Editor’s Note: In last week’s issue of Medical Travel Today, we featured Part One of our conversation with David Mair of Soter Healthcare in which he offered insight into how Soter health plans integrate both domestic and international opportunities, including telemedicine, to reduce claim costs for the insurance plan and out-of-pocket costs. In Part Two we learn how consumers are currently using the plans, as well as Soter’s facilitator services and credentialing process.

MTT: What’s the nature of care most of your patients are seeking? DM: I’d say the biggest use falls under the area of futile conditions. That is something that is too expensive to treat for the benefit that’s gained. Stroke rehabilitation, organ transplant for certain stages of life, spinal cord injury, those all fall under that umbrella. Our plan makes a collective world knowledge and experience available. Things you wouldn’t find in the US, like stem cell and some integrated programs of Western and Chinese medicine, specially designed acupuncture techniques and son on, these can be very effective for stroke and brain injury but, again, you can’t get them here. And then there are simply outcomes and survival rates. If you go on our website you can see a comparison chart of clinical outcomes for various conditions. It’s pretty compelling. Another interesting component of our plan is telemedicine. We’ve actually integrated telemedicine on a global basis to reduce the number of patient visits to the doctor or ER when plan members are abroad. If someone has a non-emergent medical need, they can access a US-based doctor group for a consultation. So let’s say you’re in Mexico and not feeling well. Rather than going to a hospital or clinic, where they may not speak English or have the level of care you’re hoping for, you can contact our telemedicine service and get an assessment of your condition. The telemedicine doctors obviously can’t diagnose everything, nor can they prescribe medication. They can provide some suggestions for relief or advise you to seek more care. We can then assist them in locating the care they need. Either way, it gives the patient peace of mind and reduces the overall cost of care. MTT: Tell me about the facilitator side of your business. DM: We launched the facilitator piece of Soter’s business first and the insurance side evolved around it. But even that we do a bit differently. Unlike a lot of facilitators who tout the size of their network, we maintain one of the smaller networks. We do this intentionally for a couple reasons. First, we focus on medical centers of excellence, because we emphasize quality of care and medical outcomes over price and location. A hospital has to be able to meet or exceed the quality of its American peer hospitals and rank among the best in the world to be considered for our network. When we look at US peer hospitals we look at specialty facilities, not just regular hospitals. Second, we have stringent requirements for inclusion and for remaining in our network. We monitor very closely the performance of each hospital and its staff. They have to deliver at or above the levels that got them into the network, including in areas of patient experience. We set the bar very high on both sides of the equation. The best hospitals are able to meet our requirements pretty easily. The marginal hospitals generally don’t apply or don’t meet Soter’s standards for acceptance. MTT: I imagine that bar alone limits how many facilities get in. DM: That’s true. We decline about eight hospitals that start the process for every one that makes it. There are a lot of hospitals that contact us and later don’t even try to secure credentialing, because once they see the requirements they recognize it’s not likely they’re going to make it. There are many hospitals found in other facilitator’s networks or that market themselves to international patients that don’t meet our credentialing standards. That doesn’t mean they aren’t good hospitals in some respects. It just means they aren’t great or they aren’t sufficiently committed to providing the levels of care and support our clients expect. MTT: What exactly are you looking at or for? DM: We’re looking at a range of things. We have a proprietary credentialing process that includes over 300 individual items to be evaluated. Some items are addressed by domestic and international accreditation agencies and others are specific to Soter. MTT: What kinds of things are on that list? DM: (laughing) For us, it’s a little like the formula for Coca-Cola. We hold on to it pretty tightly. I can share some at a high level though. We look at frequency and outcomes of medical procedures, physician experience and expertise, patient safety, international patient experience, hospital-acquired infection rates, among others. We look as well at patient experience items, like availability of 24-hour nursing care from English-speaking staff, frequency of linen changes, temperature control and on-site services. We also include how well a hospital is prepared to support our pre-treatment consultation and continuity of care requirements. Another big area is the matter of resolving patient disputes. We contractually require our network hospitals to agree to a dispute resolution procedure. Even though it’s rare for a malpractice issue to arise in medical travel, it continues to be the greatest area of concern for many people. We try to minimize that by requiring facilities to commit to a process if an issue arises. This way there’s accountability on the part of every provider for every client. It also helps to ensure that both the care and continuity of care are performed with equal quality. MTT: You actually offer a credentialing program. Can you describe that and how it compares to other options? DM: It’s not so much something we offer as much as it is our process for evaluating hospitals for inclusion in our network. What I mean by that is we don’t offer it as a standalone service. Our process consists of three phases. We price it for hospitals that are interested in joining our network in phases, so they only have to pay for them one at a time. The first is a baseline review focused on determining whether a hospital has the right commitment to international patient care and the resources to deliver well. The other two stages are the proprietary process I mentioned. They include on-site evaluations, discussions with staff and patients, and negotiations around the agreements needed to ensure care is always delivered and patients served well. The process includes features that were important to me during my time supporting Olympic athletes. We believe every patient needs and deserves that same level of service. 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 US 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 B.A., 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]