Volume 2, Issue 20

Dear Colleagues,

With the growing pressures on U.S. employers to get better value for their healthcare spend, the Health Transformation Alliance was formed to create a better way of delivering healthcare benefits to workers, and focusing on reducing the redundancies and waste in the supply chain that drive up the cost of health care coverage. Collectively, the 20 companies are responsible for healthcare benefits for four million people and spend more than $14 billion annually on healthcare for employees, their dependents and retirees.

Our spotlight interview features Robert Andrews, CEO of the Health Transformation Alliance who discusses the importance of "Triple Aim" - improved patient experience, lower cost, and improved population health through continuous process improvement.

This month, we also bring you research that may prove that the U.S. falls short of expectations that it is a "healthcare mecca," although millions of people travel to the U.S. for care. We also look at postponement of CMS expansion as well as reports on a deadly fungal infection that doctors have been fearing.

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.

"Rising health insurance premiums, lack of transparency and increased awareness of how varied medical costs and quality vary dramatically between hospitals and across regions, have pushed consumers right into the arms of international and domestic medical travel. The growing industry provides the perfect solution for patients to receive the high-quality, cost-effective care that they need AND rightfully deserve!"
- Laura Carabello, Executive Editor and Publisher, Medical Travel Today and U.S. Domestic Medical Travel.

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

Laura Carabello
Executive Editor and Publisher


SPOTLIGHT: Robert Andrews, Health Transformation Alliance

Robert Andrews


About Robert Andrews
Robert E. Andrews currently serves as the CEO of the Health Transformation Alliance. Rob led the Government Affairs practice at Dilworth Paxson law firm for two years before joining the HTA.

Rob served as a Member of the United States House of Representatives for nearly 24 years. Upon his departure from the House, President Barack Obama praised Rob's service as "an original author of the Affordable Care Act...and a vital partner in its passage and implementation," and cited his "tenacity and skill" in representing the people of New Jersey.

Rob is married to Camille Spinello Andrews, an Associate Dean at Rutgers Law School and former Dilworth partner, and they have two daughters, Jacquelyn and Josie.

Mr. Andrews' representative experience includes: Member of the House of Democratic Leadership as Co-Chairman of the Steering Policy Committee; Senior Democratic Member and former Chairman of the Health, Employment, Labor and Pensions (HELP) Subcommittee of the House Committee on Education and the Workforce (The HELP subcommittee has jurisdiction over the ERISA law, dealing with all employee benefits, the National Labor Relations Act, Title VII of the Civil Rights Act, dealing with employment, as well as all other labor and employment laws); Senior member of the House Armed Services Committee, with responsibility for all military defense matters; Senior Democratic member and the former Chairman of the Defense Committee Panel on Defense Procurement Reform; Senior Democratic member and former Chairman of the Defense Committee Panel on Audit of the Pentagon; Participant, White House Summit on Health Care Reforms (2009 and 2010); One of the Original Authors of the Affordable Care Act; One of the original authors of the Defense Procurement Reform Law (2009); and he holds record for the highest number of votes ever received by a U.S. House candidate in the history of the state of New Jersey.

Mr. Andrews' professional and community activities include his time as former Director of Camden County Board of Chosen Freeholders.

Mr. Andrews has been a keynote speaker at charitable, educational and governmental events for 30 years, including: Bucknell University commencement; Rutgers Law School commencement; and Rutgers Camden commencement. He is a frequent guest on CNN, Fox News, MSNBC, and CNBC.

J.D., magna cum laude, Cornell Law School, 1982 • Cornell Law Review • Order of the Coif
B.A., summa cum laude with honors, Bucknell University, 1979 • Phi Beta Kappa


US Domestic Medical Travel (USDMT): Could you provide our readers with some background information about your company and how you got involved with HTA?

