Managed Care - March 2008 - (Page 45) of dollars. He wants to spark serious discussion about the effect of high costs and mediocre outcomes in the United States. “We compete in a global economy,” says Hayes, “and we need to find ways to think about the value of the health care we’re delivering. Why does this procedure cost $40,000 here, when the rest of the world is doing it for far less?” Often with far better results. Until now, those questions helped foster the rise of medical tourism among Americans with little or no insurance coverage for particular procedures. For the uninsured, going abroad offered a less expensive way to get treatments they often couldn’t afford in the United States. Now, though, some employers are jumping in. And like it or not, some insurers are going along, taking their first tentative steps toward piecing together a global provider network for corporate clients. This is one trend, though, that is begging to develop at a deliberate pace. No one has suggested innovative benefit managers,” says Mike Taylor, a principal at the benefits consulting company Towers Perrin, “and Peter Hayes at Hannaford is one of them.” “We hadn’t done this until now,” acknowledges Aetna medical director Charles Cutler, MD. “It does require a fair amount of thought. And one of the things Hannaford wanted was to have us think this through.” That process starts with a host of questions: What kinds of procedures make sense when patients are traveling long distances? Will there be a good cultural fit between patient and provider? Do the doctors speak English? Is the blood supply safe? Where do joint-replacement prostheses come from? At first blush, the cost differential between U.S. and foreign hospitals may appear enormous, says Cutler, but the differences aren’t always so dramatic when you compare that overseas rate with a discounted domestic figure negotiated by insurers. That’s another consideration to be weighed care- Foreign hospitals are not accredited as consistently as American hospitals, and global industry standards are not uniform, says Jacquelyn Aube, Cigna’s VP for product development. making overseas health care mandatory. Concerns about medical liability and continuity of care and the challenges presented by traveling to distant facilities continue to counter the case for foreign provider networks. There is also an uneasy sense that some unions may come down hard against exporting the work. At least one national insurer thinks that the future of this kind of business will hinge heavily on whether American providers will be willing to compete on cost with physicians and hospitals around the globe. That could make global networks a new weapon in the unending tussle over steadily rising health care expenses. And it could put doctors and other providers in the same boat with software engineers and others who now have to compete with lower-cost providers in India, China, and elsewhere. fully before selecting which procedures can be exported. “We want to do this in a thoughtful way and see how it goes,” Cutler says. “They’re all looking at it,” says Taylor. “They are looking at the facilities and doing the due diligence. It is edging forward. And there is more interest this year than last year. Of course, if another large influential employer working with United or Cigna or even Anthem says that it wants to do it, I’m sure that insurer will try to accommodate them. The national account business is so hard to get that they’re going to want to do this. And if a couple of employers that other employers know and trust are willing to give something a shot and it works out reasonably well, others will follow.” But it won’t be fast or easy. There is a possible union backlash for some companies to be concerned about, says Taylor. What can they do when the surgery they got halfway around the world goes wrong? Who can be held accountable? Also, says Taylor, there is always a concern when a complex case gets handed off to a physician on another continent. Doing the homework Still squarely in the pioneering stage, this is one insurance product where a few employers are likely to play a leading role in pushing adoption. “A handful of clients are led by experienced and MARCH 2008 / MANAGED CARE 45
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