home email us! sindicaci;ón

Archive for Podcasts + Videocasts



Interview with ZixCorp’s Peter Wilensky

by David Williams

ZixCorp is a leading provider of e-prescribing and secure email services. Peter Wilensky is the company’s VP of Corporate Communications and Investor Relations, but he’s a lot more on the ball than your typical corporate mouthpiece. With degrees from Harvard and Wharton and a close relative who ran Medicare and Medicaid, he’s got deep knowledge of health care, technology and business.

Peter and I discussed the benefits and challenges of e-prescribing, the role of health plans in paying for it, and the relationship between e-prescribing and electronic health records.

icon for podpress  David Williams interviews ZixCorp's Peter Wilensky: Play Now | Play in Popup | Download (45)

Here’s the transcript.

David Williams: This is David Williams, co founder of MedPharma Partners and author of the Health Business Blog.

ZixCorp is a leading provider of e prescribing and secure email services. Peter Wilensky is the company’s VP of Corporate Communications and Investor Relations. He’s a lot more on the ball than your typical corporate mouthpiece. With degrees from Harvard and Wharton and a close relative who ran Medicare and Medicaid, he’s got deep knowledge of health care, technology, and business.

Peter and I discussed the challenges and benefits of e prescribing, the role of health plans in paying for it, and the relationship between e prescribing and electronic health records.

Peter, tell me a little bit about ZixCorp.

Peter Wilensky: We have two core businesses. One is email encryption, which is really how the company was founded, back in the late ’90s. And initially, we focused the email encryption on health care for HIPAA compliance, so we’ve been a health care IT focused company, really, almost since the inception of the company.In 2003, we acquired a startup called PocketScript, which was an e prescribing vendor, and then entered the e prescribing space, which is our second core business today. And both of them run as a managed service, hosted in our SysTrust certified data center in Dallas. They’re both a high volume of sensitive transactions that we manage on behalf of our users, and that’s kind of what links the two businesses together.

David
: And the platform, the client is a mobile solution? Or is there a desktop component or service..?

Peter
: Yes. There’s both, actually. We view both businesses as platforms. One’s the data center. Specifically, with e prescribing, it is the real time connection to the doctor at the point of care. So our typical deployment would be giving a doctor the handheld, and also there’s a browser version that the office staff uses so that they’re able to efficiently work with the system as well.

But mobility is a very important aspect of providing that information. When they’re in front of the patient, in the exam room, that’s really how you get the value from e prescribing. We actually started with Blackberries…
Because anywhere the doctor was –he could be in the office, out of the office, at home– would be great. We found, however, that Blackberry basically ran over a cellular network, and then you always had coverage issues.

David
: Yeah. Inside, especially.

Peter
: Exactly. One exam room to the next, even one part of the exam room to the next, could have bad coverage. And if doctors didn’t get a connection right when they wanted it, they were likely to put the device down. So we’re now all WiFi, on a PocketPC based handheld, and that way we completely address the coverage issue, it’s faster; and those are important aspects for the doctors to keep using the device.

David
: And when the physicians use the device, are they mainly writing out new prescriptions, or what about renewals? Is that what the desktop is for?

Peter
: The desktop helps facilitate the renewals. Most of the doctors would write new prescriptions from the device. The patient comes in, they can pull up eligibility, which gives them their formulary. We can pull up a dispensed drug history for interaction check, and you can send it right to the pharmacy.

A renewal works slightly differently, depending where the request for the renewal comes from…If it’s the patient in front of the doctor, and they’re just going to renew it during the visit, then the doctor can pull up the medication history and basically click the same drug and send it, and that’s that simple. You can do that from the handheld.

A lot of renewals would actually come either from the pharmacy or someone calling into the doctor’s office. That would most likely be a charge nurse at a desktop, who can pull up, electronically, the record, if it’s the same prescription, same form factor and all that, can click “yes, ” and he or she approves it. The doctor gets a signal at the bottom that says, “Nurse so and so has approved this refill. Do you approve?”

And the doctor can just click “yes.” So, rather than doing a chart pull and reviewing everything, it’s a couple seconds. Most doctors, I think say, “If a charge nurse reviewed it and OK’ed it, then I’m probably going to OK it.”

David
: Yeah. And the renewal, though, is coming from, it’s a phone interface, right? So the nurse still has to listen to it?

Peter
: It may or may not be. If it comes into the pharmacy, the pharmacy can send it EDI. So the same EDI that sends a prescription to the pharmacy can receive a request from the pharmacy, pops right into the application, and the nurse can click through and just hit it, and it goes right to the doctor’s handheld. So it can all be electronic.

David
: Now, I understand that a lot of the so called e prescriptions actually have a fax component in them somewhere.

Peter
: They do.

David
: Is yours a faxed solution?

Peter
: We do both. So if there is an EDI connection, we work with a partner, SureScripts, which you’re probably familiar with as a connectivity partner for vendors like us. If they’ve established an EDI, we’ll send it EDI. If they don’t, then it will go by fax.