Robert Andrews (RA): The quest for an improved employer-sponsored health system has been in the works for years, and large employers have long been in the vanguard of making cutting-edge and innovative changes to the employer-sponsored insurance (ESI) system. In the 2000s, employer efforts in wellness plans and Consumer Directed Health Plans contributed to the recent stabilization of health care inflation. And in the spring of 2014, the American Health Policy Institute was formed to help employers think of solutions to the challenges facing employer-sponsored health care. In May of 2015, AHPI issued its Call to Action, signaling that employers were ready to try a new approach to securing better health coverage for employees and dependents. The HTA grew out of that Call to Action, and was formed one year ago, in February of 2016.

I was retained in 2015 to provide counsel to the HTA, and because of the incredible commitment and leadership of our Member/Owners was drawn to this mission. I was honored to assume the position of CEO in December of 2015.

USDMT: What do you see as the biggest obstacle to our current health care system and how does HTA aim to improve this?

RA: The health care status quo cannot be maintained. We want to deliver better health care outcomes for our employees and to do something about rising prices. Costs, especially premiums, deductibles, and copayments for employees, are rising faster than can be afforded. We believe that by joining together, we can fix what's broken and help transform the healthcare marketplace to help our employees, retirees, and their dependents.

USDMT: What are your main areas of focus?

RA: The HTA is currently focused on three primary solutions:

  • Data and Analytics: The HTA is collaborating with IBM Watson Health to build a Data and Analytics Platform, which will pool de-identified data and leverage cognitive analytics capabilities to generate actionable insights that support transformational solutions aimed at improving health outcomes.
  • Prescription Drugs: The HTA launched new partnerships with CVS Health and OptumRx to change how companies provide prescription drug benefits. This new approach focuses on partnership and transparency, resulting in lower prices for the same medicines, and allowing HTA members to achieve considerable savings.
  • Medical Solutions: HTA is working in partnership with United Healthcare and Cigna to build solutions that provide top quality care, focused on enhanced provider and physician care management and engagement for employees, retirees, and their family members. Better health outcomes will reduce costs for families as well as employers.

We are focused on connecting cost and quality improvement powered by data and working with physicians and hospitals to collaborate and improve quality and efficiency. Focused on the Triple Aim - improved patient experience, lower cost, improvement in population health through continuous process improvement.

USDMT: What companies are you working with? Do you expect to work with any others?

RA: We are currently 38 strong and growing. We expect others will join. These companies represent a mix of industries and regions across the country. We started with companies that are members of the HR Policy Association and that's why these are the first to join.

USDMT: Is your focus direct to consumers or business-to-business? How are you operating?

RA: Our membership is business to business, but our solutions are all focused with the end consumer in mind. This is about helping companies take better care of the people who take care of them. Employees are the engine of our businesses, our face to customers, and our most valuable assets. They're the reason we succeed or fail-and they deserve better. So you could say we are business to everyone.

USDMT: What size employers are you working with?

RA: We are working with large employers who employ at least 1500 persons and have annual revenues in excess of $3 Billion.

USDMT: Who is impacted most by your platform and why?

RA: Initially our member companies will benefit from the savings. In the end this is about helping companies take care of the people who take care of them, that means better healthcare value - lower costs and healthier outcomes.

USDMT: What tools do you offer to educate employees about their health care choices?

RA: We created a set of standards and guidelines which are and will continue to be embedded into the HTA's core service provider contracts and serve as the foundation for the HTA consumer engagement strategy. The HTA standards and guidelines are built upon a number of objectives which guide consumer engagement for all HTA solutions and solutions:

  • Motivate our members to take positive actions to achieve greater levels of well-being and health through prevention, mindfulness, and appropriate health care utilization
  • Help employers create engaged consumers through a suite of edited and validated consumer solutions
  • Bring cost and quality transparency to the health care consumer
  • Educate and empower members to lead their own health journey by accessing high quality/value health care

USDMT: What sets you apart from your competitors?

RA: We don't really have any competitors. As our name implies, this is about transforming how health care benefits are provided to our employees so they become more affordable and are focused on quality outcomes for our employees and for member companies. And it's about changing existing practices in the supply chain so health care costs don't spiral even more out of control. We are committed to the proposition that better health outcomes improve people's lives and make health care more affordable on a sustainable basis.

USDMT: Why do you think HTA will be so successful?

