Ron Johnson, M.D., F.A.C.S., Chief Medical Officer of Satori World Medical 

The new Administration has placed high priority on healthcare reform, to lower costs and improve quality.  Maybe a recent article in Health Affairs (Lessons from India in Organizational Innovation:  A Tale of Two Heart Hospitals, Sept. 08) can help.  Authors from the Duke University schools of law, business and medicine describe how organizational innovation has made Indian heart hospitals a low cost, high quality success story.  Can the US do the same? 

The Indian market is different – with over a billion people and a large middle class, only 14% has health insurance, so Indian hospitals understand that their services have to meet the middle-class family budget.  Lower labor costs are important, but much of their success is due to developing and improving innovative organizational structures to provide care.

• Hospital Management Structure.  Many leading healthcare organizations in India are led by dynamic physician-executives, and there is much more collaboration between physicians and senior administrators than in the US.  Hospital management teams come with experience in the hotel industry to give a more focused customer/patient approach.
• Pricing.  Hospitals are competing on both price and quality – they have developed differential pricing, to target different income sectors and maintain volume and efficiency.  Fixed or capitated pricing is offered, to allow patients and payers to “shop” for procedures and compare prices.  This also shifts financial risk to the service providers, and makes them continually evaluate cost drivers and develop new, innovative approaches to care delivery.
• Drive for efficiency in supply and delivery chains.  The competitive market and fixed costs demand efficiency, increased production volumes, with reengineering service delivery models to maximize use of capital equipment.  Some develop and manufacture routine equipment to reduce costs.  There is considerable investment in information technology.
• Competing on quality, paying for mistakes.  Because Indian hospitals compete on both quality and price, hospital managers have instituted quality assurance and improvement as integral to the business models.  As one physician said, in this business model, “we can’t afford to have complications.”

Can US hospitals learn from these Indian successes, where quality care is provided at a fraction of the cost in the US?  There are barriers to this experimentation, entrepreneurialism and technological progress.

• Medicare and insurance payment policies.  The Medicare DRG payment system does not reward innovation or efficiency or price flexibility.  Private insurance does little to stimulate price competition.  Innovation – new procedures or delivery models – is discouraged.
• Legal Barriers.  The Stark Amendment, the Medicare Prescription Drug, Improvement, and Modernization Act, and other laws stifle physician ownership and investment in new facilities and discourage their involvement in corporate strategy – both beneficial in the Indian heart hospitals. 
• Tort standards.  Even the US medical malpractice system discourages innovation – the “community standard” often locks in expensive and conventional practices.

The Duke University authors conclude that “although most innovation-intensive industries have enjoyed a history of producing new generations of industry leaders, offering dramatic improvements in both capability and affordability, the US health sector has not.  The US health sector, however, may soon resemble other innovation-intensive industries in one important respect: it may find its industry leaders displaced by Indian offerings.  If dramatic cost differences persist between procedures performed in Indian and US hospitals, it might not be long before employers and insurers begin sending patients to India for treatment.”

One of the biggest driving factors fueling global healthcare and medical tourism in America, whereby patients seek medical care outside of the U.S., is the high quality of care now available in international hospitals. But what are the crucial attributes to look for in a high quality global health care program? If you are considering a medical tourism program, here are some important tips to help you ensure the medical care is of the highest quality and safety.

Make sure all hospitals in the network are accredited by the Joint Commission International (JCI): More than 220 public and private health care organizations in 33 countries around the world are now accredited by JCI, the international arm of the U.S. accreditor of hospitals.

1. Look for a global health network comprised of U.S./U.K. or equivalently trained and Board Certified physicians
2. Check to see if the hospitals in the global network have affiliations with prestigious medical universities and hospitals: There are several top-tier international hospitals that are directly affiliated with Harvard Medical, Johns Hopkins, The Cleveland Clinic, The Mayo Clinic, and other leading medical universities and hospitals.
3. Partner with organizations that follow AMA guidelines on medical travel: The American Medical Association (AMA) has set specific and important guidelines pertaining to medical travel. Global healthcare organizations should follow these established guidelines.
4. Determine if the program has a full-time Chief Medical Officer (CMO) and quality assurance team in place: The best global healthcare companies have a full-time CMO and Medical Quality Advisory Board to ensure ongoing quality improvements in patient care.
5. Work with an organization that offers dedicated support for the patient throughout the entire experience: Choose a medical travel program that offers a team of experts, comprised of Nurse Patient Advocates and Travel Care Coordinators, to ensure optimal delivery of healthcare services and a rewarding experience for the patient and his or her travel companion. Ideally, the Nurse Patient Advocates should be Registered Nurses with surgical training.
6. Find out if the program covers all costs for not only the patient, but a companion as well: Another important part of ensuring patients’ safety and comfort when undergoing surgery in another country is that they have a trusting companion to accompany them and be on hand to help them through the entire experience. That’s why a key distinguishing factor to look for in a global health care program is whether or not the costs of travel and accommodations for a companion are included.
7. Visit some JCI-accredited international hospitals online: To view the amenities and features international hospitals offer, take a virtual tour of them online. For instance, Clinica Biblica, a top, JCI-accredited hospital located in Costa Rica offers a virtual tour of their facilities, as well as National University Hospital in Singapore.

