Join the Movement! 10th Caribbean Health Financing Initiative Conference

October 28, 2015

Dr. Kester J. NeddChairman and CEO, JIPA Network

A Noble Ideal

“The Value of a Nation is determined

by the health of its people”

-Franklin D. Roosevelt

 

National Health Challenges: Consumers

Relatively sick population with lifestyle illnesses (associated high cost of care)

Retirees have limited and high-cost coverage

Consumers are more focused on property & casualty than health care insurance

High out-of-pocket expenses for health care services

Populations are limited and scattered across multiple nations - not operating as a unit (fragmented, higher acquisition costs)

National Health Challenges: Health Care Providers

Relatively small population with small number of specialists (high turnover of specialists)

Few training programs (fear of training the competition)

Blending of the public and private sector – compensation system not reasonable

Specialists work independently

Provider network not organized until now!

National Health Challenges: Payers

Focus on profits not coverage

Only 40-50% of insurance premiums spent on actual health care compared to the United States: 71-82%

Laws governing health coverage and insurance are antiquated and favor insurance companies, not consumers or health care providers

Premiums not adequate to cover the benefits members want

Health care coverage focused on the wealthy

Small insured population with fragmented pools of covered lives - competition is both regional and international

Provider network not organized

Blending of the public and private sector

Caribbean people should have

Access to High Quality,

Coordinated, Affordable Care

where they need it and when they

need it.

Challenges & Opportunities

Health care is seen as a Cost Center rather than an opportunity for growing the economy

Expats want to come home but choose not to because of the limited health care services

Flight of health care dollars: South Florida USD $600 million – 20%

We need a way to pay for health care

What will work in the Region?

A new model to pay for and provide health care

Federated organization across country, political divide and economic status

Consolidation and concentrated

Collective bargaining arrangements

Introducing JIPA Network

A Global Multi-Provider Association

JIPA’s Strategy

Health Care Providers Payers Consumers 

Consolidate and Collectively Bargain on behalf of:

We connect patients to world-class, affordable health care through our

integrated family of global health care providers.

 

JIPA Network, A Provider Organization

• Physician-driven and operated

• Mutual company: Investor/ownership with health care providers and payers

• Providers contracted to provide care:• Primary care• Specialty physicians• Hospitals• Ancillary providers of health care

services• Concierge providers

Provider Organization Focus

Organize providers across countries to create Centers of Excellence

Organize care coordination and triage of patients to allow for timely access and cost-effective care between network providers

Utilize collective bargaining methods to make health care affordable

Group purchasing power to keep cost down

 

Regional access to over 300,000 providers and National (USA) and international

Access to over 1 Million providers through Aetna First Health Network and other Network Partners

Scope and Reach of JIPA’s Provider Network

Payer Strategy - JIPA’s Clients: Payers

Employer Groups

Consumers: Self-Pay

Traveling Public

Travel for Health Care: Destination Medicine

Assistance Companies

Cruise Industry

Self-Funded Organizations

High-Deductible Insureds

Union Members

Workers Compensation

Government Workers

National Health Insurance Plan

Non-Governmental Agencies

Insurance Companies and Reinsurance Companies

Stratified Pooled Risk Coverage (SPRC)

 

  Additional Premium Paid Above Second Tier Highest Coverage Limits Local, Regional and International Payers

Additional Premium Paid Above First Tier Benefit Limits Higher Local, Regional and International Payers

Lower Cost Premium and Benefits Local Plan or Self-Funded Large Population will Have Access

JIPA’s Three-Tiered Stratified Risk Program

Third

TierSecond Tier

First Tier

Payer Organization Focus

Local coverage for basic and basic+ coverage that is focused on wellness and prevention (broader population can now buy health insurance)

Catastrophic coverage pooled across many countries and groups to spread risk and lower insurance cost

Care provided through a network of credentialed providers

Lower administrative costs with more dollars available for patient care

 

Stratified Pooled Risk Coverage allows for the following:

Self-Funded and Self-Administered

Allows for financial, administrative and care risk up to a certain level

TPA and Provider Network maintains the following capabilities:

• Administer benefits

• Manage and coordinate care

• Collect and distribute premiums

• Adjudicate claims

• Case management

• Utilization management

Stratified Pooled Rick Coverage (SPRC)

• Allocate less premium to administration and marketing

• More premiums utilized on health care

• Lower cost administration

• Can offer richer benefits

• Must structure benefits to protect plan and members

• Conglomerated Risk: Work with other entities and membership to purchase catastrophic coverage including stop-loss, reinsurance and major medical coverage

 

JIPA’s ArchitectureIntegrated Care Utilizing a Continuum of Care Model with Technology and Incentives as the Focus of Integration

 

