Volume 1, Issue 13

Dear Colleagues,

The cost and quality of orthopedic surgery varies significantly by location, which is why employers are demanding price transparency and outcomes reporting from care providers at hospital Centers of Excellence and physician-owned surgi-centers. 

James T. Caillouette, M.D., Surgeon in Chief, Hoag Orthopedic Institute, declares that a number of patients travel to his facilities from all parts of the U.S., as well as from international locations, to access the value-driven orthopedic procedures including ACL reconstruction, shoulder reconstruction, arthroscopy meniscectomy, bunionectomy, primary total joint replacement, and spine surgery. 

For the growing number of readers who are interested in the U.S. domestic medical travel space, I am pleased to report that the Self Insurance Institute of America has invited me to chair a panel on the subject at the annual meeting: www.siia.org/national.

Date: October 5-7, 2014 
Location: JW Marriott Desert Ridge Resort, Phoenix, AZ

The SIIA National Conference & Expo is the world's largest event focused exclusively on the self-insurance/alternative risk transfer marketplace, typically attracting more than 1,700 attendees from throughout the United States and from a growing number of countries around the world. The program features more than 40 educational sessions designed to help employers and their business partners identify and maximize the value of self-insurance solutions.

For additional details about SIIA and the medical travel panel, read the article entitled, "SIIA Panel Discussion: Domestic Medical Travel - Opportunities and Challenges for Self-Insured Employers," below.

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: editor@USDomesticMedicalTravel.com.

Laura Carabello
Editor and Publisher

SPOTLIGHT: James T. Caillouette, M.D., Surgeon in Chief, Hoag Orthopedic Institute 



About Dr. Caillouette
James T. Caillouette, M.D. is a board certified orthopedic surgeon with Newport Orthopedic Institute, specializing in joint replacement and adult reconstructive surgery of the hip and knee. He has been on staff at Hoag Hospital and in private practice for 25 years.

Dr. Caillouette earned his medical degree from the University Of Southern California School Of Medicine. He was elected President of Alpha Omega Alpha, the National Medical School Academic Honor Society. He served both his internship and orthopedic residency at the University of California, Irvine. He is a fellow of the American Academy of Orthopaedic Surgeons, the past President of the California Orthopaedic Association, a former Director of the American Association of Hip and Knee Surgeons, a member of the International Society for Technology in Arthroplasty, and a member of the International Society of Computer Assisted Orthopaedic Surgery. Dr. Caillouette reviews articles for The Journal of Arthroplasty and Clinical Orthopedics and Related Research. He has developed multiple orthopedic devices and instruments over the past 22 years and is currently consulting worldwide for DePuy/Johnson and Johnson.

Dr. Caillouette participates in surgeon education at a national and international level. He has numerous publications in the orthopedic literature. He is currently focused on healthcare economics and reform, along with the design of next generation hip and knee implants.

For more information, please visit: www.DrCaillouette.com.
Contact: jcaillouette@newportortho.com


About Newport Orthopedic Institute
Newport Orthopedic Institute (NOI) is the largest orthopedic and musculoskeletal group in coastal Orange County. We provide a continuum of care ranging from conservative treatment to surgical intervention in every area of orthopedic care. The breadth of experience and expertise of NOI's 18 Board-certified or Board-eligible specialists serves patients well by providing a high level of comprehensive care and service in every major orthopedic specialty including: Sports Medicine and Arthroscopic Surgery, Adult Reconstruction/Joint Replacement, Disorders of the Spine, Foot and Ankle Surgery, Hand Surgery, Physical Medicine and Pain Management, Orthopedic Trauma, and Non-Surgical Orthopedic Care.

About Hoag Orthopedic Institute
Hoag Orthopedic Institute specializes in the most advanced orthopedic surgery, total joint replacement surgery and spine surgery. From the newest minimally invasive techniques to total joint replacement to complex spine procedures, their expertise in orthopedic medicine translates to better results and fewer complications. For more information, please visit: http://orthopedichospital.com/.

U.S. Domestic Medical Travel (USDMT): Give our readers a little bit of background on the facilities that you work with.

Dr. James T. Caillouette (JC): I am currently involved with Newport Orthopedic Institute, Hoag Orthopedic Institute and the Orthopedic Surgery Center of Orange County.

Newport Orthopedic Institute is a physician practice that has approximately 20 specialty trained, board certified physicians and surgeons, and the Orthopedic Surgery Center of Orange County is a state-of-the-art, specialty, four-room surgery center.

The Hoag Orthopedic Institute, which owns the Orthopedic Surgery Center of Orange County, is an orthopedic specialty hospital with 70 beds and is the highest volume center for in-patient orthopedics west of Mississippi.

The Hoag Orthopedic Institute now owns two ambulatory surgery centers - the Orthopedic Surgery Center of Orange County and Main Street Surgery Center in Orange.

