Your employees at times will experience medical conditions that surface seemingly overnight. But, waiting until one of your crew members has an acute condition arise to find a provider for immediate care is like planning ship safety while your ship is already sinking.

So, how can your plan be best positioned to help your crew members with such conditions at a reasonable cost? Just a few “access to care” scenarios to consider during the planning stages are care:

• While traveling,
• During normal business hours, and
• After business hours.

What is a Preferential Provider?

A preferential provider is a specific healthcare provider recommended by the plan that provides members with quality care at a reasonable price. Of course, the cost can depend on the severity of the condition, and inevitably some situations require an emergency room trip. That said, for other, less urgent issues, having a preferential place to go or someone to call when the need surfaces can be invaluable.

The Problem

Members often don’t know where to go when a healthcare issue surfaces and they’re unable to get an appointment with their primary care physician (PCP). During such a moment, members can completely forget where to go or what to do. The emergency room seems to be the most common (and most costly!) provider. As such, every plan must educate its members so that not if, but when the need surfaces, they’ll know where to go for cost effective care.

Member Education, Provider Contracts, and Incentives

The plan sponsor can take three (3) steps to help members engage the best provider for acute care:

Step 1

Member Education. Educating members should be a multipronged approach. Member emails, breakroom posters, quick reference materials, and informational videos are excellent tools to help members identify the availability of these benefits. Consistently informing members about such benefits during employee meetings also reinforces “anytime access to affordable care” concept for members.

Step 2

Provider Contracts. Health plan members reside in a variety of areas (i.e., the city v. the suburbs v. rural), so providing members with 24/7 telemedicine is a great way to provide access to care for a variety of non-emergency issues. A quality telemedicine partner can treat minor illnesses, skin irritations, and other ailments from anywhere the member is.

Likewise, contracting with either a national and/or local area chain of walk-in clinics is a great way to add another avenue to low-cost, quality care. Walk-in clinic pricing is comparable to telemedicine visits, and since many clinics remain open until 7 or 8 p.m. members have a better opportunity for care without visiting the emergency room.

Step 3

Incentives. When launching or reinforcing these kinds of benefits, it may be necessary to create an incentive for members to utilize them. For example, the plan could provide access to telemedicine with a $0 (100% covered) copay per visit. Though some employers may push back on such a concept as a waste of money, creating such an incentive could save thousands more than the cost of making the benefit free. What is it worth to save a couple of visits to the urgent care or the (even more costly) emergency room? Claims at both providers will cost hundreds, if not thousands, of dollars to the member and the plan.

All three (3) of the steps mentioned above must exist in the plan to achieve a measurable difference. Only providing education without quality tools to encourage members simply won’t work.

At GBS, we understand that finding solutions for high plan costs could mean the difference between being able to offer a benefit plan or not. Providing benefits that help families keep costs low in turn improves your health plan’s sustainability. In addition, by collaborating with your plan members, your plan is more likely to be perceived as true “benefit” and thus improve member engagement.