Medical Assistance Networks: An insider’s look at what makes them work
Author: David Sarafinas, VP of Travel Risk Management at Collinson
With over 20 years of Travel Risk Management experience, I have come to see the importance of having a strong network of medical and logistical providers. Although security and technology get the lion’s share of attention, especially with all the political and social concerns discussed regularly on the evening news, the reality is that 80-95% of all calls from business travelers are not about security issues but are medical in nature.
Providing the right level of medical assistance to business travelers is a challenging task, usually outsourced to Travel Risk Management providers. These providers must make sure they can support any medical need, whether it involves ambulance, helicopter or motorboat, bringing patients to a facility where their medical needs will be met, resulting in the best outcome for both company and personnel.
To learn more about the various methods to obtain and deploy a network of credentialed providers, I spoke with Helen Love, Head of International Medical and Assistance Networks at Collinson Assistance. With more than 24 years of experience in Medical Assistance, Helen manages Collinson’s global network out of her office in London.
Helen, what do you consider the most important aspects of a medical assistance network?
The most important aspect of a medical network is ensuring that a patient’s needs can be met, regardless of what is needed and where it is needed. Essentially, this is the core deliverable of a medical assistance network.
That said, an excellent network is one where the quality of services and facilities are known and understood, supporting the delivery of optimal patient outcome. The costs for services are negotiated and managed to ensure they deliver the best value for money and access to services is available without having to involve patients in administration and payments process.
What are the ways some assistance companies obtain access to a network?
Many medical assistance providers will opt to subscribe to an outsourced or shared network, which lowers their costs significantly. However, we feel that this removes important quality control aspects. If a medical operations team has never worked with a provider or has never performed a credentialing process, how can the team be certain the provider is the right fit?
Others will opt to use agents to gain admission or expedite financial arrangements almost exclusively, again removing any quality control process.
How are providers credentialed and what are you looking for?
All providers in our network are evaluated prior to being included, and these credentials are routinely and systematically revalidated to maintain currency of information of the network. The process for reviewing network providers is rigorous in assessing the clinical quality, services and facilities available and patient outcomes and safety. As the network covers the entire medical supply chain including, but not limited to, ground ambulances, air ambulances, hospitals, clinics, doctors, dental practices, the credentialing processes are specific to the provider type.
When minimum standards have been satisfied, all providers in the medical and assistance supply chain are referred into Collinson’s clinical team for a quality assessment. A quality ranking is then apportioned to the provider record.
All providers, irrespective of whether or not they are included within our direct network, are geocoded, ranked and entered into our network database, Intaworld, enabling case managers and medical team members to quickly determine the most appropriate medical provider or course of action relative to a patient’s location and condition. Medical and logistic networks can be researched, audited and tagged within the system for particular clients or those working in remote environments, where pre-arranged and rehearsed operational procedures specific to the client site are essential to provide expedient and lifesaving care.
The team are also regularly out ‘in the field’ visiting, collecting data and validating providers, increasing our collective local knowledge and expertise.
Thank you, Helen, for walking us through the process and considerations. Before we close, can you share with me techniques you use to promote positive outcomes and manage expectations?
Our clients have access to a fully credentialled network of over 1.2 million providers worldwide, so we have a very robust selection.
We work with patients to advise them of preferred provider networks to enable an informed choice about services.
We are also able to deliver bespoke, restricted networks, dependent on client requirements and demonstrate the value that the network contracts are delivering.
Our network is proprietary, and the network team members are regionalized to manage the direct relationships and ensure that we are close to the providers. This enables an intimacy in terms of knowledge of local practices, standards of healthcare and ability to benchmark costs and quality performance measures that drive the assessment of the costs of healthcare. Costs are agreed contractually, and the agreements ensure that there can be no balance billing of patients for any services that are covered under the contract.
Having direct relationships with providers supports the case management process with arrangements in place for clinician to clinician communication at the point of care. We ensure that care pathways are monitored and managed to ensure treatment is appropriate and medically necessary, to prevent costs being incurred for treatment that is not needed. Each invoice is compliance checked with the contractual terms and any deviance will see the amount being reduced from the billed charges, whilst holding the patient harmless. Retrospective compliance can also be conducted to look at not just case by case scenarios, but the overall billing patterns and trends to identify any over utilization or repeat servicing.
Remembering that this is all about successful outcomes for the patient helps keep us focused on providing the best possible outcome.