how to design a benefit plan to include a medical travel option
DESCRIPTION
Insight into Medical Tourism in Costa Rica. Fascinating information on the growth of obesity in the U.S.TRANSCRIPT
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HOW TO DESIGN A…BENEFIT PLAN TO INCLUDE A
MEDICAL TRAVEL OPTION
• Medical Tourism declared
of national and public interest by former President
of the Republic Oscar Arias
in 2009
• Formal commitment of
actual President of the Republic Laura Chinchilla
• In 2009 Costa Rica received
• Costa Rica offers three JCI
accredited hospitals:
– HOSPITAL CIMA
– HOSPITAL CLÍNICA BIBLICA
– HOSPITAL & HOTEL LA CATOLICA
• Additionally, Costa Rica is
home of Latin American
branches of accreditation body
ABOUT COSTA RICA
• In 2009 Costa Rica received
approx. 30.000 medical
travelers injecting about
U$250 million in Costa
Rica’s economy
like AAAASF and AAAHC
(deeming authorities for
CMS).
• Today there are more than
20 ambulatory clinics internationally accredited
Costa Rica: quality health care and nature within your reach!
• PROMED is the board for the promotion and quality
assurance of the Costa Rican healthcare industry.
• PROMED is a private association of accredited
Hospitals, certified Doctors, Universities and Tourist
Services, supported by the Costa Rica Ministry of
Health and the Costa Rica Tourism Board.
• Through the seal of quality PROMED makes sure
that any healthcare and recovery facility provides
ABOUT PROMED
that any healthcare and recovery facility provides
with services of excellence in favor of patients
security.
PROMED: the gate to quality healthcare in Costa Rica!
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• WHAT is a Global Centers of Excellence Program
• COMPONENTS of a Quality Program
• SPECIALTIES of a Program
• WHY Enhance Your Benefit Program
• Benefits to YOUR COMPANY
Agenda
Benefits to YOUR COMPANY
• Benefits to YOUR EMPLOYEES/RETIREES
• HOW to Add Global Centers of Excellence
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What Are Centers of
Excellence (COE)Courtesy of
Humana
1982
Designed to
Improve
Outcomes
Provided Travel
for Member and
Companion
Cost Savings
with Reduced
Complications
Bariatric
Centers of Excellence (COE)
Every Major
City has
Multiple COE’s
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Quality
Outcomes
for a
Reduced
Cost
Highly
Accredited
English
Speaking
Providers
What is a GLOBAL CENTERS
OF EXCELLENCE PROGRAM
JCI
Accredited
(similar to
US
Standards)
Providers
Specialized
Targeted
Procedures
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• Correctly ID Patient• Improve Effective
Communications• Improve High-Alert Med
Safety• Ensure Correct site,
Correct-Procedure, Correct-Patient Surgery
• Reduce Risk of Health Care – Associated
Joint Commission Accreditation - International
• Correctly ID Patient• Improve Effective
Communications• Improve High-Alert Med
Safety• Ensure Correct site,
Correct-Procedure, Correct-Patient Surgery
• Reduce Risk of Health Care – Associated
Joint Commission Accreditation – United States
Accreditation
• Reduce Risk of Health Care – Associated Infections
• Reduce Risk of Patient Harm Resulting from Falls
• Reduce Risk of Health Care – Associated Infections
• Reduce Risk of Patient Harm Resulting from Falls
Although US Accreditation is different the standards for the International Community are same and in some cases more stringent
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Courtesy of
Patient
Advocate
Reduced
Cost
Adverse
Outcome
Protection
Measurable
Outcomes
THE PATIENT ADVOCATE IS THE KEY !!!
Facilitating the process for the member- Medical Necessity- Providing Cost and
Provider Options- Coordinating Travel
and In-Country Transportation
- Facilitating Claim
Components of a Global
Centers of Excellence Program
Enhanced
Clinical
Service
- Facilitating Claim Payment
- Providing Medical Follow Up Contact
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Measurable OutcomesCourtesy of
Volume of
Procedure at
Facility or by
Provider
MorbidityComplications
Measurable Outcomes
MortalityRe-admission or
Secondary
Infection Rates
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Measurable OutcomesCourtesy of
Nursing
• Increased Level of Service
• RN patient ratio 4:1
•US nursing ratio can exceed 10:1
Technology/
Training
•Many US/ Western Trained Physicians
•Technologically advanced hospitals
•Example: oxygen chamber to enhance healing after surgery
•Private rooms
•Recovery Centers with personalized care
Enhanced Clinical Experience
Follow up
•Recovery Centers with personalized care
•Patient Advocate coordinates return to home country; follow patient through
recovery
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Enhanced Clinical ExperienceCourtesy of
Domestic US
• Mal-practice Insurance
• Legal System• Protracted
• Uncertain
• Up to 33% of Award to
International
• Insurance Policy
• Specific
• Protections for both patient and employer/plan• Up to 33% of Award to
Lawyers
• Adversarial
• Outcome Uncertain
employer/plan
• Outcome Assured
Adverse Outcome ProtectionCourtesy of
Up to 50%
savings in
Medical for
Package Price
Up to 80%
Dental Savings
Up to 90% on
Prescription
Drugs
Reduced Cost
Package PriceDrugs
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• Savings of up to 80% on Dental Procedures• Most US dental plans pay 50% up to $1000-$2000
annually costing member thousands, if not tens of thousands out of pocket
• Package price savings of approximately 50% for Medical• Saves Plan Money (ERISA allows use of tax advantage
dollars)
• May save employee money (FSA, HSA, Possible HRA)
Reduced Cost
• May save employee money (FSA, HSA, Possible HRA)
• Prescription Drug savings• Nexium 30 day 40 mg, available OTC for $22
• US cost $160, prescription required
• One of the TOP 5 drug in ANY US corporate medical plan
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• Sleeve
• Lap Band
• Roux-en-Y
• Knee
• Hip
• Shoulder
• Full Rehabilitation
IncludedOrthopedic Bariatric
Major
and Plastic
Specialties
• Implants
• Crowns
• Veneers
• Whitening
• Face/Neck
• Body Contouring
• Enhancements
• Laser Re-Sculpting
and
Cosmetic
Dental
Plastic
Surgery
Courtesy of
Company
• Cost savings
• Comparable Quality
• Enhanced Service
• Competitive Difference
Employee
• Patient Advocate• Comparable
Quality• Enhanced Service • Tourism• Potential Cost
Savings
Who Benefits? EVERYONE !!!
