Volume 1, Issue 9

Dear Colleagues,

I am saddened to report that William F. Ruschhaupt, M.D. a skilled physician who was respected by all, has passed away unexpectedly. Dr. Ruschhaupt, an Internist and Specialist in Vascular Medicine and Chairman of Global Patient Services at the Cleveland Clinic, was an important member of the global healthcare community and will be missed. Read more about Dr. Ruschhaupt.

The Affordable Care Act (ACA) has drastically shifted payment responsibility for care from health plan sponsors to individual consumers. The result is high out-of-pocket healthcare expenses.

This week, Jeffrey C. Bauer, Ph.D., LLC, health futurist and medical economist, reveals his thoughts on the ACA and its likelihood of success (or failure), as well as the impact recent healthcare reform will have on the future of the medical travel industry.

I am also pleased to announce that I will moderate a panel discussion on medical travel, "ALL ABOARD!  U.S. Centers of Excellence Banking on Employer and Payer Uptake of Domestic Medical Travel Benefits," during the Institute of HealthCare Consumerism's (IHC) 5th Annual IHC FORUM & Expo Conference, on Thursday, May 8, 2014, between 3 p.m. - 4 p.m., in Atlanta, Ga.  It will be a great meeting and an opportunity to showcase your offerings in medical travel.

Thank you for your interest in this exciting, growing market space. Please be in touch with your comments and editorial contributions, which can be sent directly to:

Laura Carabello
Editor and Publisher

SPOTLIGHT: Jeffrey C. Bauer, Ph.D., LLC, Health Futurist and Medical Economist

Office: (773) 477-9339 Mobile: (970) 396-3280

About Jeffrey C. Bauer
Jeffrey C. Bauer, Ph.D., is an internationally recognized health futurist and medical economist. As an independent industry thought leader, he forecasts the evolution of healthcare and develops practical approaches to improving the medical sector of the American economy. He is widely known for his specific proposal to create an efficient and effective healthcare delivery system through multi-stakeholder partnerships and other initiatives focused in the private sector.

Dr. Bauer has published more than 250 articles, books, Web pages and videos on healthcare delivery. He speaks frequently to national and international audiences about key trends in healthcare, medical science, technology, information systems, reimbursement, public policy and creative problem solving. Dr. Bauer is quoted often in the national press and writes regularly for professional journals that cover the business of healthcare. His recent books include Statistical Analysis for Health Care Decision-Makers (2009) and, as co-author, Paradox and Imperatives in Health Care: How Efficiency, Effectiveness, and E-Transformation Can Conquer Waste and Optimize Quality (2008), both published by CRC Press. His latest book (2014) is addressed at the end of this interview.

As a consultant, Dr. Bauer has assisted hundreds of providers, purchasers, and payer organizations with strategic planning and performance improvement. He served in several major corporate positions from 1999 to 2010, including vice president of Healthcare Forecasting and Strategy for ACS, a Xerox company. His previous consulting firm, The Bauer Group, specialized in consumer-focused strategic planning and development of clinical affiliation agreements for multihospital networks from 1984 to 1992.

In his academic career, Dr. Bauer was a full-time teacher and administrator at the University of Colorado Health Sciences Center in Denver from 1973 to 1984, where he held appointments as associate professor and as assistant chancellor for Planning and Program Development. He also served concurrently for four years as health policy advisor to Colorado Gov. Richard D. Lamm. From 1992 to 1998, Dr. Bauer was a visiting professor in Administrative Medicine at the Medical School of the University of Wisconsin Madison, where he taught physician leaders how to conduct research and evaluate published studies.

He received his Ph.D. in Economics from the University of Colorado, Boulder. He graduated from Colorado College in Colorado Springs with a B.A. in Economics, and completed a certificate in Political Studies at the University of Paris (France). During his academic career, he was a Boettcher Scholar, a Ford Foundation Independent Scholar, a Fulbright Scholar (Switzerland), and a Kellogg Foundation National Fellow. Dr. Bauer lives in Chicago, where he is actively involved in painting and music.

U.S. Domestic Medical Travel (USDMT): Our sister publication, Medical Travel Today, interviewed you a few years ago. Can you give our readers an update on what you've been involved with since then?

Jeff Bauer (JB): During my previous interview with Medical Travel Today, I was vice president of Healthcare Forecasting and Strategy for a Fortune 500 corporation. Now, I am self-employed and actively working as an independent health futurist and medical economist.

The passage of the ACA was a major reason why I returned to self-employment. I had a lot of concerns about the poorly conceived law and needed the freedom to talk about them from an unbiased perspective.

As I expected, the ACA has not worked out as intended by its creators, so I spend a majority of my time traveling nationwide to talk about the serious conflict created by the ACA's one-size-fits-all concept of health reform and the remarkable number of more exciting possibilities generated by advances in medical science and communications and information technologies.

