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© 2012 Medical Travel Today

Medical Travel Today is a publication of CPR Strategic Marketing Communications, a public relations firm based near New York City that specializes in healthcare and life sciences, with an international clientele. CPR, its Partners, and clients are at the nexus of where medical travel is today, and where it will be tomorrow.

Publisher, Laura Carabello

Table of Contents

From the Editor

From the Editor: This week in Medical Travel Today, Amanda Haar

News in Review

Southwest Winning Hearts in Medical Travel

Renub Research Releases "South Korea Medical Tourism: Number of Medical Tourists & Medical Tourism Market Forecast to 2015”

Medical tourism becomes popular with affluent Chinese

$1bn medical city development by Apex Medical Group officially named International Medical City


Inside Look

Medical Travel Today Follows One Employer's First Foray into the World of Medical Travel


JULIE STONE, Towers Watson

Industry News

Joint Commission Adds Hospitals to Top-performers List

Editor Concerned International Medical Travel Creating Substantial Challenges National and Global Public Health Delivery

Major Medical Tourism Initiative Launched

Upcoming Events

New Health Insurance Business Models for a Post-Reform World

International Reinsurance & Finance Symposium

The 5th International Health Tourism Congress

5th Annual Middle East Healthcare Expansion Summit

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Global Health Voyager

Volume 6, Issue 20

by Amanda Haar, Editor


Beginning with today's issue, we'll be featuring an ongoing series (INSIDE LOOK) at how one US-based employer is approaching the prospect of adding medical travel to its benefits option. This will be a watch-it-as-it-unfolds type of series and one that will surely be of interest to other employers, benefits managers, insurance brokers, hospitals, and facilitators, as it will examine the entire decision-making process.

We're grateful to Sam Shallenberger, CFO of RJ Young and Alex Tolbert of Bernard Health for allowing us to track the progress. Readers are welcome to offer suggestions and comments throughout.

As always, we welcome your comments, story ideas, and press releases.


Amanda Haar, Editor


Medical Travel Today
recently partnered with Well-Being Travel to host the first "Well-Being and Medical Travel Conference 2012." The event - which took place June 20-21 in Scottsdale, Ariz., and drew in 400+ attendees - educated travel sellers on how and why they should sell medical and wellness travel.

As a follow-up to the conference, we're conducting a survey in an effort to gather benchmarking information...and help everyone increase their success in this specialty niche (including medical practitioners and facilities, wellness therapists and retreats, travel suppliers and travel sellers...and ultimately the patient travelers).

Take our brief 10-question survey today and you could win a $250 American Express Gift Card!!!

Just click on this link: https://www.research.net/s/5L687QT

Log onto Facebook and join the Medical Travel Today Group. Look for recent news, trends, and post discussions in the board. If you would like to see something in Medical Travel Today let us know in the discussion board. If you have a question, post it there!

You can also follow Medical Travel Today on Twitter. For more information log onto www.medicaltraveltoday.com

INSIDE LOOK: Medical Travel Today Follows One Employer's First Foray into the World of Medical Travel

Three years ago Sam Shallenberger, CFO of RJ Young, a $100 million equipment and leasing company based in Nashville, TN was faced with a dilemma plaguing many American employers: How to provide affordable healthcare coverage to its 450 employees.

When he asked his then-broker for advice he got a bad news/good news scenario: "Industry rates are going up 14 percent but yours are only going up 11 percent". Not surprisingly, he found cold comfort in that so-called good news.

"I'm a numbers guy so I began playing out the trends and expenses," say Shallenberger. "It didn't take long to figure out that in a matter of just a few years we'd exist only to pay medical bills. I knew there had to be a better way."

When Shallenberger approached his broker about health savings accounts (HSAs) he was met with a discouraging prediction: "It'll never work. Your employees are too blue collar for that approach."

At that point, Shallenberger conceded that his broker was not really interested in finding solutions for RJ Young -- but rather in keeping his commission. So Shallenberger made a bold move. He dropped his broker and found a new one, Alex Tolbert of Bernard Health.

After some initial research into RJ Young's specific needs, Tolbert suggested they switch to a consumer-directed health plan. The plan the company executives agreed upon was a High Deductible Health Plan with Health Savings Account.

