Volume 1, Issue 20

Dear Colleagues,

Unique to the marketplace, Abacus develops and designs voluntary benefit policies and the entire policy language, which allows great flexibility and the ability to match plan design to the desires of client companies.

With more than 25 years of experience in the voluntary market, Hal Denton, senior vice president of Sales/Technology, Abacus, discusses the company's short- and long-term disability plans, state-specific plans and hospital indemnity plans.

According to Denton, the company's distinctive abilities to customize policies and create flexible benefit options are what drives optimal results for clients. 

I also had the pleasure of speaking with I. Glenn Cohen, director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, who recently published Patients with Passports: Medical Tourism and Law and Ethics. Based upon all available medical travel data, this book encompasses the nature of the industry, i.e., popular treatment destinations, pricing and so on.

EXCITING NEWS! I am pleased to announce that I have been featured as a guest blogger for The Alliance®. To view my recent post entitled: "Who do you trust for a medical referral?," click here.

We're starting to hear from many hospitals, independent surgi-centers and provider groups that want to be better positioned to serve self-funded employers offering medical/surgical travel options.  If you have a good story to tell us, please be in touch!  We want to boost opportunities for Centers of Excellence nationwide. 

Tell us:

What distinguishes your service offering in terms of cost, patient experience and satisfaction, outcomes, or other quality indicators. 

Send us your descriptor, including photos or charts, and we will evaluate for publication in this newsletter.

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: Hal Denton, Senior Vice President of Sales/Technology, Abacus


About Hal Denton
Hal Denton, 51, is senior vice president of Sales and Technology of The Abacus Group. From his humble beginnings as a sales representative, his climb to success has provided him with invaluable knowledge to evaluate the market direction, and then react proactively.

With over 25 years of experience in the voluntary market, Denton understands that in sales flexibility and technology go hand in hand. By delivering product and marketing support to the broker (our client), he realizes the importance of getting the information they need to communicate the benefits in a variety of ways. Denton believes that, whether the customer is price-driven or benefit-driven, the information must be simple to understand, simple to communicate and simple to administrate.

Hal and his wife Susan, live in Knoxville, Tennessee. They have three children, Hal, Sam and Riley. Boating is his family's passion.

About Abacus
For more than 35 years, Abacus has been offering dynamic voluntary benefits that deliver peace of mind, confidence and security. We are an experienced and effective marketing and managing general underwriter, dedicated to forging long-lasting relationships with our clients. Our specialty is developing voluntary benefits that match your particular needs. With products issued through the world's largest re-insurers, we maintain full underwriting authority and discretion. We are rooted in the belief that quality doesn't just happen, but rather is a result of high expectations, intelligent direction and skillful execution. 


U.S. Domestic Medical Travel (USDMT): Please describe your professional background.

Hal Denton (HD): After I graduated college in 1987, I was hired by the Professional Insurance Corporation (PIC) as the state manager for Tennessee, North Carolina, Kentucky and Virginia.

I was responsible for the all of the recruiting, training and product distribution that took place.

In 1988, PIC was sold and eventually bought out by Sun Life of Canada. Through this exchange, the employees transitioned from being home office salaried workers to becoming independent contractors. This was also the launching pad for Abacus.

As independent contractors, Abacus went out and decided that it was necessary to build a policy that was more employer-friendly for the worksite, which meant going from being a guaranteed renewable policy to a group platform - more like the voluntary groups you see today.

Initially we worked with a company called Medical Life Insurance (MLI), which allowed us to take on 16 states, but, eventually, MLI was sold to Fort Dearborn (now known as Dearborn National). As you would expect, we were told nothing would change. But as it turned out, there were channel conflicts with Dearborn. While we continue to support the cases we have in force, and we continue to call on them for situations that need them, we looked for other opportunities.

Baltimore Life Insurance (BLI) company moved to the forefront. They were a mutual company and would not be easily sold. They really gave us the ability to shape and grow the product line. However, being a mutual company also meant they did not have easy access to capital. This pushed us back out to the market. But this time, we were outsourcing the different components. We brought in Towers Watson to help us build the new product. We brought in top tier re-insurers like Assurant and Hartford for their risk appetite. In addition, we brought in North American Benefits Company for the administration, and Kansas City Life to issue the policy.

Now, our company, ABACUS, designs policies and builds the entire policy language - which is unique in the marketplace. This approach allows us great flexibility and the ability to match plan design to the desires of client companies.

By doing this, we are able to receive the best services from everybody involved.

Essentially, what we have done is build policies that are extremely flexible. Of course, we have the normal elimination periods, benefits periods and voluntary disability that you'd expect.

We are able to customize policy age calculations into two categories - an attained age policy, where the rates change once a year based upon somebody's age, or an issue age policy where a person locks in their age when they purchase the policy. If an employee wishes to buy more at a future time we go back to that original issue age. We can change the pre-existing language to match the need and desires of the group - this includes the ability to remove the pre-existing condition limitations all together.

Years ago, the industry used the terminology "payroll deduction" when discussing this type of product. Now, the term has since morphed from payroll deduction, to work-site services, to voluntary benefits.

Professionally, I have been around through all of these transitional phases. However, in the end, it is still the service that separates the excellent carriers from the ones that just also carry the product.

USDMT: How are clients referred to your company?

HD: We only work directly with agents. The agent normally already has a relationship with a client. This may be the major medical, the property casualty lines or the retirement program. They approach us to help round out their offerings.

We are the second level of products that an agent would be bringing to their clients, and if they are trying to bring in the best-of-class services, which is where we feel we really stand out.

USDMT: Can you elaborate on the voluntary benefits that Abacus offers?

HD: Abacus is well known for its short-term disability plan, which makes up roughly 60 percent of our sales.

For almost any industry, we are able to guarantee issue up to $3,000 per month with no participation requirement other than five enrolled lives, which is very unique.

With long-term disability plans that dovetail in with the short-term offering, we can guarantee issue a LTD with no participation requirement, as well. If an individual wants to go out to age 65 or Normal Social Security Retirement Age (NSSRA), we will build that product, as well.

Term Life is only about 12 percent of our annual sales, but this is due to the much lower average premium than the short-term disability plan. The guarantee issue offering varies by the needs of the employer group.

We have recently re-introduced hospital indemnity plans (HI).

