Many health insurance companies, serving employers as their claims-paying administrator, have allowed the largest employers - 25,000+ employees - to implement a medical benefit for planned surgeries. So, I'd really like to see the mid-size to small employers - let's say 1,000 employees plus - to receive the same benefits. But, here's the problem: The carriers have little incentive to do this and maintain to the employer that they are providing this service already which isn't entirely accurate -- certainly not to the level that it should be. Ideally, this type of benefit carve out should be available for any self-funded employer.

About five years ago, I asked a major carrier to tell me how many Centers of Excellence (COEs) they had in their transplant network, and do you know what their answer was?

USDMT: One?

MK: Surprisingly, it was the polar opposite. The carrier informed me that they had over 100 COEs in their transplant network. And, what good does that do for the patient? How many COEs do we have for complicated heart surgeries? Back surgeries?

Unfortunately, carriers can't seem to eliminate certain COEs from their networks because they are needed for other routine and specialty procedures within their local markets. And hospitals put the pressure on the carriers to keep them in their networks, and so the cycle continues. In the meantime, employers keep paying the bill for it all. Why?

USDMT: How can the mid-size employers enter into this market?

MK: This is what I am working on, but it is very difficult to get enough employers and TPAs together to develop a plan in a certain timeframe.

There are so many different players in the healthcare continuum that once the insurance carriers get onboard with the employer's demands, then you've got to have the hospitals participate in bundled pricing and output results, followed by the hospital billing system, and so on.

Unfortunately, we have to attempt to figure this process out manually most of the time, rather than with the help of technology.

A recent survey documents that insurance companies are utilizing the worst technology systems in comparison to any other major industry, yet they have the biggest coffers to invest in it. And then we have to integrate with hospital billing systems, as well. So, many times, it's a matter of bypassing all of these integration issues and having a separate TPA handle these planned surgeries. We are getting closer to making it more routine for sure, but the carriers are not making it easy.

USDMT: Would it be effective for mid-size employers to have purchasing coalitions so they would be able to aggregate their volume and increase their purchasing power?

MK: I think this would be a great option to explore, and some have already started. The use of captives for smaller employers is also a burgeoning strategy we are exploring to accomplish this answer.

Due to technological reasons, some carriers are allowing outside TPAs to take over their claim processes. Many of the TPAs that are independently owned have access to newer technology and can administer multiple plans, enticing some of the carriers to rent out their networks. Although this is few and far between, it is a start in allowing mid-size employers to carve out the benefits they want on their plans.

By having the option to choose between four or five different COEs, the employer is going to save money by requiring second opinions and avoiding unnecessary surgeries. Too often surgeries are performed on patients who do not need a procedure. Cost avoidance on these unnecessary surgeries is one of the main cost saving strategies for self-funded employers. And think about the impact on the employee who has a surgery that could have been avoided with a less invasive alternative. Requiring objective second opinions is critical.

USDMT: What are your thoughts on the disparity of prices?

MK: This is where software and transparency tools can come into play for employers of all sizes. For example, if the tools are available, some employers are able to note the value of an MRI within, let's say, a five-mile radius. With more of the responsibility for healthcare costs being passed to the employees, we have to start educating our members of benefit plans about the huge disparity in pricing on the same procedure within the local markets, and there are very good solutions available.

As advisors, we innovate wonderful solutions, but their effectiveness can only be maximized when members engage with the program. Service steerage, precertification requirements and concierge handholding can all be shortcuts to this engagement, but ideally we want members learning how to be medical consumers and making smart decisions for themselves. Consistent, ongoing education is key to this effort.

For example, there is a significant number of benefit plan members who believe that they only have coverage at the hospital nearest to them. So many individuals do not realize that their network allows them to receive care at a COE on the other side of the country, or even the next big city closest to them.

The overall education on healthcare will begin to start increasing as a result of the multiple HRA and HSA plans that are now available. Americans need to become more informed healthcare consumers, and we have to give them the tools to do it.

USDMT: And that has to happen under self-funding?

MK: Most companies with more than 400 employees now self-fund.

We can break down cost spending very easily. For instance, employers with 10,000 covered lives spend about $100 million per year on healthcare - that is what companies are spending - 100 million dollars! We all agree that five percent of members create about 65 percent of the cost, then five percent of the 10,000 members equals 500 members - and those 500 members are responsible for creating a $65 million cost to the employer's plan. The other 95 percent, or 9,500 members, cost the company $35 million. Those five percent need our help, and we should have a laser light on finding solutions for them. This is true for any self-funded group - the numbers are lower in spend obviously for smaller companies but the percentages hold true.

Of course, the ultimate goal is to lower the amount of spend the five percent creates for the plan. Regardless of employer size, there will always be that "five percent" of their population driving most of the cost, which makes the specialized healthcare information valuable to a company with 10,000 members or 600 members!

USDMT: What are some of the productive ways to cut costs?

MK: All plans need to work on becoming smarter about cutting costs - and one way to do that is to avoid unnecessary surgeries. I understand you cannot avoid a car crash that puts a member into a coma for a year, but in terms of scheduled surgeries, a member should have no less than three surgeons provide an opinion on the necessity of the procedure.

