International Patient Landscape · 2019-07-29 · Source: Sg2 Interview, October 2016; Sg2 Analysis, 2018. LARGE DESTINATION PROVIDER Essential Factors Reputation and Brand Physician

International Patient Landscape Vizient Global Executive Services

Joan Moss, RN, MSN Senior Principal and

Chief Nursing Officer, Sg2

October 26, 2018

Confidential and Proprietary © 2018 Sg2 2

Agenda Landscape

International Patient Journey

International Health Programs

Expanding Our Global Presence

3 Confidential and Proprietary © 2018 Sg2

International Medical Tourism Is an Attractive Industry

Mayo Clinic Care

Network includes

members from

Mexico, Philippines,

and Singapore

Sources: Cleveland Clinic. State of the Clinic Annual Report, 2017; Mayo Clinic. Mayo Clinic Facts, 2017; Chambers A. Trends in US Health Travel

Services Trade.Sg2 Analysis, 2018.

Annually, between

seek medical care in the United

States, resulting in more than

100-200K patients

$1.8 billion in trade

International patients are

typically self-pay.

Cleveland Clinic

Mayo Clinic

In 2017, Cleveland Clinic saw

from 135 different countries, over

40% from the Middle East.

3,265 international patients

In 2017, Mayo Clinic

provided care for

patients from

136 countries.


Many US Health Care Providers Have Some Form

of International Presence

Arkansas Children’s Hospital

Ascension Health

Boston Children’s Hospital

Cedars Sinai Medical Center

Children’s Hospital of Philadelphia

CHI Health

CHRISTUS Health

Cincinnati Children’s Hospital

Cleveland Clinic

Duke Health

Hartford Hospital

Houston Methodist

Johns Hopkins Medicine

Lurie Children’s Hospital

Mayo Clinic

MD Anderson Cancer Center

NewYork-Presbyterian

Ochsner Health

Partners Healthcare System

St Jude Children’s Research

Hospital

Stanford University Medical Center

Tampa General Hospital

UC Davis

UCLA Health

University of Chicago Medicine

University of Pittsburgh Medical

Center

Note: This is a select list of organizations with an international presence and is not all-encompassing. Source: Sg2 Analysis, 2018.


International Patients Demand Even More Than

US Patients

= +

High touch and high tech

equally important

Willing to travel to other

countries if their needs

are not met

Willing to spend extra

money on better quality

products and services

+

Speed

Convenience

Service

Outcomes

Costs

Quality

Disposable

income

Higher

Expectations

Online

Information

Spending

Power

Patient

Empowerment

Source: Sg2 Analysis, 2018.

Quality

Value = Cost


Organizations Vary in Stage of International Program

Development

Sources: Merritt M et al. Academic Medicine. 2008;83(6):541-549; Sg2 Analysis, 2018.

Stage Characteristics Details

1 Education programs and training Limited in scope

Few personnel, resources or investment needed

2 Consulting and advisory programs

Often involves affiliation status, such as use of

name

More resource intensive

Can use

3

Management services for hospitals,

medical schools, or educational and

research centers

Long-term agreements

Affiliation but not ownership

4 Local presence and delivery of patient

care, education and/or research

Most commitment needed and most risk

involved

Often requires overseas offices and staff

Can entail owning and managing assets abroad

Indefinite time frame


Trends in International Programs

1. Destination Care

Johns Hopkins Medicine International provides support for international patients

seeking care in the United States and also collaborates with many other organizations

throughout the world.

2. Second-Opinion Consults

Boston Children's Hospital provides an online second opinion program in which a

Boston Children’s pediatric specialists reviews a child’s records remotely, answers

questions, and provides a detail report within 5-7 business days.

3. Real-Time Patient Rounding

UC Davis partnered with Shanghai East International Medical Center in China to

provide second opinions on complex diagnoses using an InTouch Health robot that

rounds side-by-side with the local Chinese physicians.

4. Foreign Investments

Cleveland Clinic Abu Dhabi opened in 2015 and completed 54,000 appointments and

3,000 procedures in its first year.

