Originally Posted by fuji
So basically the same as the UK where everyone has a general practitioner who they see on like a few days notice who can then refer them to specialists?
No not at all I'm talking about from an insurance perspective. When you enroll in our insurance John Smith would give you a call welcoming you to the network, maybe getting some additional info, and telling you that if you have any questions about your insurance, from coverage to billing or anything else, you call him. His phone number would be on your bill and when you call he'd pick up - no voice menus. Any questions you have that he can't answer, he'd refer to you to one of our specialists. So for example, if you had a complicated billing question, and he didn't know it, he'd get you over to someone else who is a billing specialist.
This not only gives our customers personalized service with a real human being, but it also allows us to group reps together in small teams and implement medical management practices and review and tweak our training and oversight for best service. So maybe group A has higher pharmacy adherence than group B, we could look at the groups and see what they're doing different to update our medical management practices.
It's a win-win for everyone, the question is just how expensive it would be. I think it's doable, though. Imagine having one person, a real human being, that is your point of contact for everything health related. While you still have to navigate the maze that is the US healthcare system, you'd have someone on your side that's knowledgeable and looking out for you.
GP with specialist referrals are essentially HMO's in the US, which for the most part have sucked but if implemented properly can be great for a certain market segment.Edited by Khayembii Communique - 6/8/15 at 8:28am