When a surgeon tells a member that he or she needs a spine surgery, for example, why is it that we as patients just schedule the procedure right away without a second or third opinion?

The way this can happen in the employer setting - which dominates the way employees are covered in the U.S. - is through continued education offered through an employee benefit plan and educating our members on their options when faced with a planned surgery event.

USDMT: How can we generate the same level of interest and utilization of these COEs among employers of all sizes?

MK: This is a difficult concept to figure out because different geographic areas deliver care at different prices with a wide variation in output results. Some so-called COEs employ more highly trained specialists than others, and then how can you evaluate their output results? And some hospitals are very good on orthopedics for example, but may not be a COE for women's health. Of course, safety outcomes can help with this evaluation- but at the same time, not everyone can agree on safety standards.

What we really need are hospitals that are willing to post their pricing prior to a planned surgery and be willing to share output results for those surgeries with the employer. And yes, there are some hospitals that have agreed to this very logical starting point of protocol.

In essence, that is what Wal-Mart did. Wal-Mart told providers that if they wanted to treat their employees then Wal-Mart had to know the data beforehand.

USDMT: Wal-Mart has the purchasing power - but can the middle market come to the same conclusion?

MK: Certainly the mid-sized employers can do that. They need to decide on the top four procedures to offer and mandate a second opinion before executing any surgical decisions. Likewise, many self-funded employers do not realize they can carve out certain procedures from their plan to force greater scrutiny around them. If knee or hip replacements, for instance, were carved out of a plan, they would not be subject to network constraints and could be paid at different levels depending on where the procedure occurs. Employers could also significantly narrow the acceptable network of providers for these procedures based on quality and cost data.

USDMT: I receive a tremendous number of inquiries from groups, employers, hospitals, etc., asking, "How can we make this work?" I believe if there was a platform established, there would be a lot of positive market receptivity.

MK: I agree, there is already receptivity - no question about that. Ultimately, the employers have to demand a place in this market. We really need to have more employers willing to have the courage to develop a successful strategy. After all it's their money! It's a simple strategy but may not be easy in the beginning to navigate and execute. It can and is being accomplished. Many more than you know have already started and are accomplishing great success stories for their employees and their families. And that is what it is really all about - employers having the ability to provide a member-centric plan with access to high quality healthcare at affordable costs.

INTERVIEW: Michael Thompson, President and CEO, National Business Coalition on Health

www.nbch.org

Editor's Note: It's the beginning of a new era for the National Business Coalition on Health (NBCH), and Michael Thompson, incoming president and CEO, talks about his plans which are already underway.
Michael recently convened a conference call with leaders from the health and business communities to learn about the future direction of NBCH and the future role of its National Health Leadership Council - and I was lucky enough to get an invitation. Here are some of the highlights:

"I'll just set the stage that the NBCH is an umbrella organization of coalitions across the country, representing about 51 coalitions by 7,000 employers, 35 million people and the National Health Leadership Council, our multi-stake holder organization that brings together organizations that have national significance in health and healthcare.

Especially as we get into a consolidation type mode, I think you really are talking about a few key players in a lot of different sectors that collectively will be able to kind of change and improve the system. Historically, the NBCH has largely focused on value based purchasing. So the new mission -- as I define it -- is for NBCH, which is probably not as important as the collective coalitions, to really focus on empowering the employers and their partners to improve health, well-being and value in our companies, communities and our country.

All of that really matters, and is part of the reason I've been attracted to NBCH. My belief is that employers really are important in the context of shifting the system. I've been in the industry well over 30 years and with almost every change, other than Medicare, the major employers have largely driven through the system, and so when you look at the supply chain, I think employers are at the top.

Having said that, they can't do it alone, and they can't do it without their partners and their stakeholders. And I think that is what this organization and group is about - which is bringing people to the table that do play a major role in influencing the future directions. Frankly, many people want to influence those employers who will then influence plans who will then influence providers and pharmaceutical companies, etc. And so bringing people together to the table is very important.

When I think about improving health, I think we are underperforming as an industry, whether it is employers or health plans. Our health is getting worse, not better in spite of all the activity and the rhetoric around health.

I do think, in fact, that community-based population health efforts are going forward, and I actually think the coalitions play a very important role in facilitating and making some of that happen. I'd also say from the second tenet of well-being, it's is an area that many people have equated to wellness even though it is not what I think about well-being. When I think about well-being, I think about helping our people, our workforces to be all they can be to thrive and be at their best -- and that is an area that is underserved and ties into some key issues that are very important like mental health, social determinacy of health. I think as we take a bigger focus both on well-being within the companies, as well as well-being in our communities, it is going to have a broader impact on the overall system and then finally value.

I started by saying that NBCH and the coalitions have largely been focused on value based purchasing. I would argue that we haven't done a good job at defining what value is. I know having lived on the health plan side for many, many years (I was at a health plan for 17 years) that when health plans hear value they hear cost. And yet I know today that the things that do deliver great value to people are often times our challenge because they are costly -- and sometimes not even because they are costly, but because there is a cost to it.