RA: The private sector has a good record in taking on big challenges like this. By working together, instead of company by company, we believe we can make transformational changes in the way health care benefits are provided and that those changes can make health care more affordable. Because of the consolidation of the supply chain during the past four years, we know that Heads of Human Resources and other corporate leaders have a strong desire for the services we will provide and develop together, and that gives us confidence we will be successful.

USDMT: What pilot projects do you have planned for the rest of 2017? /What does your timeline look like?

RA: We currently do not have any pilots anticipated for 2017. Our solutions will be available as follows:

  • The first phase of the HTA Data and Analytics platform will be available in June of 2017.
  • The prescription drug plan as well as medical solutions in select service areas are expected to be in place on January 1, 2018.

USDMT: Tell me more about the data you have found or seek to collect.

RA: Through our partnership with IBM Watson Health, the HTA will leverage data from all member companies along with analytics, and cognitive insights to support our transformational solutions. Better understanding data, trends, and results, we believe, has the potential to predict and prevent disease, improve outcomes, and enable the integration and collaboration of all stakeholders in the health care ecosystem. This will increase the value of health care for our members, their employees, retirees, and families.

USDMT: What impact has the ACA had on your mission?

RA: The goal of the ACA was to make health care more affordable, and we share that goal. The HTA, however, is a private sector response to what's happening in the marketplace, and we are not seeking any assistance from Washington. The HTA is designed to work on its own, regardless of the twists and turns that take place in government health policy.

No matter what the government does, we in the private sector must move ahead to improve and fix what we can in the healthcare system. We can't wait. We're moving ahead.

USDMT: What changes do you expect to see in the future of the medical tourism industry- both nationally and internationally?

RA: I expect more health care providers to provide more and better options around the country and around the world. We aspire to offer solutions to the employees, retirees and families of our Member/Owners as part of that movement.

USDMT: At this point, is there anything else that you want to share with the readers?

RA: At the HTA, we are honored to be part of a mission that is fixing a broken health care system. We are inspired by our commitment to take better care of the people who take care of our Member/Owners: their employees and retirees, and their families.


Global Medical Tourism Market By Treatment Type and by Region - Industry Analysis, Size, Share, Growth Trends and Forecasts (2016 - 2021)

The global medical tourism market has been estimated to be valued at USD 14,278 million, and it is anticipated to reach a market value of USD 21,380 million by the end of 2021 at a projected CAGR of 8.41% during the forecast period, 2016 to 2021.

Medical tourism involves travelling to another country for obtaining medical treatment. It is a high-growth industry driven by globalization and rising healthcare costs in the developed countries. A study shows that in United States, about 750,000 residents travel abroad for healthcare each year. A range of governments across the globe has taken up various initiatives to stimulate and improve the medical tourism in the respective countries in order to improve patient care and help expand the market. Many countries could see potential for significant economic development in the emergent field of medical tourism. Cosmetic surgery, dental care, elective surgery, fertility treatments, cardiovascular surgery and genetic disorder treatments are the most preferred healthcare treatments in this sector.

High cost of medical treatment in the developed countries and availability of those treatments at a lower cost in other countries have fueled the development of medical tourism. In addition, the availability of latest medical technologies and a growing compliance on international quality standards drive this market. The use of English as the main working language solves the problem of communication and patient satisfaction, adding to the growth of this market. Enhanced patient care, health insurance portability, advertising and marketing help the medical tourism industry to grow at a fast rate. On the other hand, infection outbreaks during or after travel, issues in following up with the patients before returning to their own country, and medical record transfer issues are the factors restraining the growth of the tourism industry. However, the unavailability of certain treatments at a lower cost hampers this market more than any other factors.

The global market for the medical tourism industry is segmented based on treatment type (cosmetic treatment, dental treatment, cardiovascular treatment, orthopedics treatment, bariatric surgery, fertility treatment, eye surgery and general treatment) and geographical regions. Cosmetic treatments hold the largest market share, as cosmetic surgeries are not covered by insurance.

Based on geography, the market is segmented into North America, Europe and Asia-Pacific. APAC holds the largest market share, followed by Europe. Thailand and Malaysia are strong markets with prospect for significant growth, followed by Korea.