David
: And what’s the proportion of faxes to electronic these days?

Peter
: It varies by location. Really, it seems like certain regions kind of come up together.

David
: Right.

Peter
: So I believe there are certain regions, probably Massachusetts, who are heavily EDI. Other locations are a probably a majority faxes and kind of working toward that all the time. And as you probably know, if the whole thing’s electronic and you still have faxes, then you have transcription errors, and you lose a lot of the potential efficiency.

David
: I know CMS has taken a dim view of e prescribing uses faxes and has proposed a new rule recently. Are you involved with that? What’s your view on whether that’s a good idea or not?

Peter
: We think it’s a good idea, because, again, if it’s more efficient, both for the doctor and the pharmacist, everyone’s better off, more likely to be safer because fewer transcription errors or other sources of error. So we think it’s a good thing. We weren’t involved. My guess would be that someone like SureScripts or the retail pharmacy industry was really driving the change, but we support it.

David: What’s the adoption rate for e prescribing?

Peter
: Our model is to first approach the insurance companies, or the payers, and get them to sponsor, on behalf of the doctor, the use of e prescribing. So we never approach the doctor and ask them to pay. It’s always free to the doctor.

David
: OK.

Peter
: So once we approach a payer and they say ‘I’ll pay for 500 doctors or 1, 000 doctors’ then we work with those payers to identify who the highest prescribers are on their patients. And then we approach the doctor. So, we get the list started from the insurance company. When we get those lists we have a telesales staff that will try to set up appointments for a separate field staff that just calls on the doctors. When we get in front of them, we get about 50 percent sign up. We have 3,200 physician users.

So we have a pretty good ratio. And then, of the people who go through and complete the training, we have about 60 to 70 percent that become active users and regularly use the device afterwards.

David
: OK.

Peter
: We don’t actually think physician adoption is the big issue; it’s funding. That’s really the issue. Our model is approach the payers. They, from the purely economic benefits, have the lion’s share of the economic benefits. And we think it’s only fair for them to kind of pay the freight there. And so, for us, if the funding issue were solved, I think adoption would really take off.

David
: Right, OK. 3,200’s a respectable number, but it’s still a pretty low percentage of the overall physicians…

Peter
: Yeah, so we target the highest prescribers, which are generally primary care. There are 131,000 primary care physicians that are office based in the US.

And so, yeah, 3,000’s a pretty small portion of that.

David
: What do you find, in terms of the pattern of adoption? You’ve got a lot of people who probably have access. And then some are going to be writing all their prescriptions, or virtually all. Some are going to be writing one or two and drop off. Are there ones, also, in the middle, and how do they tend to shift around?…

Peter
: We find that most people who adopt adopt pretty much all the way. We look at 70 or 75 scripts as a key benchmark, or milestone for a doctor. Once they’ve written 70 or 75, we think they’re hooked. So there’s a learning curve. There is a change in workflow that’s involved. That’s where, to the extent that there is, a lot of resistance comes from doctors, because the highest prescribers are generally more established. They’ve been doing it for 15 or 20 years a certain way, and convincing them that it could be better a different way is sometimes a challenge.

Once we can get them these 70 to 75 scripts, then they’re pretty much hooked. We found once they’re there, they’re writing the vast majority. If they practice in multiple locations for whatever reason, they’re in the hospital and they didn’t want to use it there, then maybe those prescriptions would be written by hand. But most of our doctors primarily office based, and they write the vast majority of theirs electronically.

David
: And what happens if there is a prior authorization requirement? Does the system kick out a form for that, or…?

Peter
: Yeah, it can kick out a form. We work with the individual payer, depending on how they want to do it. In Massachusetts we’ve worked to develop a prior authorization form, and we’re working with other ones to see how they want to approach it. Ultimately we’d like to get to an electronic prior authorization, which would kind of work integrated into their back office systems. But we’re not really there yet, and mostly because the insurance companies aren’t there yet.

David
: You talked about a lot of the benefits accruing to the payer. Can you describe maybe what the benefits are, and why they accrue to the payer, as opposed to somewhere else?

Peter
: It’s particularly the economic benefits that accrue to the payer. There are really two sources of economic benefits. One is lower drug spend, and the other is patient safety benefits. On the lower drug spend, what the application does is when you’re in front of a patient, and you know their specific formula already, when a doctor goes to prescribe a drug, we can show alternatives that are maybe higher up on the formulary, and therefore a lower cost, both to the plan and to the patient, or generics, as another example.

Many doctors, when they’re presented with that information, will say, “Oh, sure”. Cheaper for the patient, they’re more likely to take it, they’ll go ahead and select a generic drug that obviously is going to end up saving the insurance company a lot of money. Or, I said, being more compliant with the formulary. In Massachusetts, they have about 3 or 3.5% savings on their drugs spend per doctor who uses e prescribing versus those that don’t use e prescribing. And also a $20 to $25 savings from the patient’s point of view in their co-pays.

