Alexander “Sander” Domaszewicz is a Principal and Senior Consultant housed in the Mercer Health & Benefits Services (Mercer) Newport Beach, California office. He is Mercer’s National Practice Leader for Consumerism and leads Engagement efforts for the Total Health Management group, specializing in emerging benefits and ways to encourage groups to become involved and informed around health care cost and quality. Areas of focus include health care strategy, consumer directed health care, health and benefits decision support tools, web health resources, HR portals and online benefits.

Sander: I think there is a lot of interest in any solution that has the promise to help control health care costs and make the out of pocket costs shifting less burdensome to employees. The majority of interest around International medical travel seems to have been focused on learning of the possibilities rather than a willingness to adopt in the near term.  But that learning always has to be a predecessor to adoption – there is value in getting folks interested in talking about a topic and discussing pros and cons. More employers are thinking about the concept, and some have had us run the numbers or map out a pilot scenario to see what implications it would have. We haven’t seen a lot of adoption yet, but I think we are a few large employer adoptions away from this becoming more mainstream.

Sander: Yes, there may be some employer risk, but employers also must consider how to overcome employee’s concerns that they may not be in a position to bring successful litigation or have a favorable conclusion to their medical procedure they traveled to get. So from these perspectives, I think employers often may be ok with encouraging folks to consider international medical travel as long as it is completely voluntary to the employee and their exposure is fairly modest.  The types of offerings that are being developed and refined for the future will need to put both the employer and the employee at ease that any risks that they are taking are adequately covered with a “Plan B” - can I be repatriated if there a medical emergency, will the cost of redoing a procedure State-side be covered, or if things don’t work out favorably is there a blanket policy liability that pays out some fixed amount of dollars… I think all these options and more are going to be necessary components for meaningful uptake of travel medicine and will go a long way to make both employers and employees feel more comfortable about the solution when venturing into a potentially less certain legal and clinical environment.

Sander: The programs we have looked at have addressed some of the basics of continuity of care.  There are protocols in place for transfer of records, staying in country after surgery to receive recommended follow-up care is often part of the package, as well as care transitions back to home providers.  You know the funny thing is the continuity of care issues are probably as well or even better addressed in international medical travel than when folks are travelling domestically for care within the US, I haven’t seen it being a barrier yet when reviewing the travel programs.  It is a consideration, but it seems to be doable with the current state of technology and programs.

Sander: This is a hard one for employers because ROI is largely a matter of what the volume is and what are the specific conditions being addressed and knowing the marginal cost advantage for overseas care by procedure.   A lot of assumptions go into these, so ranges of opportunities are probably the best we can get at right now.  Employers who want to move down this path want to see that there is meaningful opportunity for ROI if they decide to go through the effort of putting a medical travel program in place, but they are not going to fix all their financials hopes on an assumption that 30% of all plan members who are eligible for hip replacements are going to choose an international option.  There is still a lot of work to be done around how to make this a desirable option, and that type of nuance won’t come immediately, it will have to be developed over time.  There aren’t many who have had success at marketing to encourage uptake by the participants.  This is still a work in progress in the world of well-insured participants.

Sander: To the extent the concept makes sense financially and clinically, there could be robust uptake over time.  But I think a lot of it is going to depend on the early reports of success or lack of success of programs to achieve employer’s goals. There have to be early employer trailblazers, and to the extent that we have half a dozen large, successful employer plan sponsors using international medical travel, widespread adoption could quickly follow.  But if most of the early adopters have struggling programs 3 to 4 years into their efforts, without much uptake or financial return, adoption could be a very long, generational process.

Sander: With employers we’re working with on medical travel, we’re trying to integrate the program with other health initiatives into what we call a Total Health Management framework.  Providing choices around where to get significant surgery fits much better into an environment where it’s not just a one-off initiative, and you’re already encouraging people to think about their health and getting maximum value when they seek health services. One of the biggest challenges has been getting large, national insurers to be willing to coordinate and support the program when it’s being launched with smaller emerging medical travel vendors.  Linking with existing pre-surgery notification processes and case management would be of great value.  Some medical third party administrators have welcomed the expertise of the new companies in this space, but many of the largest insurers have thrown up barriers or forced non-integrated and non-coordinated programs.  On the incentives front, I think the models need to be built around the employee’s safety, both in financial and quality terms. They need to be as user friendly as possible, and it seems likely that large financial incentives are going to be a requirement in successful programs, at least to start.  I know a couple of models that have included HSA or HRA funding, say $5,000,  that would be deposited into some one’s account to cover health expenses.  An a number of programs will reduce or eliminate the out of pocket expenses and cost sharing for a procedure done using medical travel.  And covering basic added expenses like travel costs and the costs of bringing a companion are critical to the model.  I think there needs to be a direct line of sight, if I am willing to do something out of the ordinary and use this new program, what’s in it for me as a patient?  I would recommend employers adjust expenses in the cost modeling and apply a good percentage of any potential savings to initially getting folks to try the program.

About Alexander “Sander” Domaszewicz:

Sander is a frequent presenter at health care and benefits-related events and has published articles in Benefits Quarterly, Employee Benefit News, HR Magazine, Workforce and HR Executive.  His consulting assignments include work with many large and small public and private organizations in both the benefits and product development areas. Sander holds a Bachelor of Science degree in Mechanical Engineering from San Diego State University, a Masters degree in Business Administration from the University of Phoenix and a certificate in Human Resources Management from Cornell.