Sources: Cleveland Clinic. Annual Report, 2015; Kehoe B. Hospitals expand their global reach. H&HN. September 5, 2016;Children’s Hospital of Philadelphia website; Lurie

Children’s website; Kutscher B. The long reach of medicine. Modern Healthcare. October 20, 2012; Sg2 Analysis, 2018.


Bumrungrad Thailand… An International

System of Care

BUMRUNGRAD INTERNATIONAL HOSPITAL (BIH), THAILAND

BIH= Bumrungrad International Hospital

Source: Bumrungrad International Hospital website. Accessed October 2018.

Building a System of Care

As one of the largest private hospitals in Southeast

Asia, BIH provides patients from over 190 countries

with a full range of tertiary healthcare services and

over 30 specialty centers.

Over 50% of BIH’s patients are medical travelers.

Of its 1,200 physicians, surgeons, and consultants,

approximately 220 are US board-certified, making the

facility a favorite of Western medical travelers, expats

and regional business executives.

Over 150 interpreters, international/airport concierge

service, embassy assistance, VIP airport transfer, e-

mail contact center, international insurance

coordination and international medical coordinators,

visa extension counter, and Muslim prayer room.

Thai vs. International Patients

(% of total revenue)


Agenda Landscape





Proposed Patient Journey and Key Success Factors

Key Success Factors

1. Single person who coordinates patient journey

2. Highly defined care delivery process to guide patient through the system

3. Fast access to clinical team, ideally speaking directly to physician

4. Joint agreement across clinical touch points to prioritize these patients while

they are on-site

Second

Opinion

Sales Marketing Intake and

Stay Preparation

Patient

Care Follow-up Discharge



Patient Journey Best Practices and Next Steps

Process Existing Infrastructure Workforce Involved

Marketing

Attract potential patients to

contact your organization for

medical needs

Current marketing software and

tools

Marketing team

Potentially hire new

physician liaisons

Sales*

Receive initial patient inquiry

Explain offerings

Assign coordinator (if not

already being handled by

coordinator)

Insurance Information

Price estimation software

eHealth Technologies medical record

review software

Coordinator

Screening

and/or Second

Opinion

Offer cost estimate

Assess clinical

appropriateness

Physician approval

Collect $1,000 fee

Insurance Information

Price estimation software

eHealth Technologies medical record

review software

Finance team

Managed Care team

Clinical team/Coordinator

Scheduling

Schedule appointments with

clinical teams (defined care

delivery processes to be

created)

Electronic Medical Record Clinical Team/Coordinator

Information systems

*This step/role may overlap with intake or second opinion in select situations.


Patient Journey Best Practices and Next Steps

Process Existing Infrastructure Workforce Involved

Travel and

Accommodations

Assist with airline, hotel

and transportation booking

Current hotel relationships Coordinator

Concierge

Services

Advise on local attractions

and religious/spiritual

resources

N/A Coordinator

Patient Care

Proceed with patient

treatment as normal but

with “VIP” treatment

Support patient and family

needs throughout their

stay

Electronic Medical Record Clinical teams

Coordinator

Discharge

Scheduling

Discuss continued patient

care

Communicate with

caregiver and home

physician

Electronic Medical Record Clinical teams

Coordinator


Nationally Renowned Hospital Strategically

Markets Its Services for Destination Care

Marketing Strategy

Market the condition and a recognized brand.

Hospital never markets an individual physician.

Stay connected with residents, medical students and

fellows to build referrals.

Airport needs to be accessible.

Target patients that need complex IP surgery or

innovative OP clinical trials or procedures with

advanced technology.

Results

Patients travel from outside of the hospital service area

and internationally.

For bladder cancer 41% of patients and for brain

cancer 54% of patients travel from outside the

hospital’s service area.

LARGE DESTINATION PROVIDER

Rebuilding the Downtown Area

City/state partnerships to build a

new medical center district

Create new landscape for patient

convenience

– Hotels

– Attractions

– Transportation

– Patient touchpoints

Prioritized Services

Oncology

Transplant

Neurosurgery

Cardiology

Source: Sg2 Interview, October 2016; Sg2 Analysis, 2018.


