Anthem Blue Cross & Blue Shield of Wisconsin, a subsidiary of WellPoint Inc., is the latest insurance company to step into the medical tourism arena.

Beginning in January, the insurance company will allow employees at Serigraph Inc., a Wisconsin-based graphics company, to travel to India for certain elective surgeries.

Below is part of an interview with Dr. Razia Hashmi, vice president and CMO for Anthem's national accounts about this new endeavor as was published in Medical Travel Today (MTT) newsletter Volume 2 Issue 29.

Medical Travel Today (MTT): Can you tell me how and when you first began considering offering a medical travel benefit and how you came to select Serigraph as your "beta" account?

Dr. Hashmi (RH): We've actually been following the trend for some time. It's for obvious reasons, very intriguing. Over the past year and a half we've looked for potential partners and have had conversations with several medical tour groups to obtain information which could be used to base our decision.
As the same time, we started to explore what segments of our client base might be interested. Our clients were, of course, also interested in health solutions that provide better or equal quality at a lower cost.
In the past year we noticed an increase in employers asking about medical travel as an option. It's now a frequent question in Request For Proposals (RFPs) and client conversations. I believe all the recent media attention contributed to that.

As for how we chose Serigraph, the truth is they chose us.

They were already a customer of ours, and they had been looking for ways to improve the value of their benefit offerings.   They knew we were working on something in the medical travel area, and they said they'd like to be part of the pilot.

We consider Serigraph an early adopter of innovations in benefit management in many ways. For example, we work with them in Wisconsin on a program they call MedSave through which they provide their employees comparative cost information for domestic medical tourism. For example, if an employee needs a procedure, they share with them how much it costs to get the procedure at various locations in the state.

MTT: Are you exploring the benefit with other employer groups at this time?

RH: We are in conversations with several other groups, and there's certainly a lot of interest out there. We will evaluate further expansion of the pilot once we have some experience with this. We want to ensure we have a program that works smoothly and delivers high member satisfaction along with high quality and value.

MTT: What parameters will you use to evaluate the benefit and in what sort of timeframe?

RH: Depending on the volume it may take us a while to evaluate the full impact of the pilot. We don't expect a huge volume right out of the gate. There are a number of parameters that will be used to evaluate success. One parameter will be the uptake and its impact on the client's health benefits strategy. What kind of consumer is using medical tourism and does this information allow us to segment the consumer population and their needs? What makes them choose this option? What's unique about this segment?  And of course we'll be evaluating the standard parameters: clinical outcomes, quality of care metrics, patient satisfaction, and even family satisfaction. The ease of care with which patients can access and receive what they need will also be evaluated.

MTT: What were the guidelines you used to determine which procedures would be covered?

RH: We use the same process that others use. We selected a subset of elective procedures for which types of care can be provided safely in the international setting. We further narrowed the list by evaluating the potential for enhanced value through lower cost and equal or better quality. We also followed the American Medical Association's guidelines very carefully to select procedures.

The basic guidelines for the pilot are:
1. The procedure is elective in nature
2. The patient is able to travel
3. The surgery is commonly performed at the referral hospital with demonstrable quality outcomes
4. Local follow-up care upon return home can be arranged
5. The patient can safely return home post procedure

MTT: How did you determine what facilities patients could access?

RH: All hospital systems in WellPoint's program will be accredited by the Joint Commission International (JCI).  JCI accreditation standards are based on international consensus standards and set uniform, achievable expectations for structures, processes and outcomes for hospitals. Serigraph employees will be able to visit the Apollo Health Systems hospitals in either Bangalore or New Delhi .  We are also exploring further expansion to include other countries.

MTT: Are you or Serigraph doing anything to educate the employee population about medical travel?

RH: Yes, we've talked up-front a great deal about the importance of education and how best to partner with Serigraph on employee education. Obviously Serigaph is a critical first resource, and we're working to make sure they have the appropriate information and resources to offer employees and help them understand the option.

One of the key points we'll be communicating is the fact that patients will have a dedicated case manager to coordinate all steps of the medical tourism process; all medical arrangements are handled for the member, and all travel arrangements are booked and paid for, for both the patient and a travel companion.  The case manager will also make arrangements for any necessary post-operative care for the member's return to the United States.

Our case managers will work with Healthbase to: make the necessary travel arrangements, including securing passports and/or visas for members and their travel companions; schedule the medical procedure; facilitate transfer of the medical records; and arrange for the member to speak with the international provider.