Government Procurement of International Health Services

Gain Rapid Access to Care, Save Money, and Better Navigate Foreign Health Systems

Many governments and healthcare organizations around the world face challenges in delivering health services to their citizens because of scarcity of access. The technology, specialists, and procedures simply aren't available locally.  For many, this translates to procuring health services, telehealth consultations, surgery, and diagnostic testing and consultations outside their boundaries. I've been working in procurement and contracting for international health services since 1985.

While some new consultants may proclaim that there is no expert in the field for this, I've been successfully helping government health program officials to source and procure services at predictable prices, with contracts negotiated for return of advance deposited funds that were overestimated, and to negotiate bundled package pricing for more than 3 decades.  I help my clients to establish the necessary business and legal frameworks in order to achieve value for money and high quality health services and to coordinate the logistics and destination ground support for the patients and their companion travelers.

Government authorities and health ministries are welcome to call me for a no cost, no obligation, initial telephone consultation to discuss, inter alia:

  • options to improve health access and contain or reduce costs for medical, dental and rehabilitation travel, and to help them choose surgical, diagnostic and telehealth providers willing to negotiate fair and reasonable prices and packages on a procedure by procedure basis
  • choices of brand name (access to world renown academic centers of excellence such as Mayo, Cleveland Clinic, Johns Hopkins, MD Anderson, Huntsman, etc.) and what I call "hidden treasures", (inspected and accredited providers at destinations in 116 countries, who offer excellent culturally competent service, certified medical interpreters if needed, high quality, and great value, but just don't spend a lot of money on marketing their brand, or are prohibited from advertising by local regulation)
  • introductions to providers who are open to sharing financial risk and are accountability for outcomes, avoidable mishaps ("never events') and patient satisfaction

In our discussion, I will listen to what you've done in the past, the challenges you've faced, how you've implemented efforts to contain or reduce costs and the outcomes, good or bad. I will listen to what you want to change, how you envisage the ideal solution, and I will be honest in my recommendations.  I will discuss with you the fees I charge if you hire me to move forward. Please note that unlike many other "facilitators" and "consultants", I do not accept fees from providers or suppliers as a referral broker or as their marketing agency. I view this practice as abusive and unethical. My fiduciary responsibility is to you, my client. I owe you objectivity, specialized insights, and unbiased impressions as a professional in this domain area of expertise.

Insights

Learn what is possible and what is practical in your unique situation. I will inform you about everything that's relevant to your requirements. I will share with you my findings on healthcare facilities and practitioner services, the destination, cultural and language matters, and ancillary support providers (interpreters, destination support (hotels, drivers, private duty nursing care at a rental home or accommodation). I will guide you to appropriate hotels or short term home rentals for larger groups and families and about services available for, airport reception and departure services, car and driver services, VIP amenities and high-security services for high profile, high risk travelers. I can arrange all end-to-end business away from home support services, (rental of business equipment, secretarial and administrative services, etc.) for executives and government officials, all based on direct inspection.

International Patient Services Program Design

Once the program is developed (budget, actuarial and provider supply chain contracted) I will assist you to document your program specifics, guide the development of your infrastructure and protocols for treatment abroad, authorization forms, appeal appeal policies and procedures, extension policies and procedures. I will also address and help create policies and procedures to coordinate escort or companion travelers who are eligible to accompany the patient on their international patient care. I work well with actuaries and predictive analytic software programs you may own or desire to implement to predict international care and diagnostic services utilization and develop budgets.

Site Inspections

When you are ready, I will accompany you on field missions to inspect your chosen candidate suppliers and destinations, and sit on your side of the table during contract negotiations with hospitals, surgery centers, specialists, and ancillary suppliers. Having guided many hospitals in the USA and abroad through the preparation for various  U.S. and international hospital accreditation surveys and certification audits, I structure your site inspections in alignment with the best practices and requirements of these programs in a direct observation and select "tracer" exercises to validate relevant policies, procedures and practices.

Problem Solving /Ombudsman

When any issue or concern arises, I will act and advocate as your officially-appointed designee to keep things running smoothly, around the clock. If the matter can be handled by phone, I'll make that happen. If I must travel to the patient's location on short notice to intervene on your behalf as the patient's ombudsman then that's what will be done.

  • As an experienced case manager, I know what to do, how to get things using an assertive and diplomatic demeanor that gets quick results.
  • As an experienced surgical nurse, if the need arises, I know how to listen to patients and caregivers listen for clinical signs and symptoms and when to implement "panic" protocols and how to provide compassionate reassurance.
  • As a former hospital administrator, I know my way around the hospital and healthcare delivery world.
  • As a former travel agent, I know many tricks and secret ways to get around standard commercial air travel itinerary disruptions, and get help in any commercial or private airport or FBO station.
  • For urgent and emergency situations, or unplanned visa extensions, or extreme conditions (e.g., severe storms that require evacuation and service interruption, flooding, fires, or other civil emergency)  I will use my training in disaster preparedness and follow your exact protocols when embassy attaches must be involved or to act as their proxy.
  • As a trained and experienced mediator, I will also step up and work out any service, pricing or other contract disputes so that all parties settle down in the immediate term and refocus on your patient's needs.