Concierge Program and Scheduling

Greet, direct and help guide patients related to visit

(sight-seeing, lodging, popular attractions).

No travel arrangements are made by staff.

No nurse navigator or care coordinator

Centralized call center handles all appointments;

patients call general line on website.

Provide information in several different languages.

Business office handles financial and business items.

Ronald McDonald is an option for patients and families.

Strategy

Get patients to come here for everything, who often stay

after surgery to receive care at hospital.

Developed affiliated practice network to offer the

organization’s clinical expertise internationally.

Payer and employer strategies focus on specific

procedures (eg, transplants, cardiac).

Unique Features and Essential Factors to

Building a Destination Program

Source: Sg2 Interview, October 2016; Sg2 Analysis, 2018.

LARGE DESTINATION PROVIDER

Essential Factors

Reputation and Brand

Physician Expertise

Research/Clinical Trials

Training

Patient Experience

Innovation

One-Stop Care

Cutting-Edge Technology

Access and Convenience

Subspecialization


Agenda Landscape





Hopkins Participates in Many Different

Collaborations and Agreements

JOHNS HOPKINS MEDICINE INTERNATIONAL (JHI)

Overview

JHI exists as a separate legal entity from the rest of the system, allowing assets to be

kept separate for tax purposes, and creates a distinct contracting entity.

International Collaborations

JHI participates in various international collaborations with different goals and

agreements, including:

Advising—faculty liaisons, virtual tumor boards, remote second opinions, patient referrals

Consulting—strategy, equipment purchasing, recruitment, facility planning, patient safety,

quality improvement, Joint Commission International accreditation preparation

Education—medical education programs, observerships, resident rotations, nursing

development, conferences, clinical lecture series, clinical trials, curriculum development

Management—management teams responsible for day-to-day operations

Program development—clinical, education, training, HR, capital equipment

Sources: Johns Hopkins Medicine International website. Accessed March 2017; Sg2 Analysis, 2018.

Destination

Care


Overview

Established in 2000, Johns Hopkins Singapore is a joint venture between the National

Healthcare Group (NHG), a health system in Singapore, and JHI.

JHS is located in Tan Tock Seng Hospital, the second-largest acute care hospital in

Singapore.

The hospital specializes in oncology treatments, with a focus on solid tumors, and is one

of the leading oncology centers in the state.

JHS works with researchers from Johns Hopkins, National University of Singapore and

National Cancer Centre, Singapore.

Results

In 2004, JHS became the first private hospital in Singapore to be accredited by the Joint

Commission International.

JHS sees over 1,400 new cancer patients per year from Asia-Pacific and the Middle East.

Completed 65 clinical trials to date, with many focusing on diseases that are prevalent for

the Asian population.

Advance Cancer Research and Care

to Patients in the Asia-Pacific Region

JOHNS HOPKINS MEDICINE INTERNATIONAL (JHI) (Cont’d)

JOHNS HOPKINS SINGAPORE (JHS)

Sources: Johns Hopkins Medicine International website; Johns Hopkins Singapore website; Sg2 Analysis, 2017. All websites accessed March 2018.

Destination

Care


Quaternary Hospitals Can Take

Alternative Approaches

BOSTON CHILDREN’S SECOND OPINION CLINIC

CLINICAL EXPERTISE

Diagnostic program for complex cases

Team of specialists to diagnose and treat

Second opinions for >200 clinical

specialties

Access to experts

In person or online

Expert opinion delivered quickly

Detailed report in 5–7 days

Logistics coordination

Personal-care coordinator assigned to

families

Staff physician to collect medical

information

PATIENT EXPERIENCE

Family and patient centeredness to

“Get Started”

Step-by-step instructions on process

Assurance of confidentiality

FAQs

Out-of-pocket costs

Transparency

Turnaround time

User-friendly portal, prompts, contact #

to call

Experience

Stories

Video

Sample online second-opinion report

Second

Opinion

Consults

Source: Boston Children’s Hospital. Second Opinions Program website, Accessed September 2018.


