Francesca Glenn, MHA
Mercury Healthcare International – Denver CO
More and more small to medium U.S. companies are joining the large employers and labor unions in examining medical tourism as a value-based solution for their self-funded health benefit plans. In recent years, the media has reported program implementation by Pepsico, WalMart, Serigraph, Lowes Home Improvement and Delta Airlines. But small to medium enterprises (SMEs) like B&H Photo, North Carolina furniture manufacturers, glass blowers, shipping companies are commissioning feasibility studies to determine if a corporate medical travel benefit makes sense for them.
“One interesting trend is where the companies are located” says Maria Todd, CEO of Mercury Health Travel. “The calls we are receiving come from benefits administrators at companies located in rural areas where employees have limited local access to healthcare. Often, the closest health facility is a small critical access hospital with 25 or fewer beds, located 35-60 miles of where they live and work. They are already accustomed to traveling for tertiary care or complex diagnostic services that require expensive technology. They are already resigned to the fact that they must travel to access specialists that may not be present in their area.
Another interesting trend she reports is that they are strongly committed to “Buying American” and have no interest whatsoever in including foreign destinations in their networks.
“One interesting trend is where the companies are located” says Maria Todd, CEO of Mercury Health Travel. “The calls we are receiving come from benefits administrators at companies located in rural areas where employees have limited local access to healthcare.”
“For decades, employers have covered the cost of health travel to centers of excellence and tertiary research facilities through their benefit plans. Today more of them are re-examining the option to travel to a designated provider out of their immediate area for more common elective procedures, Todd explains.”
In the past, these services were coordinated by the TPA or insurer, and referrals were made only for very specialized treatment, usually associated with high-dollar claims or life-saving treatment and limited clinical trials. But now, with most self-funded employers’ ability to use predictive modeling and access their own primary big data, employers are now able to scrutinize value for money, outcomes, patient satisfaction, and in turn, steer plan beneficiaries to designated Approved Providers more easily.
“That’s changing now. For one thing, employers report that aren’t all that impressed with the TPA and ASO network choices or negotiated rates.” Todd explains. “Through disintermediation (direct contracting bypassing the ASO or TPA and their monthly network access fees) employers are negotiating direct deals with health facilities and professionals with whom they have chosen to do business. They negotiate steerage (directed volume), rates, and often negotiate bundled case rates for the cases they’ll steer in the direction of the out of town provider.”
…employers report that aren’t all that impressed with the TPA and ASO network provider choices or negotiated rates.
Instead of waiting for a special programs (burn care, transplants, and long-stay, complex cancer treatment, for example) to be operated by the TPA or ASO or their reinsurer they call on Mercury Health Travel to help them design an exclusive program that meets their plan’s needs.
We offer our clients a simple and straightforward three step process:
- Feasibility: Is it likely to work? Where’s the proof? This comes from an assessment of plan beneficiary culture and primary data. Past claims and predictive data are examined for a complete assessment. At Mercury Health Travel, we include a consulting medical epidemiologist on the assessment team if the company doesn’t already have one on retainer.
- Program Design: Creating the shortlist of candidate Approved Providers from the Mercury Health Travel network – or going straight to providers they want to approach, setting up the benefit design, travel and logistics, and integrating the medical travel benefit with the routine local care services already available. We accompany them on site inspections at candidate provider clinics and facilities and in assist them in contract negotiation meetings with hospital executives and staff physicians. We also examine HRA and HSA program integration possibilities for special circumstances.
- Program Documentation: We help them to complete any needed tweaks to their SPD and wrap documents. A “wrap” document is a drafting device used to supplement already-existing documentation. More specifically, a wrap document provides the information required by ERISA by incorporating (or “wrapping” itself around) the benefit program or TPA/ASO network provider contract. When a wrap document is utilized, the basic benefit plan remains part of the plan document. The “wrap” document and the existing SPD or contract together comprise the complete plan document.
Once Mercury Health Travel consultants and the employer establish the program framework, actuaries and underwriters may be called upon to examine costs and risks and utilization assumptions. “Some employers want that final level of review. In past years, they always did. “Now, over the past 6 years or so, with access to their predictive modeling and claims data, if they start with a small scope pilot program, they often skip this step and save the plan assets to pay for those reviews” says Todd.
Once the three step process is finished, the program is prepared for launch. Mercury Health Travel prepares a custom beneficiary mini-portal that explains the benefit program. The portal contains information about the program, the “why” story which explains why it was developed, who should use it, where they can go, and what they can expect if they decide to travel for care. A step-by-step procedure is posted. These pages are inexpensive to add to an existing employee benefits intranet that the employer may already have in place. If an employer has no benefit portal at all, Mercury’s team can build out the entire portal for them. The entire information portal can be designed, edited, tested and completed in 30 days or less. Much of the same information is condensed and used to prepare pay envelope and employee newsletter informational pieces.
Simultaneously, the care management team onboards the new account and prepares for case management. Onboarding an account involves preparing a portal licensed to the client. We helped designed this first and only medical travel case management software, but we don’t own it. The client purchase a license for their own installation of the software and has the option to take it to any care coordination provider if they choose not to work with us. Some employers have an internal care coordinator in-house. Todd explains, “Most decide to work with Mercury Health Travel for the medical travel case coordination even if they have routine care coordination for local care through their TPA for three reasons: Most TPAs and ASOs aren’t set up for medical travel benefits administration, the TPAs and ASOs cannot process the privately negotiated bundled case rates, and the employer and the healthcare provider mutually decide that the exclusive negotiated case rates should be protected from being shared outside the relationship.” If they decide to segregate the rates and bundled claims processing, the employer meets with and negotiates with Mercury’s partner TPA, located in Kansas.
