THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL™
Volume 2, Issue 13
Corporations, third party administrators, brokers and others are burdened by issues related to back pain, which eighty percent of individuals will experience by the time they are 55.
To avoid costly surgical interventions, Winifred Bragg, MD, asserts the value of opting for a non-surgical route first, which often leads to lower costs, faster healing and a more rapid return to work. Read on to learn more about back pain and appropriate care methods.
Switching Gears: For employers and providers who are interested in getting involved with direct contracting, who should their first point of contact be? Third party administrators? Benefit advisors?
What about LAWYERS?
I spoke with healthcare lawyers, Lynn Shapiro Snyder and Anjana Patel of Epstein Becker Green, who describe their multidisciplinary roles serving as consultants, and legal and regulatory advisors.
Lawyers may get involved in the early stages of direct contracting, either on behalf of a self-funded employer or a provider, to fully identify the health regulatory issues relevant to direct contracting, and create, negotiate and execute a legal document.
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 key 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!
Please join me in congratulating our assistant editor, Megan Kennedy, on the birth of her son:
Greyson Ryan - Born on July 29th, 2016, 8 pounds 7 ounces.
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.
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 firstname.lastname@example.org 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.
Editor and Publisher
SPOTLIGHT: Winifred Bragg, MD, author, KnockOutPain® Secrets to Maintain a Healthy Back
About Winifred Bragg, MD
Winifred Bragg, M.D., FAAPMR, Diplomate, Pain Medicine, author, KnockOutPain® Secrets to Maintain a Healthy Back, is an expert in providing non-surgical treatment for injuries and pain resulting from spinal and orthopedic conditions. She has been featured in numerous broadcast and print media outlets, including ABC, NBC, CBS, FOX, Redbook, Women’s World, and Self magazine.
"Using Non-Surgical Strategies to Avoid Costly Surgeries"
Tailored programs for corporate meetings, roundtables, planning sessions and targeted seminars.
Company-Wide • C-Suite Executives • Human Resource Departments • Risk Managers • Team
Leaders • Safety Officers • Case Managers • Wellness Programs
- Understanding Non-Surgical Treatments of Low Back Pain
- Practical lessons that are proven to reduce costs and maximize work performance.
- Myths About Back Pain: Causes and Relief
- Educate and entertain all employees with opportunities to understand non-surgical solutions for their musculoskeletal injuries and pain management.
- Understanding the Difference Between Chronic Pain and an Addict
Training Programs to Avoid Costly Surgeries
- Warning Signs to Determine Whether You Need Back Surgery - 3 Defining Indicators"
- Practical lessons that are proven to reduce costs, maximize worker productivity.
- Reduce Your Costs Part I
- Non-Surgical Spine Specialist as the first option in the treatment of low back pain.
- Reduce Your Costs Part II
- How to choose the appropriate pain medications and management options.
- Reduce Your Costs Part III
- Secrets to maintain a healthy back.
- 12 Steps to Reducing Back Injuries
- Prevention is key to improving work performance and productivity while reducing absenteeism.
- What’s in your medicine cabinet?
- NSAIDs, over-the-counter-medications and prescription drugs can be harmful.
- Non-Surgical Strategies for Musculoskeletal Injuries
- Physical medicine and rehabilitation should be the first point of contact for treating musculoskeletal injuries and pain management.
Workers’ Comp Programs
- Shifting the Paradigm: How to choose the appropriate pain management options
- Using a non-surgical specialist as the first step in workers’ comp cases.
- Pearls for Adjusters on the Non-Operative Treatment of Low Back Pain
- Enhance Your Case Management
- Strategies to facilitate the most effective plan for treatment of low back pain.
- When to Choose Needles Over Knives
To schedule appearances, contact: WBragg@knockoutpain.com
U.S. Domestic Medical Travel (USDMT): Why is it significant for corporations, third party administrators, brokers and others to recognize the importance of avoiding back surgery?
Winifred Bragg (WB): Back pain is one of the leading causes of disabilities among people who are 45 years and younger, resulting in a growing number of missed work days for employees.
Additionally, eighty percent of individuals will experience back pain by the time they are 55. Back pain doesn’t discriminate against men or women, or blue or white collar workers.