Extend Your Services Globally

in Real-Time

UC DAVIS & SHANGHAI EAST INTERNATIONAL

Overview

UC Davis partnered with Shanghai East International

Medical Center in China to provide second opinions on

complex diagnoses using an InTouch Health robot that

rounds side-by-side with the local Chinese physicians.

Interoperable, purpose built-devices, and proactive

monitoring allows for successful international telemedicine

efforts.

Sources: Modern Healthcare: The Long Reach of Medicine. October 2012; InTouch Health: Telehealth’s Tremendous Travel Savings. April 2017; Sg2 Analysis, 2018.

All websites accessed October 2018.

Real-Time

Patient

Monitoring

Results

This technology has created a rise in demand for international telemedicine, especially in fields

such as radiology and pathology that lend themselves to virtual care.

This partnership eliminated the need for patients to travel five million miles, saved nine years’

worth of travel time, and saved patients $3 million in travel costs. For each patient served, that’s

an average of 278 fewer miles traveled and $156 in travel savings.


Abu Dhabi Location Expands

Brand and Footprint Internationally

CLEVELAND CLINIC INTERNATIONAL

CLEVELAND CLINIC ABU DHABI

Sources: Al Nowais S. Cleveland Clinic Abu Dhabi to double number of doctors. The National. September 20, 2016; Bukhari I. Innovative Healthcare: Unique Cleveland Clinic is

ahead of its time. The Peninsula. February 4, 2017; Sg2 Analysis, 2018.

Overview

Cleveland Clinic Abu Dhabi is a 365-bed hospital opened in

2015 in partnership with Mubadala Development Company.

Clinic staff includes over 200 physicians representing over

70 nationalities and 35 languages.

There are 5 Centers of Excellence in the Heart & Vascular, Neurological, Digestive

Disease, Eye and Respiratory & Critical Care Institutes.

Results

As of January 2017, the Abu Dhabi location completed 262,000 appointments and more

than 11,500 procedures.

The clinic has seen over 5,000 patients from outside of the UAE, originating from over

60 different countries.

As a response to complaints about long wait times, the Clinic plans to hire an additional

200 physicians by the end of 2017.

Foreign

Investments



Patient Journey From Prevention to After Care

Strategy: Focus on the Patient Journey From Prevention to After Care

Source: The Hospital of 2018 and Its Embedding in a Health Ecosystem of a Digital World, Austria. July 2018.


Strategy: Employ Team-Based Care



Strategy: Build a System of Care



Strategy: Implement Digital Outreach Source: The Hospital of 2018 and Its Embedding in a Health Ecosystem of a Digital World, Austria. July 2018.


Agenda Landscape





How Do I Create an International System of Care?

What’s your “Why”?

Diversification of patient revenue (e.g. growing cash pay)?

Brand recognition as international provider of choice?

Superstar physician interest?

Quaternary care volumes?

Contributing to the development of the health system of another country?

Providing expertise and guidance in key service line development?

Open new revenue streams by leveraging your comparative advantage through

management, physician expertise and consulting?

Do you have what it takes to be “global”?

Very few health systems are even “national” in scope; being “global” is highly

competitive, requires significant time and investment as well as a multifaceted

approach

Which countries should my organization target?

Who are the competitors in these international markets?

What industry factors in these markets drive patients to travel for care



Methodology for Quantifying the Medical Tourism

Opportunity for the Oncology Service Line



Oncology Market Opportunity Assessment Informs

Facility Planning and Technology Investments



Medical Tourism Attractiveness:

Market Force Factor Overview



How Do I Create an International System of Care?

On a Scale of 1-10, 10 being the highest, how high of a priority is

international program development for your organization?


Patients

Traveling for

Health Care

Physical

Presence

Abroad

Providing Medical

Personnel, Management

Agreements, Staffing,

Education and

Consulting Abroad

Virtual Care,

Second

Opinions and

Clinical Protocol

Delivery

10 1

Which pieces of the puzzle do you have today; and what do you need to

build?

Sg2, a Vizient company, is the health care

industry’s premier authority on health care

trends, insights and market analytics.

