1. Managing Overseas Care in TCI-
the NHIP Experience
Dr. Hamlet Nation
Medical Advisor / Medical Officer

2. OVERVIEW Background The Referral Process Provider Management
Patient Care and Experience
Medical Claims
Policies and Organizational Framework

3. Background- Health in TCI
The Turks &Caicos Islands has a population of 31,458 (39%TC Islanders, 35% Haitian, 26 % others) 2012 Census
Healthcare is delivered at the Primary healthcare level (TCIG/Private) 8 TCIG centers/6 private centers* Including Psychiatry)
Secondary healthcare 2 Centers (30 beds 2 NICU, 2 HDU, 2 L&D) ability to increase by 100%
Treatment Abroad Program (TAP) for Tertiary and Specialized Care

4. Background-TCI Hospitals
TCI Hospitals emerged from a 25 year contract between TCIG & InterHealth Canada The first Public Private Partnership (PPP) involving the construction and operation of full service hospitals in the Region. There are 2 facilities operated with approximately 180 multi-disciplinary clinical staff. 5 diamond accreditation since 2012, highest rating by Accreditation Canada

5. Background-TCI Hospitals

6. Background-TCI Hospitals Services
Resident Specialists; Radiology, Internal Medicine, Obstetrics and Gynecology, General Pediatrics/ Neonatology, General Surgery, Orthopedics, Maxilo-Facial Surgery, Family Medicine, Nephrology, Emergency Medicine, Anesthesiology
Visiting Specialists (monthly) Medical Oncology, Urology
Visiting Specialists (every 3 months) Ophthalmology, Neurology, Plastic Surgery, Otorhinolaryngology (ENT)

7. Background-NHIP
Emerged in 2010 as one of the pillars of the Health Sector Renewal Policy
NHIP has 25,340 registered clients
Manages local pharmacy / providers and TAP benefits
Processes Medical Claims for both Local and TAP care
Coverage for 81% of Population ***

8. What does this mean to us?
We spend NHIBs money…
We manage interactions with beneficiaries
We manage interactions with providers

9. Treatment Abroad Program (TAP)
Since 04/10 to 07/15 total of 3,473 referrals through TAP
10-15% of all referrals Urgent
Over Ninety-six percent (96%) of all cases are treated regionally sent to the Jamaica, Dominican Republic and the Bahamas.
Process 500/month claims for TAP

10. Referral Process Urgent
TCI Hospital Medical Officer NHIP Overseas Provider
Non Urgent Referrals
Doctors Chief Medical Services Joint Referrals Meeting (TCIG, NHIP, TCI Hosp) NHIP Overseas Provider

11. Referral Process -NHIP
Functions of NHIP
Provide approval for care based on the benefit package
Contact Overseas Provider for appointments and acceptance
Transfer medical information/ images (before and after treatment)
Arrange transportation (air ambulance, charter, commercial)
Prepare treatment agreements for Patients/ Providers
Process claims for patients and providers
Follow up patient who are overseas

13. TAP Services

14. COST FOR TAP FINANCIAL YEARS 2010 – 2015

15. COST FOR TAP FINANCIAL YEARS 2010 – 2015
Services
FY 2010/2011
FY 2011/2012
FY 2012/2013
FY 2013/2014
FY 2014/2015
Medical
$6,947,674.88
$7,
$9,173,837.97
$8,769,876.52
$8,091,905.58
Subsistence
$155,386.89
$328,647.44
$448,335.00
$645,825.00
$694,500.00
Travel
$663,740.15
$327,506.68
$1,462,840.97
$2,364,328.68
$2,356,660.68
TOTAL
$7,766,801.92
$8,125,662.42
$11,085,013.94
$11,780,030.20
$11,143,066.26

16. TAP Expenditure

17. Provider Management
NHIP via TAP has over 200 major medical providers, 6 Hospitals, 10 Majors transport providers and we process over 9000 claims /month
Providers in 3 majors countries ( 1 Spanish Speaking)
Use of a Third Party Administrator TPA

18. Provider Management-Lessons Learnt
Establish a Preferred Provider List
Frequent opportunities for engagement with the providers (surveys on relationship NHIP)
Establish standardized requirements (documentation, indemnity, etc.)
Limited benefit in using (TPA) services
Provider Audits
Communication Protocol

19. Provider Consultations

20. Patient Care and Experience; Lessons Learnt
Personalized care (case managers)
Provide on the ground assistance for patients traveling overseas
Daily subsistence ( allows for your patient to be more independent )
Selection of providers with concierge services
Purchasing Private vs Public Care

21. Patient Care and Experience; Lessons Learnt
Patient assessment forms/ Staff and facilities
Follow up visits reduction through bringing the overseas provider on island
Cultural sensitivity /Immigration
Comparable clinical outcomes/standards**

22. Medical Claims
NHIP Processes 500/month claims for TAP ( transport, subsistence, medical claims)
Varied standards of claim submission ( paper based, codes)
Timeliness of claims submission ( 30 days to 1 years)
Use of Letters of Guarantee (LOG)
Prompt pay discount (15-20%)
Provider Contracts

23. Policies and Organizational Framework
Purchasing care regionally – Policy implemented in 2011
Building staff capacity – Operations Department
Training & Participation
Information Technology platform

24. Strategic Vision 2015 & Beyond
Standards, Efficiency and Quality in Service