Virtual health could move Destination Medicine to the next level

By Felix Matthews, MD, MBA, managing director, and Ann Mills Freund, MBA, senior manager, Deloitte Consulting LLP

Destination Medicine is the domestic form of medical tourism. Medical tourism typically involves traveling outside the US to obtain high-quality, low-cost care. Destination Medicine changes the travel direction to domestic centers of excellence (COE) as compelling options for specialty care. The effort to travel to a COE is justified by the expectation of higher-quality care and a lower total episodic cost of care.

The exponential adoption of virtual health during the pandemic could help move Destination Medicine to the next level. Virtual health solutions can connect patients to COEs for pre-travel consultations, post-procedure follow-ups, and remote monitoring. This technology could also reduce typical access barriers for Destination Medicine. (Read our perspective on using virtual health to support Destination Medicine programs.)

Destination Medicine is not a replacement for medical tourism. An estimated 650,000 Americans traveled abroad for medical or dental procedures last year—up 124% from 2020, but short of the 780,000 who traveled in 2019. Over the next five years, the global medical tourism industry is expected to grow to $207 billion.¹ The most common procedures that people travel for include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplantation, and cancer treatment, according to the US Centers for Disease Control and Prevention.

Destination Medicine is a newer development. We like to think of it as being made up of three concentric geographic circles—regional, national, and international. The goal is to expand access to specialty care, concentrate case volumes to drive down costs, and elevate quality. COEs typically require patients to travel to (and usually stay in) another location. 

Virtual health could remove some barriers

While the benefits of Destination Medicine are uncontested, the health care sector has often struggled to overcome various administrative and logistical challenges. These challenges include the effort and cost of travel for medical evaluation prior to the actual care episode; prior authorization and financial clearance; post-discharge communication between specialist and local provider, and interrupted follow-up, which can compromise outcomes. In addition, some patients might not be healthy enough or have the resources to travel.  

Virtual health, which gained significant traction during the COVID-19 pandemic, could help address those challenges and make it easier for Destination Medicine to reach its potential. It also could open the door for health systems that want to expand into Destination Medicine. The technology could eliminate or reduce travel burdens. Moreover, the integration of diagnostics, combined with remote patient-monitoring tools, could make it possible to manage patients pre- and post-care without requiring them to travel. 

Travel restrictions that emerged during the pandemic made it almost impossible for patients to travel for treatment. Many of them turned to virtual medical platforms for their diagnoses and consultations. Virtual health visits soared from just 840,000 in 2019 to 52.7 million in 2020—a 63-fold increase, according to a report from the US Department of Health and Human Services.²

Virtual health technology could also make it easier for people to receive second opinions and could make clinical trials more accessible to some patients. Additionally, it could give patients more health care options (domestically and internationally), which could make care more equitable to populations that have been historically isolated or marginalized. However, internet connectivity could remain a barrier, particularly among individuals in lower socioeconomic levels and those who live in rural settings where broadband access might not be well established.

Benefits for employers, payers, providers, and patients 

We are helping health care clients define their Destination Medicine strategies. The value proposition is different for each stakeholder. Here is an overview of how Destination Medicine could benefit health care stakeholders:

• Health plans: Some commercial health plans see Destination Medicine as a tool to achieve cost savings and outcome improvement. Short-term expectations could include preferential volume discounts, while the long-term objective might be reduced total episode of care cost stemming from superior outcomes.   
• Employers: Some self-insured employers cover travel and treatment costs for insured employees who are willing to travel to health systems that have demonstrated high-value care. There is also a productivity element. Employees who receive high-value care are likely to return to work sooner and have fewer complications.
• Patients: People who take part in Destination Medicine could receive high-quality medical treatment packaged in a seamless experience. Being treated by leading experts at a COE can build confidence.
• Hospitals and health systems: Destination Medicine services could help boost patient volume, which could help cover the costly infrastructure of specialty services. There could also be a value proposition around strengthening the brand of the hospital system (regionally, nationally, or internationally). It also could help to attract a more diverse pool of clinical-trial candidates. 

Conclusion

The idea that health care is local is being disrupted in front of our eyes. Many employers, health plans, and patients are shifting the focus of care toward centers of excellence. Health systems can either hop on the Destination Medicine bandwagon today or risk being disintermediated. Virtual health can be a key tool to promote access and drive care coordination in Destination Medicine. The virtual health capabilities that were adopted in response to COVID-19 could become a key component in the future of Destination Medicine. 

This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.

Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.

Endnotes:

¹ Medical travel rebounds: What to know, HealthCareInsider, July 15, 2021

² New HHS study shows 63-fold increase in Medicare telehealth utilization during the pandemic, HHS press release, December 3, 2021

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