A New Path to Innovative Encounters

With recent changes to the healthcare system still being hotly discussed (and highly visible in the media), not to mention scores of new members joining your plan (many previously uninsured), are you prepared for the increased number of office visits to your networks, and additional member service traffic?

There was a time when the job of payer member services was a relatively familiar (if not simple) process:  Manage the member through his/her life cycle with the plan.  But now, all the rules have changed – the Affordable Care Act (ACA) affects the entire member experience.  In addition, with the renewed emphasis on pay-for-performance and outcomes-based measurement of physicians, as well as compliance challenges and government incentives, reducing wasteful spending in healthcare is more important than ever.   An important approach to addressing this phenomenon is through innovative encounters:  Methods to improve the efficiency and effectiveness of office visits.  NetCare Clinic is one way to do it.

We are industry experts, including physicians and pharmacists, who have played pivotal roles in helping payers give members and providers the tools to maximize quality, reduce waste and lower cost, such as the industry’s first lower-cost-alternative Rx engine.

The member experience needs to be transformed.  The challenge will be to discover ways to lower the cost of care while improving quality, and enhancing the member experience.  Payers, providers, and members will work together to accomplish these three objectives.

 

NetCare Clinic (NCC) Offers Real Solutions

NetCare Clinic provides an “innovative encounter” method to address many Rx renewals.  The problem is significant:  For patients with chronic care medications, the process of renewing prescriptions is cumbersome, leading to poor drug adherence, higher costs, and inconvenience.  The numbers are staggering:  With just high cholesterol, the impact is felt across one-third of all members in the United States.  That’s just one of the conditions you can choose to impact with NCC.

 

How Does It Work?

NetCare Clinic represents a way to perform chronic condition script renewal online.  Simply:

Instead of an office visit, payers identify candidate members using claims analytics.  Then, those members are presented with a voluntary option to obtain the prescription renewal through a NetCare Clinic.  Using either a self-service approach or facilitated by your member service staff, the member completes an online process that confirms that their condition is within accepted guidelines for a standard drug renewal (which is what the office visit would have done.)  If blood work is necessary, the member is instructed to obtain it at a payer-approved resource.  After the member completes the process, the renewal is sent to the doctor in the same manner as a prescription change request (a common process which takes only moments).

The result?  Even with a small administrative fee, and the potential cost of member service assistance, the cost of the process is up to sixty percent less than the office visit would have been…since the payment to the provider is much lower than the office visit charge.  Best of all?  Since the process requires almost no effort or time on the part of the provider, the net proceeds he/she realizes are higher than the margin they would have received on the office visit – not to mention that their time is freed up for more constructive patient work.  Since only those patients who fit strict guidelines are eligible for this option, patient care does not suffer…in fact, the perception of convenience and personalized service enjoyed by the member is enhanced, leading to a higher-touch experience, which equals better adherence, better star ratings and more accurate risk scores… and improved member retention.

While myriad opportunities exist to improve the healthcare experience in the new world of ACA, NetCare Clinic represents an actionable step you can take now.  Contact us to learn how.