Transcript Dr Kester Nedd, Founder and CEO, JIPA Network

Join the Movement!
10th Caribbean Health Financing Initiative Conference
October 28, 2015
Dr. Kester J. Nedd
Chairman and CEO, JIPA Network
A Noble Ideal
“The Value of a Nation is determined
by the health of its people”
-Franklin D. Roosevelt
National Health Challenges: Consumers

Relatively sick population with lifestyle illnesses
(associated high cost of care)

Retirees have limited and high-cost coverage

Consumers are more focused on property & casualty
than health care insurance

High out-of-pocket expenses for health care services

Populations are limited and scattered across
multiple nations - not operating as a unit
(fragmented, higher acquisition costs)
National Health Challenges: Health Care Providers

Relatively small population with small number
of specialists (high turnover of specialists)

Few training programs (fear of training the
competition)

Blending of the public and private sector –
compensation system not reasonable

Specialists work independently

Provider network not organized until now!
National Health Challenges: Payers

Focus on profits not coverage

Only 40-50% of insurance premiums spent on actual health
care compared to the United States: 71-82%

Laws governing health coverage and insurance are antiquated
and favor insurance companies, not consumers or health care
providers

Premiums not adequate to cover the benefits members want

Health care coverage focused on the wealthy

Small insured population with fragmented pools of covered
lives - competition is both regional and international

Provider network not organized

Blending of the public and private sector
Caribbean people should have
Access to High Quality,
Coordinated, Affordable Care
where they need it and when they
need it.
Challenges & Opportunities

Health care is seen as a Cost Center
rather than an opportunity for
growing the economy

Expats want to come home but choose
not to because of the limited health
care services

Flight of health care dollars:
South Florida USD $600 million – 20%

We need a way to pay for health care
What will work in the Region?

A new model to pay for and provide
health care

Federated organization across country,
political divide and economic status

Consolidation and concentrated

Collective bargaining arrangements
Introducing JIPA Network
A Global Multi-Provider Association
JIPA’s Strategy
Consolidate and Collectively Bargain on behalf
of:
Health Care Providers
Payers
Consumers
We connect patients to world-class, affordable
health care through our integrated family
of global health care providers.
JIPA Network, A Provider Organization
•
Physician-driven and operated
•
Mutual company: Investor/ownership
with health care providers and payers
•
Providers contracted to provide care:
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Primary care
Specialty physicians
Hospitals
Ancillary providers of health care services
Concierge providers
Provider Organization Focus

Organize providers across countries to
create Centers of Excellence

Organize care coordination and triage of
patients to allow for timely access and costeffective care between network providers

Utilize collective bargaining methods to
make health care affordable

Group purchasing power to keep cost down
Scope and Reach of JIPA’s Provider Network
Regional access to over 300,000 providers and National (USA) and international
Access to over 1 Million providers through Aetna First Health Network and other Network Partners
Payer Strategy - JIPA’s Clients: Payers
Employer Groups
High-Deductible Insureds
Consumers: Self-Pay
Union Members
Traveling Public
Workers Compensation
Travel for Health Care:
Destination Medicine
Government Workers
Assistance Companies
Cruise Industry
Self-Funded Organizations
National Health Insurance Plan
Non-Governmental Agencies
Insurance Companies and
Reinsurance Companies
Stratified Pooled Risk Coverage (SPRC)
JIPA’s Three-Tiered Stratified Risk Program
Third
Tier
Second Tier
First Tier
Additional Premium Paid Above Second Tier
Highest Coverage Limits
Local, Regional and International Payers
Additional Premium Paid Above First Tier
Benefit Limits Higher
Local, Regional and International Payers
Lower Cost Premium and Benefits
Local Plan or Self-Funded
Large Population will Have Access
Payer Organization Focus
Stratified Pooled Risk Coverage allows for the following:

Local coverage for basic and basic+ coverage that is focused
on wellness and prevention (broader population can now buy
health insurance)

Catastrophic coverage pooled across many countries and
groups to spread risk and lower insurance cost