These plans used to be very popular and faded away when HMO's and PPO's came around to fill in the out-of-pocket expenses. Now that we are seeing much higher deductibles, greater out-of-pocket expenses and more limits on medical benefits, the HI plans are starting to come back into vogue.

USDMT: Do you consult with prospective employers before a voluntary benefit plan is designed?

HD: Generally, the employer's agent has a good feel for what kind of plan a client wants. We take a holistic approach to benefits -what is the core offering from the employer? Where are their employees left with gaps? And what is the most effective way to cover them?

From there, Abacus will build plans to fit the needs of the client and work with the agent.

Often times, the elimination period is set up to dovetail in with the other benefits the client has in place.

USDMT: Do you work with clients nationwide?

HD: We are approved to operate in every state, except New York - although the southeastern United States has always been a leader in voluntary markets.

We have also been doing a lot of work with clients in states that have state disability benefits for their employees. These states normally have minimal coverage for employees, and leave employees thinking they have more coverage than they really do. We will provide a "buy up" on top of the state plan as a way to allow employees to cover more of their income.

USDMT: How can individuals enroll?

HD: We only sell through an employer relationship, an association, or through a 1099 prior relationship.

Today, we get approximately 80 percent of our business in an electronic format. We work with all of the different enrollment companies and many of the homegrown enrollment systems, as well. For individuals who want to build policies, we always accept electronic enrollments, but we still take paper enrollments from the people who prefer that option.

USDMT: Does Abacus have any involvement in the medical travel industry?

HD: Currently we do not have any involvement in the medical travel industry.

However, a disability is a disability - it doesn't matter if a person is traveling away from home or not.

With our policy, individuals are, of course, covered when they are in the U.S., but there are limited benefits when they are out of the country. We are really more domestic.

USDMT: Has the Affordable Care Act impacted your company?

HD: Absolutely.

The commissions have been removed from the major medical products, so now agents are realizing that they need to look at all aspects of employee benefits to make up for lost revenue. This has caused a much greater interest in voluntary products.

At the same time, we are seeing more carriers who are getting into the market who truly don't understand what they are getting into, which results in wild pricing options.

USDMT: Where is Abacus headed in the future?

HD: We are always looking at the voluntary markets and trying to figure out where the gaps are.

Recently, we have been working with Health Options Worldwide (HOW), a company that offers wellness coaches for individuals.

HOW works with current wellness programs to help inform employees about available options and whether or not they have utilized all options. It will communicate with employees through email or text and help encourage healthy lifestyle choices.

USDMT: At this point, is there anything else you would like to add?

HD: When it comes to claims, we've taken a telephonic intake approach, which teaches employees to call a toll-free number rather than to inquire about claims with Human Resources.

In the past, the claim forms for disability policies were handed to the employer who would then turn it into the issuing company for payment.

This led the employee to inquire with the employer regarding the status of their claim. By utilizing the telephonic intake approach, the employee can eliminate the middle-man and speak directly with a claims adjudicator.

This process greatly speeds up the time it takes to put money back into the employee's pocket when they are out on disability and need financial stability the most.

INTERVIEW: I. Glenn Cohen, Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School


About I. Glenn Cohen
I. Glenn Cohen is professor of Law at Harvard Law School, and director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics. He is one of the world's leading experts on the intersection of bioethics (or medical ethics), and the law, as well as health law. He also teaches civil procedure. Prior to becoming a professor, he served as a law clerk to Judge Michael Boudin of the U.S. Court of Appeals for the First Circuit, and as a lawyer for U.S. Department of Justice, Civil Division, Appellate Staff, where he handled litigation in the Courts of Appeals and in the U.S. Supreme Court. He was selected as a Radcliffe Institute Fellow (2012-2013) and by the Greenwall Foundation to receive a Faculty Scholar Award in Bioethics. He also leads the Ethics and Law initiative as part of the multi-million dollar NIH-funded Harvard Catalyst for The Harvard Clinical and Translational Science Center program. Professor Cohen is the author of more than 80 articles and chapters, and his award-winning work has appeared in leading legal law review journals, including: Stanford, Cornell, and Southern California; medical journals including the New England Journal of Medicine, and JAMA; bioethics journals including the American Journal of Bioethics, the Hastings Center Report; and for public health, the American Journal of Public Health. He is the editor of The Globalization of Healthcare: Legal and Ethical Issues (Oxford University Press, 2013) and the author, editor or co-editor of six other books already published or in production. His newest book, Patients with Passports: Medical Tourism, Law, and Ethics, is now available from Oxford University Press http://www.amazon.com/Patients-Passports-Medical-Tourism-Ethics/dp/0199975094 . The Press has allowed him to post the first two chapters of the book, containing the book's introduction and the most up to date and complete data on the medical tourism industry online for free download: http://ssrn.com/abstract=2514371 .


About Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School was founded in 2005 through a generous gift from Joseph H. Flom and the Carroll and Milton Petrie Foundation, with the goal of promoting interdisciplinary analysis and legal scholarship in these fields. The Center is not an advocacy organization, but rather is dedicated to the unbiased analysis of pressing questions facing health policymakers.

The future promises to raise new and fascinating issues that will make these interdisciplinary analyses all the more important. Scientific advances are pushing the boundaries of existing thinking on everything from what defines a human life to what constitutes an ethically tenable area of research, as well as raising complex issues about the appropriate role of intellectual property. At the same time, transformations in healthcare financing and business practices, changes in the role of health law, and the growing realization that the environment has a direct link to human health have upset traditional professional and market paradigms.

The founding vision of the Petrie-Flom Center is to promote scholarly inquiry that breaks away from existing disciplinary lines and brings the totality of these disciplinary methodologies under its compass to inform policy. To achieve this goal, the Center fosters a community of leading intellectuals, practitioners, and policymakers from a variety of backgrounds and at all stages in their careers.

U.S. Domestic Medical Travel (USDMT): Give our readers some background on your newest book: Patients with Passports: Medical Tourism and Law and Ethics.

I. Glenn Cohen (IGC): Before this publication, I spent a great deal of time as an academic bystander in the medical travel space. To enhance my knowledge about the industry, I began to attend FAM tours and regional meetings, and engage in conversations with health geographers, lawyers and medical travel enthusiasts.

As I gradually expanded my background, I realized there are many unanswered inquiries around the legal and ethical issues of the industry - which is what motivated me to author this piece.

