Medical Travel Today (MTT): Let’s start with your background and involvement in medical travel. What can you tell us?

David Mair (DM): I started in the international healthcare business when I served as the director of risk management and athlete benefits for the United States Olympic Committee (USOC). Going back to 1989, the USOC began offering a health insurance plan for top athletes. We developed a global benefits plan affiliated with quality providers around the world. The plan provided for 1,500 athletes as they traveled and competed on every continent and provided care 365 days a year no matter where they were. I directed that program up until 2002, when I stepped into the consulting world for a time. I then got back into global health at a travel medical assistance company. The focus there was on the evacuation side of things and working with clients to plan for providing care wherever the need arises. I then joined China Connection Global Healthcare, a start up at the time, and served as its chief operating officer for two years. It was after that experience that I set out to launch Soter Healthcare with my partner, Rick Gallagher. MTT: My recollection is that China Connection (now International Health) dealt directly with consumers. But it appears Soter is a bit more business centric. Is that correct? DM: Yes. China Connection dealt only with the consumer market. In launching Soter, we were definitely looking at the potential in the business-to-business arena. In addition, China Connection really had a limited focus on a limited number of medical conditions and worked with hospitals in China alone. Our aim from the start was to operate on a more global platform using several international centers of excellence and to bring opportunities to both the business community (i.e. employer groups) as well as individuals. Once we built that out, we turned to the second part of our vision for growth: to craft a health insurance plan that includes destination medical care. Today we work with clients to establish plans that include a full global benefit. MTT: I’m curious. Do most of your clients have a multinational presence? DM: I’d say fifty percent have global exposure. Actually, I think the fact that half don’t really highlights the point that the plan makes sense no matter the scope of your organization. The typical US health insurance policy will provide benefits for emergency medical care when you’re outside the US, but you need to pay the costs up front and be reimbursed later. But it won’t cover the costs of minor care. That cost is yours alone. Here’s where the odd nature of US-based health insurance becomes apparent. If you’re in Costa Rica on vacation, for example, and get hit by car, you may very well have coverage from your US health insurance company. However, if you get strep, in most cases, you’re out of luck. Not only will your health insurance not provide benefits, the expenses you pay won’t apply toward your deductible. So if you get strep in Costa Rica you might just want to step in front of a car. I know that’s extreme but it points out how US insurance forces people to make silly decisions. Another aspect worth noting about US care is your health underwriter plans and charges for you to have a 365-day exposure. You actually give them a break when you travel out of the country. From our perspective, it shouldn’t matter whether the Paris you are in is in Texas or France, the Athens in Georgia or Greece or the Melbourne in Florida or Australia; if you’re sick, you’re sick. We treat your need the same no matter where you are. And it doesn’t matter whether you’re a leisure traveler, traveling for business or even on a short-term assignment. You’re covered. MTT: So what exactly are you offering clients in terms of a plan? DM: We actually have two arrangements available, based on whether our client utilizes a self-funded or fully insured benefits plan, and whether they are using a plan we design for them or want to integrate Soter benefits and services into their existing plan. In either event, we integrate domestic opportunities, including telemedicine, to reduce claim costs for the insurance plan and out-of-pocket costs to the individual and a specialized financial design with medical reimbursement plans with international reach using our global centers of medical excellence. The international destination medical care benefit provides affordability to the plan and the individual and access to the latest in medical treatment and technology, including procedures not yet available to patients where they live. MTT: What’s the typical reception you get when first presenting the plan options? DM: Because our design and services are so outside the norm of what many people think about in terms of a health plan, our first meetings often start with a mix of interest, followed by skepticism. But by the time we really get into and reveal the quality of doctors and hospitals and explore the credentialing process for facilities in our network, the skepticism is usually gone and the executive with whom we’re meeting is asking for a quote. Later, we go through a very similar process with many of the same reactions as we educate employees and families about this new, different design. What the majority of people with a good strong benefits package are looking for are ways to save money and to provide access to care that provides positive medical outcomes. MTT: And your plans do that? DM: Absolutely. On the cost side, our average client reduces their health insurance cost by 22 percent. And in terms of medical outcomes, many of the stories are beyond powerful. One of the more personal situations for me involves my niece, Kara. She has cerebral palsy (CP) and until a couple years ago primarily used a wheelchair for mobility. She had little independent use of her left hand, had frequent seizures and had significant spasticity. She traveled to China for treatment with stem cells, and she’s remarkably improved. Her gait is improved, and she now walks with a single crutch. Her vision has improved, and she can use her left hand independently. Her focus in school is better as a result of improvement in other areas. She’s just one of the patients with CP we’ve been able to see benefit from this treatment that is not available in the United States. More recently, we had a patient who had suffered two previous heart attacks, one around 40 years old and the second about 10 years later. Early last year, he began suffering very similar symptoms, was in pain and feeling weak. He went to physicians at three very good hospitals in the Twin Cities, none of whom were able to diagnose his problem. He met with us and decided to visit TEDA International Cardiovascular Hospital, one of the top hospitals in the world. He then went to China to a cardiovascular hospital and within 36 hours they discovered it wasn’t a heart issue but rather a lung issue. Forty-eight hours later he had a complete change in medication and treatment and now he’s back in full health. MTT: What was the difference? The diagnostic tools? DM: That and the approach to the problem. Their approach is more holistic and blends Western and Eastern approaches to understand how the body is or isn’t functioning. Part Two of this interview will be featured in Issue 12. About David Mair David Mair is a founding partner of Soter Healthcare, Inc., a global healthcare and benefits firm that designs and delivers insurance and medical care solutions for individuals and organizations. Soter Healthcare’s unique blending of international destination medical care and value-added benefits provide cost control, financial relief, and access to a global network of medical centers of excellence, as well as the latest in medical treatment, technique and technology. Mair is a 20-year international risk management, benefits and insurance executive. He began his international benefits career as director of Risk Management and Athlete Benefits for the United States Olympic Committee, where he oversaw the design and administration of the USOC’s health insurance program for America’s Olympic athletes. During his tenure, he was responsible for assisting athletes locate and access medical care around the world as they trained and competed in international events Following his departure from the USOC in July 2002, Mr. Mair was president of Risk Excellence, a strategic risk and leadership consultancy with an emphasis on governmental and nonprofit entities, and later area vice president at Arthur J. Gallagher & Company. Prior to forming Soter Healthcare, he briefly served as director of Client Relations and Interim chief of emergency operations for MEDEX Global Group. Mair is a former president of the Risk and Insurance Management Society and served five years on its Executive Council. He also served two terms as president and seven years on the Board of Directors of the Nonprofit Risk Management Center (NORMAC). NORMAC, located in Washington, D.C., provides risk management education and support services to over 20,000 nonprofit and small public entities nationwide. Mair received a Bachelor of Arts degree, with honors, from Oklahoma Baptist University in 1980 and a Master of Science degree in Sports Administration from the University of Oklahoma in 1987. He can be reached at: [email protected]