Additionally, I author approximately six to ten journal articles a year. I write regularly for the Healthcare Financial Management Association (HFMA), which is the professional association for individuals in healthcare who oversee the flow of currency through the system. For the last 13 years I have written the lead article for every issue of the Healthcare Information Management System Society (HIMSS) Journal, which focuses on future information technology.

USDMT: Do you believe that healthcare reform in the U.S. will impact the medical travel industry?

JB: Overall, I think government-driven healthcare reform is going to fizzle and set things back a few years. I never had much faith in the ACA because the law was so poorly crafted.

When the ACA was passed in March of 2010, the Democratic leadership was focused on reducing the number of Americans without health insurance, not creating a better healthcare delivery system.

The law's creators claimed that the ACA would extend affordable, high-quality health coverage to roughly two-thirds of the uninsured population - something very unlikely to happen now, given the way the law is being implemented.

The actual result of the ACA has mostly been unintended consequences and badly executed programs. I am forecasting that the probability of the ACA succeeding is 20 percent and declining. For every step forward, there is at least one step backward.

The ACA's unspoken effect is to reinforce one of the biggest recent changes in the medical marketplace: the shift in payment responsibility for care from the government and employers to individuals.

Contrary to what most people were led to expect, the ACA is increasing the percentage of care that the patient is obligated to pay, and I think that is what really gets to the crux of medical travel.

Assuming the ACA fails to live up to its creators' expectations, more individuals will be forced to seek affordable care in ways other than through federally mandated health plans - which could result in a dramatic growth in the medical travel industry.

I think the very premise of medical travel, especially international medical travel, is the fact that individuals can get high quality care and save money by traveling to different locations, such as Costa Rica, India, Indonesia, etc.

In 2013, I did some consulting work in Belgium and observed that the reform culture there is focusing on disease management for patients who may be "at risk" for certain diseases, in addition to very impressive performance improvement programs.

For American patients, more and more will seek healthcare providers who have adopted this different approach because it is a better, more affordable option in the long-run. They will understand that simply mandating health insurance does not mean the delivery system will make the desired transformation from acute care to disease management.

A vast majority of patients cannot afford to pay upfront for procedures, such as an expensive bone operation, that could have been avoided through preventively focused disease management. Many will find better, affordable acute care from foreign providers.

USDMT: Do you think it is clinically and cost effective for lower income individuals in the U.S., who are not Medicaid eligible, to travel internationally for care?

JB: The change in the clinical paradigm is so significant today that it provides a great opportunity for foreign health systems to compete successfully for more American patients.

For example, foreign providers that seek business from Americans will have an ability to lead in precision medicine as a result of telemedicine. This will appeal to a lot of Americans, not just those with lower incomes.

Telemedicine isn't used as it should be in the U.S. because most insurance companies aren't paying for it, but if an individual is paying out of pocket for care, then it makes sense to travel to a foreign country that offers telemedicine for pre- and post-procedure care and good acute care.

Many diseases can be managed virtually. Cell phones and technology are capable of reminding individuals on a daily basis to take their medicine. The diagnostics of weight and blood pressure can all be done at home, etc.

A few years ago, I conducted a survey regarding patient's attitudes towards medical travel, and the biggest concern was receiving adequate care after returning home from a procedure.

Now, due to the incredible telemedicine capabilities that are available, a foreign provider can see patients in the comfort of their own home without requiring any additional travel.

Virtual healthcare effectively has no borders.

USDMT: What is your outlook on the future of the medical travel industry?

JB: A few years before the ACA was passed, I felt that the medical travel industry was stabilized. Forces favoring it were pretty evenly balanced by forces against it.

Now, witnessing the colossal disaster brought about by government-driven healthcare reform in the U.S., I have changed my forecast from stability in the medical travel industry to growth.

The medical travel industry's chances to experience advancement are increasing and better than ever, which is a central conclusion of my latest book. Innovative leaders have an unprecedented opportunity to create international healthcare markets from a new realm of possibilities, providing viable solutions to problems created by the ACA.

Please Note: Dr. Bauer has released his latest book, Upgrading Leadership's Crystal Ball, which places heavy focus on the expanding realm of possibilities created by the globalization and technological changes that create international growth opportunities for entrepreneurs.

To purchase Upgrading Leadership's Crystal Ball click here.

Laura Carabello Moderates IHC Medical Travel Panel Discussion

Institute of HealthCare Consumerism's (IHC) 5th Annual IHC FORUM & Expo Conference, Thursday, 3 p.m. - 4 p.m., May 8, 2014, Atlanta, GA

Laura Carabello, founder and principal, CPR, and publisher of Medical Travel Today and U.S. Domestic Medical Travel™, will moderate a panel discussion on medical travel - "ALL ABOARD! U.S. Centers of Excellence Banking on Employer and Payer Uptake of Domestic Medical Travel Benefits" - during the Institute of HealthCare Consumerism's (IHC) 5th Annual IHC FORUM & Expo Conference, Thursday, 3 p.m. - 4 p.m., May 8, 2014, Atlanta, Ga.