Ancillary Providers

Specialty Physicians

Inpatient

Outpatient Services

Primary Care

Therapies

International Patients

High Deductible

Self Funded

Insurance

PPO

Self Pay

PSA Admin Services

Clinical ProvidersPayersThird Party

Administrator

JIPA

Pain Management

Instant BenefitsNo Sign-Up or Membership Fees

Harold Martin PT12711 2015

Membership BenefitsAccess to network of world-class doctors, facilities and service providersFree complex case review by clinical specialistsCompetitive pricing for health care servicesFree quotes for medical services and cost negotiation on your behalfCustomized care plans developed by medical specialistsPatient Care Coordinators and complimentary hospitality services24/7 emergency care coordination and medical evacuationAccess to DiscountsTravel, health and air ambulance insuranceMedications, supplies and medical equipmentHotel arrangements

•••

•••••••

U.S. Toll Free: 1.877.749.5472 • Int’l: 1.954.331.6530

This is not an insurance card

JIPA’s Three Fundamental Pillars

Follow the Care: Triage and Care Coordination

Follow the Information: Plan of Care Document

Follow the Money: Collect & Make Payments, We Pay Up-Front

JIPA NETWORK, LLC(Discounted Case Sampling - Actual Claims/Negotiations)

Service Location

Treatment Summary Service Provider

Total Expenses Discount Write-Off Amount Paid Discounted %

Hialeah, FL Adenocarcinoma-Ovary; TAH,BSO+ Facility/Professional $122,070 $94,070 $28,000 77%

Miami, FL TBI, Surgery and Rehab Facility/Professional $710,894 $615,803 $95,091 87%Miami, FL Pubic Symphysis Dislocation, Rt Sacroiliac Joint

Dislocation, Left Acetabulum FractureFacility/Professional $288,515 $165,016 $123,499 57%

Miami, FL Malignant Neoplasm - Breast; Biopsy/ Diagnostics, Surgery, Chemo and Radiation Therapies

Facility/ Professional $388,000 $290,000 $98,000 75%

Miami, FL Heart Transplant Facility/ Professional $461,243 $182,643 $278,600 40%             

Service Location

Treatment Summary Service Provider

Total Expenses Discount Write-Off Amount to Pay Discounted %

Colombia Lumbar Herniated Disc L4-5, L5-S1 with Subluxation of L4 on L5; Discectomy with instrumentation fusion and interbody cage

Facility/ Professional/ Air Ambulance

$62,475 $25,592 $36,883 41%

Panama Malignant Neoplasm - Breast; Presurgical, Surgical (bilateral mastectomy / reconstructive) and Chemo and Radiation therapies

Facility/ Professional $119,890 $58,985 $60,905 49%

Trinidad

ESRD on hemodialysis, Infective endocarditis, Klebsiella UTI, Myelodysplastic Syndrome with Anemia, Hypertension, Gastric Polyp - Tunneled left internal jugular vein Permacath, left brachio-basilic vein transposition AVF, upper/lower endoscopies with gastric polyp biopsy (24 days admit)

Facility/ Professional $91,650 $42,937 $48,713 47%

Colombia Aneurysm Posterior Cerebral Artery Facility/ Professional $46,119 $14,297 $31,822 31%

Colombia

Male Newborn, Complex Cyanotic Hearth Disease, Malposition of Great Arteries, Pulmonary Atresia. Air Ambulance x2, Ground Ambulance, 12 ICU days, 18 regular days, Heart surgeries

Facility/ Professional $200,000 $80,000 $120,000 40%

Health Care as a Commodity

Accessibility

Quality

Price 

Health Care as a Commodity

Accessibility

Quality

Price 

Coronary Artery Bypass Surgery

Cost vs Outcome

CostComplications

Miami $70,0004%

Panama $40,0003%

Colombia $20,000 1.8%

Increasing Patient Traffic Through JIPA Network

Over 2,200 Patients Served in 3.5 Years

Patients from 44 Countries

Average Payment US $41,000

Estimated Financial Impact of over US $89 Million

JIPA Network IS…

A Provider Network Promoting Centers of Excellence

An Administrator (TPA)

An Enabler of Information Technology

A Risk Manager

A Triage and Care Coordination

A Payer Syndicator

A Consumer Consolidator

An Association Company – Member Ownership

JIPA Network IS NOT

1. An Insurance Company

2. A Broker

3. A Health Care Provider

4. A Risk-Bearing Entity

5. A Bank or Financial Services Company

JIPA’s Caribbean Focus

The identification of and development of “Centers of Excellence” in the Caribbean

Improving access and quality of health care by promoting care coordination and appropriate triaging of patients

Organizing a heath care syndication to increase affordable health care coverage for Caribbean citizens utilizing the SPRC model

Organize consumers as a large buying group utilizing the JIPAconnect card system

Promote information technology, education, managed care principles and wellness in the Caribbean

Join the Movement!