Back pain and associated surgical interventions are a costly burden that corporate America cannot run from.
USDMT: When you speak to corporate audiences, what do corporations learn about back pain?
WB: When people think of other parts of the body besides the back, they tend to opt for non-surgical options prior to an invasive procedure.
However, when it comes to back pain, individuals tend to first consult with an orthopedic surgeon.
I always tell the audiences that I speak to that we need to explore all of our options before we agree to surgery.
A non-surgical route often leads to lower costs, faster healing and a more rapid return to work.
USDMT: Do you provide practical training for corporations?
WB: I have a conference that I conduct called ‘Twelve Steps in Reducing Back Injuries.’
The program shows attendees how to carry out every day activities in their home or office to reduce back pain.
A lot of back pain is mechanical - which entails lifting or sitting for prolonged periods of time.
My workshop is hands on and I can provide props that show individuals how to reduce the incidence of back pain.
USDMT: Does the program have application to companies where employees strictly have desk jobs?
WB: Absolutely - a lot of individuals experience back pain due to poor posture and prolonged sitting.
The same employees will go home after sitting all day and continue to clean, vacuum or do dishes in a way that causes additional back pain.
I have exercises that people can integrate into their personal or work lives to offset this pain.
USDMT: What have you found to be people’s greatest problems with their backs?
WB: The most significant problem seems to be lower back pain.
A number of individuals experience neck pain, but roughly 80 percent of people have a problem with their lower backs.
USDMT: How long should individuals consider non-surgical options prior to back surgery?
WB: Let’s say we are pulling weeds in our garden - the next morning we may wake up with back pain because we didn’t stretch properly before we pulled those weeds, resulting in a lumbar strain where the muscle goes tight and aches.
A lot of that kind of pain can disappear within a few days, and in 90 percent of cases it will go away within six to eight weeks.
It is when the pain persists for longer than eight weeks that individuals will need to have a diagnostic work up, usually with an MRI, to see what the cause of the pain is.
There are definitely certain medical conditions that can cause back pain, including certain kinds of cancers that can spread to the bone, leading individuals to believe they are experiencing a lumbar strain.
I’ve evaluated patients that were experiencing back pain that inevitably were diagnosed with prostate cancer that spread to the bone.
When I see a patient who hasn’t had a mammogram in a while and is experiencing back pain, I want to rule out breast cancer.
If a patient is above 50 and having worse pain symptoms at night - that is a warning sign and lets me know that I need to check for a malignancy. In these patients, I always ask if they are experiencing a fever, chills or night sweats, as well, to rule out cancer.
If a person is suffering from back pain with a loss of bowel and bladder control, that would be the number one reason to consider surgery.
Aside from fractures and loss of bowel or bladder control, most other issues can be treated non-surgically. If a patient says, "My leg is weak," and two days later it seems even weaker, than that may be an indication for surgery.
Individuals can often have back surgery without any positive results.
I would have to say the best outcomes with back surgery are in cases that deal with pinched nerves - which results in pain radiating from the back to an extremity.
My recommendation is to wait six to eight weeks prior to considering back surgery, and of course to make sure all non-surgical options have been exhausted first.
And, that being said, patients should always receive a second opinion. If both surgeons come back with completely different feedback, then I recommend a third opinion.
USDMT: Are there any guidelines for back pain related to sports?
WB: A lot of athletic injuries come from not doing preparation stretches and warm ups prior to working out or competing.
We tend to think that all athletic injuries are medial medical issues - and we neglect them - but not warming up is what causes the recurrent injury.
USDMT: What are your thoughts on women who carry heavy pocket books?
WB: This is my pet peeve - I often say that Michael Kors has helped pay for my house and car.
I continuously tell my patients that while Michael Kors makes a fabulous purse, it’s just made from heavy leather. When they put their change, wallet and umbrella into the purse, it can cause back pain. I recommend they choose the smaller purse.
I’ve gone to the grocery store and asked people if they’ve ever bought a watermelon mini wallet, which weighs about four pounds. I’ll say, "When you go to the grocery store and pick out two or three cantaloupes and a watermelon, do you put them in the grocery cart or carry them around?"
Of course, most of the individuals will say, "Yes," which is when I will then ask them why they insist on carrying around an eight pound purse then.
