Managed Care - March 2008 - (Page 47) As for the liability issue, Boucher says some new insurance policies are taking shape that would cover anyone victimized abroad by a medical error. “If your motivation is to sue for hundreds of thousands of dollars,” adds Boucher, “it will continue to be very difficult to do that.” But for every executive Boucher meets with there are many more MCO executives who have yet to do more than study the new strategy. “We definitely have customers and consultants that have asked a lot of questions about medical tourism,” says Jacquelyn Aube, vice president for product development at Cigna. “But no clients have approached us to do it. As a general rule, we attempt to create our products in response to anticipated market trends, so we’re following this one closely. “We do have relationships with facilities all over the world,” she adds. “Making a connection would be relatively easy. Our primary concern is that we’re used to having robust quality standards that are used industrywide within the United States and based on a consistent set of criteria to provide a source of confidence. That same level of accreditation doesn’t exist internationally yet.” Of course members in a high-deductible health plan could already make use of overseas care, and have those costs applied to their deductibles, so long as they had out-of-network coverage built in to their particular plan. Getting providers’ attention Hannaford’s new coverage policy was prompted by stinging criticism from its European owners, says Hayes. For them, says the benefits manager, medical costs and outcomes in the United States just don’t add up. “Look at what they’re spending in the United States,” says the benefits manager. “It’s two or three times what they’re spending in any other industrialized country. But if you look at quality, based on disability-adjusted life years (the international yardstick combining mortality and morbidity), we’re ranked dead last. So the Europeans said, why is health care going up at this extraordinary rate in the United States?” But this was more than a philosophical discussion. The owners demanded the grocery chain rein in its health care budget so that it grows no faster than the average consumer rate of inflation. And that made the foreign medical option — which Hayes first stumbled across in a Reader’s Digest article, of all places — a lot more appealing. Workers’ first exposure often came when Hayes started sitting down with rank-and-file employees. Their first reaction surprised him. “When I presented this the first question they asked was not where it was, but what can you tell me about quality.” When Hayes told them the institutions were rated by the Joint Commission International (part of the Joint Commission, formerly JCAHO) as better than or as good as U.S. facilities, nine out of 10 said they would give overseas care options serious consideration. “What we’re pursuing, like a lot of employers, is evidence-based medicine, value-based purchasing,” says Hayes. “Let’s make sure we’re delivering the right care, and let’s find ways to deliver the right care as efficiently as we can.” That’s exactly what virtually every other company is dealing with, adds Hayes, and many are likely to reach the same conclusion as Hannaford, especially if the pioneers start reporting success. Getting providers’ attention hasn’t been hard, either, he adds. Even moving a couple of marginal procedures abroad can cost hospitals significant income. “We selected Singapore because it’s a very safe city, it’s a former English colony, and there is a legal system if things go awry,” says Hayes, “so there is some measure of protection. It’s also a wonderful program. Aetna makes all the travel arrangements for them; they’re escorted from the plane to the hospital. So far, Hannaford is offering only hip replacement, but there are other possibilities: “back surgery, spinal fusions, and we’re not sure what else,” adds Hayes. “Down the road, having images read abroad is something that we might do.” Whether the trend toward overseas care really gets going, says Cutler, will have a lot to do with the way American providers respond. “I haven’t heard any employers say that they would want to offer this if quality and cost were competitive in the United States,” notes Cutler. “Employers are considering this because institutions outside the country have made quality data public and made the costs attractive.” As for providers, he adds: “It’s already raising awareness in the physician community.” MC MARCH 2008 / MANAGED CARE 47
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