Care Coordination: Closing the Gaps on Patient Advocacy

Coordinating optimal care when patients need surgery requires professionally-trained and experienced care coordinators and concierge team members to do the work many physicians and medical groups can't.

Care coordination is even more critical when care is sourced outside the area in which the patient resides. In recent months we’ve noticed that most TPAs and ASOs who sell care coordination and case management do a great job when care remains local because they know the local healthcare ecosystem. 

It’s all good until it isn’t

But add medical travel coordination to the mix and altitude physiology or appropriate hotel accommodation and aircraft seating and out of town ground transfer coordination for appointments and surgery day transfers and that same competent case manager or care coordinator is suddenly over-matched by the demands of the job.

“Care that is disjointed tends to cost more and is prone to complications and unnecessary, preventable risks and harms.”

photo of Maria K Todd

– Dr Maria Todd, Chief Transformation Officer and cofounder of SurgeryShopper.com,Santa Clara, Utah and author of The Handbook of Medical Tourism Program Development and the Medical Tourism Facilitator’s Handbook and 18 other internationally-published healthcare business management titles.

“At SurgeryShopper.com our specially-trained care coordinators know the healthcare ecosystems that exist in the patients’ hometowns and are professional trained to learn the ecosystem of the location where the surgery will occur if travel is involved,” says its Chief Transformation Officer, Dr. Maria Todd. SurgeryShopper invests in its network development by upholding its internal standards and provider recruitment criteria. Specially-trained and experienced destination site inspectors visit each location where the provider is situated and conduct a dry run of airport arrival, hotel partners, ground transfer options, pharmacy and grocery delivery services, as well as the surgical facility and a review of surgeon, anesthesia and other providers’ credentials and qualifications.  This is what differentiates us from most of the other companies that are coordinating surgery and medical services that involve medical travel.

“Each day, we turn down providers and medical facilities who want to submit their application to be listed on SurgeryShopper.com and immediately expect to begin receiving patient referrals. They are unprepared or unwilling to be inspected, lack designated hotel partners and negotiated patient rates and amenities, aren’t located near an airport, have poor online feedback, or are located at altitudes that can be problematic for certain procedures,” Todd adds. “They just want to “do surgery” as if surgery happens in a vacuum.”

When the local hometown physician advises that surgery is necessary, and leaves the patient to fend for themselves, bad things can happen. Fragmented care is the source of all evil. If a physician or surgical facility has a competent care coordinator in-house, we coordinate with their staff as a courtesy and hand-off coordination to them. But most don’t have this set up. They lack the time, financial means to compensate care coordinators and the technology to help them do their work. 

Care continuity begets cost containment

At SurgeryShopper.com, our care coordinators are trained to know how to wrap the patient and their travel companion in the services needed to keep them out of crisis. They take the time because that’s their role. They are paid competitive hourly rates to do their work and they are provided the technology platform, using Higowell‘s patent pending software that was purpose built with functionalities needed to coordinate medical travel. SurgeryShopper’s Chief Transformation Officer, Dr Maria Todd was the primary subject matter expert who led the design and coordinated with programmers to make the software meet the need. As a founder and shareholder, she knows many of the more than 700 users of the tool throughout the world, so she knows for sure that other U.S. surgical travel coordination firms aren’t using this unique, purpose built tool.

SurgeryShopper care coordinators and travel concierge team members

  • are specially trained to manage sharing confidential and privileged patient records and digital images, coordinate pre-operative and post-operative care, testing, and follow up services, measure outcomes and patient satisfaction;
  • establish a patient record for an episode of care, assess care, create a master plan for the surgical episode of care, and teach the patients and their companion travelers how to manage their particular condition and episode of care, and guide them through the various transitional stages of pre-operative, destination care and post-operative periods;
  • are fluent in medical terminology, anatomy, physiology, altitude and travel physiology, and the surgical procedures and episodes of care;
  • know how to coordinate employer-paid and union-paid insurance benefits under ERISA and Taft-Hartley, managed care, PPO and other network arrangements, work with patients using HSAs, HRAs, and health expense sharing programs. They understand deductibles, copayments, pre-authorization and pre-certification procedures, and can help arrange no-interest financing for patients;
  • coordinate appropriate travel itineraries in appropriate aircraft, in appropriate seats in the aircraft, and to coordinate wheelchair and transfers, special meals, and to monitor flights. They are on duty around the clock and prepared to step in and mitigate the impacts of missed connections, flight cancellations, reroutes, and late arrivals, among other mishaps. They also know how to coordinate self-driven travel and can find the nearest health facility, mechanics, hotels, and coordinate emergency services along the designated route to and from the surgical destination, if needed;
  • don’t just make sure that the patient leaves the facility with prescriptions. Instead, they make a point of knowing how the patient will procure the medications that have been ordered. They coordinate overnight nursing attendance when ordered, and physical therapy appointments in a gym or at the hotel fitness center and pool when needed; and 
  • know what to do if a civil disturbance occurs at the travel destination (weather, violence, natural disaster, etc.). They are FEMA disaster management trained, BLS certified, and they know how to reach the patient and coordinate in spite of unexpected emergency chaos. 

