Benefits Consulting

The Four Pillars of High-Quality Health Plans 

By February 22, 2022 February 23rd, 2022 No Comments
doctor does paperwork

We disrupt the employee benefits space. It’s who we are. It’s what we do. Our consulting team works to continually improve the quality of healthcare our clients provide to their employees, all while reducing costs and maximizing value. 

The four pillars of high-quality health plans that differentiate us from competitors are simple — but effective.

Virtual Primary Care 

By encouraging your people to spend more time with high-quality Primary Care Providers, you can prevent up to 90% of specialist visits and make a large dent in Emergency Room visits too. Virtual Primary Care includes preventive care, chronic care, mental health treatment, pediatrics, and specialist consults – all available at $0 cost and conveniently accessed with a mobile device. With Virtual Primary care, members have access to a dedicated care team, and the scope of care is greatly expanded. Think telemedicine on steroids. 

Centers of Excellence 

Our Centers of Excellence programs are designated multi-disciplinary facilities staffed with the top doctors in the nation. As you may know, doctors are misdiagnosing complex conditions like cancer about 30% of the time. In addition, our programs incorporate bundled pricing and a consensus team-based diagnosis model, resulting in the best care for your employees at the best cost for the patient and the plan.  

Pharmacy Solutions

We are proud to partner with a leading Pharmacy Consultant to provide our clients with 30% – 40% in annual Rx savings. Our transparent pharmacy solutions include no spread pricing or rebate games, value-based formularies, international drug importation, and specialty drug management programs. 

Steerage to High-Quality Providers

We direct our members and their employees to high-quality providers in their area. This steerage results in better healthcare outcomes and significant cost savings for employees and employers.

While each pillar deserves its moment in the spotlight, the real star is high-quality care. And here’s why:

We don’t believe the “You get what you pay for” mentality applies to healthcare.

We use plan design incentives to steer members to the high-quality providers in their communities. Our solution results in lower costs to self-funded plans and less out-of-pocket costs to members.

Here’s how it works: According to Garner Health, members who regularly see top-notch physicians aren’t breaking the bank for that care. In fact, it’s the opposite. There’s a 35% lower total cost of care accompanied by members who choose high-quality doctors. So by providing your employees with better care, you experience significant savings. 

Four Pillars of High-Quality Health Plans

Let’s take hip replacement surgery, for example.

Option A: $25,000 for a procedure with a high-quality surgeon and team that performs hip replacement surgeries several times per week, while confidently charging less.

Option B: $45,000 for a procedure with a surgeon and team that performs hip replacement surgeries only once per quarter.

In the world of healthcare, the highest charge doesn’t always equate to the best care. In option B, there’s a surgeon who only performs one hip surgery per quarter and charges significantly more. Performing this operation is much less efficient than their core competency, which in this case is shoulder surgeries. 

In option A, the $25,000 procedure is performed by a team just as equipped as surgeon B, and they just perform more surgeries with better outcomes, therefore the cost is lower for the more efficient procedure.

Don’t automatically assume a higher price tag equals the best care you can find. That’s why Totem is committed to helping you find the health plan strategy that will most effectively get employees to the best physicians.

How do we do it? Here’s our tried and true approach: 

  1. Totem leverages the largest claims database in the United States to identify the best doctors for specific procedures, in every community across the country.
  2. Members have direct access to top-of-the-line concierge services, which makes it easy to find those high-quality providers.
  3. High-quality steerage programs can be bolted onto any network and any employer health plan. 

So how exactly does this impact employers and employees?

Using search tools before seeing a doctor

+

Seeing a recommended doctor

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Reimbursement of out-of-pocket cost

The bottom line? Doing your research before seeing a physician pays off. 

More importantly, choosing to work with Totem improves your bottom line and the health of your employees. Our four pillars of high-quality health plans are a game-changer. If you’re ready to take the next step with your health plan, contact a member of the Totem team today.