The results were better than anyone could have imagined.

"In the first year. we cut cost by 30 percent and saved over $1 million. Specifically, the company saved $823,000 and our employees saved $221,000," says Shallenberger.
The success continued the next year with healthcare costs dropping another 1percent. In year-three, the costs held steady.

"Believe me, everyone was and still is pretty happy, but I can see already that we need another solution,” notes Shallenberger. “Things won't hold flat for long."

In the course of looking around for innovative ideas Shallenberger learned about medical travel.

"From all that I read, it was clear that seeking care outside the U.S. was one way to save money for both the employer and the employee," he says. "The question now is whether or not it's something I can -- in good conscience -- ask our employees to do."

While most employers try to answer this question by poring over data related to outcomes and quality, reviewing accreditations, seeking out references, etc., Shallenberger is going another route. He's going to become an actual medical traveler.

As it turns out, Shallenberger has a bum shoulder. Knowing that rotator cuff surgery is in his future, he's decided to use that pending experience as the ultimate test of medical travel as an option for his company.

Turning once again to Alex Tolbert and Bernard Health for assistance, Shallenberger will take the next several months to sort through the various options and winnow the choices to a final three or four.

"When we've got it narrowed down to a few, I'm going to visit each option for an executive check up and to do a general sniff test," says Shallenberger.

His impressions and findings from those experiences will determine where he'll eventually go for surgery.

As for Tolbert's effort to narrow down the field options, the work has just begun.

"We actually just took our first meeting today (9/26/12)," says Tolbert. "I'm extremely excited about the opportunity as it is completely in line with Bernard Health's mission to help individuals and employers to find innovative ways to plan and pay for both expected and unexpected healthcare expenses. I have no doubt this effort will lead to the opening of new and money-saving doors for not just R J Young, but also many other employer groups that we assist."

Editor's Note: Medical Travel Today will be following Tolbert and Shallenberger's efforts over the next several months and reporting on their progress, decision-making process, and ultimate choice. If you would like to reach Alex Tolbert regarding a potential option, please email him at alex.tolbert@bernardhealth.com. Please use the subject line of "RJYoung Medical Travel."


Julie Stone, Towers Watson

Julie Stone, Towers Watson

Editor's Note: A recent Towers Watson survey of 440 midsize and large companies revealed that employers are actively looking for ways to address the increasing costs of healthcare. Senior Consultant Julie Stone kindly agreed to speak to us about how medical travel may or may not fit into cost containment plans in the future. Her comments follow below.

Medical Travel Today (MTT): Of the 440 companies interviewed for your recent survey, are any actively engaged in either domestic or international medical travel?
Julie Stone (JS): We do not ask a question specifically about international medical tourism. But regarding domestic travel, the survey gets at the subject by asking about employers offering incentives for using high performing networks and centers of excellence for care. The idea is to motivate employees to seek care at facilities with the best outcomes. Personally, I see that as a version of domestic medical tourism. I just think we have a terminology difference.

I can definitely say that this is a type of incentive we'll be seeing more of in the future.

In the most recent survey we found that 14 percent of employers are planning on using incentives for high performing networks in 2012-13, with 44 percent aiming to do the same in 2014-15.

MTT: Can you offer an example of the type of incentive they're offering?
JS: Sure. Let's say the current benefit an employee receives is 80% of the cost of coverage by the employer health plan. If you use center of excellence or high performing facility your employer coverage might tick up to 90 percent reducing your out of pocket expense.

MTT: Is your sense that they're incentivizing people to go to nearby centers of excellence or across the country?
JS: How far an employee may depend on both the health plan and the employer. When there is a critical illness or rare disease, the center of excellence will likely be based on where to get the best outcome rather than geography. So if you have a particular type of cancer you may end up in Texas for treatment whereas another type of cancer could lead you to a facility in New York.

MTT: Do you anticipate adding questions related to international medical travel to future surveys?
JS: That's a good question. Just last week I was involved in a discussion about our upcoming surveys for the balance of 2012 and 2013.I anticipate international medical travel will be an area we explore in future surveys.