Difference
• Embracing Global Workforce Solutions
Potential Cost Savings• Dental• Cosmetic• Potential Design
Changes to Reduce Out of Pocket Cost
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• Self Funded Employer – Houston
• 2 employees
• BMIs of +40 and 32
• Procedure – Gastric Sleeves
• Outcome – at 6 months more than 100lbs combined – No complications.
• Cost –
CASE STUDY 1
• Cost –
• Houston $30,000 -$35,000
• Costa Rica $14,000 (included travel, hotel, surgery, complication insurance, companion)
• Savings = 53%
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• Employee seeking full mouth reconstruction
• Employer Dental plan annual maximum $2,500
• Cost –
• Houston $38,000 over 6 months
• Absent from work 21 days
• Costa Rica $16,000 over 2 weeks,
• Absent from work 14 days
CASE STUDY 2
• Absent from work 14 days
• Savings –
• Employer 7 days of lost time ($8,500)
• Employee $22,000 ($35,500 - $13,500)
Courtesy of
Courtesy of
Decide on
Specialties
Obtain
Committee
Approval
Amend
Documents
Design Plan
Incentives
Contract with
Patient
Advocate
Organization
Employee
Communications
Competitive
Enhanced
Benefit
Offering
HOW TO ADD THIS TO YOUR PLANCourtesy of
Definitions:Definitions:
•• Obesity: Body Mass Index (BMI) of 30 or higher.Obesity: Body Mass Index (BMI) of 30 or higher.
Prevalence Of Obesity…Trends Prevalence Of Obesity…Trends Among Among U.S. Adults U.S. Adults between between 1985 and 20091985 and 2009
•• Body Mass Index (BMI): A measure of an adult’s Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the the adult’s weight in kilograms divided by the square of his or her height in meters.square of his or her height in meters.
Obesity Trends* Among U.S. Adults
BRFSS, 1985(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1986(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1987(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1988(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1989(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1990(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1992(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1993(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1994(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1998(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1999(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2001(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2003(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2004(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2005(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2006(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2008(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
1999
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009
(*BMI ≥≥≥≥30, or about 30 lbs. overweight for 5’4” person)
2009
1990
2009
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
THANK YOU!The Council for International Promotion of Costa Rica Medicine PROMEDUS phone number (305) 381-2988
Costa Rica +506 2201-5265
Obesity Obesity Obesity Obesity Obesity Obesity Obesity Obesity TrendsTrendsTrendsTrendsTrendsTrendsTrendsTrends Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009
Source of the data:• The data shown in these maps were collected
through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data departments use standard procedures to collect data through a series of telephone interviews with U.S. adults.
• Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.
• In 1990, among states participating in the Behavioral Risk Factor
Surveillance System, ten states had a prevalence of obesity less than
10% and no states had prevalence equal to or greater than 15%.
• By 1999, no state had prevalence less than 10%, eighteen states had a
prevalence of obesity between 20-24%, and no state had prevalence
equal to or greater than 25%.
• In 2009, only one state (Colorado) and the District of Columbia had • In 2009, only one state (Colorado) and the District of Columbia had
a prevalence of obesity less than 20%. Thirty-three states had a
prevalence equal to or greater than 25%; nine of these states
(Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri,
Oklahoma, Tennessee, and West Virginia) had a prevalence of
obesity equal to or greater than 30%.
CitationsCitationsCitationsCitations
• BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss/
• Mokdad AH, et al. The spread of the obesity epidemic in the United States, 1991—1998 JAMA 1999; 282:16:1519–22.
• Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;
• Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10:1519–22.
• Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003: 289:1: 76–9
• Vital Signs: State-Specific Obesity Prevalence Among Adults —United States, 2009 MMWR 2010;59(30).