If you think about it - that’s like carrying around an infant. It increases your chances of back pain.
The same goes for children and backpacks. Children can use backpacks, but they can’t be too heavy because it increases the risk of back pain.
USDMT: This kind of advice is relevant for individuals of all ages.
WB: That’s right. Research suggests that even babies have back pain - I don’t know how the baby tells you that, but the literature does.
Back pain is experienced by children, women, men - everyone.
INTERVIEW: Epstein Becker Green: Leading the Discussion on Direct-to-Employer Contracting
Lynn Shapiro Snyder, Board of Directors and Firm Member
About Lynn Shapiro Snyder
Lynn Shapiro Snyder is a senior member of Epstein Becker Green in the Health Care and Life Sciences and Litigation practices in the firm's Washington, District of Columbia, office, and she is strategic counsel with EBG Advisors, Inc. Ms. Snyder has over 35 years of experience at Epstein Becker Green, advising clients about federal, state and international health law issues, including Medicare, Medicaid, TRICARE, compliance, managed care and FDA issues. Her clients include healthcare providers, payers, pharmaceutical/device manufacturers, and companies and financial services firms that support the healthcare industry. She publishes extensively and is a frequent speaker, particularly on topics related to health reform. Ms. Snyder is founder and president of the Women Business Leaders Foundation. www.wbl.org.
Anjana D. Patel, Firm Member
About Anjana D. Patel
Anjana D. Patel is a member of the firm in the Health Care and Life Sciences practice, in the Newark and New York offices of Epstein Becker Green, and serves on the firm's National Health Care and Life Sciences Steering Committee. She represents a diverse group of healthcare providers, including hospitals and health systems, ambulatory care facilities, post-acute providers, private equity funds, pharmacies and physicians, as well as various other healthcare industry suppliers and businesses. Ms. Patel represents clients in a variety of complex business transactions, including mergers and acquisitions, joint ventures, physician-alignment transactions, value-based and population health management contracting. She also provides guidance and compliance strategies with respect to issues involving federal and state healthcare laws. Ms. Patel is a frequent speaker on a wide array of healthcare issues and has authored numerous articles in various national and local healthcare industry publications.
About EBG Advisors, Inc.
EBG Advisors is a Washington, District of Columbia, based consultancy, affiliated with Epstein Becker Green, that takes a multi-disciplinary approach to helping healthcare and life sciences companies navigate the many obstacles that they face. EBG Advisors is a network of international attorneys, policy analysts, strategists and other professionals who specialize in providing coordinated guidance and solutions across various segments of the healthcare industry. http://www.ebgadvisors.com.
About National Health Advisors
National Health Advisors (NHA) is a consultancy (affiliated with Epstein Becker Green and the Oldaker Law Group, LLP) dedicated to the provision of legislative and regulatory advocacy. No other consultancy matches NHA’s depth of expertise in helping a wide range of organizations navigate and influence policies that affect the U.S. healthcare system. NHA gives health, education, and not-for-profit institutions a strong voice in the halls of Congress and throughout federal administrative agencies. www.nationalhealthadvisors.com.
U.S. Domestic Medical Travel (USDMT): What is your forecast for the growth of direct-to-employer contracting?
Anjana Patel (AP): Direct contracting is certainly growing, and for a number of reasons. One of the major reasons is the Affordable Care Act (ACA). With the implementation of the ACA, there is an emerging transformation in how providers get paid, which is a shift from fee-for-service payments to payments based on quality of care and efficiency. Initially, these initiatives were voluntary, but now they are becoming mandatory and providers have no choice but to engage in these value-based purchasing initiatives.
As providers adapt to this new reimbursement environment, the role of data analytics, transparency and cost management are being put front and center and becoming more important. Providers are becoming better at managing these issues and, with this expertise, are better able to compete for direct contracting business - not only to survive in this new environment, but also to thrive.
Additionally, over the last two years, everyone has been grappling with the looming introduction of the Cadillac Tax, which will be a non-deductible tax on the richness of an employer’s employee benefits. So employers now have a huge incentive to monitor their healthcare spend, and this has motivated them to engage in direct contracting.
These are some of the major factors at play when it comes to direct-contracting, and I think it is going to happen quickly in the near future.
