A Solution to Rising Health Costs
Government paid treatment abroad is one way that developing nations with scarce access to complex treatments, diagnostics and specialists manage population health in their country. Every health and finance ministry worldwide, large or small, faces increasing pressure to save money on health care. A growing number of government officials and health authorities offer a treatment abroad option to their citizens as a part of their health scheme.
If you administer a government funded treatment abroad program, we work as a Special Envoy to support your medical attachés wherever they are. As your special envoy, we save your government time, money and bring advanced expertise in negotiating contracts with:
- hospitals, clinics
- private consulting physicians
- home and hotel visiting nurse agencies
- hotel and other accommodation providers
- ground support services
- certified medical translators
- car and driver services, and
- other cost centers
For one predictable annual retainer fee per year, we will:
- Set up a bespoke network of Approved and contracted providers. You indicate your preferences as to destinations and suppliers. The prices we negotiate on your behalf take into consideration the volume of cases you are predicted to send based on a multi-year look back at previously paid claims with that supplier, predictive modeling of future claims, your timely payment history, your ability and willingness to pay a deposit on estimated charges in advance of admission, and other data we review to determine your leverage and negotiation power.
- We supply draft contract templates for full agreements, limited scope contracts, single case agreements (SCA), continuous discount arrangements (CDA), and memorandums of understanding (MOU) used worldwide. These templates have certain protections for your government for some of the most egregious billing offenses we've encountered, including, but not limited to: nonpayment for substandard quality and safety or avoidable consequences and complications, fraud prevention, unauthorized services unrelated to the reason for admission, price gouging, return of excess funds deposited on account, alternative dispute resolution, medical records documentation requirements and bill audit rights, and more.
- Integrate Pay for Performance (P4P) programs. Reward partners with shared risk payment agreements that reward good performance and penalize substandard performance and measure for improvement. Metrics cover clinical quality and safety, patient satisfaction, repeat admissions, avoidable complications, and billing accuracy.
- Access to our pre-inspected and approved Centers of Excellence. If you need to find a treatment destination provider in a hurry, use our short list of Pre-approved Centers of Excellence. They stand ready to accept your patient on a rapid access basis and will agree to a single case agreement or MOU that we negotiate on your behalf to get things moving. If at a later date you decide to offer them a contract for additional services, they will collaborate to execute a longer or more comprehensive arrangement. Our Globally Integrated Health Delivery System® is available to you at no additional cost.
- Negotiate predictable episodic/bundled case rates for a well defined episode of care. This eliminates surprise charges, price gouging, and allows for more orderly fee settlement.
- Access to domestic and international clinical trials for last chance therapies
- Accommodate workers across multiple domestic and international worksites
- Access specialized and tertiary care, telehealth, and more
- Implement an All-in-One-Day, Executive Checkup Concierge Program for your VVIPs and government officials
- Remove patients from costly inpatient settings to approved and appropriate accommodation until they are deemed "fit to fly".
- Negotiate special cost savings to save on repatriation costs when sudden onset illness or injury occurs but confinement can be adequately managed back home
- Manage all initial contract negotiations and contract renewals, cancellations, and modifications or amendments necessary
- Verify cultural and language readiness and sensitivity of your providers, facilities, and other network suppliers
- Travel to over 180 countries to perform rigorous site inspections or develop or maintain partner relationships with providers and suppliers whenever and wherever necessary. (Travel costs are not included in our professional services retainer.)
- Help you transition more cases back home as medically appropriate.
OUR 10-POINT PROMISE TO YOU
- You will conserve financial resources and have rapid access to inspected and approved medical providers worldwide.
- We own and operate the world's first and only globally integrated health delivery system® giving you access to a network of hundreds of pre-approved and inspected international healthcare Centers of Excellence and consulting specialist physicians in the USA and 119 other countries.