The key players in the global medical tourism market are Bangkok Hospital Medical Center, Asian Heart Institute, Apollo Hospitals Enterprise Ltd., Bumrungrad International Hospital, Fortis Healthcare Ltd., Min-Sheng General Hospital, Raffles Medical Group, Prince Court Medical Center, KPJ Healthcare Berhad, and Samitivej Sukhumvit.

For more information please click on:

Is U.S. Preeminence in High-Tech Medicine a Myth? The Case of Cystic Fibrosis
by David Squires and David Blumenthal, M.D.

commonwealthfund.org- U.S. health care has many well-documented shortcomings. However, it is often assumed that, because we invest so heavily in technology and specialists, our health care system performs well for patients who have rare or complex diseases.

New research shows that we should be skeptical of that assumption. A recent study in the Annals of Internal Medicine compares the health outcomes of U.S. and Canadian patients with cystic fibrosis, an incurable, genetic disease that affects about one in 10,000 people in both countries. The results are disturbing: on average, Canadian patients live 10 years longer than American patients. And the gap has been widening for the past two decades (see exhibit).

Median Age of Survival for Patients with Cystic Fibrosis over Time
Median age of survival (years)

Note: Median survival age obtained by using a five-year rolling window, Canada versus the United States, 1990-2013. 

Data: A. L. Stephenson, J. Sykes, S. Stanojevic et al., "Survival Comparison of Patients with Cystic Fibrosis in Canada and the United States: A Population-Based Cohort Study," Annals of Internal Medicine, published online March 14, 2017. Used with permission.

The researchers suggest the likely culprit is the significant gaps in health insurance coverage among U.S. children and adults under age 65. Uninsured patients with cystic fibrosis, they find, face a much greater risk of early death than their insured peers. Of particular note, given recent events in Washington, D.C., Medicaid patients have significantly better health outcomes than those without insurance, despite the fact that they tend to be poorer and more socially vulnerable.

In Canada, of course, there are no uninsured: the government provides universal health coverage for all residents, without copayments for physician visits or hospital stays. (The study also finds that Canadian patients are much more likely to receive a lung transplant than U.S. patients-shattering another common assumption about the U.S. health system's technological superiority.)

When one considers the medical needs of people with cystic fibrosis, it is obvious why lacking health insurance could lead to an early death. The disease causes abnormal secretions to impair functioning of the lungs, pancreas, and other organs, which in turn leads to infections and lung damage, and prevents the body from properly digesting food. Inhibiting the build-up of these secretions and ensuring proper nutrition and wellness are crucial to preventing the rapid progression of the disease. In this context, staying well requires constant self-management and frequent contact with the health care system-which comes at a cost. Coverage gaps and financial barriers to care are incredibly dangerous for these patients and can quickly undermine their health.

And while several promising pharmaceuticals that treat cystic fibrosis have hit the market in recent years, these are priced at a quarter of a million dollars... per year. High-quality care is simply out-of-reach for patients without insurance.

In medical terms, we might call uninsurance a "comorbidity"-one unique to the United States among all industrialized nations, and just as deadly as pneumonia or diabetes.

The study is a reminder, if one was needed, of the fundamental problem with the U.S. health insurance system: not everyone is covered. The focus of would-be health reformers should be-not solely on whether the 20+ million Americans who gained coverage under the ACA should be allowed to keep it-but rather how to extend those gains to the 28 million remaining uninsured. For some, their lives will depend on it.

To view the original article, click here.

WalletHub: The top states for physician pay
by Paige Minemyer

Fiercehealthcare.com- Doctors practicing in Indiana have the highest annual wage, according to a new report, while those working in the District of Columbia make the least.

WalletHub, a financial planning site, ranked Iowa as the best state for doctors in this year's list. The state ranked highly for annual physician wage (4th) and was also noted for its fairly inexpensive malpractice insurance (only Wisconsin, Minnesota, Kansas and Indiana were less expensive), according to the report.

To view the original article in its entirety, click here.