I don't think that's what employers want. I think they want a more thoughtful and balanced approach as to how we pay for, how we deliver and how we receive care -- and I'd be glad to talk about that. One of the things I think is critical as we think about changing the system is that nobody can really do that alone, particularly when we move to the supply side of the system. It's one thing for the employers to influence their employees and even for health plans to influence their members. But once you get into trying to influence the delivery system it is very difficult for anybody to independently influence that in a significant way.

I don't think the health plans matter; I don't think individual employers matter; I don't even think coalitions of employers matter. I think what really matters is getting on the same page about what the agenda is and how we are going to influence that agenda.

In that regard, I think Medicare and Medicaid are very important, and employers and health plans being aligned around that will be increasingly critical. There is, of course, a lot of the system that is designed to help support and influence consumers, and how they get care and how they take care of themselves. But I think the supply chain isn't as clean as it once was.

We have a tool called eValue8 that we use to systematically look at all the various elements around evidence-based practices, and evaluate how health plans perform against that. Yet, when you look at the functions that we are evaluating for health plans to perform, many times employers don't even get it through their health plan. Whether you're talking about consumer tools or population health, if you're talking about wellness -- or even networks - increasingly there are other people doing those same functions and stepping in.

So I think as we think about supply chain, we are thinking we are going to have to modularize our thinking and engage more stakeholders in the mix in that conversation. Again, what makes the coalitions unique and what makes the NBCH unique is having boots on the ground across the country.

I've had people say why would you take that job? And I think because when you look at delivery reform and improving health in our communities and in our companies, I don't think it happens unless you localize it. And the infrastructure that already exists in our coalitions across the country is unique and won't be built again. The key is execution, communication and collaboration, and working together to make a difference.

There's a lot of topics we can talk about on this call. From my standpoint, the issues of the day are that you can't talk to an employer without talking about specialty drugs. You can't talk to an employer without hearing about population, wellness, improving the health of our population and how does that play into our strategies, our communities and our companies.

Private exchanges are a hot topic. Mental health, too. If there is any place in the system that is radically broken, it is mental health. Delivery payment reform, delivery and payment reform. Consumerism. Again, I think we are going to work with stakeholders to do what we can do to make it better to help use the leverage that our collective employers bring to move the system in the direction it needs to be moved.
Increasingly, one of the things I've learned in my first 30 days here is that none of the coalitions have it all. But if you look collectively the talent, the resources, the knowledge, the programs - we are going to find a way to leverage that across the coalitions, and we are going to accelerate the pace to change faster than any of these coalitions can do on their own.

I look at things like the College for Value Based Purchasing, the purchaser value network, even the innovation. Some of the innovation is happening with the vendors, but a lot of the innovation is happening with the employers. I'm hearing great stories as we talk to people across the country about the great innovators.

There is also the fact that so many of our coalition leaders are connected to people - like the people on this phone today -- whether it is NQF, or the LeapFrog Group, or Health IT Policy or MEDPAC. It is just an opportunity for us to bring it together and have thoughtful debate, and then independently empower our stakeholders to get better to get this right."

Q&A: Laura Carabello, Editor and Publisher, www.USDomesticMedicalTravel.com and www.MedicalTravelToday.com

Since many of our readers are interested in direct contracting with employers, I posed this question:

Laura Carabello (LC): I was wondering if you had any feedback on the Coalitions as far as their efforts or initiatives to contract directly with providers and hospitals that don't include perhaps the carriers.

Michael Thompson (MT): One of the things I am doing as we are getting started is a lot of outreach with each of the 51 Coalition directors. I've been on it for 30 days, and I've probably only spoken with 18 - 19 of them at this point.

But you do start seeing patterns in terms of what exists where. For some of the Coalitions, they are very active in direct purchasing, collective purchasing, group purchasing, and in some instances, they are quite successful in doing that.

They find that they bring a more holistic picture of what employers are trying to drive, and they are successfully delivering that to employers on a direct basis. I would say that tends to be found more in self-contained geographies that to some degree are underserved by health plans.

It gets a little harder when you are in these big metropolitan areas with very complex delivery systems all over the place that are very disjointed. It is a lot of infrastructure to build to do that. But having said this, it is more when they are building the whole thing. Again, I think there are multiple forms of transformation that are taking place.

One example is if you build the whole thing and develop contracts based on this alone. Another is looking at the Center of Excellence approach where you start looking at an episode of care type structure that includes bundled payments. That approach, I think, is starting to get much more legs.

Some of you may know David Lansky at the Pacific Group on Health where he has convened an initiative called the Purchaser Value Network. Simply put, it has really developed the framework for how to contract episode by episode within categories. It might start with maternity.

Many in the industry believe that a high percentage of the care could be contracted that way, and they received a grant. David has gotten a whole lot of grants, and he has gotten a grant to execute against this concept - not just in his area but to leverage it across the country as best as he can.

