ITV#1 Dr Achraf Sokari – Medical director

An emergency physician specializing in travel medicine and aviation, Dr. Ashraf Sokari, Medical Director at C3Medical, acts as an interface between foreign doctors, Care Managers and care teams in France, Morocco or Tunisia. His objective: to offer the best care and ensure the most appropriate follow-up for the patient.                                                                                           

What is the specificity of C3Medical in the management of care-pathways for international patients? 

C3Medical facilitates and optimizes medical and logistical benefits within the context of medical travels. We have observed that international patients travel more and more for treatment, for several reasons: easier access to information, lack of specific care or the higher cost of care in their country of residence, and, up until last March, increasingly easier travel. However, seeking treatment outside their country is often a trying experience for them. Firstly, because few patients are familiar with international medical networks and it is difficult, if not impossible, for them to grasp the price policy. In addition, care-pathways are an anxiety-riddled process that requires solid accompaniment, both medical and personal. The idea of C3Medical is to place itself within this framework to facilitate access to care and to optimize costs. As a doctor, I know the prices and I have a good idea of the required number of days of hospitalization for the most common procedures. This helps to limit the risk of exceeding the budget for hospitalisation expenses. But our uniqueness lies not only in cost optimization; we have C3Medical care managers that are mobile or present in some hospitals that are part of our organization. With me, they support our patients during their hospitalization and accompany them if necessary during admissions or a consultation, should the need arise.   
How do you define the support offered by C3Medical? 

As soon as I am solicited for the arrival of a patient, I accompany them from pre-op to post-op.  The first step in our support process consists in studying and consolidating the medical file before sending it to our experts. This is an important step because a complete file provides a more precise estimate, thereby avoiding surprises and additional costs. Then, in cooperation with the medical team treating the patient, we devise a full course of treatment: what treatment? For how long? Will physical therapy be required? Will there be a post-hospital stay? As early as possible and with the primary physician, we establish an ambulatory care plan that we organize. We prefer this mode of treatment to make the stay in the hospital as short as possible, for both financial reasons and the patient’s well - being. In short, for me, it is end-to-end support.    
Coordination is one of the pillars of C3Medical, what is specific about it? 

Indeed, coordination is part of the 3 Cs of C3Medical: Coordination Care Cooperation. Often, an international patient has a doctor in the country in which he lives, and through my experience in Africa and the Middle East - I visited more than thirty countries in these areas - I have constituted a network of doctors who are all relays for me. Before the patient arrives, if we need it, I call upon my network to help consolidate their medical file.  During treatment, I follow the situation closely, with the teams in Paris, requesting regular reports on the progress of the patient's condition and I keep the patient’s doctors, as well as the doctors of our partners (insurance, institutions, companies) informed of the patient's situation. I also go and meet the patient. We then enter the post-operative phase which, for me, is the cornerstone of this coordination. Because unfortunately in the majority of cases, we have found that as soon as the patient leaves the hospital abroad or returns home, he is released into the wild.  At C3Medical, we coordinate the post- operative period according to the patient's condition through a hot line that allows the patient to notify us if necessary, through physical visits if a physical contact is necessary and through our medical logistics department, which makes reservations and appointments. We also organize follow-up by telemedicine when possible. For me, coordination is present at all stages: before, during and after.   
Who are your contacts in French hospitals? How do you work with them?  

France is one of the main destinations of our " Medical Travel " activity. This is why we settled in Paris. But, we do not only work with France, we also have a network in Maghreb - especially in Morocco where we have an office, and in Tunisia. We choose our network of experts very carefully because it is the heart of the matter. We attach a great deal of importance to human resources, to expertise in a particular specialty of partner hospitals, but also to the choice of equipment, whether it is as efficient as possible and properly used. For example, this is why we work closely with the Institut Curie, recognized for its expertise and its excellence in the treatment of cancer. The Institut Curie provides proton therapy (an innovation in radiation therapy that only irradiates the cancer cells, thus sparing healthy tissue). It is the oldest and most experienced of the three centres in France and 70+ centres in the world. This is also what explains our proximity to the Institut Mutualiste Montsouris, which is one of the leaders in robot-assisted surgery on the European scale.       
We have also developed relationships with partners specializing in other pathologies such as haematology, organ transplants, orthopaedics, neurosurgery, ophthalmology, cardiology, digestive medicine, etc.   Each time, we endeavour to select the best and those who also have an ability and a willingness to develop an international patient base.

