A New Efficient and Cost-Effective "Gatekeeper" Model For Containing Health Insurance and Care Costs

With Health Insurance and Healthcare prices patient with to skyrocket and entry to skillful Doctors reducing, one matter wants to alter. The present system is dear, wasteful, and inefficient. We are proposing a brand new Gatekeeper Model that may present Employees higher entry to Doctors at a divide of the price with much better outcomes.

The Traditional Gatekeeper Model for Healthcare?

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What was the normal Healthcare Gatekeeper Model? The Alliance for Health Reform guide defines the doorman/care superior program as a "Health Care professional, unremarkably a primary care doc, who coordinates, manages, and authorizes all health services provided to a soul ariled by certain types of health plans. Unless an emergency exists, the doorman generally must pre-authorize referrals to specialists, hospitalizations and lab and radiology tests."

Unfortunately this proficiency was typically stricken by redundancies inefficiencies, and added - not ablated - prices. It has change into an increasing number of difficult to accomplish a Doctor appointment and the ERs are overrun. Under this proficiency - and the opposite conventional norms for delivery these in precise want of care on with docs - there's a large waste of money and time!

Just a couple of very important statistics!

70% of Doctor's Office Visits are Unnecessary

55% of ER Visits are Unnecessary

41% of ER visits are pointless as a result of the Patient couldn't Get a Doctor's Appointment

51% of Ambulance employments are pointless

The present norms clearly have issues. The difficulties in gaining an appointment with a Doctor are rising. PPACA/Obamacare will make this a much bigger drawback. Millions of individuals can have new disariled entry to medical insurance and can anticipate entry to Doctors. The previous system was already dysfunctional and now will probably be extra stained.

The new Gatekeeper Model!

Utilizing Telemedicine because the Gatekeeper to deliver folk shortly and effectively on with Doctors. This will take away the Barriers between Employees and Doctors for calculation out one of the best course of medical motion. Telemedicine is just not new! There are a variety of Vendor/Providers. Each gives a unique stage of service and whole different price construction. Most wouldn't qualify as a Gatekeeper! I'll qualify the necessities under.

The Telemedicine/Gatekeeper Model is new!

When the Employee or Family Member Calls the Doctor First - victimisation the Telemedicine Plan - they instantly entry an emergency skillful doc who assists them with their medical want, coordinates, manages, and authorizes all well being companies required as a part of their Employer's Health Plan. The Gatekeeper Doctor authorizes the referral to a specialist, hospital, pressing care facility or lab for exams if wanted.

Let's get a load at how Telemedicine power be used because the Gatekeeper.

What should the Telemedicine Plan Provider/Gatekeeper be able to offering based mostly on the Plan Providers historical past and their Telemedicine Plan Design?

• A case particular ROI Calculator to indicate the Employer, CFO, TPA, and so forth. the worth of implementing and supporting the mannequin.
• Immediate entry to ER skillful US docs - no electronic messaging or name backs.
• Accepts emergency and non-emergency calls.
• The potential to direct the caller to Emergency Rooms or Specialists care if medically required.
• The potential to dictate wanted dictated drugs PR based mostly on a well being historical past when the individual joined the plan.
• A health care provider's prescription medical equipment - inside the possession of the member - offering the correct instruments to manage what the doc directs over the telephone whereas the member is heading to their doc's workplace, pressing care middle, or resting the place they're.
• Follow-up with the member after prognosis and therapy to determine if there are extra wants.
• A give attention to decreasing well being Plan employment prices whereas encouraging the usage of the Telemedicine System and their skillful Doctors.
• A flat, cut-price month-to-month price for the Telemedicine Plan that features the price of the doc's medical equipment.
• The Telemedicine Plan should be cut-price and but have a depth of companies required to encourage Employees to Call the Gatekeeper Doctor First decreasing pointless employment of the core healthcare plan.
• No further charges or fees for employment by the members or their relations.
• The Telemedicine Plan should be: (1) a professional well being deduction for the Employer, (2) certified below Section 125 for the Employees to pre-tax a contribution to the Plan, and (3) HRA/HSA certified.
• The Telemedicine Plan should present help to the Broker and Employer for implementing the Plan and Educating the Employees about Calling the Doctor First and victimisation the Plan because the Gatekeeper.

The above only describes what options the Telemedicine Gatekeeper should present the Employer and Employees to scale back prices whereas rising Doctor entry.

Now let us get a load at what the Employer, Broker, and Telemedicine Provider (and presumably the TPA) want to perform when establishing the Telemedicine Plan as a Gatekeeper

:

1. Determine the Employer's particular ROI for implementing the Telemedicine/Gatekeeper Plan.
2. Determine who pays for the price for the Telemedicine Plan - optimal ROI will probably be accomplishd if the Employer pays for the plan and all Employees and their Families are on the Plan.
3. Create an Employee Benefit Plan Design that requires the Employees and their Family Members to Call the Doctor First (except there's an absolute emergency) to start the method of prognosis and tips on how to proceed with medical care.
4. Include inside the Employee Benefit Plan Design an added price for Doctor visits if the Employee or Family Member doesn't Call the Doctor First - very like going out-of-network fees. This will assist Encourage Plan and Gatekeeper Utilization, Provide Better Employee Care, and Increase ROI.
5. Create a scientific program - together with Owners, Executives, the CFO, and so forth. - for Educating Managers and Employees in regards to the Plan, Timelines for Implementation, Effective Dates for Coverage, and Proper Utilization of the Telemedicine/Gatekeeper Plan.
6. The Owners, Managers, and CFO should be concerned in monitoring the Gatekeeper Plan to encourage Plan Utilization by Employees and in decreasing pointless Core Benefit Plan Utilization.

Five stairs to implementing a Telemedicine/Gatekeeper Plan!

• Work by way of an ROI Calculator to ascertain the Potential Savings
• Carefully Select a Qualified Telemedicine/Gatekeeper Provider
• Make Simple Changes to the Employee Benefit Plan Design
• Put the Plan in place now for the Fall Enrollment and the 2014 Effective Date
• Educate the Employees and their Families in regards to the Value of the Plan; and clarify the "Gatekeeper" operate
• As an Employer or Broker/Trusted Advisor, the Employer, and the Employees/Families will expertise an enhanced, cost-saving, Plan with Greater entry to skillful docs

What's Next - (1) As an Employer (2) as a Broker

1) Employers -- Use the ROI Calculator! Whether you're Self-Funded or Fully Insured, contact us to make the most of the ROI Calculator - there's No Cost. You can see the worth of shifting ahead with a Telemedicine Plan and even higher - victimisation the Plan as a Gatekeeper. You can: (a) Substantially Reduce Health Plan Costs, (b) Reduce Unnecessary Doctor and Emergency Room Visits, (c) Dramatically Improve Employee Access to Healthcare Professionals, (d) Reduce Lost Employee Work Time and Absenteeism. Employers have realised triple digit returns on their funding through the first 12 months.

2) Brokers - Use the ROI Calculator and see what it power knock off your Clients. (a) You can save your Current and Potential Clients substantial Dollars (b) Improve the Employees and their Families Health Care, (c) Gain Employees and their Families speedy entry to Emergency Trained Professionals, (d) Retain and Attract Employer and Individual Clients. Employers have realised triple digit returns on their funding through the first 12 months.