Earlier this month, David asked that we convene the Coalition leaders for a call to talk through how to execute through the Purchaser Value Network. In other regions -- and to his great satisfaction with the sponsorship with the National Business Coalition on Health -- he had over 60 people on the call...and we only have 51 Coalitions. It was an hour call, and he set a date.

So will that expand? How quickly will that expand? Absolutely it will expand and Coalitions will rely on each other to execute that. We will get grants to make that happen.

There's a couple of other good examples where leaders are taking these best practices from one Coalition and applying them more globally. Larry Boress at the Midwest Business Group on Health created a whole initiative around onsite corporate clinics. He has done some joint efforts down in Tennessee around onsite clinics, bringing multiple coalitions and coalition employers together to talk about what is the current state of these clinics happening in Tennessee.

Laurel Pickering in New York has done incredible work in workplace mental health. I happen to be close to that because it is an area where I am very familiar and gratified that it is now being exported. We just had a conference out in Chicago on workplace mental health leveraging the work that came out of the Northeast Business Group on Health.

So this is not a D.C.-based initiative -- this is a countrywide initiative that leverages a great deal of talented people across the country and that has access to employers in all of these communities. Some of the small Coalitions are increasingly looking for support and depending on the more sophisticated Coalitions to help them get better and help support the employers in their community.

One of the initiatives we have underway is called the College for Value Based Purchasing. It is actually a one-two day seminar where we bring in Coalition leaders - some of the more sophisticated Coalition leaders across the country to educate employers in a community where the employers can benefit from the expertise that exists collectively across the country.

I think it is a mistake to see the NBCH as a small D.C.-based operation. The value of the Coalitions is the collective of all the Coalitions and the leadership that our little group in D.C. brings to this.

36th Annual National Educational Conference & Expo
September 25-27, 2016 • JW Marriott Austin • Austin, TX

SIIA's National Educational Conference & Expo is the world's largest event dedicated exclusively to the self-insurance/alternative risk transfer industry. Registrants will enjoy a cutting-edge educational program combined with unique networking opportunities, and a world-class tradeshow of industry product and service providers guaranteed to provide exceptional value in four fast-paced, activity-packed days.
http://www.siia.org/i4a/pages/index.cfm?pageid=4400

PRESENTATION SESSION:
Monday, September 26, 2016
TIME: 1:45 p.m. - 3:00 p.m.

"Taking a page from the travel surgery playbooks that the large, high-profile companies have followed over the past few years, mid-size or smaller employers and plan sponsors now recognize that the site of service significantly impacts the quality and cost of care. These are the keys factors in selecting where to have procedures performed - everything from MRIs and diagnostics to complex surgeries. 

Learn how TPAs, brokers and employers are educating and incenting employees to make better choices - from reducing coinsurance to eliminating copayments, paying travel expenses or cash rewards.  The goal is to help employees seek the right care, at the right time, and in the right place - in or out of current networks."

Panel Chair: Laura Carabello


Editor and Publisher

 

777 Terrace Avenue
Hasbrouck Heights, New Jersey 07674
201.641.1911
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Laura Carabello, principal and chief creative officer, CPR Strategic Marketing Communications, is a strategy consultant in healthcare and technology who has more than 25 years of experience in positioning public, private and non-profit entities in medical travel, health information technology, managed care and employee benefits, and life sciences. Carabello presents and chairs numerous industry conferences, and has testified before the U.S. Federal Trade Commission on healthcare advertising and marketing ethics. The recipient of multiple leadership and humanitarian awards, Carabello serves as a member of the Board of Directors of the YWCA of Bergen County. She received a B.S. in Journalism from the Newhouse School of Communications at Syracuse University.

Panelists:
Simeon Schindelman, CEO, Brighton Health Plan Solutions


One Penn Plaza, 46th Floor, New York, NY 10119
Office Phone:  212.485.9017

Combine a commitment to multiple market stakeholders and a passion to empower individuals and families with the healthcare tools that they have long desired, and you'll have an introduction to Simeon Schindelman, CEO, Brighton Health Plan Solutions (BHPS), parent of MagnaCare LLC, MagnaCare Administrative Services, as well as a brand new commercial health plan currently in development.

Simeon is responsible for all aspects of these businesses including current performance, as well as establishing and implementing strategic priorities that will enhance future success.

Effective and transformative innovation is Simeon's personal trademark, and he will draw upon his broad management experience, leadership expertise and deep understanding of the varied participants in the healthcare marketplace to drive the growth of BHPS.

Given his demonstrated success building businesses that transform the traditional approach to healthcare, and proficiency in working with plan sponsors of all size and scope, Simeon is powering a business model that leverages data analytics, consumer service, and advanced technology to deliver personalized healthcare solutions. He is recognized for incorporating high-touch, thoughtful services that people value in virtually every aspect of their lives, but have been missing in their insurance and healthcare experiences. His formula is also designed to serve the targeted, unique needs of providers, employers and brokers, all of whom are key to bringing tomorrow's healthcare solution to the marketplace today.

This brand of forward-thinking management contributed to the success of his most recent leadership role as chairman and CEO of Bloom Health, Minneapolis, Minnesota (2012 - 2015), a leader in designing, building, and operating private exchanges. Simeon drove rapid growth that was catalyzed by a commitment to bringing consumers "knowledge, trust, and confidence."

