Containing the costs of treating international patients

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Staying in the green

The medical needs of the growing numbers of international patients have been pushing healthcare costs for insurers, healthcare facilities, and patients alike. Femke van Iperen investigates the key measures that today’s industry is taking to help contain these costs

As more and more people are travelling the world, be it for work, relocating or leisure, more are also finding themselves in need of medical support when abroad.

International patients need medical support for a variety of reasons, but according to experts such as Stephen Ho, Global Marketing Director of insurance broker Pacific Prime, they are mostly related to chronic conditions such as high blood pressure and high cholesterol, as well as injuries, maternity and dental care. 
Soraia Arroyo Lynch, Vice-President of Networks at GMMI, Inc., indicated that when looking at the company’s claims’ history, the reasons for travelling patients seeking medical care have remained largely consistent over time; and she listed the most common ones as related to diseases of the respiratory, musculoskeletal and digestive systems. Particularly among expats and long-term travellers, however, she has noticed an increase in neoplasms or cancers. And more recently, she has also noted a rise in the number of patients travelling to the US for CAR-T and transplant services that may not yet be available in their country, as well as a rise in ‘non-age-related prescribed medication’ among international patients.

When looking at the company’s claims’ history, the reasons for travelling patients seeking medical care have remained largely consistent over time

When it comes to starting a new job in a different country, there may be additional emotionally challenging demands, cultural barriers and the lack of a support network – as well as an increasing number of what Dr Mitesh Patel, Medical Director of Aetna International Inc., termed the ‘globally mobile’ who are also in need of mental health support. A review of Aetna’s global membership data between 2014 and 2016, for example, showed a 33-per-cent increase in medical insurance claims by international patients seeking mental health support in Europe, a 28-per-cent increase in the Middle East, and a 19-per-cent increase in Southeast Asia.

Matching standards

Not only are numbers of international patients on the rise, today’s well-informed international patient is also on the lookout for a service that matches standards at home; with high-quality, around-the-clock healthcare in their own language. 

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Pacific Prime’s Stephen Ho notes that international patients most often need medical support for chronic conditions such as high blood pressure.

“In the emerging countries that tend to attract expatriates, international patients expect, and will only use, a high quality of treating medical facility, preferably in their own language,” said Eugenia Guskova, Key Account Manager at AP Companies Global Solutions. This is particularly the case, she has found, in the newer expatriate-oriented clinics that often have English-speaking doctors available and the capacity to accept payments in international currencies. They often have a monopolised position in the region – something she considers a primary cause for the increase of the claims cost of some of the main international insurers – and this can make the rates of such clinics two- to 10-times higher than the local R&C (reasonable and customary charge) ones, she has found. 

Today’s international patients often also request practical assistance with the navigation of unfamiliar medical systems, immigration services, lodgings, transportation, and medical translations, said Nicole Commander, Manager of Assist & Medical Management at Seven Corners – and they are often directed to medical facilities with ‘culturally-competent medical and support personnel, 24/7 language interpretation, and familiarity with diseases endemic to the patient’s home country or region’.

A costly affair

Costs can vary, but they can be particularly high in the case of prolonged hospital stays, ICU admissions and more complex repatriations, Commander has found.

Meanwhile, Stephen Ho considers a ‘lack of oversight on the cost of private treatments’ as a key factor for driving up medical costs. For example, a routine delivery in China can cost from US$2,000 to $20,000, and he said that this makes it very difficult for insurers to predict costs and price premiums. But, in his experience, medical bills get particularly high when patients are kept in hospital with no hope of recovery on life support. In such cases, he noted: “It’s not unknown for costs to be in the region of $0.5 million.”
Medical support for an international patient can also be costly when they there is no plan in place in the event of an emergency, said Lynch: “When travelling, knowing whom to call in case of an emergency can save thousands of dollars – not to mention peace of mind.”

In addition, cost is area-related. “A one-night stay in a US ICU can cost upwards of $5,000, whereas a one-night ICU stay in the Philippines can cost less than $1,000,” added Commander. 
Indeed, Ho noted that Pacific Prime´s 2019 Cost of International Health Insurance Report found the US to be the most expensive country for international health insurance for both individuals and families. He added: “Canada overtook Hong Kong as the second most expensive country for both individual and family IPMI rankings.” Whereas Thailand, he noted, was ranked the least expensive country*.

Costs can vary, but they can be particularly high in the case of prolonged hospital stays, ICU admissions and more complex repatriations

Sector response

“Today, anyone utilising only traditional ‘cost containment techniques’ for managing international patient costs – or essentially attempting to get a discount on a bill after the service has been rendered – is losing out,” argued John Spears, Global Excel’s Vice-President of Business Development and Marketing. “As healthcare costs continue to rise unabated around the world, the industry needs to adopt new techniques which provide better customer service, while at the same time minimising net paid claims costs.”
So, with international patient numbers growing, and their medical needs getting more complex, what key cost containment measurements has the sector been using to manage the resultant increasing costs?

Accurate diagnoses

First, the use of patient co-ordinators, monitoring and interpreting services, and more transparency in general, are all measures that can be taken to help ensure accurate diagnoses and avoid over utilisation, a key sticking point when it comes to international health claims.
A team of assistance co-ordinators, such as the one at Seven Corners, will ensure that in some cases – when clinically appropriate – a patient is transported back home, particularly if this helps avoid large hospital bills in case of a long stay.

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In the US particularly, medical costs can be very expensive.

