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Open referral system gives quality at low cost: Aviva

The medical director of Aviva said there was an “increasing need” among some corporate clients to control healthcare spend without “compromising on the level or quality of cover”.

His comments came after Aviva launched GuideWell, a low-cost private medical insurance product for large employers.

It uses an open referral technology-based service to manage claims costs and deliver sustainable and competitive pricing.

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Dr Wright said: “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.”

Employees covered by GuideWell will be helped to access health treatments and investigations covered on the policy following referral by a GP. Employees will have prompt access to private medical diagnosis and treatment, with appointments close to either work or home at one of more than 250 hospitals and clinics nationwide.

Background:

Earlier this year the Competition Commission carried out PMI research on patients’ views of the referral process and what was important to them when choosing a hospital and specialist. It found:

* When choosing a hospital, the single most important factor for private medical insurance patients was location – 50%

* The second most important factor was whether the fees and charges would be fully covered by their policy – 39%.

* 18% of all Aviva PMI claims met in 2012 were on an open referral basis.

* 48% of members with an open referral specifically asked their GP not to name a consultant.

Adviser view

Chris Daems, director of London-based Principal Financial Solutions, said: “While there is a greater focus on employee benefits by employers due to auto-enrolment, we’re finding that their main priority initially is to ensure they comply with the changes and are choosing to defer implementation of the ancillary benefits, such as PMI, until they are used to complying with both the costs and administration that the regulatory changes undoubtedly brings.

“However I believe that once auto-enrolment becomes embedded then we’ll see an upturn in ancillary benefits provided to employees as a differentiating factor.”