From various other studies, and math we can do based on information we get from the payers, we think there’s a $4 to $5 per click savings for the insurance company when you factor in that they continue to get the savings on the refills. The other real source of savings is on patient safety.

One of the things that we can check in the prescribing process is an interaction with another drug, or allergies, or things like that. Again, in Massachusetts, which is our most established program, in December there were 8600 alerts where a doctor actually changed the prescription based on the alert. That’s on a basis of about 2000 doctors, so it’s a little over four per doctor per month, in terms of these changes.

There are various estimates on what a severe ADE, Adverse Drug Event, could cost, but I think the Institute of Medicine estimated $2000 to $2500 per instance. All 8600 probably wouldn’t have been that severe, but we know that if we’re preventing an adverse drug event that could result in a hospitalization or surgery, ultimately that’s going to end up saving the insurance company money for not having to pay for that.

We’ve also found with e prescribing that there’s a higher fill rate and compliance with their drug therapies. Therefore, over time, healthier patients cost their insurance companies less if they’re really taking their medicine.

David
: Why would there be a higher fill rate?

Peter
: I’m not exactly sure. We’ve seen it…, but we don’t know why. I don’t know if there’s a certain amount of patients that just lose their scripts, and that’s why they don’t fill it. Obviously if it goes right to the pharmacy, that’s not an issue.

David
: Right.

Peter
: If it’s a convenience factor that they want to go there, and it’s a half hour before they can pick it up, they say forget it. But here, it’s already filled when they get there. It could be those kinds of things, but we’re definitely seeing a reported higher fill rate.

David
: Electronic health records are getting a lot of attention. When people talk about e health these days, that’s mostly what you hear about. Pretty much every EHR would incorporate e prescribing. How does that play into your plans, or your business model?

Peter
: We look at it in two ways. First, there’s the near term. That’s three to five years. We focus particularly on the smaller end of the market. We don’t think there’s going to be a significant penetration of EMR’s, EHR’s, in the one or two doctor practices. They don’t have the time, they don’t have the infrastructure. You know, IT staff. They don’t have the money.

It’s significantly more expensive. For us right now, there’s kind of a greenfield. Most of the people who do e prescribing don’t do e prescribing on the small end of the market. So we think we can offer a lot of benefits to doctors and insurance companies, and get a good share of the market before the EMR really starts the penetration on the low end. Longer term, everyone will probably end up on an EMR or EHR.

We can integrate with anybody, but we’ll evolve, and continue to offer additional features, which maybe will be consider an EMR, EHR over time. Or, we’ll just partner with people, and integrate, and be able to trade information. So even the EMRE/EHR vendors who say they offer e prescribing, in almost every case, it’s a “jack of all trades, master of none”. So they’re e prescribing application is inferior to those of us who are really standalone e prescribing and are really focused on that. So we think there’s continued value we could add even just partnering with them.

David
: Have you been doing partnering actively today?

Peter
: Today we haven’t. Today we’re focused on just getting to doctors, and trying to get it out there as much as possible. Over time, it’s something we continue to look at, and we’ll evaluate opportunities. Right now, it’s not a key part of our strategy.

David
: What’s the state of play in terms of being able to present a patient specific formulary?

Peter
: We have partners with PBMs through RxHub, which is a consortium, originally started by the three major national PBMs. Others have joined over time. So the primary mechanism… we have some direct connections to insurance companies, especially if they’re their own PBM, as well that we can show. So if the information’s available, we can obviously show it. I’m not sure what the percentage of times we’re able to show it. A lot of it is finding a match for the patient. The match is defined by five specific fields. It’s first name, last name, date of birth, gender, and zip code to uniquely identify one patient. So if you don’t have a match –somebody misspelled it, or one of the data fields is missing– then we may not get a match when there’s really a match to be found. The other aspect is if they’re with an insurance company, or have Medicaid coverage, or are not covered at all, that’s not part of this consortium, then we wouldn’t be able to locate them.

David
: But if you find a patient, you can present the formulary?

Peter
: We can present the formulary, right, and the dispensed drug history. I believe we’re the only one that is also working with SureScripts to present pharmacy dispensed drug history. So we get, for the PBM, to show claims based dispensed drugs, and then we can show from the pharmacy. And there’s a large overlap. If you paid cash for a drug, or it’s not covered by the insurance company, the pharmacy would have the information that the insurance company doesn’t have.

If it’s mail order, it may not have it. The retail pharmacy may not have it. So we think going to multiple sources gets the most complete dispensed drug history to show the doctor, which obviously benefits everybody.

David
: What’s the role of the pharmacist in all of this?

Peter
: So, I think the pharmacist obviously benefits from, especially when it’s EDI.