MTT: Is your perception that medical travel might find some traction with employers in the future?
JS: Yes, particularly on the domestic side. There is definitely an open-ness to strategies that help employers bend the cost curve. If that requires having people to travel for care, I think employers will consider it. Employers are very receptive to things that impact the conditions and services that drive health care cost.

On the international side, I think there's still a considerable lack of awareness and appreciation for the quality of care that may or may not be available outside the U.S.

Employers are comfortable with the oversight and standards that exist here. Things like NCQA, various hospital reporting mechanisms, etc. However, they are not familiar with how quality is monitored or evaluated in other countries. Without that understanding they're not necessarily going to encourage an employee or their family member to go there for care. They truly feel responsible.

MTT: What do you think it will take to make employers feel more comfortable?
JS: Education and exposure will be critical. I also think that that the expansion of telemedicine may serve to break down some barriers. Right now we're seeing employers with expats applying it to let those outside of the US access top flight specialists within. It really is, in a sense, medical travel, albeit virtual medical travel. In time I think it could serve to flatten the world a little bit.
I also think there's a potentially interesting application for those in the US living in rural areas where high quality care may be less accessible.

MTT: What do you consider to be the challenges to increased domestic medical travel?
JS: You know, it's communication. Often the family healthcare decision maker is not the employee. It used to be that employees carried home books and pamphlets about plans and options but now most of that communication is done electronically. Often the folks at home may not know all of the details of what is available through the benefit plan including access to providers in areas other than where they live. But to get both the best health care outcome and cost reduction, everyone needs to know the full range of benefits.

MTT: Are employers taking steps to improve communication?
JS: Both employers and health plans are changing the way they communicate. It's not unheard of for a plan to call a member who is going through a pre-approval process and say, "I see you're going to facility XYZ for a given procedures. Did you know there's a high quality center of excellence with high quality outcomes a bit further away that you may want to consider?" They're taking the step to raise the patient awareness of their options.

MTT: I'm curious if there have been other cost-containment offerings in the past that might parallel medical travel. So, let's say smoking cessation classes or nutrition programs. Are there lessons that can be learned from the introduction of those programs that can be applied to medical travel?
JS: I can't think of anything that's truly parallel however there have been incentives for transplants for some time; incentives that include care at certain centers of excellence, the cost of a family member's travel, etc. It completely makes sense to link patients with the most appropriate facility. One idea is to help employers see that they are actually already offering medical travel in very specific circumstances...

In some ways, is the pendulum of healthcare is swinging back to an approach where the tradeoff between choice is offset by favoring smaller networks with both quality and cost advantages.

If you think about the development of HMOs in the late 70s and 80s which were really pretty tightly controlled health plans, followed by a hue and cry from the masses that led to the creation of PPOs which offered more choice. Now I think you're seeing the pendulum swing back to the tighter ship, if you will. Employers and others recognize that if you have a smaller network made up of the most efficient and effective providers, it costs less. That movement back in general to a tighter network could really set the stage for directing people to the most appropriate care and providers. That trend could help propel domestic medical travel forward at a faster pace.

About Julie Stone
Julie Stone is a Senior Consultant in Towers Watson's Health & Group Benefits practice in Parsippany, New Jersey and our Practice Leader for Business Process Excellence and Learning & Development.
Julie works with her clients to develop Health & Welfare benefit strategy in alignment with organizational/business goals as well as to design, implement, measure/monitor their health and welfare programs through a variety of quantitative and qualitative vendor assessment and vendor management approaches and tools. Julie's expertise covers the full range of health & welfare programs including medical, dental, disability, life insurance, and more. Particular areas of focus include care management and integrated health care programs that focus on overall cost management and employee engagement. In addition, she assists clients with vendor selection, oversight, and evaluation. Julie has worked with clients in a variety of industries including financial services, pharmaceutical, and utilities.

Julie joined Towers Watson in 1999 after spending 18 years with a national health plan. She has a B.A as well as a Master's degree in Public Administration with a concentration in Health Care Management, both from New York University.


Industry News

Joint Commission Adds Hospitals to Top-performers List

fiercehealthcare.com - The Joint Commission's second annual report on quality and safety recognized 620 hospitals as top performers for achieving excellence on quality care metrics, a more than 50 percent increase from last year's list, The Joint Commission announced today.

