Courtesy of

HOW TO DESIGN A…BENEFIT PLAN TO INCLUDE A

MEDICAL TRAVEL OPTION

• Medical Tourism declared

of national and public interest by former President

of the Republic Oscar Arias

in 2009

• Formal commitment of

actual President of the Republic Laura Chinchilla

• In 2009 Costa Rica received

• Costa Rica offers three JCI

accredited hospitals:

– HOSPITAL CIMA

– HOSPITAL CLÍNICA BIBLICA

– HOSPITAL & HOTEL LA CATOLICA

• Additionally, Costa Rica is

home of Latin American

branches of accreditation body

ABOUT COSTA RICA

• In 2009 Costa Rica received

approx. 30.000 medical

travelers injecting about

U$250 million in Costa

Rica’s economy

like AAAASF and AAAHC

(deeming authorities for

CMS).

• Today there are more than

20 ambulatory clinics internationally accredited

Costa Rica: quality health care and nature within your reach!

• PROMED is the board for the promotion and quality

assurance of the Costa Rican healthcare industry.

• PROMED is a private association of accredited

Hospitals, certified Doctors, Universities and Tourist

Services, supported by the Costa Rica Ministry of

Health and the Costa Rica Tourism Board.

• Through the seal of quality PROMED makes sure

that any healthcare and recovery facility provides

ABOUT PROMED

that any healthcare and recovery facility provides

with services of excellence in favor of patients

security.

PROMED: the gate to quality healthcare in Costa Rica!

Courtesy of

• WHAT is a Global Centers of Excellence Program

• COMPONENTS of a Quality Program

• SPECIALTIES of a Program

• WHY Enhance Your Benefit Program

• Benefits to YOUR COMPANY

Agenda

Benefits to YOUR COMPANY

• Benefits to YOUR EMPLOYEES/RETIREES

• HOW to Add Global Centers of Excellence

Courtesy of

What Are Centers of

Excellence (COE)Courtesy of

Humana

1982

Designed to

Improve

Outcomes

Provided Travel

for Member and

Companion

Cost Savings

with Reduced

Complications

Bariatric

Centers of Excellence (COE)

Every Major

City has

Multiple COE’s

Courtesy of

Quality

Outcomes

for a

Reduced

Cost

Highly

Accredited

English

Speaking

Providers

What is a GLOBAL CENTERS

OF EXCELLENCE PROGRAM

JCI

Accredited

(similar to

US

Standards)

Providers

Specialized

Targeted

Procedures

Courtesy of

• Correctly ID Patient• Improve Effective

Communications• Improve High-Alert Med

Safety• Ensure Correct site,

Correct-Procedure, Correct-Patient Surgery

• Reduce Risk of Health Care – Associated

Joint Commission Accreditation - International

• Correctly ID Patient• Improve Effective

Communications• Improve High-Alert Med

Safety• Ensure Correct site,

Correct-Procedure, Correct-Patient Surgery

• Reduce Risk of Health Care – Associated

Joint Commission Accreditation – United States

Accreditation

• Reduce Risk of Health Care – Associated Infections

• Reduce Risk of Patient Harm Resulting from Falls

• Reduce Risk of Health Care – Associated Infections

• Reduce Risk of Patient Harm Resulting from Falls

Although US Accreditation is different the standards for the International Community are same and in some cases more stringent

Courtesy of

Courtesy of

Patient

Advocate

Reduced

Cost

Adverse

Outcome

Protection

Measurable

Outcomes

THE PATIENT ADVOCATE IS THE KEY !!!

Facilitating the process for the member- Medical Necessity- Providing Cost and

Provider Options- Coordinating Travel

and In-Country Transportation

- Facilitating Claim

Components of a Global

Centers of Excellence Program

Enhanced

Clinical

Service

- Facilitating Claim Payment

- Providing Medical Follow Up Contact

Courtesy of

Measurable OutcomesCourtesy of

Volume of

Procedure at

Facility or by

Provider

MorbidityComplications

Measurable Outcomes

MortalityRe-admission or

Secondary

Infection Rates

Courtesy of

Measurable OutcomesCourtesy of

Nursing

• Increased Level of Service

• RN patient ratio 4:1

•US nursing ratio can exceed 10:1

Technology/

Training

•Many US/ Western Trained Physicians

•Technologically advanced hospitals

•Example: oxygen chamber to enhance healing after surgery

•Private rooms

•Recovery Centers with personalized care

Enhanced Clinical Experience

Follow up

•Recovery Centers with personalized care

•Patient Advocate coordinates return to home country; follow patient through

recovery

Courtesy of

Enhanced Clinical ExperienceCourtesy of

Domestic US

• Mal-practice Insurance

• Legal System• Protracted

• Uncertain

• Up to 33% of Award to

International

• Insurance Policy

• Specific

• Protections for both patient and employer/plan• Up to 33% of Award to

Lawyers

• Adversarial

• Outcome Uncertain

employer/plan

• Outcome Assured

Adverse Outcome ProtectionCourtesy of

Up to 50%

savings in

Medical for

Package Price

Up to 80%

Dental Savings

Up to 90% on

Prescription

Drugs

Reduced Cost

Package PriceDrugs

Courtesy of

• Savings of up to 80% on Dental Procedures• Most US dental plans pay 50% up to $1000-$2000

annually costing member thousands, if not tens of thousands out of pocket

• Package price savings of approximately 50% for Medical• Saves Plan Money (ERISA allows use of tax advantage

dollars)