Filling the gaps in care coordination

All of these preparatory checklist items are things that a local TPA or ASO case manager or care coordinator who only knows the local healthcare ecosystem cannot do well, if at all. And the same-day surgery centers and hospitals across the USA don’t offer these services in most cases. Care that is disjointed tends to cost more and is prone to complications and unnecessary, preventable risks and harms.  When employers or consumers hire SurgeryShopper care coordinators, they get a turnkey, all inclusive platform staffed by trained specialists who assume the primary care coordination role and activities as well as analyze, monitor and measure the key health metrics to document quality, safety and savings. All these services are charged by the case, not on a per-employee-per-month basis the way most other companies bill. Most of the other companies don’t offer this depth of service, either.

“They may have one of the items on the bulleted list above, but we often have to hire for ability and train for technique,” Todd explains. “And the BLS and FEMA healthcare disaster management training takes time and commitment to the effort to train and maintain the skills. The necessary medical travel skills and training are above and beyond the average travel agent’s scope of training and competency. Hotel booking insights are far beyond the skills of a central hotel booking agent’s or average front desk clerk’s experience and competency. Driving routes are critical if the patient and companion are meant to self-drive. You can’t just put them on the shortest road between two points as there may be no emergency health services nearby, cell signal, no gas stations for miles and hotels that are not appropriate are adequate to meet their needs along the route for miles and miles. Road closures and construction sites must be taken into consideration. Backup contingencies must be arranged – just in case.”

Training and certifications

We asked Dr Todd if there are certification programs that offer this sort of training that anyone wishing to work as a care coordinator can matriculate. She’s familiar with most of the training and certification programs in the medical travel industry and hasn’t found one that covers all that is necessary to be qualified to work for SurgeryShopper.com. “Most of the medical tourism training and certification courses and workshops don’t cover any of the items on the bulleted list above at the level of depth we require. That means we must train our staff internally for these skills and competencies.” These skills are drawn from professional case management, care management, transitional care for after one has had the surgery, and specialized medical travel planning as well as data collection and evaluation. 

Continuous quality improvement and professional development

 “We study each case when the file is closed to cull bits of new information we gather along the way. That’s part of our continuous quality improvement and ongoing internal professional development.”  We invest close to $5000 per care coordinator in training and specialized professional development,” she added.  We deployed a full-service EMR  and practice management software to be able to send and receive data and medical records to labs, imaging and to and from primary care or specialists in the hometown and at the care location and back. Using Higowell, we handle the back end referral management far more efficiently than a paper-based or spreadsheet system or an adaptation of a CRM that wasn’t designed to be used for this purpose.

Ongoing care management and outcomes measurement

One other differentiator of SurgeryShopper is our follow up care coordination and case management. Using specialized measurement and evaluation tools, we track clinical and patient satisfaction outcomes. These data are also used in our continuous quality improvement and value-based reports that we prepare for our self-funded employer clients. They don’t just receive a report of expenditures. They get a comprehensive report that includes documented clinical outcomes and patient-reported health status over time. The tool we use is an internationally-adopted measurement tool and survey designed to estimate the cost effectiveness of health interventions. Todd has implemented and refined these tools over 35 years to measure patient self-reported feedback on physical functioning; perceived limitations because of physical health problems; pain; function; stress and perceived well being; self-reported emotional problems; vitality; and general health improvement or deterioration perceptions for decades as an adjunct measurement tool for every medical travel company she established.

Effective care coordination is paramount to the overall success and brand integrity of SurgeryShopper’s operations, outcomes and value-based care delivery.

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