Previously, he was senior vice president, Commercial Markets (2009 - 2012) at Medica Health Plans, Minnetonka, Minnesota, where he and his team created My Plan by Medica, an exceptional provider-oriented product developed in partnership with health systems. Over the years, he has held senior level management positions at several high-profile healthcare companies including a succession of leadership roles at UnitedHealthcare.

A graduate of Dartmouth College, Schindelman is determined to make a measurable difference in people's lives and bring about positive change. These are the hallmarks of his unique approach and vision for the success of BHPS.


Mark Kendall, Senior Partner, HUB International Midwest Limited

55 East Jackson Boulevard Chicago, Illinois 60604
Direct Dial: 312-429-2287
Mobile: 312-848-8298
Email: mark.kendall@hubinternational.com
www.hubinternational.com/midwest

With 30 years' experience in the corporate employee benefit industry, Mark has a proven record in consulting corporations. His core competencies include alignment of strategic and tactical objectives of Fortune 500 corporations to enhance their own future financial position with their total rewards plans and with the insurance carrier. Starting his 16th year in consulting, Mark has created over $150 million in documented savings for large corporations and their employees relative to their plans.

Mark is a senior partner at Hub International located in their Chicago office. Hub International is the largest privately held brokerage in the U.S. with over 8,500 employees serving customers in North America. Mark has worked with many of the Fortune 500 companies over his consulting career, including Accenture, W.W. Grainger, Gannett, HCR ManorCare, HSBC, JohnsonDiversey, ArcelorMittal, Presence Health, United Airlines, Union Pacific Railroad and Reyes Holdings.

Prior to his consulting career, Mark's carrier background includes leading the Chicago operation of Unum and leading Prudential Financial's Midwest operation. Throughout his career, Mark's experience also includes extensive training to the industry, product innovation and development specifically directed towards national account sized multinational companies.


Carrie Hatch, Chief Operating Officer, AmeriBen

3449 Copper Point Drive Meridian, Idaho 83642
Office Phone: (208) 947-9229
Email: CHATCH@ameriben.com
Website: https://www.ameriben.com/

Carrie has been with AmeriBen since 2004. As chief operating officer, she is responsible for Operations and is a member of AmeriBen's Executive Leadership Team. She oversees the Claims and Customer Care Centers, Provider Relations, Client Accounting, Plan Build, and Support Services. Carrie's exceptional attention to detail and ability to understand the complexities of the TPA business have been instrumental in the quality of AmeriBen's operations.

Prior to joining AmeriBen, Carrie served seven years as a project coordinator for a large executive consulting firm. Previous capacities she has served in here at AmeriBen include Accounting, Technology Services Center Analyst, and EDI Services Coordinator. Her internal advancement and contributions to the organization truly embody our Core Purpose as it pertains to developing great leaders.

Carrie received her Bachelor's degree in Accounting from the University of Phoenix in Arizona.

New World Medical Network Announces Agreement to Provide Significant Medical Savings Through "One Price Healthcare" Platform to Municipality in Botetourt County, Virginia
New World Medical Network Signs Contract to provide significant medical savings for Municipality; Botetourt County in Virginia. This 'Travel for Treatment' platform is unique with its all-inclusive "One Price Healthcare" (includes procedure, surgeon fees, anesthesia, hospital stay, hotel, nursing care and physical therapy on-site, if needed, and travel costs for two) and often saves significantly compared to the regional average costs for 70+ procedures.

New World Medical Network (New World) announces an agreement to provide its services to Botetourt County, Virginia, with the roll-out of the all-inclusive One Price Healthcare® quality domestic medical tourism platform that will not only provide their employees significant savings on select procedures, but also the assurance that the same transparent, reliable price for every procedure will be delivered.

"The leadership of Botetourt County has, like many municipalities, been searching for innovative ways to reduce their health costs without increasing deductibles and co-pays to the members. A strategy that includes transparent bundled pricing for elective medical services at prices less than the regional average can help save the County money and provide quality healthcare services to the members. When these savings are shared with employees, a major family budgeting need is also addressed: out-of-pocket costs. These savings are available for both employer and employee by using New World's network of quality services from providers located in Oklahoma, Georgia and New York. This new transparent, bundled price model for members who elect to travel for treatment marks a pivotal shift in the way healthcare is delivered in the United States. We are optimistic that our agreement will result in a win-win for both employer and employee,” shared New World's chief operating officer Terry Johnson.

“As administrative executives in today's governmental world, we have seen many of our costs rise, particularly as relates to health costs. Many factors have contributed to this issue, but we were surprised to learn of this new way to help reduce costs provided through New World Medical Network. We welcome the chance to both save money on health costs and to share these savings with our employees,” said David Moorman, deputy county administrator.