AP Companies’ automated cost containment system has been helping it control charges implemented by medical providers – for example, by safeguarding that prices listed in the claims match those of the providers and making sure that any inconsistencies are flagged up. 

Care of Asia crew too warrant that through daily monitoring practices, peer-to-peer consultations, and pre-booked medical appointments, unnecessary trips to emergency rooms can be avoided, Dr Pierre Cooper of the Medical Department at Care of Asia Ltd explained. Or they may, for example, recommend that a patient seek new advice from their hospital back home to avoid purchasing medicine that may turn out to be superfluous to their needs.

It is in particular regions such as the Middle East, Dr Patel has found, where medical professionals may work on a fixed salary and commission (and there is potential for a higher prevalence of over-prescribing and unnecessary tests) where he has found advanced business intelligence software useful to ‘help identify health providers whose billing, treatment or patient demographic profiles differ significantly’. 

Innovation is key

When it comes to driving patient engagement and improving patient access to care – as well as negating the need for office appointments with doctors and urgent care trips or non-emergent visits to the ER – there are also innovations in telemedicine and state-of-the-art equipment that have started playing a key role. 

Although experts such as Ho assert that many insurers are still testing certain innovative measures to see which can deliver the best client experience – and Lynch, for example, has found that a high number of clients still prefer a face-to-face experience.  There have been considerable cost-saving and client-experience improving results attributed to innovations in medicine.

The electronic information and telecommunications technologies of telehealth – which give patients opportunities to benefit from some health services from home – for example, is hailed by some as ‘one of the fastest growing healthcare delivery services in America’ for its potential to ‘enhance engagement between patients and providers, improve health care maintenance, and, in some instances, avoid unnecessary and costly acute care settings’**.

“Downloaded data from wearable health-measuring devices into electronic health records allow clinicians to have remote access to patients’ real-time health data,” Commander said, adding that Seven Corners itself is able to offer telemedicine with its government health plans, and intends to advance this to commercial policies in the near future. “Telemedicine apps on smartphones and tablets are giving clinicians currently the opportunity to conduct some physical or psychological assessments remotely,” she said. “[Chatbots can] help the medical sector utilise artificial intelligence to answer non-emergent patient questions, as well as provide timely reminders to take medications and keep appointments.”

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Innovative digital advancements, including the likes of telemedicine, are proving to be considerable cost-saving and client-experience improving solutions.

Dr Patel considers virtual health services a game-changer in their potential for reduced costs, and particularly for their ‘efficient monitoring and management potential of chronic diseases and conditions such as diabetes’. Of virtual health services, he said: “[They] provide the essential ‘time, touch and compassion,’ which can make a massive difference to their wellbeing and recovery.” He noted that virtual health services also provide ‘the reassurance of a family doctor in their pocket’, who not only speaks the same language as them, but can be accessed any time of day or night, and from almost any location around the world.

Global Excel Management’s own solution StandbyMD, which has been designed with a proactive focus in mind, can help provide immediate access to a physician for a teleconsultation or a house call visit, Spears explained – adding, though, that for any solution to work, it needs to incorporate the three elements of assistance, case management and cost containment. StandbyMD offers a recommendation based on data of millions of historical medical incidents and provides a risk assessment algorithm that ‘ensures the member is getting the right care, at the right cost, in the right location’, Spears said. 

According to Lynch, it is the digital therapeutics and connected care services that should be looked out for as a potential key factor in reshaping the healthcare industry: “According to PWC, 54 per cent of US consumers would be likely to try an FDA-approved app or online tool for treatment of a medical condition,” she said***. 
What can also be considered an innovation is the more recent shift in focus from a system based on sick care to one based on illness prevention and healthcare. Guskova said: “More and more insurers tend to include preventive treatment and check-ups in their international policies, something that, historically, was never covered.” And Ho concurred with this: “Wellness and preventative initiatives are going to be the best measures for keeping long-term treatment costs down, and we are seeing more insurers and employers willing to support this.”  

More and more insurers tend to include preventive treatment and check-ups in their international policies, something that, historically, was never covered

Considerable savings

It has been estimated that the use of AI, including chatbots, has the potential to ‘lead to [global] cost savings of almost $1.3 billion by 2023 across motor, life, property and health insurance’****, and, going forward, there are some concrete figures available on the financial savings that can be made with such measures and innovations.

The savings to be had by being proactive and using intervention have had what Spears called a ‘cascade effect on the net paid claims costs’, and he said that because of this approach, some of Global Excel Management’s clients have seen a 50-per-cent reduction in their outpatient claims costs over their standard benchmark. He added: “Because members are calling in advance, and by being able to direct the patients into preferred facilities and through earlier intervention of our medical case management team, we’re also seeing an impact on inpatient costs.”

AP Companies’ cost containment tool has allowed the company to add 21 per cent of additional savings on top of the usual saving rate. “When cases are properly triaged, we have noticed that at least 90 per cent of medical issues are resolved with telemedicine consultation. The savings are measured in terms of cost avoidance as opposed to traditional percentages of savings,” Lynch said, referring to cost containment at GMMI. Ultimately, Lynch reiterated the prime focus of these cost containment methods within international patient care. “The key is directing the patient to the right service at the right time,” she said.  

The World Tourism Organisation predicts there will be more than 1.8 billion annual international tourists by 2030*****, and the number of expatriates is at an all-time high, with growth of this segment expected to continue, according to international market research company Finaccord******. With the increasing appetite for people around the world to travel, live and work abroad come opportunities for international insurers and healthcare facilities, especially to those who are prepared to respond to the changing needs of the international patient and be ready for the future. ■