This is the transcript of my podcast interview with Jonathan Edelheit.
David Williams: This is David Williams, CEO of MedTripInfo.com. Jonathan Edelheit is an executive at a company that sells limited benefit health plans, which are sometimes called Mini Meds. These plans cover day-to-day expenses but they don’t cover major surgery. Jonathan’s involvement in medical tourism began as a way to add affordable major medical coverage to Mini Med Plans. But now, he’s going a step beyond, by founding the Medical Tourism Association.
I spoke with Jonathan about the future of medical tourism as an insurance benefit and his plans for the Association.
I’m speaking today with Jonathan Edelheit, Vice President of OptiMed Health/United Group Programs. Jonathan, thanks for being with me today.
Jonathan Edelheit: Oh, it’s my pleasure. I appreciate you having me.
David: Jonathan, what is OptiMed Health and United Group Programs. Can you tell me a little bit about the company?
Jonathan: OptiMed Health Plans is a subsidiary of United Group Programs and it’s a special arm of our company that we have that offers low-cost health care to part-time and hourly employees, 1099 contractors, full time employees who aren’t eligible for major medical benefits and also for individuals who are part of associations. And basically, it’s an alternative to expensive major medical insurance for people who need low cost, affordable insurance. It starts at about $50 a month and covers the day-to-day expenses like going to the doctor, getting prescription drugs, going to the ER, but not the catastrophic.
United Group Programs is the parent company. We’re a national health care company. We administer health care plans here and throughout the United States. We’ve been in business for about 40 years and we have about 4,300 corporate and governmental clients throughout the United States and we are really trying to focus on cutting-edge health care products.
David: So would that be a kind of a third party administrator business?
Jonathan: Yes, absolutely.
David: And so, with 4,300 companies, roughly how many covered lives does that represent?
Jonathan: It’s several hundred thousand.
David: You’re a major player then in that space.
Jonathan: Yes, absolutely, and we’re very well known nationally.
David: And on the low cost plans, are those plans what some people call limited benefit plans or Mini Med Plans?
Jonathan: Exactly.
David: How did you become interested in medical tourism then?
Jonathan: It kind of segues, exactly into what we’re doing with Mini Med because with our Mini Med or low cost health care plans, they don’t cover the catastrophic like major surgeries, major hospitalization. We had heard about medical tourism, people going overseas for surgical care. Basically, I think our initial thought was the same thought everybody else had, that America had the best health care and this was substandard care overseas, “health care under a hut”. I ended up talking to several people who had gone over for health care overseas and got the exact opposite impression, that they thought it blew away our American hospitals and they got great care and great service.
So we started to look into it and what we found was our initial perception, which is most Americans’ perception, was wrong and that the health care in certain countries is very advanced and in some ways, it can be more advanced than ours, but especially in the area of better service, people who need more quality time with the providers and better standards in the actual room people are staying in.
David: So it sounds like you’re well positioned to introduce a product like this into the market because unlike somebody who maybe has a comprehensive Blue Cross, Blue Shield plan, and when their insurance says they were offering this as a benefit, they get skeptical, you’re explicitly not offering major medical and this is the way to offer low cost major medical, at least a portion of it, and it’s something that your customers, your members might be paying out of pocket anyway. They might be some of those so called medical tourists who are going on their own nickel.
Jonathan: Oh, absolutely. Now, we’re able to give them the option to say, “Hey, you really don’t have coverage for surgery here in the US and we know you can’t afford it. So now, here’s an option to go overseas for surgery at an international hospital for 80% less than in the United States.”
David: If you look at introducing medical tourism as a benefit, what sort of hurdles do you need to overcome beyond the initial one that you described upfront about people assuming the US health care is the best and if you go overseas, it’s going to be dirty and nasty? Are there other sorts of hurdles and how have you been addressing them?
Jonathan: I think the first hurdle that we have is just convincing employers of the quality of the health care over there and the cost savings, and that’s not very hard. Usually in one meeting, we can convince them and they’re ready to sign up on the project.
The next major phase is actually communicating it to the employee and that’s where I think most people in the industry are completely lost because they’re not focusing on that. You really have to focus on educating the employee and making them feel totally comfortable with the opportunity to go overseas for health care.
David: Are there certain mechanisms that you would use to do that? As I had said up front about Blue Cross telling me all of a sudden it’s a good idea to go overseas, even if it is a good idea, I’m going to be worried, I’m going to take a second or third look at it, to see, “Why are they trying to send me away?”
Jonathan: The key is finding the right partner to go overseas. You’ve got to do your research, you’ve got to do your due diligence to make sure you’re going to a quality hospital by the provider that’s helping you get over there and actually has the experience. I think people will be skeptical at first and we look at it as a long-term project where we educate the employees. We know we have to wait for the first employee who needs a surgery and is willing to go overseas to do it. And when he comes back or she comes back, all the employees at the company are basically going to be waiting there anxiously to find out the stories, whether positive or negative. What our experience shows is that the employee will come back, talk about what an amazing experience they had and how they had a free vacation, and then all of a sudden the other employees at the workplace will start thinking about, “Well, why am I going to, you know, my local hospital when the care isn’t as good and the service is not as good when I can go overseas and get better service and care and actually get a free vacation, too?” Then you’ve changed the corporate climate and attitude at that employer.
