How To Design A Benefit Plan To Include A Medical Travel Option

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Insight into Medical Tourism in Costa Rica. Fascinating information on the growth of obesity in the U.S.

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How To Design A Benefit Plan To Include A Medical Travel Option

  1. 1. Courtesy ofHOW TO DESIGN A… BENEFIT PLAN TO INCLUDE A MEDICAL TRAVEL OPTION
  2. 2. • Medical Tourism declared • Costa Rica offers three JCI of national and public accredited hospitals: – HOSPITAL CIMA interest by former President – HOSPITAL CLÍNICA of the Republic Oscar Arias BIBLICA in 2009 – HOSPITAL & HOTEL LA CATOLICA• Formal commitment of actual President of the • Additionally, Costa Rica is home of Latin American Republic Laura Chinchilla branches of accreditation body• In 2009 Costa Rica received like AAAASF and AAAHC approx. 30.000 medical (deeming authorities for travelers injecting about CMS). U$250 million in Costa • Today there are more than Rica’s economy 20 ambulatory clinics internationally accreditedABOUT COSTA RICACosta Rica: quality health care and nature within your reach!
  3. 3. • 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 with services of excellence in favor of patients security.ABOUT PROMEDPROMED: the gate to quality healthcare in Costa Rica!
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  5. 5. • 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• Benefits to YOUR EMPLOYEES/RETIREES• HOW to Add Global Centers of ExcellenceAgenda Courtesy of
  6. 6. What Are Centers ofExcellence (COE) Courtesy of
  7. 7. Designed to Improve Outcomes Bariatric Cost Savings Humana Provided Travel with Reduced for Member and Complications 1982 Companion Every Major City has Multiple COE’sCenters of Excellence (COE) Courtesy of
  8. 8. Quality Outcomes for a Reduced Cost Highly Accredited English Speaking Providers JCI Accredited Specialized (similar to Targeted US Procedures Standards)What is a GLOBAL CENTERSOF EXCELLENCE PROGRAM Courtesy of
  9. 9. Joint Commission Joint CommissionAccreditation – United States Accreditation - International• Correctly ID Patient • Correctly ID Patient• Improve Effective • Improve Effective Communications Communications• Improve High-Alert Med • Improve High-Alert Med Safety Safety• Ensure Correct site, • Ensure Correct site, Correct-Procedure, Correct-Procedure, Correct-Patient Surgery Correct-Patient Surgery• Reduce Risk of Health • Reduce Risk of Health Care – Associated Care – Associated Infections Infections• Reduce Risk of Patient • Reduce Risk of Patient Harm Resulting from Falls Harm Resulting from FallsAlthough US Accreditation is different the standards for the International Community aresame and in some cases more stringentAccreditation Courtesy of
  10. 10. Courtesy of
  11. 11. ReducedTHE PATIENT ADVOCATE Cost IS THE KEY !!!Facilitating the processfor the member- Medical Necessity- Providing Cost and Adverse Measurable Patient Provider Options Outcome Outcomes Advocate Protection- Coordinating Travel and In-Country Transportation- Facilitating Claim Payment- Providing Medical Enhanced Follow Up Contact Clinical Service Components of a Global Centers of Excellence Program Courtesy of
  12. 12. Measurable Outcomes Courtesy of
  13. 13. Volume of Procedure at Facility or by Provider Complications Morbidity Re-admission or Secondary Mortality Infection RatesMeasurable Outcomes Courtesy of
  14. 14. Measurable Outcomes Courtesy of
  15. 15. • Increased Level of Service • RN patient ratio 4:1 Nursing • US nursing ratio can exceed 10:1 •Many US/ Western Trained Physicians •Technologically advanced hospitalsTechnology/ •Example: oxygen chamber to enhance healing after surgery Training •Private rooms •Recovery Centers with personalized care •Patient Advocate coordinates return to home country; follow patient through Follow up recoveryEnhanced Clinical Experience Courtesy of
  16. 16. Enhanced Clinical Experience Courtesy of
  17. 17. Domestic US International• Mal-practice • Insurance Policy Insurance • Specific• Legal System • Protections for • Protracted • Uncertain both patient and • Up to 33% of Award to employer/plan Lawyers • Outcome• Adversarial Assured• Outcome UncertainAdverse Outcome Protection Courtesy of
  18. 18. Up to 50% Up to 90% on savings in Up to 80% Prescription Medical for Dental Savings DrugsPackage PriceReduced Cost Courtesy of
  19. 19. • 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)• 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 planReduced Cost Courtesy of
  20. 20. • Knee • Sleeve • Hip • Lap Band • Shoulder • Roux-en-Y • Full Rehabilitation Included Orthopedic Bariatric Major Plastic and Surgery Cosmetic Dental• Face/Neck • Implants• Body Contouring • Crowns• Enhancements • Veneers• Laser Re-Sculpting • WhiteningSpecialties Courtesy of
  21. 21. Company Employee• Cost savings • Patient Advocate• Comparable • Comparable Quality Quality• Enhanced Service • Enhanced Service • Tourism• Competitive Difference • Potential Cost Savings• Embracing Global • Dental Workforce • Cosmetic Solutions • Potential Design Changes to Reduce Out of Pocket CostWho Benefits? EVERYONE !!! Courtesy of
  22. 22. • 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 – • Houston $30,000 -$35,000 • Costa Rica $14,000 (included travel, hotel, surgery, complication insurance, companion) • Savings = 53%CASE STUDY 1 Courtesy of
  23. 23. • 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• Savings – • Employer 7 days of lost time ($8,500) • Employee $22,000 ($35,500 - $13,500)CASE STUDY 2 Courtesy of
  24. 24. Courtesy of
  25. 25. Design PlanDecide onSpecialties Incentives Competitive ObtainCommittee Contract with Patient Enhanced Advocate Approval Organization Benefit AmendDocuments Employee Communications OfferingHOW TO ADD THIS TO YOUR PLAN Courtesy of
  26. 26. Prevalence Of Obesity…Trends AmongU.S. Adults between 1985 and 2009 Definitions:• Obesity: Body Mass Index (BMI) of 30 or higher.• Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters.
  27. 27. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
  28. 28. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
  29. 29. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
  30. 30. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
  31. 31. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
  32. 32. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
  33. 33. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  34. 34. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  35. 35. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  36. 36. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  37. 37. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  38. 38. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  39. 39. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
  40. 40. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
  41. 41. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
  42. 42. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
  43. 43. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  44. 44. Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  45. 45. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  46. 46. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  47. 47. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  48. 48. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  49. 49. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  50. 50. Obesity Trends* Among U.S. AdultsBRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  51. 51. Obesity Trends* Among U.S. AdultsBRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  52. 52. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2009 (*BMI ≥30, or about 30 lbs. overweight for 5’4” person) 1990 1999 2009No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  53. 53. THANK YOU!The Council for International Promotion of Costa Rica MedicinePROMEDUS phone number (305) 381-2988Costa Rica +506 2201-5265info@promedcostarica.com
  54. 54. Obesity Trends Among U.S. Adultsbetween 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 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.
  55. 55. • 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 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%.
  56. 56. Citations• 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; 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).

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