- You'll also save money on specialized health travel arrangements - up to 60% on international business class fares, last minute fares, and no travel agency service fee. We've negotiated special arrangements for our clients with a fully-certified travel agency. Our health travel clients benefit from savings on airline tickets, hotels and car rentals at discounted rates, helping them cut their travel expenses significantly. They offer our clients product and service guarantees, price meet or beat guarantees, and full service support. If you have special arrangements with airlines and hotels in place, we will defer to your arrangements on request or check to see if we might be able to provide greater savings.
- You may pick and choose your bespoke shortlist of treatment abroad destinations and provider choices.
- We evaluate, review and negotiate with your chosen providers and set everything up and ensure smooth operations.
- As your Special Envoy for your Treatment Abroad program, we are your advocate. We are not agents of the providers and we don't accept commissions from providers.
- Everything we do is transparent, ethical and always placing your citizens' best interests and your program requirements at the forefront.
- Terms and prices negotiated with providers are exclusive to your program and confidential.
- We'll negotiate higher discounts (often up to 55%) than the average medical tourism price charts you find on the Internet for the same providers.
- The services we perform as your Special Envoy will be paid for through the savings we negotiate. This means that by retaining us for a year, you will save, at a minimum, an amount equal to our retainer plus travel costs and possibly more.
Special Envoy Duties and Responsibilities
- analyzing current program data review and current situation analysis - and initial benchmark snapshot
- learning the Minister of Public Health’s objectives and targets for the short, medium and long term
- drafting contract targeting priorities and an action plan development and implementation for approval
- creating the negotiation strategy for each treatment destination for approval and execution
- drafting and gaining approval of contracting criteria, standards of performance by suppliers to serve as contract Exhibits, provider manual, etc.,
- developing, finalizing and implementing business rules for contract negotiations
- acting in an authorized plenipotentiary role to execute contracts, renew or modify existing arrangements or manage contract cancellations with suppliers autonomously or in collaboration with your medical attachés.
- understanding limits and expectations on autonomous decisions
- identification of situations when higher authority is required- and following through to obtain and carry out decisions made by senior authorities
- connecting with treatment destination suppliers and introducing the new approach and value proposition
- following through with negotiations to finalize fully executed contracts
- helping to design a proprietary contract management database and web portal for internal use by the national health program and the High Council staff to know what contracts are in force and other key bits of information
- scouting and inspecting new prospective suppliers and contracting partners
- vetting new potential treatment destinations and partners
- traveling to meet face-to-face with contract partners as necessary to ensure standards of performance, accreditation and service levels are maintained
- performing special investigations, case management, concurrent review, medical records documentation review and billing audits for accuracy and appropriateness
- participating in alternative dispute resolution, as needed
HOW WE DETERMINE OUR FEES
We review your past Treatment Abroad expenditures and other statistics. We estimate your potential savings. We then establish a target budget to cover: (a) the costs of a flat fee annual retainer, for negotiation activities and provider network development and maintenance; divided over 12 monthly payments, plus (b) coverage of all reasonable, related and authorized travel expenses (flights, business visa and immigration fees, per diem, etc.). An adequate amount of time is included to prepare for, gain your approvals for, and launch the contracting strategy including many of the above duties and tasks and preliminary activities. The balance of the the first year is spent primarily on site inspections, negotiations and renegotiation of existing contracts as indicated. Subsequent years' duties are more focused on relationship maintenance, monitoring quality, safety, patient and government satisfaction, contract renewals or modifications, and new network provider additions. We also continue to perform case management, concurrent review, bill audits and documentation reviews.
This target budget requires your Special Envoy to save the program a targeted savings per case in the first year to break even. If we don't meet the established target savings, you may cancel the agreement at the end of the first term. Every savings beyond the targeted break even point remains in your treasury, or can be used to expand your domestic healthcare services, or to fund the Special Envoy role for a subsequent year.
We are happy to negotiate shared-risk incentives in the event we exceed mutually-agreed targeted savings thresholds. That way you are assured of our commitment to saving your government as much as possible without added cost to your existing treatment abroad budget.