It saves them time. There are fewer call backs, fewer potential errors, call backs for legibility, call backs because there’s a higher likelihood it’s on formulary or they’ve already prescribed a generic and so I think it makes the pharmacist’s job easier. Obviously, we need pharmacies to be connected and able to accept and process electronic scripts. I believe that the pharmacy chains, the major chains, have a much higher percentage than the community pharmacies, so if there’s a role for the community pharmacy, it would just help kind of build out the infrastructure so that everyone could get online and working.

David
: Right. But in terms of taking an active role, like in patient counseling or anything like that, does it tie into the prescribing, or it just gives them more time, and they don’t have to be calling back..?

Peter
: Exactly. It gives them more time to spend with the patient.

David
: Yeah.

Peter
: So, e prescribing, it’s not good for answering questions of “How do I do this? What do I have to watch out for?”

So I think there’s still a major role. And as you said, to the extent they have more time to spend with their patients and less calling doctors’ offices, I think they’ll benefit.

David
: What have you found in terms of the physician acceptance? It sounds like the physician appreciates being able to give something to the patient that’s going to match their formulary and save them time and all that. But compared to just sort of scribbling something on a pad and then letting somebody else deal with all those issues, that’s been one of the complaints.

Peter
: Yeah. So I think, initially, a lot of people think, “It takes me a half second to scribble something completely illegible on a pad, and they’ll figure it out.” Although, that’s really kind of, I won’t say short sighted, but it doesn’t really think of the whole process, because someone’s going to call back.

David
: Yeah.

Peter
: And a lot of times, even the nurse or the front office will have to go back to the doctor and say, “What is this?”
So it is good for the doctor, overall. What we found, really, is doctors who kind of take the plunge and use it, they love it. They say, “We’re never going back.” It’s Stone Age to be writing it on a pad of paper, when it can be so easy, and it gives you the added benefit of knowing that there are these safety checks going on, because a lot of doctors, if you rely on the patient to give you their medication history, they know that’s unreliable.

David
: Yeah.

Peter
: In particular practices we’ve seen other benefits. Pediatricians, for instance, say they love to kind of have a cool factor, where their patients appreciate the fact that it’s going electronically.
It’s kind of an ease of use and a knowledge of a safety net that, for doctors, once they’ve adopted it, the thought of, “I can scribble it in a second, ” is really some of the resistance we would get up front. Once they’re using it, then I think most of them say, “I’m never going back.”

What we’d like to do is go approach other payers in a given market and say, “Here, we have this capability to both save you money and improve the safety of your patients.”

“If you would pay just for the scripts for your members… So we don’t want you to subsidize anyone else, but I think it’s only fair for you to contribute for the scripts for your members.” We think that’s a viable model, and we’re working on, basically, in markets where we are, approaching other payers in those same markets, who then don’t even have to sponsor the deployment of the device. It’s already been taken care of. All they have to do is pay to play, right?

David
: At the scale where you are now, a big player, like Massachusetts Blue Cross Blue Shield, they’re not so worried about if somebody else is going to get some benefit, because they’re going to learn about it. But there is kind of a free rider problem, it sounds like.

Peter
: There is. Now, I think there’s a lot more value added functionality we can show to our customers.

David
: Like what?.

Peter
: We provide basic functionality. The doctor can use it for any patient that comes in, but there’s certain value added information we can show the doctors that will benefit an insurance company. Massachusetts was an anomaly, I would say. They have always been kind of leading edge. And from the very start, Blue Cross Massachusetts partnered with one of their biggest competitors, Tufts Health Plan and then added another one, Neighborhood Health Plan, over time. We’re not going to compete on e prescribing. Let’s make everyone safer. We’ll compete on other aspects; and they’ve been kind of forward thinking in that aspect.

Blue Cross of Illinois was another one that’s kind of taken that same approach. They say, “We’ll pay to get it up and running. We want all the other payers…”
In the model I was talking about, you pay for your own members, and we’ll help build the infrastructure. And I think that’s a model that’s going to be successful as well. It’s relatively recent, so we’re really just getting it deployed, but it’s another model that I think is a way to go.

And I think these collaborative approaches make a lot of sense, because you want to get the broadest coverage, be able to show information on the broadest amount of patients that you can, and that requires participation from all the various payers in a given market.

David: What about patient adherence?

Peter: Until there was e prescribing, there was no electronic record of what was prescribed. You can get what was dispensed. If you have an electronic record of what was prescribed, you can look for the delta, and that identifies areas of non compliance.

David
: Right.

Peter
: So we’ll be able to give a message to a physician, or to a patient or to a health plan, to say, “David didn’t pick up his insulin, and therefore is probably not being compliant with his therapy.”
There are other things… Prior authorization we discussed earlier. Online disease management program enrollment, so certain indications or certain prescriptions will trigger, “Let’s send you information and get you into a disease management program for, say, diabetes.”

Those are things that we’re working on.

David
: When you start to talk about things like adherence and compliance, certainly the ears of the pharmaceutical industry perk up as well.

Peter
: Right.