Placing the person in the centre is another pillar, what does this mean for you? 

For me, medical travel is a very precious thing: it is not tourism, nor is it a leisure activity.  It is travel undertaken for a specific reason: to seek treatment because one is ill. Thus, the personal side of the patient is of great importance to us because we know that care-pathways can be a source of anxiety for patients and their family. This is why keep this personal aspect at the forefront and communicate a great deal. 
Cost control is part of C3Medical's proposals, can you explain to us how you manage to offer optimized care itineraries? 

For C3Medical, the optimization of a care itinerary focuses primarily on the length of hospitalization. All too often, we have found that—for international patients—certain structures tend to keep patients too long. We also know that single patients tend to wish to stay in the hospital rather than leave it, convinced that they are more secure within than without.  But as a doctor, I am more or less aware of the length of hospital stays for various interventions, and we also have access to databases allowing us to control this. Lastly, our individualized support for patients allows us to get them out quickly and therefore not to exceed what would be considered a "normal " hospital stay.   

Secondly, optimizing the cost means constituting a recent, high-quality medical record from the very beginning. For example, if I receive a medical report that speaks of pancreatitis and I notice after obtaining all the necessary elements that it is more probably cancer, the care and the structures to be sought out are very different. 

Thirdly, we choose the structures that maintain transparent and reasonable prices. Unfortunately, we have noticed that when it comes to patients coming from abroad there may be overcharging, which is unacceptable. We have the pricing charts of our partner establishments, which allow us to understand the pricing actions and validate invoices we receive to make sure not to pay more than what is due. Lastly, we can optimize costs through post-operative accommodation choices; for this and in agreement with the primary physician, we offer the possibility to integrate a physician rehabilitation centre if necessary or, as soon as we can, rest homes, apartment-hotels or hotels, where we can organize " home care ".  The four components of cost optimization are: knowledge of nomenclature associated with a patient follow-up, a complete record from the beginning, optimized hospital stays, and management of the suggested prices by health structures.

Do you have a case that particularly affected you? 

I will talk about a recent case. I was urgently called by a partner for a patient of Gabonese origin. He was suffering from abdominal pain with suspicion of pancreatic cancer. The unconscious patient was not able to board a regular flight; it was therefore decided to opt for a sanitary air transfer that we organized.  I accompanied the patient during the flight from Libreville to Paris, I was even called upon to ensure that he remained in traveling condition throughout the journey. Upon arrival, the ambulance was waiting on the tarmac, at the foot of the aircraft, and we were able to quickly transfer the patient to the hospital where the team was awaiting him. After 2-3 days when I visited him, the patient was out of the woods, luckily for him it was not cancer. This case affected me, I was pleasantly surprised: here before me was a man who could speak to me, who thanked me, when just a few days prior he was struggling between life and death.

Has the pandemic changed your methods? If so, how?

The health crisis has had a very significant impact on our activity. We saw fewer patients that we were to accompany in France and Morocco, and have noticed a worsening of symptoms or situations of patients who were finally able to travel after significant delay.
However, the closure of certain borders has forced us to rethink our processes and our offers. In particular, we accelerated our development with Tunisia, which was more flexible to allow foreign patients to return, and we developed tele-consultation, in particular for control or follow-up visits.
In order to repatriate patients with COVID-19, we had to develop our medical evacuation offer so as to be able to respond to very specific requests from all parts of the world.
We also expedited necessary medication for treatment when possible. There was no disruption for the patients, which was greatly appreciated by them and which helped to further solidify our bond with them.