Introduction
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The need for new approaches
in health care delivery has never been more critical. The PrimeCare System
is the engine that powers the creation of new insurance
products to meet the needs of millions of uninsured Americans
at a cost that they can afford. It will enable the insurer to
reduce the cost of care for current enrollees and introduce new
cost-effective products while maintaining the quality of care. |
PrimeCare
Online
PrimeCare Online (PCO)
enables the health insurer to offer a new, low-cost product that uses
today’s technology to provide outstanding delivery of medical
care and services. The PCO Plan can be used to target individuals
or families without health coverage or improve care for current enrollees.
The PCO system will be an efficient tool for the delivery of health
care services, and can be positioned to compliment traditional HMO,
PPO, and POS plans.
How it
works
The PCO product will provide
coverage for catastrophic injuries, but unlike existing policies,
it will include an innovative set of primary care services.
- The online system will
use the full-service patient management system, the PrimeCare™
System, to help the medical staff efficiently gather appropriate patient
information and facilitate the delivery of needed medical care.
- The health insurer will
establish a Medical Services Triage Desk staffed by physicians, physician
assistants and registered nurses. The medical staff will be online
24 hours a day/7 days a week. The PCO enrollment agreement will require
that all PCO enrollees use the online system to request medical care.
- At the time of enrollment
an annual exam and general medical history questionnaire will be completed
by each patient.
- PCO patients will not
be required to have traditional relationships with primary care physicians.
When a PCO enrollee has a health concern, he or she will speak online
to a member of the PCO medical staff and request services. The responding
medical staff member will triage the patient and ask the patient to
complete one or more of PrimeCare's 280 plus medical questionnaires.
Depending on the complexity of the complaint, the patient will complete
the assigned medical questionnaire(s) by logging onto the PrimeCare
System via secure access from any Internet browser-enabled computer.
- All information is secure
and compliant with HIPAA guidelines for electronic medical records.
After the patient completes and submits the questionnaire online,
staff members will determine the next proper medical steps that should
be taken to complete the patient’s online visit. The medical
staff will decide the course of action and may:
- Prescribe prescription
or over-the-counter medications
- Send acutely ill
patients to the nearest approved hospital
- Dispatch an ambulance
from a nearby emergency medical facility
- Request that the patient
go to an approved laboratory for medical tests
- Make an appointment
for the patient with an approved network physician or specialist
for follow-up care - Provide the patient
with a recommendation to monitor their symptoms and to call back
or
resume the online visit if their symptoms worsen.
Patient-Directed
Healthcare
The
PCO system gives the health insurer, for the first time, direct
control over the delivery and cost of medical services. All in-network
referrals and prescriptions are electronic. All medical billing
data is collected directly within the PrimeCare Management System.
Laboratory requests and results are electronic and stay with the
patient’s medical record.
All tests and visits
to specialist are first approved by the health insurer, thus eliminating
the unnecessary cost of visits or repeated tests due to lost results.
PCO also provides the patient with online and printable patient
education from the PrimeCare System. |
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An
exclusive opportunity
- Start a pilot program
- Free from start-up fees
- Be a leader in your industry
- Introduce a new model
of care
SUMMARY of BENEFITS
Insurer Benefits
- Increased market share
- Increased accuracy of
patient records
- Ability to review chronological
development of patient files accurately
- Reduced administrative
cost
- Early detection and prevention
of illnesses
- Reduced number of doctor
visits
- Enhanced outcomes research
- Less expensive to
perform
- More complete and
accurate
- Increased performance
capacity
- Increased risk assessment
and evaluation
Consumer Benefits
- Affordable insurance
- Faster initiation, evaluation
and resolution of patient inquires
- 24/7 access to healthcare
- Enhanced responsiveness
of healthcare
- Greater transfer of information
to consumer
You may download the information
on this page as a printable
PDF document.
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