DENVER -- Maria Todd, medical tourism and healthcare administration expert and the owner of the world's only globally integrated health delivery system® for medical tourism has been contracted to author The Employer's Guide to Medical Tourism Benefit Design.
Todd, who has long been involved in group health benefits management, claims administration and managed care brings more than 25 years of experience in medical tourism program design fused with more than 30 years of managed care and ERISA industry insight.
The Employer's Guide to Medical Tourism Benefit Design starts with an introduction and overview discussion of medical tourism - what it is, how it works and how it applies to the group health benefit arena. She explains how underwriting and actuarial concerns can be addressed with non-traditional paths to evaluate risk, project utilization and program engagement. She also addresses why the fully-insured market will take years to catch up in adding this innovative healthcare cost containment program into their offerings.
Todd brings her surgical nursing and case management background into the picture to explain how to evaluate instances where medical tourism would be appropriate and where medical tourism might actually pose additional risk to the plan member that might outweigh the benefit of the savings. She also addresses continuity of care and longitudinal outcome measurement models that can be used to track savings, plan beneficiary program satisfaction, and clinical improvement.
She draws upon her managed care experience to discuss benefit design and ways to align the medical tourism programming with existing local health network utilization. Here, she uses her practical experience and insight from visiting more than 3000 hospitals in the USA and abroad and explains how to carve out the destination healthcare cost and service component from traditional procedure payment models and episode of care. She shares various models that can be used to evaluate the price for medical tourism services coupled with local evaluation and management services for follow up.
Todd leverages practical experience to explain ways that patient engagement can be intensified through various incentive programs with HSA, HRA, and defined contribution benefit plans, voluntary health benefit plans, and the special considerations necessary to ensure summary plan description modification compliance.
In a section on narrow network design, she weaves in her managed care network development knowledge to explain how to create a designated network of high-quality healthcare providers, and how to incorporate the travel costs, evaluate hotels, destination management services, home health services and other cost tags into the program. She also includes checklist on how to evaluate healthcare facilities, physicians, and other healthcare value chain suppliers to ensure continuity of care, provider readiness and competency.
The book includes step-by-step explanations on how predictive modeling, past claims history, and basic epidemiology constructs can be used to perform a pre-program design feasibility study. This technique comes from several years of working with group health clients to design their programs and incorporates lessons learned. These data can be utilized to model the potential financial risks and savings from low-, medium-, and high-volume engagement in certain case types to project network size, which destinations may be most appropriate and how to decide.
She addresses ways to negotiate with providers directly, and supplies a model contract template that can be used to memorialize understandings between the parties. She also includes tips and workarounds to deal with TPAs and ASOs that may be unable or unwilling to manage such a program.
Few people in the world possess the unique combination of experience that enables Todd to author the Employer's Guide to Medical Tourism Benefit Design from such a deep subject matter expertise. She is the author of 11 other books including such industry best sellers as The Managed Care Contracting Handbook, 2nd ed, and Physician Integration and Alignment: IPA, PHO, MSO, ACOs and Beyond, which addresses issues on provider network development. She authored three other titles in medical tourism, The Handbook of Medical Tourism Program Development, which guides providers on medical tourism service line management and programming for hospitals and clinics, and the Medical Tourism Facilitator’s Handbook which addresses logistics and case management for coordinated care and patient safety through the episode of care. It is only natural that in The Employer's Guide to Medical Tourism Benefit Design, she rounds out the collection to explain to group health buyers how to use this innovative cost containment tool to complement an existing healthcare value chain at the local level.
Maria Todd (http://mariatodd.com) is the CEO of Mercury Healthcare International (http://mercuryhealthcare.us), a diversified healthcare management company based in Denver, Colorado. Active in medical tourism since 1987, she consults frequently to employers and facilitates medical tourism program arrangements between employers and over 15,000 pre-inspected and approved healthcare facilities throughout all 50 states in the US and another 96 countries abroad. She is a highly sought after keynote speaker and workshop leader at international and US healthcare industry and medical tourism conferences and is a guest columnist about managed care for three international magazines in Dubai, Germany and Romania. She is available for interviews and consultation.
