The case management arm of the US-based Mayo Clinic has signed a two-year contract with the Cayman Islands National Insurance Company to manage overseas care of local patients.
Mayo Clinic Health Solutions is taking over from Canadian Medical Network from 1 April and signed a contract with Lonny Tibbetts, CEO of CINICO on Wednesday afternoon, 11 January.
Mr. Tibbetts said most of the details of the contract had been finalised but some issues, including arrangements for air ambulances and out-of-hours operations and services were still being discussed.
The contract is the culmination of efforts CINICO began in late 2010 to find a new third party administrator to facilitate overseas care for its more than 13,000 members. CINICO covers public servants, seafarers, veterans, pensioners and indigents in the Cayman Islands.
A request for proposals issued in November 2010 underwent a few iterations, according to health minister Mark Scotland, who said the original request was changed to ensure that eventually CINICO and the Cayman Islands Health Services Authority could create its own network of medical facilities in the US, to where they may send patients.
“Some of the criteria in the initial RFP had to be changed and we had to go back to the tenderers to clarify some issues … We needed tenderers to help us realise the creation of our own network eventually and our own in-house case managers,” Mr. Scotland said.
Canadian Medical Network has been CINICO’s third party administrator since 2005. It currently takes care of case management and provides the network of hospitals to which the insurance company sends patients from Cayman, with many patients going its network of facilities in South Florida.
Mr. Scotland said that with working with a new company would open up new options for patients.
“CMN was familiar with south Florida, which was good years ago, but South Florida knows it gets a huge number of patients from the Caribbean so its rates have started to reflect that,” he said, adding CINICO and the Health Services Authority were looking some more efficient and cost-effective solutions for patients who have to leave Cayman for healthcare.
James Berg, director of business and product development at Mayo Clinic Health Solutions, told the members of the CINICO board and health officials at the contract signing: “We’re excited about the relationship and the chance to share some of our knowledge and expertise and help direct care and manage care. One of the primary values of Mayo Clinic is the needs of the patient come first and that’s really something that we take very seriously and will extend to your patients and members as well.” Mayo Clinic Health Solutions will coordinate with US healthcare providers to sort out accommodation, transport and care for patients with CINICO insurance travelling from the Cayman Islands, and coordinate any follow-up care.
“There is a number of reasons why we chose the organisation – primarily, its name and its reputation. It has a very good cost factor on the price of those services as well,” Mr. Tibbetts said.
“We felt the depth of knowledge and expertise and quality of personnel was a tremendous factor in our final decision and analysis of who we chose in this process,” he said.
The exclusive contract to provide case management services will not mean that patients from Cayman will be sent only to Mayo Clinic-related facilities, Mr. Tibbetts said. “The contract is for case management services … we have no agreement to exclusively use Mayo Clinic. We certainly would not shun the opportunity to work with the Mayo Clinic for any patients that require that but it’s a matter of the network definition and if the Mayo Clinic can be offered in the network, we would utilise it when and where possible.”
He added: “You could have had a procedure at Baptist [Health in South Florida] and follow up at Baptist. None of that would change because you’re essentially going through a different manager for your experience and medical treatment, but the facilities would not change.”
Asked if his company would be looking at cheaper options for overseas care for patients travelling from Cayman, Mr. Berg responded: “From our standpoint when you say cost, the focus is not so much on what is being charged. Obviously, that is important but, from our standpoint, the best care provided the first time, at the end of the day, is going to be the most efficient and cost-effective care.”
Mayo Clinic is a not-for-profit medical practice and medical research group, with a large presence in Rochester, Minnesota; Jacksonville, Florida; and Scottsdale/Phoenix, Arizona. It also owns and operates the Mayo Clinic Health System – a network of more than 70 hospitals and clinics across Minnesota, Iowa, and Wisconsin.
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