USDMT: What is the role of a lawyer in direct contracting?
Lynn Shapiro Snyder (LS): As health lawyers, we have a combined role as consultants, legal and regulatory advisors.
In regard to direct contracting, sometimes attorneys will get involved in the early stages - either on behalf of a self-funded employer or a provider.
Many of our projects are multi-disciplinary and that requires us to work collaboratively with not only the inside team, but also with any other consultants that have been brought on board. As lawyers, our job is to make sure that we have identified the health regulatory issues that are relevant to direct contracting and then to create and negotiate a legal document to its execution.
Often times, clients ask if they should have the first draft of an agreement in place, or if they should wait for the other side to draft a document.
If an employer is looking for more of a request for proposal (RFP), then they would want to draft a document that outlines what they are looking for.
Whoever wants to be on the offensive should have the first draft. Whether they utilize the first draft of the original agreement is beside the point. Our job is to help with the negotiation process to obtain a successful outcome.
USDMT: When individuals think about providers, they immediately think hospitals - but we are not referring to only hospitals in this case. Can you please expand?
AP: Direct contracting is extending across the entire provider spectrum. While hospitals, especially, large health systems, may have originally been the pioneers in this area, we are seeing it extended to other types of providers, including large physician practices and urgent care centers.
LS: Exactly. There are many benefits that may not be as prominent in the group health plan and part of the reason some providers choose big ticket items is to lower the group health plan premium.
Direct contracts need to be customized to an employer. For example: Where is the employer located? How far is the employer from a Center of Excellence?
USDMT: Do you see the mid-size to smaller employers getting more involved in direct contracting?
AP: Direct contracting is not limited to large employers. More and more mid-size employers are also engaging in direct contracting. It depends on the needs of the employer and its workforce. Years ago, we would have been looking at self-funded employers with 500+ employees, and today, for the reasons I mentioned, we see self-funded employers with as few as 100 employees also engaging in direct contracting.
USDMT: If I was an employer who wanted to get involved in direct contracting, would you recommend the first call be to a law firm?
LS: I would say "yes" - because lawyers can help connect employers to the right contact. Additionally, we can help with the strategic planning that goes into direct contracting.
However, for employers, it can be difficult to get started because they really need to understand the realms of healthcare, healthcare reimbursement, claims, and more. For this reason, a lot of times the first call an employer makes is to the health benefits advisor.
On the provider side, lawyers are generally the first point of contact. Providers want to know how to get started and how a direct contract impacts their relationship with payers. Generally, lawyers are at least present during the initial stages of a direct contract on the side of the provider to help figure out the risk-reward analysis from a strategic standpoint.
USDMT: With Medicare mandating bundled pricing for joint replacement surgeries, do you see this trend impacting direct contracting along the healthcare continuum?
LS: The Center for Medicare and Medicaid Innovation has statutory authority that can be quite confusing. Not everyone realized what was in the statute under the ACA. Basically, the Centers for Medicare and Medicaid can implement a pilot plan, and if they are happy with the results, they can mandate the plan across the U.S. -- without going back to Congress to change the law.
Right now there is a collaborative initiative underway between American’s Health Insurance Plans, some of the private payers and the Centers for Medicare & Medicaid Services (CMS). They are attempting to bring commonality to the marketplace and uniformity to bundled payment initiatives and to outcome measures to minimize the complexity.
USDMT: Where do the carriers - the health plans - fit into this?
LS: A lot of carriers offer some type of third party administration (TPA). That being said, a lot of the health insurance companies play different roles, whether it is in claims administration, or working toward keeping the group health plan affordable.
USDMT: If you are a provider, can you look at contracting with employers that are outside your geographic location?
AP: Depending on the state, I think this is possible. It also depends on the needs of the employer and custom fit package that the provider can offer, so for example, telehealth initiatives can reach a broader base of patients.
LS: An employer can have 80 percent of their employees in one geographic area, and the other 20 percent sprinkled around the country. Employers in these circumstances try to have a direct contract relationship with a provider in the area where they can drive the most volume, and then they may incentivize the remaining 20 percent of employees around the country to fly to the contracted provider to utilize the competitive pricing.
USDMT: What advice would you offer to an employer who was deciding to enter into a direct contract?
