Interview: Pamela Frank and Jarrett Fowler, USCIPP

Stethoscope
Packing a punch

Pamela Frank, Director, International Services, Children’s Mercy Hospital; Founding member of The US Cooperative for International Patient Programs (USCIPP); and current USCIPP Premium Member, and Jarrett Fowler, Senior Manager, USCIPP, discuss their work to meet the needs presented by rapidly expanding health innovation and healthcare

What aspects of your role as Director of an international programme at Children’s Mercy Hospital do you find most fulfilling?

PF: International programmes are still relatively new to most hospitals, creating a start-up/entrepreneurial environment (as much as that can exist within the constraints of academia). As such, there is a lot of opportunity to generate enthusiasm among many departments. I love energising others and helping them to engage in new ideas. Children’s Mercy has opted to create a decentralised international programme, so I get to involve colleagues (both internally and abroad) in the building and expansion of the programme. 

Have you always aspired to forge a career in this line of work? 

PF: Not at all. My first jobs were in telecoms and then medical equipment, with a regional focus on Latin America. My introduction to healthcare happened when I was job searching and ended up temping at a hospital. It was during that time, 1995-97, that I first learned of a new trend at hospitals to target foreign patient referrals. My then boss and continued mentor encouraged me to pursue that path, and two years later I landed a job that launched my career as the first Director of International Services at Tufts Medical Center. I was fortunate to have two strong female mentors to help direct my career, Dr Pat Recupero who first encouraged me to bushwhack this path, and Carol Sayles who was an earlier pioneer in the field of medical travel. Carol grew MD Anderson’s international revenue tenfold before coming to Boston Children’s to launch their programme, where I eventually landed. 

As health innovation and healthcare needs continue to expand globally, successes need to travel across borders much more quickly

Who inspires you in your day-to-day work?

PF: The families of our patients. Supporting them during what is likely the most difficult time in their lives is a privilege and a reminder of the tenacity of the human spirit. Often those that are hardest hit will have the most grace. I get to experience firsthand what Isabel Allende meant when she wrote ‘We all have an unsuspected reserve of strength inside that emerges when life puts us to the test’.

Pamela Frank

Can you highlight the importance of expanding global access to US expertise in high-quality healthcare? What is the present situation and what is your long-term vision?

PF: US sub-speciality care is still considered to have the most breadth and depth in the world. People who can afford advanced technology and quality care want access to it. But there are other ways to export our expertise. We help train foreign clinicians and researchers. We offer advisory services to hospitals and governments seeking to expand their medical infrastructures. Some hospitals even have overseas satellites. Quality and advanced care, access (short waiting periods) and affordability are key variables for deciding to travel for medical care. As a country we don’t do well on the latter. And while US hospitals grapple with cost containment, hospitals in other countries now offer viable and affordable substitutes closer to home. Since 2009, the Joint Commission International (JCI) has accredited more than 1,000 hospitals in over 100 countries. 
The US needs to not only lead this global transformation but also learn from it. We have a lot to gain in doing so, especially in the field of genomic medicine, which will be a major global unifier for healthcare systems worldwide. 

Why do you think that global access to US expertise in high-quality healthcare is lacking and what can be done to improve the situation?

PF: There are a number of variables as to why people can’t access US healthcare, but the ones we have a shot at influencing include: uniform telemedicine regulations; packaged pricing (which one can argue goes hand in hand with cost containment); and on-demand billing. 
Countries are developing their individual telemedicine laws. As a result, it’s cost prohibitive for a hospital to understand and comply with the laws in each country in order to help a handful of individuals who could benefit from our physician’s remote expertise. 
Similarly, packaged pricing is commonly offered by our international competition to self-pay patients. We know this is a growing market segment, but we can’t meet their needs by telling them the price will be US$200,000 but with a margin of error upwards of 30 per cent, and we might need to collect an additional $60,000. That just doesn’t fly unless they’re very wealthy, and the majority of our patients aren’t. 
Finally, our hospitals’ billing systems aren’t helpful to the international patient. It takes upwards of seven days from date of service to generate the bills and often there are late charges. Our international competition offers a final bill in the same format as you would receive when you check out from a hotel.

Can you discuss some of USCIPP’s key partnerships and explain why they are so important?

PF: Without a number of key partners and individuals USCIPP would not exist. When I was still at Boston Children’s, we hosted an international forum at which Professors Tricia Johnson and Andy Garman from Rush University presented their research on medical travel. Ultimately, Tricia and Andy became USCIPP’s executive leadership and the driving forces behind the initial $500,000 seed funding from the Market Development Cooperative Program (MDCP) under the US Department of Commerce (DoC). Since then, USCIPP has gone on to win a second MDCP grant for $300,000.

