Sarah Lynn Brown, Partner, Oceanic Partners firstname.lastname@example.org About Oceanic Partners Oceanic Partners connects international hospitals to healthcare payers, with a focus on self-insured employers, public pension funds and, in Canada, provincial health authorities. We consult on the marketing and contract process to bring patients from the U.S. and Canada to international hospitals for healthcare delivery. Our mission is to bring better outcomes to patients at a reduced cost. About Sarah Lynn Brown Sarah Lynn Brown founded Oceanic Partners in 2012 after working for 10 years in healthcare. In Oceanic Partners’ first year, Sarah traveled 80,000 miles around the globe touring hospitals, many of which she had previously identified as having superior outcomes to national averages in the U.S. and Canada. Previous to Oceanic Partners, Sarah was a senior vice president at ICC Lowe, owned by the Interpublic Group, and a senior program director at Health Science Communications, owned by Omnicom. In those roles, Sarah developed medical education initiatives for pharmaceutical clients. Sarah developed ICC Lowe’s practice in payer account profiling, competitive intelligence processes, impact of healthcare reform, and reviews of Joint Commission patient safety initiatives. Sarah led a matrix team of physicians, pharmacists and project managers in supporting medical education initiatives for the 2010 launch of Pradaxa, the first oral anti-coagulant to gain FDA approval in more than 50 years. Within eight months of FDA approval, Pradaxa was on the formulary 50 out of 50 major academic medical centers in the U.S. With ICC Lowe’s medical education reaching 80,000 U.S. physicians in the launch year, Pradaxa reached blockbuster status (one billion USD) in less than two years on the market. Before working with the pharmaceutical industry, Sarah founded another company, BrownsCR, which provided competitive intelligence on national public health campaigns, and also served as the director of Marketing & Communications for the Michael Cohen Group, a consumer research group. Her analytic were honed during her time at Columbia University Medical Center, where she worked as the department electronic resources librarian for the Department of Child Psychiatry. Highly involved in the research fellowship post-doc program, Sarah worked on the Columbia team to bring the first Spanish psychiatry fellows to the U.S. for advanced studies in child and adolescent psychiatry. Sarah holds a B.A. in government from the University of Texas at Austin. She maintains executive responsibility over Oceanic Partners LLC, including identification of prospective healthcare partners, partner relationship management, marketing strategy and market sizing. Sarah maintains sole fiduciary authority over Oceanic Partners. Medical Travel Today (MTT): Tell us about your company and the hospitals that you represent. Sarah Lynn Brown (SLB): Currently, I am based out of New York, but spend 90 percent of my time traveling. Oceanic Partners markets international hospitals to self-funded employers and public pension plans in the United States. These are organizations that are paying for their own healthcare delivery services. We look for hospitals that generate superior outcomes. Initially, we began in India looking at orthopedic surgery. I was in the pharmaceutical industry researching knee replacement surgery due to my involvement with an anti-coagulant drug. My findings led me to observe a high volume of knee replacements coming out of India, as well as some innovative techniques in orthopedic surgery in general. In many, but not all therapeutic areas, high volume is tied to higher quality or positive outcomes. I went to India and took a tour of numerous hospitals and started really drilling down into why quality care in India is superior and offered at a tremendous decrease in cost as compared to the U.S. and Canada. After looking at the healthcare delivery crisis that we are experiencing in this country, I said to myself, Wait a minute-you could send patients to hospitals outside the U.S. and get a better outcome at less cost and everyone wins! So that’s how we started. MTT: How is your business progressing? SLB: It’s been a year and a half since we started, and it is progressing, but it is slow going. Our proposed model for global healthcare delivery is a fairly bleeding edge way to do things. No one wants to be the first one. And it doesn’t work for every therapeutic area. For example, no matter what the price or how good cardiac surgery is in Mumbai, that’s not a great reason to travel, if it poses more risks than advantages. I’m not going to put a patient with cardiac problems on a plane for 12 hours, because the patient may be stable upon boarding the plane, but not stable when they arrive at a destination. Many kinds of orthopedic surgery and cataract surgery are different-it totally works. So you have to go through the entire patient flow process, as well as identify and investigate the healthcare facilities, and profile the unique needs of the payer’s plan members. Healthcare facilities are not used to paying for this kind of consulting: they are more familiar with the direct-to-consumer model. It’s interesting to observe how those who work in healthcare outside the U.S. react to the health system here. The complexity of the United States system is to the point where potential clients will not believe me when I present on it. They believe no one could run a healthcare system like that. MTT: You represent hospitals — Mumbai in India, for example – and where else? SLB: The hospitals that we engage with in India maintain a private practice in Mumbai. We have had relationships in Chennai and Hyderabad, but not currently. The other country that we deal with is United Arab Emirates. It’s a country that I couldn’t be more enthusiastic about. The ease of travel in the UAE is extraordinary-it’s the easiest country in the world to travel in. It is friendly, it is safe, very low crime rate, and it is just such a luxury experience to go there, yet the cost of healthcare is 20 percent lower as compared to the U.S. MTT: Do you represent any hospitals in Europe? SLB: We do not because we do not see the price differential. MTT: If there was a price differential, would you be open to it? SLB: We would, but we would have to see the outcomes. Anyone can perform surgeries for a lower price. In order to convince the patient to board a plane, you need to assure them that they are getting a better experience than you would here. Note that our presentations for pitching a contractual relationship are made to medical directors and health economists, so we present very, very detailed comparative data. MTT: In the last year and a