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Considerable attention has been given during the past five+ years
to international medical tourism as a tool for health care purchasers to
provide a lower cost alternative for applicable targeted high-cost
procedures. While international medical travel continues to experience
overall growth, there remains material reluctance on the part of a
significant portion of employers, health plans and consumers to
participate in these international programs for various reasons.
However, both due to cost and quality concerns with complex care
delivered locally throughout widespread portions of the country, the
concept of Domestic Medical Travel is receiving significant interest.
Within the United States, increased focus on variations in quality and
cost has brought new energy to the concept of channeling care to centers
of excellence. Historically, its application was limited to transplants,
but now some employers are adopting this concept for other complex,
high-risk surgical procedures.
Medical travel, even domestically, when sponsored by employers, health
plans or other purchasers, still raises legal and regulatory concerns
and issues that should be adequately addressed by purchasers seeking to
pursue such initiatives. Medical travel legal expert Kevin J. Ryan of
Epstein Becker & Green identifies and discusses potential approaches to key issues
in this regard.
The most prominent large employer initiative in this regard may be the
Lowe's and Cleveland Clinic relationship entered into last year. Now
with over a year of experience to draw upon, Kyle Wendt, Vice
President - Benefits of Lowe's Companies, and George Wagoner, FSA, MAA,
Senior Partner of Mercer discuss the experience, issues and implications
of their initiatives.
Lowe’s full-time employees and their covered dependents enrolled in the
company’s self-funded medical plan may elect to schedule qualifying
heart surgery procedures at the Cleveland Clinic in Cleveland, Ohio at
an enhanced benefits coverage level. For patients approved for the
qualifying heart surgery, the Lowe’s program will cover all medical
deductibles and coinsurance amounts as well as travel and lodging
expenses for the patient and a companion plus concierge services to make
the arrangements. With fiscal year 2008 sales of $48.2 billion, Lowe’s
Companies, Inc. is a FORTUNE 50 company that serves approximately 14
million customers a week at more than 1,700 home improvement stores in
the United States, Canada and Mexico.
Mercer worked with Lowe's to design the program and negotiate a bundled
provider payment rate structure on their behalf. Mercer is also working
with other national employers to implement similar programs with a small
number of nationally renowned medical facilities. Mercer actively
monitors emerging results and works with employers to adjust and expand
these initiatives. |
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Participants will be able to:
- Examine the specific Domestic Medical Travel program designed by
Lowe's Companies, in consultation with Mercer.
- Consider the experience and implications of the Lowe's and
Mercer initiatives to date.
- Identify legal and regulatory issues to address when designing
and operating Domestic Medical Travel programs
- Evaluate potential approaches in addressing Domestic Medical
Travel legal and regulatory concerns.
- Engage in interactive learning through online question submission, attendee feedback and opportunity for
follow up questions, and networking with attendees, faculty and other
professionals through dedicated LinkedIn group.
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Interested attendees would include:
- C-Suite Executives
- Human Resource Executives and Staff
- Employee Benefits Management and Staff
- Provider Network Executives and Staff
- Legal and Regulatory Executives and Staff
- Managed Care and Revenue Cycle
Executives and Staff
- Strategy and Planning Executives and
Staff
- Business Development Executives
and Staff
- Marketing and Business Intelligence Staff
Attendees would represent organizations
including:
- Employers
- Third Party Administrators
- Health Plans
- Hospitals
- Provider Networks
- Agents and Benefit Consultants
- Government Agencies
- Solutions Providers
- Associations, Institutes and
Research Organizations
- Media
- Other Interested Parties
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Individual Registration Fee: $195. Audio Conference CD-ROM: $40
for attendees; $285 for non-attendees after the event.
Corporate Site licensing also available. Click
here to register or call 209.577.4888 We look forward to your
participation in this event!
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Kevin J. Ryan
Member of the Firm
Epstein Becker & Green
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Kevin J. Ryan concentrates his
practice on legal and regulatory issues facing the health care industry.
Kevin’s clients include hospitals, nursing homes, surgery centers and
physician groups, as well as other provider organizations and
businesses, such as management organizations, staffing companies and
employee outsourcing organizations.
