Building a Business Case - HGK

Dr. Paul van OstenBerg, Consultant/Surveyors

Building a Business Case

February 22, 2017

Best Practices in Medical Travel

Topics• A look at national readiness

• A look at facility readiness by understanding risks in the medical travel care continuum

• Turning readiness into a successful medical travel program.

Agenda

www.globalhealthcareresources.com 2

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Medical Tourism Defined …

Medical tourism can be defined as

the process of traveling outside one’s

local area of residence for the

purpose of receiving medical

services.*

*Medical Tourism Association ®

Medical Travel.

Integrating :

– Hospitality,

– Clinical and

– The Patient Experience.

These three component are

important at the National and

Facility levels.

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National Readiness for

Medical Travel has many Dimensions

….

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Mortality & Health Indicators in Croatia2000 - 2012

2000 2005 2010 2012

Life expectancy at birth, total 72.8 75.2 76.5 76.9

Life expectancy at birth, male 69.1 71.8 73.5 73.9

Life expectancy at birth, female 76.7 78.8 79.6 80.1

Total mortality rate, adult, male (per 1000 male adults) 174.6 158.8 143.2 138.4

Total mortality rate, adult, female (per 1000 female adults) 71.0 65.5 60.0 58.4

Source: WHO (2014)

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Maternal, Child & Adolescent Health Indicators2000 - 2012

Source: WHO (2014)

2000 2005 2010 2011 2012

Infant Mortality Rate 7.4 5.7 4.4 4.7 3.6

Probability of dying by age 5 (per 1000 live births) 8.4 6.6 5.3 5.2 4.4

Maternal mortality rate (deaths per 100,000 live

births)

6.9 7.1 9.2 9.7 7.2

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Trends in Health Expenditure in Croatia2000 - 2012

EXPENDITURE 2010 2011 2012

THE AS % OF GDP 6.82 7.82 6.82

THE in US$ PPP per capita 1461.7 1361.72 1409.78

Public sector expenditure as health as % of THE* 84.8 82.5 82.32

Private expenditure on health as % of THEa* 15.2 17.5 17.68

OOP payments as % of THEa* 14.58 13.75 13.89

OOP payments as % of private expenditure on health* 95.92 78.56 78.56

Source: WHO (2014)

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Rights guaranteed by the 2004 Act on the

Protection of Patients’ Rights

Right to information

Right to accept or refuse specific diagnostic and therapeutic procedures

Right to protection whilst taking part in clinical trials

Right to access to medical information

Right to confidentiality

Right to maintenance of personal contacts

Right to leave the health institution voluntarily

Right to compensation for damages

Source: WHO (2014)

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Patients and Cross-Border Healthcare in EU

Patient mobility, both inward and outward, is not significant in Croatia. Patients coming from

abroad to use health care services in Croatia are mainly motivated by lower prices for some

services, such as dental care or cosmetic surgery. No records about patients coming from abroad

to use health care services in Croatia on an elective basis are maintained; only the use of

emergency care is monitored. From 1 July 2013, Croatian patients have been able to use their

European Health Insurance Card to access care in providers from other EU countries with which

the CHIF has an agreement – not only emergency care but other types of care as well (e.g.

dialysis in the case of patients with chronic conditions). A great challenge for EU Member States is

Directive 2011/24/EU on the application of patients’ rights in cross-border health care. The

Croatian Parliament accepted the Directive in June 2013. While Regulation 883/2004 only

determines treatment and reimbursement of expenses to persons in cases of using health care in

health care institutions working under a contract with an insurance fund, the Directive expands

such rights to treatment provided in the private sector (Government of the Republic of Croatia,

2012).

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Key Elements of a Successful National Initiative

Government

Support

Public-Private

Partnerships

Tourism

Planning

Human

Resources

Planning

Accreditation

& Certification

Marketing &

Promotion

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Understanding Risks to Understand

Facility Readiness….

Medical Travel.

Integrating :

– Hospitality,

– Clinical and

– The Patient Experience.

There are risks in each component

through the Medical Travel Care

Continuum.

APPROPRIATELY TRAINED STAFF

DEFINED CLINICAL AND NON-CLINICAL

PROCESSES

DEDICATED

FINANCIAL

RESOURCES

PATIENT EXPERIENCE

METRICS &

ADVOCATES

LEADERSHIP

ENGAGEMENT

BRAND

MANAGEMENT

Components of Facility Readiness …

THE MEDICAL TRAVEL CARE CONTINUUM

The Entire Care Continuum.Integrating Medical, Hospitality and Patient Centered Services.

Enhancing patient experience and engagement underpins each touch point of the cycle

Clinical Risk - poor or non-satisfactory clinical outcome and short-or long-term complications.

Financial Risk - International Patient Department can lose money on its services, litigation

costs may become excessive.

Brand or Reputation Risk - Your organization can have a negative outcome that gets into the

media, resulting in a loss of new business. An event can occur in your country, which may

negatively reflect on the “medical tourism brand” of your country and your organization’s

services.

Operational and Capacity Risk - Your organization may find it does not have the business or

clinical expertise to deliver the services that you have promised the International Patient

community. You find that you cannot provide the services promised due to a lack of number

of staff or shortage of hospital beds in your organization.

Traditional Categories of Risk …

• Give non-diagnostic information such as: Services provided,

locations, costs, local information, explain to caller/inquiry how

to complete any on line forms and the “next step” in the

process. Only explains any consents as a non-licensed person.