David: I’m sure we’re early in that process so far. About how many people have actually gone overseas and have been able to come back and tell the stories around the break room?
Jonathan: We’ve had several. It’s a very long process that I think that most people do not understand or appreciate. What I mean by that is, after you explain to the employer the whole concept of medical tourism, and after that employer signs off on it, it could be six months to a year before you really have a taker on medical tourism, because it’s not just signing someone who needs a surgery, it’s signing that person that’s willing to go overseas. So it’s a very long-term approach, and the idea is that an employer has to buy into it and know that it’s going to take a couple of years for the program to be fully in swing, where they’ll have a change in corporate climate.
So we’ve sent less than 10 people overseas for surgery, and everyone who’s gone over has been very satisfied with their experience. We have a lot more that are in the pipeline of who’s going over, but we’ve been focusing very strongly on the whole concept of educating the employees to the point that we’re going to be getting a lot of them to go over, not just one or two each year.
David: What is the potential overall impact? I understand that for an individual surgery, you could have a major impact, maybe 75, 80 percent, or perhaps even more, on a given surgery. If I’m an employer, and I looked at all the things that I’m trying to do to reduce health care costs or improve benefits, how big of a difference does this make, overall? In other words, those expensive surgeries, how much is that really costing me today?
Jonathan: It can actually make a very significant savings, for everyone they’re going to send overseas, they could save up to 80 percent on the cost of the surgery. So, a surgery that costs $100,000, with airfare and other expenses, the surgery might cost $10,000; it might add up to about $20,000 in costs. For the employers, it’s going to be an immediate, direct savings. We actually believe if an employer gets a lot of their employees to go overseas for major surgeries when they’re needed, an employer can easily see a savings in their health care from anywhere from 20 to 50 percent. But that requires not just one employee to buy into it, but a lot of employees.
So if the employer believes in it, and what will end up happening is the employees will begin to believe in it. When their health care costs actually don’t go up each year, but start going down, then everyone at the company is going to have a significant interest in trying to work with medical tourism to keep their costs down, because everybody knows their contributions towards health care aren’t going up and the benefits are not being reduced by giving higher deductibles and co-insurance, and that’s because the employees are utilizing medical tourism, which saves the company money.
David: I know you’ve been doing a lot of international travel these days, in order to see some of these different destinations. Can you tell me about some of the places you’ve been and maybe some of those that you’re most impressed with?
Jonathan: I’ve been to Costa Rica. And I just got back from there, and it was a very nice trip. It’s a great location if people actually want to do the tourism part, along with the medical care. I was very, very impressed with the hospitals. I actually felt they were equal to or better than United States’ hospitals. And it was just a very big difference. The level of the care and the service you get definitely, tremendously surpasses the United States.
What I mean by that is the nurses, the doctors, it’s all about being polite to the patient, helping the patient, taking as long as the patient needs. It’s not with the mentality that we have here in the United States, which is you have three to four minutes and then you have to leave the doctor’s office. I spent about 40 minutes with my doctor there, and that’s unheard of here in the United States. It was just a great feeling to have communication and feedback and just kind of go over everything with the doctor, without feeling pressured or raced. The same thing with the nurses, is it’s all about service. Everybody’s there to help you, to make sure you have just a great experience.
To give you a crazy example about it, I had some people I was down there with who actually went ahead and had breakfast at Denny’s, which happens to be one of the most popular restaurants in San Jose, Costa Rica. They were just shocked and surprised, and they were telling us a story with extreme enthusiasm that they went into this Denny’s and they could not believe the level of service they had, how polite the people were, how clean the restaurant was, and how much these employees really cared about the customers. They thought maybe they were in the wrong restaurant. That equates to everything in the culture of Costa Rica; it’s just very high-quality care. Someone that I went down there with got an ultrasound, and it only cost $70. Their prescription drugs that they picked up at a pharmacy down there cost less than their co-pay with Blue Cross Blue Shield here in the United States, and the government doesn’t subsidize prescription drugs, so it’s a very different culture there.
In a couple months I’ll be going to India and also the Philippines to go visit all their hospitals. Then next month, the Medical Tourism Association has a couple board members who are going over to South Korea to inspect the South Korean hospitals, because they’re launching a big initiative for medical tourism.
David: Tell me more about the Medical Travel Association, because I understand that you’ve gone well beyond looking at medical tourism for your core businesses and are instrumental in founding this association. What’s the thinking behind that?
Jonathan: The thinking, really, is that we had really gotten together with a bunch of the top leaders in medical tourism and the top hospitals, and we found that there was no forum for anyone to get feedback or information on medical tourism. Nobody knows what conventions are going on, who’s written books, what hospitals are quality, which are not, who to work with, who not to, or just to get general information on medical tourism. Then, also, there was some real concern by a lot of the hospitals of the horror stories and negative things that could happen by unscrupulous and immoral medical tourism travel companies who send people to bad hospitals or send people to countries for hospital care that don’t have the same standards as the United States, in order to generate extra fees.