USDMT: Give us a preview of the contents.

IGC: The first 260 pages of the book are devoted to the legal side of medical travel, and the latter half pinpoints the borders of medical travel legality or illegality.

The initial half details medical tourism as it is most widely known: patients traveling for high-quality, affordable and legal treatment services in a foreign location.

The second portion of the book addresses consumers traveling to foreign locations to seek illegal treatments, which may include: abortion, assisted suicide, stem cell therapy that is not yet approved by the FDA, reproductive technology, etc.

The book begins with my attempt to gather all of the medical travel data that is currently available, but more broadly encompasses the nature of the industry, i.e., popular treatment destinations, pricing, etc.

Unfortunately, the majority of data available on the industry is more hype than fact, with only estimates available for public review.

The initial section details quality, and in particular, the way information is and is not available, as well as the travel of pathogens between locations, multi-drug resistant bacteria, and more.

In this era of Ebola, we are very much aware of the way the law does, or does not, generate incentives to provide information to patients and insurers who need to make a medical decision.

USDMT: Does the book address legal liability and other aspects of insurance?

IGC: Yes, and it includes when one can sue a medical practice if involved in medical travel, and how treating destination hospitals can protect themselves against legal action.

In the third chapter of the first half of the book, I discuss private health insurance in the U.S., employers that utilize a medical travel benefit in their plans, what law governs whether insurers can offer incentives and coverage, the liabilities an insurer or employer face, and plan design.

Next, it focuses on public health insurance, especially in the E.U., issues regarding prior authorization and when home countries must reimburse others. I also briefly make a suggestion that Medicaid and Medicare should provide coverage which enables medical tourism, and examine the way in which one U.S. government plan allows portable coverage - the TRICARE policy for military veterans who retire abroad.

The final chapter in the first half of the book glances at the effects of medical tourism on destination countries, examines the existing empirical literature on the positive and negative effects of the industry, and questions what our obligations are to these countries.

USDMT: Do you focus on Americans traveling outside of the country?

IGC: Americans are my primary focus, but I am also interested in inbound medical tourism, inter- European medical tourism, and Middle Eastern medical tourism.

USDMT: How would you characterize the current volume of medical travelers?

IGC: The destinations where you will find the best data comes from places such as Malaysia, where the government collects the data.

When it comes to Americans traveling for care, the Affordable Care Act (ACA) has slightly changed the composition in terms of who is engaging in medical travel.

As an increasing number of individuals are getting insurance, and therefore gaining healthcare coverage, the number of individuals traveling and paying out-of-pocket is decreasing.

On the other hand, I see a growing number of employers and insurers opting for a medical travel benefit, and sending employees and their dependents to a number of different locations.

We must not forget about the undocumented aliens in America who are omitted from participating in the exchanges - these individuals are major medical travel enthusiasts, often forced to pay out-of-pocket.

USDMT: Will the growth of U.S. domestic travel have an impact on the outbound market?

IGC: Yes, the growth of U.S. domestic travel for medical services will have some impact on the outbound market, but the price differentials in the U.S. are not large enough to be in competition with the price differentials in the international market.

When patients travel within the U.S. it's more often than not based on quality, accessibility or specialty care, rather than cost.

Most of the outbound medical travel in the U.S. is based on price competition or "price shopping" because an insurer has issued a check.

USDMT: Which treatments seem to be the most popular among patients traveling internationally?

IGC: I see a lot of patients traveling for heart bypasses and valve replacements, hip replacements, knee replacements, spinal fusions, hip resurfacing, gastric bypasses and mastectomies.

Dental procedures, including crowns, teeth whitening and implants, have become quite attractive to medical travelers, as well.

Lastly, cosmetic surgeries are prevalent among medical travelers - breast augmentations, rhinoplasties, etc.

USDMT: Do you see a definite move toward bundled pricing, including revisions, readmissions or any problematic outcomes?

IGC: Certainly as the market becomes more competitive between countries, bundled pricing will be marketed as a selling point.

Patients seem to find bundled pricing attractive, but the actual percentage of individuals who utilize this approach is unknown at this point.

For me, a more attractive approach encompasses legal liability, which bundles a form of insurance which provides coverage for medical malpractice and doesn't require the traveler to return abroad to take legal action if necessary.

USDMT: What does that legal realm of medical travel consist of now?

IGC: I always tell individuals, "If you go abroad for medical travel and treatment goes wrong, your ability to recover in the court is very, very weak."

On one hand, it is very unlikely you will be able to sue international facilities or providers in a U.S. court, and if one does sue them, they would be governed by a medical malpractice law, that by American standards, merits lower remuneration.

If you look at the medical malpractice law in Thailand, or Malaysia, or Mexico, the kind of recoveries you see Americans making, in terms of top dollars, are almost nonexistent.

If one has to sue an international facility or provider in a foreign court, they are in an even worse position because there is a major delay in many of the court hearings for medical malpractice action -local officials and doctors must testify.

There is only one published decision I've ever seen about a case that went to trial and had a decision, and the fact pattern is very unlike medical tourism. As I recall it involved someone in police/prison custody. Either people are discouraged from taking legal action, or in many cases, foreign hospitals have a strong public relations team to settle the cases quickly and quietly.

Most facilities are unwilling to provide data on adverse events, which makes it hard to tell if we are not seeing lawsuits because there are not a lot of errors, or because patients think it's too hard to win.

USDMT: Have you interviewed employers in different countries that are concerned with liability?

IGC: I've talked with a number of employers who are very interested in the medical travel industry as a whole.

First, employers must make sure the Employee Retirement Income Security Act (ERISA) interacts with state insurance law in a way that allows them to build medical travel into their plans. The ERISA preemption states that if you are a self-insured employer you can virtually avoid the majority of state level regulation of health insurance, which is good news because that regulation will often make medical tourism legally problematic.

Many employers are more concerned with the way medical travel looks from a public relations perspective rather than a cost-savings standpoint.

Since the ACA requires all Americans to have health insurance, many employers are under pressure to find affordable plans, leading to medical travel.

USDMT: Do you think the medical travel market will explode or grow steadily?

IGC: Personally, I believe it is a watershed moment for the industry when ABC News produces a positive story on a company that gives its employed individuals the option of traveling to Costa Rica for care.