• Discuss/Arrange travel plans and options.

RISK POINTS

Non-licensed staff “over promises” or “recommends” specific treatment

options.

Non-Licensed Staff

Medical, Dental or other Healthcare OrganizationsInquiry Stage RISK POINTS

• Ask medical questions about current status and history, ask about permission to

communicate with the potential patient’s local physician, and agree on the next step.

• Obtain consents for any next step.

• Arrange a diagnostic follow up via telephone or confidentiality video meeting with

potential patient and home physician.

• Develop treatment plan.

Licensed Staff

RISK POINTS

Licensed person commits to admission to quickly

without having adequate medical information or

medical history.

Language presents misunderstandings that effect

evaluation process.

Disregards “red flags."

Medical, Dental or other Healthcare OrganizationsInquiry Stage RISK POINTS

Non-Licensed Staff:

• Arrange patient and companion transportation, lodging and tourism.

• Arrange for patient and companion to get to hospital or clinic or office.

• Acts as navigator for patient and companion.

RISK POINTS

Non-licensed person tries to explain the procedure or consent forms.

Licensed Staff:

• Approves admission

• Assesses patient for planned procedure.

RISK POINTS

Language presents misunderstandings that effect care.

Patient has misrepresented health status.

Medical, Dental or other Healthcare Organizations

Admission Stage RISK POINTS

Non-Licensed Staff:• Acts as navigator for patient and companion.

• Arranges hotel pick up if treatment is protracted.

Risk Points-Non-licensed person fails to arrange timely transportation for

procedure.

Licensed Staff:• Provides medical or dental or other specialty care.

• Clears patient from recovery.

Risk Points-Poor outcome from procedure or treatment.

Not prepared with all supplies and equipment necessary for timely procedure.

Medical, Dental or other Healthcare Organizations

Treatment Stage RISK POINTS

Non-Licensed Staff:• Assist patient and companion with departure planning and transportation

RISK POINTS

Non-licensed person fails to make proper arrangements for departure of patient

and companion.

Has not planned for patient and companion in the event of travel delays and

disability needs.

Patient not in agreement with final bill.

Medical, Dental or other Healthcare Organizations

Discharge & Follow-up Stage RISK POINTS

Licensed staff:• Approves discharge.

• Provides electronic and hardcopy of clinical care and recommended aftercare.

• Provides prescriptions

RISK POINTS

Patient refuses to stay in host region or country as long as physician requested.

Post surgery/procedure/treatment complications.

Poor patient and companion education on follow up so complications occur.

Poor discharge protocols are available in the language of the patient and companion.

Patient and/or companion not happy with treatment experience.

Patient experiences medical complications traveling home such as DVT (Blood clots).

Medical, Dental or other Healthcare Organizations

Discharge & Follow-up Stage RISK POINTS

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Turning Readiness into a Successful

Medical Travel

Program …

Risk Reduction through Accreditation

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Accreditation Defined …

Usually a voluntary process by which a

government or non-government agency

grants recognition to health care

institutions which meet certain standards

that require continuous improvement in

structures, processes, and outcomes.*

*ISQua ®

The Global Healthcare Accreditation Program

The Clarion Call for Accreditation

From the Wild West to Maturity

Bring Clarity, Leadership and Coordinated Effort to Resolve Issues

Engagement of Stakeholders

Engagement of Patients

Consensus on Definitions, Data Collection, Legal Liability, etc …

Facilitate Insurance Products

Raise Awareness of Employers, Insurers, and Consumers

Disruption of Market and Sharing of Innovations

Knowledge vs. Anecdotes

The Global Healthcare Accreditation Program

The Value

The patient experience is enhanced.

We offer the opportunity to collect data and benchmark for medical travel patients

We incorporate business solutions.

We share best practices.

BRANDING IDENTITY

Most designers set their

type arbitrarily, either by

pulling values out of the sky

or by adhering to a baseline.

GRAPHIC DESIGN

Most designers set their

type arbitrarily, either by

pulling values out of the sky

or by adhering to a baseline.

WEB DESIGN

Most designers set their

type arbitrarily, either by

pulling values out of the sky

or by adhering to a baseline.

SKILLS &

COMPLIANCE

REFINED

MANAGEMENT

APPROACH

UNIQUE

BUSINESS

SOLUTIONS

NEW PROGRAM ESTABLISHED

PROGRAM

STAGE OF DEVELOPMENT

VALUE DELIVERED

THE CLIENT SPECTRUM

THE STANDARDS

Complementary to existing

Quality & Safety

Achievements.

Focused on

the entire Medical Travel Care

Continuum Performance

Improvement Plans, Measurement

Collection for Quality and

Satisfaction Benchmarking.Unique Focus on Marketing,

Travel & Tourism, Cultural

Competence and Financials

Processes.

17 CORE COMPETENCIES

GHA FOCUS AREAS

Clinical Processes The Patient ExperienceHospitality & Business Processes

• Clinical Assessment &

Treatment

• Infection Control & Waste

Management

• Patient Management

• Quality Improvement

• Risk Management

• Cultural Competency

• Communication & Education

• Ethics

• Patient Advocacy

• Physical Environment

• Financial Transactions

• Health Leadership

• Marketing

• Supply Chain Management

• Technology

• Transparency & Compliance

• Travel & Tourism

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Thank You