Competitive Benchmarking and Medical Tourism: The Case for a Value-Based Model

Highly awarded influential Healthcare Systems expert, Dr. Baez describes how Value-based delivery should define the framework for performance in medical tourism to ensure safety for patients.

Executive Summary

Medical tourism (MT) describes the travel of people to another country for the purpose of obtaining medical treatments. Quality has been the traditional driving force for MT, however, a recent trend is for people to travel for medical treatments for cost reduction considerations, thus creating an important concern for quality of care being delivered. The global nature of this market constructs a great challenge regarding setting up transparent and measurable standards that provide safety for patients.

Value-based delivery should define the framework for performance in medical tourism. Achieving high value for patients must become the overarching goal for the industry, with value defined as the health outcomes achieved per dollar spent. This goal is what matters to patients and unites the interests of all actors. Rigorous, disciplined measurement and improvement of value is the best way to assess standardized care across geographical boundaries.

Understanding that the global nature of medical tourism leads important system, practice and quality variations, an imperative presents for creating standards of care that allows patients to make informed decisions about, costs, quality of care and results. We propose developing a framework that combines patient-centered strategies with value-based benchmarking with open access data that can serve as system force to improve competitiveness and allows patients to make informed transparent decisions about their care process.

About Medical Tourism

Medical tourism (MT) is a form of health tourism that describes the travel of people to another country for the purpose of obtaining medical treatments. Quality has been the traditional driving force for MT, thus people would travel from less-developed areas to medical centers in highly developed countries for care that was unavailable in their own communities. However, the recent trend is for people to travel for medical treatments for cost reduction considerations. This creates an important concern for quality of care being delivered, and the global nature of this market constructs a great challenge regarding setting up transparent and measurable standards that provide safety for patients.

Recent publications appraise  the Medical Tourism market size to be one of USD 38.5-55 billion, based on approximately eleven million cross-border patients worldwide spending an average of USD 3,500-5,000 per visit, including all medically-related costs, cross-border and local transport, inpatient stay and accommodations. It is estimated that approximately  1,200,000 Americans traveled  outside the US for medical care in 2014.

About Value-based Healthcare delivery

“The only way to truly reform health care is to reform the nature of competition itself.” — Michael E. Porter, ‘Redefining Health Care: Creating Value-based Competition on Results’

Value should define the framework for performance assessment in medical tourism. Achieving high value for patients must become the overarching goal for the industry, with value defined as the health outcomes achieved per dollar spent. This goal is what matters to patients and unites the interests of all actors. If value improves, patients, payers, providers, and suppliers all benefit. Rigorous, disciplined measurement and improvement of value is the best way to assess standardized care across geographical boundaries.

Value is the true measure of system efficiency, when value improves, patients, payers, providers, and suppliers can all benefit. Thus by increasing value the economic sustainability and overall quality standards of the healthcare system, in turn, will increase as well. Cost reduction without regard to outcomes is dangerous and self-defeating, leading to false “savings” and limits on effective care.

To improve medical care in the Medical Tourism market, standardization, clear quality metrics and a framework for positive-sum competition must be achieved. We propose a reorientation around patient value, this way, a system will be developed that delivers sustained improvements in quality and efficiency; this in turn results in a positive sum competition framework.

Value should always be based on the customer and in a well-functioning healthcare system patient benefits should define rewards for all participants in the process. Since value depends on results, not inputs, healthcare value is measured by outcomes achieved, not volume of services delivered. Shifting focus from volume to value is a central challenge. Value is not measured by the process of care offered; process measurement and improvement are important tactics, but should not be substitutes for measuring outcomes and costs.

A global value-based benchmarking initiative

We need to understand that the global nature of medical tourism can lead to important and often dangerous system, practice and quality of care variations. Thus an imperative presents for creating standards of care that let patients and payers make informed decisions about costs, quality of care and results. We propose developing the framework for a value-based benchmarking and incentives platform with open access data that can serve as system force to improve competitiveness and allow individuals to make informed transparent decisions about their care process.

Similar to the United States Hospital Value-Based Purchasing (VBP) program developed by the Centers for Medicare & Medicaid Services’ (CMS’). The Medical Tourism value-based system will be designed to improve healthcare quality, including the assessment of quality of care provided by various international providers, services and centers.  Our proposed program attaches a value-based platform to international certification standards and ultimately to a payment system for institutions all over the globe embarked in international patient services

The program will use a set of expert stablished quality data integrated with procedural/ intervention and hospitalization costs; thus creating an integrated clinical and economic value platform. Whereas the benchmarking initiative can start with selected “tracer” conditions that follow market trends and later expand on multiple processes across the spectrum of conditions. The benchmarking results will be published in a web-based outlet and participating institutions will promote their transparency as a value-added initiative. For example let’s choose bariatric surgery, lets pick clinical and administrative indicators:

Clinical: average length of stay, ICU admits, Infection rate, Leak rate, re-intervention rate, average weight loss. Surgeon availability, Follow-up, team approach, Cost of the procedure. Credentials of the clinicians/ surgeons.

Cost: Benchmarked with US billing standards, packaged (inclusive of all services) vs only the procedure without incidentals (ICU time, additional tests, etc..)
A score system would be created that integrates standardized elements of quality, results in cost as a “Medical Tourism Value index (MTVI)” based on specific clinical conditions.

The system will include a formal certification by leading medical travel authorities and to maintain certification the provider needs to post their results and rating based on yearly results. The current framework is being developed in collaboration with the International Board of Medicine and Surgery.

Conclusions

There is a unique opportunity of creating a successful framework that integrates value-based concepts in an effort to bring transparency, efficiency accountability and better results in an already complex global market.