The initial media coverage on medical travel was very negative, and now, coverage is based on curiosity and interest.

Employers are still trying to resume balance after the implementation of the ACA, but I do believe that this is an industry that will grow steadily, especially on the insurance side.

USDMT: When choosing locations, hospitals and providers outside the U.S., is there any value to an accreditation program? Is Joint Commission International (JCI) still the benchmark?

IGC: Yes, JCI and its accreditation standards still seem to be the benchmark for institutions.

For international facilities, collaborating with well-known U.S. institutions seems to be a marketing tactic, as well.

If you observe the way JCI accredits, it's really a process-based accreditation system, rather than an outcome-based system, and just because those requirements have been met doesn't guarantee that the morbidity and mortality rates will be excellent.

The reason I would rather travel to a JCI accredited institution is because, to me, it means that the destination country picked this institution to be its flagship - it has invested a lot of time and resources to ensure positive publicity.

A portion of my book argues that we still need a plan to push facilities to disclose more data, regardless of accreditation.

USDMT: What are your thoughts on patients traveling to the U.S. for treatment?

IGC: Again, the data is not great, but I do believe most people see the growth of outbound medical tourism, and in particular, inter-regional tourism.

Post 9/11 and post-9/11 security has turned some of the Arab world away from seeking medical treatment in the U.S.

There has been a rise in the number of individuals traveling for care from one middle-income country to another, but if these individuals want the best cancer treatment or high-tech surgery, they will travel to the U.S. regardless.

USDMT: Are U.S. hospitals marketing more aggressively to attract foreign patients?

IGC: Marketing plans are definitely in place, but hospitals are in a much more competitive situation now than they were five or 10 years ago. Again, the growth of outbound medical tourism from the U.S., and elsewhere in the world, has allowed facilities in Malaysia, Korea, Singapore, Thailand and others to look attractive to patients now, but may not have been viable 10 years ago.

USDMT: Do you see potential for a medical travel benefit to be incorporated into Medicare, Medicaid and/or Workers' Compensation?

IGC: I would think Workers' Compensation might be the easiest to incorporate a medical travel benefit, in part because it is mostly state law, not federal. Medicare is completely federal, and Medicaid is joint federal and state. But to be honest this is not an area I have studied so I would want to research more before giving a firm answer.

As I mention in my book, the one place government will pay for medical travel is the retirement plan for individuals who serve in the military - the Tricare plan. If you are an individual who retires abroad, the U.S. government will cover your healthcare and pay for it with U.S. federal government dollars.

USDMT: What are the less common procedures that people travel abroad for?

IGC: I call this "circumvention tourism" because people are trying to circumvent domestic rules.
Many individuals travel, particularly to China, for stem cell therapy, in an effort to curb conditions ranging from Autism to impotence to Down-Syndrome. We have very little evidence that stem cells are useful outside of areas such as blood source human stem cells.

There have been documented cases where some children have developed brain tumors, and there's very little regulation and disclosure about what type of stem cell is being used during treatment. There are many reasons to be concerned with this practice, but on the other hand, despite the serious risks, I'm very sympathetic to these situations - especially with parents who have terminally ill children.

USDMT: What are your thoughts on the negativity around surrogacy?

IGC: I believe there are two sets of issues around surrogacy. One issue is the exploitation of surrogates in the developing world and whether they are really being exploited or treated appropriately.

The other issue is about the recognition of children born abroad. Parents are now faced with great immigration difficulties when they try to bring the child back to their home country, and that is a concern that many parents haven't fully wrapped their heads around.

I would advise anybody who is considering traveling abroad for surrogacy, or any reproductive technology, to meet with a family law expert who can handle a case like this to guarantee they will be able to bring their child home.

Employer Direct Contracting: Game-Changing Medical Travel Trend
This article will appear in the 2015 HealthCare Consumerism Outlook magazine.
by Laura Carabello, Founder and Principal, CPR Strategic Marketing Communications, and Editor and Publisher, Medical Travel Today and U.S. Domestic Medical Travel™

Ihcc.com-America's businesses are facing some of the most monumental challenges in history regarding the provision of healthcare benefits for their employees, with significant employer compliance provisions of the Affordable Care Act (ACA) looming in 2015.  The ACA impacts all employers that collectively account for 95 percent of all commercial health coverage currently in the United States.i Large employers, in particular, face substantial monetary penalties for non-compliance with the new regulations, and the cost of providing health benefits mounts daily for companies of every size and in every industry.

With the sticker-shock of health reforms resonating in the employer community, business leaders are seeking solutions that not only lower costs, but also ensure quality.  While there are a few pioneers in the large business category that have tested the waters to execute direct contracting arrangements with targeted centers of excellence (COEs) (e.g. Wal-Mart, Lowe's, Boeing) the vast majority of large employers are now contemplating these arrangements in the year ahead. Furthermore, virtually all of the mid-size and small employers are also receptive to this concept and may aggregate their purchasing power through coalitions and other multiple employer welfare arrangements (MEWAs).

Concurrently, the nation's hospitals - which now total 5,723 registered institutionsii -- are on the frontline in the federal government's campaign to rein in sky-high costs while improving the quality of care.  All stakeholders are often coping with more requirements and less money.  Furthermore, competition among the hospitals is fierce, both locally and nationally, and 75 percent of all hospitals have a competitor within 15 miles (24 km).iii As hospital administrators and their marketing teams vie for patients that represent optimal reimbursement, they face another competitor:  doctors who now perform some procedures in their offices and with specialized clinics and surgi-centers.

In this new environment, a volatile pressure-cooker for every entity in the healthcare continuum, innovative solutions that were once considered far-reaching are now meeting receptive audiences. Direct contracting, often characterized as "U.S. domestic travel," the practice of traveling out of one's hometown or home state to a care provider or COE located in another part of the country, represents this type of phenomenon.

It's a trend that has also spawned a new breed of health management. Health Design Plus (HDP), a healthcare management company with experience administering travel surgery programs, enables its clients to control the spiraling costs of healthcare by giving employers access to the country's top hospitals and doctors - at a predictable cost.

The select hospitals involved in the HDP program had to meet strict benchmarks for positive outcomes, low hospital-acquired infection rates, high patient satisfaction, advanced staff training and skills, thorough patient data capture and other factors. Doctor's costs, hospital expenses and fees are part of a single, transparent price.iv

Ruth Coleman, CEO, anticipates growing interest in the regional model that they rolled out with the nation's largest retailer -- patients traveling for care within a smaller geographic region. The appeal with the regional model is that plan members travel within their own geographic region.

