International Plan of Mystery:What Self-Insured Employers Need to Know About Global Health Care Programs

International Plan of Mystery:What Self-Insured Employers Need to Know About Global Health Care Programs

PRESENTED BY

Victor Lazzaro, Jr.Chief Executive Officer

BridgeHealth International, Inc.

Tom EmerickPresident, Emerick Consulting

Former VP Global BenefitsWal-Mart Stores, Inc.

David HomFormer VP Strategic Initiatives

Pitney Bowes

October 6, 2008

PresentationOverview

PresentationOverview

Medical Travel and BridgeHealth

Overview of Medical Travel

Who is BridgeHealth?

Destinations, Network, Procedures

Care Coordination

The Advantage to Employers

Examples

Myths and Realities

Experience as Mythical Patient

Popular Myths

Witnessed Realities

Conclusions

What Could It Have Done For Us?

US vs. “Peer” Countries

Decision Example: Hip

Sample Design & Savings

Discussion

Open Discussion

Medical Travel&

BridgeHealth

Medical Travel&

BridgeHealth

The Trusted Bridge to World-Class Healthcare™

Overview of Medical TravelOverview of

Medical TravelOne of the newest, most innovative options for U.S. employers, health plans, third party administrators, and other health benefits administrators.

Significant savings

Innovative health benefit design

Ensures high quality, cost effective medical care

Transparent costs

Complements consumer-driven programs

Overview of Medical TravelOverview of

Medical TravelA recent Deloitte study put the number of Americans traveling in 2007 at 750k, and a staggering 15M by 2016

Many players have entered the space on the B2C level, but few qualified on the B2B arena

Top criteria to consider:

• Flexible Benefit Design• Simplified Billing• Financial Stability• Deep Healthcare Experience• Solid Infrastructure

• Quality Care• Broad Network and Service Offering• Transparent, Cost-Effective Plans• Safety• Premium Experience

Who is BridgeHealth?Who is BridgeHealth?

BridgeHealth International, Inc.

(BridgeHealth) …is the premier

service provider in the burgeoning

medical travel industry—a real

company with infrastructure,

expertise, growth capital and

industry-specific experience.

…maintains an international

network of physicians and

accredited hospitals and clinics

…offers significant savings

…provides a turnkey solution

…has sent many Americans

abroad for medical travel

BridgeHealth…BridgeHealth…

DestinationsDestinationsBridgeHealth International has selected centers of excellence in the following countries: Brazil, China, Costa Rica, Hong Kong, India, Mexico, Panama, Singapore, South Korea, Taiwan, Thailand, and Turkey.

Additional locations in Europe and elsewhere are under evaluation.

NetworkNetworkJust two examples of the high quality network are:• Wockhardt Hospital in Bangalore, India –

affiliated with Harvard• Punta Pacifica Hospital in Panama – affiliated

with Johns Hopkins

Aftercare Network• Our Travel Care Coordinators work individually

as needed plus:• Over 160 locations in the U.S. for any follow up

that their usual physicians might not take.

Pre Travel care and consultation

The same network is available for discussion and medical review as needed prior to travel

Suite of ProceduresSuite of ProceduresBridgeHealth provides prospective patients an all-inclusive, transparent pricing plan which includes: surgery/procedure costs, airfare, lodging, transfers and a 24/7 concierge service.

A suite of medical and dental procedures are available, including:• Gastroenterology• General Surgery• Gynecology• Internal Medicine• Neurosurgery• Oncology (selective)• Ophthalmology• Orthopedics

• Cardiology• Cardiothoracic• Chemical Dependency• CyberKnife® (cancer)• Dental• Detox/Rehab• ENT• Executive Health

Physicals

• Pain Management• Pediatrics• Plastic and

Reconstructive Surgery• Urology Male/Female• Vascular• Weight Loss/Obesity Surgery

Care CoordinationCare CoordinationTravel Care Coordinators work with client and their needs

All U.S. information is treated in HIPAA compliant manner

Coordination of Pre travel medical records are made for client to host country hospital and physician

Pre travel telephone and/or email consultation with client and their host country physician can be arranged

Full outcomes data prior to travel is available to client

Care CoordinationCare Coordination

Post procedure medical records are translated as needed and coordination arranged for the client for their medical records to get to their U.S. physicians

Any after care needs can be coordinated

Client satisfaction surveys are done

Client outcomes are tracked and monitored

What Could It Have Done

For Us?

What Could It Have Done

For Us?

The Trusted Bridge to World-Class Healthcare™

Health Care Per Capita Spending (2003)

GDP %

U.S. $5,711 15.2

Switzerland $3,847 11.5

Canada $2,998 9.9

U.K. $2,317 7.8

Japan $2,249 8

Source: OECD Health Data 2006

US Healthcare Spending vs. “Peer” Countries

US Healthcare Spending vs. “Peer” Countries

“One fifth of all countries exceed U.S. in life expectancy.”

“Americans are living longer, but not as long as people in

41 other countries.”