Care provided through a network of credentialed providers

Lower administrative costs with more dollars available for
patient care
Self-Funded and Self-Administered
Allows for financial, administrative and care risk up to a certain level
TPA and Provider Network maintains the following capabilities:
•
Administer benefits
•
Manage and coordinate care
•
Collect and distribute premiums
•
Adjudicate claims
•
Case management
•
Utilization management
Stratified Pooled Rick Coverage (SPRC)
•
Allocate less premium to administration and marketing
•
More premiums utilized on health care
•
Lower cost administration
•
Can offer richer benefits
•
Must structure benefits to protect plan and members
•
Conglomerated Risk: Work with other entities and membership to
purchase catastrophic coverage including stop-loss, reinsurance and
major medical coverage
JIPA’s Architecture
Integrated Care Utilizing a Continuum of Care Model with
Technology and Incentives as the Focus of Integration
Payers
Self Pay
Third
Party
Administrator
Clinical Providers
Primary Care
International Patients
Specialty Physicians
High Deductible
Ancillary Providers
Self Funded
JIPA
Outpatient Services
Insurance
Inpatient
PPO
Therapies
PSA Admin Services
Pain Management
Instant Benefits
No Sign-Up or Membership Fees
Membership Benefits
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Access to network of world-class doctors, facilities and service providers
Free complex case review by clinical specialists
Competitive pricing for health care services
Free quotes for medical services and cost negotiation on your behalf
Customized care plans developed by medical specialists
Patient Care Coordinators and complimentary hospitality services
24/7 emergency care coordination and medical evacuation
Access to Discounts
Harold Martin
PT12711
2015
• Travel, health and air ambulance insurance
• Medications, supplies and medical equipment
• Hotel arrangements
U.S. Toll Free: 1.877.749.5472 • Int’l: 1.954.331.6530
This is not an insurance card
JIPA’s Three Fundamental Pillars
Follow the Care: Triage and Care Coordination
Follow the Information: Plan of Care Document
Follow the Money: Collect & Make Payments, We Pay Up-Front
JIPA NETWORK, LLC
(Discounted Case Sampling - Actual Claims/Negotiations)
Service Location
Treatment Summary
Service Provider
Total Expenses
Discount Write-Off
Amount Paid
Discounted %
Hialeah, FL
Adenocarcinoma-Ovary; TAH,BSO+
Facility/Professional
$122,070
$94,070
$28,000
77%
Miami, FL
TBI, Surgery and Rehab
Facility/Professional
$710,894
$615,803
$95,091
87%
Miami, FL
Pubic Symphysis Dislocation, Rt Sacroiliac Joint
Dislocation, Left Acetabulum Fracture
Facility/Professional
$288,515
$165,016
$123,499
57%
Miami, FL
Malignant Neoplasm - Breast; Biopsy/ Diagnostics,
Surgery, Chemo and Radiation Therapies
Facility/ Professional
$388,000
$290,000
$98,000
75%
Miami, FL
Heart Transplant
Facility/ Professional
$461,243
$182,643
$278,600
40%
Service Provider
Total Expenses
Discount Write-Off
Amount to Pay
Discounted %
Service Location
Treatment Summary
Colombia
Lumbar Herniated Disc L4-5, L5-S1 with Subluxation
of L4 on L5; Discectomy with instrumentation fusion
and interbody cage
Facility/ Professional/
Air Ambulance
$62,475
$25,592
$36,883
41%
Panama
Malignant Neoplasm - Breast; Presurgical, Surgical
(bilateral mastectomy / reconstructive) and Chemo
and Radiation therapies
Facility/ Professional
$119,890
$58,985
$60,905
49%
Trinidad
ESRD on hemodialysis, Infective endocarditis,
Klebsiella UTI, Myelodysplastic Syndrome with
Anemia, Hypertension, Gastric Polyp - Tunneled left
internal jugular vein Permacath, left brachio-basilic Facility/ Professional
vein transposition AVF, upper/lower endoscopies with
gastric polyp biopsy (24 days admit)
$91,650
$42,937
$48,713
47%
Colombia
Aneurysm Posterior Cerebral Artery
$46,119
$14,297
$31,822
31%
Colombia
Male Newborn, Complex Cyanotic Hearth Disease,
Malposition of Great Arteries, Pulmonary Atresia. Air
Facility/ Professional
Ambulance x2, Ground Ambulance, 12 ICU days, 18
regular days, Heart surgeries
$200,000
$80,000
$120,000
40%
Facility/ Professional
Health Care as a Commodity
Accessibility
Quality
Price
Health Care as a Commodity
Accessibility
Quality
Price
Coronary Artery Bypass Surgery
Cost vs Outcome
Cost
Complications
Miami
$70,000
4%
Panama
$40,000
3%
Colombia
$20,000
1.8%
Increasing Patient Traffic Through JIPA Network
Over 2,200 Patients
Served in 3.5 Years
Patients from 44 Countries
Average Payment US $41,000
Estimated Financial Impact
of over US $89 Million
JIPA Network IS…
A Provider Network Promoting Centers of Excellence
An Administrator (TPA)
An Enabler of Information Technology
A Risk Manager
A Triage and Care Coordination
A Payer Syndicator
A Consumer Consolidator
An Association Company – Member Ownership
JIPA Network IS NOT
1.
An Insurance Company
2.
A Broker
3.
A Health Care Provider
4.
A Risk-Bearing Entity
5.
A Bank or Financial Services Company
JIPA’s Caribbean Focus
The identification of and development of “Centers of Excellence”
in the Caribbean
Improving access and quality of health care by promoting care
coordination and appropriate triaging of patients
Organizing a heath care syndication to increase affordable health
care coverage for Caribbean citizens utilizing the SPRC model
Organize consumers as a large buying group utilizing the
JIPAconnect card system
Promote information technology, education, managed care
principles and wellness in the Caribbean
Join the Movement!