It was not business as usual for the medical travel industry during the recent annual meeting of the Self Insurance Institute of America. At this well-attended event and with four outstanding panelists, the presentations and discussions were lively and thought-provoking. Here’s an overview: Employer Direct Contracting: Game-Changing Medical Travel Trend Panel Chairperson: Laura Carabello, Founder and Principal, CPR Strategic Marketing Communications, and Editor and Publisher, Medical Travel Today and U.S. Domestic Medical Travel In this pressure-cooker healthcare environment, solutions that were once considered far-reaching are now meeting receptive audiences. Direct contracting, often characterized as “U.S. domestic travel,” the practice of traveling out of one’s hometown or home state to a care provider or COE located in another region or part of the country, represents this type of phenomenon. Employers are opting for bundled, fixed price procedures, leveraging the fierce competition among hospitals, Centers of Excellence, and physician-owned clinics and surgi-centers. While there are a few pioneers in the large business category that have tested the waters to execute direct contracting arrangements, the vast majority of large employers and virtually all of the mid-size and small employers are now contemplating these arrangements in 2015. 
Here are the topics discussed – and we welcome your feedback on these subjects:
- What is a bundle? What is included Government bundles v. private sector bundles
- Is there a warranty or guarantee in the bundled contract? 90-day window
- Who negotiates the bundled rates? Coalition? Direct? TPA?
- What about follow up care? Same providers?
- Benchmarks for go-forward surgery? Too early and can be treated otherwise? A1C? Dental? Smoking cessation?
- We hear a lot about the importance of transparency in pricing…if the public markets are promoting this, why can’t the private sector follow this path? It appears that separate “deals” preclude transparency,
- Can anyone divulge the “going rate” for knee surgery or hip replacement?
- Should volume present opportunities for better rates? How about risk?
- How many surgeries do not get scheduled because of issues?
- Providers: What regional area? Within driving distance? Other parts of the U.S.? International?
- We hear a lot about orthopedic procedures – but what other surgeries or treatments are appropriate for direct contracting? Bariatrics? Oncology?
- What size employers can use this strategy? Small – medium, 500+ employees?
- How can employers incent workforce to utilize the benefit? Deductibles, co-pays, mandates?
- Will employers with HSA plans be able to incent since the individual must meet deductible before this kicks in…
- Can we redesign payments – not just focus on more bundles?
Please send your thoughts to [email protected].