David
: Is there a potential role of working both with health plans and with pharma companies?

Peter
: Historically, the pharma companies and the health plans are a little at opposition on a lot of issues, so right now, we’re focused on the health plans. I think, as you say, pharma would definitely benefit. I mentioned earlier, we’re seeing a higher fill rate on our electronic prescribing, so they ought to be happy with that.

At the same time, by providing doctors information on different drug therapies, that is maybe a counterbalance to all the direct to consumer marketing, so maybe they’re not quite as happy about that.

David
: Yeah.

Peter
: Because of that tension, maybe, between pharma and insurance companies, we don’t want to get in the middle of that, at this point.
So, I think there’s a benefit, but I don’t know how much that will work. People have said e detailing, for instance, is maybe something we could do. That’s something we haven’t wanted to get into yet. Down the road, there are all kinds of possibilities.

David
: I’ve been speaking today with Peter Wilensky, ZixCorp’s Vice President for Corporate Communications and Investor Relations. Take care.



Interview with Jim Guest, President and CEO of Consumers Union

by Hylton Jolliffe

Malorye Branca interviews Jim Guest, the president and CEO of Consumers Union. From the 4th Annual World Health Care Congress. For more coverage from the conference click here.

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Podcast Video [3:19m]: Play Now | Play in Popup | Download (100)


Theodore Lutins interview

by Hylton Jolliffe

Theodore Lutins, a consultant with MedWorks, talks about his company’s mission and his impressions of the 4th Annual World Health Care Congress. For more coverage from the conference click here.

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Podcast Video [2:06m]: Play Now | Play in Popup | Download (71)


Thomas Stegmann on new blood vessel growth treatment

by Hylton Jolliffe

Malorye Branca interviews Thomas Stegmann, whose company - CardioVascular BioTherapeutics - has developed a novel medical therapy that encourages new blood vessel growth in damaged hearts that could, says Stegmann, prove safer and more cost-effective than traditional therapies. From the 4th Annual World Health Care Congress held in Washington DC in April.

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Thomas Stegman: Play Now | Play in Popup | Download (102)


Tadataka Yamada of the Bill & Melinda Gates Foundation

by Hylton Jolliffe

Malorye Branca interviews Tadataka Yamada, President, Global Health Program of the Bill & Melinda Gates Foundation. From April, 2007.

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Podcast Video: Play Now | Play in Popup | Download (104)


Kim Slocum interview

by Hylton Jolliffe

Malorye Branca interviews health care consultant Kim Slocum. (This and other video interviews we’ve been posting are from the 4th Annual World Health Care Congress held in Washington DC in April. We’ll be releasing more in the coming weeks.)

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Podcast Video: Play Now | Play in Popup | Download (92)


Keith Batchelder Interview

by Malorye Branca

A consultant specializing in personalized wellness, Batchelder discusses how this trend will affect health care overall. From the 4th Annual World Health Care Congress.

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Podcast Video: Play Now | Play in Popup | Download (103)


Interview with medical tourism author Jeff Schult

by David Williams

Jeff Schult,  author of medical tourism book Beauty from Afar: A Medical Tourist’s Guide to Affordable and Quality Cosmetic Care Outside the U.S., began writing the book when he journeyed to Costa Rica for major dental work. What started out as a magazine article turned into a full length book once he got to Costa Rica and learned the extent of the medical travel phenomenon. As the name implies, Beauty from Afar focuses mainly on cosmetic and dental procedures. However, he does delve into some of the more “serious” treatments as well. The afterword of the book is written by Curtis Schroeder, CEO of Bumrungrad International in Thailand.

You can listen to the interview at MedTripInfo.



Podcast interview with Rudy Rupak, Founder and President of Planet Hospital (transcript)

by David Williams

This is a transcript of my recent podcast interview with Rudy Rupak, founder and president of Planet Hospital. You can listen to the audio version here.

David Williams: This is David Williams of Medpharma Partners and the Health Business Blog. I spoke earlier today with Rudy Rupak, Founder and President of Planet Hospital, a company that arranges medical travel to fourteen international destinations. Listen in to hear Rudy and me talk about the ins and out of medical travel; what patients can expect when they leave the country for care; how insurance carriers are thinking about coverage, and what happens to patients when they return to the US. Rudy, thanks for joining me today.

Rudy Rupak: Hello David. Thanks for having me.

David: Rudy, tell me a little bit about how Planet Hospital works. What sort of services do you offer?

Rudy: We are in the business of saving our clients lives. We do this by helping them find the best possible care in any of our fourteen different destinations for their health care needs as well as for their financial and time needs. We do this by finding the most appropriate surgeons from one of our destinations and we are able to bring hard-to-find treatments for people who need it the most.

David: Now what sort of destinations are you talking about? Are these all outside the US?

Rudy: These are all outside the US. However, we have been bringing some patients into the US as of late, especially from the Middle East.