AP: I think it is important to mention that direct contracts will not work unless the employees use the benefits. If an employee is not going to travel halfway around the country for a procedure, it is not going to work. The idea of customization is extremely important.
Providers must fully understand a particular employer’s workforce, and invest in patient navigators and care coordinators to ensure communication and convenience for the patients.
LS: If all parties involved in a direct contract put in the appropriate time and effort to have this form of relationship set up, they must also be in sales mode to turn around and sell the program to their employees.
AP: Additionally, the employers should understand that they may have leverage to shop for their customized narrow network of providers for direct contracting. With all of the consolidation that’s happening in the provider industry, also as a result of the ACA, everybody is aggressively competing for the same business.
USDMT: Is there anything else that you would like to share with our readers?
LS: Whenever there is a collaboration of multiple employers, the goal is to maintain a competitive market place, and not to have too much market concentration on either the purchaser or seller side.
Additionally, I think it is extremely vital that employers stay ahead of employee complaints and provide a central repository for issues to be addressed adequately and quickly.
For example, an employer could have a really great system in place, and one employee or their dependent can have a bad experience and blast information about the bad experience in a multitude of social media platforms.
AP: To add to that, employers can always build an employee satisfaction metrics into their program so the provider is also responsible for satisfaction results.
Why Health Tourism Destinations Succeed and Fail
...lessons from the Silicon Valley of the Second Industrial Revolution
by Constantine Constantinides, M.D., Ph.D.
Some of the websites cited may, at the time of reading this paper, be temporarily inaccessible.
Policy and Strategy "Bottom Line Executive Briefs"
"Bottom Line Executive Briefs" aim to extract and present the essential information related to specific issues and topics as briefly as possible. For deeper dives, one needs to read the corresponding Policy and Strategy Papers.
Health Tourism Policy and Strategy "Bottom Line Executive Briefs" are only available "by invitation" or "by referral."
This Document is an EMVIO Entity meaning that it is ever-evolving (probably containing errors) and never definitive - aiming for perfection but probably never achieving it. As such, it is revisited and updated, if and when necessary.
This Executive Brief is also available online: http://www.healthtourismpolicyandstrategy.com/Policyand-Strategy-Executive-Briefs/Why-Health-Tourism-Destinations-Succeed-and-Fail.pdf
The Story which goes with it...past prominence is no guarantee of future eminence
Before writing this Paper, I had written an article in Health Tourism Affairs titled: Health Tourism and Survivorship Bias. Its subtitle was: "past prominence is no guarantee of future eminence."
The point I wanted to make in that article was that when it comes to health tourism destinations, we only get to hear and read about the successful ones, suggesting that they are the ones whose model and approach to development we should all emulate.
But the question that should be asked is: how many emulated the model and adopted this approach and failed?
This is something we do not get to hear or read about.
No doubt, we can blame this "failure to report failures" on the media ("how to succeed" stories, press releases, advertorials and the work of paid sycophants).
No doubt, the gurus, who populate the health tourism sector, also contribute to the phenomenon of survivorship bias and to the shaping our selection bias. But as Nassim Nicholas Taleb, the author of
Fooled by Randomness and The Black Swan, points out: gurus will fall into the trap and be shown to be wrong - since most have not had any proper training in inference (the relationship between cause and effect).
Inspiration and Motivation for this Paper ...with due attribution to The Economist
I was motivated and inspired to write this Paper by a "Schumpeter" article titled Silicon Valley 1.0 (in The Economist, July 23, 2016). The article’s subtitle is: "Cleveland can teach valuable lessons about the rise and fall of economic clusters."
The Economist article reminds us that Cleveland was the Silicon Valley of the Second Industrial Revolution, but that the city has clearly fallen from greatness.
The article closely reflects my already-documented views on the factors leading to health tourism destination success and failure.
Health Tourism Destinations as Economic Clusters ...and the role of West’s Revenge
In my spoken and written word, I have often pointed out that integrated health tourism destinations can be regarded as industrial or economic clusters (and vice versa).
With regards to health tourism destinations, I have also pointed out that "past prominence is no guarantee of future eminence". Furthermore, I have also written and spoken about "West’s Revenge," a term I introduced to describe the phenomenon whereby "nations" once regarded as "sources of
medical tourists" (by medical tourism destinations) became destinations themselves - often leading to the loss of prominence of once-leading destinations.