Collectively, those three centers -- one in-patient and two outpatient -- perform over 16,000 procedures annually, including spinal pain management. If pain management is not included, approximately 11,000 orthopedic procedures are performed annually.

The Orthopedic Surgery Center of Orange County has been working alongside medical travel patients since 2008.

We have had patients travel to us from all parts of the U.S. as well as from international locations to access orthopedic procedures including ACL reconstruction, shoulder reconstruction, arthroscopy meniscectomy, bunionectomy, primary total joint replacement, and spine surgery.

We believe that the future of the medical tourism industry is going to be value driven. Therefore, we embraced access, availability and affordability many, many years ago.

Recently, we even published our global cash pricing to ensure healthcare price transparency for patients. To view please visit oscoc.com.

USDMT: When you say global pricing, is that a bundled rate?

JC: We define a bundle separately from global pricing.

When our group is working with a third party administrator (TPA), the TPA will typically negotiate a single fee that covers the majority of costs.

The single fee will not usually include a warranty, outpatient physical therapy or preoperative testing. However, all of these services and fees are variable, flexible and negotiable.

We were the main participant when the Integrated Healthcare Association (IHA) did their bundled payment pilot project in California. Ninety percent of the cases for that pilot were covered by our company, allowing us to become very familiar with bundled rates. In this particular case, the bundle included a warranty period, as well.

USDMT: Was the IHA pilot project the only time that you offered that bundle?

JC: No, we have done it with others.

Typically we will be contacted by a TPA, and they'll inform us of their client's particular case.

I will schedule an initial conversation with the patient's primary care physician (PCP) to ensure the patient is a candidate for the specific procedure to be considered, and is fit for travel and surgery.

The PCP will then send me all of the patient's medical records electronically, including x-rays, for my review.

Next, I will arrange a 30-60 minute telephone call with my prospective patient to further discuss the patient's background. As long as the patient's history deems eligibility for candidacy, the patient will then fly to CA the weekend before surgery.

I will see the patient on a Monday to perform a physical examination, conduct another history report, take additional x-rays, and then perform the procedure on Tuesday.

Depending on the procedure, the patient will usually be discharged by Thursday and transferred to a facility where he/she will stay and undergo physical therapy for the next few days.

Generally, we will make a house call to the patient over the weekend. The following Monday, the individual will come back to my office for a wound check and be able to fly home by Tuesday.

USDMT: In terms of pricing, please clarify what the limited warranty is?

JC: As previously mentioned, for travel patients we do not generally include a limited warranty in bundled rates.

However, if a limited warranty was in place, it would cover the medical costs if a patient needed to be readmitted for a complication related to their procedure.

USDMT: And if they had an infection?

JC: Generally, an infection is not going to be evident within the first week or so after treatment and that is usually when the patient is flying.

We have done well over 100 cases and haven't experienced any complications yet. We have had a zero complication rate!

USDMT: Typically how far do patients travel?

JC: The vast majority of our patients are from the U.S., and we get quite a few patients specifically from Alaska.

Predominately, we treat patients from the western U.S., but we do have a number of patients travel from the east because the cost of care is higher there.

USDMT: Can you talk a little bit about outcomes?

JC: We publish our outcomes from the Hoag Orthopedic Institute and are about to publish our 2013 outcome book. To view Hoag Orthopedic Institute's 2012 Outcome Report, click here.

Our outcome data is significantly better than the national average on all fronts.

Our HCHAPS scores typically fall around the 98-99 percentile.

Our overall infection rate for all procedures is 0.3 percent and the national average is about 1.4 percent, so we are dramatically lower.

USDMT: How would you compare your program to other physician owned surgi-centers?

JC: When we started looking at bundled or global pricing, we recognized that we needed to create some process changes that were distinctly different.

For example, I have been performing primary hip replacement in selective patients in our ambulatory surgery center 23 hours a day since 2008, which is very different from most surgery centers.

Again, we have a zero complication rate and it has been a great experience for patients to be able to get their primary hip replacement and not be hospitalized.

In terms of our philosophy, our ambulatory surgery center was founded as a joint venture with our not-for-profit community hospital in the late 1990s.

Subsequently, when we formed the Hoag Orthopedic Institute, it acquired the interest of all the physicians. From inception, we have always been in network, we have never been an out-of-network center. Thus, our fees have been significantly lower.

Transparency in pricing is important, and so philosophically we have not been driven by maximizing profitability from the get-go. We have been driven by outcomes and value.

USDMT: How do you handle the concierge services when a patient travels from a different location?

JC: We have an individual, Gabrielle White, RN, who is in charge of this program. She is also the executive director of ambulatory services for Hoag Orthopedic Institute.

Gabrielle has spear-headed the program since its inception, and has developed the entire infrastructure to manage travel patients.

USDMT: Would you say the access and opportunity for care in the U.S. is equal to or better than what they can get abroad?

JC: Yes.