Despite adding 215 hospitals, notable academic medical centers still failed to make the Joint Commission's honor roll. Just as in the inaugural list last fall, compliance scores at teaching hospitals missed the mark.

For example, Johns Hopkins Hospital in Baltimore, the Mayo Clinic in Rochester, Minn., NYU Langone Medical Center in Manhattan and UCSF Medical Center in San Francisco remained absent, Kaiser Health News reported.

The longer list didn't stem from top grades among teaching hospitals or from hospitals performing better. Rather, the agency this year included psychiatric hospitals in the calculation, which added 43 freestanding psychiatric hospitals or hospitals with inpatient psychiatric units as top performers, noted KHN.

To make the list, hospitals scored 95 percent for every accountability measure related to heart attack, heart failure, pneumonia, surgical care and children's asthma care, as well as new measures for inpatient psychiatric services, venous thromboembolism (VTE) care and stroke care during 2011.

The Joint Commission hopes the top-performers list will encourage better quality care among accredited hospitals. However, other hospital rankings like U.S. News & World Report's "America's Best Hospitals" and HealthGrades' "Best Hospitals" have come under fire, with critics blasting them as misleading and incomplete.


Industry News

Editor Concerned International Medical Travel Creating Substantial Challenges National and Global Public Health Delivery

voxy.co.nz - A University of Canterbury (UC) lecturer is concerned about the booming medial tourism industry, combining cosmetic or dental surgery with an overseas holiday, because of the future of medical services and health security.

UC Professor Michael Hall, editor of a recently released book on international medical tourism, said that the lack of accurate data on the international flow of medical tourists, along with some governments promoting medical tourism was creating substantial challenges to national and global public health delivery.

The Wall Street Journal has reported the international medical tourism industry would reach $US100 billion this year.

The way medical tourism has evolved is the result of deliberate decisions by governments as to their spending, economic, welfare and taxation priorities and shed a substantial light on their commitment to public health provision,'' Professor Hall said.

In many western countries the growth of medical tourism is the result of the failure of some governments to respond to increasing demands for public health services.
Some governments see medical tourism as a means of not only raising revenue but also as a way of subsidizing their ailing health systems.''

He said medical tourism was raising substantial questions about equity to medical and healthcare access as well as the long-term implications of medical tourism. Some governments might even feel relief when people travel overseas for medical treatment as it would potentially take the pressure off local services.

Growth in international medical tourism was a reflection of globalization and changing political philosophies on health provision. But he said not all medical tourism was bad.
In some cases for cultural or language reasons travelling internationally for medical treatment made a lot of sense. Similarly, cross-border medical treatment in the European Union provided opportunities for economic efficiencies while still being in a high quality medical environment. Nevertheless, he said there was also a dark side to medical tourism.
There are major issues with respect to quality of treatment, liability if things go wrong, as well as the ethical dimensions of medical practices in some cases. Medical tourism also reinforces the current mind-set of some governments and medical institutions that changes the perspective from that of a patient to that of a consumer.

How does this affect the traditional patient and medical services provider relationship? What are the obligations to treat if things go wrong, and who should pay?"

Perhaps the most concerning aspects of international medical tourism is the potential danger it poses to public health. Medical tourism can only further globalize the growing drug resistance of some medical diseases and conditions while also being a potential vector of future pandemics.

Unfortunately, even the best bio-security arrangements make it very difficult to intercept people returning from medical treatment overseas who are carrying either antibiotic-resistant bacterial infections or a disease as the symptoms may not show up immediately. Such events or outbreaks are then a major cost on the public health fund in their own right.

We need to get a much more rigorous assessment of the potential longer term effects of medical tourism not only on people who decide that they want to travel abroad for treatment but also because of the effects on health services and public health.''



Industry News

Major Medical Tourism Initiative Launched

Brookline, Massachusetts - 1 October 2012 - Elizabeth Ziemba, President of Medical Tourism Training, Inc. has been invited to participate with Stackpole & Associates in the project to conduct a national "Medical Tourism Market Analysis" for ProExport Colombia.