David: How would you distinguish what you do from what others do; from what other agencies that are involved in international medical travel do, or from people just arranging these trips on their own?

Rudy: We didn’t focus so much on price when we first started the company, and we still don’t. We focused on quality and in doing so we basically choose the absolute best surgeons we could find around the world, including in the US, and made them part of our network. Usually, with very rare exceptions a good surgeon works at a great hospital in an international location. The hospital benefits by being associated with great surgeons and the destination is an afterthought.

If a good surgeon happens to be in the JCI hospital in India then that is where we would recommend our patients to go to. But we don’t just provide them with a choice of one surgeon, we provide them with multiple choices…

David: How do you identify these good surgeons in the first place?

Rudy: Well we review things like medical journals. For… oncology, who’s out there that’s doing a lot of research and is recognized by their peers in their field? Who is Western Board certified and / or Western educated? What have their success rates been? What is their bedside manner like?

I will meet them, I will interview them, and I will do some background research on them. I will also look at their teams. If we have a great surgeon but he happens to work with a local, nondescript anesthesiologist it’s a cause for concern for me. If, on the other hand, he’s got an outstanding anesthesiologist, an outstanding scrub nurse and an outstanding OR assistant then I know that this is somebody that I would put my life into their hands and I can comfortably feel that the patients can do so as well.

David: You mentioned JCI facilities. Can you tell me what JCI is and what that means for a patient who might be looking for medical travel?

Rudy: JCI is the International body for JCAHO, which is the Joint Commission on Accreditation of Healthcare Organizations, and this is the body that accredits the quality of a hospital in the US. In fact, any hospital in America must be JCAHO in order to receive work with an insurance company. To work with doctors and Medicare they must be JCAHO. Now, a lot of international hospitals are not JCAHO yet but a lot of the good hospitals are getting there.

David: So, if somebody has JCI accreditations is that the same as a JCAHO accreditation or are there some differences in what they are required to do?

Rudy: Standards of measurement may be the same but the standards of scrutiny unfortunately are not, and that’s where JCI lags. Hospitals here live in absolute dread that a JCAHO inspector will just show up, unannounced. The hospitals overseas at least have the comfort of knowing that that’s not going to happen - currently. But we’re not worried about that because they are trying to maintain great standards. They have to if they’re going to be in the business of international guests.

David: Now what specific services would you provide to a patient who is considering traveling overseas for medical care? What would they get if they worked with you compared to just making arrangements on their own?

Rudy: Well, patients are kind of divided between what we call “wants” and “needs.” A “wants” patient is typically somebody who wants a cosmetic dentistry or cosmetic surgery, IVF or surrogate pregnancy. The needs patients happen to be people who need more elective care such as orthopedics, cardiology, neurology, cancer surgeries and other general surgery.

David: And what sort of services would you provide for those different types of patients?

Rudy: We offer a complete wraparound service for anybody who wants Medical Tourism. That means when they first contact us they speak to a doctor or a nurse within our company. These doctors and nurses do a pre-consult with the patients. They then recommend the various surgeons that would be appropriate for the care that they are looking for. Ultimately, of course, the patients choose that. We then book the surgery date; we then book their flights, their hotels and even take care of their passports and visas. Then we have staff that meets the patients in the destination country where the procedure will take place and we take care of them from the moment they land to the moment they leave.

David: That sounds like a pretty comprehensive kind of a service. Does that tend to erode the savings?

Rudy: We charge exactly what the hospitals charge. We don’t mark-up the cost of the care so when they’re getting all these services it’s a ‘value add’ by working with us versus doing it themselves. We’ve done the research for them already. They’re getting the benefit of our research and then the benefit of our ’strength in numbers’ when dealing with the hospitals to get good savings and good care. Optionally the patients could pay $395 for the concierge service.

David: And what do they get in addition if they want to have the concierge service?

Rudy: First of all we would book the airfare for them and [if] they need to change their return trip there’s no penalty charge; that’s the first benefit. The second benefit is that somebody meets them at the airport when they land, gives them a mobile phone and escorts them to their hotel or the hospital, is with them on the day of the surgery, is with them on the day of they’re discharged, takes them to the hotel, arranges any special request that they need. If something should go wrong, there’s somebody within our company there to take care of them. Not that we would do that if they didn’t pay the concierge, of course we would. At least you know that there’s somebody on your side in a foreign country,

David: Right.

Rudy: It makes a huge difference and for $395 most people don’t argue the point. I mean heck; they save more than that if they’re changing their flights alone.

A lot of people need to change their flights because… they need to stay longer.

David: Now are the airlines seeing this as a market for them and are they making any accommodations for patients who at least have some sort of disability when they’re going over and then still maybe recuperating on their way back?

Rudy: Some are exploring it; one airline and I have just recently partnered together on creating cosmetic surgery packages to Costa Rica and Panama.

David: I notice when you talk about your destinations, you have some destinations that are in the Western hemisphere and then some that are over in Asia and my understanding is that typically more of the serious sort of orthopedic or cardiovascular surgeries are typically done in Asia. Are you also seeing the ability to do those in the Western hemisphere?