There are a number of variables as to why people can’t get access to US healthcare, but the ones we have a shot at influencing include: uniform telemedicine regulations, packaged pricing … and on-demand billing

Boston Children’s played a key role as well in those early days. It was during a visit to the DoC in my former role as their Director of International Services that I first learned of the MDCP grant. Obama had just been elected and we arrived on the first day of his newly appointed head of their service sector. There was a palpable excitement as you walked the halls. So when we were unexpectedly introduced to him in passing he spontaneously invited us to participate in an impromptu roundtable discussion about our nascent industry. During that meeting, he turned to my student intern and asked what our industry needed. She immediately responded, ‘transparency and data,’ and from that single answer, the seed of USCIPP was planted. The first grant application was denied because we couldn’t apply as a single hospital and the non-profit I had established for the purpose of the grant was still pending approval. Furthermore, less than half of the original group of hospitals submitted letters of support. The following year, however, Rush University’s Department of Health Systems Management, in collaboration with the University Health Systems Consortium revised and resubmitted the grant and won. 
USCIPP’s continued success has been because of its hospital members and dedicated staff. A number of the founding institutions with strong brands like Johns Hopkins, Brigham and Women’s Hospital, UCSF Health, Cleveland Clinic and UCLA Health have played an important role as premium members. Their leadership has been key in growing the base and advising on best practices. 

Jarrett Fowler

On a personal level, are there any particular goals you would like to achieve?

PF: USCIPP’s continued success is personal for me so of course I’d like to see it gain additional funding to expand its staff and services. I worry about staffing burn out as members who weren’t around pre-USCIPP take it for granted and increase their expectations and demands, despite limited funding.
On a hospital level, I’d like to help Children’s Mercy gain global recognition for its many world-stage endeavours and innovations. Our decentralised model for international operations can serve as an example to other hospitals wondering if they have what it takes to jump on the international bandwagon.  

How does USCIPP go about supporting the efforts of its members in expanding global access to US expertise in high-quality healthcare?

JF: While it is still a small nonprofit organisation, USCIPP definitely punches above its weight when you look at our current portfolio of activities. We conduct ongoing research and business intelligence for our Premium members to help them understand new markets and how geopolitical changes may affect the delivery of international healthcare services; we engage in advocacy and awareness building activities with important stakeholders around the world; we work with the International Trade Administration of the US Department of Commerce to maintain the ChooseUSHealth brand and connect the hospitals with potential partner organisations at trade events in the US and abroad; we facilitate member-to-member networking and the sharing of best practices through ongoing educational initiatives, including an in-person annual meeting for our members; and we’re currently piloting a patient experience survey initiative that is exclusively focused on international medical travellers. 

Can you discuss USCIPP’s member-driven approach to pushing forward an agenda of research, benchmarking, education, and awareness building?

JF: Everything that USCIPP does – research, benchmarking, education, building awareness – is ultimately driven by our members. We have a number of committees and working groups to advance our initiatives. These are composed of representatives from our member institutions and include an Advisory Council, a Benchmarking and Analytics Subcommittee, a Membership and Partnership Subcommittee, an Education and Conference Subcommittee, a ChooseUSHealth Strategy and Design Committee, and an advocacy and awareness working group. 

Can you tell us about USCIPP’s international patient experience survey initiative and the importance of involving patients?

JF: USCIPP members have expressed an interest in the collaborative development of a common set of international patient experience-of-care metrics that would allow for cross-organisational comparisons and the identification and dissemination of evidence-driven best practices. USCIPP members identified this as a collaborative goal in April 2016, which saw the creation of the Patient Experience Initiative Committee and the selection of the Rush University Center for the Advancement of Healthcare Value (CAHV) to provide survey development and pilot testing services. The Patient Experience Initiative Committee has designed a 34-question survey that accounts for different touchpoints unique to the international patient experience that may not otherwise be identified by traditional surveys designed for domestic patients. The survey is to be given to patients in a standardised format and allows benchmarking capabilities once aggregated scores come in from all participating institutions. The pilot survey is available in English, Spanish, and Arabic. Preliminary data will be presented to members in May during the USCIPP 2018 annual meeting at Cleveland Clinic.

Can you talk a little about ChooseUSHealth and how the resource works?

JF: ChooseUSHealth is a federally supported, collective branding initiative that aims to globally communicate the value of American healthcare. It is the result of a multi-year collaboration between USCIPP and its members, experts at the Chicago-based branding agency Health Brand Group, and the International Trade Administration of the US Department of Commerce. ChooseUSHealth helps international patients connect to American medical institutions that can both treat a specific illness and address issues around travel, interpreters, cultural sensitivities, and financing. ChooseUSHealth also encourages collaboration with potential international partners by highlighting USCIPP’s members’ educational, advisory, and management services capabilities. The ChooseUSHealth website features individual hospital profiles and is currently available in both English (www.chooseushealth.org) and Chinese (www.chooseushealth.cn). We expect a Portuguese-language version of the site to go live later this year.  

Looking ahead to the next five to 10 years, what will be your key foci?

JF: My ideal five-to-10-year plan for USCIPP is to continue to broaden our focus on encouraging international healthcare collaborations and to more fully and intelligently integrate our activities with global health. As health innovation and healthcare needs continue to expand globally, successes need to travel across borders much quicker. I think USCIPP is uniquely positioned to help our members make important contributions to these goals, as well as to help the US learn from advances abroad.