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Wo Working wi with Assistance ce Companies es A ‘Provider ers’ p perspec ective
Ab About T t The Mc McGrigo gor Group p James McGrigor (UK, CEO) Key Focus – Growth Consulting for Insurance & Health Service Co’s David Vogdt (France, Partner) Key Focus – Int’l Development for Medical Providers => 25+ years; 400 advisory projects; 40 acquisitions; Int’l patient provider experience; a truly global perspective from Mexico to China => 4 main activities: Consultancy, M&A, Publishing (IPMI/PHM), Specialty • Client Examples: o PAYERS - International Private Medical Insurers (Cigna, BUPA, MSH,..) o PROVIDERS : PHF (Paris Hospital Foundations); Clinalliance Group (Fr) o SERVICE CO’s : Third Party Administrators (MSH, NEXtCARE); Assistance companies (ISOS, AXA Assistance, Asia Assistance..); Cost containment co’s and medical facilitators (Medigo..); Health and wellness providers (Optum..) o GOVERNMENT BODIES: WHO; Multiple MOFA and MOH eg (Benin, Morocco, Spain)
Abou out the PHF HF Ho Hospital Grou oup The Foch Hospital , the Rothschild Foundation Hospital and Diaconesses Croix Saint-Simon Hospital Group: Leading Hospitals in France in several fields such as Neurology, Neurosurgery, Pneumology, Oncology, Urology, Orthopaedics, Ophthalmology and others. - 3 General Hospitals, offering over 1000 Hospital Beds - Over 1000 Employed Physicians in 3 Hospitals - No doctor fees applied - Covering around 90% of the Medical Specialities - 3 Teaching Hospitals
Qu Ques estion on of t the day: How w should Assistanc nce compa panies & p provide ders work together, , give ven the situational pres essure? e?
Assistanc nce c compa panies - Role & Main criteria PROVIDER => Role Place patients with Urgent medical needs ⇒ 4 main criteria for Providers, also called the 4 pillars are: • Medical Excellence • OPs efficiency (quick responses, fluid communication, ? ability to speak foreign languages, to accept GOP, to bill internationally etc.) • Cost-containment • Credentialing These are the main priorities reflected in figures used to calculate the global ranking with different weighting. Above a certain grade, the local network manager can assign the “Preferred” status to the provider.
Provi vider r - Role ole & Expectatio ion =>Provider ASSISTANCE COMPANY • Treat patients => Priorities & Expectations: • Provide quality medical care ? • Have accurate medical information before arrival (including Lab, Images, updated status of patient) • Have solutions for patients departure once treatment is considered finished (Eg: Recovered or medical project has come to and end) – Avoid a bed blocker • Get paid, easily, quickly • Repeated activity. Don’t become the Plan B when others fail to accept
Areas as of frict ction: Matching r roles, di , different pr priorit ities… => Role => Role • • Place patients with Urgent medical Treat patients Match needs => Priorities: => 4 main criteria's for Providers, • Provide quality medical care also called the 4 pillars are: • Have accurate medical information • Medical Excellence before arrival (including Lab, Images, updated status of patient, …) • OPS efficiency (quick responses, fluid communication, ability to • Have solutions for patients departure speak foreign languages, to accept once treatment is considered finished Possibl ble a area ea GOP, to bill internationally etc.) (Eg: Recovered or non treatable) – Avoid a bed blocker • Cost-containment of fr f friction • Get paid, easily, quickly • Credentialing • Repeated activity. Don’t become the Plan B when others fail to accept
Solving friction Possible area o of f f fricti tion Criteria Assistance Company Provider Solution Medical Excellence Primary Primary Keep good Ops Efficiency Primary Secondary, according to Have primary admin & general activity medical contact Cost-containment Primary Last Arrange 2 way benefit according to growth with clear pricing Credentialing Primary Administrative burden Publish it, open source Have accurate medical Works with available Medical teams refuse Connect medical teams information upfront information without information and build trust Have departure Depends on Assistance Can not have a bed Define exit scenario solutions companies. Sometimes blocker situation upfront or don’t do the abandon patient after mission. Will damage delivery relationship otherwise Get paid, easily, Depending on 3 party for Do not wish to run after Build money recovery quickly payment their money into price, speedy payment discounts Repeated activity Based on relationship with Become frustrated if Don’t send cases that providers, tend to work they are only a Plan B are not likely to happen with preferential network when others fail
Concl clusion: Building a an e emotional r relationship Ask y yoursel elf b before e e engaging ng • Provider: Am I a potential medical partner for Assistance Companies (High Performing ICU, heavy case management, close to International Airport, etc) • Assistance company: How much of a network do I need in the region? (Avoid signing without bringing volume..) Possi sible w e ways t s to impr prove. S Simple c cha hanges, bi s, big i g impa pact • Consider each others priorities when negotiating with a potential partner • Adapt & make changes to internal procedures (Eg Billing) • Improve communication to focus on mutual key priorities • Introduce medical teams to understand each other’s processes • Meet on a regular basis
THAN ANK Y YOU
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