Editor’s Note: A recent Towers Watson survey of 440 midsize and large companies revealed that employers are actively looking for ways to address the increasing costs of healthcare. Senior Consultant Julie Stone kindly agreed to speak to us about how medical travel may or may not fit into cost containment plans in the future. Her comments follow below.

Medical Travel Today (MTT): Of the 440 companies interviewed for your recent survey, are any actively engaged in either domestic or international medical travel? Julie Stone (JS): We do not ask a question specifically about international medical tourism. But regarding domestic travel, the survey gets at the subject by asking about employers offering incentives for using high performing networks and centers of excellence for care. The idea is to motivate employees to seek care at facilities with the best outcomes. Personally, I see that as a version of domestic medical tourism. I just think we have a terminology difference. I can definitely say that this is a type of incentive we’ll be seeing more of in the future. In the most recent survey we found that 14 percent of employers are planning on using incentives for high performing networks in 2012-13, with 44 percent aiming to do the same in 2014-15. MTT: Can you offer an example of the type of incentive they’re offering? JS: Sure. Let’s say the current benefit an employee receives is 80% of the cost of coverage by the employer health plan. If you use center of excellence or high performing facility your employer coverage might tick up to 90 percent reducing your out of pocket expense. MTT: Is your sense that they’re incentivizing people to go to nearby centers of excellence or across the country? JS: How far an employee may depend on both the health plan and the employer. When there is a critical illness or rare disease, the center of excellence will likely be based on where to get the best outcome rather than geography. So if you have a particular type of cancer you may end up in Texas for treatment whereas another type of cancer could lead you to a facility in New York. MTT: Do you anticipate adding questions related to international medical travel to future surveys? JS: That’s a good question. Just last week I was involved in a discussion about our upcoming surveys for the balance of 2012 and 2013.I anticipate international medical travel will be an area we explore in future surveys. MTT: Is your perception that medical travel might find some traction with employers in the future? JS: Yes, particularly on the domestic side. There is definitely an open-ness to strategies that help employers bend the cost curve. If that requires having people to travel for care, I think employers will consider it. Employers are very receptive to things that impact the conditions and services that drive health care cost. On the international side, I think there’s still a considerable lack of awareness and appreciation for the quality of care that may or may not be available outside the U.S. Employers are comfortable with the oversight and standards that exist here. Things like NCQA, various hospital reporting mechanisms, etc. However, they are not familiar with how quality is monitored or evaluated in other countries. Without that understanding they’re not necessarily going to encourage an employee or their family member to go there for care. They truly feel responsible. MTT: What do you think it will take to make employers feel more comfortable? JS: Education and exposure will be critical. I also think that that the expansion of telemedicine may serve to break down some barriers. Right now we’re seeing employers with expats applying it to let those outside of the US access top flight specialists within. It really is, in a sense, medical travel, albeit virtual medical travel. In time I think it could serve to flatten the world a little bit. I also think there’s a potentially interesting application for those in the US living in rural areas where high quality care may be less accessible. MTT: What do you consider to be the challenges to increased domestic medical travel? JS: You know, it’s communication. Often the family healthcare decision maker is not the employee. It used to be that employees carried home books and pamphlets about plans and options but now most of that communication is done electronically. Often the folks at home may not know all of the details of what is available through the benefit plan including access to providers in areas other than where they live. But to get both the best health care outcome and cost reduction, everyone needs to know the full range of benefits. MTT: Are employers taking steps to improve communication? JS: Both employers and health plans are changing the way they communicate. It’s not unheard of for a plan to call a member who is going through a pre-approval process and say, “I see you’re going to facility XYZ for a given procedures. Did you know there’s a high quality center of excellence with high quality outcomes a bit further away that you may want to consider?” They’re taking the step to raise the patient awareness of their options. MTT: I’m curious if there have been other cost-containment offerings in the past that might parallel medical travel. So, let’s say smoking cessation classes or nutrition programs. Are there lessons that can be learned from the introduction of those programs that can be applied to medical travel? JS: I can’t think of anything that’s truly parallel however there have been incentives for transplants for some time; incentives that include care at certain centers of excellence, the cost of a family member’s travel, etc. It completely makes sense to link patients with the most appropriate facility. One idea is to help employers see that they are actually already offering medical travel in very specific circumstances… In some ways, is the pendulum of healthcare is swinging back to an approach where the tradeoff between choice is offset by favoring smaller networks with both quality and cost advantages. If you think about the development of HMOs in the late 70s and 80s which were really pretty tightly controlled health plans, followed by a hue and cry from the masses that led to the creation of PPOs which offered more choice. Now I think you’re seeing the pendulum swing back to the tighter ship, if you will. Employers and others recognize that if you have a smaller network made up of the most efficient and effective providers, it costs less. That movement back in general to a tighter network could really set the stage for directing people to the most appropriate care and providers. That trend could help propel domestic medical travel forward at a faster pace. About Julie Stone Julie Stone is a Senior Consultant in Towers Watson’s Health & Group Benefits practice in Parsippany, New Jersey and our Practice Leader for Business Process Excellence and Learning & Development. Julie works with her clients to develop Health & Welfare benefit strategy in alignment with organizational/business goals as well as to design, implement, measure/monitor their health and welfare programs through a variety of quantitative and qualitative vendor assessment and vendor management approaches and tools. Julie’s expertise covers the full range of health & welfare programs including medical, dental, disability, life insurance, and more. Particular areas of focus include care management and integrated health care programs that focus on overall cost management and employee engagement. In addition, she assists clients with vendor selection, oversight, and evaluation. Julie has worked with clients in a variety of industries including financial services, pharmaceutical, and utilities. Julie joined Towers Watson in 1999 after spending 18 years with a national health plan. She has a B.A as well as a Master’s degree in Public Administration with a concentration in Health Care Management, both from New York University.