Rudy: Well, if you define Belgium as Western hemisphere then yes. A lot of our orthopedics clients are going to Malta and Belgium right now. They’re giving India a good run for their money since the costs –when you’re include the air and the hotel– the cost between India and Belgium, the gap narrows very significantly.

David: Can you tell me a little bit about the typical customer? You talked about your “wants” customers and your “needs” customers but can you personalize that or just give me an example of what a typical customer might be like?

Rudy: Sure, on the “wants” side they are typically female, 40 plus [years old], whether it’s cosmetic surgery or whether it’s dental or IVF. In the “needs,” I describe them as too wealthy for Medicaid and too young for Medicare. And I often describe them as the rude awakening clients, who have Medicare, but they just learned for the first time that Medicare doesn’t cover everything they thought it did.

David: So they would be typically someone in their 60s or 70s that’s experiencing what looks like it’s going to be a costly procedure and they find out that Medicare doesn’t cover it and they look for alternatives?

Rudy: Right, well Medicare won’t give them what they want. Medicare will give them medications but not surgery.

David: What happens for patients that have a commercial insurance? Do you have patients whose commercial insurance would pay for them to go overseas? Or do you also find this similar sort of a gap like you described with the Medicare patient where someone may find that something is not covered and they go abroad even though they’re insured in the U.S.?

Rudy: We believe the future of our business lies in insurance. And to date we’ve managed to convince the insurance companies to pay for five of our client’s surgeries so far. We’re working with insurance companies to help them wrap their heads around this. We feel that insurance is definitely a market; I think we’re going to get there. This industry will definitely change when insurance companies start to adopt it more and more. We’re definitely leading the charge in that area.

We’ve got five different opportunities; I’d say two low hanging fruit opportunities and about three opportunities that would be like a one year’s adoption cycle. And I’m going to do an analogy, for a moment, to another form of outsourcing that we are familiar with. Healthcare outsourcing is what we do.

12 years ago, [software] outsourcing didn’t even exist as an industry. It was a niche beyond a niche and companies that adopted it originally were very small businesses. I think they had some data worked on that they couldn’t do cost effectively themselves. Then 12 years later, there’s 30 companies in the outsourcing industry that have a market capitalization of over a billion. And seven years ago, overseas call centers entered the field. Year one most people that used them were some marketing outfits and specialty agencies or again, data entry and suddenly there’s over eight companies in that field that are a billion dollar market cap.

So, the industry has a good future, but how to get there, it can’t be consumer driven only. The institutions will have to adopt it.

David: What do you see as some of the drivers of that? Obviously there’s the high healthcare cost but are there particular issues or barriers that an employer or health plan would have to get over before they could see this as a mainstream sort of outsourcing opportunity?

Rudy: What I typically tell a lot of insurers is that America does have the best healthcare in the world. There’s no argument about that. But! Only if you can afford it; and healthcare is becoming more and more expensive… Companies get into a crisis over promises made relating to healthcare; whether it’s retiree benefits, whether it’s employee benefits or union contract. It’s starting to hurt a lot and not just in the private sector but in the public sector as well.

What we do… drives down the cost, but the quality [is] driven up as well. You [can] get the equivalent of a high-end hospital in America for a lot less, and that’s good value. I can get you a surgeon for cheap. The quality barrier we have managed to address very well. They ought to and meet and review the type of surgeons we’re talking to.

The next barrier is obviously malpractice and there have not been any instances, knock wood, of situations like this.

David: What kind of reaction do people get these days when they say they’re heading overseas for a medical procedure? I can imagine if you’re talking about a Medicare population, these are people who maybe have not traveled internationally before and all of a sudden, they’re getting on a plane to go over to Thailand or India. What sort of reaction do they get from their friends and their family?

Rudy: We’ve had patients who’ve never even left Georgia or Iowa and are now getting on a plane to go to India. So I think it’s a huge culture shock! Usually, there is a bit of fear in the patient and then it’s exacerbated by friends and neighbors telling them, “Don’t do it,” and, “You’re going to wake up missing a kidney,” or some strange story like that. But they come back with amazing stories and they turn skeptics into believers.

So what happens is that I hear the word “dignity” used a lot. “I was treated with dignity at this hospital.” That I hear, over and over again, because they are so tired of that mistreatment that they seem to receive in American hospitals.

David: Now do you think that there is going to be any impact on the US healthcare system from competition, if you will, overseas and in terms of improvement of customer service, the sorts of things that you are talking about for dignity or even on the price side?

Rudy: I hope so. I mean, healthcare is one of the few companies, industries in America that has no competition. Hey, competition is healthy –if you would pardon the pun. I remember my mother describing a hospital in Connecticut where it was like going into the Shangri-La hotel. It was bright, it was beautiful and she was a private payer. They took such great pampering and care of her. Now the same hospital no longer does that. They have been cowed by malpractice and cowed by cost control just to provide the most basic of services and doctors are practicing defensive medicine, you know, because they are hearing of lawsuits and so a lot of their cost has been because of a litigious society more than anything else.

