Smart Benefits: Can Better Doc Choices Lower Costs?
Monday, November 07, 2011
Remember the HMOs of the 1980s and 90s? These plans featured restricted networks of doctors and required consumers to select a primary care physician. With healthcare reform placing new emphasis on higher quality of care and better clinical outcomes, health insurers are reviving the emphasis on the patient-doctor relationship with a variety of new products.
UnitedHealthcare recently announced an HMO-like product called Navigate. With this plan, consumers need to select a primary care physician from a narrower network of doctors. However, instead of consumers having access to a small, local network, they can choose from a larger, national network as long as the participating physicians make the grade. To participate, physicians must meet high quality measures, promote efficient care and hold down costs.
Other insurers are emphasizing tiered-networks as a cost-control measure. Under these arrangements, consumers pay varying copays and deductibles according to which tier a provider belongs. The tiers are based on quality benchmarks and cost, helping consumers understand these factors as they make healthcare decisions.
Tufts Health Plan's Your Choice
Tufts Health Plan in Massachusetts now offers Your Choice HMO, a tiered-network plan that encourages preventive care and groups primary care physicians (as well as some hospitals and specialists) into three tiers, with the lowest tier providers being the least costly to consumers and the top tier the most expensive.
The bottom line? Consumers are starting to be rewarded with lower costs when they choose the “right” providers. And it’s not just savings that consumers benefit from with these new products. By providing more transparency into quality and cost, consumers will have better information when choosing doctors, hospitals and related-services. If the plans are successful, maybe this blast from the past will be the wave of the future.
Amy Gallagher has over 19 years of healthcare industry experience. As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.
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