On the edge of a modern metropolitan area, Botetourt is a dynamic and vibrant county of rich and unique carefully protected and preserved historical and natural resources. Visitors from around the world are drawn to its mountains, waterways, scenic highways, historic and cultural attractions, and award-winning sports competition and entertainment venues. Businesses from across the nation and around the globe have located to Botetourt and enjoy advantages of reliable and responsive governmental and community partners, an ample and skilled workforce, low costs, superior access, and an enviable quality of life. To learn more about Botetourt County, call 540-928-2006 or visit http://www.BotetourtVA.gov.

New World Medical Tourism LLC (New World), is run by experienced healthcare and insurance professionals and caters to the self-insured marketplace - TPAs, companies, municipalities, and unions - with its one-cost, all-inclusive approach to non-emergent medical procedures and surgeries called "One Price Healthcare®." The New World Network consists of quality, accredited medical facilities within the United States, as well as Costa Rica, often saving organizations roughly 30-50 percent off U.S. costs for select procedures. The platform attaches to an existing health plan, achieved with a simple amendment to the plan document; there is no need for Open Enrollment and the program can be implemented at any time. New World can be reached at 800-475-PATIENT (7284) or by visiting NewPatient.Net.

To view the original release click here.

Some Firms Save Money By Offering Employees Free Surgery

WFAE.org-Lowe's home improvement company, like a growing number of large companies nationwide, offers its employees an eye-catching benefit: Certain major surgeries at prestigious hospitals are free.
How do these firms do it? With a way of paying that's gaining steam across the healthcare industry, and that Medicare is now adopting for hip and knee replacements in 67 metropolitan areas, including New York, Miami and Denver.

Here's how the program works: Lowe's and other employers pay one flat rate for a particular procedure from any of a number of hospitals they've selected for its quality. Under the agreement, the hospital handles all the treatment within a certain time frame - the surgery, the physical therapy and any complications that arise - all for that one price.

It was Bob Ihrie, senior vice president for Compensation and Benefits at Lowe's, who came up with the idea in 2010. When he told managers at other companies about it, he says, "The first question was always, 'Oh, this is just for executives, right?' And I said no, absolutely not, this is for any Lowe's employee in the Lowe's healthcare plans."

The program is optional for employees. They can still use their local surgeon, if they prefer, and pay out of pocket whatever their insurance doesn't cover. But more than 700 Lowe's employees have taken the company up on its offer, Ihrie says.

It's a great deal for patients, he says, and for his company.

"We were able to get a bundled price, which actually enables us to save money on every single operation," Ihrie says.

The Pacific Business Group on Health negotiates that price for Lowe's, Walmart and a number of other large employers. Associate director Olivia Ross oversees these deals, and says her team is able to negotiate rates that are 20 to 30 percent below what the companies used to pay for the procedures.

"We're seeing savings at the front end," she says, because Lowe's pays less for the surgery. And, because the hospital is responsible for all that care, the institution has a strong incentive to be careful and thorough, Ross says.

That means "huge savings on the back end," she says, "from things like reduced re-admissions, reduced return to the O.R. and lower rates of blood clots. Those are hugely expensive, preventable complications."
Lowe's comes out ahead, even after paying for the patient's travel, Ihrie confirms.

Participating hospitals win, too, by attracting more patients, says Trisha Frick, who handles such negotiations on behalf of Johns Hopkins Medicine in Baltimore.

"It's new business for us," Frick says. "And, for the most part, the reimbursement is acceptable; we believe that we can provide that, within that amount of money."

Medicare, the health insurance program for people 65 and older, started using bundled rates for hip and knee replacements this month in Miami, Los Angeles and 65 other metro areas. Medicare had some early evidence from pilot programs that "the model works well," according to Rob Lazerow, a healthcare consultant with The Advisory Board Company.

"Medicare is saving something like $4,000 on orthopedic cases," he says.

Medicare's deal is somewhat different from the one at Lowe's. Patients may pay something out of pocket, depending on the type of Medicare policy that insures them. And while the few hospitals selected in Lowe's program can bank on increasing their revenue and the number of surgeries they'll get, the rates established by Medicare's bundled payment system hold for every hospital in a participating market.

"Entire markets are selected for participating," Lazerow explains. "If you're in the San Francisco market or you're in the New York market, all of the hospitals are actually participating in the program."

But there are similarities, too, and Medicare may learn some lessons from Lowe's experience. Lowe's initially had trouble wrangling all a patient's medical records from local doctors. The company found that patients who had questions weeks or months after an operation sometimes had trouble following up with the out-of-town doctor who had performed the surgery.

"You have some setbacks, and things happen, and you just have questions," Ihrie says. "So what we give every patient now is a little card with the doctor's name and direct phone line and the nurse's name and direct phone line. And all of a sudden, things were a lot better."

Another lesson was startling, Ross says. In addition to cutting the cost of procedures, another chunk of savings to the companies came from avoiding surgeries that probably shouldn't happen in the first place.

"We're seeing up to 30 percent - close to 30 percent of cases - who should not be moving forward with the joint replacement," Ross says.

What typically happens in these cases, she says, is that employees get a recommendation from a local doctor that they should have surgery, only to have physicians at the selected hospitals deem the operation inappropriate.

