How will medical tourism insert itself into the mainstream of U.S. healthcare reform?
Under healthcare reform, employers are beginning to express interest in concepts and reform measures which have variously been labeled ―value-based, ―results-based, ―performance-based, or ―outcomes-based purchasing and bundled reimbursement for an episode of care. The bundled payment methodology that works well in medical tourism is challenging for most U.S. healthcare providers because legacy systems support and maintain “-silo-based”, and “-impression-based purchasing” and limited reporting capabilities, when you get right down to the core requirements for actionable insight.
While employers have access to new and innovative tools to pair sophisticated data integration technology from products such as Johns Hopkins Adjusted Clinical Groups® (ACG®) System with customized preventative care and employee wellness programs and convenient mHealth and easy-to-use applications such as the Lifestyle Risk Calculator® integrates evidence-based, health care delivery and cost avoidance by capturing all clinical transactions (including biometric monitoring of vitals for each employee and dependent). At MHI Benefits Group, we sell that capability to employers for as little as 5 cents per employee, per day.
The Johns Hopkins Adjusted Clinical Groups® (ACG®) System, and its competitors in the space, offer a unique approach to measuring morbidity that improves accuracy and fairness in evaluating local and regional provider performance, identifying plan particpants at high risk, forecasting healthcare utilization and setting more defensible payment rates. These are an integral part of value-based purchasing, because value-based purchasing initiatives aim to improve quality of care while avoiding unnecessary healthcare delivery and their associated risks and costs. While I can appreciate their “aim”, I am not so sure they hit many bullseyes.
One major concern in healthcare reform, not just in the USA, but all over the world, involves the significant variation in practice patterns observed both across and within regions, which prominent research has argued does not improve quality of care even though these patterns entail large differences in resource utilization.
Therefore, as I see it, the most difficult challenge for medical tourism to overcome, is to insert itself into the mainstream of health delivery reform choices. The choices will initially be made by super consumers (employers and insurers and other group health purchasers) and individual consumers (plan participants). But who will they choose? What and how will they measure and make comparisons? Where will the data come from and how will it be measured? How will the value be portrayed and presented? What will bring this choice to front-of-mind? As the CEO of the largest medical tourism network for group health, together with our authorized brokers and agents, we struggle with these answers for clients on these questions every day.
The power to change healthcare comes not from doctors or health plans. It comes from primary, reliable data that is informative and actionable. When the data is useful and credible, plan administrators, physicians and patients will all be enabled to make better treatment and lifestyle decisions. I invite you to share some solutions you may have identified along the way.