A New Cost-Containment "Gatekeeper" Strategy for Reducing Health Insurance and Healthcare Costs!

SHAKER HEIGHTS, Ohio - May 25, 2013 - PRLog -- With Health Insurance and Healthcare costs continuing to skyrocket and access to trained Doctors decreasing, something needs to change. We are proposing a new Gatekeeper Model that will provide Employees greater access to Doctors at a fraction of the cost.
The Traditional Gatekeeper Model for Healthcare?
What was the traditional Healthcare Gatekeeper Model?  The Alliance for Health Reform guidebook defines the gatekeeper/care manager as a “Health Care professional, usually a primary care physician, who coordinates, manages, and authorizes all health services provided to a person covered by certain types of health plans..."
Unfortunately this system was often plagued by redundancies inefficiencies, and added - not reduced - costs.
A few vital statistics!
70% of Doctor's Office Visits are Unnecessary
55% of ER Visits are Unnecessary
41% of ER visits are unnecessary because the Patient could not Get a Doctor's Appointment
51% of Ambulance utilizations are unnecessary
The new Gatekeeper Model!
Utilize Telemedicine as the Gatekeeper to bring people quickly and efficiently together with Doctors. This will remove the Barriers between Employees and Doctors for determining the best course of medical action. Telemedicine is not new!  
The Telemedicine/Gatekeeper Model is new!  When the Employee or Family Member Calls the Doctor First - utilizing the Telemedicine Plan - they immediately access an emergency trained doctor who assists them with their medical need, coordinates, manages, and authorizes all health services required as part of their Employer's Health Plan.
Let's look at how Telemedicine could be utilized as the Gatekeeper.
What must the Telemedicine Plan Provider/Gatekeeper be capable of providing?:
1) A case specific ROI Calculator to show the Employer, CFO, TPA, etc. the value of implementing the model.
2) Immediate access to emergency room trained US doctors - no messaging or call backs.
3) Accepts emergency and non-emergency calls
4) The ability to direct the caller to Emergency Rooms or Specialists care if medically required.
5) The ability to prescribe needed pharmaceuticals as required based on a health history when the person joined the plan.
6) A doctor's prescription medical kit - in the possession of the member - providing the proper tools to administer what the doctor directs over the phone while the member is heading to their doctor's office, urgent care center, or resting where they are.
7) Follow-up with the member after diagnosis and treatment to ascertain if there are additional needs.
8) A focus on lowering health Plan utilization costs while encouraging the use of the Telemedicine System and their trained Doctors.
9) A flat, affordable monthly fee for the Telemedicine Plan that includes the cost of the doctor's medical kit.
10) The Telemedicine Plan must be affordable and yet have a depth of services required to encourage Employees to Call the Gatekeeper Doctor First!
11) No extra fees or charges for usage.
12) The Telemedicine Plan must be a: (1) Qualified health deduction for the Employer, (2) Qualified Plan for Employees under Section 125, and (3) Qualified HRA/HSA Plan.
13) The Telemedicine Plan must provide assistance to the Broker and Employer for implementing the Plan and Educating the Employees.
The above merely describes what features the Telemedicine Gatekeepermust provide the Employer and Employees to reduce costs while increasing Doctor access.
Now let's look at what the Employer, Broker, and Telemedicine Provider (and possibly the TPA) need to accomplish when establishing the Telemedicine Plan as a Gatekeeper:
> Determine the Employer's specific ROI for implementing the Telemedicine/Gatekeeper Plan.
> Determine who will pay for the cost for the Telemedicine Plan - optimal ROI will be achieved if the Employer pays for the plan and all Employees and their Families are on the Plan.  
> Create an Employee Benefit Plan Design that requires the Employees and their Family Members to Call the Doctor First (unless there is an absolute emergency) to begin the process of diagnosis and care.
> Include in the Employee Benefit Plan Design an added cost for Doctor visits if the Employee or Family Member does not Call the Doctor First - much like going out-of-network charges.  
> Create a systematic program - including Owners, Executives, the CFO, etc. - for Educating Managers and Employees about the Plan, Timelines for Implementation, Effective Dates for Coverage, and Proper Utilization of the Telemedicine/Gatekeeper Plan.
> The Owners, Managers, and CFO must be involved in monitoring the Gatekeeper Plan to encourage Plan Utilization by Employees
Five steps to implementing a Telemedicine/Gatekeeper Plan!
1) Work through an ROI Calculator to establish the Potential Savings
2) Carefully Select a Qualified Telemedicine/Gatekeeper Provider
3) Make Simple Changes to the Employee Benefit Plan Design  
4) Put the Plan in place now for the Fall Enrollment and the 2014 Effective Date
5) Educate the Employees and their Families about the Value of the Plan; and explain the "Gatekeeper" function.
With this Plan the Employer, and the Employees/Families, will experience enhanced care and cost-saving
What's Next - (1) As an Employer (2) as a Broker    
       1) Employers -- Use the ROI Calculator!  Whether you are Self-Funded or Fully Insured - there's No Cost. Employers have realized triple digit returns on their investment during the first 12 months.  
       2) Brokers - Use the ROI Calculator and see what the Planwill do for your Clients. Employers have realized triple digit returns on their investment during the first 12 months.  
Contact BenefitPlace.biz now to utilize the Telemedicine/Gatekeeper Calculator.  We'll walk you through the process. Email - max@benefitplace.biz   Call - 216.577.5579 to schedule an an ROI Calculator Demo!