"The fast-growth phenomenon of U.S. domestic medical travel -- inter-state to Centers of Excellence (COEs) throughout the country, inbound to the U.S., and outbound to destinations worldwide - is capturing the attention of employers, payers, third party administrators, insurance companies and other intermediaries throughout the world," Carabello says. "With the growth of HSAs as well as self-funding, a domestic medical travel benefit is now gaining traction among small, medium and large employer groups."

The United States is now one of the top three destinations worldwide for medical travel, and receives as many as 800,000 international patients seeking help with the most difficult health conditions. As a result, and in the new era of health reforms, Americans are witnessing:

  • Rapid adoption of domestic medical tourism: travel to another state or region within U.S. borders
  • Employer receptivity to introducing a medical travel benefit
  • Consumer willingness to travel to other parts of the United States to access quality care with improved outcomes
  • Increased demand for more cost-effective care that meets budget requirements

"There is growing interest among U.S. hospitals, providers and Centers of Excellence to attract foreign patients," Carabello adds. "Physician-owned ambulatory surgi-centers are participating in this growth trend, as well. International patients are often cash-paying customers and originate from countries where there are significant financial resources but limited healthcare infrastructure or access to quality diagnostics or care."

This session will examine the top volume procedures for medical travel, track the growth of the industry, evaluate the positioning of provider organizations and COEs, and review initiatives by some of the nation's largest employers to introduce domestic medical travel programs. With the implementation of healthcare exchanges, and amid mounting challenges for balancing quality and cost-savings, this discussion will help conference attendees to evaluate their participation in a medical travel program.

Medical Travel Today would like to extend to you a discount registration code for the only Conference Series 100 Percent Dedicated to HealthCare Consumerism Progress, Collaboration and Education.

USE PROMO CODE: MEDICALTRAVEL for $100 off Registration Rates

...where so much innovation is discussed and demonstrated around all aspects of health and benefit management's current opportunities and challenges.

...that attracts such a diverse group of stakeholders, both speaking and attending, and meets their needs with a wide range of rich, educational and interactive content.

...where real-time collaboration and problem solving takes place, creating an energy that conference-goers continue to talk about long after returning back to their companies to implement what they've learned.

...that has been at the forefront of the healthcare consumerism mega-trend as we witness one of the most monumental shifts in our industry's history.

Wondering what specifically you will take away from the 2014 IHC FORUM & Expo? Read our Attendee Takeaways.
IHC FORUM's 2014 Theme:
"HealthCare Consumerism: The Solution for HealthCare Reform"

The IHC FORUM is the ONLY Conference Series 100 Percent Dedicated to Healthcare Consumerism

Learn More and Register Today!

2014 IHC FORUM & Expo, May 7-9
Cobb Galleria Centre, Atlanta, GA

"HealthCare Consumerism:
The Solution for HealthCare Reform"


Produced by: The Institute for HealthCare Consumerism
292 South Main Street, Ste 400
Alpharetta, GA 30009


The Truth of the Matter: Off to Nogales, Mexico
by Don Keelan - In the near-term future -- a conversation with my orthopedic surgeon:

Doc: You can get dressed now.

Don: So doc, what's the news? Give it to me straight.

Doc: I have good news, and I have not so good news. Which do you want first?

Don: Let's have the good news.

Doc: It seems like you will need a hip replacement.

Don: That's the good news?

Doc: Yes, but only one hip -- your left one. Your right one is not too bad, at least for the time being.

Don: I hate to have to ask, but what exactly is the bad news?

Doc: Under the new Vermont Universal Health Care System, you will have to wait some time before you can have the hip replaced.

Don: Well, that's not bad. If I have to get a new hip, I wouldn't want it done until next month. I can endure the discomfort a bit longer.

Doc: I'm afraid to say, you might have to wait two years or more.

Don: You're kidding.

Doc: No, I'm serious.

Don: Why's that?

Doc: We've been informed by Vermont's Knee and Hip Joint Replacement Allocation Board, this year's replacement quotas are filled up.

Don: What board?

Doc: A few years ago, when Vermont's Universal Health Care was adopted, the state took control of all aspects of healthcare. Boards were established to review and determine allocation for all elective and more non-elective medical/surgical procedures.

Don: Why, and who serves on these boards?

Doc: The medical/surgical delivery system is broken down into 354 different procedures -- joint replacements, heart stents, cataracts, tonsils, sinus and on and on. The members of the review board -- some professionals, more lay members -- and are appointed by the governor.

Don: I get it, but what's their role?