Kevin advises for-profit and not-for-profit businesses on a variety of
transactions, including mergers, acquisitions, joint ventures and
maintenance of tax-exempt status. He also counsels clients on
day-to-day, operational issues such as the negotiation and drafting of
managed care agreements, physician employment agreements, licensing
agreements and management services agreements. Kevin provides guidance
on a host of state and federal regulatory, legislative and other
administrative policy issues, including licensing laws, Certificate of
Need matters and compliance with HIPAA privacy requirements. He helps
providers navigate complex Medicare and Medicaid laws and regulations
relating to state and federal anti-kickback and fraud and abuse laws;
the physician self-referral laws, also known as the Stark Law; and
reimbursement issues.
Kevin is at the forefront of attorneys advising clients on the emerging
globalization of the U.S. health care industry. For example, he
regularly advises foreign and domestic entities and networks on the
development of and participation in the growing medical tourism
industry. Prior to beginning his legal practice, Kevin served as a
senior administrator at a 700-bed community hospital. After his
admission to the bar, he served for six years as General Counsel for a
national preferred provider organization.
Kevin has been recognized by the Leading Lawyers Network as a top
Illinois lawyer in the area of health care law (2003-2010). A member of
the American Bar Association and the Executive Healthcare Council of the
Illinois Chamber of Commerce, he is a frequent speaker before legal and
industry associations, and a regular contributor to legal and health
care journals. Kevin has a J.D. from the Chicago-Kent College of Law, a
M.B.A. from the University of Chicago, and a B.S. from the University of
Notre Dame. He is admitted to practice in Illinois
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Kyle L. Wendt
Vice President-Benefits
Lowe's Companies, Inc
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Kyle Wendt has served as vice president of, benefits since 2008, after
serving as director of benefits for Lowe’s since 2002. Wendt is
responsible for employee health, medical and dental coverage, retirement
and other key benefits programs for the company’s more than 234,000
employees. Wendt joined Lowe’s in 2002 with more than 20 years of
human resources and benefits experience in both business and government.
He is a Senior Professional in Human Resources (SPHR) and Certified
Compensation Professional (CCP).
Under his leadership, Lowe’s has established a highly successful
employee wellness program, Life Track, and garnered several awards and
accreditations including:
- Best Employers for Healthy Lifestyles Award, Gold Winner: The
National Business Group on Health
- Excellence in Workplace Tobacco Control Award: The American Cancer
Society
- CDHC SuperStar Integrated Care: Wellness & Disease Management Award
- CEO Cancer Gold Standard™ accreditation
- 2011 Best Ideas by Human Resource Executive Magazine for Lowe’s
Cleveland Clinic Heart Surgery program
Wendt has a bachelor’s degree in business administration and labor
relations from Kansas State University.
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George Wagoner
FSA, MAAA
Senior Partner
Mercer
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Present Responsibilities
George is a Senior Partner in the Richmond Health & Benefits practice.
He works with clients nationwide in employee benefits and human
resources strategic planning, managed care, consumer directed health
care, long-term care, disability, dental, prescription drug, vision and
life coverages.
Experience
Before joining Mercer in 1985, George worked for a regional insurance
company and a major non-profit health insurance company as a chief group
actuary. George has over 30 years of experience in the group life and
health actuarial field. On both a company- and industry-wide basis, he
has served on task forces dealing with health care and group benefit
issues such as managed care, consumer directed health care,
postretirement medical and life, health care data analysis, health care
strategy and health care reform. George has authored numerous articles
and is a frequent speaker regarding a wide range of health and welfare
topics.
Education
George received his BS degree in mathematics from Davidson College. He
is a Fellow of the Society of Actuaries, a member of the American
Academy of Actuaries, and a past member of the board of directors and
vice president in charge of health care activities for the Conference of
Consulting Actuaries. George is a member of the board of directors of
The Health Project, which presents the C. Everett Koop National Health
Awards honoring cost-effective health promotion and disease prevention
programs.
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Phone 209.577.4888 |
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Case experience to date for the Lowe's Domestic
Medical Travel initiative