Nueterra Global Alliance - HFMA of Greater St. Louis

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Nueterra Global Alliance
Medical Exchange
Nueterra
Breaking It Down
Medical Exchange- when a consumer travels across international
borders to receive some kind of medical treatment. This can
include patients who travel inbound or outbound.
Medical Tourism - movement of patients across borders in the
pursuit of medical and health treatments that could or could not be
received in the home country. These services can include, but are
not limited to, dental, cosmetic, elective surgery and fertility
treatments.
Medical Travel - traveling primarily for the purpose of medical care
with a focus on care that is delivered in an inpatient or outpatient
hospital setting. A vacation-worthy locale is not a consideration.
Nueterra
Distinguishing Characteristics
Major Catalysts of Medical Exchange
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Desire for more healthcare choices
Strains on domestic health systems
Globalization
Sophistication in technology
Advances in biology and medicine
Demand drivers for medical services overseas:
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Familiarity
Availability
Cost
Quality
Bioethical legislation
Technological platform
(“Medical Tourism: Treatments, Markets and Health System Implications”)
Nueterra
Educational Component
• Nueterra Global Alliance believes in the importance of providing
educational opportunities. In response, Nueterra hosts
international educational events with networking components for
providers across the globe.
• We believe that when the medical team has a chance to engage
in these activities they can build relationships nurse-to-nurse,
physician-to-physician and health system-to-health system,
increasing patient volume to the facility.
Nueterra
Market Opportunities
According to a report from Johnson & Garman, 2010, for
every $1 spent by an American on healthcare services
abroad, $5.64 is spent by international patients seeking
healthcare in the U.S. Those international patients with the
most severe illnesses also stay 28% longer (Satjapot,
Johnson & Garman, 2011).
Nueterra
Market Opportunities
Scope of Services
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Ear, Nose and Throat (ENT)
Plastics/Reconstructive
Audiology
Neurosurgery
Foot and Ankle
Ophthalmology
Urology
Hand Specialist
Orthopedic
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Pain Management
General Surgery
Cardiovascular
Transplants
Pediatrics
Prosthetics
Wound Care
Physical Therapy
Etc…
Nueterra
Hospitals & ASCs
Best In Class Hospitals
Boutique Specialty Hospitals &
Surgery Centers
Nueterra
Nationally Ranked in Eleven Areas of Best Hospitals
US News and World Report: 2012-2013
Rank
SPECIALTY
# 20
Cardiology and Heart Surgery
# 10
Gastroenterology
# 14
Pulmonary
# 21
Ear, Nose and Throat
# 22
Orthopedics
# 28
Geriatrics
# 22
Gynecology
# 37
Nephrology
# 32
Urology
# 44
Neurology & Neurosciences
# 10
Diabetes & Endocrinology
*Source: U.S. News & World Report’s Best Hospitals
Communication
Nueterra
Technology
Real Time Collaboration
Nueterra
Patient Management
Nueterra
Integrated Portals
Nueterra
Patient Experience
Nueterra believes that the most important aspect of the
medical exchange program is to facilitate an excellent
pre-care, active-care and post-care patient experience,
complementary on-site care, case management and
concierge services.
Many times this experience is more than how the patient
is treated, but also the family.
Nueterra
Patient Experience
What to Expect
 Before their Visit:
A dedicated Patient Care Coordinator
Assistance with Medical Treatment or Consultation plans
Cost estimates that break down charges for anticipated medical services
Assistance in arranging financial payments
Confirmation of medical appointments and procedures
Assistance with travel and lodging coordination
 During their Stay:
Translation services
Assistance with hospital admission process and follow-up visits
Arrangements to address dietary, cultural and religious needs
 After their Visit:
Copies and translation of medical records
Expedited payment processing of medical bills
Final bill that includes itemized list of services
Follow-up services
Patient satisfaction
The Happy Patient
Nueterra
The Happy Patient
Patients seeking care across international borders do so because it’s not
available locally but no matter where they go a patient desires, more than
anything, to have excellent experiences and outcomes.
As a nurse or a physician, you can help your patients obtain a successful
medical exchange experience by understanding what they need, why
they need it and who can deliver/meet their needs.
Excellent Communication
Excellent Outcomes
Excellent Experience
A Medical Exchange Program is not about replacing the patient’s local
care team, it’s about creating synergies to improve the delivery of
healthcare. A great medical exchange program recognizes that it’s a
large global partnership— caring for people and improving lives.