Doc: The various boards meet once a month, some weekly, and decide how many procedures can be done the following month, up until the year's end. It is based on the funds allocated by Vermont Health Connect, the overriding board.

Don: I'm still lost.

Doc: The board we must deal with had funds last year, to do 510 replacements. There were requests filed to do 3,220. The patients that were not attended to got placed on a waiting list and put into the cycle for this year's review and allocation.

Don: So where do I fit in, and why two years?

Doc: To put it bluntly, you just don't fit -- you are too old, and your age does not make you a priority. You are 74 years old and you are not working in a critical profession or job. Lastly, you are not the main financial supporter of a family with kids under 18.

Don: Why didn't we know this was coming? Why wasn't this allocation -- rationing is a better term for it -- talked about before now?

Doc: Because all the blabbering was about how we would be paying for healthcare, and that only came after all the chatter on getting the enrollment corrected -- remember the mess that was back in 2013/14?

Don: Yeah, I do, but nothing about getting to see a doctor and being put on a waitlist was ever discussed.

Doc: Well, Vermont was the first state. Many doctors saw the allocation -- rationing, if you will -- of medical/surgical procedures coming and just packed up and left the state.

Don: Can I go where they went?

Doc: No, the way things work now, you have to get your treatments done in the state you reside in -- no state-to-state doctor shopping is allowed.

Don: Is there anything I can do to get my hip replaced?

Doc: Yes, but you will have to go to Nogales, Mexico. The clinic there does about 30 to 40 hip replacements a day. It is all cash, no insurance and for about a tenth of the cost here and it will take two weeks to get an appointment.

Don: What will that mean?

Doc: It means you'll pay about $6,000. But keep in mind your rehab will have to be performed back here. And you can't sue if anything goes wrong."

Don: What have you heard?

Doc: They're not bad, do fairly good work, but they do experience a high rate of infection -- around one out of six last count -- but they're improving. It used to be one out of four hips became infected. 

Don: Last summer I was told by my cardiologist that I might be a candidate for a pacemaker and said nothing about this waitlist.

Doc: When you are in Nogales, get it done. In Vermont you will have an even greater wait for that procedure under Vermont Health Connect. I need one, too, and I've been told I'm on the schedule 18 months out. And guess what, I'm younger, with three kids and in a critical profession.

Don: How ignorant of me for not seeing healthcare rationing coming -- and now a lack of doctors and cost being the ultimate driver of the system -- shame on me.

To view the original article click here.

Three Out of Four Travel Agents Report Growth for Spa Travel in 2013

SpaFinder Wellness 365's "State of Spa Travel" report reveals how critical female bonding is to the spa travel segment - and heightened desire for more exotic destinations, from Cambodia to the Czech Republic

Spafinder Wellness 365™ today released key findings of its 2013 "State of Spa Travel" report, designed to provide annual insight into the health of, and emerging consumer trends in, the North American spa travel* market.

According to the study, a significant majority (73 percent) of travel agents reported growth in bookings to hotel, resort and destination spas in 2013. The survey also shed light on the evolving spa traveler demographic, revealing that "women traveling with other women" represents the number one way people now journey to spas, and that Gen X is slowly overtaking Baby Boomers as the age group most likely to book spa travel. The findings are based on a survey of over 300 North American travel agents completed in Q4 2013.

"This new data provides fresh evidence that what we've been hearing about the growth of the wider wellness tourism category is undeniably true. And it also proves that spa travel is on the rise in North America, which is the now the world's largest wellness travel market, generating over 40 percent of the total dollars spent in that global segment," said Mia Kyricos, Spafinder® Wellness, Inc.'s chief brand officer.

Growth in 2013: Last year's survey revealed that 2012 was a rebound year for spa travel after the long recession: 68 percent of travel agents reported growth, up from 37 percent in 2011. But in 2013 agents report even more momentum: 73 percent of U.S. and Canadian agents experienced growth in spa property bookings last year, while another 23 percent say they remained about the same as in 2012. 

Deals Stay Very Strong: Despite economic and travel market recovery, a strong "deal culture" seems to be a permanent fixture of the hotel/resort spa market - continued great news for consumers. Thirty-two percent of agents report that global resort/destination spas were actually more aggressive with special pricing/packages in 2013 over 2012, with 53 percent claiming that the spa deals continue just as strong as in 2012. (Only 15 percent report declines).

Gen X and Youngest Boomers = Core Spa Travelers: Wellness-obsessed Baby Boomers (now aged 49-68) fueled the wider spa revolution and have for years represented the main spa traveling demographic. For 2013 agents reported that the number one age group most likely to book spa travel is 46-55 (the very youngest Boomers), followed very closely by those aged 36-45 (Gen-Xers). Also significant: the very young, 26-35-year-old group now trumps those over 65 (which includes the eldest Boomers) for spa bookings. As demographic groups age, the story of who is in their peak earning/spending years is also naturally re-written.

