Information for Plan Administrators
Mercury Health Travel's Program for Corporate Health Travel Administration
Our CEO Wrote the Book on Health Travel Benefit Design
Maria Todd, Mercury Health Travel's CEO, wrote the only book in the industry that provides the details of how employers, unions and even commercial insurers can create a health travel benefit option for plan participants and beneficiaries. The book was vetted by the publisher and peer reviewed before contracting with her to write the book. This is her fifth internationally-published book on medical tourism business.
Read What Others Have Said
The Medical Tourism Industry has a great but, as of yet, unrealized potential to transform the way global healthcare is delivered. After much press and many start ups, no one has yet developed the ideal system to connect patients and providers on a global basis. Perhaps, had her book been available earlier on, the Medical Travel Industry would look completely different today. Dr. Todd writes with much wit and grace and explains the elements required to succeed in this difficult but essential business. Following her suggestions and implementing her ideas are as important to Medical Tourism as following a detailed recipe is to cake making. In either situation, the end result can be very tasty or a disaster. My experience tells me there are many bad cooks in the Medical Tourism arena. Dr. Todd is the Chef’s Chef of this industry. To be a successful Medical Tourism cook, I recommend a short course in her kitchen!
Maria Todd is the only author to contribute to the development of the medical travel industry in this way. No other "how to" books have been written to guide the industry and develop best practices and workflows, address group health benefit design, or help health and wellness tourism coordinators to develop their competency and skills. Instead, the market has been little more than a cutthroat competition and an every person for themself attitude. On the contrary, Maria generously and openly gives guidance and trains industry stakeholders to work collaboratively through the Center for Health Tourism Strategy training and research division. She's been a member of SHRM and ASTD and supported SIIA for decades. You'll recognize some of the reviewers of her books and the regard they have for her knowledge and insight.
Maria's best practices and her quality and safety inspection criteria for medical tourism and wellness travel have been adopted worldwide. She was awarded a direct appointment contract to develop the medical tourism national product and economic development strategy and framework regulation for Greece and several other countries. She vehemently objects to commission based referral arrangements for medical tourism and health travel services because of the regulatory and ethical challenges these arrangements present. Other medical tourism administrators may claim to have the same hospitals in their network but the prices and services won't be the same because it takes far more than a hospital and an airline ticket to operate the program.
Her approach is refreshing and innovative and the expertise she brings to group health benefit management for health travel is unparalleled. You will love working with her and feel instantly at ease with her approach.
We Understand Your Fiduciary Concerns
We Make It Easier To Add A Health Travel Option
The Five Duties of a Fiduciary
Duty #1: Loyalty
Duty #2: Documentation
Duty #3: Prudence
Duty #4: Diversification
Duty #5: Reasonable Plan Expenses
Your Fiduciary responsibilities under ERISA must be carried out in accordance with the documents of the plan in accordance with ERISA § 404(a)(1), 29 U.S.C. § 1104(a)(1) (200).
Duty #1: Loyalty
The duty of loyalty, also called the “exclusive benefit rule,” means the fiduciary’s actions must be solely in the interest of the participants and beneficiaries and must be for the sole purpose of providing benefits to the individual participants and their beneficiaries as well as ensuring that expenses for administering the plan are reasonable. If you are paying someone a rate that has an embedded commission in it for referrals to providers, that may break a few US regulations and cause you to pay a higher price for the procedure. This is true in countries where foreigners are required (in some cases, by local regulations) to pay a surcharge of up to 150% of nationally set fee schedules.
For example, most hospitals in India and a few other countries charge foreigners more for the same identical services rendered to locals - just because they are foreigners. countries like Korea allow for a 150% price hike by law. In addition, many sellers of health tourism services embed the referral agents' commissions in the price on top of the foreigner surcharge. While this practice may still ultimately result in a lower price to you than that which you might negotiate locally, it is not compliant with ERISA because you still end up paying more than you should, and not conserving plan assets to the highest extent possible.
