U.S. healthcare systems and companies have long had a presence overseas, but a new export is creating a lot of buzz abroad: clinical risk management.
Consider Deerfield, Ill.-based MMI Cos., which has found a market for risk-management services in Europe.
Through its insurance subsidiaries in the United Kingdom and Ireland, MMI began to notice a growing number of medical malpractice complaints along with a rise in the average amount in damages awarded to plaintiffs in these cases.
MMI saw the trend as an opportunity to be the first U.S. company to bring its risk-management expertise to Europe, says Anna Marie Hajek, executive vice president at MMI.
"All the things that we do here have a good application over there," Hajek says. "Care paths, education, information systems, marketing systems-it all works together. It has a lot of resonance in the U.K., Italy, France and Germany."
Changes in the U.K.'s national health system also led to a greater demand for clinical risk management. Like federal health programs here, the U.K.'s National Health Service is facing an imminent cost crunch as its population ages. The British government is committed to controlling costs and getting the most for its money, Hajek says.
The NHS is the largest client of Heathcare Risk Resources International, MMI's London-based risk and quality services subsidiary.
Stephen McAndrew, managing director of HRRI, says that while the NHS will remain HRRI's biggest account, more than half the subsidiary's business will come from other systems in the European Union.
That's because E.U. nations want to make it easier for their citizens to receive healthcare services in neighboring countries.
"(The differing systems) have caused healthcare providers some problems managing demand, with the limited access to services (in other countries)," McAndrew says. "And then there's the issue of how to get reimbursed. The E.U. says that you must provide services to everyone, regardless of what the pay system is in their country, and that will bring the European systems closer together."
MMI is betting that the U.K. will have a strong voice in that process and that MMI's operations in the U.K. will benefit as well.
"We felt the U.K. would have a lot to say about healthcare reform in the European Union," Hajek says.
And MMI is not the only company with that thought in mind. St. Paul Insurance Co. in St. Paul, Minn., has had a presence in the U.K. for 10 years, says Dan Collins, an underwriting services director who recently returned from a three-year assignment in Europe. Products offered include professional liability insurance and risk-management services.
St. Paul Insurance also has opened offices in Argentina, France, Germany, Ireland, Mexico, the Netherlands, South Africa and Spain.
Like MMI, St. Paul Insurance hires local employees for those offices.
"To be a success, (risk management) has to be seen as a local product, and it truly is," Collins says.
Offering medical malpractice insurance in the U.K. also has helped to give MMI a foothold in Latin American markets, says Carol Adelman of McManis Associates, MMI's consulting arm. McManis advises healthcare groups about whether to pursue business opportunities abroad.
Latin America is more attractive to U.S. healthcare systems than other emerging markets, like China and Southeast Asia, especially because of the ease of doing business there.
In Argentina and Brazil, managed-care expertise is needed, Adelman says. Until the early 1990s, the public and private payer systems in those nations weren't incorporating utilization review and cost-containment techniques that are common in U.S. managed care, she says.
"Now that managed care is expanding, need for that efficiency is there," Adelman says.
Argentina is also one of St. Paul's most successful markets.
"Risk management is really embraced there," Collins says. "Our risk managers have worked hard to create an awareness and a demand for services. They know that that can really have an impact on the quality of patient care in their corner of the world."
And the bridge overseas is not a one-way street, both MMI and St. Paul Insurance say.
"We take their best practices and see if they can apply to the U.S. market," MMI's Hajek says.
St. Paul Insurance's Collins agrees: "Our starting point is our experience in the United States. The (risk management) philosophy might work, but the tools involved vary from country to country."
In April, St. Paul Insurance set up an international healthcare unit to facilitate the sharing of information among countries where St. Paul does business.
But managing risk abroad is not something just any U.S. company can do, MMI executives say.
"I've heard that CEOs (of U.S. healthcare systems) are thinking that they can go overseas and consult. I'm not so sure you can do that," Hajek says.
"You need to know a country's health policy. You can't just look at a healthcare system. You have to understand the economy."