This Is Female Bonding Travel: For the first time the survey asked agents how spa-goers most typically travel, and they reported that women traveling together ranked number one by solid margins. This was followed by 2) a woman traveling with a man; 3) women traveling solo; 4) families/intergenerational groups; 5) men traveling solo; and 6) men traveling together. Clearly, spa resorts' marketing and property offerings need to speak to women looking to do a little "spa bonding," as well as pay close attention to the lone female spa traveler. And it's notable that family groups outpaced men either traveling solo/together, given that just a few years ago the spa was quite the opposite of a family affair.

Increased Desire for Total Wellness Experiences: Agents reported on what spa programming now matters most to clients, and traditional pampering retained its number one spot for the seventh straight year (important to 96 percent). But in 2013 there was notably more parity in traveler demand for other key spa elements: agents reported that health/wellness offerings like exercise and weight loss are now important to 84 percent, mind-body-spirit programming is important to 68 percent, and nature/adventure experiences like hiking, water sports, etc. are sought by 67 percent. So, for the first time, agents claimed that all four, key spa components were important to at least two-thirds of their clients: further evidence that the spa traveler increasingly seeks comprehensive, integrative wellness options at destinations, mixed with ‘pure pampering.'

Top U.S. Spa Regions: Agents reported on which U.S. regions now attract the most North American spa travelers, and the West Coast reclaimed the top spot from Hawaii in 2013. The rankings: West Coast, Hawaii, Southwest, Southeast, Northeast and Midwest.

Fastest-Growing Global Spa Regions: Agents also weighed in on which international spa destinations are growing fastest with North American travelers in comparison with 2012. The top five: the Caribbean, Mexico, Asia, Europe and Central/South America.

Increased Demand for Off-the-Beaten-Path Destinations and Authentic, Local Experiences: Given the luxury travel market's resurgence, travel agents were queried on how this wider category is evolving. The top two luxury travel trends identified were: 1) Travelers seeking more exotic, off-the-beaten-path destinations (62 percent reporting); and 2) Travelers seeking immersion in more unique, indigenous cultural experiences, vs. generic luxury at destinations (57 percent reporting). Luxury travelers increasingly want a wide, wide world of destinations to explore - and authentic, hyper-local experiences when they get there.

A New, Bigger Spa Travel Map: Given that the top luxury travel trend identified was demand for more exotic locations, agents were also asked to submit countries they felt were getting significantly hotter with the North American spa traveler. While dozens of nations from the Dominican Republic to South Africa received numerous votes, the clear standout was Costa Rica. Other top Central American up-and-comers: Belize and Nicaragua. In South America the standouts were Argentina and Chile. In Europe, The Czech Republic, Croatia and Turkey garnered the most responses, with Italy, Ireland and Slovakia also making a strong showing. For Asia, Cambodia, India, the Maldives, Myanmar and Vietnam made the most agents' "getting hotter" list - and in Africa, South Africa and the Seychelles ranked highest.

Further Evidence of Wellness Tourism's Rise: Wellness tourism can be defined as all travel associated with the pursuit of enhancing/maintaining personal wellbeing. And while recent research from SRI International** shows that spa tourism constitutes a hefty 41 percent of the total $439 global wellness tourism market, the category also spans adventure/nature travel, all breeds of fitness-focused travel, yoga and lifestyle retreats and eco-tourism. The survey found that an overwhelming majority (75 percent) of North American agents see wellness tourism as a distinctly rising travel trend, with 22 percent indicating that it continues just as strong as in the past.

"We're grateful for the insights into booking trends from travel agents who help us to understand the changing profile of today's spa traveler, as well as the new destinations and programming they now most seek," said Kyricos.

For more information, contact Beth McGroaty: (213) 300-0107 or

About Spafinder Wellness, Inc. ®
Spafinder Wellness, Inc.®, is the world's largest media and marketing company for the spa and wellness industry and the leading consumer resource for feeling good and living well all year round. With over 25 years of experience as a spa and wellness authority, millions of people find inspiration to keep well every day via the Spafinder Wellness 365™ brand, also known for its widely distributed gift cards-available at 70,000-plus retailers worldwide-and its global network of 20,000-plus spas, salons, fitness, yoga and Pilates studios and travel destinations. Learn more at, and

*For this survey "spa travel" was defined as "all bookings for travel/vacations/packages with a strong spa component."

**Research for the Global Spa & Wellness Summit conducted by SRI International, "The Global Wellness Tourism Economy," 2013. 

To view the original release click here.