WHO puts medication-related errors on global hit list
by Ilene MacDonald

Fiercehealthcare.com- Medication errors cause at least one death every day and injure roughly 1.3 million people each year in the United States alone. But it's not only a national problem, and the World Health Organization is taking action to reduce these preventable adverse events worldwide.

The WHO aims to reduce severe, avoidable medication-associated harm in all countries by 50% over the next five years.

To view the original article in its entirety, click here.

CMS postpones expansion, implementation of bundled payment programs
By Emily Mongan

mcknights.com- The Centers for Medicare & Medicaid Services is pushing back the implementation date for its recent rule creating a bundled payment program for cardiac care, as well as changes to the Comprehensive Care for Joint Replacement program. Further delays also are being considered.

The cardiac care models, announced late last year, would create bundles for patients who receive cardiac rehabilitation, suffer heart attacks or undergo heart surgery. The models were slated to begin demonstrations on July 1, 2017, and run through 2021. A fourth bundle was also finalized, focusing on patients who undergo non-replacement surgery following a hip fracture.

To view the original article in its entirety, click here.

Depression is the No. 1 cause of illness and disability worldwide: WHO report
by Meera Jagannathan

nydailynews.com- The World Health Organization has two words for anyone who's "Sad!": "Let's talk."

Depression is the no. 1 cause of illness and disability worldwide, the UN's public health arm said Thursday. An 18% spike from 2005 to 2015 puts the most recent estimate at more than 300 million people.

To view the original article in its entirety, click here.

5 thoughts on why value based care will survive partisanship over healthcare
by Laura Dyrda

beckersspine.com- While the ACA encouraged the transition toward value-based care, the value movement in healthcare is non-partisan, according to a URAC blog report.

To view the original article in its entirety, click here.

More re-enrolled for ACA health plans for 2017, though total sign-ups fell
by Amy Goldstein

washingtonpost.com- More than 12 million Americans chose health plans for this year through the Affordable Care Act's insurance marketplaces, according to new federal data that show an increase in the number of returning customers and a significant drop in new participants.

To view the original article in its entirety, click here.

Care Coordination in U.S. Lags Other Developed Nations
By Lisa Rapaport

medscape.com- U.S. patients are more likely to experience gaps in coordination among healthcare providers than their counterparts in other high-income nations, a new study suggests.

To view the original article in its entirety, click here.

Deadly fungal infection that doctors have been fearing now reported in U.S.
By Lena H. Sun

washingtonpost.com- Nearly three dozen people in the United States have been diagnosed with a deadly and highly drug-resistant fungal infection since federal health officials first warned U.S. clinicians last June to be on the lookout for the emerging pathogen that has been spreading around the world.

To view the original article in its entirety, click here.


American-made biosimilars a differentiator in US market, Coherus
By Dan Stanton

in-pharmatechnologist.com- US patients and physicians favour domestically-made biosimilars according to Coherus Biosciences. But if quality is assured should the manufacturing location matter?

To view the original article in its entirety, click here.

US infant mortality rates down 15%
By Robert Jimison

CNN.com- Infant mortality rates have reached new lows, according to a report released by the US Centers for Disease Control and Prevention on Tuesday.

To view the original article in its entirety, 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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Copyright © 2016
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.

For advertising inquiries, please email us at editor@USDomesticMedicalTravel.com

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Spotlight Interview

SPOTLIGHT: Robert Andrews, HTA Health

News in Review

Global Medical Tourism Market By Treatment Type and by Region - Industry Analysis, Size, Share, Growth Trends and Forecasts (2016 - 2021)

Is U.S. Preeminence in High-Tech Medicine a Myth? The Case of Cystic Fibrosis

WalletHub: The top states for physician pay

WHO puts medication-related errors on global hit list

CMS postpones expansion, implementation of bundled payment programs

Depression is the No. 1 cause of illness and disability worldwide: WHO report

5 thoughts on why value based care will survive partisanship over healthcare

More re-enrolled for ACA health plans for 2017, though total sign-ups fell

Care Coordination in U.S. Lags Other Developed Nations

Deadly fungal infection that doctors have been fearing now reported in U.S.

American-made biosimilars a differentiator in US market, Coherus

US infant mortality rates down 15%