1. Presented by Morgan Pile, CES, GBDS Strongside Solutions
Why Self Funded Employers are Implementing Medical Travel Into Their Insurance Plans.
Presented by
Morgan Pile, CES, GBDS
Strongside Solutions

2. Who We Are
Strongside Solutions LLC is privately held in Atlanta Georgia, USA. We are a boutique healthcare consulting firm specializing in Human Capital Risk Management, and healthcare cost containment. Through comprehensive consulting services, innovative technology, and strategic partners, we help implement strategies that eliminate fraud, waste, and abuse in the healthcare for self funded employers. Leaders in Medical Tourism, Workers Compensation, and Prescription Drug fiduciary programs. We are experts in creating networks, and working with providers to help, self-funded employers save money. We maintain the highest level relationships with our Channel partners which include; Insurance companies, Third Party Administrators, Brokers, Consultants around the world.

3. What We Do.
Leveraging real-time data, using sophisticated analytics, and our technology platform, we help employers, self-insured plans, fiduciaries, insurance companies achieve large savings while improving health outcomes. We increase claims payment accuracy, provide greater transparency, and improve population health while lowering costs, mitigating risks, and driving high value-based health care.

4. Problem in US
Annual cost of orthopedic issues in the U.S is $950 Billion per year, 4.7% of GDP.  So what is the number one reason patients see a doctor?  Yes, pain or Orthopedic issues are the biggest drivers.  We don't like pain, but these surgeries are costing way to much.
Employers health and workers compensation orthopedic cost range from 50% - 80% of their health plan.  By implementing a Medical Tourism Program, employers are seeing almost a 10% savings on their total healthcare spend.  

5. CHALLENGES No Data Rising Costs with no solutions
Consumer Driven Plans/High Deductible not holding back costs
Plan design changes
Benefits reduced
Increased Copays and deductibles
Still a trend of 9 % to 10 %
Employees holding off major surgeries = larger claims later
No Data

6. CEO/CFO TOP 5 ADDRESSABLE AREAS OF CONCERN FOR HEALTH PLANS
Pain Points (Rate 1-5 with 5 being high degree of pain) and whether you feel like you have a Solution In Place
1.) Medical Cost Data (independent and autonomous)
2.) Provider Quality Data (independent and autonomous)
3.) Pharmacy/PBM Costs &Transparency (independent and autonomous)
4.) Proactive/Mobile Communications/Alerts related to above
5.) Healthcare Education and Consumerism Promotion PP
SIP 5 1 2 4
In other words, they don’t believe that they are getting value from payer or network and understand plan members need help making decisions about how to use any network
Data taken from Survey of 32 large self-insured employers representing 2 million covered lives and $23B in health care spending.
CHC Survey 2014

7. 2016 WTW EMERGING TRENDS HC SURVEY
Through a variety of actions, including plan design and vendor strategy, health care cost trend for active employee medical benefits is expected to remain around 4% after plan changes.
Nearly 2/3 of respondents indicate that the excise tax will have a small to moderate influence on benefits strategy despite the delay in the effective date of the tax.
Digital engagement is becoming the norm with increased focus on the use of social media and health improvement apps expected in the future.
Telemedicine has quickly become a core offering. Employers are exploring centers of excellence and high-performance networks.
Employers see choice as a key value of a private health exchange.
Source: 2016 Willis Towers Watson Emerging Trends in Health Care Survey.

8. Example 1: The Tyranny of Averages:
Healthcare Services Price Comparison
Do Network Discounts really matter when this variance exists?
ANGIOGRAM
COLONOSCOPY
HIP REPLACEMENT
LIPITOR
M.R.I. SCAN
AVG. U.S. PRICE
$914
AVG. U.S. PRICE
$1,185
AVG. U.S. PRICE
$40,374
AVG. U.S. PRICE
$124
AVG. U.S. PRICE
$1,121
Range in Same US Network:
($400-$3650)
Range in Same
US Network:
($11,100-$126,560)
Range in Same US Network:
($325-$15,073)
Range in Same
US Network:
($3.50 (generic)-$203/month)
Range in Same US Network:
($382-$8736)
Healthcare
Management
Real-time, fiduciary-level transparency guarantees awareness of, and access to the best price every time!
Sources: 2012 Comparative Price Report by the International Federation of Health Plans and TrendShift independent analysis