Once in operation, the portal can be used for both regular medical travel and workers compensation case coordination. The software interfaces with the benefits portal to allow medical records uploading and other protected information. The software is designed to be HIPAA, PIPEDA (Canada) and EU compliant and supports the case management and care continuity activities. One software installation can serve employees anywhere in the world, whether its a manufacturing plant in Europe, an oil rig off the coast of West Africa, a scientific research center in Antarctica, or the corporate headquarters in Silicon Valley. While this entire preparation phase all sounds complicated, it is very methodical and be accomplished from first call to first case, end-to-end in about 120 – 180 days.
Finally, at the time a plan beneficiary decides to use the program, one call starts the process and the case managers coordinate care and monitor and measure outcomes. Employers receive detailed reports that explain the savings, patient satisfaction, and clinical outcomes on a periodic basis. The clinical outcomes and patient satisfaction incorporate tools such as HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems) and other measurement tools created by developed by RAND Corporation to measure and explain variations in patient outcomes through a generic, coherent survey. These measures rely upon patient self-reporting to the case manager at specific intervals across a multi-year event horizon. The measures are widely utilized by managed care organizations and by Medicare for routine monitoring and assessment of care outcomes in adult patients.
Local and Global Workforce Employers
Companies that employ global workers are often very interested in medical tourism and health travel by necessity. Often, they deploy workers to remote locations where health services are in short supply or non-existent. As a result, they are no stranger to medical travel and health tourism concepts, and are often already familiar with the process. For years, they have depended on international private medical insurance (IPMI) supplemental coverage as an adjunct to local public health programs operated in the host country, or local supplemental private medical insurance that widens the scope of providers, clinics, and hospitals available to the employees, both expatriates and local nationals, and perhaps also for their dependents. These policies, like those in the USA, can run the entire range of value and cost, and are often expensive to purchase. Most IPMI programs are not set up to include elective medical travel benefits coordination for employer groups. They are also not viewed as medical tourism insurance policies.
About Mercury Health Travel
Only one company in North America currently offers this level of service to self-funded employers. Mercury Health Travel, started working on disintermediated deals between employer self-funded health benefit plans and healthcare providers since 1977. It has grown and transitioned from a simple consumer medical tourism facilitation company to the largest, privately-held medical tourism network in the world. It maintains provider and supplier relationships with over 6000 inspected hospitals, over 9000 ambulatory surgery centers, 850,000 physicians, and 65,000 ancillary providers (home health, medical equipment, dialysis, physical therapy, etc.).
Maria Todd, the company’s founder and CEO worked for one of the largest HMOs in the United States as their director of provider relations network development and contracting operations. She designed the network so that employers could choose their short-listed providers at locations throughout the USA and in 120 countries. Over the past few years, she completely remodeled the brand approach to medical travel benefits administration. In addition to her HMO and managed care background, Todd is a former surgical nurse, hospital exec, and in the 1970s was a travel counselor and field inspector for America’s largest leisure travel organization, with more than 1000 full service travel agency offices in the U.S. and Canada. With the new approach, Mercury Health Travel focuses solely on corporate health travel administration for self-funded health & wellness benefit plans offered through employers, unions and membership associations.
What was once a much costlier PEPM network leasing model has been reconfigured into to a less expensive approach that leverages the company’s experience in corporate medical travel administration. The new approach requires less owned infrastructure, fewer employees to hire resulting in lower overheads and better efficiency. Mercury Health Travel works as a solutions provider for many healthcare benefits consultants and benefits advisers, eliminating the need to employ and train full-time sales representatives. Accounts are onboarded more quickly, and it costs less to administer the program. In turn, Mercury Health Travel passes those savings on to its clients.
What’s Different about Mercury Health Travel
- Clients choose their selected providers either from our existing network of of Approved Providers or any other provider they choose to approve and empanel.
- Mercury Health Travel acts as the buyer’s agent and assists in the negotiation discussions and helps the providers and employers to develop exclusive case rates.
- Contracts are negotiated directly with providers. Rates are proprietary and based on the business opportunity in each specific case which often results in better pricing than the prices negotiated with ASOs, TPAs and PPOs.
- Steered volumes result in lower prices than those advertised in medical tourism articles and advertisements found on the Internet for “one off” consumer business.
- Mercury Health Travel charges for its value added case management instead of embedding 20-30% referral commissions in provider rates – a common practice of most medical tourism companies.
- No PEPM network access fees. If the system is not being used, there’s no ongoing cost.
- Mercury Health Travel focuses solely on corporate health travel administration for self-funded health & wellness benefit plans offered through employers, unions and membership associations.
- Consumer medical tourism inquiries are referred to trusted colleagues in the USA, Canada and Europe who specialize in business-to-consumer medical tourism.
- Mercury Health Travel operates a global executive checkup program designed to assist corporate executives and senior level managers to arrange comprehensive screenings required by employers. Sometimes those who run the show can’t find the time to mind their health. With an eye toward prevention, these one- or two-day examinations attempt to accommodate busy schedules while supporting the long-term wellness and productivity of a firm’s key players. Designated checkup locations are available on 6 continents.