I think a lot of what is published in the newspapers and other sources is fundamentally inaccurate when it comes to the prices that they quote.

They are off by an order of magnitude and I think the general public is being misled.

USDMT: What do you foresee under the new ACA regulations and Obamacare? Do you see an increase in the volume of business that you are doing?

JC: I think we will see an increase in the volume of business we are doing because patients are going to be responsible for a much larger share of their care.

Patients are going to start looking for value, and part of my hope is that patients will begin to distinguish between low prices and high quality.

I believe that those who create the greatest quality should garner the highest volumes.

With the ACA and all of the significant healthcare reform taking place, the public is going to be increasingly driven towards value, which is part of the reason we never got involved with being an out-of- network center.

We were always focused on long term goals, rather than short term.

USDMT: Do you foresee your group replicating this model within the U.S. or outside of the U.S.?

JC: There is a consortium that has been recently founded by five large orthopedic groups across the U.S. including the Cleveland Clinic, the Rothman Institute, Ortho Carolina, CORE and our group which is now under the name Ortho California - which encompasses the Newport Orthopedic Institute and Orthopedic Specialty Institute.

These five groups have come together to form the National Orthopedic and Spine Alliance (NOSA).
Part of the reason our group was brought in is because we have a lot of experience with bundled care and travel, high volumes, good outcomes, etc.

I think there are plenty of high quality groups with similar philosophies across the U.S. They already exist and now it is our job to put them together.

Spotlight: Noel Khirsukhani, Executive VP of Sales & Marketing, PatientPoint®


About Noel Khirsukhani
Noel Khirsukhani is the Executive Vice President of Sales, Payer Solutions. Noel is responsible for developing the payer solutions strategy focused on providing patient engagement and coordination technologies that will help health plans align physicians and consumers with new care models such as PCMH and ACO. Noel has been with PatientPoint since 2011.

Noel brings over 12 years of valuable experience in the healthcare technology industry. Most recently, he served as the National Sales Manager, Channel Partnerships for Availity, LLC where he led a sales team to develop clearinghouse and information exchange partnerships with over 500 PMS/EMR vendors, regional health plans and hospitals. In addition, Noel helped spearhead the clinical integration strategy between key health plans and EMR vendors for the exchange of relevant clinical data at the point of care.

Noel earned his M.B.A. degree from the University of Phoenix and his B.S. in Management, Information Systems from Florida State University.

About PatientPoint®
PatientPoint® is the leader and innovator of patient and physician engagement solutions at the point of care. PatientPoint award-winning patient education programs and care coordination platform drive meaningful outcomes for patients, healthcare providers and program sponsors. The PatientPoint Care Coordination Platform is the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the National Committee for Quality Assurance (NCQA) for 2011 patient-centered medical home (PCMH) criteria. PatientPoint serves more than 61,000 physicians across all programs and more than 750 hospitals throughout the U.S., and impacts over 456 million patient and caregiver exposures annually.

U.S. Domestic Medical Travel (USDMT): Tell our readers about your professional experience in the industry.

Noel Khirsukhani (NK): I have been employed in the healthcare industry for more than 15 years.
I helped build and develop some of the first electronic medical record (EMR) solutions in the market.

Later, I transitioned into more of a business development role and have spent the last several years of my career working on partnership development, sales, marketing for hospital information system companies and leading sales teams for e-marketing companies.

Prior to joining PatientPoint, I led the channel partner division to the third largest clearing house in the U.S., where I worked with 500 or so EMR's in an effort to build clinical integration strategies between health plans and providers, specifically to support new venture models such as patient centered medical homes (PCMH) and accountable care organizations (ACOs).

One of the major reasons I joined PatientPoint three years ago was because I felt there was a gap in how we were leveraging data points - health plans, EMR's, and even other stake holders in the industry such as pharmaceuticals, manufacturers and pharmacies.

Ultimately, what I have found, is a tremendous burden on the physician to extract data and try to synthesize the information into a very specific manner.

At PatientPoint, rather than forcing this burden on the physician, we take the data and create intelligence out of it-we substantiate the patient work load.

USDMT: What is PatientPoint's primary focus?

NK: A lot of individuals focus more on the clinical analytical space rather than the population health space. At PatientPoint, we play an active role in both population health and care coordination.

Our main objective is to engage patients and create better access to physicians, which in turn, will result in improved outcomes over the long run.

USDMT: How do you connect patients and physicians to new healthcare models such as PCMH's and ACO's?

NK: There are a few different ways we try to accomplish this.

In terms of the PCMH and ACO, one of the major challenges we see, and have witnessed in the market, is that this space is becoming incredibly competitive.

In some situations, physicians and/or business organizations can be assigned a pool of patients that they are expected to manage. The issue that exists with this scenario is whether or not the providers are able to close all of the relative clinical care gaps based upon different conditions and disease states.

