Interview with Roger Amato
What is the World Hospital Monitor and how will it improve patient volumes for hospitals?
The Aequitas’ World Hospital Monitor is a unique database that will provide reliable and authoritative performance information for international hospitals that are looking to attract patients from other countries. Specifically in the US, there are three drivers of whether or not a patient will travel abroad for medical care: lack of information or trust in the information that is being provided, fear and motivation.
Dealing with each of these in turn. First, there is a lack of information available to patients (and payors) about procedures being performed in “foreign” hospitals. The World Hospital Monitor will provide standardised information on a variety of key elements that are important to patients and payors. Secondly, there is fear. Patients are fearful to travel for medical procedures. It is something outside of their comfort zone. The World Hospital Monitor has a Patient Reported Outcomes (PRO) tool, which will help new patients overcome the fear of the unknown by accessing qualitative information from former patients who have every reason to report their experiences accurately. Finally, there is motivation. Right now, a major motivator is the cost of an alternative procedure. As payors have increasing financial pressures brought upon them, there will be new and innovative ways that they will seek to have patients travel abroad for specific treatments.
How does The World Health Monitor intend to translate aggregated outcomes data into a meaningful purpose? How will such an initiative benefit the hospitals and, most importantly, the patients?
How we collect, analyse, translate and compare statistics remains proprietary. We’ve developed trusting relationships with hospitals which understand the importance of transparency and objective comparisons. Our coalition of accurately compared outcomes data will benefit both hospitals and patients because it offers a level-playing field to shop for other aspects, such as price and proximity.
Can you tell how The Aequitas Group is going to collect, standardise and compare outcomes data between hospitals?
We are developing data from specific hospitals based outside of the US that have an interest in bringing patients in from the US, or for that matter any market outside of their home market. The World Hospital Monitor has a standardised data collection procedure and further a standardised PRO tool which are all used in the development of this unique database.
The World Hospital Monitor is able to provide an index of hospitals by any number of criteria to determine the appropriate value for the patient, relative to other hospitals and procedures in their home region or country.
How does cost of procedures figure into your model?
Cost is very important to payors, but when you are talking about patients and medical procedures, that is not the only consideration. Travelling a great distance, what the evidence shows in terms of outcomes, and the “overall” patient experience, all play into our model. This gives us a qualitatively unique analysis, which will help patients make the right decision for their healthcare. It will give them the opportunity to adopt a locus of responsibility for determining good value for money. Where they or their employers must freight the cost of travel, now the patients and payors will know what value is being offered on the other end, and at what price relative to newly proposed standards.
You have now formed a coalition to standardise the reporting of data from foreign hospitals. How does one go about standardising reporting between settings, when the care and cost may be very different?
It is an interesting paradox that what are foreign hospitals to us, are local hospitals to others. One problem is finding the resources to ensure that any self-reported data is accurate. This problem was solved when we asked clinics if they wanted us to measure such data. The answer was a resounding “yes”.
A coalition of aggregated data is clearly one step to solving the “which hospital is best” guessing game. Analysing that data in a meaningful way that combines hospital and patient-reported outcomes is the hard part. We deal with the case-mix problem every day in the pharmaceutical world. We solve this problem the same way when we compare hospitals based on objective measures of cost and quality.
Can hospitals be compared easily to one another? What about procedures such as stem-cell therapies that are not approved in one setting, but routinely administered in another?
The end-user is the patient and it is really patient satisfaction that needs to be compared accurately across procedures, hospitals, languages and international borders. If a hospital is willing to stack up against others with long-standing reputations for excellence, that hospital must collect reliable outcome measures and report them in a manner that can be trusted. Even if procedures are different, patient satisfaction can be measured and compared across settings. We do this already in the pharmaceutical world and it is an easy step for us to measure treatment satisfaction in this world.
Why are American companies willing to send their personnel abroad for healthcare?
One reason would be if the quality of care is really better than we would otherwise see at home. Another would be if the care given is better value for money. A third but essential reason would be if our personnel report high satisfaction with medical tourism. Ultimately, resources are going to flow into procedures and regions where patients report the highest satisfaction. Those hospitals which are not on that short-list may struggle.
As you see it then, is the current state of affairs in the US really a tipping point for medical tourism?