The company also expects to see more regional programs that will go beyond surgical procedures to include programs for conditions that are difficult to manage, such as diabetes. Currently the company is focused on domestic programs, but anticipates that ongoing trends will gradually make international travel more attractive for employers and plan members.

Centers of Excellence: Transparent Costs, High Quality Care

Employers, especially large, high-profile companies are increasingly exercising their options to pursue direct contracting and offer a medical travel benefit, and employees are quickly becoming willing travelers. The path toward better outcomes and cost-efficiencies represents high value for all parties, although the vast majority of businesses are still uncertain as to the appropriate steps for offering this type of program, selecting the optimal COEs, and ascertaining ROI. 

Several organizations and purchasing coalitions are helping to guide employers in their selection process. For example, The Pacific Business Group on Health (PBGH) brings employers together with the aim of improving the quality of healthcare while moderating healthcare costs. PBGH's 60 member companies provide healthcare coverage to 10 million Americans and their dependents, providing employers with a wide array of services that range from advising on relationships with carriers, supporting projects that accelerate price and quality transparency, and advocating for policy initiatives.

One of the organization's key members, Wal-Mart, launched a COE travel surgery program for cardiac and spine, and suggested that this type of program could have a stronger impact moving the market if multiple employers joined together. Since then, PBGH has learned that employers want a travel surgery program that offers high quality surgical care at affordable rates, not just an arrangement that provides the "best deal."

With its extensive background in quality measures and orthopedics, PBGH has developed an effective assessment and selection process for hip and knee replacement COEs. PBGH has also placed a COE in each region of the United States to minimize travel for patients, and will continue to add centers to meet participating employer demand.

Employers that sign on with PBGH's Employers Centers of Excellence Network (ECEN) can expect to receive a complete return on investment within two years -- and significant savings thereafter. In addition to the competitive bundled rates, the bulk of savings opportunity is the result of the higher quality of care.

Multiple Factors Impact Decision-making

While quality of care has traditionally been the primary deciding factor in choosing a hospital or physician for a specific treatment or procedure, the cost of healthcare has become an increasingly important factor for consideration. As patients have been asked to pay a greater proportion of the cost of their care - through higher co-pays, deductibles and other plan cost-sharing features - they are becoming more comfortable with the notion of leaving home to access better care that is easier on the pocketbook. Employers are also incenting patients to make the journey: offering full coverage for the procedure, eliminating deductibles and out of pocket costs, and covering the travel costs of a companion or family member.

Having access to geographically-specific healthcare cost information will also be key to empowering patients to make more informed decisions regarding whether to travel for care and how to plan for it financially. But transparency of information on the costs and quality of healthcare remains elusive, despite the efforts of the Centers for Medicare & Medicaid and private sector organizations that are starting to report this information.

In turn, hospitals and providers increasingly mimic the practices of successful retailers and are continually updating their offerings to lure corporate customers.  In their quest to become recognized COEs, they seek to attract patients from all parts of the country, and in many cases from throughout the world.  For the most part, however, these care providers are unsure about how to approach corporate audiences, market their capabilities, and leverage the opportunities that now exist throughout the country. 

Implementation of a medical travel program is a complex undertaking, and the majority of health systems need guidance.  Achieving clinical excellence is just one piece of the puzzle, and while most institutions like to point to their accomplishments in this area, they are missing many of the components for truly delivering an excellent, start-to-finish patient experience. 

Key Advantages to COE Programs

Among the many advantages to COE programs two stand out: price transparency and bundled pricing.

Price Transparency

Enormous variation in healthcare prices exists across the country. For example, one hospital might bill $40,000 to remove a gallbladder using minimally invasive surgery, while another hospital might charge $91,000.v

Prices can also vary within each state. For example, the median cost for a common inpatient heart procedure in southeastern Wisconsin ranges from a high of $178,647 at Waukesha Memorial Hospital to a low of $105,119 at Wheaton Franciscan All Saints in Racine.vi

By only signing contracts with providers priced in the low range, but who also demonstrate good outcomes, employers can lower the cost of providing healthcare without compromising quality.

Bundled Pricing

Bundled payment, also known as episode-based payment or packaged pricing, is defined as the reimbursement of healthcare providers based on expected costs for clinically defined episodes of care. Providers are paid a single fee for a set of evidenced-based services related to a diagnosis, with payments typically linked to outcomes, as well as other quality measures.vii

Last year, the Department of Health and Human Services announced a "bundled" payment program that allows providers to bid as a team for fixed price reimbursement for procedures, such as heart surgery or hip and knee replacements.viii

This strategy incents providers to collaborate to ensure the best outcomes because any additional cost incurred beyond the fixed price comes out of the provider's pockets. As a result, Geisinger Health System, for example, has seen a 21 percent reduction in complications, a 25 percent reduction in surgical infections and a 44 percent drop in readmissions.ix

Models of Quality, Cost-Effective Care

Virginia Mason Medical Center

As more companies shift employees to high-deductible health plans leading to higher out-of-pocket costs, more employers are prompted to engage with local health systems as a way to help employees shop for cost-effective care.

Serving as a model for this trend, companies like Starbucks and Costco have aggressively forged relationships with medical centers to meet the kinds of rigorous standards they use in daily business practices. The results include better health, higher patient satisfaction and lower costs.x

To improve care for back pain, for example, Starbucks worked with Virginia Mason Medical Center, requiring same-day access for employees, no unnecessary medical care and 100 percent customer satisfaction. This supply-chain approach demanded the same high standards Starbucks expects from all of its suppliers. With fewer unnecessary tests and more use of therapists -- which cost significantly less than use of doctors -- Starbucks experienced lower costs in the treatment of back pain.xi

What's more, the standardized, efficient system also meant better outcomes. In fact, data showed that Virginia Mason's spine clinic patients returned to work more quickly, missing two days on average compared with five elsewhere.xii

Northwestern Memorial Hospital

General Electric Co. (GE) chose Northwestern Memorial Hospital as one of the company's national COEs for total hip and knee replacement surgery. As part of this partnership, Northwestern Memorial Hospital offers bundled services for hip and knee replacement at fixed prices.