Often what ends up happening is patients will opt to receive treatment from a different healthcare provider, or competitor, or the patient chooses not to receive treatment at all.

If no treatment is sought, then there is no outreach to the patient, who will ultimately end up feeling worse, or in the emergency room with higher healthcare expenses, etc.

To alleviate this challenge, we try to identify those patients, the clinical care gaps and the medication non- adherence gaps that are associated.

Lastly, we will then utilize an outreach process in the patient's preferred locality in order to drive them into a practice and prepare them for their visit.

USDMT: How many physicians and organizations do you work with nationwide?

NK: PatientPoint is an enterprise that consists of 68,000 physicians and 770 hospitals that currently use any one of our apps.

USDMT: Do you employ a specific outreach program to connect with these providers?

NK: We utilize a secure coordination platform.

Our hospital network divisions are responsible for our patient education technology. We produce, publish and distribute our own educational content in the form of waiting room screens, print base brochures and even digital technologies online, with the sole objective to try to impact behavioral change for the patient.

Our tier coordination platform, which provides true personalization of care by extracting data points, helps identify care gaps, and so our outreach process for this division is most important in post-care.

To close care gaps, we provide a care management dashboard, also known as a command center, which displays each patient's relevant events based upon our outreach efforts.

Of course, patients receive access to this command center through the Internet, but we also have our own patient-facing modules where we can interact with the patient and send interactive voice response messages on behalf of the physician to the patient.

Recently, we've introduced a patient mobile platform that is branded for a particular physician or health system. We can create a push message that allows patients to set up appointments directly through their mobile device.

USDMT: What is the feedback on this platform?

NK: The feedback has been phenomenal.

With this platform, not only are patients able to schedule appointments, but they are also able to locate providers within certain proximities, as well as look up approximate wait times.

This app provides tremendous ease of accessibility. One of our clients has already witnessed about a 30 percent increase in patient appointments just from the mobile platform alone.

USDMT: Are patients willing to travel to different areas of the U.S. for care?

NK: We still believe that healthcare is delivered locally, and at this point, most of our patients stay close to home.

However, there are some cases where patients move, for example, from New York to Florida for six months out of the year. In these circumstances, we believe our outreach mechanism gives us a touch point with the patient to find out if any medical treatment has been completed since their leave, as well as the steps we need to take upon their return.

USDMT: What was your role during the American Medical Group Association (AGMA) Conference, April 3-5, 2014?

NK: The annual AMGA conference is one event that we believe is so significant to this industry right now. At this event, PatientPoint engages in a number of speaking engagements, which place heavy focus on the newer patient models.

This particular conference drives a significant number of large health systems, as well as large individual practices to our customer base, which will greatly help us become the thought leader in best practices for patient engagement moving forward.

Spotlight: Cheryl Smith, Medical & Wellness Tourism Manager at the Las Vegas Convention and Visitors Authority  

Cheryl Smith is no novice to communicating the value of medical travel. She's been boosting opportunities for the city of Las Vegas in her role as Medical & Wellness Tourism manager at the Las Vegas Convention and Visitors Authority (LVCVA.com) for nearly three years.

"If I told you about everything new happening in Las Vegas I'd run out of words," quips Smith. "But the whole focus in terms of what I'm doing with medical and wellness travel is a new concept for our destination."

Under her direction, the LVCVA has taken a multi-faceted approach to examining what Las Vegas does very, very well.

"Certainly healthcare meetings and medical meetings are a key piece, and an obvious thing, for us to begin strategizing ways to expand and grow that business," she explains. "This includes increasing the number of bookings for medical meetings, like the Bio Skills Training and Continuing Medical Education for doctors, nurses and other healthcare professionals. We have five surgical-skills training facilities here that provide continuing medical education services for physicians, so there are approved cadaver training facilities and approved veterinary training facilities, too."

Smith is powering up presentations and programs for the upcoming Institute for Healthcare Consumerism™ Forum West, November 10-12, 2014, Las Vegas, Nevada. (http://www.theihccforum.com/2014west/) The City will feature its hotels, spas, accommodations and specialized accommodations for corporate medical travelers and others interested in Las Vegas as a medical/wellness destination.

"We are working on a special set of programs for pre-conference day -- an opportunity to really showcase the medical and wellness facilities that are offered within the destination," says Smith, "We want to promote the concept that Las Vegas is a medical and wellness travel destination. That idea in and of itself is new to many people."

From a value proposition perspective, she says that Las Vegas offers many features that employers would find very attractive.

"Some are obvious, but others may not be so obvious," says Smith. "The number of hotel rooms and availability for combinations that we offer is staggering. Airline transportation schedules are incredible -- over 900 daily inbound and outbound flights. While this number fluctuates, the ease and ability with which people can travel domestically, as well as internationally, to Las Vegas is remarkable."

Smith also cites the fact that Las Vegas offers an abundance of other amenities.