The country has invested substantial sums of money in improving and expanding its health care infrastructure, creating the environment to provide high quality health care services to increasing numbers of international patients. The marketing project is the next step in leveraging those assets to raise Colombia's profile in the medical travel sector to increase the kinds of services delivered to increasing numbers of patients.

"The extraordinary assets of Colombia are well known in the region", states Irving Stackpole, President of Stackpole & Associates ." This project is an opportunity to promote those assets on a global scale. For example, there are Centers of Excellence for organ transplant in Colombia. At one hospital alone, doctors perform 40 heart transplants per month. This is the type of skill and expertise that Colombia has to offer the world".

Over the next several months, the team including The Center for Medical Tourism Research and Margaret Ball, founder of Health Links International, will be conducting original research to identify the best competitive marketing position for the country.

According to Dr. David G. Vequist IV, the founder and Director of the Center for Medical Tourism Research (CMTR), "The CMTR will be capturing and analyzing primary data on the preferences of potential medical tourists for Latin American and specifically Colombian healthcare destinations." The results of this research will be vital in the development of the country's marketing plan.

Combining the knowledge and experience of the project team promises the client research-based results with practical recommendations for growing the country's medical travel sector.

About Medical Tourism Training, Inc.
Medical Tourism Training, Inc. is a dynamic company offering on-line courses as well as on-site training and consulting services to the individuals and organizations involved in the rapidly growing international health travel sector. With a focus on business skills and training designed to improve the patient/customer experience, the company is the first to market affordable, convenient, and easy to use eLearning solutions that are oriented to working professionals. By collaborating with experts in the fields of medical tourism, health care, business, hospitality, and law, Medical Tourism Training is ready to deliver high quality on-site training and consulting services designed to create measurable change for its clients. For more information about the services offered by Medical Tourism Training, contact Elizabeth Ziemba <mailto:eziemba@medicaltourismtraining.com> .

About Stackpole & Associates
Stackpole & Associates specializes in designing and delivering marketing, market research, consulting, as well as sales and customer service training to healthcare and senior living organizations around the world. With extensive experience in the international health travel sector, Stackpole & Associates guides clients through each phase of developing and implementing strategies and tactics to create innovative and practical solutions to the challenges facing service-intensive organizations. For more information about the services offered by Stackpole & Associates, contact Irving Stackpole directly.

Upcoming Events

New Health Insurance Business Models for a Post-Reform World

October 4-5, 2012  • Marriott Wardman Park Hotel • Washington D.C.

Health insurers and their partners and competitors have never faced a period of greater change, uncertainty and potential turmoil. When you attend New Health Insurance Business Models, you'll gain a thorough understanding of today's most compelling bottom-line issues for health care professionals, from exchanges to dual eligibles to new benefit designs to ACOs and medical homes. You'll leave with an arsenal of new strategies you can employ to take advantage of the unprecedented opportunities ahead ... and avoid the many pitfalls.

This ambitious event features a Keynote Presentation by Former Senate Majority Leader Tom Daschle, a Luncheon Presentation by former CMS head Tom Scully, and 29 industry experts who will participate in provocative Health Business Roundtables. (Please see the Full Program to review the "Who's Who" of health business leaders you will interact with on October 4-5.)

New Health Insurance Business Models will be state-of-the-art in terms of comfort, convenience and technology, in a luxury destination that has hosted many of the nation's most important events for the past century. The registration fee is just $795 for AIS's health business newsletter subscribers - a $250 discount off the regular rate of $1,045. See the registration details.

Space is limited! Be sure to reserve your place today.

International Reinsurance & Finance Symposium
Santo Domingo, Dominican Republic
October 24, 2012 to October 26, 2012
Slated for Wednesday, October 24th to Friday, October 26th in the Dominican Republic this conference will focus on the education of insurance professionals, finance and regulatory officials on the insurance and reinsurance industry as well as emerging banking and regulations on trusts and investments.
Presentations will provide an overview of reinsurance including products, history, financial, technical and regulatory information and will include discussions on underwriting, pricing, claims processing, captive insurance companies and product development. The event will offer a global perspective on reinsurance discussing North American, European, Caribbean and other international reinsurance markets including developments and emerging products/issues.
Keynote speakers include representatives from Aquarius Capital, Benedetto Laskay LLC, Hannover Life Reinsurance Company of America, Langa & Abinader, WorldCare International, and other international organizations specializing in insurance, reinsurance and finance.  