The simple answer is yes. Healthcare, and more specifically, hospital costs in the US are rising at double-digit rates. Yet, payors have hit a wall in terms of their ability to increase premiums. Insurers have become very motivated to look at ways of reducing costs, yet maintaining excellence. Additionally, self-insured employer groups are searching for ways to control costs. These pressures point to an increased opportunity for travel outside of the US for certain procedures. Ultimately, we live in a global world market, and I am convinced that in this case, markets are efficient so long as patients can make a fair assessment based on robust information. The tipping point rests in making sure this information is accurate. That is in turn one step in the direction of ensuring that, when push comes to shove, every employer can adequately insure their personnel to a high standard and without breaking the budget. The secret rests in the accuracy of information.
How can hospitals get involved in this initiative?
As patients come to understand that these hospitals are outstanding institutions, with terrific and caring staff, they will start to put travel into their healthcare calculus. The journey of discovery starts with accurate information. Ultimately, that is a tremendous step for the patient.
We have been busy putting the word out about this project. International hospitals have been quick to recognise the power that WHM will provide the market place, notably the creation of a rational market in which hospitals, patients and payors can participate on a level plane. Hospitals can contact us at info@worldhospitalmonitor.com, and we can get them on board.
Roger Amato is publisher of the World Hospital Monitor, a global initiative launched from The Aequitas Group of San Diego, California. Amato has had a long career in media and communications in the healthcare sector, where he has owned and operated some of the largest medical information companies in the world.
Interview with Christopher Jones
You are planning a documentary film on medical tourism entitled International Rescue.
Yes. The film is my way of showing that the same quality known to exist in first-rate Western clinics can be found elsewhere in Asia, South America, Eastern Europe and the Middle East. For many readers, that’s not news, but for the general public, particularly in the US, it is. There’s more to it than that, though. The real question to us, from a humanitarian perspective, is not whether cutting-edge procedures such as stem-cell therapies are good or bad; they are probably both good and bad, depending on where you sit in terms of moral and ethical views, but rather will healthcare access to the poor be stifled or accelerated by emerging niche markets? Is medical tourism imperialism revisited, or the democratisation of modern healthcare? We hope to find the latter is the case, and to illustrate this in International Rescue.
What will your documentary film do for local communities in foreign destinations?
Stated simply, we intend to show the wider human value of medical tourism. On the one hand, those clinics offering high-value treatments in foreign destinations instill new hope for patients in need of quality and affordable care. On the other, placing such hospitals in regions that improve local economies is capacity building. Done right, this could be a win-win situation for hospitals and communities. The proceeds from the film will help orphanages local to those hospitals just as the increased flow of patients to top hospitals will build upon their ability to offer health services to locals.
In America, searching for support, the healthcare industry has principally relied on income and profits from specialised care, industry-guided research and government funding. In addition, however, there is a tremendous amount of philanthropic wealth that is eager to be put to good use.
In the UK, a similar situation is where several trusts collectively account for the largest healthcare funding bodies in the world. In conjunction with the award-winning film producers at Golden Light Studios, our team is backed by over 30 charitable individuals, including principals of investment houses and executives in every major motion-picture studio. Our mise en scène will be foreign hospitals and neighbouring local communities. These hospitals will need to demonstrate their ability to give back to local communities if they want to be seen on the big screen. The film will also address other matters, linked to the patient’s willingness to explore foreign alternatives to domestic healthcare. I have a theory that a form of contingency management might be a good way of empowering patients to understand value for money.
Define contingency management; how could this help the patient?
Contingency management or voucher-based reinforcement has historically referred to paying drug-abusers to stay drug-free. When I was working at NICE in England, we saw excellent results in keeping people off the drugs by targeting at-risk individuals and offering money or vouchers as a reward for staying clean. When we looked at the cost-effectiveness, it was far better value for money to reward good behaviour than to pay for the down-stream consequences of bad ones. The long-term consequences of poor decisions turn up as financial stressors on emergent care, the criminal justice system and society as a whole.
How this relates to medical tourism is simple: new hospitals are able to start from a blank slate in terms of how they interact with the patient. By offering their patients incentives (holidays, return visits etc) to make wise health decisions, we can subtly raise health awareness and standards to new levels. By the same token, hospitals can give vouchers for emergent, outpatient or even preventative care to the local communities. My research suggests that socially minded patients would be willing to pay for such an initiative. It all starts with the patient and this will become clear in International Rescue.
Dr Jones can be reached on cjones@aequitas.us or through his personal website at www.investigativehealth.com. Golden Light Studios is asking any hospital holding excellent standards that would like to be considered for participation in this series to get in contact. All proceeds will go to the Our Orphans Charity.
Dr Christopher Jones has worked in the fields of fertility, public health and medical tourism. He has two post-graduate degrees from Oxford University and has contributed insights to the National Health Services, Department of Health and Johns Hopkins University. He is director of health economics and outcomes research at The Aequitas Group.