In some cases that may be because the employee hasn't first tried less invasive treatments, such as physical therapy, Ross says. Or the employee may need to lose weight first, to make the surgery safer.
Ihrie says what heartens him most about his company's program is that Lowe's employees are now taking a more active role in decisions about their care.

"What treatment you receive is not always very black and white," he says. "The mere fact that people now think about what they're doing helps us control costs across the board."
This story is part of NPR's partnership with WFAE and Kaiser Health News.

To view the original article click here.

Philadelphia International Medicine and the Medical Association of Jamaica Announce Collaboration
Organizations come together to enhance physician knowledge, training and patient care

Philadelphia International Medicine (PIM) and the Medical Association of Jamaica (MAJ) have signed a Memorandum of Understanding (MOU) to establish a knowledge bridge between Philadelphia, a hub of medical innovation, and Jamaica, an island of medical sophistication.

PIM and MAJ have agreed to form a continuing medical education affiliation between MAJ physicians, and the doctors, surgeons and hospitals of PIM's network, which includes Temple University Hospital, Thomas Jefferson University Hospital, and Fox Chase Cancer Center. The affiliation will provide continuing medical education for Jamaican physicians through clinical training, knowledge transfers, symposia and medical technology.

Under the terms of this agreement, the Medical Association of Jamaica and Philadelphia International Medicine will focus on enhancing physician training and continuing medical education for the island's doctors, thus increasing the standard of patient care, hospital management and the quality of healthcare delivery to provide the best experiences for their patients.

"We are extremely excited to share such important news with our patients, our physicians and the country at large. Many of our local Specialist Physicians have been trained to international standards, but have been constrained in our practice by a lack of the equipment that are necessary to practice at first-world standards. In affiliating with Philadelphia International Medicine, the members of the Medical Association of Jamaica will be better able to meet the current and growing healthcare care needs of the communities we serve today, as well as play a critical role in helping to establish new standards of care through research, innovation, technology and medical training provided to our physicians. This means that with the knowledge-sharing arrangement, we can ensure that our local practice is current with international standards. It also benefits our patients as the PIM network is now available for patients to be transferred for specialist care in circumstances where the necessary expertise or equipment is unavailable locally," says Dr. Myrton Smith, president of the Medical Association of Jamaica.

The MOU will assist both organizations in establishing a formal on-going relationship that will build a "health gateway," linking members of MAJ to PIM and its network of seven hospitals, including four specialty hospitals and two medical schools for on-going training, university research and innovation, insight on new treatments and procedures, and more.

"This opportunity allows PIM hospitals to expand their teaching mission and establish relationships with Jamaica's healthcare community. We look forward to working with the Medical Association of Jamaica for many years to come, exploring ways both sides can enhance the health care of our populations and mutually sharing our innovations and best practices," said Leonard Karp, president and CEO of Philadelphia International Medicine.

To cultivate this relationship PIM will provide on-going continuing medical education (CME) exchanges beginning in May, which are expected to include quarterly video conferencing of clinical seminars, training in Philadelphia through peer-to-peer collaborations, in-person conferences, grand rounds and case reviews. Additionally, MAJ and PIM will collaboratively explore joint opportunities in Jamaica and in Philadelphia to provide comprehensive healthcare to patients of MAJ's network of surgeons and physicians.

About Medical Association of Jamaica 
Medical Association of Jamaica is the oldest professional association in Jamaica, which was constituted as the first overseas branch of the British Medical Association in 1877. The Medical Association of Jamaica is an organization of medical doctors committed to the enhancement of the professional and personal development of the members. It has over 2,000 members, including students, and recently celebrated its Golden Jubilee as an independent organization in June 2015. For more information visit http://www.doctorsja.com.


About Philadelphia International Medicine 
Philadelphia International Medicine (PIM) is a healthcare organization dedicated to bringing the services of seven prestigious Philadelphia area hospitals to the international community. PIM's network includes Fox Chase Cancer Center, Temple University Hospital, and Thomas Jefferson University Hospital as anchor organizations, and our affiliate hospitals include Wills Eye Hospital, Rothman Institute Orthopedics, Magee Rehabilitation Hospital and the Renfrew Center. To learn more visit philadelphiamedicine.com.
To view the original release click here.

Higher Prices for Children's Health Care Drove Spending Growth in 2014, While Use of Services Declined

New Report Points to Price Hikes for Prescription Drugs, Hospital Stays and ER Visits; Examines State Trends in Spending for Children's Health Care

Rising prices were the chief driver of growth in spending for children's health care in 2014, finds a new report from the Health Care Cost Institute (HCCI). A widespread drop in children's use of medical care that same year-a relatively new trend in HCCI's reporting-saw decreases in doctor visits, ER visits and hospital admissions, and lower prescription drug use, particularly for anti-infective drugs such as penicillin among younger children and babies.

Per capita spending on health care for children covered by employer-sponsored insurance (ESI) grew an annual average of 5.1 percent per year between 2010 and 2014, reaching $2,660 in 2014. At the same time, there was a general decline in the use of health care services between 2012 and 2014. Out-of-pocket spending on children increased an average annual 5.5 percent, to $472 in 2014. This growth was due in part to higher out-of-pocket spending on ER visits, which increased an average annual 11.7 percent or $21 per capita.

