Article date: 1 July 2013
- Open referral pathway for claims manages quality of care as well as cost
Aviva has launched a new private medical insurance product for large employers. GuideWell, which uses an open referral pathway1 to manage claims costs and deliver sustainable and competitive pricing, will provide employees with an easier claims journey that promises no shortfall on hospital charges or specialist fees.
The new PMI product, which is available in addition to the insurer’s established large corporate health policy Optimum, has been developed to both manage the rising cost of claims and to meet an increasing need by some corporate clients to control their healthcare spend, so that PMI can be sustained as a valued employee benefit without compromising on the level or quality of cover.
Employees on a GuideWell policy will be helped to access health treatments and investigations covered on the policy following referral by a GP. Any musculoskeletal problems will be managed effectively through Aviva’s innovative BacktoBetter rehabilitation service. The combined approach, with Aviva working closely with healthcare providers to manage costs, will help to contain spend and keep premiums down for large corporates whilst ensuring employees get the most appropriate treatment promptly through recognised specialists and hospitals.
Competition Commission research into PMI patients’ views of the referral process and what’s important to them when choosing a hospital and specialist, has also informed the development of GuideWell. When choosing a hospital, the single most important factor for private medical insurance patients is location (50%) followed by whether the fees and charges will be fully covered by their policy (39%).2
Through GuideWell, employees will have prompt access to private medical diagnosis and treatment, with appointments close to either work or home at one of over 250 hospitals and clinics nationwide. In most cases, employees can expect an appointment within a 20 mile radius of their given postcode outside of Central London, or 10 miles within. Details of relevant specialists will be drawn from Aviva’s comprehensive specialist finder database, which combines the insurer’s extensive claims experience with independent external data. Where multiple specialists could equally undertake the appointment, a choice of specialist will be given.
Employees have the reassurance that by following GuideWell’s open referral process, there will be no shortfall in hospital charges or specialist fees for treatment that is covered by the policy. Moreover, they will have the peace of mind that the specialist selected will have undertaken the same type of procedure at least three times for Aviva in the last two years, and that all specialists on the database are recognised by the GMC and have been subject to Aviva’s registration process.
Further Aviva research highlights the increased use of open referral by GPs. 18% of all Aviva PMI claims met in 2012 were on an open referral basis. Of those members with an open referral who were interviewed, nearly half (48%) specifically asked their GP not to name a consultant3.
Dr Doug Wright, Medical Director at Aviva, UK Health, said: “GuideWell has been crafted to deliver benefits that we know our clients, members and intermediaries will value. As open referral helps manage costs as well as quality, it means that some large companies will benefit from competitive pricing upfront, making the provision of this employee benefit much more sustainable over time.
“We have already seen an increase in the use of open referral in our PMI claims, with more GPs and customers choosing this route for their diagnosis and care. When managed properly, open referral is a great way for employers to regulate their costs and for employees to access prompt, local treatment by recognised specialists and hospitals.
“The addition of GuideWell to our portfolio of products is all about offering the corporate market choice and control, and making private healthcare more affordable and sustainable.”
Aviva’s extensive clinical and rehabilitation expertise makes the claims process as stress-free and swift as possible, to ensure employees get the right treatment at the right time. In-house clinicians work closely with the claims team to understand employees’ clinical needs, using a proven triage process to identify the appropriate approach to the treatment required. Employees with more complex conditions such as cancer, heart, women’s health and psychiatric conditions are provided with a dedicated case manager experienced in their condition, who will provide seamless support from one treatment stage to the next.
In addition to BacktoBetter and treatment for health conditions covered by the policy on an open referral pathway, GuideWell also offers additional core benefits. Employees can access a 24-hour GP helpline, stress counselling helpline, gym discounts, Aviva’s Home of Health online portal to help improve health and fitness and a mobile Stress App. In addition, employees on a GuideWell scheme are eligible for up to 15% discount on Aviva’s motor, home and travel insurance.
GuideWell is available from 1 July 2013 and Aviva will take a consultative approach to work with clients and intermediaries to identify whether GuideWell is suitable for a company’s needs and would deliver cost savings.
The product carries a range of options to build a policy that meets specific needs and it can be adapted to include or exclude a range of enhanced benefits, or to carry set excesses or out-patient limits to help control costs. Different sets of GuideWell benefits for different levels of employees can also be arranged to provide a high degree of flexibility; and clients may also choose to offer GuideWell to some employees and Aviva’s Optimum health insurance to others, all under one policy number.
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If you are a journalist and would like further information, please contact: Melissa Loughran: Aviva Press Office: 01904 452791: 07800 691947: Melissa.email@example.com
Notes to editors:
1) Open referral is a recommendation by a GP for a medical investigation or treatment, without the GP being specific about which specialist or hospital carries out the procedure. An open referral from a GP should include the type of specialist that the member needs to see and the sub-speciality, if necessary, but should not name a specific specialist. Around 18% of Aviva’s total PMI claims in 2012 were presented on an open referral basis.
2) Competition Commission Research. Patient Survey GFK Report, 27 February 2013. Online survey with 1,043 PMI patients (63% on a corporate scheme and 37% individual policyholders.) conducted Nov/Dec 2012.
3) Aviva commissioned research by ICM Research (April/May 2013). 234 interviews were carried out with Aviva PMI customers who had recently seen a consultant for treatment.
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