"For example, we are known as a dining and foodie destination with great restaurants," notes Smith. "For people who are traveling for a wellness purpose, they may ask, ‘How many of those restaurants offer healthy dining options?"

The answer is that the City has just added this information to its website: www.lasvegas.com. People can actually search healthy dining, vegetarian and vegan-friendly menu options at restaurants. Smith estimates that there is well over 50 or 60 restaurants just on the Las Vegas strip alone that offer those types of amenities.

When people are coming to a conference, they will have the ability to see Las Vegas from many perspectives, including the "wellness side." Las Vegas boasts 45 resort model spas that offer wellness and preventative health type services for de-stressing, relaxation, rest and rejuvenation. Ten of these spas are Forbes-rated and considered "five star."

"I've been told by industry gurus that Las Vegas has more spas in one destination than anywhere else in the world," says Smith. "So when you look at the availability and accessibility to experience a wellness, preventative health or even a corporate wellness team-building experience tied to wellness and healthcare, Las Vegas is the destination of choice."

From her point of view, Smith views medical care and wellness as two separate offerings.

"Our primary approach is certainly to promote medical meetings, but we are also focusing on wellness travel and preventative health, as well as medical travel," adds Smith. "The reason that medical travel is positioned in third place is because it does involve more collaboration and represents an entirely different industry than the travel and tourism industries -- which is the specialty focus of LVCVA."

Smith goes on to explain the collaborative relationship with a multi-disciplinary, not-for-profit healthcare organization called Las Vegas HEALS (http://www.lasvegasheals.org/)

"This collaboration spans our economic developing agencies, medical schools and main university -- the University of Las Vegas -- for the development of a strategic plan for the community to look at the development of medical tourism in the community," says Smith. "Part of that does include working with the community around price transparency and packaged pricing, and bundling of medical services. It covers the whole experience."

While the focus at LVCVA is on travel tourism, the organization is not comprised of medical experts, making this partnership with Las Vegas HEALS so important.

"Las Vegas HEALS embraces that concept on behalf of the medical community, and then works with the medical providers here in town to really identify who is doing what, who is an expert in which areas, and what our Centers of Excellence offer," says Smith. "We really just launched the relationship and still have some work to do. Some providers have figured it out and offer package programs with transparent pricing. Others are still in the development process."

Smith is very proud of the fact that Las Vegas has a lot of hotels - over 150,000 hotel rooms within the destination. Not all of them are the necessarily the best places for a medical traveler to recover, but some hotels have taken the lead for the hotel industry to begin incorporating wellness technologies and amenities into the rooms.

"A great example of that is the Stay Well Room Product at MGM," says Smith. "They have really been a leader for the hotel industry in working with the Cleveland Clinic and a company called Delos Living (http://delosliving.com/mission/defining-wellness-real-estate/) to really infuse the rooms with wellness technology."

These technologies may be of interest to any traveler, whether they are coming to Las Vegas for a medical or wellness purpose or otherwise.

Smith adds, "M Resort also has a new room that they call the Experience Room, which is basically a room that comes with wellness amenities that can be brought into the room. They also offer a Vitamin C-infused shower head and other types of aroma therapy and enhancements that create more of a wellness environment."

She points to other accommodations that are "off the strip" that may appeal to medical travelers who are traveling with a spouse or family members.

"Hilton Grand Vacations has a new medical traveler's discount program, and these are non-gaming, non-smoking facilities hotels and accommodations that are apartment/condo type units with kitchens and in-room washers and dryers," says Smith. "Sometimes they offer multiple bedrooms, and are terrific for a family or people who are coming here for care and having to stay for a longer period of time."

Then there's a whole different type of experience like the one available at Trump International Hotel Resorts and Spas in Las Vegas.

"It's also off the strip and non-gaming, but offers a different experience," she says. "Trump Wellness includes everything from an early morning boot camp for organized workouts to complete spa treatments -- all designed around a wellness and preventative health experience. They are trying to target the traditional medical surgical traveler and the wellness preventative traveler."

The logical question is this: Are there any other cities that are making any effort to do this kind of program?

Smith responds, "Honestly, I am so focused on Las Vegas -- which is the greatest city in the world, in my opinion - that I really couldn't address what other cities are doing. I am focusing strictly on what we are doing here, and I love it."

Nota bene (NB): She says that no other cities have called her to get some guidance - but one would bet that those calls will be forthcoming. After all, many other cities now have gaming, spas, hotels, medical providers and Centers of Excellence....so medical travel will be a natural ally. Stay tuned.

World's Largest Self-Insurance/ART Event Coming to Phoenix!

The Self-Insurance Institute of America, (SIIA) today announced the program for its National Educational Conference & Expo, scheduled for October 5-7, 2014, at the J.W. Marriott Desert Ridge Resort & Spa in Phoenix. The event typically attracts more than 1,700 attendees from throughout the United States and from a growing number of countries around the world.