"The decline in children's use of health care services is a relatively new trend that we need to continue monitoring," says HCCI Senior Researcher Amanda Frost. "While we know that prices have fueled much of the spending growth in 2014, future research should examine whether these higher expenditures are leading to better health care outcomes for children."

For the first time, HCCI examined children's health care spending trends at the state level, reporting on Arizona, Connecticut, Florida, Illinois, Maryland, Ohio, Texas, Virginia, and Wisconsin, as well as the District of Columbia (DC).Among the states studied, Arizona had the lowest per capita spending ($2,151 per child in 2014), while Wisconsin had higher per capita and out-of-pocket spending than the national average in every year studied - reaching $3,017 per capita in 2014, and $577 in out-of-pocket costs. In 2014, DC had the highest rate of spending ($3,040 per capita), but lowest out-of-pocket payments ($362). High spending in DC was in part driven by an increase in the number of hospital admissions for sick newborns. Additionally, DC had the most ER visits as compared to the other states examined.

Additional Key Findings:

Prices for Brand Prescriptions More Than Doubled. Between 2010 and 2014, the average price per filled day for brand prescriptions more than doubled (from $7 per filled day in 2010 to $16 per day in 2014). As observed among other health care services, increases in spending were driven by the rise in the average price per filled day of a brand prescription, rather than use. In 2014, per capita spending for brand prescriptions rose 6.8 percent, the fastest spending growth rate for any service category that year. For generic prescriptions, the average price per filled day remained stable at $2 across all years studied.

Price Hike for Surgical Admissions. One influence on the increase in spending on acute inpatient admissions over they study period was the rising price of surgical admissions. In 2010, the average price of a surgical admission for a child was $35,423, and by 2014 it was $53,372 - a more than 50 percent price increase.

ER Prices Went Up, But Use Dropped. ER visits comprised eight percent of total health care spending per capita for children in 2014. Spending increased from $165 per capita in 2010 to $214 in 2014. The average price of an ER visit increased by $298 between 2010 and 2014. At the same time, the number of ER visits dropped from 181 in 2010 to 177 ER visits per 1,000 children in 2014.

Doctor Visits, The Most Common Service For Children, Declined:
Going to the doctor was the most widely used health care service for children. In 2014, there were 3,228 doctor visits per 1,000 children, down slightly from the previous year. Doctor visits accounted for 12 percent of the total per capita spending in 2014 ($339 per child), and was the largest share of health care spending for the average child.

"In 2014, growth in health care spending was largely due to rising prices," says HCCI Executive Director David Newman. "We hope policymakers, providers, and payers use this report to improve health care for kids."

The report presents the most up-to-date information on health care spending trends for privately insured children under age 19. It is based on fee-for-service claims for 10.2 million children per year who were covered by ESI. About half of the children in the United States were covered by ESI in 2014.

The report Children's Health Spending: 2010-2014 is available on the Health Care Cost Institute's website at: http://www.healthcostinstitute.org/childrens-report-2014.


About the Health Care Cost Institute
The Health Care Cost Institute was launched in 2011 to promote independent, nonpartisan research and analysis on the causes of the rise in U.S. health spending. HCCI holds one of the largest databases for the commercially insured population and in 2014, became the first national Qualified Entity (QE) entitled to hold Medicare data. HCCI's consumer-focused website guroo.com was launched in 2015 and provides national, state and local price information for nearly 300 health services. For more information, visit www.healthcostinstitute.org or follow us on Twitter @healthcostinst.

Contact:
Jemma Weymouth
301-280-5706
jweymouth@burness.com

Scripps Health to Help Run Hospital Along U.S.-Mexico Border
Joint venture with Mexican health insurer to meet needs of growing binational community
by Ilene MacDonald

Fiercehealthcare.com-Scripps Health will work with a Mexican health insurer to create the region's first hospital aimed to meet the needs of the growing number of Southern Californians who seek medical care south of the border.

To view the original article click here.


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MatchingDonors is a 501c3 nonprofit organization and the nation's largest online living organ donor organization finding living organ donors for people needing organ transplants. In conjunction with various health organizations throughout the United States we have created a very successful Public Service Announcement campaign to help people recognize that they can save lives by being a living organ donor, to encourage them to register as an altruistic living organ donor, and to make them realize they can help save the lives of people needing organ transplants by donating other things. This MatchingDonors Living Organ Donor Initiative program has already saved thousands of lives.

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36th Annual National Educational Conference & Expo

New World Medical Network Announces Agreement to Provide Significant Medical Savings Through "One Price Healthcare" Platform to Municipality in Botetourt County, Virginia

Some Firms Save Money By Offering Employees Free Surgery

Philadelphia International Medicine and the Medical Association of Jamaica Announce Collaboration

Scripps Health to Help Run Hospital Along U.S.-Mexico Border

Higher Prices for Children's Health Care Drove Spending Growth in 2014, While Use of Services Declined

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