THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL

Volume 2, Issue 15

Dear Colleagues,

As Vice President of HealthSCOPE Benefits - the largest independent third-party administrator (TPA) in the U.S. - Tim Hyde offers his insight on the development of the medical travel industry.

Hyde asserts that while international medical travel may have been more popular in the past, the interest in domestic medical travel seems to have spiked in recent years, in part due to the light that is being shed on transparency.

More and more employers are considering a domestic medical travel benefit for their workers as an affordable way to access high-quality, lower cost care.

Read on to find out where Tim Hyde believes the industry will be heading.

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: Tim Hyde, Vice President, HealthSCOPE Benefits

http://www.healthscopebenefits.com/

About Tim Hyde
Tim Hyde serves as Vice President for HealthSCOPE Benefits. In this capacity, Mr. Hyde is responsible for national account service, relationship management, implementation of new business, and new business sales.

Mr. Hyde began employment with HealthSCOPE Benefits in 2003, developing relationships with multiple new and existing clients, serving that role until 2012. At that time, Mr. Hyde left HealthSCOPE Benefits as President of National Accounts for Cornerstone Benefits, a full-service life and health insurance brokerage firm based in Fort Smith, Arkansas. However, in 2013 he was brought back to HealthSCOPE Benefits in his current role as Vice President. Prior to employment with HealthSCOPE Benefits, Mr. Hyde was a Certified Financial Advisor in Little Rock, Arkansas, for both Merrill Lynch and Morgan Stanley. In this capacity, he developed an extensive book of business, gaining knowledge in the areas of asset allocation, financial planning, and individual and group insurance. Mr. Hyde is a licensed insurance agent and received a Bachelor of Business Administration Degree from Mercer University in Macon, Georgia.

About HealthSCOPE Benefits
HealthSCOPE Benefits is a full service claims administration and health management firm providing administrative and other support services to self-funded employers. In select geographic markets, HealthSCOPE Benefits also works with strategic insurance company partners providing access to HealthSCOPE Benefits' networks.

U.S. Domestic Medical Travel (USDMT): What is your current role at HealthSCOPE Benefits and how is the company evolving?

Tim Hyde (TH): I began working at HealthSCOPE Benefits in 2003, after a career in the financial industry.

I started out as an account manager, and when a person works in account management they learn every aspect of operations and are expected to become a ‘master of everything.' As I've transitioned into the business development world, my experience as an account manager has proved to be very beneficial.

Over the years, HealthSCOPE Benefits has had various ownership arrangements; however, as of January 1, 2008, we are the largest independent third-party administrator (TPA) in the U.S., headquartered in Little Rock, AR.

Since the implementation of the Affordable Care Act (ACA), I'd say that everybody has had to go through some level of transition - which has actually been good for us being a TPA that only administers self-funded health plans.

The interest in the self-funded market has skyrocketed among groups of all sizes, and we are met with a lot more interest in partnering and strategizing together.

We jumped head first into the state co-op market, and after the feds eliminated the funding, we were forced to exit that business - but we also gained a lot of knowledge that helped to open our eyes to a lot of other opportunities.

USDMT: Where do you see an interest in medical travel among your clients?

TH: While international medical travel was more popular about ten years ago, I would say that my clients are now showing a stronger interest in the domestic market.

The stigma associated with sending employees overseas - whether this assumption is valid or not - is that the quality of care outside of the U.S. is not up to par, not to mention there is an inconvenience to traveling overseas for care.

Domestic medical travel is on the verge of exploding due to the traditional carrier discount model.

Transparency has been lacking in the industry, and now that it is being brought to light, employers are showing a stronger interest in sending employees outside of their geographic region for low cost, high-quality care.

I think domestic medical travel will really start to flourish once existing organizations and/or start-up companies can perfect a portal for members to locate the most affordable, high-quality care for a particular service.

USDMT: How far do you think individuals will travel for treatment?

TH: I think this will depend on the level of incentive offered by the employer group.

There are so many different factors that come into play, for example some employers may waive an employee's deductible, they may offer to pay for a companion to travel with the employee, etc.

Some individuals may travel all the way across the country. I just think it will strongly depend on the incentives that are offered.

USDMT: Can you discuss the technology platforms that you see coming on the market, such as DoctorGlobe?

TH: From a technological perspective, I think DoctorGlobe is exactly what this market needs.

There are other groups out there that are trying to do similar things, but due to the lack of data they don't seem to have travel as their main focus.

DoctorGlobe combines the motivation of domestic travel with pricing transparency, and as an early stage company, it is still expanding its platform to provide ‘complete data transparency.'

By partnering with TPAs, large hospital systems and/or other organizations that pay claims and generally know what costs are, a really powerful application can be developed and would be able to make meaningful change.

USDMT: Can employers really judge quality of care?

TH: I don't think an employer will want to get involved in that aspect of the business. Their primary focus will most likely be providing a level of benefits that makes sense from an affordable perspective and allows consumers to make their own decisions regarding quality.

A number of employers are nervous about getting involved with their employees' care, so for the employers that do offer a quality perspective, the focus may be on assessing volume as a quality indicator.

To me, volume and readmission rates are two of the more important things to look at vs. mortality rates.

Certain providers and networks choose their clientele based on the status of their health prior to a procedure and that often is a pre-determinant of mortality.

USDMT: Tell the readers about your experience with large employers that have adopted a domestic medical travel benefit.

TH: Because a lot of our larger groups have the volume and the brand recognition, they are building out centers of excellence (COE) programs and developing carve outs.