Nueterra
Partnership
Nueterra Delivers
Nueterra
Conclusion
➤Nueterra is expanding its global health network with owned and
managed facilities that connect people, nurses, physicians,
educational institutions and health systems
➤Nueterra will increase patient volume for our partners while
providing excellent patient and provider satisfaction, consistent with
their current service levels
➤The Academy will provide our provider partners with the
opportunity to strengthen relationships with in-country partners,
increase brand awareness, and capture international market share
At the Center of
Cayman Heart Care
Marcia McCoy, RN, MSN
Director, Saint Luke’s
International Heart Care Program
Cayman Islands
Island Overview
• Combined Population: 60,000
• 3 Hospitals: Georgtown Hospital, Chrissie Tomlinson
Memorial Hospital, Faith Hospital
• Health Services Authority – Chief Medical Officer
• Facilitates appointments/referrals
• Government Health Care Insurance : CINCIO
• Private Insurance: Atena, Generali, BritCay, Fidelity
• Heart Health Centre
Challenges
CVD Care
Sparse Availability
Fragmentation
Lack of Standards
No Continuity
Repeat Testing
Variable Quality
Poor Satisfaction
High Cost
Poor Outcomes
Proposed Solution
•Integration of on-island and off-island care
• The Heart Health Centre
• St. Luke’s Mid America Heart Institute
•Partnership with experienced health care
provider that can assure
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Continuity
Top Standards and Quality
High Patient Satisfaction
Excellent Outcomes
The Heart Health Centre
• Free standing cardiovascular and imaging center
• Provides services unavailable elsewhere on the
island
• Consulting cardiologist every other week –
all based at Saint-Luke’s Cardiovascular
Consultants
• Echocardiography
• Nuclear Cardiology (exclusive)
• Seamless integration with off-island care at
SLH
Heart Health Centre, Grand
Cayman
Historical Milestones
Cayman – SLMAHI Partnership
•1/2010: SLCC cardiologist starts seeing patients
at The Heart Health Centre
•9/2010 – 06/2011: Rising demand, practice
expands from 1 to 5 SLCC cardiologists
•11/2010: 1st CINICO insured comes to SLMAHI
for heart surgery
•7/2011: Minister Scotland, Mr. Tibbetts, Phillip and
Jacki Ebanks visit SLH/MAHI
Letter of Agreement
SLHS – CINICO Partnership
• 10-21-2011: 1st Letter of Agreement, making SLHS
a preferred CVD care provider for CINICO is signed
• Intended to:
• Improve the continuity and quality of CVD care
• Improve patient satisfaction
• Reduce cost to CINICO
Cayman Government
Delegation 2012
Honorable Mark Scotland,
Minister of Health, Environment,
Youth, Sports, & Culture
Delroy Jefferson, M.D.,
Medical Director, Cayman Islands
Health Services Authority;
Chief Medical Officer
Bob Bonney, Sr. VP Business
Development
Lonny Tibbetts, CEO, CINICO
Mikhail Kosiborod, M.D., Medical Director,
Saint Luke’s International Heart Care
Honorable Michael Adam, Minister of
Community Affairs and Housing
Meet the Cayman Delegates!
Lonny Tibbetts, Dr. Jefferson, Minister Scotland, Marcia McCoy, Minister Adam
Steve and Nola Bodden, Cayman Brac
Saint Luke's International Heart Care
Overseas Referral Process
• Overseas referral request to the Health Services
Authority Referral Office for approval by the Chief
Medical Officer (CMO)
• Patients with private insurance are encouraged to call
health insurance provider to start this process
• Patient contact information is sent to Director, Saint
Luke’s International Heart Care (SLIHC)
• Provisional Phase - Patient/identified family member is
contacted by SLIHC within 48-72 hours
• Inquire about availability/limitations for travel to
SLMAHI
Saint Luke's International Heart Care
Overseas Referral Process
• SLIHC investigates procedural, surgical, consult, or subspecialty schedule availability
• Confirmation of Approved Overseas Referral
• Obtain confirmation/proof of benefits from insurance company
• Verification of co-pay, out of pocket, out of network financial
responsibilities determined at this time and to be collected at
time of admission
• Cost estimate(s) obtained if necessary
• SLIHC contacts patient or identified family member to
• Confirm CMO/pre-authorization approval, travel dates, current
medication list and allergies
Saint Luke's International Heart Care
Overseas Referral Process
• Medical itinerary confirmed with detailed travel
dates, patient information and call to action steps
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Hospital and or office registration
Request for flight information
Airport to hotel transportation information
Lodging options
On island pre travel lab requests with instructions
Medications to bring (i.e. - 2 weeks, 1 month)
Educational tools pertaining to medical procedure test, etc.
