If an unexpected medical issue arises when abroad, the first port of call for travellers and expatriates is too often the emergency room (ER), as travel and health insurers know only too well. Otherwise, such travellers often take themselves to the nearest clinic or urgent care centre, whether or not it is in-network. In both scenarios, cost is a serious issue. The US National Hospital Ambulatory Medical Care Survey estimates, however, that one-third to half of all ER visits are for non-urgent care; while the New England Health Institute said 56 per cent of emergency room visits are ‘totally avoidable’. 

“The simple answer,” says Alex Sanchez, Director of Global Excel Management, “is that not every case requires a patient to be seen in a hospital.” And with the average cost of a US ER visit totalling around US$1,917, according to a Health Care Cost Institute report, and an urgent care trip costing around $375, Dr Jose Gardens – whose US-based visiting doctor company Doctors @ Your Home has been active since 2008 – presents a strong case for why a home visit doctor service could be a positive addition to the arsenal of any travel or IPMI insurer: because a visit costs, on average, significantly less, he says – at between $150 and $200.

First impressions

Why contain on the back end and pay fees on the savings, when you avoid on the front end and make the member journey a better one?

Like other forms of primary medical evaluation, the way that visiting doctor services manage to so effectively contain costs is that they act as a gatekeeper, keeping the patient from immediately heading into expensive secondary care and ‘making an ill-informed decision off their own back’, according to Dr Mitesh Patel, Medical Director at Aetna International in the UK. “It’s a control mechanism,” he told the Hospitals & Healthcare Review.

What differentiates a home visit doctor from a ‘bricks and mortar’ operation like a pharmacy or General Practitioner's surgery is the ability to pre-assess a patient before a health professional is contracted to take a more in-depth look. Dr Gardens stresses the importance of this when his company is utilised by an insurer. When contacted about a patient, a medical professional evaluates the case, before speaking with the patient. They are then able to arrive at the patient’s home or hotel within one to two hours, knowing more or less what they are treating.

Sanchez’s company also uses pre-evaluation, coupling this with StandbyMD, its directional care programme. “StandbyMD was built on a risk assessment algorithm that effectively identifies the best medical care, taking into consideration multiple factors such as location, age, symptoms, time of day, availability of services and more,” said Sanchez. “The most important element of our service is first call resolution. We aim to provide the right service to the member on this first call. Because we track the complete claim from first call to final resolution, we know if the member needed and received additional services or not. Our algorithm is continuously learning from each outcome and we deliver real resolution rates higher than 80 per cent.”

From the point of view of a traveller or expatriate, a visit from a doctor at their accommodation can be comforting. Tourists rarely research the nuances of the healthcare system in the countries they are travelling to and, as such, are generally unaware of cultural or financial differences in hospital systems. For example, someone heading from the UK to the US would not just be confronted with a different billing system within the country’s hospitals but would potentially also not know the differences between an emergency room and an urgent care centre. Throw in a possible difference in language and medical culture, and the personal touch of a home call doctor could greatly improve a customer’s experience. 

technology is giving home call doctor services a bright-looking future

“In general, travellers are not familiar with local healthcare systems, may not speak the language, and may not even know how to find their way around,” Sanchez asserted. His company uses telemedicine, house calls and clinic networks combined to keep patients out of expensive emergency rooms. “A win-win situation for everyone,” he concluded. Dr Patel echoes these sentiments, saying that having an independent healthcare professional on your side could also help a patient to properly navigate a foreign health system more effectively, and not be over billed for unnecessary treatment or consultations.

Expanding horizons 

Unsurprisingly, a majority of the emphasis for companies providing this service is on the US, infamous for its expensive healthcare. However, the market is growing elsewhere. “Outside of the US, discounts on medical bills are less prevalent, and a greater focus is on assuring quality and cost-effective care,” said Sanchez. Global Excel Management, a cost containment company based in Canada, has also made business acquisitions to increase its global reach for these services – including Choicenet International in Mexico, ChargeCare International in Europe and Prima Sarana Jasa in Indonesia – and has handled home visit cases in over 100 countries.

The market for home call doctors is clearly growing. Dr Gardens has seen an increase in demand for his company’s services in tourist hotspots, near beaches and in cities. Sanchez also says that he has seen a ‘dramatic increase in the utilisation of these services’. He puts this down to the changing face of global healthcare: “Traditionally, our industry has focused on ‘containing’ costs after a healthcare event has occurred. However, with global healthcare inflation rates averaging over six per cent, costs continue to rise dramatically, and this traditional way of thinking needs to change. We are convinced that the only way to truly manage healthcare risk is to intervene much earlier in the process. We want to avoid costs first (while providing a better patient experience) and contain costs second. In other words, why contain on the back end and pay fees on the savings, when you can avoid on the front end and make the member journey a better one?” 

Like other forms of primary medical evaluation, the way that visiting doctor services manage to so effectively contain costs is that they act as a gatekeeper

Like most areas in the insurance industry, customer education is one of the biggest hurdles facing a visiting doctor system, no matter where you are in the world. Dr Patel stresses the importance of understanding a customer’s home culture as part of this. For example, he explains, in the UK the idea of having a primary care lead is not too alien, meaning a client would be more trusting of a GP visiting them in their hotel room or holiday destination. In the Middle East, however, the expectation is that to receive proper medical treatment, you go to a hospital, see a specialist and are prescribed medication on the spot. Dr Patel says that changing these cultural attitudes will take ‘a lot of marketing, a lot of education and you may have to end up using mechanisms by which you steer [patients]’ – including altering policy wording to give customers incentives to use these services. 
One way in which Doctors @ Your Home tries to intercept patients before they head to an ER is by partnering with hotels and concierge services, whereby these establishments advise guests to call the company when seeking advice regarding where to receive medical care. The company is also able to provide a range of services for patients to supplement and support a home visit doctor, including in-house X-ray, ultrasound, prescription refill, dental services, physical therapy and, in some areas, even veterinary services. 

The bot will see you now

Like other areas of medicine, and insurance, technology is giving home call doctor services a bright looking future. Sanchez says that Global Excel hopes to integrate ‘new innovations such as artificial intelligence, voice recognition, and blockchain technology’ into its already existing systems, meaning that not only will the depth and breadth of its home doctor services improve, but also that its continuously learning StandbyMD algorithm will be able to pick the most effective solution for a patient every time.

the most important element of our service is first call resolution. We aim to provide the right service to the member on this first call.

Dr Patel, however, acknowledges that the luxury of a home visit doctor may not be the most cost-effective method of primary healthcare in the future. “With the globally ageing population and the demand for global healthcare increasing at such a rapid rate, we’re simply unable to train the number of doctors needed, so virtual healthcare is the future. Whether that is actually having a physical doctor at the end of your phone is yet to be seen, but artificial intelligence’s growing intelligence means a bot could basically make a diagnosis for the simplest conditions using an algorithm.” A technology-based method is far more scalable, and though he believes that the technology could combine with a home doctor or other primary care service provider, exploring this technology may not only benefit the insurance industry, but may also enable better healthcare access to those in countries where such access is poor.

The personal approach is not something that is likely to go away in healthcare, however, Dr Gardens concluded: “I think the future is in house calls. Every day, there is new technology in this marketplace, like telemedicine, robotics, and so forth; but there will never be a substitute for hands-on patient care.” ■