North Dakota is Number One and West Virginia is Number 50 in Annual Gallup-Healthways State Well-Being Rankings
Well-Being Is a Key Metric for Governments, Communities and Businesses Looking to Lower Healthcare Costs and Improve Performance

For the sixth consecutive year, global well-being improvement leader Healthways (NASDAQ: HWAY) and world-leading management consulting firm Gallup have released their analysis of the state of well-being across the United States. North Dakota and West Virginia bookended the list, with top and bottom rankings, respectively. The analysis is based on data from the Gallup-Healthways Well-Being Index®, a definitive measure and empiric database of real-time changes in well-being throughout the world. More than 178,000 interviews nationwide fueled the 2013 analysis, which examined Americans' perceptions on topics such as physical and emotional health, healthy behaviors, work environment, social and community factors, financial security, and access to necessities such as food, shelter and healthcare, to create a composite well-being rank for each state.

Comparatively speaking, the difference between states is not as notable as the fact that so much room for improvement still exists, even for the top states.

The ten states with the highest well-being in the nation are:
North Dakota
South Dakota

Certain states stand out for specific well-being achievements, as reported by their residents. Colorado, for example, is always at or near the best in the nation for the lowest obesity rate. Utah has the lowest smoking rate. Massachusetts residents have had the greatest access to health insurance in all six years that the rankings have occurred. New Jersey has the lowest levels of depression, and people in Vermont eat more produce than people in any other state.

"States that score high in well-being have achieved success in creating environments where people can live their best lives, something that goes far beyond physical wellness and traditional health risk factors," explained Dan Witters, research director of the Gallup-Healthways Well-Being Index. "Individuals in these states are motivated to achieve their goals, enjoy what they do each day, feel safe and financially secure, have pride in their communities, and have the supportive relationships and good health they need to get things done each day. We not only commend the top finishers but recognize Colorado, Hawaii, Iowa, Minnesota, Montana, Nebraska and Vermont for achieving the distinction of being in the top 10 for two years in a row."

Understanding the Value of Well-Being
According to James E. Pope, M.D., senior vice president and chief science officer at Healthways, both measuring and improving well-being are becoming increasingly important to governments, communities, healthcare organizations and employers.

"Achieving high levels of well-being is a strategic imperative for all types of organizations because it unlocks economic value on so many levels. In short, healthier people cost less and perform better," Dr. Pope stated. "Our partnership with Gallup helps us continue to advance the science of well-being and create a definitive measure of well-being for individuals and across populations. Measuring well-being ultimately helps organizations systematically improve well-being because measurement helps organizations establish a baseline, determine where they should invest resources and then identify the impact of those investments."

Research shows a strong link between well-being, healthcare costs and engagement in the workplace. Each point in well-being improvement equates to a statistically significant percent decrease in the likelihood of hospital admission and emergency room visits and in the likelihood of incurring healthcare costs.

For a community, the achievement of higher well-being for its citizens yields competitive advantage for economic development and job creation. For employers, it means greater productivity and better health in the workforce and dependent families, resulting in better business performance. For individuals, it simply means living well, longer.

"Comparatively speaking, the difference between states is not as notable as the fact that so much room for improvement still exists, even for the top states," said Ben R. Leedle, Jr., president and chief executive officer of Healthways. "Steady improvement in well-being is indeed possible even where well-being is already strong, as Montana, Vermont, Nebraska and Iowa have shown these last several years. Consumers have made the connection between lifestyles and behaviors, and between quality of life and longevity. Strong leadership and proven solutions that identify opportunities, break down barriers and encourage sustained consumer engagement in well-being improvement activities are the key to community, organizational and individual transformation."

Working Together to Improve the Health of Populations and Individuals
In 2008, Gallup and Healthways initiated a 25-year partnership merging decades of clinical research and development expertise, health leadership and behavioral economics research to track and understand the key factors that drive well-being. Together, the organizations have built the world's largest data set on well-being to support their mutual goals of helping governments, communities and businesses better understand and improve the health of both populations and individuals.

Launched that same year, the Well-Being Index provides unmatched, in-depth insight into the well-being of populations. Gallup conducts 500 telephone interviews a day with Americans to gather their perceptions of well-being, for a resulting sample that represents an estimated 95 percent of all U.S. households. In 2013, Gallup and Healthways extended the reach of the Well-Being Index beyond the United States. Global leaders now have the ability to benchmark the well-being of their country against the results of roughly 140 countries around the world.

To access the "State of American Well-Being: 2013 State Rankings and Analysis," report visit The full "State of American Well-Being: 2013 State, Community and Congressional District Analysis" will be available online in April at

About Gallup
Gallup delivers forward-thinking research, analytics, and advice to help leaders solve their most pressing problems. Combining more than 75 years of experience with its global reach, Gallup knows more about the attitudes and behaviors of the world's constituents, employees, and customers than any other organization. Gallup consultants help private and public sector organizations boost organic growth through measurement tools, strategic advice, and education. Gallup's 2,000 professionals deliver services at client organizations, through the Web, and in nearly 40 offices around the world.