GE requested that Northwestern be transparent about costs in creating the bundled pricing, which is necessary to ensure that pricing is not only competitive, but also financially viable. Once GE selected Northwestern Memorial, the hospital project teams began working closely to implement the program in a highly collaborative process.

Northwestern Memorial Hospital has built in extra controls to ensure that before a patient makes travel plans, its physicians on both the surgical and pre-operative clearance sides have had a chance to fully review their records.xiii

Positioned for Success: COEs Strategize to Compete

Current market forces have created a perfect storm for the introduction of new services, which will work to ensure patient-centric care that focuses on better outcomes for every individual.  Innovative services, however, must never lose sight of the importance of first meeting patient needs and expectations, and then guiding employers and care providers to execute on their commitments to each and every person.  What is needed is a single intersection for the healthcare medical travel industry, parallel to the "matching" programs for other industries such as dating, leisure travel, and business networking to accomplish these goals:

  • Empower employers of all sizes with information and resources to pursue a medical travel program that generates the highest quality care at the greatest value.
  • Position hospitals and care providers to serve employers and their workforces
  • Offer Web and event platforms to connect the audiences

Gone are the days when a hospital's competitors were across town or in a neighboring community. Today, the marketplace has literally forced health systems to compare themselves to institutions in a five-state radius or on another coast. The need to travel is no longer a major concern for those seeking the best care at the best price.

As plan members take on a greater share of their own healthcare costs, they are beginning to distinguish between low prices and high quality.xiv At the same time, employers are playing a more aggressive role by contracting directly with healthcare providers and COEs in order to find the best value for their employees, and opting for bundled, fixed price procedures. This has created a new dynamic in the world of health benefits that plays out as a win-win for all stakeholders.

About the Author
Laura Carabello has been an entrepreneur and a strategy consultant in both domestic and international businesses related to healthcare and technology since 1985. She is the publisher/managing editor of Medical Travel Today, the authoritative, online business-to-business international newsletter of the medical tourism industry, as well as US Domestic Medical Travel, the newsletter dedicated to U.S. intra-state and inbound medical travel. In 2011, Carabello published Medical Travel Today: Opinions and Perspectives on an Industry in the Making.  


i Benefitfocus Solution; ACA Impacts A Transformation of the Benefits Landscape; Benefit Focus White Paper, 2014; http://cdns.benefitfocus.com/netstorage/corporatesite/production/static/media/Benefitfocus_ACA_Whitepaper.pdf; Accessed June 25, 2014.

ii American Hospital Association; Registration Requirements for Hospitals; http://www.aha.org/research/rc/stat-studies/REGISTRATION_FY_08.pdf; Accessed June 25, 2014.

iii American Hospital Association.

iv Featherly, Kevin; Paying Less for the Best; Delta Sky; pg. 81; February 2014.

v  Meier, Barry et al; Hospital Billing Varies Wildly, Government Data Shows; New York Times; May 8, 2013; http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?pagewanted=all&_r=0; accessed December 23, 2014.

vi Kirchen, Rich; Latest hospital pricing data show wide variance in costs of procedures; Business Journal; Aug. 21, 2014; http://www.bizjournals.com/milwaukee/news/2014/08/21/latest-hospital-pricing-data-show-wide-variance-in.html?page=all; accessed January 9, 2015.

vii Satin, David J. & Miles, Justin; Performance-Based Bundled Payments; Minnesota Medicine; October 2009; http://www.minnesotamedicine.com/Past-Issues/Past-Issues-2009/October-2009/Special-Report-Oct2009; accessed January 9, 2015.

viii Champion, Wes; How Bundled Pricing Just Might Save Healthcare From Itself; Healthcare Blog; Oct. 26, 2012; http://thehealthcareblog.com/blog/2012/10/26/how-bundled-payments-just-might-save-health-care-from-itself/; accessed January 9, 2015.

ix Champion, 2012.

x Levey, Noam N.; Unequal Treatment Where Employers Use Quality Control to Shape Healthcare; LA Times; Dec. 15, 2014; http://www.latimes.com/nation/healthcare/la-na-healthcare-employer-leadership-20141215-story.html#page=1; accessed January 9, 2015.

xi Levey, 2014.

xii Levey, 2014.

xiii Carabello, Laura; U.S. Domestic Medical Travel; to be published: Vol. 1, Issue 21; March 2014.

xiv Carabello, 2014.


To view the original article click here.

Highmark's Quality Blue Program Helps Hospitals Reduce Readmissions and Infections for Members

Hospital pay-for-value programs continue to reap health benefits for their members, according to Highmark Inc.'s 2014 Quality Blue program results.

After four years of tracking hospital readmissions, the Quality Blue program has helped to avert 2,900 readmissions, with a potential cost savings of $27.7 million. Following eight years of monitoring healthcare-associated infections, Quality Blue has helped to prevent 5,630 infections, with a potential cost savings in the range of $34.8 million to $109.4 million.

"We began our Quality Blue program in 2002 because we sincerely believed, amid some skepticism, that we could work with hospital partners to improve the quality of patient care while reducing the cost of care," said Paul Kaplan, M.D., senior vice president of provider integration and strategy for Highmark. "Our data for 2014 demonstrate that substantially improving care and safety translates not only to a better quality of life for patients but also to cost savings for all parties - our members, their employers, the hospitals and the insurer."

In 2014 alone, the hospital-insurer collaboration helped to avert 754 readmissions, with a potential cost savings of $7.2 million. In addition, 1,267 healthcare-associated infections were prevented, resulting in a potential cost savings of $5.7 million.

The following are highlights of the Quality Blue program's results as of December 31, 2014:


  • The rate of returns to the emergency room within 48 hours of discharge decreased by nearly seven percent.
  • From 2011 to 2014, 30-day readmission rates decreased by more than three percent.

Patient Care

  • Seven-day follow-up care after discharge for heart failure patients improved by 72 percent; for stroke patients, 17 percent.
  • For end-of-life care, hospitals following protocols improved by nearly 44 percent.
  • Elective labor inductions at less than 39 weeks gestation decreased by 37 percent. (Reducing early elective inductions can reduce harm to both mothers and babies.)
  • Compliance with sepsis protocols improved by 37 percent. (Early detection of sepsis and quick intervention can reduce patient deaths.)
  • Risk screening for pre-surgical anemia increased by 32 percent.