half you said you presented this opportunity to self-funded companies. I would imagine TPAs. Any others? Individuals? Do you differ from a typical medical travel facilitator? SLB: Absolutely, our model is all-inclusive. We provide the models for care before and after the surgery. What is also different is that we come up with the model and consult on the contract, but we, Oceanic Partners, bow out of the relationship between the payer and the hospital. The payer and the hospital are partnering together to provide care to the patient. Our models include linking in to the electronic medical records, where the surgeon is able to view X-rays, MRIs and other diagnostics before the patient arrives in the destination country. Our model includes a meeting in the patient’s home, which is another advantage. We send a technician out to the patient’s home as a way to further weed out high risk patients that would not tolerate a flight. As previously stated, Oceanic Partners works with the international hospitals and the payers to arrange for after care, as well. For example, with orthopedic surgery, we’ve designed a model arranged for post-surgical at two weeks, six weeks and six months to ensure the patient is not abandoned once they get off the plane. That’s why our model is different. MTT: How many individuals have you sent abroad for surgery? SLB: We have not sent the first patient yet, as we are still in the contracting stages. In 2014 we are estimating 7,500 patients. We scale up, and that’s what makes our model so attractive to the hospitals-the volume. These are multiple year projects, so the hospital, in some cases, has to actually scale up its infrastructure and staff to handle that volume-but the numbers are extraordinary. In Canada alone, there are 250,000 cataract surgeries done every year. The value proposition is that it’s cheaper for the payer, in this case the health authority in Canada, where there’s no wait to get your cataract surgery, and at the low cost, it’s not a hard sell. With cataracts, if you wait, the condition gets much worse. So the health authority looks good and the patients like it. We improve access to care and save everyone money. We are going to do a value-based contract, as well. This way if an operation doesn’t go well, the hospital will take responsibility. Let’s say you need a re-operation. We could potentially refund the cost of the first operation if it was something within our control. MTT: How does Oceanic get paid? Is it on a per case basis? SLB: So this has also been a point of learning for hospital clients. We get paid upfront to market the hospital, including an analysis of which states or regions to target. We also get paid a percentage of the minimum or maximum when a contract is signed between a payer and a hospital. MTT: So do the patients pay the all-inclusive fee? Does that include any insurance policy in case there is an untoward outcome or does that protect that patient — and yourself — from any lawsuit? SLB: Patients, generally, don’t pay anything under this model: we even pick up the co-pay under most models. The payer is paying the all-inclusive fee directly to the hospital. The healthcare providers are acting as preferred providers under the insurance plan and it’s important to emphasize that a plan member chooses to engage an international surgeon in their plan, just as we choose one surgeon or another through our insurance plans. The use of an international healthcare provider or international hospitals is not mandated by the insurance plan or in the contract. So why would a patient choose an international provider? The value proposition differs between Canada and the U.S., but in both cases we are only marketing to the insurance plans those hospitals or healthcare providers with superior outcomes. So the patient is choosing to have a procedure performed by the best that there is. The contract for services is between the payer and the hospitals, which reduces the liability of Oceanic Partners. MTT: So you are in a sense a medical travel facilitator, but you are really focusing on the group market? SLB: We are focused on the group market, and we set up the model for logistics-but that’s not what we consider the big sell. We consult with the hospital so that after a year or two, we bow out and the facilities have that relationship with the payer. MTT: Are you getting any push back about going to India or the UAE? Do the patients want to go closer to home? SLB: There is pushback in specific countries because of bad press. That’s a challenge we are trying to address holistically through public relations, but that’s a big challenge. MTT: If you had hospitals closer to the U.S., do you think the program would be more attractive? SLB: I do. What I don’t understand is why some hospitals, for example in Singapore or India, are not moving more quickly to build an infrastructure on one of the Caribbean Islands or in the U.S. and have their surgeons rotate there. I think the financial numbers could work if surgeons rotated because the doctors don’t have to live in the U.S. where it’s so expensive. I think we’re starting to do that with healthcare reform and publication of the fact that if you walk two blocks, it will cut your bill by $3,000. MTT: What do you think the impact of healthcare reform is going to be on the medical travel scenario? SLB: It’s an interesting question. I think healthcare reform is predominately about health insurance premiums. From the consumer point of view, I’m not sure it’s highlighting the need to reduce cost within the hospital delivery system. I do think that sort of transparency is being created by some of the industry studies and reports. It’s not just the self-insured employers calling around to get the prices-that’s changing. Consumers had no idea why Mt. Sinai Hospital was a great hospital except by qualitative reputation. But now, you can literally go online and check the outcomes. We get into arguments regarding the right outcomes and whether the institution is taking on low risk cases that skew their results, but public posting of outcomes is a great step in the right direction. I think that is absolutely huge in terms of the payers contracting with a particular hospital. Hospitals are attracting North American patients based upon their willingness to publish their outcomes-particularly in Singapore. But there are other hospitals that are not doing so, and they are going to lose in the next year. They simply don’t understand the importance of outcomes in the American market. The key takeaway for the international hospitals is this: in presenting your hospital to a payer audience, your competitive set is not the other hospitals in your country — it’s the other hospitals in the payer’s regions.