Travel to and from island dates
Pre-procedure/testing medication alerts, NPO, etc
Appointments - which include date, show up time, location, estimated time of
procedure, transportation, check-in/co-pay expectations, physician performing
procedure, test or consult
 Discharge/return to island plan/disposition
 Local weather status
Interesting Challenges!
AH HA Moments!
•Travel
•Hospital registration (SS#, address, race?)
•Airport pickup – lodging
•Weather – clothing
•Concierge service
•Midwest culture – Cayman way
•Communication
•Private insurance companies
Overseas Referral Trends
•2010 – 1 patient
•2011 – 7 patients
•2012 – 41 patient (570% growth)
• 36 CINICO (90%)
• 4 Private Insurance (10%)
•2013 – 42 to date (21% private insured)
• 1 self pay
Procedures/Encounters
•Transesophageal echo
•Cath
•Cath/PCI
•CTO
•Alcohol Ablation
•Implants (ICD/PM)
•CVT consults
•Other
•Open Heart Surgery
• Valve
• CAB
• Ascending aneurysm
Patient Care Perspective Continuity
• 100% follow up at The Heart Health Centre
after return to Cayman Islands
• Medical records and patient disposition
within 24-48 hours of leaving KC
• All necessary non-invasive follow up testing
done on-island (The HHC or Georgetown
Hospital)
Patient Satisfaction
• “Prior to arrival, we received complete medical itinerary and in-depth
literature of the procedure to be done.”
• “The entire staff at St. Luke’s, including the doctors that come down
on rotation to our local Heart Health Centre, were excellent.”
• “St. Luke’s Mid America Heart Institute is a first class facility and we
were treated with first class service and with the utmost care and
dignity.”
• “It is so wonderful to know that once you have been to St. Luke's you
can still continue to see these doctors, who already know your history.”
Patient Satisfaction
•“We’ve been telling people [on the island] about you all. St.
Luke’s is the place to go! It’s a state of the art Hospital with
excellent staff and professional service.”
•“You’re extremely organized, and to top it all off you have the
most friendly, helpful, caring people.”
•“I am writing to express my thanks for the first-rate standard of
care I received. From admission to discharge, all of the
personnel were thoroughly professional and highly skilled.”
•“Doctors were as expert at explaining what they are going to do,
as they were at performing the procedures they described.”
Patient Satisfaction
Comparing Cleveland Clinic (Florida) to St.
Luke’s is like a VW and a Rolls Royce. They
are both cars, but there is no comparison!
Heart Health Centre Stats
The Heart Health Centre Statistics
2009
2010
2011*
2012
55
177
201
302
222
0
45
0
19
11
Total New
Patients
Total Exercise
Stress Tests
7
Total Device Testing
Total Follow
13
Ups
Total EKG's
Total
Echocardiogr
7
ams
Total Echocardiogram with Stress
Total Nuclear Stress Tests
Total Patient
Encounters
82
48
2013 (mid Sept)
126
217
298
313
339
238
147
219
321
39
271
31
120
103
131
105
618
994
1449
1236
Program Development Perspective
•Committed to
bringing care to Caymanians and building
true partnerships
•Improves quality of care and satisfaction
•Device Clinic (pacemaker
and defibrillator checks on the
island) – 1st quarter 2013
•Remote interrogation of cardiac devices through St. Luke’s
electrophysiology service
•Athlete Heart Clinic – screening of national team players to
prevent sudden death in athletes
Heart Smart Week 2012
Lonny Tibbetts, CEO CINICO
Health Minister Scotland
Why Work Together?
•Better quality care for patients
•Better continuity
•HHC and SLH the only partnership that provides
continuity on & off island
•Better patient satisfaction
•Caymanian patients are extremely pleased with
SLH
•Appropriately aligned incentives
•No repeat testing (do it right the first time)
•Dedicated to provide more services on-island
(HHC is NOT a vehicle to channel patients to SLH)
•Substantial cost savings
Why Work Together?
Thank You