Combining Traditional PPO Savings with Medical Tourism for Even Deeper Discounts
Mercury Healthcare International offers a refreshingly innovative option to the group health, wellness and health travel benefit redesign arena. The firm launched a unique program for 2012 coupled with access to the largest independent national PPO giants, MultiPlan and PHCS. In this tripartite combination, employers enjoy effective inpatient discounts of around 28% (10-60%) on routine and emergency care, and an average effective professional discount of about 40% nationwide. Plan participants experience minimal, if any, preferred provider network disruption. With MHI, they have access to over 4300 acute care hospitals, research institutes and name-brand centers of excellence, as well as over 9000 ambulatory surgery centers, just in the USA.
With all the provider pricing in a single database, MHI steers plan participants to employer selected providers with the highest network discounts or best outcomes for any surgical or diagnostic case. MHI manages the travel worldwide, according to medically appropriate guidelines. A similar deal was recently announced by PepsiCo, but employees can only elect to go to Johns Hopkins (Baltimore) for certain high-cost cases. According to its website, John's Hopkins has only 22 operating theaters. This could lead to backlogs if cases from PepsiCo's 225,000 employees "choke" the Johns Hopkins' schedules. MHI's health travel network options include centers of excellence in all 50 states and others in 92 other countries to avoid that potential case backlog and reduce travel times and potential complications associated with blood clots caused by sitting in airplanes for more than two hours.
Employers seem reluctant to "send" employees abroad for sensational savings but many are eager to explore all potential savings on joint replacements, cardiac and spine cases, without having to travel across U.S. borders to third-world countries. MHI manages and administers all health travel logistics coordination, TPA services and clinical and plan participant satisfaction outcomes measurement. While PHCS and MultiPlan are direct access networks, MHI network cases are pre-arranged across the care continuum and coordinated by trained Care Navigators and registered nurses.
Global employers such as PepsiCo with active and retiree expatriates and global nomad workers can wrap non-statutory foreign health benefits management, emergency assistance and medical evacuation under the control of their self-funded SPD and reinsurance covers as well. They can choose inspected network providers in 92 countries to access medically necessary care, and reduce their need for expensive IPMI supplements and coverage. Employers can keep healthcare costs well under the threshold limits for excise tax penalties under PPACA using MHI network services. So far, 19 USA insurers and 3 employers permit subscribers to use MHI's network to save money. Others are in process. Employes can add MHI's products at any time in the year.
How it Works
Under one combined managed care service agreement, health plan sponsors enjoy the convenience of network access to national PHCS and/or MultiPlan network access plus MHI's proprietary global and domestic case rates. Lower monthly network access fees and other administrative fees associated with employee benefits and claims management are also possible. MHI's benefit experts help develop and manage special purpose HRA plans and prepare model plan documents for the programs.
According to Maria Todd, MHA PhD, MHI's founder and CEO "We chose to work exclusively with MultiPlan and PHCS for several reasons, but mainly because MPI's credentialing criteria mirrors Mercury's and because their broad national coverage means less preferred provider disruption and higher effective discount rates nationwide. MultiPlan's sales and support team members have been exemplary to work with in helping us bring this product to market."
Todd, with an established reputation as a healthcare provider advocate and the author of The Managed Care Contracting Handbook, was adamant that the partner PPO selected had to be the right fit to avoid compromising her reputation in the industry. "Now that I know more about the internal workings, policies and operations at MPI and PHCS, I have a greater respect for MultiPlan and PHCS than ever before."
Transparency and Accountability
"We chose to avoid other PPO choices for many reasons, says Todd. With MultiPlan and PHCS we avoid the effects of small network volatility and networks stitched together that aim to compete with MPI/PHCS in scale. We also avoid the PPOs that charge employers and TPAs access fees to access discounts, but then take back 4% or more from the providers as a rebate for steerage. Those double dipping fees come from what would have otherwise been discounts to the employers and plan participants. We don't engage in or approve of those practices and neither does MultiPlan.
Healthcare Silo Busting
Understanding managed care and cost containment as Todd does, MHI's network design is unlike any medical tourism competitor's. It weaves together extras such as prescription discounts that stack on top of PBM arrangements at 54,000 pharmacies, other lab testing, and high-cost radiology imaging services used for high-cost cancer, joint replacement and cardiac diagnoses, and every accredited ground and air ambulance, worldwide. They also included medical case management, quality and safety site inspections, and all TPA and repricing services. Nurse case managers and specially trained travel coordinators manage the complex logistics of elective health travel, according to network standards adapted from the Veteran's Administration, NCQA, Joint Commission, Joint Commission International, Leapfrog, Bridges to Excellence, PROMETHEUS, Value-based Purchasing, predictive modeling and disease management best practices, and others, often missing from many of these employer-hospital direct contracting and other medical tourism arrangements.
MHI's healthcare information systems includes globally integrated electronic health records system that can gather electronic health records from anyone, anywhere and send them anywhere in the world via fax, secure file transfer protocol, and other electronic means. With the patient's permission, providers can view the patient's medical record as a single virtual record of all previous care at any contributing provider or hospital. "This will enhance continuity of care and reduce costs for everyone involved" says Todd.
Asked if she thinks employers will be eager to examine this new PPO combination product, she is extremely optimistic. "What employer wouldn't at least explore the possibility to offer a program to their employees that gives plan participants the option to drive 90 minutes down the road if the plan could save $80,000 on a spine surgery and the employee could save on their portion of copays? MHI steers plan members to savings opportunities at facilities chosen by employers.
We're hoping employers will be curious about an option that allows plan members to fly a few hours or less to save money on costly elective surgeries. When you examine the frequency of certain surgeries (in the chart above), any savings per case can greatly reduce the excise tax threat without cutting benefits or raising premium contributions, copays and deductibles. We like this kind of healthcare reform better than the present alternatives!"
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Mercury Healthcare International is a Globally Integrated Health Delivery System®.
The organization provides employers with ERISA or Taft-Hartly self funded benefit plans with a comprehensive array of solutions to manage domestic, expatriate and traveling employee health and wellness program benefits. Mercury operates the largest single global healthcare network with over 800,000 providers in 92 countries. The network includes over 6000 pre-screened, inspected hospitals and more than 750,000 licensed physicians, all of whom have had credentials and hospital privileges and professional references verified.