David: Do you see any changes already underway? I am thinking, for example, in the area of cosmetic surgery, which has been self-pay for long time and which has been popular for overseas travel. Do you see any impact on the US cosmetic surgeons?

Rudy: No, not really. US surgeons are still busy. They are still making millions and they are still doing well because there’s a certain population that just will not go overseas for that kind of care and they believe that American doctors are the best. And I agree with them, they are the best.

The changes I am seeing are certain American plastic surgeons are now working with us to travel overseas to do certain cases as well.

David: You are actually finding that you got US physicians coming with you overseas in order to enhance their reputations?

Rudy: We have got this program called “Best of Both the Worlds,” which is one of the low hanging fruits I was talking about in the insurance world, where an American physician travels to a foreign destination and takes care of American patients, …and then the follow-up care is back in the US. Only the geography of the surgery changes. That change has significant impact on the cost.

You could have your executive health checkup overseas. We are now doing this program: colonoscopy, cardio test, lab test, EKG, and 64-slide CT scan, all for $1995 with air, hotel, and meals included.

David: Now Rudy, tell me about how you got into the field because you are obviously one of the trailblazers and you had Planet Hospital for a bit. How did it all start for you?

Rudy: We started the company in 2002 when my fiancee and I were traveling overseas in Bangkok. I describe her as a professional patient and she got ill while we were in Bangkok and refused to go to a third-world hospital. She had visions of…you know, tents instead of buildings. And I tell her, at least get a shot of painkillers and come back to the hotel room or something. Now we go there and this hospital was just truly amazing. And, she had her own private nurse, a doctor who saw her within 20 minutes of her arrival, took ownership of the problem, and a chef to take care of her meal requirements based on the doctor’s orders. After three days stay with her medications, tests, etc., her bill was a staggering 411 dollars. And that’s when I thought there is a business here.

David: What if someone travels all the way to India for a hip operation and then they find out when they are there that the surgeon thinks that it’s actually a different diagnosis? Does that happen and how do you deal with it, if and when it does?

Rudy: Let me give you a bittersweet story. We have a client who needed tour help… we sent her to Singapore ultimately for her breast cancer and follow up on her radiation. She was also told that she was going to get cataract surgery done [in the US], but she decides to put it off, and get the breast surgery done instead. And since she was going to stay there for six weeks and get radio, we thought why not get the cataract surgery done there, too. Now the surgeon in Singapore did some tests and said that you don’t have cataracts. I don’t know why your American doctors told you have cataracts; you do not have a cataract problem. The problem seems to be behind the eye. So we did a diagnosis and discovered that she had cancer [in her optical nerves]. So here’s a patient from America who was ready to get cataract surgery even though it would have done nothing for her and she learned, you know, that she had a different condition now. It’s a good thing that happened there because it obviously got caught there and it is going to cost her a lot less to get it fixed there. While she is there now she is taking care of this issue as well.

David: How about coordination between the US and overseas? Some of these patients, I imagine, don’t have a good primary care relationships, but what happens when the patient inevitably needs some sort of follow-up even if there is not a complication from the procedure? Do there tend to be tensions between the US physician and the fact that the patient was treated overseas? How do people handle that?

Rudy: Not really. I mean, because they don’t have insurance, they are used to being cash-paying patients and so we have a network: it’s small now, but it is growing. A network of physicians, primary care practitioners, and specialists throughout the US that we recommend…

David: These are people within the US who are…

Rudy: …willing to see my patients after they come back.

David: OK, so you have a real international network that’s both here and abroad.

Rudy: Correct.

David: How do you expect the field to evolve? What do you think we will see if we look back five years from now? What will we see?

Rudy: I think we will see a lot of insurance companies adopting the concept of medical tourism. I think it will become a more common, acceptable practice with, on one side baby boomers going to exotic locations to get plastic surgery done where they can lose a decade in a day, to retirees and employees of companies being given the option of getting healthcare carried out in the US or abroad.

David: I have been speaking today with Rudy Rupak, Founder and President of Planet Hospital. Rudy, thanks for very much for your insights today, I really appreciate it.

Rudy: It was a pleasure, thank you again for having me.



Matthew Holt interviews Jonathan Cohn, author of “Sick”

by Matthew Holt

Matthew interviewed Jonathan Cohn, the author of “Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price”, at the recent 4th Annual World Health Care Congress. Cohn, a senior editor at The New Republic, lucidly shows, says this New York Times review, “how America’s system for financing medical care helps determine who gets proper medical attention — and who doesn’t.”

Watch Now:
...
 previewImg 
.. ..
icon for podpress  Jonathan Cohn interview: Play Now | Play in Popup | Download (236)
Next entries »