Agenda and Accommodations
The agenda and speaker bios for the meeting can be viewed here.

Tours of the city of Santo Domingo and a luncheon at Boca Marina, Boca Chica are included.
To register for the event, click here.

The 5th International Health Tourism Congress
Ankara, Turkey, November 18-21, 2012

Organized by the Turkey Health Tourism board, The Fifth Annual International Health Tourism Congress will be held November 18-21, 2012, in Ankara.

Participants are expected to include representatives of health organizations from Turkey and the world, government representatives, and bureaucrats from Turkey Health, Culture and Tourism Ministry.

The Congress is expected to serve as an effective background for showcasing Turkey's potential to create new business and investment opportunities with partners from neighboring nations, the Middle East, Central Asia, Balkans, Europe, North Africa and the United States.

To learn more or to register click here.

5th Annual Middle East Healthcare Expansion Summit

October 10 & 11, 2012, Abu Dhabi

The Healthcare - IT industry has always been growing, and with the advent of mobile health, telecom leaders have also joined the league. In the Middle East, the healthcare segment is a primary focus area for the IT as well as telecom industry with opportunities in areas such as diagnostics applications, interactive mobile applications, self-care, hospital information systems and integration of IT platforms with mobile health apps.

The 5th Annual Middle East Healthcare Expansion Summit aims at addressing the challenges and opportunities of the healthcare information and communications technology (ICT) industry through a forum of healthcare providers, ICT industry leaders and government representatives who will brainstorm on how to meet challenges and adopt new and upcoming technologies to the healthcare sector in the Middle East.

To register or learn more click here.

Medical Travel Today: Opinions and Perspectives on an Industry in the Making

Medical Travel Today - the authoritative newsletter for the worldwide medical travel industry - is pleased to announce publication of a new book, "Medical Travel Today: Opinions and Perspectives on an Industry in the Making.

Featuring 40 of the newsletter's most compelling interviews from the first five years of publication, the volume chronicles the explosive growth of international medical tourism as witnessed and experienced by some of the key stakeholders and players. A must-read for anyone interested or involved in the industry.

News in Review

Southwest Winning Hearts in Medical Travel
blogsouthwest.com - Blogger Shannon Roberston is doing all she can to make the world aware of her love and gratitude for Southwest Airlines' Medical Transportation Grant Program.

Renub Research Releases "South Korea Medical Tourism: Number of Medical Tourists & Medical Tourism Market Forecast to 2015”
A new report from Renub Research provides the current status and outlook of South Korea medical tourism market survey analysis, comparison of the overall market size in Asia, the number of customers of the medical tourists change projections and the cost of various types of surgery in the United States, UK, growing to promote the exchange of factors and issues analysis information. The report also entails major drivers and roadblocks of South Korea medical tourism market.    

Medical tourism becomes popular with affluent Chinese
eTN - Modern care and a bit of shopping is just what the doctor ordered. An increasing number of wealthy Chinese are flying overseas, but not to shop for luxury brands such as Louis Vuitton, Gucci and Prada. These people are looking for something not found on department store shelves. They are seeking beautiful faces, stronger hearts, clearer eyes or just a better understanding of their health.

$1bn medical city development by Apex Medical Group officially named International Medical City
ameinfo.com - The President of the Apex Medical Group (AMG), Dr. Abdullah Al Joaib is pleased to announce that his landmark integrated medical tourism project of the medical city (TMC) in Salalah, Oman has been officially named as the "International Medical City" (IMC).


Editor's Note: The information in Medical Travel Today is believed to be accurate, but in some instances, may represent opinion or judgment. The newsletter's providers do not guarantee the accuracy or completeness of any of the information and shall not be liable for any loss or damage caused - directly or indirectly - by or from the information. All information should be considered a supplement to - and not a substitute for - the care provided by a licensed healthcare provider or other appropriate expert. The appearance of advertising in this newsletter should in no way be interpreted as a product or service endorsement by the newsletter's providers.