Detailed event information, including registration forms, can be accessed on-line at www.siia.org, or by calling 800/851-7789. Sign up today and take advantage of discounted early bird registration fees and secure your room at the host hotel. NOTE: This hotel is a SIIA member favorite and always sells out early, so please keep this in mind as you make your arrangements.

The program features more than 40 educational sessions designed to help employers and their business partners identify and maximize the value of self-insurance solutions.

We'll cover self-insured group health plans from every angle, including plan design and cost containment, financial risk transfer, broker involvement and healthcare reform compliance. Extra content has been incorporated this year that should be of specific interest to TPA executives and their key management teams. And you won't want to miss our panel discussion sessions featuring top thought leaders talking about the future of the self-insurance marketplace.

Another focus will be stop-loss captive programs (also known as employee benefit group captives). An increasing number of smaller and mid-sized employers have been considering self-insured group health plans and stop-loss captive programs can help facilitate this transition. SIIA has become the recognized industry leader in this fast-growing captive insurance market niche and the session speakers for this topic area will be many of the industry's top experts.

Also within the Alternative Risk Transfer track, additional sessions will focus on Enterprise Risk Captives, also known as 831(b) captives, which have become an increasingly popular self-insurance solution for many companies.

Given the rapidly involving business and regulatory environment for group workers' compensation self-insured funds (SIGs), we have incorporated a series of roundtable sessions where SIG leaders from around the country will provide a unique opportunity to share perspectives on how their organization should be positioning itself for future success. These SIG-focused roundtables will be supplemented by additional timely sessions of interest to both groups and individual workers' compensation self-insurers.

Rounding out the program will be some sessions addressing key self-insured issues, including healthcare reform compliance requirements for companies with global operations and/or workforces, giving the conference an added international flavor.

This top notch educational program will be supplemented with quality networking events, including an exhibit hall with more than 150 companies showcasing a wide variety of innovative products and services designed specifically for self-insured entities. If you are searching for a self-insurance business partner, they will be waiting for you at this event. For more information about exhibiting and sponsorship opportunities, please contact Justin Miller at 800/851-7789, or jmiller@siia.org.

Your can get a head-start on your networking by participating in the conference golf tournament the morning of Sunday, October 5. And then cap things off with an incredible social event on the closing night of Tuesday, October 7, so be sure that you make your travel arrangements accordingly.

New to Self-Insurance/Alternative Risk Transfer? SIIA Welcomes You!....While the conference will be packed with industry experts and many advanced-level educational sessions, SIIA warmly welcomes those who are new to self-insurance/alternative risk transfer and want to learn the basics. To help you get started, we have scheduled "beginner" sessions immediately before Sunday night's welcome reception to help you more fully participate in the overall event. Additionally, for employers (non-industry service providers) considering self-insurance, you can take advantage of a highly discounted registration fee.

If self-insurance is important to you in any way, this is simply a must-attend event. We look forward to seeing you in Phoenix.

Register Now: www.siia.org/national

SIIA Panel Discussion: Domestic Medical Travel - Opportunities and Challenges for Self-Insured Employers

Description: While international medical travel has been highly publicized over the past several years, domestic medical travel has been more quietly gaining traction among a growing number of self-insured employers.   This panel discussion will explore the latest trends in domestic medical travel and what employers need to consider when evaluating whether to incorporate this strategy as part of their health plans.

Moderator: Laura Carabello
                           Editor and Publisher:  National and International Newsletters
                           U.S. Domestic Medical Travel:  www.USDomesticMedicalTravel.com
                           Medical Travel Today:  www.MedicalTravelToday.com


  • Ruth Coleman, CEO, Health Design Plus
  • G. Keith Smith, M.D., CEO, Surgery Center of Oklahoma
  • Olivia Ross, Senior Manager, Employers Centers of Excellence Network
  • Pacific Business Group on Health

About Ruth Coleman

Prior to founding Health Design Plus in 1988, Ruth Coleman had almost 20 years of experience in HMO and hospital management, patient care, and nursing education. Her experience includes several executive HMO and hospital management positions with responsibility for network development, utilization management, customer service, quality management, marketing, strategic planning, and operations. Coleman used this breadth of managed care and care delivery experience to create an organization that provides high quality management for employer-sponsored health benefit plans.

Her experience, expertise and leadership have guided Health Design Plus through incredible growth, recognized by numerous awards, including the prestigious Inc. 500 and 11 consecutive years as part of the Weatherhead 100, along with being named one of the Top Ten Women Business Owners in Northeast Ohio, and a finalist for the Ernst and Young Entrepreneur of the Year Award.

About G. Keith Smith, M.D.

G. Keith Smith, M.D., is a board-certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.

Operation of this free-market medical practice, arguably the only one of its kind in the United States, has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith's pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.