Duty # 5: Reasonable Plan Expenses
The typical medical tourism arrangement of paying inflated professional and facility fees by paying fees that contain inflated charges and embedded commissions also flies in the face of Duty #5: Reasonable Plan Expenses. This is because in order to determine whether the fees being charged to the plan are reasonable, it is necessary to create a process by which you can determine the services needed by your plan and review the fees and expenses related to these services, both direct and indirect. We help you analyze population health data and use predictive modeling to prepare an analysis of projected health travel utilization and savings. Based on what the analysis reveals, we target destinations, procedures, and create the report that will be presented to the candidate hospital to start negotiated discount discussions.
When a Plan Participant Is Ready To Travel
Upon request by your plan participant to open a new case, we review their eligibility for the program, both from a benefits perspective and a medical appropriateness perspective. (Some should not travel for care.) If everything looks good, they arrange their time off and our team of coordinators handles all the other details (except pet sitting, child care or picking up the mail and stopping the newspaper delivery!)
When They are Ready to Come Home
Upon notice from the facility discharge planner that the patient is ready to head back home, we coordinate a case management conference by video-assisted meeting to ensure continuity of care with the local hometown provider who will oversee any necessary follow up and recuperation. We also coordinate records exchange and check to ensure that the records transferred are complete. We remain engaged in case management and outcomes monitoring and measurement for up to 36 months. You benefit from this long tail monitoring and measurement in several ways, one of which is cost and quality/value documentation.
Why Our Approach is Better
The approach we recommend is compliant and doesn't play games with transparency, reasonable plan expense, and loyalty duties. We don't get involved in commissioned referral arrangements and we don't involve ourselves in prohibited transactions. Instead we work as your advocate to identify your unique short list of Approved Provider candidates. Next, upon request, we accompany you on site inspections, and sit next to you as your advocate at the negotiation table so you don't overlook details that can cost you later. Our team has decades of managed care and provider contracting experience at leading health plans, HMOs and PPOs nationwide. We know from experience what to expect and how to negotiate volume discounts with providers. We know what compelling data they want to see to determine if you present a "real" opportunity for them.
Once you've finalized your candidates and negotiations seem eminent, our destination development team learns about your existing corporate travel programs to determine how we can integrate local hotel and other accommodations that are the appropriate for your plan participants and beneficiaries. Not every hotel is a match for the special needs of health travel guests. The same with ground transfer services. We attempt to integrate your existing discount programs with airlines, hotels and ground transfer providers. When we can't or you don't have an existing program, we build the care and ancillary services continuum from scratch.
The duty of loyalty further prohibits a fiduciary from receiving a benefit as a result of its relationship with an ERISA client. The prohibited transactions rule provides guidelines about what types of activities result in a transaction being found to be for the fiduciary’s own benefit and to the detriment of the client. Prohibited transactions apply to a party-in interest. We are not a party-in interest. We are consultants and advisors to corporate health benefit plans operated by self-funded employers and union health and welfare plans.
Once your program framework is designed, we check what your unique program will be and how it will operate and compare that to existing SPD and wrap documents. If gaps exist, our experts are available to close them, draft the document modifications and prepare them for submission to your attorney or other compliance advisers, your underwriter and your reinsurer.
After the paperwork is finalized, we help with implementation. We draft plan communications documents, build an employee and beneficiary portal to communicate with case managers and logistics coordinators. We also come to your company or prepare a short "explainer video" that instructs plan participants how to use the health travel benefit, where they can go, how to start the process, and any out-of-pocket costs or savings associated with their choice to use the benefit.
Provider Fee Settlement and Operations
From the time the case is accepted and the rate confirmed by the Approved Providers, before departure, our TPA works out the details of negotiated provider fee settlement arrangements.
Our TPA is prepared to adjudicate case rate invoices that are a real problem for most U.S. TPAs. By separating out provider fee settlements for the health travel program from your usual TPA or ASO, your rates remain confidential as negotiated.
This means that your existing TPA doesn't have to do anything different, your providers get paid timely, you remain compliant and things run smoothly. Everyone is happy.