“The U.S. health care system ranks last compared with five other nations on measures of quality, access, efficiency, equity, and Outcomes.”

Example: Decision for Hip ReplacementExample: Decision for Hip Replacement

Hospital A Hospital B Hospital C Local US Hospital

Underlying Cost of Procedure, including Airfare and Hotel

$15,000 $12,000 $9,000 $50,000

Complication Rate for Procedure 0.5% 1.8% 1.1% 1.2%

Travel time from home (showing flight transfers required.)

4 hrs (0) 22 hrs (2) 30 hrs (1) 0.5 hrs (0)

Patient Satisfaction Score (5 point scale)

4.5 4.1 4.9 4.7

Impact to Employee*

Patient co-payment and

deductible

$500 Waived Waived $5000

Incentive paid by ER by EE $0 $1500 $3000 $0

Net benefit to employee with variable incentive

$4500 $6500 $8000 -$5000

Assumes a $5000 copay/coinsurance at a US hospital and a variable incentive paid by employer (ER) to employee (EE) based on provider selected.

Sample Benefit Design & SavingsSample Benefit

Design & SavingsHypothetical Company Example:

Current Insurance

International Insurance

Benefit

Savings to Employer* $0 $41,000

Deductible $1,000 waived

Coinsurance 80/20 waived

Max. out of pocket $5,000 waived

Additional Benefits:

Travel Incentive n/a $3,000

Travel costs, air & hotel n/a $4,000

Partner air n/a $2,000* Hip replacement done in Asia: U.S. cost ~ $50k, Int’l cost ~$9,000

Cost to the Employer: $14,000 ($5k OOP, + $9k incentives & costs)

Net Savings to Employer: $27,000.

Pro’s

Employees requesting it

Lower cost

Good quality

Con’s

Due diligence required

Controls important

Pros & ConsPros & Cons

Myths & RealitiesMyths & Realities

The Trusted Bridge to World-Class Healthcare™

• Spent 2 days in Mexico to “feel” the experienceas a patient

• Gained deep understanding of the process• Visited several hospitals as a patient• Visited a cosmetic surgical center• Saw it firsthand and had “bias” pre-visit

My Experience as aMythical Patient

My Experience as aMythical Patient

• Hospitals are state-of-the-art facilities– Many are newly built with an understanding of patient flow for expedited

care• Similar principles to just in time production

– Visually attractive– High touch service for patients

• English speaking coordinators and forms are in English

• Physicians are often US or western trained– Updated on newest procedures and technologies– Typically are English speaking

• Nursing Staff are trained to handle US patients– Recent graduates with up to date training– English speaking

Myth 1: Medical Care isNot Quality Focused

Myth 1: Medical Care isNot Quality Focused

Myth 2: Only Cosmetic or Excluded Benefits

Myth 2: Only Cosmetic or Excluded Benefits

• This is shifting to mainstream care for other conditions such as– Cardiovascular – Pain– Hips and Knees– Optical surgeries

• Cosmetic surgeries will continue to grow due to the aging of the US population

• Dental care will expand

Myth 3: Patients Won’t Go Outside the US for Care

Myth 3: Patients Won’t Go Outside the US for Care• Access to additional services will continue to be

important • Options or choices will remain important to patients• Individual insurance premiums will continue to

increase at high levels• Growth of high deductible plans will continue to grow• Growth of ethnic populations will continue and

willingness to go their home country for care will continue

Myth 4: Medical Travel Won’t Be SustainableMyth 4: Medical Travel Won’t Be Sustainable

• Supply side growth will continue– Hospital beds designated to medical travel will continue to grow – Physician availability for multiple specialties will grow

• Demand side will grow significantly– Patient volume will grow

• Under or Un Insured• Ethnic Population growth in the US

– Employers will begin to adopt these programs as an additional choice for employees

– Health plans will need to get active as this will serve as a growth engine for members

Myth 5: Malpractice and Liability Barriers PersistMyth 5: Malpractice and Liability Barriers Persist• Demand side of health care will force innovative

financing of health care malpractice for returning patients in the US

• Liability coverage will likely move to shared captives by hospitals and other systems or companies

• Intake processes to manage patients will need to be automated and to improve to manage expectations

ConclusionsConclusions

• Growth industry• Venture capital is now entering this market to drive

adoption and sustainability• Health plans will see the need to invest• Employers who have specific needs will use these

services • Employees will demand services over time

DiscussionDiscussion

The Trusted Bridge to World-Class Healthcare™

Contact InformationContact Informationwww.BridgeHealthInternational.comThe Trusted Bridge to World-Class Healthcare™

Victor Lazzaro, Jr.Chief Executive Officer

BridgeHealth International, Inc.VLazzaro@BridgeHealthInternational.com

O: 303.457.5725C: 303.358.0300

Tom EmerickPresident, Emerick Consulting

Former VP Global Benefits, Wal-Mart Stores, Inc.Tom.Emerick@emerickconsulting.com

O: (479) 957-4902

David HomFormer VP Strategic Initiatives, Pitney Bowes

davehom@optonline.netO: (203) 685-6790