Last week, Steven Lash, President and CEO of Satori World Medical, spoke with HealthBlawg, an industry blog focusing on issues related to law and healthcare, last week about Satori’s take on medical tourism, including its method of sharing cost savings with consumers who use Satori’s services through employer-sponsored health plans.

David Harlow writes:

Sharing cost savings with employees through Health Reimbursement Accounts — funded through tax-deductible contributions by the employer if an employee uses an overseas medical service, and are used to pay for an employee’s health insurance premiums, deductibles and copayments in future years — is one of the Satori innovations.  Lash distinguishes his offering from that of the Hannaford’s-Aetna medical tourism plan which was announced with great fanfare, led to no employee taking advantage of an overseas procedure, and brought out a domestic provider that offered to match the overseas pricing Hannaford’s had obtained.  He also presents a number of other aspects of his company’s program in our conversation, including patient intake, patient choice, and quality assurance through selective contracting with JCI-accredited overseas providers for a limited set of services.

There are wildly varying estimates of the numbers of medical tourists originating in the U.S. — 50,000 to 750,000 a year, depending on who you ask and how you count — but that number seems likely to go up before it goes down.

You can read the blog and hear HealthBlawg’s audio Podcast interview with Lash here.

Download the audio here

Stay tuned for next week’s Satori World Medical blog post on international medical quality.

By Steven Lash, President & Chief Executive Officer of Satori World Medical

Satori World Medical has been quite busy over the past several months in our mission and vision to provide individuals, employers, financial sponsors and insurers with world-class healthcare, excellent client services and significant financial benefit.  We are very pleased to announce that we have executed an agreement with McGregor & Associates, an employee benefits consulting firm specializing in servicing public sector employers, to offer Satori World Medical’s innovative global healthcare network to thousands of McGregor & Associates’ contracted employers and their employees, as well as its own staff.

The costs of healthcare in the U.S. are higher than in any other country in the world, placing an enormous burden on today’s U.S. companies that fund their employees’ healthcare, in addition to the employees themselves who have become responsible for more and more of their own medical expenses.

McGregor & Associates is an organization committed to its customers and their employees.  Ensuring that the quality of care their constituents receive at our international hospitals is equal to or better than the care they would receive in the U.S. was the number one decision criteria for selecting Satori World Medical.  According to George McGregor, President of McGregor & Associates, our company has the most sophisticated quality assurance programs and processes compared to all the competitors that operate in medical travel space. George holds numerous other positions including General Manager of the Southern California Schools Voluntary Employees’ Benefits Association (VEBA), administrator of the California Public Employers Employees Health Care Coalition, and administrator of the SDCS-SDEA, a Joint Retiree Medical Benefits Trust.

Through our global network of Board Certified doctors and Joint Commission International (JCI)-accredited, state-of-the-art hospitals, Satori World Medical provides a comprehensive, high quality integrated medical benefit program that reduces the costs of selected surgical procedures by 44-84 percent.  The savings generated are shared with all stakeholders, while a portion of the savings, is funded in the employees tax-advantaged Health Reimbursement Account (HRA) when they select a Satori Global Network™ provider for their medical procedure. With Satori World Medical’s innovative Health & Shared Wealth Program™, everyone wins.

Other key benefits to U.S. employers are as follows:

·       Ability to compete better globally: Global healthcare models result in major economic benefits for U.S. companies because the costs of their employees’ healthcare are greatly reduced.  U.S. companies have access to same quality healthcare at much lower expense and as a result, companies can be more profitable and competitive globally.

·       Improved employee retention and satisfaction: An organization’s financial strength is built and reinforced by reducing costs and investing in the financial security and well-being of its workforce.  Therefore, companies that offer a global healthcare benefit option to their employees can greatly strengthen the overall morale and productivity of their workforce.  This is a new medical benefit at no cost to the employer or employee.

·       Seamless integration with any existing medical plan: A global healthcare benefit program can be seamlessly added to an employer’s existing employee benefit program and without any startup or ongoing expenses for the employer.  This medical benefit is in addition to the medical plan that is currently in place.

·       Single bill for employee claims: When considering the implementation of a global healthcare benefit program, one common concern among employers is whether or not significant internal resources and staff to administer patient claims and billing are involved.  Satori World Medical meets this challenge by handling the entire billing process for the employer, in which a single bill in U.S. dollars is provided for all services rendered, thus reducing company claims processing costs and with no foreign currency exchange fluctuations.

We are extremely excited about our partnership with McGregor & Associates because we believe our program will allow them to significantly improve the quality of their participating employers’ benefit administration processes, as well as their own, resulting in improved value and reduced costs across the board.  McGregor & Associates understands the importance of providing quality improvement solutions that increase employee and customer satisfaction, competitiveness, and financial performance.