The Surgery Center of Oklahoma is a 32,535 square-foot, state-of-the-art multispecialty facility in Oklahoma City, owned and operated by approximately 40 of the top surgeons and anesthesiologists in central Oklahoma.
If you have a high deductible or are part of a self-insured plan at a large company, you owe it to yourself or your business to take a look at our facility and pricing which is listed on this site. If you are considering a trip to a foreign country to have your surgery, you should look here first. Finally, if you have no insurance at all, this facility will provide quality and pricing that we believe are unmatched.

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost-prohibitive. As more and more patients find themselves paying more out-of-pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.

Transparent, direct package pricing means the patient knows exactly what the cost of the service will be upfront.

About Olivia Ross
Olivia Ross is senior manager with the PBGH Paying for Value team. Her projects include management of the Employers Centers of Excellence Network, which is a multi-purchaser (employer) collaborative established by PBGH as part of its commitment to improving the quality and affordability of healthcare. Additionally, Olivia participates in several ongoing projects focused on changing physician and hospital financial incentives to ensure high-quality healthcare delivery, while also containing costs.

Olivia joined PBGH in 2012 after four years at the Feinberg School of Medicine Center for Healthcare Studies at Northwestern University. She initially served as project coordinator for several programs working with the Chicago Pediatric Patient Safety Consortium to advance patient safety through improved clinician communication and teamwork. Olivia's activities included conducting failure modes effects analysis (FMEA) risk assessments, training and evaluation of clinician handoffs and directing nearly 50 in situ simulations across six local hospitals

Olivia was then recruited to serve as the Research Project manager of the newly formed Northwestern University Transplantation Outcomes Research Collaborative (NUTORC). In addition to managing patient safety projects, she supported strategic planning and oversaw the day-to-day operation of a group tasked with creating innovative health services and outcomes research in organ transplantation.

Olivia holds a master's in Public Health (MPH) from UCLA, and an M.B.A. from the Kellogg School of Management at Northwestern University.

Florida Medical Tourism
by Adel Eldin, M.D.

Recognize Florida Medical Tourism as we celebrate our second anniversary serving global clients for inbound and outbound traffic as your favorite global HUB for medical tourism. We appreciate your trust in us and we will do our very best to give you a top notch medical tourism experience, mixed with universal values of compassionate care. We offer the best competitive pricing, services and with the most trusted providers globally. We provide unique culture-sensitive medicine as well as customized services that would fit everybody's personal needs and goals (whether an individual employer or corporate self-pay or self-insurance).

We also offer a spend-a-day-in-Tampa package with our $999 special:
We can arrange flight, accommodation and sightseeing for you as well.
- Save thousands of dollars over the cost of traditional medicine.

Come and enjoy the sunshine that is unique to Florida along with unique services in mixing wellness and medical tourism, as well as having the leisure of travel. This will be an ultimate package that is offered uniquely by Florida medical tourism.

 In addition to that, we offer telemedicine services for an honest second opinion from the comfort of your home or office, and thus obviate the hassle of getting a visa and traveling all the way to the United States. You simply get a world-class service from the comfort of your home or office online in both English and Arabic languages and, including also for the first time, Woman's Health consultation to provide privacy and comfort for our female patients in both English and Arabic languages!

  1. https://www.floridamedicaltourism.com/tele-medicine/dr-eldin-eclinic.html
  2. https://www.floridamedicaltourism.com/tele-medicine/dr-eldin-econsult.html
  3. https://www.floridamedicaltourism.com/tele-medicine/dr-zaher-eclinic.html

We invite everyone to visit our website www.floridamedicaltourism.com. We will be happy to answer any questions about our services or offer any help to you among the previous mentioned services.

Now, the mobile version of www.floridamedicaltourism.com is live, so any client anywhere in the world can use utilize our telemedicine services, available in English and Arabic, which includes women's health consultations done by Dr Zaher. Women across the globe can access her care through her eClinic, again in English and Arabic.

Clients can also take advantage of the Summer Vacation Special, which is a 50 percent discount off of the original price of the Wellness Tourism Package.

Please feel free to contact us at info@floridamedicaltourism.com  or call toll free 1-877-DRELDIN and we look forward to hearing from you, serving you and making a great long-lasting, positive medical tourism experience with your favorite global HUB floridamedicaltourism.com.

Laura Carabello Presents at QualityPath® Webinar

Laura Carabello, presented "Helping Employees Switch Providers in a Steerage Program" for QualityPath® on June 19. If you were able to attend we hope you enjoyed this event and found the information useful.

As a follow-up to Cheryl DeMars' update on QualityPath and Laura Carabello's presentation we have compiled some resources for your reference that include:

If you have any questions regarding QualityPath or Laura's presentation please contact Laura at lcarabello@cpronline.com.

