A health care strategy that makes sense. It can be placed alongside any health plan of the employer’s choosing without asking anyone’s permission.
It doesn’t interfere with existing relationships.
You don’t need the permission of your third party administrator, broker or consultant to implement the plan. They don’t have veto power. If they think they do, release them.
CHOICE IS GOOD
It’s a separate, stand alone, optional benefit giving plan members the freedom to choose what’s best for them. Choice is good and its up to each plan member to make that decision. It’s in their best financial interests to choose the right option because otherwise members will face all the usual financial barriers to health care such as deductibles and other out-of-pocket expenses common to employer sponsored health plans.
The “right choice” option removes all financial barriers to health care.
SECRET SAUCE
Building a better health plan begins with collaborative partnerships with direct primary care physicians (PCPs). Members seeking care through designated PCPs have unlimited same day brick & mortar access, no copay required. Virtual care is a 24/7 added value bonus benefit. Prescriptions prescribed by the PCP are covered at no cost to members.
Referrals to specialty care is managed through a dedicated concierge service which identifies providers of high quality with good outcomes. Appointments are scheduled on behalf of the member. All patient financial responsibility is waived for covered medical services including hospital care, out-patient surgery, and other medical procedures and services.
COST SAVINGS
Direct primary care including prescription drugs is capitated on a PEPM basis. All other services managed by the concierge service are plan-paid cash-driven transactions with savings of 50% and more over traditional PPO managed reimbursement rates.
Claim payments are diverted from the core medical plan which otherwise would have eroded plan assets by an unnecessary amount through significantly higher insurance based provider reimbursement rates.
No stop loss insurance is necessary because the program has built-in loss protections.
SUMMARY
- Can be added to any health plan
- No permission required
- Removes all financial barriers to health care
- Provides a better member experience
- Significant savings for plan sponsor
- Win Win for the provider community
ATTENTION HEALTH INSURANCE BROKERS, CONSULTANTS AND PLAN SPONSORS:
This blog posting should be shared with every TPA you do business with. Unlike other strategies we have developed in the past wherein we must convince willing TPA’s to buy-in, this strategy does not require that onerous and time consuming process of “selling” the concept to potential TPA partners.
You won’t hear TPA’s saying “It’s a heavy lift. Not sure upper management will want to do this. It’s replacing our core business model. We don’t want to give up that much control. etc……..
This strategy benefits everyone including the in-force TPA. The plan sponsor wins, plan members win, providers win and the TPA wins too because they are viewed as part of a winning strategy.
This can be added alongside any group plan, anywhere, at any time.
Our capitated PCP PEPM rate, Inclusive of brick & mortar plus virtual care bonus benefit plus prescription drugs, is market competitive.
Identifying and contracting with PCP brick & mortar partners is what we do.
For information write RiskManager@RiskManagers.us