  • Catheter-associated urinary tract infections (CAUTI) declined by eight percent.
  • Clostridium difficile infections (CDI, or C. diff) decreased by 40 percent. (CDI can lead to colitis and severe diarrhea.)
  • Central line-associated blood stream infections (CLABSI) dropped by 31 percent.
  • Outpatient surgical site infections (SSI) decreased by 37 percent; inpatient SSI declined by more than four percent.

Highmark's 13-year-old Quality Blue hospital program has grown to include 102 hospitals.

About Highmark Inc.
Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.

For more information, contact:
Leilyn Perri
Highmark Health

To view the original release click here.

Losing Big in Vegas
While people come from all over the world to "win big" in Las Vegas, others come with a very different goal in mind.  

Dr. Tom, as his patients affectionately call him, was first drawn to bariatrics after discovering the incredible potential it had in significantly reducing the effects of diabetes or eliminating diabetes altogether. His journey was then fueled by the stories that came in day after day - obesity since childhood, failed diet after failed diet, severe knee pain and joint complications, depression, etc., etc. The thought of being able to put an end to people's suffering was irresistible.

Dr. Tom quickly recognized that it was compassion that ultimately set him apart as a bariatric surgeon, and he knew that his practice needed to reflect that fact - from the first interactions with a bariatric candidate to the comfort of the facility, from the quality of the surgery to the pricing.  

Compassion and Affordable Quality

But what would really compel someone to travel from across the United States to see Dr. Tom? Or from the Marshall Islands? Nigeria? New Zealand?!

Dr. Tom has more than 15 years of specialized experience in bariatric surgery. He's board-certified and a Fellow of both the American Society of Metabolic and Bariatric Surgery and the American College of Surgeons. In 2012, Newsweek named him one of the "Nation's Leading Bariatric Surgeons." But while his credentials speak authoritatively for his competence, and patient outcomes prove his superior quality, what about the cost?

Where the average weight loss surgery in the United States can run anywhere from $20,000 to $25,000, Dr. Tom's gastric sleeve and gastric bypass surgeries range from about $14,500 to $16,500 - and that covers more than the procedure alone. Included in the price are the most advanced anesthesia available, a psychological evaluation, the ERAS (Enhanced Recovery After Surgery) program, pre- and post-operative consultations, nutrition and fitness support, online support groups, body image counseling, post-op IV nutrition therapy, and the perioperative beverage that nourishes and hydrates before and after surgery eliminating the need to fast, Clearfast®.

At a fraction of the cost of average weight loss procedures, bariatric candidates can travel to Las Vegas and still save money.

Continually seeking to pass on savings to the customer is just another way Dr. Tom's compassion drives his practice.



NBA Announces Kaiser Permanente as First-Ever Healthcare Partner
Strategic collaboration to focus on community health and wellness initiatives

Kaiser Permanente and the National Basketball Association announced today a new multiyear strategic partnership that will focus on building healthier communities. The agreement also makes Kaiser Permanente the Official Healthcare Partner of the NBA, Women's National Basketball Association, NBA Development League and USA Basketball.

The collaboration - an extension of both organizations' shared commitment to improving the health and wellness of fans and the communities in which they live - marks the NBA's first-ever healthcare partner and Kaiser Permanente's first-ever national partnership with a professional sports league. As part of the relationship, Kaiser Permanente will serve as the healthcare expert and consultant for the NBA on health and wellness programming, and will play a critical role in the development of an annual NBA Health and Wellness Forum to address health issues affecting NBA fans and local communities. The forum will feature top leaders in the healthcare industry, as well as representatives from the NBA family.

The partnership aligns the NBA FIT campaign, which encourages fans to "Be Active, Eat Healthy, Play Together," with Kaiser Permanente's "Thrive" campaign, focused on empowering people to maximize their health in mind, body and spirit. The partnership will leverage the NBA's marquee events, community programming and fitness platforms, and Kaiser Permanente's leading medical and community health management expertise, to provide fans with greater access to health and wellness content and advice.

"Kaiser Permanente has a long history of investing in the health and well-being of our communities, and we fully recognize the importance of working with organizations such as the NBA to improve community health," said Kaiser Permanente chairman and CEO Bernard J. Tyson. "As a country, we need a more comprehensive approach to health, and this relationship with the NBA will be fully aligned with this approach by identifying opportunities where together we can have the greatest impact on advancing health where people live, work, learn and play."

"This groundbreaking partnership enhances the work we're doing in our communities through NBA FIT and NBA Cares," said NBA Commissioner Adam Silver. "We look forward to working with Kaiser Permanente to create new and custom activities and programs that impact the health and wellness of fans of all ages."

Kaiser Permanente will serve as the presenting partner of NBA FIT Live Healthy Week, which tips off today and runs through Jan. 29. Throughout the week, Kaiser Permanente and the NBA will mount a social media campaign to encourage fans to make a pledge toward healthier living. On Jan. 26, NBA FIT team member and Kaiser Permanente ambassador Stephen Curry will join the Golden State Warriors for a special partnership tip-off event and Get Fit Clinic at an elementary school in Oakland, California.

In addition to this groundbreaking program, Kaiser Permanente and the NBA will conduct 14 community health and wellness events annually across NBA, WNBA and NBA D-League markets. At NBA All-Star 2015, Kaiser Permanente will serve as a partner of the NBA All-Star FIT Celebration, a citywide event which brings fun, fitness and basketball-related programming to youth throughout New York City's five boroughs.

Kaiser Permanente will also become the presenting partner of the NBA Cares Community Assist Award, a season-long program that each month honors a different NBA player who reflects the league's passion for community service.

About the NBA
The NBA is a global sports and media business built around three professional sports leagues: the National Basketball Association, the Women's National Basketball Association, and the NBA Development League.  The league has established a major international presence with offices in 13 markets worldwide, games and programming in 215 countries and territories in 47 languages, and NBA merchandise for sale in more than 125,000 stores in 100 countries on six continents.  NBA rosters at the start of the 2014-15 season featured a record 101 international players from 37 countries and territories.  NBA Digital's assets include NBA TV, which is available in 60 million U.S. homes, and NBA.com, which recorded 26.9 billion page views during the 2013-14 season, with more than half of all visitors originating from outside of North America.  The NBA is the number one professional sports league on social media, with more than 750 million likes and followers globally across all league, team, and player platforms.  Through NBA Cares, the league and its teams and players have donated more than $242 million to charity, completed more than three million hours of hands-on community service, and created more than 915 places where kids and families can live, learn or play.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of healthcare. We are recognized as one of America's leading healthcare providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable healthcare services and to improve the health of our members and the communities we serve. We currently serve more than 9.5 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health, and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

To read the original release click here.