• May save employee money (FSA, HSA, Possible HRA)

Reduced Cost

• May save employee money (FSA, HSA, Possible HRA)

• Prescription Drug savings• Nexium 30 day 40 mg, available OTC for $22

• US cost $160, prescription required

• One of the TOP 5 drug in ANY US corporate medical plan

Courtesy of

• Sleeve

• Lap Band

• Roux-en-Y

• Knee

• Hip

• Shoulder

• Full Rehabilitation

IncludedOrthopedic Bariatric

Major

and Plastic

Specialties

• Implants

• Crowns

• Veneers

• Whitening

• Face/Neck

• Body Contouring

• Enhancements

• Laser Re-Sculpting

and

Cosmetic

Dental

Plastic

Surgery

Courtesy of

Company

• Cost savings

• Comparable Quality

• Enhanced Service

• Competitive Difference

Employee

• Patient Advocate• Comparable

Quality• Enhanced Service • Tourism• Potential Cost

Savings

Who Benefits? EVERYONE !!!

Difference

• Embracing Global Workforce Solutions

Potential Cost Savings• Dental• Cosmetic• Potential Design

Changes to Reduce Out of Pocket Cost

Courtesy of

• Self Funded Employer – Houston

• 2 employees

• BMIs of +40 and 32

• Procedure – Gastric Sleeves

• Outcome – at 6 months more than 100lbs combined – No complications.

• Cost –

CASE STUDY 1

• Cost –

• Houston $30,000 -$35,000

• Costa Rica $14,000 (included travel, hotel, surgery, complication insurance, companion)

• Savings = 53%

Courtesy of

• Employee seeking full mouth reconstruction

• Employer Dental plan annual maximum $2,500

• Cost –

• Houston $38,000 over 6 months

• Absent from work 21 days

• Costa Rica $16,000 over 2 weeks,

• Absent from work 14 days

CASE STUDY 2

• Absent from work 14 days

• Savings –

• Employer 7 days of lost time ($8,500)

• Employee $22,000 ($35,500 - $13,500)

Courtesy of

Courtesy of

Decide on

Specialties

Obtain

Committee

Approval

Amend

Documents

Design Plan

Incentives

Contract with

Patient

Advocate

Organization

Employee

Communications

Competitive

Enhanced

Benefit

Offering

HOW TO ADD THIS TO YOUR PLANCourtesy of

Definitions:Definitions:

•• Obesity: Body Mass Index (BMI) of 30 or higher.Obesity: Body Mass Index (BMI) of 30 or higher.

Prevalence Of Obesity…Trends Prevalence Of Obesity…Trends Among Among U.S. Adults U.S. Adults between between 1985 and 20091985 and 2009

•• Body Mass Index (BMI): A measure of an adult’s Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the the adult’s weight in kilograms divided by the square of his or her height in meters.square of his or her height in meters.

Obesity Trends* Among U.S. Adults

BRFSS, 1985(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1986(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1987(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1988(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1989(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1990(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1992(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1993(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1994(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 1998(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 1999(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 2000(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 2001(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults

BRFSS, 2003(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults

BRFSS, 2004(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults

BRFSS, 2005(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2006(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2008(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI ≥≥≥≥30, or about 30 lbs. overweight for 5’4” person)

2009

1990

2009

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

THANK YOU!The Council for International Promotion of Costa Rica Medicine PROMEDUS phone number (305) 381-2988

Costa Rica +506 2201-5265

info@promedcostarica.com

Obesity Obesity Obesity Obesity Obesity Obesity Obesity Obesity TrendsTrendsTrendsTrendsTrendsTrendsTrendsTrends Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults Among U.S. Adults between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009between 1985 and 2009

Source of the data:• The data shown in these maps were collected

through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data departments use standard procedures to collect data through a series of telephone interviews with U.S. adults.

• Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.

• In 1990, among states participating in the Behavioral Risk Factor

Surveillance System, ten states had a prevalence of obesity less than

10% and no states had prevalence equal to or greater than 15%.

• By 1999, no state had prevalence less than 10%, eighteen states had a

prevalence of obesity between 20-24%, and no state had prevalence

equal to or greater than 25%.

• In 2009, only one state (Colorado) and the District of Columbia had • In 2009, only one state (Colorado) and the District of Columbia had

a prevalence of obesity less than 20%. Thirty-three states had a

prevalence equal to or greater than 25%; nine of these states

(Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri,

Oklahoma, Tennessee, and West Virginia) had a prevalence of

obesity equal to or greater than 30%.

CitationsCitationsCitationsCitations

• BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss/

• Mokdad AH, et al. The spread of the obesity epidemic in the United States, 1991—1998 JAMA 1999; 282:16:1519–22.

• Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;

• Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10:1519–22.

• Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003: 289:1: 76–9

• Vital Signs: State-Specific Obesity Prevalence Among Adults —United States, 2009 MMWR 2010;59(30).