There was a big concern to help promote the industry in a positive way, and also to help regulate it. So a bunch of us all came together and made the decision to form this association, to provide information. We’re launching a comprehensive website at medicaltravelauthority.com, where people can go online and get information on hospitals, on medical tourism, and do all the research that they would want, from a non-biased, non-profit standpoint. They’ll get detailed information on the hospitals themselves and on doctors. We’re also working on launching both a magazine and a documentary, to keep the industry informed of what’s going on. We’re looking at a lot of really neat initiatives that people just don’t know of in this industry unless you’re fully involved in it, such as we’re looking at creating minimum standards and credentialing and accrediting recovery centers, because recovery centers are popping up around the world.
While there’s maybe 100 around the world right now, there’s expected, within one to two years, to be tens of thousands. Americans don’t know that these are unregulated. There’s no government regulation. There’s no standards. The industry has no standards. We want to protect people in getting the best care after they complete medical tourism, so we’re working with all the top international hospitals to come up with minimum requirements and to certify those recovery centers that meet those requirements so that American patients aren’t going to a bad facility where they might get an infection.
David: I understand you have some fairly prominent and important people that are involved. Can you tell me some names of some of the key folks that you’re working on the Tourism Association with?
Jonathan: Yeah. We have Tom Johnsrud, who works for Parkway Hospital in Singapore. And he also used to work for JCI, who accredits all the international hospitals. He’s brought a wealth of experience and knowledge, and has really helped drive a lot of this in the Association. There’s Robert Krone, who’s the president and CEO of Harvard Medical International. We have John Bridges, who’s a Johns Hopkins economics professor who’s heavily involved in medical tourism. We have Mary Ann Keough, who’s a professor at Eastern Washington University, and then Clinica Biblica at Costa Rica is a member of the association. We’ve had several other recent members who have joined. For example, one of the new board members is Ruben Toral, from Bumrungrad Hospital. There’s a couple other very important people on there, and it’ll be posted on our website in a couple days.
But it’s neat because we have the real thought leaders and the people who have really helped, been instrumental in growing this industry and establishing it, coming together to help really promote it and also provide minimum standards and information for the public.
David: You had talked about JCI, and one of the people that’s going to be involved is ex-JCI. How does JCI fit in with your thinking, in terms of minimum standards, accreditation, and rules?
Jonathan: We’re kind of reviewing the whole accreditation process for hospitals, because I don’t think that’s going to be something that we’re going to get into right away, because we’ve got JCI, who accredits hospitals, and there’s several other international accreditation agencies.
So, what we plan on doing is really giving consumers the information as to what are the standards of each accreditation agency, so consumers can be aware of the differences between the different accreditation agencies so they can determine the quality of care and level of service at specific hospitals. The areas that we might look into, regarding any kind of accreditation, might be with the recovery centers, possibly with the medical tourism, like the travel agency type companies, but that’s where it stops.
Our main purpose is to kind of inform the consumer of the differences. Most people don’t know the international accreditation forum, the Joint Commission, is actually different and has a lesser standard than the United States’ version of the Joint Commission accreditation. So our mission is to really make the public aware, so they can make more informed decisions about their health care.
David: Jonathan, what advice would you give to a consumer who, right now, is considering going abroad for a medical procedure?
Jonathan: The advice that I would give is they really need to do their due diligence. They need to make sure they’re going to a quality hospital that’s accredited, or has certain minimum standards, or might be getting accredited shortly.
They need to be very careful if they’re working with a medical tourism travel agency type company, that they choose one that has tremendous experience, knows what they’re doing, and is going to send them to a top hospital and not just send them to a hospital that they’re going to get the biggest kickback from.
You need to make sure that you’re dealing with companies that, if they’re facilitating you getting overseas to a hospital, that they know the people at the hospital, that they’ve been to the hospital, that they can actually make recommendations. Because one of the complaints we’ve gotten from a lot of the hospitals is medical tourism type travel companies misrepresenting and making fraudulent statements to consumers about knowing hospitals, being in hospitals, and recommending hospitals, when, in fact, a lot of these hospitals don’t know who these people are and have never met them before.
If they’re going with a quality source, they won’t have to do as much due diligence, but to give you an example of why it’s so important, in the country of Costa Rica, if a hospital has under 20 beds, it’s not regulated by the government. There are Americans going over to hospitals that might have less than 20 beds, and the Americans have no idea that there’s absolutely no regulation or oversight of these facilities whatsoever.
David: I’ve been speaking today with Jonathan Edelheit, Vice President of OptiMed Health and United Group Programs, and a founder of the Medical Tourism Association. Jonathan, thanks very much for your time.
Jonathan: Thank you.
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September 30th, 2007 by 
David E. Williams of the Health business blog 
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