For example, let's say a patient is seeing a local oncologist who is devising a treatment plan. The patient is then incentivized and encouraged to call us and we will work to receive all of their current treatment notes.

From there, we would work with a COE physician to determine whether or not it makes sense for the patient to travel, and if so, we would then manage the travel component of getting the patient to another location.

A lot of times, the employers are more focused on better outcomes for their employees than cost savings.

USDMT: Is there room in this market for the non-high profile hospitals that deliver high-quality care at much more reasonable costs?

TH: Absolutely.

For example, for the last two years the number one rated hospital for cardiac is right here in our backyard - it is a client of ours and we manage their employee health plan.

We have implemented a direct contract and will likely be building out a COE program with them for cardiac.

There is great care all over the U.S. -- hospitals don't have to be in New York City, Dallas, Houston or Los Angeles. If you have the ability to build COEs with providers on a national scale, this model can be open to anybody.

USDMT: I've noticed a number of U.S. trained physicians are now rotating through hospitals in Central America. Do you see this as an attractive model?

TH: I would certainly look into this because Central America is not as far of a flight as, let's say, India.

I think there could be a certain level of interest around this model, but when you compare it to a domestic medical travel offering, I don't think it is a model that answers all the needs of a health plan.

USDMT: Is there any aspect of the domestic medical travel industry that you think would be appealing to the middle market employers or the smaller groups?

TH: Absolutely. Any employer would be interested in a platform such as DoctorGlobe, which allows users to pinpoint the transparency of cost.

The size of the employer group really doesn't matter, because if they are paying travel expenses for their employee and their spouse and still saving $15,000 for one particular procedure, any organization's CFO, regardless of size, gets that message.

USDMT: Where does a bundled pricing opportunity to come into play?

TH: Bundled pricing around transplants has been around for quite some time - it's a kind of a segregated market that is built out at this point.

Bundled pricing can be a little difficult because generally, negotiations have been made on a post claim basis - which any negotiator will tell you it's really hard to acquire something and then negotiate the price.

There are organizations out there that are doing intake from a clinical perspective and negotiating at the same time - meaning that they are verifying and getting a signature from the physician and facility confirming that they will accept payment before a surgery ever takes place.

That's the direction I think we need to move toward.

Big Hospital Network Cracks Down On The Right To Sue
Heard on All Things Considered
By April Dembosky

NPR.org-San Francisco Bay Area companies say Sutter Health is strong-arming them into a contract that would help the hospital system secure its power over prices and potentially raise the cost of medical care for their employees in the future.

To view the original article click here.

Wide Variation in Medicare Payments to Treat Post-Surgical Complications
by Ron Shinkman

Fiercehealthcare.com-Post-operative complications are always costly. But depending on the hospital, they can cost much more than anticipated.

To view the original article click here.

Bundled Payments: What Healthcare Leaders Need to Know
by Zack Budryk

Fiercehealthcare.com-Despite mixed results, Medicare is betting big on bundled payment initiatives. And that means healthcare leaders must fully understand the payment model.

To view the original article click here.

Vt. Makes Deal for Health Care Overhaul
by Neal P. Goswami

Rutlandherald.com-Vermont has reached a deal with the federal government to move forward with a plan to overhaul the way health care is paid for in Vermont.

To view the original article click here.

Cleveland Clinic Exec: Bundled Payments Require Close Clinical Attention
by Ron Shinkman

Fiercehealthcare.com- Success in the bundled payment environment requires extensive preparation and planning before a patient enters a hospital--even when the organization is powerful, prestigious or well-managed.

To view the original article click here.

New Jersey's Top Non-Profit CEOs are Paid Millions
by Ron Shinkman

Fiercehealthcare.com-The highest-paid non-profit hospital chief executives in New Jersey earn well over $1 million a year, with most earning more than $2 million.

To view the original article click here.

Quality Improvement Interventions Successfully Increased E-Prescribing Frequency by Nearly 40%
by Anuja Vaidya
Becker's Hospital Review is the original producer/publisher of the content.

A new study, published in Pediatrics, examined if a quality improvement initiative could increase the frequency of electronic prescribing at a children's hospital.

To view the original article click here.


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JOB OPPORTUNITIES
Do you know of any available job openings relative to the U.S. domestic medical travel industry? We encourage readers to submit any available, relevant job opportunities along with its descriptions and requirements for fellow readers and industry professionals to consider. All submissions are appreciated.

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U.S. Domestic Medical Travel™

About U.S. Domestic Medical Travel
U.S. Domestic Medical Travel, a sister publication to Medical Travel Today www.medicaltraveltoday.com, is a newsletter published by CPR Strategic Marketing Communications, an international marketing and public relations agency based near New York City that specializes in healthcare and life sciences. In the new era of health reforms, U.S. Domestic Medical Travel discusses the growth of domestic medical travel and its importance to hospitals, employers, insurers, health plans, government, TPAs, brokers and other intermediaries.

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Spotlight Interview

SPOTLIGHT: Tim Hyde, Vice President, HealthSCOPE Benefits

News in Review

Big Hospital Network Cracks Down On The Right To Sue

Wide Variation in Medicare Payments to Treat Post-Surgical Complications

Bundled Payments: What Healthcare Leaders Need to Know

Vt. Makes Deal for Health Care Overhaul

Cleveland Clinic Exec: Bundled Payments Require Close Clinical Attention

New Jersey's Top Non-Profit CEOs are Paid Millions

Quality Improvement Interventions Successfully Increased E-Prescribing Frequency by Nearly 40%

NETWORKING JUST GOT EASIER

Help Save a Life and Support Matching Donors