Americans Receive A Failing Grade When It comes To Their Medical IQ
by Gina Larson-Stoller

Over 60 percent of patients don't know basic information about their doctor

Our health is personal. But when it comes to navigating the system that cares for us, many Americans aren't making the grade. A new survey from the Vitals Index reveals that while two-thirds of people perceive themselves to be a savvy health care consumer, many don't know how to find quality care at a good value.

In fact, more than 60 percent of respondents didn't know basic quality information about their doctor, such as which medical school s/he attended. Younger consumers were the least likely to know which school their doctor attended, and over 10 percent of consumers said they didn't care.

Besides not heeding quality indicators regarding providers, consumers were also blind to cost-savings for their care. Just one-third said they negotiate bills with a doctor or hospital. Similarly, only 1 in 3 know the cost of a medical service or procedure before receiving care. Women (39%) were more likely than men (29%) to know the upfront cost of a procedure or doctor visit.

"At a time when the price of care can vary by thousands of dollars from clinic to clinic and high-deductibles are more common, consumers need to know how to compare prices before they go see a doctor," said Mitch Rothschild, CEO of Vitals. "No shopper would buy a TV without knowing how good it is and how much it costs. We should buy health care with that same level of transparency."

One bright spot is that about 80 percent of consumers do regularly ask for generic equivalents of their prescriptions to save money. Sixty-seven percent of people know retail clinics offer flu shots cheaper then most doctor offices or hospitals.

But at a time when health insurance is mandated for all under the Affordable Care Act, the survey revealed that common terms related to covered care are not understood.  Less than half of the respondents could accurately define the terms co-insurance or formulary. Only 66 percent could define the term deductible.

SCORE (in %)



Out of pocket maximum












Studies in the past have shown that patients who are engaged and know more about their health care have lower costs and better health outcomes.  The Vitals Index survey found a direct correlation between health care savvy and household income. Households with incomes under $50K were the least likely to know a doctor's background or understand insurance terms. They were also 50 percent less likely to negotiate medical bills compared to higher-income households.

"The people who could benefit the most from the system simply don't know how to navigate it," said Rothschild. "That's not only matter of financial well-being, but of personal well-being. It's clear that better education and access to meaningful transparency tools is necessary at all levels to improve the health and wealth of Americans."

About Vitals
Vitals is reinventing the way people chose doctors and medical facilities. We provide increased transparency to cost, quality and access information to support effective decision making. Vitals brings together actionable data, online tools and an engaging consumer experience that empowers consumers to make more informed, higher-quality and lower-cost health care decisions.  Through health plans, hospitals and our leading consumer websites, Vitals helps more than 150 million people each year access information for better, more affordable care. The Vitals Index is an ongoing report about the state of doctor-patient relationships based on proprietary data and surveys.

Click here to view the original article.

Cost of Healthcare: A Country-by-Country Comparison 

Vitals presents an in depth comparison on how different country's healthcare policies and expenses relate to their overall nation's health. Visit: http://www.vitals.com/about/resources/whitepapers/cost-burden-of-medical-care#.U6hGAxYb13Y

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Healthcare System Compares Internationally
by Karen Davis, Kristof Stremikis, David Squires and Cathy Schoen

The United States healthcare system is the most expensive in the world, but this report and prior editions consistently show the United States underperforms relative to other countries on most dimensions of performance.

To view the original article click here.

Help Save a Life and Support MatchingDonors
100 percent of all donations on MatchingDonors.com go to help people get organ transplants on MatchingDonors.com.

MatchingDonors is a 501c3 nonprofit organization and the nation's largest online living organ donor organization finding living organ donors for people needing organ transplants.  In conjunction with various health organizations throughout the United States we have created a very successful Public Service Announcement campaign to help people recognize that they can save lives by being a living organ donor, to encourage them to register as an altruistic living organ donor, and to make them realize they can help save the lives of people needing organ transplants by donating other things. This MatchingDonors Living Organ Donor Initiative program has already saved thousands of lives.

Do you know of any available job openings relative to the U.S. domestic medical travel industry? We encourage readers to submit any available, relevant job opportunities along with its descriptions and requirements for fellow readers and industry professionals to consider. All submissions are appreciated.


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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 www.medicaltraveltoday.com, 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

James T. Caillouette, M.D., Surgeon in Chief, Hoag Orthopedic Institute

Spotlight: Noel Khirsukhani, Executive VP of Sales & Marketing, PatientPoint®

Spotlight: Cheryl Smith, Medical & Wellness Tourism Manager at the Las Vegas Convention and Visitors Authority

News in Review

World's Largest Self-Insurance/ART Event Coming to Phoenix!

SIIA Panel Discussion: Domestic Medical Travel - Opportunities and Challenges for Self-Insured Employers

Florida Medical Tourism

Laura Carabello Presents at QualityPath® Webinar

Americans Receive A Failing Grade When It comes To Their Medical IQ

Cost of Healthcare: A Country-by-Country Comparison

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Healthcare System Compares Internationally

Help Save a Life and Support MatchingDonors