It's a pretty straightforward program where employees are offered and encouraged to use the designated doctors who meet certain cost-efficient and quality standards. This allows employers to offer workers competitive benefits with higher incentives. For instance, workers who take advantage of the Premium program may opt for lower co-pay and co-insurance levels, but still get and enjoy quality health care.
Employers get to choose from an a la carte type menu that lets them know in advance how much to budget for their plan contributions. For example, there are choices for emergency room co-pay ranging from $100 to $150; urgent co-pay at $50; and preventive care at 100 percent (not subject to co-pay).
The Premium program was developed in response to some amazing and somewhat depressing statistics - those stats being that roughly one-half of all the patients needing medical care actually get care that meets national medical standards.
Other attractive features the employer may choose to offer are a family deductible at twice the individual rate, as well as a family out-of-pocket maximum of twice the individual rate, and a lifetime maximum of $5 million. There are other options an employer may choose from, but suffice it to say that it's a flexible program. It has lots of potential to be a leader in the workforce offering competitive benefits without having the dreaded higher premiums.
The other spectacular point of interest about the Premium program is that it acts as an educational tool for those who "opt-in" by showing them the real costs associated with health care coverage. This is something not a lot of people realize, as they have been insulated for so long from the billing process. In addition, many health care providers do not choose to share the actual costs of services with the public.
What are the benefits of increased health care consumer knowledge? It's a shift in attitude and patient behavior in how they utilize the health care system, a change that is long overdue. The benefits for the employer are also long-term health care savings.
Here is how the program works - the nuts and bolts of it. Doctors and facilities are recognized with stars - much like a hotel is starred for its services - for following national guidelines for cost efficient and quality bare. Doctors that meet both criteria get two stars. Others who meet quality standards are awarded one star. It's pretty easy to look for the stars to find a physician you want to visit.
These stars aren't just handed out at random. They are handed out based on evaluations by The American College of Cardiology, The Ambulatory Care Quality Alliance, and The Agency for Healthcare Research and Quality.