First Stop Health Telemedicine Service Offered on TriNet Marketplace
24/7/365 access to doctors offered to more than 240,000 employees of 9,000-plus companies

First Stop Health announced that its telehealth service is now available via the TriNet Marketplace. The Marketplace is a commerce hub exclusive to clients of TriNet, a national network of some 9,000 companies with more than 240,000 employees.

First Stop Health provides unlimited, 24/7/365 phone and online access to U.S.-based physicians - licensed in all 50 states and the District of Columbia - to employers and consumers. Patrick Spain, co-founder and CEO of First Stop Health, said that with rising healthcare deductibles and out-of-pocket expenses, telemedicine is a perfect match for employees selecting benefits on the TriNet Marketplace.

"We are pleased to offer employees of TriNet's clients a discounted price and a way to save hundreds, if not thousands, of dollars by calling our doctors when they - or any of their family members - have medical concerns," Spain said. "Ninety-three percent of calls to our doctors result in avoiding expensive trips to doctors, immediate care facilities or ERs, providing tremendous value to TriNet co-employees selecting plans on Marketplace."

Andrea Sy, TriNet Marketplace manager, said, "Offering First Stop Health on TriNet Marketplace helps us fulfill our mission of providing top quality services and unique offers to our clients. We're excited to help our customers learn about this affordable and convenient telehealth option that we make available to them at a special rate."

TriNet customers can find First Stop Health's offer by going to trinetmarketplace.com, logging in and selecting First Stop Health under "featured offers."

About First Stop Health
Chicago-based First Stop Health (www.fshealth.com) is a quick, convenient and affordable telehealth and advocacy service available to employers and consumers. It offers immediate, 24/7/365 phone and online access to U.S.-based physicians who provide members with advice, diagnosis and treatment, including - when necessary - prescriptions. First Stop Health has physicians licensed in all 50 states and the District of Columbia. In addition, First Stop Health helps employers manage and reduce major medical claims. Connect with First Stop Health on LinkedIn, Facebook and Twitter (@firststophealth).

Media Contact:
Jani Spede

Legislation Aims to Streamline Interstate Physician Licensing
by Emily Rappleye
Becker's Hospital Review is the original producer/publisher of the content.

Beckershospitalreview.com- Lawmakers in nine states have formally proposed legislation to accelerate the licensing process for physicians to practice in multiple states.

To read the original article click here.

Principal Solar to Build Largest Solar Project East of the Rockies
Project in Hope Mills, NC, will have capacity of 78.5 MW AC
Project scheduled to be operational by early 2016
Duke Energy to purchase power via a 15-year PPA
Total capital to be invested in the project will be $173 million

Principal Solar, Inc. (PSI; OTC Pink®: PSWW), a solar power company that is creating a utility-scale operation, announced today that it will build the largest solar facility east of the Rockies.

The project, located in Hope Mills, NC, with a capacity of 78.5 MW AC, will be the largest solar facility east of the Rockies. Total investment in the project is expected to be approximately $173 million. Duke Energy Progress, Inc. has signed a 15-year power purchase agreement (PPA) to buy energy from the project.

"This project launches Principal Solar as a leader in the solar utility sector, meeting the growing demand for zero-emission, cost efficient energy," said Michael Gorton, chairman and CEO of PSI.  "This high-quality project has a stable source of long-term revenue, and represents a major step forward for the U.S. solar industry. Principal Solar remains focused on rapid growth via the acquisition of shovel-ready solar projects, drawing on our industry expertise to be a long-term and repeat business partner for both solar project developers and traditional utilities."

The Principal Solar team has more than 200 years of cumulative energy experience with leading utilities such as TXU Energy. Chief Executive Michael Gorton has significant energy industry expertise, and has founded successful businesses in healthcare, IT and telecommunications.

The Company’s Board of Directors includes established energy and industry executives such as Brenda Jackson, former Chief Customer Officer of Oncor, and Garrett Boone, founder of the Container Store. The Company’s Board of Advisors includes Hunter L. Hunt, President and CEO of Hunt Consolidated Power, and Erle Nye, former CEO of TXU.

PSI acquired the right to develop the project from Innovative Solar Systems, LLC of Asheville, North Carolina. The acquisition of the project is expected to close no later than June 3, 2015, with construction to be completed in early 2016.

About Principal Solar
Principal Solar, Inc. (PSI; OTC Pink®: PSWW), is a publicly traded solar power company executing a unique roll-up strategy to create a distributed solar utility. PSI concentrates its resources on the acquisition, finance, development and management of solar power generating facilities. The Principal Solar Institute, an educational organization created by Principal Solar, Inc., is dedicated to spreading solar knowledge to the critical stakeholders in the ongoing energy debate. Visit www.PrincipalSolar.com.

Forward Looking Statements
Statements in this press release that are not historical facts may be deemed to be "forward-looking statements."  Actual and anticipated future results may vary materially due to a variety of risks and uncertainties, which are detailed in Company reports filed with the Securities and Exchange Commission. All information set forth in this press release is current as of the date of this release and Principal Solar Inc. undertakes no duty or obligation to update this information.

CPR for Principal Solar, Inc.
Alexis Lignos, 201-641-1911 x 52


Investor Relations
MBS Value Partners
Hugh Collins

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

Hal Denton, Senior Vice President of Sales/Technology, Abacus

I. Glenn Cohen, Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School

News in Review

Employer Direct Contracting: Game-Changing Medical Travel Trend

Highmark's Quality Blue Program Helps Hospitals Reduce Readmissions and Infections for Members

Losing Big in Vegas

NBA Announces Kaiser Permanente as First-Ever Healthcare Partner

First Stop Health Telemedicine Service Offered on TriNet Marketplace

Legislation Aims to Streamline Interstate Physician Licensing

Principal Solar to Build Largest Solar Project East of the Rockies

Help Save a Life and Support MatchingDonors