About Healthways
Healthways (NASDAQ: HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant's health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 45 million people on four continents. Learn more at

Bruce Middlebrooks, 615-614-4463


Lauren Kannry, 202-715-3050

Bigger Hospitals Mean Higher Prices, Not Better Care
by Shannon Brownlee and Vikas Saini, originally published in Bloomberg View on 2/18/14. Reprinted with permission. The opinions expressed are those of the authors. are busily merging with other hospitals and buying up groups of doctors. They claim that size brings efficiency and the opportunity to deliver more "value-based" care -- and fewer unnecessary services. They argue that they have to get bigger to cut waste. What's the evidence that bigger hospitals offer better value? Not a lot. 

If you think of value as some combination of needed services delivered for the right price, large hospitals are no better than small hospitals on both counts. The Dartmouth Atlas of Health Care and other sources have shown time and again that some of the biggest and best-known U.S. hospitals are no less guilty of subjecting patients to useless tests and marginal treatments.

Larger hospitals are also very good at raising prices. In 2010, an analysis for the Massachusetts attorney general found no correlation between price and quality of care. A study published recently in Health Affairs offered similar results for the rest of the country: On average, higher-priced hospitals are bigger, but offer no better quality of care.

The disconnect between price and value has many causes, but the flurry of mergers and acquisitions in the hospital industry is making it worse. Hospitals command higher prices when they corner market share. They gain even more leverage when they gobble up large physician practices.

Courts are beginning to wake up to these facts. Last year, St. Luke's Health System Ltd., a multihospital chain based in Boise, Idaho, acquired the state's largest independent multispecialty physician practice group, Saltzer Medical Group, giving the hospital 80 percent of adult primary care physicians in the relevant market. On Jan. 24, the U.S. District Court in Idaho ruled that the acquisition violated federal antitrust law, and reversed it.

But the courts aren't moving fast enough. In many communities, deals between hospitals and physician practices, particularly procedure-oriented specialists, amount to a pact to fleece the system. Hospitals often command higher rates for procedures and tests than do specialists in their private practices. With specialists on a salary, a hospital can charge its higher rates, and the parties split the increased revenue. Everybody wins, except patients and payers.

The phenomenon of buying doctors' practices is changing healthcare in ways that go deeper than raising prices. Power is shifting from physicians and other caregivers, whose duty (though they don't always fulfill it) is to the needs of patients, toward administrators and corporations, whose loyalty lies with the institution or shareholders.

Physicians have long held the "power of the pen." Their decisions about whether to admit patients, which diagnostic tests to perform and which treatments to pursue ultimately determine if a patient gets the right care, and how much that patient's care costs. Few non-clinicians understand just how much medical decision-making is discretionary -- from the interpretation of a borderline test to the decision to admit to the hospital.

As large hospitals gain financial control of physician practices, the medical profession becomes another cog in the corporate machine, and many physicians have told us they feel they must skew their medical judgment to keep their jobs. A recent case in point: At Health Management Associates Inc., a chain of hospitals based in Florida, administrators rewarded and punished emergency physicians based on whether they met targets for admitting -- regardless of what the patient needed.
If we want better care and less waste, the balance of control over what happens to patients should be in the hands of physicians, not hospitals.

We're not calling for a return to the days of Marcus Welby, M.D., when doctors worked as solo practitioners, accountable to nobody and able to drive up volume (and their incomes) in a fee-for-service world. But given the proper incentives, physician groups could become one of the best levers for driving change toward a more humane and affordable healthcare system.

Some of the highest-performing medical systems in the country are multispecialty group practices whose group culture drove that of their hospital facilities, not the other way around. Most of these high-performers have robust primary care services at their core. The rest of the country needs primary care teams, including nurses and other mid-level providers, that work together and take responsibility for global budgets and can provide better care than solo doctors, or most specialist-controlled practices.
So, how can we get there? Some have suggested converting hospitals with dominant market positions into common carriers. They would be regulated much like utilities, with transparent pricing and community oversight. Such an approach would be a radical shift in how we think about the healthcare market and would require careful regional planning. The most efficient way to achieve this goal would be through a single-payer system.

But regulating hospitals as common carriers wouldn't address the fundamental question of who controls the care patients get. We should also tilt the playing field toward primary care. Since our healthcare mandarins have committed us to a national experiment with Accountable Care Organizations, how about serious fiscal support for such organizations controlled by primary care physicians?

One way to do that would be for Medicare to expand its "Advance Payment Model," a program that provides capital to small or rural physician groups. More experiments with incentives for models like this could accelerate the formation of multispecialty Accountable Care Organizations driven by primary care.

Until we give primary care groups control over what happens to patients, large hospital systems and specialist-dominated groups -- those with greatest access to capital -- will be able to keep raising prices, even as they issue press releases about their plans to control costs and improve care.
(Shannon Brownlee is a senior vice president at the Lown Institute and a senior fellow at the New America Foundation. Vikas Saini is president of the Lown Institute, an associate physician at Brigham and Women's Hospital, and a member of the departments of Medicine and Nutrition at Harvard University.)

