Medical Travel Today (MTT): I really want to focus on Global Alliance, but begin first by telling me a little bit about it Nueterra. David Miller (DM): For more than 15 years Nueterra has been helping physicians and health systems succeed. Our company is built on the philosophy of physician empowerment, with a unique model ensuring that physicians maintain control through majority ownership in facilities. By partnering with physicians in a mutually beneficial ownership partnering model, Nueterra builds, equips and manages healthcare facilities, which includes hospitals, ambulatory surgical centers, endoscopy centers and physical therapy centers. We partner with local physicians in their location to build facilities relevant to their market and talents. MTT: How exactly do physicians benefit from owning the facility in which they operate or practice? DM: As co-investors in the facility, Nueterra and physician partners have vested interest in the success of the healthcare facility and its longevity in the community. Our proven operating efficiencies use economies of scale to create owner equity and increase market share. Also, physicians benefit from the flexibility of creating their own surgery schedules and increased gains from having vested equity in the business. Essentially, they are in control of their healthcare facility in partnership with Nueterra. Our partner facilities create wealth for the physicians and superior outcomes for patients. MTT: I’m curious, what’s the initial investment on their part and how does that equity pay out? DM: The investment depends on the size of the facility, the number of investors, type of healthcare offerings, and other variables. The payout is often in the form of quarterly dividends. Ownership of the facility is shared, and normally Nueterra is a minority owner with the physicians being the majority owner. If there’s a health system involved they’ll hold the largest share. On average, the timeframe for actually seeing dividends paid out is approximately 12 to 18 months after opening. That’s our goal. Of course sometimes the timeframe is longer or shorter depending on the size and scope of the facility. MTT: And what exactly does Global Alliance do under the Nueterra umbrella? DM: Global Alliance is a new offering for Nueterra. We’re in the process of adapting our model to work with an international patient base. We have partnered with health systems and physicians- 2,500 physicians in 28 states and about 100 facilities – that we’re working with to actively bring both domestic and international patients to for care. Years ago we began researching medical travel to determine its viability within our operating structure. When we began looking into where patients were going to access care, the initial assumption was it was going to be high net worth individuals traveling for elective procedures. We couldn’t have been more wrong. What we found was that there was a $4-5 billion market for international patients coming for care in the US. And it wasn’t just elective procedures. It was large complicated cases, i.e. cardio, bypass, total knees and hip. As we continued to explore the medical travel market, we interacted with more industry leaders. During this process, I met Rolando Rodriguez, who ran the international division of a large hospital in South Florida with approximately $100 million in revenues from the Latin America and Caribbean markets alone. After recognizing that his qualifications and relationships could support our desire to bring quality care options to international patients, we began our partnership and he joined the Nueterra team. In our research of the market, procedures and the industry, trends began to emerge, and we began building our model in response to these trends. We realized at Nueterra that we wanted to establish a best-in-class network across the US to provide patient access to quality care. Technology was a significant trend we noticed in medical travel. We found that when people were traveling for care there’s little technology to capture and allow their diagnostic information to travel with them. This presents some significant challenges for the treating and referring physicians to communicate, as well as for the care or concierge manager. What we needed was a good technological component that would create a smoother, all-encompassing experience. In time we found a technology partner who had created software for patient exchange, and we acquired an ownership stake in the company so we can utilize the software. Let’s say you were in Panama and want to go to Kansas City for a procedure. You simply call Nueterra Global Alliance at (415) 651-4400 and then you are connected to a case manager who captures all your pertinent information. We then direct you to a physician in our network in the specialty area you need and within the parameters of your geographic goal. We can connect your referring physician to that physician and ensure everyone’s communicated with thoroughly about the case. We also have a travel component built into the software so that we can literally pick you up at your home and deliver you to the airport and subsequently the hotel or hospital and back. It’s a comprehensive, turnkey approach. The other missing piece that we wanted to address was post-care. We found that there was very little communication following surgery between the treating and referring physicians so we added a robust post-care component to our software that allows for very easy transfer of data, images and outcomes. We have built our system to facilitate interaction and patient exchanges across borders to provide comprehensive care. MTT: It’s very interesting. You’re really controlling the entire patient experience – from cab rides and physician to the facility and post-care. Short of buying an airline and hotel, you’re really managing the complete experience. DM: Exactly. And we believe this translates into a better experience for everyone involved. The other key to our success is our relationships. Our team has strong relationships in and across various regions that allow us to build a really strong network across countries and continents. That physician-to-physician relationship is absolutely critical. We’re doing a great deal to build and facilitate the connections. We’re doing educational seminars and hosting a series of Borderless Healthcare Symposiums… to develop an understanding between providers. The idea being that if you’re a physician in Peru and you have a patient who has a need you can’t fulfill, you’ll have a trusted partner somewhere in the US. MTT: Can you explain the symposiums a bit more? DM: Certainly. The first symposium was in the Bahamas in September of 2012. The symposiums are educational and networking events. At the symposium a physician from the US who is a Nueterra partner provides content relevant to the local physicians and the market. These seminars could be best practices, emerging technology usage or surgical procedure adaptations … the physician creates pertinent content for physicians. For the remainder of 2012 we have symposiums scheduled throughout the Latin American and Caribbean regions and plan for more in 2013. We want to be perceived as a trusted partner in the various regions, and our goal is to provide educational support for physicians and international patient access when needed. At the first symposium we were able to connect a few transplant patients and begin discussions about how to assist in their needs. This is what the symposiums are about: building relationships so that together we can improve healthcare. More information and registration can be accessed through our Healthcare Symposium websitewww.nueterraborderlesshealthcare.com MTT: Is the goal just to build a US network? DM: Actually after we’re done building the US out we’re going to move on to the UK, then India followed by China. We want to create not just an inbound US business, but also an outbound one that features our own facilities. Ultimately, we want a global network in which providers can refer patients back and forth between countries and facilities. That applies to the domestic market, too…a doctor in Minnesota may send a patient to St. Louis. All the while the patient stays in-network and in-system, so to speak. MTT: What exactly is your timeframe for your growth? DM: We actually have patients ready and in queue right now. The first one is slated to travel for care in two weeks. Our goal is to move 360 patients by end of year. By the end of next year we’re looking at 2,000 to 3,000, and by the end of year five we’re aiming for 10,000 globally. Of course that number could go a lot higher depending on how quickly we can build out. MTT: How has the experience of recruiting physicians been for you? DM: At Nueterra, our entire model is structured around empowering physicians. We believe the Nueterra Global Alliance is a benefit to physicians all across the globe. It provides access to patients who need tertiary care within a trusted dynamic network of physicians. These are people who have developed relationships at the symposiums, shared conversations, ideas and articles online. There are a lot of benefits for physicians, and we have intentionally built the Nueterra Global Alliance to benefit physicians and, ultimately, patients. Once physicians understand what we are doing and the benefits, including prestige, educational offerings, networking and patient exchanges, I think many more will join. It’s a particularly easy conversation for physicians who have dealt with international patients before. Once the physician joins the network and becomes familiar with the technological interface, they can experience the benefits of the alliance. After they are in the network we can begin connecting international patients and providers to their practice based on specialty and geographic location. About David Miller David Miller provides strategic guidance to the Nueterra Global Alliance and develops strategies for international patient exchanges. Before joining Nueterra, Miller was president of a major national health insurance company for the states of Kansas and Missouri. He has more than 20 years of experience in healthcare, including extensive experience in sales and operations.