How to Succeed...something "in the air" - the Culture and Ambience of a Destination
Some who read what I write (and say) may be tired of my repeated claim that the "culture" and "ambience" of a destination is of paramount importance in leading to and sustaining success.
Additionally, I have emphasized the need for the leadership of destinations to provide incentives which will attract Investment and "value-adding" Human Resources.
The "Schumpeter" article points out that economists from Alfred Marshall on have dwelt on the self-reinforcing characteristics of successful clusters:
- They can protect their pre-eminence by producing a distinctive "culture." (Marshall said that there was something "in the air" in Sheffield that was conducive to steelmaking)
- They provide incentives to attract money (investment) and talent
How to Fail ...the three ways
Firstly, I am on record for warning destinations against "overspecializing" - by focusing exclusively on, for example, just medical tourism, which on its own (as I have demonstrated) is not enough to make a
destination sustainable and resilient.
Secondly, I have for years been pointing to fragmentation (in the context of destinations) as the cause of inefficiency and non-competitiveness - and have been urging integration - and have also warned that
"show, flash and hype" cannot fool the health consumer into believing that a destination is efficient and competitive (worthy of his or her "preference.")
Thirdly, I have claimed that the other cause of "failure" can be attributed to Black Swans - unpredicted events with a high detrimental impact - because the destination did not "build in" resilience - in addition to sustainability.
According to the Schumpeter article, clusters fail because:
- They overspecialize in products or services that are later improved elsewhere
- They complacently fail to upgrade their productivity (efficiency) - Detroit, for example, thought more about providing its cars with ornate fins than it did about their efficiency and performance
- They suffer from an (unexpected) external shock (Black Swan) - for which they had made no provision (and from which it is extremely difficult to recover)
The Story to End the Story...quoting, almost verbatim, from the Schumpeter article
Cleveland’s story is a warning that rebuilding failed clusters or destinations is extremely difficult.
Reversing decline is harder than capitalizing on success.
Success is a delicate flower that can easily be killed.
Failure is a weed that is almost impossible to exterminate.
All the above (referring to economic clusters) are equally applicable in the case of health tourism destinations (a.k.a. clusters).
To read the online version click here.
Hospitals Expand Their Global Reach
Johns Hopkins, UCLA among the academic medical centers leading efforts to build international partnerships.
by Bob Kehoe
HHNmag.com-Like many academic medical centers, UCLA Health devotes considerable time and energy to honing its international strategy, both in treating patients from abroad and forging partnerships to deliver care to foreign patients closer to home.
To view the original article click here.
Surgeries at High-Quality Hospitals Cost Less for Medicare
by Paige Minemyer
Fiercehealthcare.com-Surgeries performed at high-quality hospitals cost Medicare less than those performed at lower-quality hospitals, new research has found.
To view the original article click here.
Rising to the Challenge
The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition
by David C. Radley, Doug McCarthy, and Susan L. Hayes
Highlights from the Scorecard
This 2016 edition of The Commonwealth Fund’s Scorecard on Local Health System Performance assesses the state of healthcare in more than 300 U.S. communities from 2011 through 2014, a period when the Affordable Care Act was being implemented across the country.
To view the full report click here.
Prescription Drug Costs Around the Globe
by Kelly Gooch
Becker's Hospital Review is the original producer/publisher of this content.
The International Federation of Health Plans has released its 2015 Comparative Price Report, detailing its annual survey of medical prices per unit.
To view the original article click here.
Ryan Prevails over Trump in Republican Health Policy Platform
by Harris Meyer
Modernhealthcare.com-No sooner had I filed a blog post late Monday afternoon asking when the Republican Party planned to release its overdue 2016 policy platform when, lo and behold, it appeared a couple hours before the GOP national convention opened.
To read the original article click here.
Costs of Zika Among the Many Unknowns of the Virus
by Shannon Muchmore
Modernhealthcare.com-History buffs and infectious-disease experts have already drawn links between the rubella outbreak in the 1960s and the current spread of Zika.
To read the original article click here.
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.
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 < DIRECT > x12
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.
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
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
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.
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