To contact the writers of this article: Shannon Brownlee at; Vikas Saini at

To contact the editor of this article: James Gibney at

To read the original article click here.

U.S. Medical Tourism To Dominican Republic Could Increase With High-Tech Clinic
by Dr. Marc Siegel - This week the Metropolitan Hospital of Santiago (HOMS), Dominican Republic, opened the first robotic surgery institute in the Caribbean. Named after Dr. David Samadi, pioneer in robotic prostate surgery and member of the Fox News Medical A Team, the institute is sure to draw patients from throughout the continent.

Close to a million Americans a year now seek healthcare outside the U.S. Medical tourism is increasingly popular in the Caribbean for its high quality, cost savings of up to 75 percent, and of course, the unbeatable beautiful surroundings. 

The Dominican Republic has long been a tourist destination known for its inexpensive plastic surgery and dental procedures. Now you can add the state-of-the-art Da Vinci robot, featuring precision robotic arms that allow surgeons to perform delicate procedures. Recovery with this kind of surgery is remarkable - you can get in and out of the hospital in a day.

Dominican Republic President Danilo Medina attended the opening of the new facility along with Dr. Raphael Sanchez Espanol, CEO of HOMS hospital and a renowned surgeon.

"You're going to change the lives of many, many people out there and be part of the first robotic institute in the Caribbean," said Dr. Samadi. "This is a huge blessing. For us to be part of this -- we're very proud."

The institute will include treatment of prostate, kidney, gynecologic and surgical cases. Doctors operating in the Dominican Republic will now be able to use techniques developed by Dr. Samadi, who became the country's first to treat prostate cancer as well as other delicate surgeries in a safer, more effective manner, with minimal blood loss.

"Big decisions have transformed into small decisions," said Dr. Sanchez Espanol. "I like to say, with less trauma. The less trauma facilitates an amazing recovery."

"This is a huge step in this country and it's going to bring a lot of patients from the entire Caribbean to this hospital," Dr. Samadi said.

And beyond the Caribbean. With more and more regulations and restrictions coming our way on American soil, many Americans may look elsewhere for their surgeries and the new David Samadi Robotic Institute could be another option.

To view the original article click here

Local Watch: Where You Live and Its Impact on Your Choices

According to Nielsen, its recent 2014 Local Watch Report indicates that regional consumption of services plays a critical role in the type of healthcare consumers receive. Unique local factors based on where an individual lives are a major determinant in healthcare factors.

To view the full report click here.

Lake Co. Becomes Hotspot for Medical Tourism
by Andrea Jackson

Recently, published an article entitled, "Lake Co. Becomes Hotspot for Medical Tourism," which details the growing interest in medical treatment throughout Central Florida.

To read the original article click here.

Obama Budget Calls for $5 Billion to Fight Physician Shortage
by Zack Budryk published an article detailing President Obama's request to Congress to commit over $5 billion to training programs in an effort to combat the physician shortage nationwide.

To view the original article click here.  

Physicians: Top 10 Major Drivers of Healthcare Costs
by Anuja Vaidya - A majority of physicians believe that defensive medicine is a major driver of healthcare costs, according to "A Survey of America's Physicians: Practice Patterns and Perspectives," released by The Physicians Foundation.

This article was originally published by Becker's Hospital Review.

To continue reading the original article click here.

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U.S. Domestic Medical Travel™

About U.S. Domestic Medical Travel
U.S. Domestic Medical Travel, a sister publication to Medical Travel Today, is a newsletter published by CPR Strategic Marketing Communications, an international marketing and public relations agency based near New York City that specializes in healthcare and life sciences. In the new era of health reforms, U.S. Domestic Medical Travel discusses the growth of domestic medical travel and its importance to hospitals, employers, insurers, health plans, government, TPAs, brokers and other intermediaries.

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Spotlight Interview

Jeffrey C. Bauer, Ph.D., LLC, Health Futurist and Medical Economist

News in Review

Laura Carabello Moderates IHC Medical Travel Panel Discussion

The Truth of the Matter: Off to Nogales, Mexico

Three Out of Four Travel Agents Report Growth for Spa Travel in 2013

North Dakota is Number One and West Virginia is Number 50 in Annual Gallup-Healthways State Well-Being Rankings

Bigger Hospitals Mean Higher Prices, Not Better Care

U.S. Medical Tourism To Dominican Republic Could Increase With High-Tech Clinic

Local Watch: Where You Live and Its Impact on Your Choices

Lake Co. Becomes Hotspot for Medical Tourism

Obama Budget Calls for $5 Billion to Fight Physician Shortage

Physicians: Top 10 Major Drivers of Healthcare Costs