Our analytics and expertise help hospitals

and health systems achieve sustainable

growth and ensure ongoing market

relevance through the development of an

effective System of CARE.

Sg2.com 847.779.5300


Appendix


6%

15%

49%

7%

7%

8%

8%

Cleveland Clinic Attracts Thousands of

International Patients to the US Each Year

CLEVELAND CLINIC INTERNATIONAL

GLOBAL HEALTH CENTER Overview

From 2014 to 2016, Cleveland Clinic has

averaged about 4,600 unique international

patients from 180 different countries each year.

International patients make up 0.2% of all

patients at Cleveland Clinic.

49% of all international patients originated from

the Middle East in 2016, followed by 8% from

the Caribbean and 8% from Canada.

International Offerings

Consulting: Offerings related to patient

experience, supply chain, nursing and wellness

are available to health care entities across the

globe.

Sources: Cleveland Clinic. State of the Clinic Report, 2016; Cleveland Clinic Global Health Center website. Accessed March 2017; Sg2 Analysis, 2018.

Middle East South America Europe

Caribbean Asia Other

Canada

International Patient Origin

Cleveland Clinic, 2016


Cleveland Clinic Has a Wide Range of

International Offerings

CLEVELAND CLINIC INTERNATIONAL (Cont’d)

GLOBAL HEALTH CENTER International Offerings (Cont’d)

Patient Support

Cleveland Clinic offers in-country offices and representatives for patients in Canada, Dominican

Republic, Guatemala, India, Panama, Peru, Saudi Arabia and United Arab Emirates.

Global Patient Services is a complimentary service offered to the Clinic’s international patients

intended to reduce the stress of receiving care abroad and create a seamless patient experience.

Global CARE program provides air transportation to Cleveland Clinic for registered patients when

traveling 150+ miles away from home.

Virtual Health

Patient offerings include online second opinion services, preadoption consultations and nutrition

consultations.

International physicians also have access to physician-to-physician and private practice medical

records systems and radiology reviews.

Education and Training: The Center for International Medical Education offers

programs for physicians, students and administrators from various countries.

Sources: Cleveland Clinic Global Health Center website. Accessed March 2017; Sg2 Analysis, 2018.


International Patients Have Access to

Specialized Support Services at Mayo Clinic

MAYO CLINIC INTERNATIONAL SERVICES CENTER

Overview

In 2015, Mayo Clinic delivered care for patients from 140 different countries.

Mayo provides a variety of services to international patients traveling to the US for care

to better serve and manage their unique, and often complex, needs.

The Minnesota, Arizona and Florida Mayo Clinic campuses each have their own

dedicated international patient centers.

Services

Patient representatives at the International Services Center support Mayo’s international

patients by assisting with:

Appointments and registration

Financial counseling

Travel

Interpreter services for 30+ languages

Representative offices are located in Canada, Colombia, Ecuador, Guatemala and

Mexico and serve similar functions to the International Services Center.

Sources: International Services at Mayo Clinic website. Accessed March 2017; Sg2 Analysis, 2018.


Network Provides Consultative and Educational

Resources to International Members

MAYO CLINIC (Cont’d) MAYO CLINIC CARE NETWORK

Overview

Mayo Clinic Care Network is composed of over 40 independent health care providers.

The network provides organizations with access to Mayo Clinic through resources such

as e-consults, e-tumor board conferences and consulting services.

International Partners and Offerings

As of March 2017, Mayo Clinic Care Network has 4 international members:

American Hospital Dubai, United Arab Emirates

Médica Sur, Mexico

Raffles Medical Group, Singapore

St Luke's Medical Center, Philippines

The network offers services specific to international health care organizations, including:

Health care consulting

Visiting administrator and leadership development programs

Nurse consulting programs

Symposium Sources: Mayo Clinic Care Network website. Accessed March 2017; Sg2 Analysis, 2018.

Documents

International Patient Landscape · 2019-07-29 · Source: Sg2 Interview, October 2016; Sg2 Analysis, 2018. LARGE DESTINATION PROVIDER Essential Factors Reputation and Brand Physician