9. Over time plan design and network are perfected…
Example 2: Real Time Healthcare Enterprise Management
Over time plan design and network are perfected…
True transparency cultivates an autonomous Value Based Medical Tourism Network

10. Savings up to 50% on certain procedures Savings 6-10% on total costs
PRICING & COST SAVINGS
A comprehensive program for Self-funded Employers
Negotiated bundled pricing which include physician, facility, anesthesia, diagnostics, etc. giving you cost predictability and manageability
Bundled Pricing
Cost Transparency
Cost Predictability
Savings up to 50% on certain procedures
Savings 6-10% on total costs
Savings without sacrificing quality of care

11. What Employers Need?
To Proactively Manage healthcare Risk by using a Medical Tourism program….
Perform a savings analysis based on claims data
Get data
Technology that is HIPPA compliant
Manage the transfer of medical records
Ability to connect that patient and the physicians (local and abroad)
A way to engage and educate the employees about the benefit
Manage the entire process: patient inquiries, validate eligibility and benefits, collect medical records, calculate the savings
Help with scheduling, bookings
Full reporting for utilization for ROI, etc.

12. AGILE VERSUS TRADITIONAL PLAN DESIGN
Agile Plan Design
Supports continuous problem solving
Constantly measures performance & implements changes
Holds all constituents accountable in Real-Time
Allows for true fiscal management of health plan
Traditional Plan Design
Seeks to solve problems retrospectively
Vendor-controlled selective data sets
At best allows for course correction the next year
Impossible to hold anyone truly accountable

13. Employer Implementation
Make changes to SPD or plan language to allow pre-certification and second opinions.
Implement rules engine to flag all TPAs for candidates.
Have Patient advocate reach out to employee about benefit of medical travel.
Have employee engagement Platform
Choose high quality providers

14. EMPLOYEE MANAGEMENT PLATFORM
A comprehensive program for Self-funded Employers
We manage the entire process using a HIPAA compliant technology platform: Global Patient System
An end-to-end, secure, ecosystem for medical travel

15. EMPLOYEE ENGAGEMENT A comprehensive program for Self-funded Employers
We provide a complete employee engagement program, designed to inform your employees about the quality and savings available to them and how to benefit from them. We make it easy for employees to be continually engaged through the employee engagement platform.
Comprehensive Employee Engagement Program
Education
Campaigns
Engagement Platform
Support

16. MEDICAL SECOND OPINIONS
A comprehensive program for Self-funded Employers
We will implement a second opinion program to determine the proper diagnosis and prognosis of the patient and to identify if there is an alternative or less invasive medical procedure that can be performed. Medical Second Opinions can also determine that a specific treatment plan is not medically necessary and ensures the patient only receives the treatment they should.
Partners Healthcare (Harvard-affiliated hospitals):
A recent study indicates that in 90% of MSO’s reviewed, an alternate treatment plan was suggested. 5% resulted in new diagnosis (
Cleveland Clinic:
Jonathan Schaffer, a physician who is managing director of the Cleveland Clinic's MyConsult Online Medical Second Opinion service, said one case resulted in savings of more than $150,000 when treatment changes were implemented for a 61-year-old patient who had undergone spinal fusion surgery.

17. HIPAA Compliant Technology Platform
HEALTH CENTERS PLUS
A comprehensive program for Self-funded Employers
Consulting & Program Setup
Cost Analysis
Network Selection
Procedure Selection
Employee Incentives
Second Opinions
Pharma
Employee Engagement & Dashboards
Employee Education
Employee Engagement Platform
Employee Support
Employee Dashboard
Employer Dashboard
Member Services & Administration
Facility Selection
Medical Records Transfer
Medical Care Coordination
Travel Coordination
Billing Verification
Process Management
HIPAA Compliant Technology Platform

18. Executive Vice President
QUESTIONS?
Morgan Pile, CES, GBDS
Executive Vice President