Contracts

As the author of the most popular "how to" manual on third-party contract analysis and negotiations between payers and providers,  I have all the model agreements, protocols and detailed written site inspection criteria available from more than three decades of hands on experience. I am fully versed in American and many other models of hospital management, healthcare revenue cycle practices, and third-party payer negotiations. I bring experience working at large insurance companies as the head of their provider contracting departments. I am also an experienced hospital manager and administrator. I have hands-on experience managing hospital and large clinic revenue management departments. As such, I know my way around what can be negotiated and how to ask and structure amicable arrangements without being overcharged.

Bill auditing and verification of charges against contracted case rates

If you like, I will carefully audit supplier bills against negotiated case rate inclusions, and certify bills as ready for settlement or request additional information to substantiate any unexpected charges.  I draws upon my clinical training and experience to decipher any extra charges outside the case rate for medical necessity, departures from authorizations, or exceptions which may or may not be payable in accordance with the terms of the agreement. Once approved for payment I transmits the invoice as "approved to pay" and the amount of the payment recommended, if any, to be paid directly to the provider.  I leverage my knowledge of U.S. billing, coding and supporting documentation practices to afford my clients maximum cost containment benefit.

Measurement and Evaluation of Outcomes

Clinical, functional and international patient satisfaction outcomes are measured and evaluated. If a complaint is received, I will investigate and acts upon it as required and authorized by you in a tactful and diplomatic demeanor.  I will also prepare meaningful periodic reports are produced to record and demonstrate cost savings, quality, safety, and value at the frequency of measurement and evaluation specified by you.

Contract Renegotiations and Renewals

Six months prior to the expiration of the in-force contract term, upon your approval, I will initiate dialogue with suppliers to renew contracts, expand services to additional procedures and diagnostic services, end the relationship and find replacement suppliers, or renegotiate terms and conditions according to current requirements.  Amendments and service expansions to add new procedures is available at any time during the in-force contract term.  Addition to approved network suppliers is available at any time.

Outsourced Coordination of Patient Movement

I will establish the entire system to coordinate patient movement, travel, arrival reception, destination backstopping, problems solving, departure coordination, discharge management conferences for proper handoffs, and continuity of care and follow up after the patient's return home. Once the program has been beta tested and fully implemented, I will either train your internal staff or train an outsourced facilitator to help you carry on independent of me. I simply don't have time to attend to all the details of patient movement personally in the long term.  I have trained many professional medical travel facilitators around the world ready to assist you and follow the system we've implemented.  They too, are committed to acting as your advocate and will uphold their fiduciary duty to you. As professionals, they do not accept touts or finders' fees or referral fees from providers.

I will also engage and train local destination coordinators (LDCs) positioned in each high-volume, contracted international patient care destination. This makes sense in destinations where frequency and duration of international patient services dictate. LDCs are subjected to criminal background and reference checks, and vetted for language fluency and cultural sensitivities prior to engagement. Drivers are subject to driving history and insurance and vehicle model and maintenance. If required, private armed or unarmed security services are also arranged.

For very high volume utilization, where it makes sense to do so, I will arrange serviced apartment rentals and arrange long term leases, hire a decorator to furnish the apartment with appropriate furnishings based on the care scenarios required by your unique population. Generally, these are apartments that will have quarters for the average entourage, be close to medical facilities and have adequate quarters for overnight nursing care as needed. Grocery delivery can be arranged, along with personal chefs, or buildings with on-site catering may be another option.  Your LDC will then become the focal point and local contact for all matters regarding leasing, lease renewals, internet, cable TV and utility accounts, delivery services, home-bound nursing and personal assistance and physical therapy services and other special requirements.

Case Management Software

I helped to design the first and only patient movement software designed to manage end-to-end patient movement, care coordination, travel, and outcomes management and measurement. We have entered the stage where the software is now pending the award of a patient in the USA.

This cloud-based software is already in use at hospitals, clinics, health resorts, practitioners and by medical tourism referral agents and facilitators, worldwide. If your internal case managers would rather manage patient movement and appointment management, travel bookings and medical records transfers, I will help you to set up the initial data load to enter all the particulars of your contracted network of providers, establish a self-service travel request portal, and train your staff how to use the system to coordinate all medical, dental, rehab and diagnostic travel.  You may trial the software for no charge, with access to all modules, and if it proves useful, you may purchase a higher capacity license at a specially-discounted rate as my client.  This software also features an international marketplace where you may discover additional suppliers ready to serve your patients and meet their international healthcare needs. This unique marketplace feature is accessible to you at no additional cost.

Training

I will train your internal staff or your designees how to continue the pathways I've initiated, and then remain available for questions for ad hoc calls, expansion and transition solutions and new ways to grow your program or reduce your dependence on foreign providers.

Transition

As your advocate and ever mindful of my fiduciary duty to you, I will consult and guide you through the local development to eventually replace some purchased services. I will guide you through the process of establishing new health facilities, technology acquisition, knowledge transfer and continuing medical education for specialists, and capacity development for all required allied health and administrative personnel.  Over time, you'll begin to replace certain high-cost, high-volume services with locally or regionally accessible, less costly services.

Please contact my office today and schedule an appointment for our discussion to discover how we can work together to reduce costs and gain rapid access to healthcare and rehabilitation services for program participants.

Dr Maria Todd

Global Health Procurement Expert